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Health Promotion

The provision of health information is firstly making people aware of what health is? Katz, Peberdy and Douglas (2000) suggest that there are differences in ways individuals and social groups define health, young people would say a person who is healthy is fit, energetic and has strength, whilst an older person is more likely to view it in terms of resilience and coping. The World Health Organisation defines health as a state of complete physical, mental and social wellbeing and not merely the absence of a disease or infirmity. What is defined as a health need? The concept of need is a word used often but not understood, according to Cohen (2008)economists tend to avoid the use of the term need altogether, arguing that it is overlaid with emotion and what is really meant by a health need is actually a matter of a person’s wants and demands. Naidoo and Wills (2009) say that health needs are therefore a question of identifying priorities and an alternative view is that there are universal needs, Maslow’s( 1954) hierarchy of needs suggests that all human needs are in fact health needs.
What is Health promotion? It is the process of enabling people to take control over and improve their health. Nutbeam (1988) explains that health promotion represents a comprehensive social and political process, it not only embraces actions directed at strengthening skills and capabilities of individuals but also actions directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health. Gottwald and Goodman (2012) say that there are approaches to health promotion that lead us on to consider the different levels of health promotion. These are primary prevention which aims to prevent ill health, Secondary health promotion that aims to help individuals with existing health problems and tertiary which is working with people who have a condition that cannot be cured.
The evaluation that I am looking at for this piece of work is the mini me project which is the evaluation of the use of sun beds and sun exposure. There are numerous different approaches to health promotion that are used to assist the public or an individual and all of these approaches reflect different ways of working. These are discuss by Naidoo and Wills (2009) and are the Medical approach which is identifying those at risk from diseases, the behaviour approach that encourages individuals to take responsibility for their own health and choose a healthier lifestyle, the educational approach to increase the knowledge and skills of people about healthier lifestyles, the empowerment approach which works with clients or communities to meet their perceived needs, the social change approach which addresses inequalities in health based on class, race, gender and population
2. 12019635 perspective and the fear creation approach where the health educator may try changing behaviour using scare tactics and legislative action which protects the population by making healthier choices available.
Within the evaluation www.icecreates.com called the mini me project they take on the educational approach by using this within a PSHE lesson to give information to make students aware of the use of sun beds and the risks of sun exposure. There are several people that have looked at different approaches within their models by using different theories to achieve an outcome. A model is a simple description of a system and since the 1980s when health promotion first appeared different, authors have attempted to conceptualise health promotion into models. http://etheses.dur.ac.uk/4325/1/4325-1845.pdf. (No date) These people include Tannahill, Prochaska and Diclimente and Beattie
Whilst doing this work I researched several models by different people but I choose to discuss only two of them, these include:
Prochaska and Diclimente 1983 looked at the stage of change model and the basis of this model is that change is a cyclical process and not an event. Individuals that are making a change for example stopping smoking or losing weight go through the five stages of this model before their behaviour can become fixed or established, the speed which they move around this cycle is on an individual basis.http://open.jorum.ac.uk/xmlui/bitstream/handle/123456789/2942/improving%20 health% (no date).As you can see from the Prochaska and Diclimente 1983 this model is not appropriate to work with on the mini me project. However the Beattie model of health promotion consists of four quadrants that are arranged in two axes. The four quadrants represent the different ways which health can be promoted by professionals, government and individuals through health persuasion techniques Thomas and Stewart (2005). In my opinion this model works better with the mini me project as Beattie is using a model which is using persuasion techniques and personal counselling for health.
Using the Beattie model and the mini me project the barriers and influences of behaviour change on health promotion can be:
Authoritative
Authoritative is someone or something having power or influence or right to control and make decision so this would mean the sun bed regulations act which came into force on the 8th April 2011 which imposes a duty on anyone involved in a sun bed business to ensure that no persons under the age of 18 years use a sun bed, is offered the use of a sun bed or is present in a restricted area where sun beds are
3. 12019635 used. The world health organisation is an authority that uses education, health surveillance and implementing policies on health promotion they use the health promotion this way because they feel that more children are attending schools and colleges for longer periods of their lives. Therefore schools can improve health programmes and promote health and advance education on health issues. Substantial evidence indicates that health influences learning and that education influences health, but it does also show that school health programmes come with high costs, so although this organisation is in favour of this education will it be prevented due to cost?
