Health promotion

Vickie Knight: Sydney Sexual Health Centre and The Kirby Institute UNSW
Gemma Hartmann: Eurobodalla Shire Sexual Health Service, NSW
Elizabeth Crock: Royal District Nursing Service HIV Program, Melbourne

What is health promotion?

Health promotion is a core element of human immunodeficiency virus (HIV) nursing, and is identified as a key domain in the Australian Sexual Health and HIV Nursing Association’s Competency Standards.[1]

Health promotion is defined as ‘the process of enabling people to increase control over and to improve their health.[2]  In 1986, the Ottawa Charter for Health Promotion identified three basic strategies for effective health promotion:

Health promotion not only includes actions directed toward strengthening the skills of individuals, but embraces actions directed toward changing social, political, environmental and economic conditions to improve the health of communities.[3]

The Ottawa Charter for Health Promotion’s strategies for health promotion practice remain relevant for professionals including nurses almost 30 years after its inception.[4]

These three strategies are further supported by five priority areas for action:

  1. Build health public policy
  2. Create supportive environments for health
  3. Strengthen community action for health
  4. Develop personal skills
  5. Re-orient health services. 

Historical importance of health promotion in HIV nursing practice in Australia

Kemppainen et al. found in an integrative review that, before 1998, the nurse’s role in health promotion had been one mainly linked to disease prevention through health education and behaviour change directed toward individuals.[5]  However, nurses can provide evidence-based health promotion to communities as well as to individuals. The Ottawa Charter for Health Promotion can be used to guide and inform nursing practice, policy development and research.[6]  For example:

  1. Build health public policy: nurses have a role in promoting effective public policy as well as advocating to policy-makers on behalf of clients and communities.[7]
  2. Create supportive environments: nurses in the HIV sector establish and foster partnerships between services and individuals and also between clinical services and HIV health promotion agencies, peer based organisations and community groups.  One such example may be ensuring services are accessible to the target population by providing a safe location, opening hours that allow users to access the service, minimising barriers to access such as financial constraints and creating a professional and non-judgmental environment for those who may engage or may contemplate engaging with the service.

In subsequent years, health promotion advocates emphasised greater social responsibility for health, investment and infrastructure[8] and later strong political action.[9] Three principal models for promoting health are:

  • Biomedical model – emphasises risk behaviours and healthy lifestyles, individual responsibility
  • Social model – seeks to:
    • address broader determinants of health
    • empower individuals and communities
    • act to reduce social inequities and enable access to health care and involve intersectoral collaboration
  • Ecological model
    • acknowledges relationships between health-related behaviours and the environments in which people live work and play[10] [11]
    • promotes social inclusion.

 

In the HIV sector, nurses, while mostly familiar with and expert in the biomedical model of health, draw from social and ecological models as well.   HIV nursing models of care exist in Australia that incorporate strong health promotion components:  community health nurses, primary care nurses and district nurses in Australia and in the region have very broad, well developed roles in HIV health promotion. For example, nurses are involved in:

  • capacity building initiatives such as training volunteers through HIV organisations including AIDS Councils and peer-support agencies[12]
  • outreach to peer-based organisations to facilitate harm reduction, health education, HIV prevention and engagement in care[13]
  • social marketing through participation in community events (such as World AIDS Day)
  • participation in policy development including national and state HIV, sexually transmissible infections (STIs) and blood-borne virus (BBV) strategies
  • action research projects.[14] [15] [16]

Health promotion into the future in HIV nursing

At the latest global conference on health promotion held in Helsinki, Finland, participants built upon the previous declarations starting from the Ottawa Charter, and asserted a commitment to Health in all Policies,[17] which demands that approach to public policy across sectors that systematically takes into account the health implications of decisions in order to improve population health and health equity.  Only one state in Australia to date has adopted this approach (South Australia).  The South Australian approach positions Health in All Policies as a core process of government rather than all health policy being instigated by the health sector.[18]

Globally it is clear that if health is treated in isolation (according to a solely biomedical model), the HIV epidemic will continue to affect some groups disproportionately.  Health in All Policies recognises that the health of populations is ‘inextricably linked to […] social and other determinants outside the health sector’.[19] For example, it was the recognition that the social, biological and environmental risks of HIV were aligned with risks of tuberculosis and malaria that prompted the establishment of UNAIDS and the Global Fund to Fight human immunodeficiency virus (HIV), tuberculosis and malaria.[20]  Namibia’s National Policy on HIV/AIDS (2007) includes a multisectoral HIV response, incorporating capacity building in the health, education, agriculture, infrastructure and transport, tourism, public services and child and welfare sectors[20] to provide better and more equitable care, treatment and prevention. 

