Category: Health Promotion

Introduction

Health promotion has been considered a vital part of nursing for over 150 years. Florence Nightingale stated in 1859 that health promotion is significant to the definition of nursing. Health promotion has been confused with health education for years in nursing literature. However, health promotion as a concept requires more patient involvement than health education because it requires the patient to make a change in their lifestyle (Raingruber, 2017).

Defining Vulnerability and Health Promotion

The concept of vulnerability has been around since the 1970’s but it has changed in its meaning over the years. This concept is still pertinent to our society today because the United States still has a large amount of the population that is considered vulnerable. The concept of vulnerability is used in multiple different situations when associated with potential poor outcomes, risk or danger within a population. (Arora, Shah, Chaturvedi, & Gupta, 2015)

When vulnerability is defined by the Indian Journal of Community Medicine it is said that it is the “state or condition of being weak or poorly defended” (Arora et al., 2015, p. 193). The definition of vulnerability can differ depending on the source. Those individuals who are vulnerable populations are extremely important to health care professionals. This is due to the vulnerable populations not always having access to medical care due to lack of transportation or even insufficient funds to be able to pay for their medical bills. These populations are also important to health care providers because since they don’t always seek treatment for their medical conditions, these conditions can worsen over time and cause further issues down the road. For example, individuals who cannot afford healthcare or do not have insurance often visit the emergency room or urgent care to seek treatment and this causes a strain on the health care system.

The concept of vulnerability can be directly related to the concept of health promotion because these concepts have many similarities when it comes to vulnerable populations. According to Raingruber (2017), health promotion is defined as “lifestyle coaching designed to promote optimal health, quality of life, and well-being” (p. 6). Health promotion has many components when it comes to motivating an individual to improve their health. These components consist of the health care provider considering the individuals financial situation, social support, educational background, and any environmental factors affecting their health (Raingruber, 2017). When the health care provider considers the individuals situation, they are acting as a patient advocate. This is done by motivating the patient to improve their health and want to change their lifestyle behavior.

Biological Domain

The biological domain of the vulnerability model includes genetic predisposition, age, or race. It has been found that certain races have a higher prevalence of teenage pregnancy than others. The ages for teenage pregnancy range from 13 to 19 years old. According to the American Public Health Association, the highest adolescent birth rates in the United States occurs within Hispanic, African American, American Indian, and Alaska Native adolescents (Burrus, 2017). Therefore, studies have shown that African American and Hispanic teenagers have a higher risk for pregnancy due to their race. According to Krost and Henshaw, although the pregnancy rate of black teenagers fell 56% between 1990 and 2010, their teen pregnancy rate remains at more than twice the rate of white teenagers (2014).

Sociocultural Domain

The sociocultural domain within the vulnerability model includes an individual’s economic status, education, social support, and health care quality and access. Studies have shown that teens with a low socioeconomic status and low education can have a higher risk of teenage pregnancy (Penman-Aguilar, Carter, Snead & Kourtis, 2013). It has also been found that teens who get pregnant while in high have a high dropout rate that could lead to a low level of education and a low economic status (Kaphagawani & Kalipeni, 2017). Lastly, it has been found that adolescents who do not have access to health care have a greater risk of getting pregnant as a teen (Bhuiya et al., 2016). It can be concluded that teens who do not have access to health care relating to reproductive health and pregnancy prevention have a higher risk of teenage pregnancy.

Environmental Domain

The environmental domain consists of an individual’s work environment, home environment, community environment, and geographical location. For pregnant teens the environmental domain mainly relates to their home environment. According to the American Public Health Association, “Rates for other vulnerable groups, such as runaway and homeless adolescents, adolescents in foster care, and adolescents living in rural areas, are higher than those of the general adolescent population (Burrus, 2017, p. 1).” An adolescent’s home life can place them at higher risk for teenage pregnancy, specifically if the teen comes from a broken home with little familial support. Studies have shown that teens who come from a household with parents who are not together or if they have witnessed domestic violence within the home are at a greater risk of teenage pregnancy (McAlister, 2016). Although an adolescent’s home life plays a large part in the environmental domain, the geographical location of the adolescent is also important. This is important because the United States has the highest teen pregnancy rates of developed countries (McAlister, 2016).

Behavioral Domain

The behavioral domain includes emotional health, sexual practices, diet and exercise, rest, alcohol, and drugs. When teenagers partake in risky behaviors it can place them at a higher chance of getting pregnant. If a teenager participates in unsafe sexual practices like not using contraception and having multiple partners, it increases their risk for an unplanned pregnancy.

Research has also shown that when teens engage in risky sexual behaviors it can correlate with an increased prevalence of engaging in other unhealthy behaviors like consuming alcohol, drugs, or tobacco (Burrus, 2017). Also, when a teenager engages in substance use it can directly correlate with them having unsafe sexual practices as well. In addition, studies have shown that if teens have lower levels of self-esteem this places them at a higher risk of becoming pregnant (McAlister, 2016).

Cultural Consideration

The teenage pregnancy population is a population that nurses should provide proficient care related to their culture and current situation. Teenagers themselves have a peculiar culture, however, pregnant teenagers have their own subculture within the teenager culture. For example, the nurse should consider the teenage culture when educating and speaking with the pregnant teenager. Many teenagers lack maturity and this could cause the teenager to use substances like alcohol or drugs while pregnant. NURSE EDUCATION

Pregnant adolescents may also struggle with the level of responsibility they will have once the baby is born.

Introduction

Public health is basically the art as well as science of improving and protecting health of the people and entire community at large. In short, public health relates to changing the health behaviour of people and improving their lifestyle. The main aim of this report is to study various aspects related to public health along with the prevalence of various diseases and devise the various actions which could be taken for ensuring well-being of people.

This report gives a brief overview of aspects of strategies of public health, emergence of public health policy in UK, comparison of health as well as being within regional population, reasons for differences, actions for mitigating differences and methods for preventing diseases.

Task 1

Aspects of strategies of public health

Public health mainly aims to promote the health of diverse population and hence protect the health as well as being of the entire community. There are generally various aspects of the public health strategies namely

Recognizing health needs

This is one of the most important strategy of public health where the main objective is to recognize the trends as well as patterns among wide population with the help of statistics. Identifying health needs of people are highly essential and forms the integral part of the public health (Baum, 2016). Through analysing the health needs, healthcare professionals are able to make effective decisions like which medication to produce, what diagnosis is required etc. On the while, by assessing the health needs of entire population organizations are able to loo at mortality as well as morbidity rates which are currently prevailing in the country and thus helps the organizations and government to take effective actions.

Controlling the communicable diseases

Communicable diseases mainly spread from person to person through virus, bacteria etc. Thus, controlling wide range of communicable diseases is one of the most important strategy of public health. Various communicable diseases like Measles, Rubella are the most highly prevalent diseases which requires immediate control. Thus, this is the another important aspect of public health strategy where the main aim to eliminate or mitigate the outbreak of communicable diseases to high extent (Brownson and et.al.,2017).

Promoting health

The most well-known as well as remarkable strategy of public health is promoting health of entire population through the use of various campaigns, seminars and educating people. Te major aspect of this strategy is to educate people and raise awareness among them for changing their health behavior and making them understand the importance of leading healthier life. In this strategy, people are educated regarding different implications of the health and a healthier lifestyle is promoted (Gostin and Wiley, 2016).

The emergence of public health policy in UK

Poor law amendment 1834

In order to promote the health of poor people, this act was established which addressed that if poor requires food, shelter, resources, clothes then they would have to work in workhouse. Popel would have to overcome their bad conditions of living as well as minimum meals. This policy was being established with the main aim to support the poor in UK and thus helped to raise awareness among them regarding the implications of the poor health (Merai and et.al.,2016).

1848 Public health act

This act was mainly amended by Edwin Chadwick wherein helping the poor to lead a healthier life and providing them better jobs were given importance. This act in 1848 changed the condition of sewers and thus made an improvement within them for ensuring that there is no waste lying on streets. This eventually prevented diseases and provided people with safe drinking water (Baum, 2016).

This growing prevalence of health issues among people of UK compelled government to take major steps and since then, national government along with federal and state government established large number of policies and thus transformed the 21st century

Smoking free policy

In the year 2016, UK government came up with the new policy in order to put a ban on tobacco-producing companies. In the year 2016, a ban on the smoking was one of the major amendment being made by the government and thus the major initiative taken for the public health of people. Within this policy, government decided to put a heavy fine and charge on the companies importing or exporting tobacco and increased the taxes on tobacco. This eventually decreased the outbreak of major diseases like lung caner, heart problems in UK (Brownson and et.al.,2017).