In local communities political, social, health and education leaders as well as the public lack significant knowledge about the impact of school health programmes and health programmes in general to make them a priority and how best to implement them. An example that has already been established is the sun smart scheme which gives teachers a guide on sun protection policies and how they can teach children to stay protected when out in the sun, because typically children are generally outdoors more than adults. The teachers of schools do this by simply ensuring they use the sun smart code which uses five key prevention messages which are spend in the shade between 11 and 3, make sure you never burn, aim to cover up with a t–shirt, hat and glasses, remember to take extra care with children and then use 15+ sunscreen. http://publications.cancerresearch.uk.org/downloads/product/SSTN07.pdf(no date).

Individuals Zoysa, Habicht, Pelto and Martines(1998) says that understanding the diverse individual, familial social and cultural factors that influence an individual’s adaption or maintained of health compromising behaviour can be useful when applying, planning or implementing and evaluating health promotion programs for an individual because everyone is different and individual characteristics and personal experiences may impact this. Barriers that can affect health changes are things such as the lack of time, motivation, and individual knowledge, the enjoyment of certain behaviour, the inconvenience and the disbelief that they can change as an individual. Optimism and persistence can influence individual’s ability and motivation to overcome these barriers http://www.nursingcenter.com/inc/journalarticile?Articile-ID=691990( no date).The notion that barriers to behaviour change can be completely removed are seen as unrealistic however with enough resources and attention to addressing these barriers for an individual some progress may be made towards making interventions of change more effective. Professionals who interact with an individual about change regarding health promotion may fail to appreciate these barriers and
4. 12019635 this is a way of the process failing, also the professionals personal perspective can infringe on an individual’s decision. The media influences all individuals especially when it comes to fashion and advertising because the media is a known source of information for society.
Groups/ collectively
Gardener, hills and Rassaby (1984) says that focus groups and interactive approaches can provide opportunities for specific individuals or groups that fit a specific age group, sex or group ability. Physical barriers include factors that prevent people from being protected from the sun which is the cost of sunscreen and protective clothing due to the financial costs this predominately affects children as their main source of income is provided by their parents or guardians and if this is not provided by them then children will go unprotected. Parents have a right to protect their children from harm but is this seen as harm, many people will have different opinions on this. Again the school environment is where children are spending most of their day and five days a week so who is responsible for the children, parents have a duty to ensure that their child is dressed appropriately for school so with this in mind I would say that children should be sent to school wearing sunscreen and provided with the correct clothing for the temperatures of the particular day. Does this mean that sunscreen should be given free on prescription? Or again are we costing the tax payer more money due to lack of educated people. In May 2012 Tenovus campaigned for free sun screen to be given to under 11s but the welsh assembly committee rejected this and said that more education was needed about sun safety and its recommendations were that areas of shelter be provided in new schools and a change in school uniforms to incorporate sun protection. (Online BBC Wales, 2011). Reported by Gardener, Hills and Rassaby (1984) was that generally males feel that sunhats and protective clothing can be problematic if they are participating within an active game as these make them too hot. The parenting organisation states that scientist have shown that much of social learning that occurs during childhood development is acquired through observation and imitation and most would agree that children learn from role models. The workplace is also a key source of health promotion as Madouros recent projections suggest that by 2020 32.1 million people will be economically active which will mean that if this amount of people can be educated in health then the government should see changes to health statics and whilst in work people will be influenced by others and have support from colleagues and this will also help to reduce the days of sickness due to people leading healthier lifestyles.

