Health promotion in Nepalese context

Health promotion in Nepalese context
Increasing health awareness and developing positive attitudes and behavior towards healthier living is still a crucial need of the people to cope an alarming health problem like communicable and non-communicable diseases, which are still the leading causes of morbidity and mortality of the people. Emerging diseases such as Japanese Encephalitis, Viral Hepatitis and STD including HIV/AIDS pose increasing threats to the health and well being of the people of the country. Tobacco use, excess use of alcohol, inadequate physical activity, obesity, improper food habit and polluted environment has significant role in increasing burden of communicable and non-communicable diseases in the nation. Similarly, mental health, oral health, hearing impairment, blindness, cardiovascular diseases, diabetes, hypertension, malignancies and problems of elderly are the health issues that need to be addressed effectively by controlling and reducing risk factors and other as necessary.

Nepal is facing several public health problems such as communicable diseases like malaria, kala-azar, tuberculosis, leprosy, encephalitis, meningitis, diarrheas and acute respiratory infections, vaccine preventable diseases, nutritional deficiency problem like malnutrition, Vitamin A deficiency, Iodine deficiency, Anemia, dewormin, poor environmental conditions and high population growth. The health programs related to curative, preventive, promotive and rehabilitative services are regarded to have Health Education, Information and Communication (HEIC) as a core component to bring a desired change in health behavior of the people of Nepal.

The national health education, information and communication centre (NHEICC) is responsible for IEC activities for health promotion. The centre develops and produces various IEC and advocacy materials for the target audience that include people and communities in general, vulnerable population, patients and health system managers and personnel. Messages and materials are disseminated using electronic and print media, health institutions, schools, community groups etc. As a result of the IEC interventions over the years, people’s health awareness has increased, as reflected in higher coverage of immunization and increased demand for health care services. Health education corners have been established in more than 38 districts hospitals and health centre, in which video set including health related VHS cassettes have been provided by the NHEICC. The observance of World Health Day, World No Tobacco Day and other events by the centre has its own impact in terms of sensitization and commitment. However, promotive and preventive health care is yet to be adequately integrated into the mainstream of health services. The people in general, lack of knowledge and awareness about priority health problems, emerging diseases and the importance of their role and healthy practices that contribute significantly to health promotion and protection. Integrated approach involving communities, schools, health facilities and other institutions/organizations is presently lacking.

The organizational wide expectation for this biennium is that capacity for governance, stewardship, planning and implementation of multisectoral health promotion policies and programmes strengthened at country and regional levels, based on gender sensitive approaches to promoting health and well-being throughout and the regional expectation is to National comprehensive health promotion policies and strategies developed and implemented. Office specific result WHO support to integrated health promotion interventions through a network of communities, schools and health institutions. Office specific expected result, product for network mechanism developed, linking selected communities, schools and health facilities for undertaking health promotion activities at individual, family, community and institutional levels. Plan of action mainly focus on health promotion integrated approach and collaborative manner for the set up of the modalities of selected village development committees with coordination sectoral ministries, partners, health institutions, schools, different committees members, communities and family members for effective health massage for preventive , promotive and curative aspect for knowledge, attitude and practices for their areas.

Support for developing integrated approach to health promotion in coordination with other partner through the existing technical committees under the Chairmanship of Director General, Department of Health Services to look the key health issues such as reproductive health, child health, communicable diseases, non-communicable diseases and other main health issues to plan and implement IEC and BCC activities in an integrated and participative manner towards health promotion. Support on baseline survey and advocacy meeting to develop action plan in two VDCs/and schools about knowledge, awareness and practices. It was taken two VDCs (300 household in each VDCs) of Lalitpur districts. Organized advocacy meeting to discuss about the major health issues of the selected community to share the knowledge of IEC/BCC activities and to match need based IEC/BCC activities and to increase awareness among selected community people (300 person) regarding major health issues and the ways to prevent. Support to development, production and dissemination of IEC materials to raise awareness among general public about the causes, ways of prevention and control of major health problems and to ensure positive change in their health behaviors and improve the health status of general public by facilitating them to make right decisions about their health. Organize to celebration of parents’ day conducted in two VDCs of Lalitpur district to highlight the importance of health promotion at the family level .Parents, students and school teachers have major role and responsibility in promoting health at family as well as community level. Celebration of 2006 and 2007, World Health Day is an annual event of WHO through out the country with different programmes. Every year slogan and theme on the aspect of health related message.