Task 2

Comparison of health as well as being within regional population

England

The health ans well-being data in England has been highly imperative from past few years and the health of people in England has improved to a great rate. In the year 2018, the average rate of people suffering from anxiety including youth and adults has decreased from around 2.53 to more than 2.32. Besides this, the average life expectancy, as well as satisfaction, has improved to around 3.4% in England along with a great improvement in the nearby areas to more than 4.6%. Along with this, the mortality rate in England has declined from around 45.3% to more than 23.7% and there has been a great increase among people regarding the awareness for different diseases. The average ratings of happiness in England raised from 7.52 to nearly 7.56 according to the report of 2018. Besides this, as per the report of WHO around 82.1% people reported their health as either excellent or very good making England a healthy country where most of the people merely suffers from health diseases (Gostin and Wiley, 2016).

Wales

Wales has been the widely known country where majority of people are facing various health-related diseases and the major cause behind this is the poor healthcare facilities and legislation. The life expectancy in Wales has decreased from past few years to more than 32.5% and inequalities has dominated Wales to high extent. More than 40000 cases of drug abuse are being reported in Wales every day and this figure mostly contains youth between age group 15 to 23. The health issues in Wales relating to heart ad lung problems has increased from 34.6% to more than 65.7% with a great rise in percentage of depression among people. According to the report of 2019, more than 70000 people suffer from mental illness every day among which around 60000 people die due to lack of proper treatment and facilities (Merai and et.al.,2016).

Reasons for the Differences Between Two Regions for Current and Future Well Being

According to the above information it can be said that the main reason of difference between England and Wales for the current and future health and well being are related to the health care facilities that are provided by the government in local health care and social care organizations. These challenges and differences that are faced by people in Wales just because of lack of facilities and resources in health care facilities. In England the standards of health care services is much better than the Wales. This better resources and facilities provided by government and health care organization provide better opportunities to the organization to live healthy and better life style (Holland, Mossialos and Merkel, 2018). In Wales lack resources and facilities are responsible for poor current and future health conditions. Some of the main factor that can affect these health standards in Wales and England are Political Instability, Poor Planning and environmental conditions. These are major factors that can affect health and well being of people.

Political instability is major issue in this process. This conditions of government reduce their capability to implement various policy in specific region. Resistance of opposition and corruption at different level can affect the health care facilities and well being of people of Wales. The other factor for this differences is poor implementation plan. This is important for the authorities to make effective plan to design and implement various facilities that are related to the health and social care organization (Ramaswami, Bayer and Galea, 2018). The most crucial factor for this difference is related to the difference in the environmental condition in this two regions. This difference in environment force the government to make different plans and policies for these two areas.

Ways to Improve Current and Future Health & Well Being

There are different processes can be used by the government to provide better facilities to people and health care organization in order to reduce the difference between two particular regions of UK. By managing better information and reducing complexities in implementation of health policies government can provide better health standards to people with effective health style (Blanchet and et.al.,2017). This is how various policies and processes can be used by the government to reduce the differences of Current and Future Health and Well being of people.

Task 3

Health protection and promotion

Communicable disease

Communicable diseases are such medical issues which are spread through person to person. Individual can come in contact with this illness through blood transmission, bodily fluids, airborne viruses etc. HIV is considered as most dangerous disease.

HIV is the most dangerous illness which badly affect immune system hence individual’s body fail to fight back. Transmission of this virus is done through blood, breast milk, semen etc.

It is difficult for medical professionals to determine the HIV within-person in initial phases. HIv has become the global issue as more than 37.9 million people are suffering from HIV.

Symptoms

Individual suffers from high fever and headache

There are rashes in the body of infected person and individual has to bear sever pain in sore throat

Swollen lymph gland is another symptom detect during the initial phase.

Prevention strategies

Though it is a serious issue but still there are many tenements are available for the AIDS. Individual must prevent themselves by taking assistance of various strategies.

• Individual needs to take care during making sexual relationship with partner (Dowell, Blazes and Desmond-Hellmann, 2016). Sexual relationship must be having with limited partners otherwise it can increase risk of suffering from HIV. Apart from this, there should be safe sex by using lubricants, condoms etc.
• Injecting equipment’s must be clean so that risk of HIV can be minimised, local hospital authorities must take care of it , so that it does not transmit to other person.
• Taking timely treatment such as antiretroviral therapy is the most common and effective prevention strategy that can aid the person in getting recover from this illness soon.

Non-communicable disease

This is another kind of disease which does not get transmitted into other person directly. These kinds of illness occur due to genetic, behaviour, environemtnal elements.

Diabetes is the most common non-communicable disease which is caused due to high consuoption of sugar.

Causes of Diabetes

• One of the major cause of increasing rate of diabetes patients are that lack of awareness towards health diet. People are taking fast food frequently which affect their metabolism and increases chances of suffering from this issue.
• Age is another major case, with the increasing age chances of suffering from diabetes gets increased.
• Personal or biological histroy is another major factors due to which such issue can take place.

Symptoms

• Individual feels hunger in shorter dyration
• The most common sign of diabetes is that person’s fails to gain weight
• Blurry vision and extreme fatigue are major signs of diabetes.

Prevention

• Person must workout on regular bases, if person do excerise regularkly then it will help individual in controling over level of sugar which will help in preventing from suffering from this illness (Kohl III, Murray and Salvo, 2019).
• By having low carb diet or healtbhy diet individual can improve their health conditon and can decease chances of sufering from diabetes.
• Smoke is another major cause and if individual quit smoking them it will be better in preventing themeselves from suffering from this illness.

Conclusion

This report is concluding information that is related to the key aspects of health strategies and origination of public health policies in UK since 19th century to the present condition. The differences between current and future health and well being has been studied for Wales and England. According to CPD a booklet is prepared that is about two diseases in which one is communicable and other one is non communicable. This diseases has been critically has been explained in the report.

References:

Books & Journals

1. Baum, F., 2016. The new public health (No. Ed. 4). Oxford University Press.
2. Blanchet, K and et.al.,2017. Evidence on public health interventions in humanitarian crises. The Lancet.390(10109). pp.2287-2296
3. Brownson, R.C and et.al.,2017. Evidence-based public health. Oxford university press.
4. Dowell, S.F., Blazes, D. and Desmond-Hellmann, S., 2016. Four steps to precision public health. Nature News.540(7632). p.189.
5. Gostin, L.O. and Wiley, L.F., 2016. Public health law: power, duty, restraint. Univ of California Press.
6. Holland, W., Mossialos, E. and Merkel, B., 2018. Public health policies in the European Union. Routledge.
7. Kohl III, H., Murray, T. and Salvo, D., 2019. Foundations of physical activity and public health. Human Kinetics Publishers.
8. Merai, R and et.al.,2016. CDC grand rounds: a public health approach to detect and control hypertension. Morbidity and mortality weekly report.65(45). pp.1261-1264.
9. Ramaswami, R., Bayer, R. and Galea, S., 2018. Precision medicine from a public health perspective. Annual review of public health.39. pp.153-168

Health promotion is the procedure of permitting individuals to elevate check over and to better their well-being. To gain the plight of accomplished corporal, intellectual and societal well-being, the person will be capable of recognizing, notice hope, please want, manage and familiarize themselves with the territory.

As stated by ( WHO) 1986 “ explained health as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing societal and personal resources, corporal capacities”. To boost health is not only for health executives, on the other drivers over the habit of life to health. It’s all about doing things ahead of keeping away from disease and better individual and society’s health by giving speedy solutions ahead of numerous health problems facing the public for instance smoking, being overweight, and exercise. Promoting health aid mankind and individuals to make options that assist health, assisted by (Curtin University, 2012) which explains that follow an important amount of ill-health associated with options like sports, the use of legal and illegal materials, daily bread, communal and social conduct.

Enhancing health is built in the use of holistic perspectives of health using a participatory approach thereby focuses on determining and directing the matter of soundness, not just ailment. These settlements incorporate the center origin to bad health, illness, and wellbeings like performance, domain, community and profitable conditions, also other features like income, employment, and development.

Programs and procedures on enhancing health must be adjusted to neighborhood requirements with chances of regions and countries to draw reports varying economic, cultural, and systems. Most especially, health promotion requests organizing efforts by individuals, government, local authorities, productive sector, voluntary organization industries, and publishing.

Furthermore, a mental disorder is another part surrounded by the health section that much observation is not given in terms of advancing health. Christodoulou (2009) stated expressly there is an increasing recognition progressing slowly there is no health without mental illness.

Positive mental illness is about a state of well-being where individuals work productively, make a positive advance in the community, and realize their own potential. The want for positive mental health promotion is useful and suitable for everyone. Professional and policymakers should appreciate psychological and comfort exist as day to day coordination by all interests like government, industry, local authorities, voluntary organization through economic, social and health sectors must put a hand on the desk to make certain positive health encouragement is supported. Mental disorder is important for the well-being of an individual. It contributes to all sides of the person and is essential for the individual, families, culture, and society.

Personal development. It implies progressing emotional, personal, and social skills. It means growing on their own to enlarge their health promotion and to become an improved person.

Wellbeing information-Means an activity that implies growing systems of providing the right information regarding peoples medical history, what general and way of behaving things can touch their well-being, and what needs to be completed to better their community health.

