The aim of health promotion is to prevent ill health, a strategy emerging in the 20th century as a multi-disciplinary approach to tackling the causes of mortality and morbidity, and a process of enabling individuals to increase control over and improve their health (O’Connor-Flemming & Parker 2001). The purpose of health promotion is to cover all aspects of those activities which attempt to improve the health status of individuals and communities (Naidoo & Wills 1994). One of the most fundamental changes in health care and medicine over the past century has been the shift from acute and infectious diseases as the predominant causes of mortality to more chronic, multi-factoral disorders (Davison et al 2003).
The Lalonde Report, published in 1974, introduced the argument for not just taking health care systems but all of the determinants of health into account. This included four broad elements – human biology, healthcare organisation, lifestyle and the environment (Pederson et al 2005). Inspired by the Lalonde Report, The World Health Organisation (WHO) produced The Ottawa Charter for Health Promotion (1978)which launched a new approach, based on the Health for All 2000 Strategy and the Alma Ata Declaration (WHO 2005). The Charter led to a broader, more social definition of health promotion, ‘the new public health’, encompassing education, policy change, the environment and an approach that was more community based, introducing strategies such as public participation, community development and healthy public policy (Pederson et al 2005).
Health promotion, incorporating health education, has predominantly focused on a behavioural approach, emphasising the suggestion that information, advice and mass media campaigns, aimed at high risk groups, can change behaviours. It is popular because it views health as the property of the individual (Naidoo & Wills 1994). Since the launch of the Ottawa Charter, the context of health promotion has changed significantly, due to the effects of globalisation and the new patterns of urbanisation, consumption and communication. And although there have been positive behavioural changes, these have been confined to people of a higher socio-economic status and education level (Tang et al 2005). The tendency of health promoters to point to risk behaviours and unhealthy lifestyles ignores the impact of class and social inequalities on health and health behaviours (Crawford 2001),and implies that all individuals have equal resources and means of complying with health promotion messages.
According to Downie et al (1996)attitudes to health are complex and incorporate different relationships between beliefs, feelings, values and behaviours. Paying attention to attitudes will strengthen a health promotion action, regardless of whether a change in attitude is the specific objective. There is also the increasing recognition of attitude towards the self, for example self-esteem and self-confidence (Downie et al 1996). Although promoting health now attempts to incorporate action at an individual, community and government level, it cannot be assumed that everyone values health as highly, and indeed, according to Dines & Cribb (1993) health is only one value amongst many others (Dines & Cribb 1993). Lack of control over circumstances is a key determinant in the ability to follow healthcare recommendations (Garcia 2006).
Unlike medicine, health promotion is value driven, and politically focused, committed to empowerment of the individual and better ways of living one’s life(Downie et al 1996). Moreover, the empowerment strategy helps to resolve a dilemma prevalent in health promotion – the need to protect public health whilst also respecting individual freedom of choice, including the freedom to live an unhealthy lifestyle.
Recent Government initiatives, for example the 'Saving Lives Our Healthier Nation' action plan (DH 1999),recognise the importance of healthy public policy and call for more active involvement and collaboration of individuals and communities. Healthy public policy involves a broad range of activities, and aims to change the socioeconomic and physical environments in which we live and ultimately affect individual behaviours to enhance quality of life and overall health and well-being (Baum 2001). Yet misconceptions about the value of health promotion in the elderly can impede the provision of funding and care for those who are just as likely to benefit from a health promotion intervention as anyone younger (Edelman & Mandle 1998). The emphasis of the biomedical model in health promotion places more emphasis on disease in old age rather than general well-being. In order to promote a more positive aspect of ageing, and reduce the prevalence and the damaging effects of, prejudice there needs to be a clear distinguishing of illness from normal ageing, and a promotion of old age as a dynamic process (Bowling & Dieppe 2005).
The Ottawa Charter defined health promotion as ‘the process of enabling people to increase control over and to improve their health’ (WHO 1986). It also suggested that health ‘is a resource for everyday life, not the objective of living’, the implication being that the goal of health promotion is not to produce behaviour change, but to help people be as healthy as they wish to be (Weare 2002). As the population of elderly people worldwide continues to grow, successful ageing has become a priority in health policy agendas. Successful ageing includes the maintenance of physical and mental function, as well as continued social engagement. The emergence of a community health movement in the 1970's in the UK led to initiatives concerned with redressing increasing health inequalities by enabling the most disadvantaged and powerless in society to have a more decisive voice in decision making (Davison et al 1997).As such, a key principle of health promotion is the active participation of individuals and communities, with health education placed firmly in the centre. However, to be empowered is to be autonomous, and the goals of empowerment must surely be self-determination, independence and inclusion.An increasing emphasis on information technology within the health service could potentially lead to those without access to computers being denied information and health promotion advice. For the elderly,often neglected in health education campaigns, information on healthy lifestyles and behaviours is vital if they are to have any control over their future.
Lynn Mythen