Technical back up from the Regional Office, Director, NMH Visited for interaction and implementation status of the programmes. Visit of Director, NMH,SEARO is quite useful for his feedback regarding further planning and implementation of the health promotion and other related areas. Participation with national focal point of Regional Consultation on Regional Strategy for health Promotion for South-East Asia, Chiang Mai, Thailand on 26-29 June 2006. On that workshop sharing experiences by countries and organizations review of the Regional strategy for health promotion. After discussion recommendations on health promotion needs to be managed as well as sustained by involving various partners, allocation of resources and gathering evidence of the effectiveness at all levels.

Main Issues and Challenges:
Lack of knowledge and awareness about priority of health problems on communicable and non communicable diseases, tobacco control activities, disability, injury prevention and role of their healthy practices for health promotion.
Lack of proper approach, using of IEC materials and equipments at all levels.
Inadequate proper trained manpower at all levels to give the proper health promotion message
Inadequate awareness program and active community participation
Inadequate appropriate multi-media campaign and relevant advocacy materials for IEC/BCC.
Security, political instability and restriction movement of relevant staff for the community level activities for the implementation of planned activities in time
Technical input and coordination with other partners but implementation part with concerning programme manager and their staff in the field level for quality of the programme.
Lack of proper coordination among relevant sectoral ministries and partners
Inadequate supervision, monitoring and evaluation of the programmes for further planning and implementation.

History of Public health in world

History of Public health in world

Introduction
Health promotion has been defined by the 2005 Bangkok charter for Health Promotion in Globalized World as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health”. Means of health promotion include health education and social marketing.
The "first and best known" definition of health promotion, promulgated by the American Journal of Health Promotion since at least 1986, is "the science and art of helping people change their lifestyle to move toward a state of optimal health”. This definition was derived from the 1974 Lalonde report from the Government of Canada, which contained a health promotion strategy "aimed at informing, influencing and assisting both individuals and organizations so that they will accept more responsibility and be more active in matters affecting mental and physical health. Another predecessor of the definition was the 1979 Healthy People report of the Surgeon General of the United States, which noted that health promotion "seeks the development of community and individual measures which can help people to develop lifestyles that can maintain and enhance the state of well-being".
At least two publications led to a "broad empowerment/environmental" definition of health promotion in the mid-1980s.
In 1984 the world Health organization (WHO) Regional Office for Europe defined health promotion as "the process of enabling people to increase control over, and to improve, their health”. In addition to methods to change lifestyles, the WHO Regional Office advocated "legislation, fiscal measures, organizational change, community development and spontaneous local activities against health hazards" as health promotion methods.
In 1986, Jake Epp, Canadian Minister of National Health and welfare, released Achieving health for all: a framework for health promotion which also came to be known as the "Epp report”. This report defined the three "mechanisms" of health promotion as "self-care"; "mutual aid, or the actions people take to help each other cope"; and "healthy environments”.
The WHO, in collaboration with other organizations, has subsequently co-sponsored international conferences on health promotion as follows:
First International Conference on Health Promotion, Ottawa, 1986, which resulted in the “Ottawa charter for Health Promotion”. According to the Ottawa Charter, health promotion.
"is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being" "aims at making political, economic, social, cultural, environmental, behavioural and biological factors favourable through advocacy for health" "focuses on achieving equity in health" "demands coordinated action by all concerned: by governments, by health and other social and economic sectors, by nongovernmental and voluntary organization, by local authorities, by industry and by the media" "should be adapted to the local needs and possibilities of individual countries and regions to take into account differing social, cultural and economic systems"
In addition, the Ottawa Charter conceptualized "health promotion action" as "Build Healthy Public Policy," "Create Supportive Environments," "Strengthen Community Actions," "Develop Personal Skills," "Reorient Health Services" (i.e., "beyond its responsibility for providing clinical and curative services"), and "Moving into the Future."
2nd International Conference on Health Promotion, Adelaide, 1988, which resulted in the "Adelaide Recommendations on Healthy Public Policy”.
3rd International Conference on Health Promotion, Sundsvall, 1991, which resulted in the "Sundsvall Statement on Supportive Environments for Health”.
4th International Conference on Health Promotion, Jakarta, 1997, which resulted in the “Jakarta Declaration on Leading Health Promotion into the 21st century”. 5th Global Conference on Health Promotion, Mexico City, 2000, which resulted in the "Mexico Ministerial Statement for the Promotion of Health”
6th Global Conference on Health Promotion, Bangkok, 2005, which resulted in the “Bangkok Charter for health promotion in Globalized world”.
Altogether, the documents produced by conference attendees emphasized "investing in health promotion beyond an individual, disease-oriented, behaviour-change model”.
Objective
To overview the history of health promotion in world.
Methodology
The study carried out will be a descriptive study. It will be prepared with the help of secondary data extracted from various internet sites, journals, documents and books. Different reports and magazines related to history of health promotion will also be studied.
2.1 Study Design
The study will descriptive type done with the help of secondary sources.
2.2 Study Area
The study will be global.
2.3 Data collection Methods
Various Internet sites, journals, books and reports.
2.4 Study time
The time duration of the study was started from January, 2009.
2.6 Limitations of study
The study will only be based in the secondary data, it may not reflect complete scenario.