Community development-Is is meant to motivate and progress communities to enhance healthier things like culture, neighborhoods, and communities of interest.

Program development-Is is a procedure to develop a design for advancing forward to health and ensure that community policies are helpful for this program. For positive health promotion, the specialists are working in separate ways and places like communities, sport, schools, offices, trim, hospitals, health centers, and local authorities.

I participated in an activity where l discussed the lack of sufficient water in the body, to members of my church. These discussions captured the principle of improving health which allows individuals to take influence over their well-being. Water is essential to the body when the humidity is warm or hot. It remains the figure from superheating. During physical activity, your strength gives rise to warmth, so to remain from burning up, the heat must be removed from your body. And the easy way to remove heat during warm weather is through sweat. Lots of sweating decreases the level of water in the body and really affects the body when the body loses fluid.

Furthermore, to keep away from insufficiency, individuals should drink 8 glasses of fluid every day. Water is what you require to be active in moderation. Effective health awareness or programs help to improve health. After discussing the absence of enough water in the body, the majority was satisfied with the discussion and was positive as they started to drink water during walking activity.

References:

1. Morgan, A (2006) Evaluation of health promotion, ln, Davis M & MacDowell, W (Eds) Health promotion theory: Understanding Public Health Series.OUR/ McGraw-Hill.
2. Keyes C.L. Promoting and protecting mental health as flourishing- A complementary strategy for improving national mental health. American psychologist. 2007.
3. Huppert F. A., Whittington J.E. Evidence for the independence of positive and negative well-being: Implications for quality of life assessment. British Journal of health psychology 2003.
4. Kelly MP (2006) ‘Evidence-based health promotion. Ln: Davis M & Macdowell W (Ed) Health Promotion Theory: Understanding Public Health Series. Open University Press/ McGraw-Hill

Health is a state of complete physical, mental and social well-being and not just disease-free or infirmity. WHO responsibilities include: Helping countries that seek progress toward universal health coverage, helping countries establish their capacity to adhere to the International health regulations, increasing access to essential and high-quality medical products, addressing the role of social, economic, and environmental factors in public health, coordinating responses to non-communicable disease and promoting public health and well-being in keeping with the sustainable development goals, set forth by the UN.

The definition of health promotion is the one defined by the World Health Organisation. WHO referred to Health promotion as the process of enabling people to increase their control over their health and to refine the overall care system. During the Ottawa Charter conference in Geneva (1986). The emphasis on requirements for health sustainable aid. The recognition of these health requirements shows the overwhelming tie between social and individual lifestyles and health. Promote social responsibility for health, community development activities are intended to encourage and develop, organization development activities involve promoting health in schools, workplaces, and hospitals. Health promotion can allow individuals to make healthier choices and reduce their risk of disease and disability. At the community level, they can eradicate health discrepancies, enhance the quality of life, and better the availability of healthcare and relevant services.

Partnership projects development involve working with people in society, for better education the partnership to promote health (Kelly 2006). Provision of health information or the provision of correct information about people’s health while attempting to answer questions about health. Health promotion is established on the overall view of health using activities to focus on the determinants in order to address the issue. Determinants include focusing on the root cause of poor health, wellbeing but also other aspects like education and income.

Mental health is another part of the health sector that is not given much attention when it comes to health promotion. Christodoulou (2009) emphasized that there is now a slow recognition that there is no health without mental health. Health promotion within mental health is subdivided into positive and negative mental health. Positive mental health involves self-esteem and the ability of an individual to solve their own problems. Policymakers and professionals must be made to understand that mental health and mental issues are day-to-day issues hence coordination by all relevant bodies such as government, local authorities, industry, and voluntary organizations must take part in this initiative to ensure that positive health promotion is conserved.

Developing strategies through executing planned approaches that are aimed at promoting health on a national scale by ensuring that local regional and national policies are supportive of this initiative (Millward, Kelly & Nutbeam,2003) In order to ensure that positive health promotion ensues health promotion specialists are placed in different work setting and locations such as sports and fitting centers, communities’ halls, health centers, local authority buildings, hospitals and schools (NHS Careers,2012)

When we look at the national scale health promotion activities will be too large and broad to manage the hence different programs and schemes are backed by the government the NHS, the Department of Health, and some charitable organizations mentioned below.

Every Mind Matters offers a range of useful resources that help spot the signs of common mental health concerns, provides practical self-care tips and guidance, and, importantly, explains when to seek further support.

It also has a free NHS-approved online tool on the Every Mind Matters website, which helps people build an action plan to deal with stress and anxiety, boost their mood, improve their sleep and help them feel more in control.

Blood pressure Uk is a registered charity in Uk. The charity helps raise awareness regarding the risks of high blood pressure. The charity activities focus on encouraging people to check their blood pressure. Every health professional needs to take their blood pressure as part of their professional responsibilities.

NHS is the UK’s health sector role model and its aims are to build a better understanding of how to deliver quality healthcare and to take a more preventive approach.

Recently the UK government has launched a public health campaign in a bid to prevent the spread of coronavirus following confirmation of the first British cases of the deadly disease. Basic hygiene such as washing hands regularly and using tissues to catch a cough or sneeze are key ways to help slow the spread of the virus, the advice says.

Health Promotion theory is a way in which a set of ideas or concepts is organized through research findings in order to carry out new assumptions.

I participated in activities where I discussed the effects of sleep deprivation among teens with a group of 20 teenagers in my church. I investigate smartphone usage in bed using discussion, questionnaires, and interviews. The best way to prevent sleep deprivation is to make sure you get adequate sleep and refrain from using electronic devices right before bed. Having participated in the effect of sleep deprivation among teens activity and also introducing sleep hygiene to my church community members. The response was very positive as most teens within my local church community started engaging in leaving their phones in a designated space in another room before retiring to bed without being prompted. Teenage children should choose what best works for them in the routine, for example, have a bath and a hot milky drink before bed, or use meditation or mindfulness activities. Gentle yoga may also help. Avoid screens such as computers, TV or smartphones, loud music, homework, or any other activity that gets your mind racing for at least an hour before bedtime. Avoid stimulants in the evening like coffee, tea, soft drinks, and energy drinks. Keep your bedroom dark at night. Your brain’s sleep-wake cycle is largely set by light received through the eyes. Try to avoid watching television or using smartphones right before bed. In the morning, expose your eyes to lots of light to help wake up your brain. Do the same bedtime routine every night for at least four weeks to make your brain associate this routine with going to sleep.

Risk behaviors often do not occur in isolation. Smoking, drinking, illicit drug use, and sexual risk are all mutually predictive. For drug use and some forms of sexual risk, with other risk co-occurrence of behaviors are driven by shared risk factors such as peer influence sensation-seeking king or by state-specific traits such as the direct effects of substance use or aggression on other behaviors. Common risk factors can be found in many areas, including social, psychological, family, school, neighborhood.

Effective health programs contribute to improved health outcomes. Having participated in increased physical activity and also introducing it to my community. After carrying out a survey of how I felt and how the individual members of the Church community felt. The response was very positive as most people within my church community started engaging in the activity every night without being prompted.

Florence Nightingale a nineteenth century medical pioneer defined health as a phenomenon which is as a result of multitude of influences and beyond the ‘sick -care ‘model of the day. She believes that when sickness is disobeyed it results in health (Rosa, Upvall, Beck and Dossey, 2019) The World Health Organization (WHO) evolved this definition by describing health as a ‘’ a state of complete Physical, mental and social well -being and not merely the non – existence of disease or illness’’.

According to Goldsmith(1972), the World Health Organization definition of health has been criticized as being abstract and simple and therefore others such as Siegrist define health as not simply the absence of disease: it is a positive, joyful attitude toward life and a cheerful acknowledgment of the responsibilities that life puts on an individual

Health promotion however has been define by the World Health organization, as a process which enable people to increase control over their own health; this covers a range of social and environmental intervention which is designed to benefit as well as protect individual’s health and quality of life by addressing as well as preventing the root causes of ill health, and not focusing on treatment and cure ( WHO, 2016 )

Health promotion is based on theories regarding what influences people’s health and what effective intervention or strategies are needed to improve health (Naidoo and Willis) The term ‘Health Promotion’ was coined in 1945 by Henry E. Sigerist, a great medical historian, who describe promotion of health, prevention of illness, restoration of the sick and rehabilitation as the four major mission of medicine.(Kumar and Preetha, 2012).

There are two major types of health promotion: the individual health approach and the community health approach. The aim of the individual approach is to improve an individual person’s health ability and therefore the individual is expected to change his or her health behaviour and lifestyle in order to improve health related aspects of the social, cultural, economic, natural and technical environment. The individual approach is centered on clinical intervention tradition such as counselling and face to face education. The second type of health promotion which is the community health approach is concern with improving the socio ecological health potential, which includes the resources of the economic, social, cultural, natural, and technical environments. The community health approach assumes that this factor will have a positive impact on people’s physical conditions, health risks and lifestyles and subsequently on the individual health potential. This approach is centered on the tradition of social medicine and public health. (Measurement in health promotion and protection, 1987)

Health Promotion in Nursing Care (2013) however states three types of health promotion. The first type of health promotion is primary prevention, and this is carried out in the community. The second type of health promotion is secondary prevention and this level of prevention is to catch the disease early in order to reverse the effect and lastly, the third type of health prevention is the tertiary prevention and this is when individual already have the disease and therefore the aim is to slow the development and allow the patient to have the highest quality of life.