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Interventions
Beattie says that Interventions such as personal counselling which can be done individually, in emancipated groups and communities, can be done by practitioners or professionals who can work with peoples self defined needs. This can be done by making people understand that although exposure to the sun or the use of a sun bed can be portrayed as a need for better health emotionally. Is in fact the same outcome by using sun protection and not using sun beds but by buying a bottle of self tan solution as the outcome would be the same physically and mentally but without the risk of other health issues? The socio economic factors according to Thomson (2002) are that ill health is not a matter of chance or bad luck; some people have greater or lesser chance of good health than others. There is mass evidence detailing variations in health status according to socio economic factors, gender culture, ethnicity and age. From the summary of the department of health (1998) the poorest in society are hit harder than the well off by most major causes of death so by improving the health of the whole nation a key priority will be better health for those worse off. Income is a key factor affecting health and individual’s income can determine access to resources such as diet and warmth, it also has an effect on people’s psychological health with those on a low income experiencing stress, depression and social isolation. Employment effects people’s health as people who work seem to live longer lives than unemployed men and women who are more likely to die prematurely from heart disease, cancer or suicide. A social network can protect people from stress and social exclusion that may arise from unemployment, low income or isolation which can have a significant effect on or health, a social network that offers practical and emotional support has been shown to have a positive effect on a person’s health. People use sun beds as the cost of this is quite low and the time that is spent on them can be quick which means people can have a sun bed in their lunch break and according to (Online the Sun newspaper, 2012). Of the 402 sun beds tested physicists found the average sun bed was twice as strong as the sun in Spain.
The mini me project worked with a group of children during a PHSE lesson and scenarios and quizzes were developed which were specifically related to the subject of sun bed use and sun exposure it used the peer to peer approach of engaging and educating individuals this was used for students in years 7-10 with the age group being from 11-14 years old but in my opinion this is too late as children have already been exposed to the sun before this age if this project was just about the use of sun beds rather than the exposure to the sun then this age group would be the best as this is when this age group begin to become influenced by the media and peers. 6. 12019635
Cancer Research UK do not recommend the use of sun beds for cosmetics purposes as it increases the risk of malignant melanoma which is a cancer and it estimates that sun beds cause 100 deaths each year. There concern is with the young people aged between 11 and 17 years old and due to this statistic they have a campaign which aims to increase the knowledge of the causes of skin cancer, increase the awareness of actions to prevent sun cancer and positively influence the attitudes to sun protection. Although we know that too much sun exposure and incorrect protection can cause health problems we can also look at the source of vitamin D as according to the NHS we need vitamin D to keep our bones and teeth healthy and that most of our vitamin D we get comes from sunlight. They also tell us that vitamin D can be got from other sources such as foods like oily fish, eggs, breakfast cereal and fat spreads.
The main reasons reported by young people for the use of sun beds are to enhance appearance Murray and Turner (2004).Young people are also influenced by parental behaviour .Stryker (2004) so children that have parents who use sun beds or expose themselves to the sun without using the correct protection pose a bigger risk at doing this themselves which is learnt behaviour. Conclusion
In this piece of work I have discussed what health is and what is portrayed as a health need included are the views of different people, of different ages and status in society. Also what health promotion is and the different approaches that are used in health promotion by professionals who have created models to promote health whilst laying out a step to step guide of how a person’s behaviour can change to improve their health. I looked at an evaluation of a health campaign that was piloted and used the evaluation for this and the model that I thought would work best for this subject which was the Beattie model to discuss barriers, influences and the Scio- economic factors that can influence person behaviour on their health. I looked at various sources’ of information to understand why this topic was seen as a cause to a person’s health and why a health campaign should be done regarding this subject.
Whilst doing this piece of work I have learnt that sun bed use is actually the incorrect way to gain a tan and that sun exposure can be beneficial when you are exposed to it with the correct protection and I feel that more information provide for people about being out in the sun should be given positively and negatively rather than most information stating people should do this otherwise they will get cancer. Yes this is the fear creation but why not try the fear vs. the benefits. Evidence based health promotion is by understanding which approaches and methods are likely to produce the strongest health improvement.