Findings
Origin of health promotion
Henry Sigerist is the first person to use the term “health promotion” with anything like its modern meaning. In 1946, Sigerist described the four major tasks of medicine as the promotion of health, the prevention of illness, the restoration of the sick, and rehabilitation. No one would disagree with that today. In an earlier work, Sigerist had defined health along similar lines to those later used by the World Health Organization (WHO), which said in its Constitution: “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Sigerist’s historical analysis of health and its relevance for human welfare, had led him to consider health in a social sense, and he wrote:

A healthy individual is a man who is well balanced bodily and mentally, and well adjusted to his physical and social environment. He is in full control of his physical and mental faculties, can adapt to environmental changes, so long as they do not exceed normal limits, and contributes to the welfare of society according to his ability. Health therefore is not simply the absence of disease; it is something positive, a joyful attitude towards life, and a cheerful acceptance of the responsibilities that life puts upon the individual.

Obviously, there have been numerous attempts to define the kind of health that should be promoted and preserved, and almost all have been rooted in a concept of wholeness or integrity. It is particularly intrigued by Fritjof Capra’s perception of that same wholeness in the systems approach to life in general and in the origin of this concept with respect to health, in contrast with the reductionist approach that has dominated Western thinking for 300 years. He writes:
Although everybody knows what it feels like to be healthy, it is impossible to give a precise definition; health is a subjective experience whose quality can be known intuitively, but can never be exhaustively described or quantified. Nevertheless, we may begin our definition by saying that health is a state of well-being that arises when the organism functions in a certain way.

