NÂNG CAO SỨC KHO�E
GS TS BS Lê Hoàng Ninh
Định nghĩa nâng cao sức kho�e
A planned combination of educational, political, regulatory, and organizational supports for actions and conditions of living conducive to the health of individuals, groups, or communities.
Green & Kreuter, 1999Green & Kreuter, 1999
Định nghĩa nâng cao sức kho�e
The process of enabling people to increase control over and improve their health…
a commitment to dealing with challenges of reducing inequities, extending the scope of prevention, and helping people to cope with their circumstances…
creating environments conducive to health, in which people are better able to take care of themselves
WHO, 1986WHO, 1986
NHỮNG ĐẶC TRƯNG CƠ BA�N CỦ�A NÂNG CAO SỨC KHO�E
1. Enabling people to take control over, and responsibility for, their health as an important component of everyday life.
2. Requiring the close cooperation of sectors beyond the health services.
3. Combining diverse, but complimentary, methods or approaches.
4. Encouraging effective and concrete public participation. The Working Group on Concepts and The Working Group on Concepts and
Principles in Health Promotion, 1987Principles in Health Promotion, 1987
THE TRIAD OF HEALTH PROMOTION
HEALTH HEALTH EDUCATIONEDUCATION
HEALTH HEALTH PROTECTIOPROTECTIO
N N
DISEASE DISEASE PREVENTIOPREVENTIO
NN
The Health Promotion The Health Promotion TriadTriad
PHÒNG NGỪA BỆNH TẬT
BA CẤP ĐỘ
CẤP I (Primary)
CẤP II(Secondary)
CẤP III (Tertiary)
Phòng ngừa cấp I
Phòng ngừa cấp II
Healthy individual
Biological onset of disease
Risk Factors
Immunization Health EducationProphylaxis
Sàng lọc bệnh
RehabilitationSupport
Asymptomaticsigns
FunctionalStatusSymptoms
and signs
Diagnosis TreatmentComplianceAdherence
Các giai đoạn phòng ngừa bệnh theo tiến trình tự nhiên của bệnh
Clinical Course of disease
Chronic disease
CureDisability
Death
Phòng ngừa cấp III
Phòng ngừa câ0p I(PRIMARY PREVENTION)
- Action taken to avert the occurrence of disease
-Interventions:o Medicalo Legislativeo Societalo Educational
o Individual efforts
PRIMARY PREVENTION
- The more directly a behavior is linked to a health problem as a risk factor, the better candidate it is for primary prevention efforts
Simons-Morton, Greene, & Gottlieb, 1995Simons-Morton, Greene, & Gottlieb, 1995
Phòng ngừa câ0p II(SECONDARY PREVENTION)
- Action taken to identifydiseases at their earliest stages and to apply appropriate treatments to limit their consequences and severity.
J. Thomas Butler, 2001J. Thomas Butler, 2001
Phòng ngừa câ0p III(TERTIARY PREVENTION)
- Specific interventions to assist diseased or disabled persons in limiting the effects of their diseases or disabilities; also may include activities to prevent recurrences of a disease.J. Thomas Butler, 2001J. Thomas Butler, 2001
PreventionPrevention
GIÁP DỤC SỨC KHO�E(HEALTH EDỦCATION)
- Planned process,- Combines a variety of
educational experiences, and
- Facilitates voluntary adaptations
or establishment of behaviour
conducive to healthJ. Thomas Butler, 2001J. Thomas Butler, 2001
GIÁO DỤC SỨC KHO�E(HEALTH EDỦCATION)
- Aims primarily at the voluntary
actions people can take on their
own part, individually or collectively, for their own
health or the health of others and
the common good of the
communityGreene & Kreuter, 1999Greene & Kreuter, 1999
Learning DomainsLearning Domains
Cognitive DomainCognitive Domain
Aspect of health education that comprises information and knowledge
Information gained from health education can be A new information A reinforcement
Psychomotor DomainPsychomotor Domain
Aspect of health education that deals with skill acquisition and reinforcement
Affective DomainAffective Domain
Aspect of health education that is mainly concerned in Habit formation Behavior change New practice
BA MỤC ĐÍCH CHÍNH CỦ�A GIÁO DỤC, NÂNG CAO SỨC KHO�E TƯƠNG ỨNG VỚI
BA CÂ0P ĐỘ DỰ PHÒNG
- Promotion of health and illness
prevention- Restoration of health when
one becomes ill
- Maintenance of health while coping with chronic, long-
term conditions
Potter & Perry, 1993Potter & Perry, 1993
THREE SPHERES• Health Education• Prevention• Health
Protection SEVEN DOMAINS1. Prevention2. Lifestyle3. Preventive
Policies4. Policy Maker
Education5. Health
Education6. Health
Protection7. Policy Support
HEALTH PROMOTION MODELS
1. Prevention(Preventive Services):
This domain includes primary preventive measures, such as immunization and exercise programs, and secondary preventive measures, such as pap smears, hypertension case-finding, and smoking cessation programs.
2. Lifestyle(Preventive Health Education)
This includes education efforts to influence lifestyle to prevent health-related problems and to encourage the uptake of preventive services.
