Older People - Health Promotion and Public Health

Original Editor - Bhanu Ramaswamy as part of the AGILE Project.

Top Contributors - Bhanu Ramaswamy and Evan Thomas  

Health Promotion and Public Health

As physiotherapists, we can influence people of all ages to increase their physical activity levels plus educate them to improve their general state of health and well-being.

The Chartered Society of Physiotherapy defines physiotherapy as a healthcare profession concerned with human function and movement, maximising a person’s potential. By identifying factors that affect movement, physiotherapists can manage / improve a condition through approaches including health promotion, preventative advice, treatment and rehabilitation. 

The World Health Organization (WHO) is the mandated leader in global health; they provide the following definitions to terms related to health.

Good Practice

It is worth knowing the defitions that seperate terms often used in health promotion and public health.

Health as defined in the WHO constitution of 1948:
A state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity.
Health is a resource for everyday life, not the object of living. It is a positive concept emphasizing social and personal resources as well as physical capabilities.
Health promotion
The process of enabling people to increase control over, and to improve their health.
Health promotion is the practical applicability of health, expressed as a resource to permits people to lead an individually, socially and economically productive life.
Public Health:
The science and art of promoting health, preventing disease, and prolonging life through the organised efforts of society.
To ensure health and health equity a country requires an empowered public sector, must utilise principles of justice, participation, and collaboration. Actions include: policy coherence across government; strengthening action for equity and finance; and measurement, evaluation, and training  

Between 2005 and 2008, a Commission on Social Determinants of Health was established to collate and publish a report in response to increasing concern about persisting and widening inequalities in social determinants of health globally.

The social determinants of health are described as the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequalities - the unfair and avoidable differences in health status seen within and between countries.

The three main recommendations advocate:

  1. Ways to improve daily living conditions
  2. Tackle the inequitable distribution of power, money, and resources
  3. Measure and understand the problem and assess the impact of action

The Commission strongly advocated the central role of government and the public sector in taking action, but recognised the need for support and action across multiple agencies such as global institutions, national and local governments, civil society, research and academic communities, and the private sector.

Thus far two problems have been identified when considering health promotional issues:

  1. Lack of evidence of their effectiveness. Whilst we observe daily improvements in health-related technology and in our increasing life expectancy rates, we are developing increasing chronic illnesses
  2. Many of these illnesses e.g. heart disease, diabetes, alcoholism and drug abuse, or obesity are preventable, yet many within a population do not choose options that promote a healthy lifestyle.

Further Reading

1. The following article provides some perspective into why health promotion is such a difficult issue to enforce: Pearce N (1996). Traditional Epidemiology, Modern Epidemiology, and Public Health. Am J Public Health; 86; 678 - 683 at http://ajph.aphapublications.org/cgi/reprint/86/5/678. Whist it may appear an old article, the issues raised have not been resolved and the message is still valid over a decade later.

2. WHO’s report on the Global burden of disease (2004). The report provides a comprehensive assessment of the health of the world’s population with estimates of premature mortality, disability and loss of health. Accessed at: http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html

Useful resource and web-link. 

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