To Capra, “a certain way” means that the various systems are in “a dynamic balance that involves the physical and psychological aspects of the organism, as well as its interactions with its natural and social environment.”
Definitions such as those given by Sigerist, WHO, and perhaps Capra have been criticized as not being useful, because they approximate a utopian state of eternal happiness to which all humankind will probably aspire, but give little basis for quantification and are difficult to promote. I have always firmly held, however, that one of the great challenges for us mortals is to grasp those things that we know intuitively to be real and vital for our wholeness, but that we cannot see or touch or measure. I am often cheered by the anecdote that Einstein had a sign in his office that read, “not everything that counts can be counted and not everything that can be counted counts.” A more useful approach would be to examine the proposals that can be made to improve what we know to be deficient, knowing that we have to be incremental in the major changes to be made.
Beyond the aspect of definitional precision, we accept that there is some intrinsic value to health itself, and that health is also valued for making it possible to work and to enjoy leisure. Let me refer again to Sigerist, who, in a lecture on health that was part of a series on “Religion in the Light of Sci- ence and Philosophy,” examined the background to the notion of health as something valuable for itself and to be promoted, taking us back to classical Greek society. The health of individuals—free ones, at any rate—was one of the centerpieces of the Greeks’ existence, and represented the condition of perfect equilibrium. The attention they paid to their diet and exercise to maintain perfect health seems almost narcissistic to us today. But then came the Roman domination of the Hellenic culture, and this engendered a more utilitarian and pragmatic approach. Subsequently, Christian understanding and practice in health were founded more on hygiene and were certainly more catholic, as opposed to the aristocratic focus of the Greeks.
A plausible thesis might be that this catholic approach to health waxed and waned, but found its crescendo in the great movements of the eighteenth and nineteenth centuries, which saw men like Allison, Villerme, Virchow, and Chadwick emphasize the social origins of the poor hygiene that caused the illnesses of the underprivileged. The means of preventing ill health were to be found in social and sanitary engineering. It has been said that the growth of the germ theory of disease and the impressive advances in medical science and technology led to a decline in interest in the sanitary and social measures that are necessary for the people’s health, and there has been a virtual hijacking of care for the public’s health by an increasingly medicalized system.5 This may well be so.
However, one of the most significant events of modern times that emphasized very much the social among the other dimensions of health was the landmark publication of the Lalonde report—A New Perspective on the Health of Canadians—in 1974.6 This has rightly been hailed as a watershed in our thinking about the public’s health, as the report focused on population health and those factors that influence it. It elaborated the “health field” concept with four components: biology, environment, lifestyle, and health care organization. These have been modified subsequently, but the basic concept remains: there are factors that influence or determine health beyond the capability of the health care services.7 It is interesting that in putting forward the notion of health promotion, the report grounded the major strategy in the changing of lifestyles, and clearly focused this more on the individual.
The timing of this approach and its geographical origin are of interest. I wish to pose here a long historical sweep in which the world—at least the Western world—has moved from an aristocratic approach of the promotion of the health of the few, through the prevention of the disease of the many, to a stage in which we now advocate for the complementarity between the prevention of the disease of the many and the promotion of the health of the many. It is a matter of speculation whether this growth of interest in applying health promotion to the many would ever have taken place if there had not already existed a sizable portion of the world’s population that could afford to be less preoccupied with the prevention of diseases, although these still constituted a scourge for much of the world’s poor and socially marginalized. And it is perhaps not accidental that the impetus for the focus on health promotion for the many should have arisen in Canada, which is often credited with maintaining a more egalitarian approach in all health matters. The current force driving us to see the relevance of both approaches is undoubtedly the increasing interconnectedness that is characterized as globalization.
It is not uncommon to propose that the State be assigned the responsibility for health promotion as an integral function of public health. This view is not new, and Virchow, in his crusade for medical reform in 1848, wrote:
[The State] must help everyone to live a healthy life. This simply follows from the conception of the state as the moral unity of all individuals composing it, and from the obligation of universal solidarity.

But today, even The State’s competence to deal with those areas that are traditionally recognized as the very bread and butter of public health has been put in question. Laurie Garrett, in her book Betrayal of Trust, points out with gripping detail that the occurrence of recent epidemics and the possibility of even many others occurring are frightening proof that the nations of the world have betrayed the trust placed in them by their people, and that there has been a collapse of global public health. There is inherent trust to protect the public, especially from the threat and reality of infectious disease.
She writes:
The only way to cope with the developing world’s overwhelming problems is to build effective public health systems. Such services monitor the health and wellbeing of its citizens, identify problems in the environment
and among the members of its community, and establish public health practices to address these problems, including the problem of whether proper health care is accessible to all.
Given the numerous gaps that exist in providing even basic surveillance of diseases—such as of plague, which has been with us from biblical times— and the feeling that somehow some of the more fundamental bases of public health are being ignored, it is a major challenge to demonstrate the relevance of health promotion as a concept grounded in principles that are equally valid for those who still feel pressed to do battle against preventable diseases. We have fortunately left behind us the stage in which there was a sterile polarization between the State’s attention to the health of the population versus the health of the individual. There is no doubt of the applicability of the strategies of health promotion to individual behavior. And while there is no negating that the State has the responsibility to make the social environment as favorable as possible for individual behavior, or that individual behavior is facilitated and reinforced by the group’s behavior, there is no avoiding the importance of individual volition and responsibility.
The Ottawa Charter still represents the essential formulation of what health promotion is about, and it says clearly that health promotion action means building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting the health services. I will not discuss these in detail, as, except perhaps for the first, they are relatively easy to understand. I have always been intrigued by the concept of healthy public policy, however, and the Second International Conference on Health Promotion, held in Adelaide, Australia, which dealt specifically with this, advanced our understanding considerably.