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Models are useful tools in health promotion as it helps people visualise and test theories and whilst reading through these models it can be seen that health promotion is a contested area however it could be argued that all health promotion should be directed to all determinants of health as each model that I have researched can work for one if not more health promotion topics although each works in a differing way but encourages you to think theoretically and comes up with a new way of working. Beatties model supports that complimentary health promotion should not focus exclusively on any one single element by allowing us to analyse the complexity of health promotion. Many lifelong habits that jeopardise health are formed during childhood and it is easier to prevent detrimental health habits than it is to change them after they have become part of your life style as some may say prevention is better than cure. Addressing the world’s most serious health problems will depend on behaviour change at every level from individuals, families, communities and organisations. My recommendations for the future would be that Health promotion should become part of the school curriculum at a young age because at the moment they seen to be educating children of the age of 11 onwards, but surely don’t we want children of a younger age being protected from sun exposure and the use of sun beds. I also feel that some professionals give out differing information regarding using sun beds instead they should ban sun beds for all. Also people should be encouraged to get there vitamin D from food sources and this way people will stop using their exposure to the sun as being for the goodness of their health.

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References 1. Cohen, D. (2008) Health economics and health studies: An introduction. Basingstoke: Palgrave/Macmillan. 2. Department of health (2004) Choosing health and making healthier choices easier. London: Stationary Office. 3. Gottwald, M. And Goodman-Brown, J. (2012) A guide to practical health promotion. Berkshire: Open University Press. 4. Gardener, G. (1984) Determinants of intentions to take precautions against skin cancer. London.

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5. http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.1984.tb00422.x/abstarct (no date) (Accessed: 6 February 2013). 6. http://etheses.dur.ac.uk/4325/1/4325-1845 (no date) (Accessed: 8 February 2013). 7. http://open.jorum.ac.uk/xmlui/bitstream/handle/123456789/2942/improving%20Health% (no date) (Accessed: 12 February 2013). 8. http://www.nursingcenter.com/inc/journalarticile?Articile-ID=691990 (no date) (Accessed: 9 February 2013). 9. http://www.publications.cancerresearch.uk.org/downloads/product/SSTN07.pdf. (no date) (Accessed: 8 February 2013). 10. http://www.sunsmart.org.uk/advice-and-prevention/sunbeds/#Sunbed5 (no date) (Accessed 9 February 2013). 11. http://www.wales.nhs.uk/news/20837 (no date) (Accessed: 9 February 2013). 12. http://www.who.int/topics/en/ (no date) (Accessed: 8 February 2013). 13. Katz, J. Peberdy,A. AND Douglas, J. (2000)Promoting health: Knowledge and practice. 2nd edn London: The Open University. 14. Murray, C.D. and Turner, E. (2004) Health risks and sun bed use: a qualitative study. London: Palgrave. 15. Maslow, A.H. (1954) Motivation and personality. New York: Harper and Row. 16. Nutbeam, D. (1998) Health promotion. Oxford: Oxford University. 17. Naidoo, J.AND Wills, J. (2009) Foundations for health promotion.3rd edn. China: Elsevier Limited. 18. Online BBC Wales (2011) Available at:www.bbc.co.uk/news/uk-wales-18115408 (Accessed: 10 February 2013). 19. Online The Sun newspaper (2012) Available at:www.thesun.co.uk/sol/homepage/news/4748187/sunbeds-have-six-times-power (Accessed: 10 February 2013). 20. Stryker,J,E., Lazovich,D., Foster, J,L., Emmons,K,M., Sorensen, G,. And Demierre, M, F., (2004) Maternal/female caregiver influences on adolescent indoor tanning. London. 21. Thomson, (2002) the role of personal control in adapting functioning. Oxford: Oxford University. 22. Thomas, H. (2002) Further studies for health.2nd edn. London: Hodder and Stroughton. 23. Zoysa,I., Habicht, J.,P., Pelto,G., and Martines,J.,(1998)Research in the development and evaluation of public health interventions.Australia.