KEY ISSUES THAT IMPACT INDIVIDUALS HEALTH

Many factors affect an individual ability to achieve the best possible health and these factors include internal and external influences. This factors can be determined in terms of domains and dimensions which provides a complete approach in nursing practice; and this areas include biological or physiological, psychological, sociological, environmental, sociological, political, spiritual, intellectual, sexual and technological factors ( Health Promotion in nursing, 2012)

According to the WHO, there are also other elements that can affect the health of individuals as well as communities, regardless of people being healthy or not, which is determined by their circumstances and environment. These determinants of health include the social and economic environment, the physical environment, the person’s individual traits and behaviour, income and social status, education, physical environment, social support networks, genetics, health services and gender (who, 2016)

Siphathokuhle (2018) explains Dahlgren and Whitehead model of the determinate of health in four layers.

The first layer according to Sipthathokuhle (2018) shows the personal behaviour of individuals and ways of living that can promote or damage health. Such factors include the choice to smoke or not, individual biology and personal characteristics, such as their age, education, income, and health history. Also, in the first layer individuals are affected by friendship patterns and the norms of their community. Relationships which involves a person’s closest social circle such as friends, partners, family members, all of them influences and contributes to a person behaviour and experiences.

The next layer is an individual’s social and community influences, which provide shared support for members of the community in adverse conditions. But they can also provide negative effect and less support.

The third layer explores the settings in which people have social relationships at schools, workplace, and neighborhood. This layer seeks to identify the characteristics of these settings that affects individual’s health. Structural factors such as housing, working conditions, access to services and provision of vital facilities can also impact an individual’s health significantly.

Lastly, the fourth level looks at the broad societal factors that favor or weaken health.

OBESITY AND ITS IMPACT ON INDIVIDUAL HEALTH

Obesity is a public health problem that has raised concern worldwide. There are about 2.3 billion overweight people aged 15 years and above, and over 700 million obese people worldwide in 2015 according to the World Health Organization (WHO)

Obesity is defined as a condition of abnormal or excess fat collection in a dispose tissue which may impair health. Body mass Index (BMI) is the most useful population level measure of obesity and is used to grade adults as being underweight, overweight, and obese. Obesity and overweight in children and adolescents however are complicated as height is still growing and their body composition overtime changes. BMI percentiles, skinfold thickness and weight for height are therefore used as references and measures (Chan and Woo 2010.

Many factors impact on individual’s health and this leads to overweight or obesity and there are some factors that makes it difficult for individuals to lose weight or avoid regaining the weight that has been lost.

Firstly, a person’s weight is linked to the person’s genes and the family environment. Research suggest that children who have overweight parent have a 80 percent chance of being overweight and therefore a person’s genes plays a role (Earhar ,2010).The chances of me being overweight are greater if one or both my parents are overweight or have obesity.

Race or ethnicity can also lead to obesity or overweight. Some racial and ethnic minority groups are more likely to have obesity. In Ghana and other African countries being overweight is linked to being healthy and those who are slim are seen to be poor and unhealthy. Obesity rates in Adults in America are highest in African Americans, followed by Hispanics or Latinos and then Caucasians. This is also true in men and women (Information et al., 2018).

Furthermore, a person’s age can also lead to obesity or overweight. Adults who have normal BMI starts to gain weight in young adulthood and continues to gain weight till the age of 60 to 65. Also, children who are obese are more likely to become obese as adults.

Eating and physical activity habits also can impact on an individual and this may lead to overweight and obesity. Eating and drinking foods and beverages that are high in calories, sugar, and fat, drinking a lot of beverages that are high in added sugars and spending a lot of time sitting or lying down and having limited physical activity. The current pandemic which has led to majority of people staying at home and having limited physical activity can lead to the rise of obesity. Children and adult are spending more time at home and therefore food sometimes can be used as a means of comfort or a coping mechanism. My kids for instance like to eat sweets, fries and lot of drinks which sometimes have high sugar. Also, because they are not able to go to school, they spend more time on their computers to do online learning and watch kids’ programs.

Again, where you live, work, play and worship can also affect a person’s eating and physical activity habit and access to healthy foods and places to be active. In workplaces where there are vending machines may not offer healthy lower calorie options. In my workplace for instance we have vending machines in all seven floors and there is no close buy food shops and therefore a lot of people at the work place use the mat and in the machines and things that are in the machine are high calorie drinks, biscuits and other high calorie snacks.

[bookmark: _Hlk38653622]Lastly, Family eating and lifestyle habits affects a person health and weight. Some Families may consume foods and beverages that have high fat, salt and added sugars or eat unhealthy foods at family gatherings. During Christmas, my brother and his families gather at our home and vice versa, and we eat a lot of different unhealthy foods as way of celebrating. Families also spends a lot of inactive time watching TV, computers, and mobile device instead of being active. For example, when my husband come back from work, he sits down on his mobile device making calls. (Information et al., 2018)

HEALTH PROMOTION ACTIVITIES FOR OBESITY

Health promotion activities that can be effective to combat obesity includes. Firstly, adult and children can be encouraged to change their eating habits by have a healthy diet through eating more vegetables, salad and fruit and limiting the intake of high fat, sugar foods and drinks.

Secondly, activities can be incorporated into everyday life such as walking, gardening, cycling, swimming and so on. online and TV workout programs can be utilized if movement is restricted such as the current pandemic which people are self-isolating and have been asked to stay home safe life and save the NHS also, employers can also identify ways that can improve food access by ensuring accessibility of safe, affordable and health food choices. According to Public Health England businesses should signpost customers to option which are healthier such as less salt, sugar, saturated fat and calories on menus.

DEPRESSION AND ITS IMPACT ON INDIVIDUAL’S HEALTH

According to the world health organization, Mental health is the basis for the well-being and effective functioning of individuals. It does not only involve the absence of a mental order, rather it is the ability to think, learn and understand a person’s emotions and the reaction of others. Factors such as physical, psychological, social, cultural, spiritual and other elements participate in producing this balance.

Depression, anxiety, personality disorders, panic attacks and so on are all types of mental health problems. Depression is a common mental disorder and more than 264 million people globally from all ages suffer from this mental disorder. (WHO)

According to Mind 2017, depression has been defined as a feeling of low mood that continues for a long period of time and thereby your everyday life is affected. Depression can make a person feel hopeless, sadness, stress, worthless, guilty and exhaustion. My husband was medically discharged in the army when he suffered an injury. He became depressed……

The current pandemic has also brought about monumental change in the lives of people around the world and this has force people such as myself and my family to remain in our homes. People who are living alone and lack social opportunities are at risk of being lonely and this can lead to depression.

Environmental pressure and financial pressure can have a substantial influence on individuals health, and this can lead to depression. The coronavirus epidemic has led to fear and anxiety in peoples mind about themselves, their kids, jobs, finances and future. A lot people have lost their jobs, struggling to combine working from home and helping their kids with home school. This can bring a lot of pressure to families and can lead to depression.

Health promotion activities for Depression

Communication with someone you trust can help when you feel depress. According to public health England, relationships with people you can trust is vital to a person’s mental wellbeing. This can be done by staying in touch with friends or family through video calls or social medial and telephone, I have been able to cope with this pandemic with my family by checking up our extended family and friends.

Public health England has also introduced a new mental health campaign which is called Every Mind Matters and this aims to support everyone to feel more confident in taking action in looking after their mental health and wellbeing through promotion of a wide range of self- care actions. Such as keeping your mind active by reading, playing games, playing and crosswords and so on.

Also, if a person is anxious or stress about work and money whiles being at home, they can talk with their employer about working from home, learning about sick pay and benefits rights. Know about how the Covid outbreaks means to individuals can reduce worry and help people feel more control. According to NHS England, lifestyle measures such as exercise and self-help groups can also help with depression.