I understand public policy to mean the guide or framework for State action, and healthy public policy means for me those guides that seek to promote or restore health. One problem I face is that since the determinants of health are so expansive and touch almost all aspects of life, then healthy public policy would apply to almost all State policy. Indeed, the recommendations from the Adelaide Conference defined healthy public policy as one “characterized by an explicit concern for health and equity in all areas of policy and by accountability for health impact.”

We note the reference to all areas of policy. Therefore, if income inequality is associated with poor health outcomes, for example, then healthy public policy would entail measures for income redistribution. With the current movement towards a system of social organization that favors increasing income inequality, a public policy to address this possible cause of ill health obviously becomes problematic. The political implications of policy formulation over such a wide range of issues are numerous, and many of them would clearly lie outside the purview of the traditional health sector. In addition, the possibility of convincing other sectors to adopt policies intentionally because of their impact on health, poses difficulties in the majority of our political systems.
The matter becomes more complicated when State action is called for in areas that lie outside of what may be called traditional public health but that are still focused on communicable diseases. Communicable diseases un- doubtedly poses threats to the body public, and there is not likely to be any questioning of the State’s responsibility here, as there are clear population interests. But in those cases in which the externalities are minimal, it will be difficult to engage citizen interest, which is often one of the prerequisites for the generation of any public policy. Buchanan, in his theory of public choice, explains why individuals in their private capacity in economic terms seek to “maximize their utility function, but as voters acting in a political process have entirely different perceptions on what is appropriate.” Thus, many of those health policies that do not have obvious individual benefit are unlikely to generate popular enthusiasm. In general, we in health have very little concept about how these political processes move towards the formation of policies and how to influence them.
From the perspective of an organization like ours, one of the most important decisions we can make is to advocate for specificity in addressing healthy public policy. We cannot address all the policy aspects of all the possible determinants of health. Similarly, it is obvious that the principal strategies of health promotion can find application in almost all aspects of the work of a health organization, and throughout this report there will be numerous examples of the health promotion focus. Health promotion is applicable to the actions taken to prevent and control noncommunicable and communicable diseases, although much of the very early focus was on the noncommunicable diseases those that were supposed to be attributable to unhealthy lifestyles and practices. Health promotion finds application in the area of environmental health, as well, and some of the essential aspects of primary environmental care, for example, are grounded in the health promotion strategies. It was, therefore, a conscious decision to structure our Division of Health Promotion and Protection so that it would not have to deal with every application of the strategies of health promotion to every possible health problem. Our Division, in fact, is based on the logic that by concentrating on its three programmatic areas it could show most clearly the application of and results from the critical strategies.
Health promotion is very much here to stay. We have gone past much of the polemic that attended the characterization of any field of study and practice. It is for us to show that there is a practical application of the concepts embedded in health promotion and that, in the final analysis, the efforts in this field result not only in our populations enjoying health, but also in every citizen glorying in the health he or she enjoys. It may not be something new under the sun, but the sun may now be shining more brightly upon it.
Health promotion is the process of enabling people to increase control over, and improve their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well being." (World Health Organization (WHO) Ottawa, 21 November 1986)
"Any planned measure which promotes health or prevents disease, disability and premature death." (Tones 1987