THREE SPHERES• Health Education• Prevention• Health
Protection SEVEN DOMAINS1. Prevention2. Lifestyle3. Preventive
Policies4. Policy Maker
Education5. Health
Education6. Health
Protection7. Policy Support
HEALTH PROMOTION MODELS
3. Preventive policies(Preventive Health Protection)
This sphere represents health protection, including fluoridation of public water supplies and inspections of restaurants.
It can be viewed as a policy commitment to the provision of preventive services such as those described under domain 1.
THREE SPHERES• Health Education• Prevention• Health
Protection SEVEN DOMAINS1. Prevention2. Lifestyle3. Preventive
Policies4. Policy Maker
Education5. Health
Education6. Health
Protection7. Policy Support
HEALTH PROMOTION MODELS
4. Policy maker education(Health Education for
Preventive Health Protection)
Given that health protection measures do not emerge spontaneously, education of policy makers is important.
Example of this is the lobbying by safety-conscious groups to encourage mandated use of automobile seat belts in the face of much public apathy.
Efforts to stimulate a social environment that demands or accepts preventive health protection measures are also part of this domain (Downie, Tannahill, & Tannahill, 1996),
As is a policy commitment to preventive health education.
THREE SPHERES• Health Education• Prevention• Health
Protection SEVEN DOMAINS1. Prevention2. Lifestyle3. Preventive
Policies4. Policy Maker
Education5. Health
Education6. Health
Protection7. Policy Support
HEALTH PROMOTION MODELS
5. Health education(Positive Health Education)
This domain comprises all aspects of positive health education, including influencing behavior by helping individuals, groups, or whole communities develop positive health attributes, such as life skills and self-esteem.
- Health promotion encompasses
health education...and is aimed at
the complementary social and
political actions that will facilitate
the necessary organizational,
economic, and other environmental supports for
the conversion of individual
actions into health enhancements
and quality of life-gains.
Greene & Kreuter, 1999Greene & Kreuter, 1999
6. Health protection(Positive Health Protection)
This domain includes implementation of a workplace policy forbidding smoking, graduated drivers’ licenses, and commitment of public funds to provide safe-walking areas and bicycles paths.
7. Policy support(Health Education Aimed At Positive Health Protection) This domain embraces raising
awareness of, and securing support for, positive health protection measures among the public and policy makers.
It includes a policy commitment to positive health.
THREE SPHERES• Health Education• Prevention• Health
Protection SEVEN DOMAINS1. Prevention2. Lifestyle3. Preventive
Policies4. Policy Maker
Education5. Health
Education6. Health
Protection7. Policy Support
HEALTH PROMOTION MODELS
HEALTH PROTECTION
- Comprises legal or fiscal controls,
other regulation policies, and
voluntary codes of practice, aimed
at the enhancement of positive
health and the prevention of ill-
health
J. Thomas Butler, 2001J. Thomas Butler, 2001
HEALTH PROTECTION
MISSION – reduce the likelihood that people will encounter environmental hazards or
behave in unsafe or unhealthy ways.
Downie, Tannahill, & Tannahill, 1996Downie, Tannahill, & Tannahill, 1996
Health ProtectionHealth Protection
Philippine Medical Act of 1959 PHILHEALTH Generics Law; National Drug Policy
and Formulary Dangerous Drugs ActDangerous Drugs Act Cheaper Medicine Bill Code of Sanitation of the Philippines
Health Protection
Disability Act Senior Citizens Law Child Protection Laws and Policies Clean Air ActClean Air Act MMDA Waste Management PoliciesMMDA Waste Management Policies
Strategies
HEALTH PROMOTION
Strategies
Educational Interventions Organizational Interventions Political/ Legislative
Interventions Community and Social
Interventions Economic Interventions
Educational Interventions
Stress management classes for middle-management employees in the workplace
Mail-outs to the public describing positive steps a person can take to reduce exposure to HIV
Educational programs designed to reduce personal vulnerability to crime
Primary school programs to develop the skills to cope with peer pressure
Organizational Interventions
Annual hearing and vision screening in schools Automobile, bicycle, and firearm safety
programs conducted by law enforcement agencies
Identification of designated smoking areas and development of a smoking policy in a worksite
Official recognition by business management of alcoholism as a disease and not a weakness in character
Development of support groups by nonprofit organizations and facilities that provide services to people with special needs
Political/ Legislative Interventions
Passage of laws requiring use of helmets while riding motorcycles and bicycles
Legislation requiring environmental polluters to measure their pollution and implement effective plans to reduce the pollution
Fluoridation of the water supply Regulations requiring agencies and
companies to monitor air pollution and governmental actions to reduce it
Regulations aimed at reducing youth access to tobacco products and alcohol
Community and Social Interventions
Organization and training of out of school youth to reduce vulnerability to sex or drug crimes
Formation of neighborhood walking clubs
Health fairs at shopping malls
Economic Interventions
Tax incentives to landlords of low-income housing to encourage maintenance of property and reduction of pest infestation
Incentives from insurance companies to those who practice healthy lifestyles
Incentives from employers to employees who stay healthy and do not miss work