The role of nurses to the global health challenge of HIV and AIDS prevention is to deliver care following the Nursing Midwifery Council (NMC) professional code of conduct. It focuses to prioritise people, ensure that people’s health need is recognised, assessed, and provided based on their preferences, goals, and values. Nurses are own a responsibility to recognise, value and celebrate individual cultural differences. They must avoid making an assumption and stereotypes ideals on their thoughts regarding people’s culture, religion and belief (NMC, 2018). Again, Nurses should value the individual human right to privacy, dignity, and choices regardless of their ethical background (NMC, 2018). Nurses must comprehend and demonstrate person-centred cultural competence care and the required skills to facilitates and provide standard quality care to people from the different ethical cultural background using an evidence best practice and be accountable for their action (NMC, 2018). They should reduce health inequalities and promote inequity in health locally and globally by acknowledging the socio-economic, environmental, and behavioural factors that determine people’s health (Quinn & Kuumar, 2014). The nurse also role extended to other specialities such as GP’s, local clinics, hospitals and communities’ settings. They work together with other health care professionals to examine and establish an evidence-based approach that connects communities tackling local and global health challenges

Nurses also play an important role in relates to health promotion interventions. According to WHO Ottawa Charter (1986 ), Health promotion is a process that enables an individual to have control over their health and achieve the best result. The role of nurses in health promotion is globally connected with the Sustainable Development Goals (SDGs) because it consolidates policies and initiatives that improve the access to obtain healthy choices, enable people to make an informed decision and promote healthy communities (WHO, 2018; Kumar & Preetha, 2012). There are five approaches to health promotion. Thus, the behavioural approach is an effective method of HIV prevention because it enables people to change their behaviour and adopt a healthier lifestyle after going through different stages of change model (Prochaska & Diclemente, 1984). The change model utilises multi-structural intervention such as the use of condoms, contraceptives for PMTCT, counselling and providing ART for HIV prevention (Rebecca et al, 2014). The different stages of change also known as the Transtheoretical model are as follows:

The pre-contemplation stage is when people are unaware of risk factors of HIV transmission and has not considered changing their behaviour. Then the contemplation stage, the individual is aware of their behaviour but still feel reluctant to change. Thirdly, the Determination stage is when an individual is trying to change their behaviour because of their belief. Afterwards, the Action Stage, the individual has initiated a change in their behaviour and intend to continue. Lastly, the maintenance stage is when Individual is making progress in their new behaviour and are working hard to prevent a setback. The transtheoretical model supplies the recommended plan of action for public health interventions used to address people at different stages of the decision-making process. However, it does not consider the individual social-economic situation that contributes to a change (Wayre & LaMorte, 2019).

The role of nurses to the stages of change model is to build patients to nurse relationship by showing empathy and compassion, assess an individual’s capacity and create awareness on sex education, use of a condom, contraceptives to prevent unwanted pregnancy and PMTCT. Also, nurses are expected to motivate and support the individual on the need to change their behaviour this could be face to face and telephone appointment, establish an action plan on physical examination, HIV testing and baseline blood test to prevent further transmission. When a diagnosis is made nurses should commence immediate treatment of ART to patients, administer ARV drug, provide emotional support and promote ART mostly patients on pregnant mother from their first antenatal check for PMTCT and them to disclose sexual status to their partners. Consequently, there is no cure for HIV infection. Hence, ARV drugs are effective to increase 30% uptake of ART control 26% of viral load suppression in the body, minimise transmission so that individual will live longer (HIV.ORG, 2020; Rosen et al., 2016).

HIV and AIDs is a global challenge that has no cure. However, several treatments have been implemented globally through policies, initiatives and health promotion approach to improving the health and well-being of those infected. To achieve the UNAIDS 90-90-90 Fast- Track- Target, every country must ensure that different strategies put in place are functioning effectively without being against a certain group of people. Again, using a multisectoral sufficient funded relevant evidence-based health promotion programme that will address health inequalities and prompt inequity in health is highly recommended to achieve a positive result. Nurses are demanded to always practice following the professional code of conduct to deliver cultural competence standards care. A failure to comply to above mention the UNAIDS target will not be achieved by 2030.

Mental illnesses continue to affect thousands of lives and communities globally but access and equity are the compromise. Australia’s access and equity policies were implemented to enable all Australians to access affordable, quality, and appropriate medical care. Equitable health is a fundamental human right; therefore, it should be available to all. Cumulative realization of healthcare inequity enables the elimination of unfair allocation of resources often resulting from disease and disability variations that hinder the course of planning and well-being (Breslow, 1972). This study focuses on the inequality that is prevalent in accessing standard healthcare, particularly among those living with mental illnesses.

Numerous media reports indicate a belief that inadequate physician access and equity are mainly affecting Australians living in regional and rural areas. The distribution of healthcare resources in remote areas is affected by poor infrastructure, specifically, distance and transportation which limits the receipt of healthcare(Branche, 1991). The fact is not surprising as Australia continues to rely on postcodes as a determinant of patient’s wait to receive medical attention(Australian Institute of Health and Welfare,2016). Nevertheless, according to Corscadden et al. (2016), the most contributing matter of causation originates from the general cost-efficacy and equity of mental healthcare systems and mental health sequels.

Australia has one of the best healthcare systems in the world with the Medicare Benefits Scheme providing subsidized costs for mental healthcare treatments, which allows patients who have obtained a treatment plan to receive free healthcare, at least up to ten sessions a year(Gorman & Brooks,2009). However, the extended long queues to obtain a mental health plan to receive free treatment become less of a priority for patients due to frustration and loss of hope, which is worsened by the scarcity of rural medical professionals(Department of Human Services, 2019).

Nevertheless, the shortage of mental health practitioners in areas of need is not only unique to Australia. The World Health Organisation[WHO] reported a healthcare shortage estimate of over 4 million globally(Gorman & Brooks,2009). Australia continues to recruit foreign doctors who are paid competitive pay packages to fill the medical shortage in rural areas. However, there are not enough doctors specializing in mental health in addition doctors do not prefer to practice in economically deprived regions. Yet, nearly 90% of the world’s population including Australia is still reported to reside in poverty-stricken areas where education is inaccessible, feeding is a problem and infrastructure is alarming( Chen & Ravallion, 2007). With a multitude of evidence-based literature linking poverty to worsened mental health, it would then be convinced that there remains a barrier for people living in socioeconomically deprived regions to access healthcare services and resources, thus contributing to healthcare inequity.

Furthermore, the lack of mental health education and awareness, as well as the poor mental health structure, are factors that also explain why there is compromised healthcare access and service inequity. People living with mental health illnesses are still streamlined. Many lack education and are not in employment either. This group accounts for more than half of homes in rural settlements and is in the very low-income quintiles (AIHW,2006). If food costs and necessary costs are about 10% higher than those in urban and regional areas, then this would suggest that patients are inclined to choose to spend on basic needs over health care.

Also, a significant proportion of the population avoids seeking treatment for mental illnesses due to the associated social stigma, and discrimination, which increases treatment avoidance, restricts health self-disclosure, worsens mental illnesses, and imposes a burden on the healthcare sector( Rouufiel & Lipzker, 2007). Poor mental health stigma and false stereotyping of people living in regional and rural areas are the main disincentives to healthcare access. Everyone seems to know everyone in smaller communities which causes people to hold on to information in fear of confidentiality breach. It is this shared belief that causes people to decide against seeing support, thereby missing out on available services and resources(Australian Psychology Society, 2019)

To conclude access and equity, the combination of factors already discussed, are what contribute to healthcare exclusion in the healthcare system, thus empowering healthcare inequity. However, a clear understanding of the presenting problems can enable preventative measures to reduce care exclusion (Currie et al. 2014).

Besides healthcare access, other factors such as psychiatry medications are medically reported as the leading cause of poor diet and nutrition which will be discussed herein, and the development of other biological illnesses. This interrelation is one that severely contributes to poor physical health in patients living with psychiatric illnesses(Jahoda, 1958).

Many patients diagnosed with mental disorders are prescribed antipsychotics, antidepressants, and anticonvulsants for extended periods of time. Intake of antipsychotics particularly triggers physical illnesses such as parkinsonism, elevated diastolic blood pressure, and diabetes. Worse still, antipsychotics affect gut bacteria thereby causing eating disorders, obesity, and in some cases behavioral concerns( de Kuijper et al, 2013). Often these individuals end up in supported accommodations, have restricted movements, and do not function instrumentally as they once did. No doubt, the long-term side effects of antipsychotics are detrimental to well-being.

On another hand, abuse and neglect is a determinant of poor biological health. A good percentage of mental health patients are physically, sexually, and financially abused by members of the public and their families. There remains a potential for victims to acquire sexually transmitted diseases, live a life of grief and trauma, divorce and separation, and poverty among other effects. In the absence of psychosocial support, patients’ mental and physical health is set to worsen due to the choice of unhealthy coping mechanisms such as self-harm, substance use, gambling, and prostitution(Currie et al. 2014).

Preventative medicine can not stress enough about the benefits of staying active on mental health. Depression, anxiety, and stress all left untreated can impact physical health, therefore, it is vital to take care of mental health as one would take of their physical health. Studies have reported exercises to improve general patient mood thus reducing symptoms such as depression and anxiety. Physical activity acts by increasing energy levels, improving the quality of sleep, and reducing stress (Kovandžić et al. 2011). Furthermore, according to Anderson, Danziger & Kalil (2000), patients who are undergoing psychiatric treatments have registered an improvement in memory, concentration, and general cognitive function. Others reported improved self-esteem and reduced social withdrawal by engaging in physical therapy.

Secondly, food and nutrition are equally central to a healthy body and mind as they are related to metabolism, appetite, culture, and behaviors which are factors, which control our physical and mental well-being. Through various studies into the complex nature of diet and mental health, researchers have suggested that nutrition could potentially treat mental health, hence the introduction of nutritional psychiatry ( Rucklidge & Kaplan, 2016).

Diagnoses for depression, anxiety, attention deficit-hyperactivity disorders, and obesity are increasing and have all been associated with poor nutrition. Studies have in fact shown that a higher intake of foods such as fruits, fish, and whole grain, for example, reduces the risk of developing depression, while other researchers have attached food to growth, increase in energy levels, hormonal regulation, stress management and improved sleep and general mood ( Treasure & Williams, 2004). However, it should be noted that to benefit from diet and nutrition, patients need to adhere to set dietary and nutritional requirements.

Pharmaceutical treatments for the mentally ill play a vital role in the treatment of recurring disorders. The main indication of antipsychotics is to reduce symptoms and prevent relapses associated with psychiatric disorders. However, these should be prescribed by licensed medical practitioners if there are no other alternative solutions for treatment (Currie et al. 2014).

Patients with mental illnesses are at risk of reduced life expectancy as well as poor physical health when compared to other people. Mental illnesses are often associated with a variety of inequalities. They are usually a result of demographic changes, social and economic differences, and geological factors. As evidence, health inequalities lead to reduced life quality, deprived health outcomes, and early mortality rates in patients, consequently, lack of equity in the distribution of health’s social determinants which affects the equity of mental healthcare (Kovandžić et al. 2011).

Statistics show that there is an increase in psychosis in the homeless and low-income households as compared to the general population. Stable employment with good earnings is vital for the recovery from mental illness, but the patients face challenges in gaining and maintaining employment, which is often associated with stigma and a negative attitude from colleagues and society.

Mentally ill patients also suffer from physical health inequalities. According to estimates, two in three deaths of severely mentally ill patients result from preventable physical illnesses like cardiovascular disease. A high rate of suicide in mentally ill patients is standard, at is a leading cause of death for psychosis. Therefore, factors related to psychotic symptoms include lifestyle factors, physical inactivity, underweight, and alcohol intake (Deans, 2017).

Mentally ill patients suffer from compromised physical health. They are vulnerable to physical health problems due to a lack of accessibility to appropriate healthcare due to overlooking their needs and wants. Behavioral factors including but not limited to drug and substance abuse (alcohol and smoking), poor dietary concerns, inadequate living situations, and poor self-care also affect people’s mental health. Social factors linked to mental health vary from social class and poverty (lower class members in the society and the unemployed are likely to suffer from mental illnesses). Other factors include social inclusion and exclusion and inequality in healthcare provision (Langley‐Evans, 2015). Physical factors affecting mental health are friendships and associations with family, friends, and co-workers, state of the environment, income and educational levels, as well as genetics and access to and the use of affordable and quality healthcare. Poor physical health increases the development of mental health problems and vice versa. Studies show that severe mental illness is associated with health diseases like cardiovascular disease; depression and anxiety go hand-in-hand with cancer mortality rates (Langley‐Evans, 2015). There is a connection between diabetes and depression as patients with both illnesses experience severe symptoms than those who have diabetes. These studies show the inter-relationship between mental and physical diseases and the need for the integration of mental health in the treatment of other medical conditions. Statistics show that mentally ill patients are prone to problems like high blood pressure, high levels of cholesterol, high levels of glucose, and weight gain, especially around the midriff, which mostly leads to heart diseases and diabetes. Therefore, it is crucial to have a regular health check when visiting a doctor or psychiatrist to rule out any illnesses and before starting any medication (Reyes et al. 2018).

For positive mental health, physical activity is essential as it helps with the management of stress and anxiety alongside the control of intrusive and racing thoughts. Physical activity is a positive strategy for coping with difficult times. After physical activity, the body releases feel-good hormones that trigger happier moods, which make one feel better as well as have a robust bout of energy (De Hert et al. 2011). One feels tired after a physical session, which translates to better sleep. Therefore physical activity pushes away lethargic feelings, and depression and promotes the feeling of being content with oneself. Previous studies show that there is a link between diet and mental wellness. An improved diet based on fresh and whole foods (enriched with nutrients) improves symptoms of mental illness and helps in the reduction of depression and anxiety.

Lastly, there is no overstating of the importance of mental health. Concerns for mental health lead to mental illnesses when they affect one’s ability to function correctly and cause stress. Mental illnesses make patients miserable and affect their ability to have healthy relationships with other people. Psychotherapy, medication, nutritional therapy, and regular exercise help manage the symptoms of mental illness. Psychosis is the leading cause of disability. Lack of treatment affects the emotional, physical, and behavioral health of patients, which may be fatal in the long run (Reyes et al. 2018). It is also significant to point out that equity in healthcare is imperative to everyone since it is a fundamental human right.

On the other hand, a spectrum of individuals and patients do not have adequate financial resources that can help them to seek the necessary support and help which leads to inconsistent and inadequate mental healthcare and other essential services. Besides, the value of medical expenses typically occurs due to the need for regular therapy, complicated medication management, and intensive treatment plans. In this regard, the insufficiency scenarios lead to mental health professionals that in the long run, facilitate to lack of healthcare equity of access to quality healthcare as anticipated by the industry.

References

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Introduction

Health Promotion is a rapidly growing field that has a wide variety of definitions. Above all these definitions, I like the one by (Kumar and Pretha., 2012) which adduces to the fact that health and well-being are determined by many factories outside the health system. They went further to list the following as factors that determine health, socioeconomic conditions, patterns of consumption associated with food and communication, demographic patterns, learning environments, family patterns, the cultural and social fabric of societies; sociopolitical and economic changes, including commercialization and trade and global environmental change. (Kumar and Pretha., 2012). They further posit that health promotion essentially involves enabling individuals to take control over their health and the factors that determine their health, (Kumar and Pretha., 2012). in their definitions, they acknowledge the importance of lifestyle and environmental adaptations to promote health and well-being.

Key terms, Concepts, and Strategies of health promotion.

Health Promotion emerged in Canada after 1974 when it became obvious that health education did not have the desired effect to produce a healthier population. Several milestones were reached post-1974 leading to the eventual formation of health promotion Canada in 2016. Modern-day health promotion has evolved and now has many key concepts and unique features which include a holistic view of health and a focus on a participatory approach, there are also key health promotion values which include empowerment, social justice and equity, inclusion and respect. Other unique features include a focus on social determinants of health, building in strength and assets and using multiple complementary strategies to promote health. There are also key health promotion concepts such as understanding health inequities patterns and understanding unconscious bias, it is important to fully comprehend these concepts to have a robust perspective on health promotion.

A student health issue to be used for the purpose is the risky health behavior of decreased physical activity or physical inactivity in University students leading to risk for Ischemic heart disease, stroke, type 2 diabetes, osteoporosis and so many other chronic non-communicable illness (Plotnikoff et al,. 2015). Currently, there are about 1.3 million students in Canadian Universities representing about 5% of the total population. There is established research that suggests that students living on the campus are less likely to be active and thus may be at risk of poorer health. (Irwin., 2004). Irwin further suggests that more than one-half of University students in the United Dates and Canada are not active enough to gain health benefits. (Irwin., 2004). According to data collected from an experiment to measure the prevalence of health risk behavior among Canadian post-secondary students where Data from over 8,000 Canadian university students were collected and analyzed, it was revealed that the prevalence rate for physical inactivity stands at 72.2% which starts up the risk for atherosclerosis, obesity and diabetes in the second and third decades of the student’s life. It is however dangerous to note that the students do not even associate this health-risk behavior of physical inactivity to such diseases (Kwan et al., 2013). The researchers further posit the need for concentrated health promotion campaigns as one of the solutions to the identified health issue. (Kwan et al., 2013). Physical inactivity remains a major cause of chronic disease and it is a major public health concern in Canada. (Yun et al., 2018). All the research is done and the data available point to targeted health promotion as a strategy for solving the health issue. According to (Bonevski et al., 2014) in a survey assessing health risky behaviors in students of tertiary institutions, the results show a prevalence rate of 88% for physical inactivity. They also posit that strategies to promote physical activity have become an important public health approach for the prevention of chronic disease (Boveski et al., 2014).

Health promotion strategy review, program planning, and evaluation

While it is an established fact that physical inactivity among University students is a public health concern leading to an increased risk of a wide variety of chronic illness, incommunicable diseases and morbid sates, the overwhelming prevalence of physical inactivity and the lack of awareness or even acknowledgment by the affected population of the potential ills of physical inactivity make it more worrisome. It is also an established fact that the use of targeted intervention and health promotion strategies to solving health issues allows for efficient and measurable outcomes and the social cognitive theory has been identified as an adequate health promotion strategy to combat this health issue.

When a health promotion intervention has been identified as the solution to a named health issue, it is important to implement health planning and evaluation methods in the design of such programs, according to (Fernandez et al., 2019) Evidence-informed health intervention planning that incorporates theoretical and empirical evidence and engages key stakeholders and community members or patients in the planning process results in interventions that are more effective. Program planning and evaluation involve assessing the needs, setting goals and objectives, developing an intervention, implementing the intervention, and evaluating the results. (King and Hartson., 2020)

The Social cognitive theory is the health promotion strategy that has been found to be used in the intervention programs that address this health issue. The Social cognitive theory is quite apt as it describes the influence of individual experiences, the actions of others, and environmental factors on individual health behaviors. (Rural Health Information Hub., 2021). This health promotion theory provides opportunities for social support through instilling expectations, and self-efficacy and using observational learning and other reinforcements to achieve behavior change. (Rural Health Information Hub., 2021) In this case when the social cognitive theory is applied, University students change their attitude to physical activity. Knowledge of health risks perceived self-efficacy, outcome expectations, health goals and perceived social and structural facilitators are core determinants of effective health practices. (Bandura., 2004).

Summary of Findings and government strategies

This experiment was a 12-week intervention to induce the health-promoting behavior of physical activity in University students based on the social cognitive theory. Their physical activity pre and post-test levels were measured and it was discovered that there was a significant shift from baseline level even for a wide variety of health-promoting behavior including nutrition behavior, health responsibility, social support, exercise behavior, stress management and overall health-promoting behavior which justified the effectiveness of the social cognitive theory-based approach to the health intervention. (Ince., 2008). The results observed support earlier studies indicating the impact of a social cognitive theory in predicting and guiding health-promoting behaviors (Ince., 2008).

As knowledge of health promotion increases, there have been various public health interventions by the government which use specific health promotion programs to design health intervention programs in a bid to address public health programs, these include the five strategies set out in the Ottawa charter for health promotion which is listed here: build healthy public policy, create supportive environments, strengthen community action, develop personal skills, reorient health services. Other government strategies aimed at effective health promotion programs include Alcohol and Substance Abuse Prevention, Heart Health, Tobacco Use Reduction, Promoting Physical Activity, Protecting Children, and Nutrition. These health promotion programs have different health promotion theories and sometimes a blend of health promotion theories and strategies used in its execution to facilitate maximum beneficial results.

Conclusion

For all the literature reviewed, there seems to be no doubt as to the impact of designing a health intervention around a fitting health promotion theory for maximum success. The inclusion of a well-understood health promotion strategy in the design process appears to make the program well targeted, well received by the audience, allows for a specific measurable outcome, and provides desired reinforcement to achieve the desired health behavior change.

Discussion

The current study was designed to assess the knowledge, attitudes, and skills among primary healthcare workers in health promotional settings and to determine the managerial interventions needed in health promotional settings in the Kalutara RDHS division.

The knowledge among 70% (215) of the study participants of this study were categorized as ‘poor’ and only 30% (92) of study participants were identified as having ‘good’ knowledge according to the scoring system. According to the self-assessed level of knowledge on health promotional settings, 87.8% (257) of primary health care workers declared that they had ‘good’ knowledge of healthy settings. This difference in the self-assessed level of knowledge and calculated value suggested that most primary health care workers can’t identify their level of actual knowledge on health promotion settings accurately. This wrong perception may prevent them being participating in training programs. A study conducted among PHMM in Kandy District revealed that 65.4% of PHMM had ‘poor’ knowledge on health promotion (16).

The highest achieved educational level (P ± 0.012) and ability to read English (P ± 0.021) were the background characteristics that were significantly associated with knowledge on health promotion settings. The basic qualification to enter PHMM training changed from GCE OL to GCE AL during the last decade. The significant association may be due to recently passed out PHMMs were trained in health promotion during their basic training which can have a confounding effect on the level of knowledge on health promotion. There were no books on health promotion written in either Sinhala or Tamil languages. Therefore, the ability to read English might have helped the primary health care workers to improve their knowledge. Whether or not residing in their field (P ± 0.962) area was not significantly associated with knowledge on health promotion settings. Perera (16) in his study conducted in the Kandy district had found that the highest achieved educational level, ability to access the internet, and ability to read English were significantly associated with knowledge on health promotion.

The year of qualifying as a PHM, the year 2004 or after was not significantly associated with knowledge of health promotion settings (P ± 0.061), or not they obtained basic PHM training from Colombo NTS or other centers was not significantly associated with knowledge on health promotion settings (P ± 0.881). This finding indicated that the PHMM who were trained on health promotion had a similar level of knowledge and probably that the quality of training on health promotion was not differing to in larger extent between training centers. The PHMM who had public health work experience of fewer than five years had a good level of knowledge compared to those who had public health experience of more than five years (P ± 0.002). These results may be due to the confounding effect of recently passed-out PHMMs being trained recently in health promotion during their basic training. Perera (16) explained that the qualifying year as a PHM, the year 2004 or before significantly associated with knowledge on health promotion.

A decade after the introduction of health promotion to the curriculum of primary health care workers in Sri Lanka and conducting the larger number of training programs, knowledge in health promotion was not satisfactory. This fact raised the question about the quality of training in health promotion and that should be taken into serious consideration.

The level of attitudes among primary healthcare workers in developing health promotion settings was good (69.4%, 204) which is in line with the findings of other international research. Peltzer (8) researching South African primary care nurses and midwives found that 63.3% of them were good in attitudes. In another study, the majority of them expressed positive attitudes about health promotion as a core aspect of primary care (9). According to the study conducted by Geensi et al (17) attitudes of primary care nurses toward health promotion were rated as good.

During my second student nurse community placement, I was caring for a 63-year elderly of Caribbean descent with a history of smoking addiction. For confidentiality to be upheld in accordance with the Nursing and Midwifery Council ‘The Code’ (NMC 2018), the patient has been given the pseudonym of Mr. Smith. He lived in a very cluttered terrace house in a poor condition which left him vulnerable, as he disclosed that the amount of money, he received from his pension could not accommodate the required renovations. Mr. Smith had recently undergone abdominal surgery and was transferred to the coronary care unit, for treatment following a minor myocardial infarction and was receiving administration of morphine to keep him comfortable. As a student nurse, and working under the supervision of my assessor, I was requested to calculate his body mass index. As well as recording a score as 32.6 kg/m2, which meant that he was classified as overweight, and his blood pressure was recorded at a steady 140/84mmHg. Mr. Smith disclosed that he had always been a heavy smoker, smoking around twenty cigarettes a day since the age of twenty. Through the assessment, it became obvious that smoking was affecting his family life negatively as his daughter refused to let him spend time with his grandchild. As a result of this, Mr. Smith revealed that he was motivated to change, however as he had attempted unsuccessfully to quit several times. However, he believed that with the support of the Multi-Disciplinary Team (MDT) he could stop. I informed my practice assessor and she decided to give Mr. Smith more information about smoking services because he had chosen not to do so independently. This included the National Health Service (NHS) applications and the stop smoking websites, which aims to provide equal support to patients using a variety of different methods. A decision was made by the nurse and suggested to Mr. Smith that, he would work in partnership with the MDT towards enabling this goal to happen. My assessor further made a referral to the local NHS stop smoking service for Mr. Smith and explained the positive impacts that smoking cessation would have on his health.

This essay incorporates a health promotion scenario I was involved in during practice. The essay will critically analyze and discuss the actions and roles of a nurse in health promotion. It will also intend to explore some relevant definitions of health, health promotion, and the lay perception of health. The essay will further explain the awareness and skills nurses are required when promoting the health of service users. The nurse aimed to focus on the autonomy model in promoting health. The scenario to this essay would be centered on the empowerment and educational approach to health promotion. It will also link and identify social determinants and the influence it had on the patient.

In order to understand this essay, one must first understand the terms related to health promotion. In the context of nursing practice, autonomy is vital as it is central to person-centered care. Flinch (2019) highlights autonomy as worthy of respect which relates to being human, thus autonomy incorporates the individual using health services to be involved in making informed decisions about the treatment and care he or she receives. In health promotion, empowerment is defined by Green et al (2019) as a procedure whereby individuals have greater self-control over actions and decisions regarding their health. Benbow et al (2019) emphasize that empowering people enables them to obtain knowledge, attitudes and skills to have control of their lives and adapt to the changing world and their life conditions.

Lundberg et al (2017) state that health is an integral part of a practitioner’s job role. The World Health Organisation (WHO 1948) defines health as a condition of whole physical, mental and social well-being and not simply the absence of infirmity and disease. Although, health can be understood inversely by some lay people as a person’s perspective of well-being centered on their daily experience of their body (Blaxter 2010). Polan and Taylor (2019) delineated health promotion as enabling service users to gain control of their health needs and being able to empower them to identify parts of their health that are most essential to them (Naidoo and Wills 2016). WHO (1948) further explains health promotion as the procedure designed of empowering people to increase and have greater control over their well-being and its determinants. Katz et al (2020) proposed that, health promotion is the skill of supporting individuals to alter their lifestyles to progress toward optimal health. The emphasis of this explanation is lifestyle and behavior because individuals only take action when their behaviors change, then they improve their health. This definition correlated to Mr. smith as it may be the reason why he decided to stop smoking, as his daughter refused him to spend time with his grandchild. Notably, it could be that, he was unsuccessful to quit smoking when his daughter banned him from seeing his grandchild. In contrast, if he had the chance to see his grandchild could motivate him to alter his behavior by successfully quitting smoking.

The concept of health promotion focuses on social, socioeconomic and environmental determinants of health which contains the narrower thought of health education (Linsley et al 2011). Health education includes providing individuals and their communities with the understanding and awareness to achieve better health. Added to the above, health promotion aims to enable people and communities to advance the skills and abilities they need to obtain to have control over everyday life conditions (WHO 2016). Therefore, health education pursues to motivate people to accept a method of behavioral change by directly impacting their beliefs and morals to enable them to achieve their potential (Dixey 2012). Notwithstanding of which definition of nursing is used, we see that health is the fundamental concept and that health promotion is a key element of nursing practice. Naidoo and Wills (2016) suggested that, nurses promote the health of people, communities and their families by educating the needed lifestyle modifications and advocating for the conditions that encourage health. This paragraph relates to Mr. Smith’s scenario and helps to understand that, educating individuals about their lifestyle conditions such as smoking can have a positive impact on patients’ values, hence encouraging them through education to enhance the skills needed for a healthy lifestyle.

WHO (1986) identified three important roles that nurses could use to develop health-promoting skills. They introduced what they called ‘advocating’, ‘enabling’, and ‘meditating’. The advocating skill relates to standing up for the desires and wants of patients and endeavoring to deliver a healthy atmosphere, by involving patients’ social upbringing or economic situations (Choi 2015). They also recognized enabling, a view providing patients with what they need to be successful by focusing at ensuring that, patients have access to resources equally by utilising a mixture of dissimilar health approaches which permit patients to follow their elite health (Hubley and Copperman 2018). This was evident when Mr. Smith was signposted to the NHS applications and through the booking referral by the nurse to the local NHS stop smoking service, which tracks development and suggests specialized advice using websites and applications (Public Health England (PHE 2016). This may have further enhanced Mr. Smith’s success with his smoking addiction as he had tried several times, however, had been unsuccessful. On the other hand, it could be that, accessing local cessation may be difficult due to a lack of motivation and knowledge as he was not reluctant to do so independently. Finally, mediating focuses on knowledge for health promotion to be positive, it needs the support of the government and other healthcare sectors (WHO 1986).

In the scenario, a positive professional relationship was demonstrated with Mr. Smith. This was done by actively listening to him to build up a rapport to establish trust and maintain a social bond. Undeniably, Deville-Almond (2013) discovered that creating a relationship with a patient could be an effective means for nurses to facilitate health promotion. Notably, trust is essential in health promotion thereby influencing the service users to experience overall (Hemmingway et al 2012). Furthermore, Stickley (2011) reports that listening is one of the most significant humane actions for healthcare professionals in health promotion. This was evident when the patient felt confident and empowered to express his needs and share information concerning his smoking addiction. This is further supported by Kitson et al (2013) who deduced that listening to patients can enhance effective health promotion and build relationships between nurses and patients. They also suggested that without listening, positive health promotion cannot be achieved to promote health efficiently. Therefore, the fact that time was spent to listen to the patient’s response demonstrates active listening and communication skills which are required to effectively promote health and wellbeing. This may be accredited to sufficient self-awareness because health promoters who have emotional intelligence and self-awareness regularly appear sensitive to the patient’s condition (Curtis 2014).

The aspect of health promotion the nurse sought to promote in Mr. Smith’s scenario was focused on autonomy. In recent literature, the partnership remains prevalent (Gregory et al 2018). The objective of the partnership is to ensure that service users views and opinions should be contributed concerning their healthcare. This applies directly to Mr. Smith as he expresses his own wishes and thoughts surrounding his aims around smoking cessation, thus improving his own locus of control. For instance, Mr. Smith was given excess information about smoking services to help him with health-promoting ideas as he had decided not to do so autonomously. Adult learners are particularly unresponsive to learning health promotion approaches that are not perceived for them. However, using small bite-sized pieces of knowledge is likely to be understood rather than overloaded information.

Todres et al (2009) expressed that, patients’ autonomy should be strengthened by nurses through sharing the responsibility for decisions to patients and acknowledging them to have a better choice. However, there will always be circumstances where this may be impossible. For instance, though accessible to health promotion advice and support, Mr. Smith had a prolonged record of repetitively trying to quit smoking without success. Varley and Murfin (2014) also stated that, service users should only be approached on occasions when they are receptive and prepared to amend, and that nurses should not impose their own recommendations of change onto service users (PHE 2016). Evidence suggests that patients want health information, but some have a problem in understanding and memorizing what they have been told by their nurse or other MDT. Evidently, McNaughton and Shucksmith (2015) suggested that checking understanding by asking the patient to repeat what was been expressed could promote health promotion. Complications that prevent understanding and action on health information include literacy, culture, language, age and physiological barriers (Beagley 2011). Patients who feel unhappy with the communications aspect of their encounters with health professionals may be unwilling to ask for more information and or may not conform with the advice and treatment prescribed for them (McNaughton and Shucksmith 2015).

Looking at the nurse’s role in health promotion, Mr. Smith was given advice in relation to smoking cessation, this could be perceived as an encouraging concept with the availability of information together with referral support, Mr. Smith is then capable to make an informed decision, thereby establishing empowerment and an aspect of self-control. Chen and Thomas (2016) proposed that empowerment is established when detailed information and well-informed advice is provided, as a result supporting the growth of self-esteem and personal skills. Castledine (2013) recommends that, the approach of an effective health promoter is to motivate people to aid them to make better choices; this involves the knowledge of participating individuals at all aspects completely. On the contrary, it is unlikely to succeed in health promotion when individuals are not motivated (Naidoo and Wills 2016).

Empowerment has been well explained by many specialists through the years as giving service users control over their personal behavioral change (Prochaska et al 2015, Yeh et al 2018). In health promotion, the use of empowerment has been stimulated to give individual autonomy. By allowing an individual to have some accountability, they advance in education and skills linking to their personal health (Powers et al 2012). Notwithstanding this, the use of empowerment has been criticized in health promotion. England (2012) argued that the empowerment approach is time-consuming in health promotion and as a result could cost the health service. Although government funds may build up if extra time with service users are not spent and they are not empowered, this could have a small positive influence for Mr. Smith, directly opposing the goals of health promotion. There is a possibility that service users, such as Mr. Smith, who are not empowered to improve their health behaviors will progress more lifestyle-correlated difficulties, consequently escalating the weight on health promoters. These ideas are directly applicable to Mr. Smith’s care as the nurse was determined to support him to be in charge of his own health. However, Mr. Smith was provided with a considerable amount of time by explaining research-based information about the effects of smoking on his health centered on education and knowledge. Relatively, he was signposted to other important information but instead tried to motivate Mr. Smith to be the advocate for his personal health. Although, if Mr. Smith had been instantly supported with extra information, he would possibly have been more successful in making decisions that were best suited for him rather than deciding his needs.

‘Making Every Contact Count’ well-known as (MECC) is a current standard viewed as an ultimate structure for health promoters to promote health (PHE 2016). MECC is related to the approach of empowerment and is outlined as health and social care experts being self-assured to empower an individual to amend their health behaviors by providing healthy lifestyle information (PHE 2016). MECC is relevant in health promotion as it is fundamentally about prevention and focuses on helping people live heathier longer lives by decreasing the effect of long-term disorders that can result from lifestyle habits and behaviors (Chisholm et al 2018). Nevertheless, MECC has been established as the perfect model for promoting health. In nursing, it is not simple for all health workers to adopt MECC in addition to their usual busy working responsibility and workloads. The use of MECC has some limitations. Nelson et al (2013) discovered that one of the obstacles to its achievement is clinicians’ perspective that involving this model would upsurge workload. Despite its barriers, MECC as a method of promoting health has been acclaimed as being a constructive and valuable method (Chisholm et al 2018). Believably, understanding and knowledge of MECC still require an increase. A survey by Keyworth et al (2018) report that, about 41% of practitioners and health professionals acknowledged the MECC consensus report.

The nurse utilized an educational approach in promoting health when providing knowledge and information to Mr. Smith, in this case, this is an example of Mr. Smith making informed choices about his own care (Naidoo and Wills 2016). According to Prochaska et al (2015), there is the possibility that in using such a method, Mr. Smith would be motivated further in wanting to change his behavior. Hinchliff (2009) recommended that placing a service user in an optimal learning environment builds a trusting rapport with the health promoter. In Mr. Smith’s case, this meant that he would have felt more capable to express himself as he felt safe psychologically.