In the future, nurses working in HIV care can contribute through leadership in supporting Health in All Policies, building and strengthening the profession’s capacity to generate evidence, working effectively with other sectors[20] and sharing their skills and knowledge in providing equitable care and promoting health for those most marginalised who are living with HIV. 

For a useful resource, see World Health Organization. Health in All Policies Training Manual. Geneva: WHO; 2015.[21]

Additional resources

The Jakarta Declaration 1997.
http://www.who.int/healthpromotion/conferences/previous/jakarta/declaration/en/index1.html

The Bangkok Charter for Health Promotion in a Globalized World 2005.
http://www.who.int/healthpromotion/conferences/6gchp/bangkok_charter/en/index.html

World Health Organization (1986). The Ottawa Charter for Health Promotion 1986. First International Conference on Health promotion, Ottawa, 21 October.
http://www.who.int/healthpromotion/conferences/previous/ottawa/en/

Victorian Health Department has a useful toolkit.
http://www.health.vic.gov.au/healthpromotion/integrated/kit.htm

1.
Australasian Sexual Health and HIV Nurses Association Inc. ASHHNA Competency Standards for sexual and reproductive health and HIV nurses. Second edition. Sydney: ASHHNA, 2011. 
2.
Murphy EM.  'Promoting Healthy Behaviour', Population Reference Bureau, Health Bulletin 2, 2005, viewed 13 July 2015, http://www.prb.org/pdf05/PromotingHealthyBehavior_Eng.pdf 
3.
World Health Organization. The Ottawa Charter for Health Promotion 1986. First International Conference on Health Promotion, Ottawa, 1986, 21 October. http://www.who.int/healthpromotion/conferences/previous/ottawa/en/ 
4.
Talbot L ,Verrinder G. Promoting Health: the primary health care approach. 5th Edition. Sydney: Elsevier. 2013. 
5.
Kemppainen V, Tossavainen K, Turunen H. Nurses’ role in health promotion practice: an integrative review.  Health Promotion Int 2013; 28(4): 490-501. 
6.
Ward B, Verrinder G. Young people and alcohol misuse: how can nurses use the Ottawa Charter for Health Promotion? Australian Journal of Advanced Nursing, 2008; 25(4):114-119. 
7.
Kemppainen V, Tossavainen K, Turunen H. Nurses’ role in health promotion practice: an integrative review.  Health Promotion Int 2013; 28(4): 490-501. 
8.
World Health Organization. Jakarta Declaration on Leading Health Promotion into the 21st Century. Fourth International Conference on Health promotion: New Players for a New Era, Jakarta, 1997, 21-25 July. 
9.
World Health Organization. The Bangkok Charter for Health Promotion in a Globalized World, Bangkok, 2005, 11 August. 
10.
VicHealth. Defining health promotion - Models of health promotion. https://www.vichealth.vic.gov.au/media-and-resources/vce-resources/defining-health-promotion Accessed 7 February 2016. 
11.
Dombrowski JJ, Snelling AM and Kalicki M. Health promotion overview: evidence-based strategies for occupational health nursing practice. Workplace health and safety, 2014; 62(8): 342-9. 
12.
Crock E, Hall J. Unlikely bedfellows: an enduring relationship between two organisations. HIV Australia 2014; 12(1):43-47, March. 
13.
AIDS Surveillance and Education project Experience in the Philippines. Community Outreach and Peer Education for HIV and AIDS Prevention. Manila: Program for Appropriate Technology in Health, 2003, August. 
14.
Casey D. Using action research to change health-promoting practice. Nursing and Health Sciences 2007; 9(1): 5-13. 
15.
Hughes, I. Action Research in Healthcare. In P Reason, and H Bradbury (Eds). The SAGE Handbook of Action Research: Participative Inquiry and Practice (2nd edition), 2013; London: Sage Publications. 
16.
Smith C, West A, Burk N, Crock E, Frecker J, Collins K, Creely D, Guest C. Tuckerbag Meals: An HIV Nutrition Support Pilot – A joint project developed by the Royal District Nursing Service HIV Team and the Victorian AIDS Council. Poster presented at the Australian Society for HIV Medicine 22nd Annual Conference, Sydney, 2010, 20–22nd October. 
17.
World Health Organization. 8th Global Conference on Health promotion, Helsinki, Finland, 2013, 10-14 June. 
18.
Kikbusch I and Bucket K, editors. Implementing Health in All Policies. Adelaide: Department of Health, Government of South Australia, 2010. 
19.
Leppo K, Olllila E, Pena S, Wismar M and Cook S, editors. Health in All Policies: Seizing opportunities, implementing policies. Ministry of Social Affairs and Health, Finland, 2013; 291 
20.
Kikbusch I and Bucket K, editors. Implementing Health in All Policies. Adelaide: Department of Health, Government of South Australia, 2010. 
21.
World Health Organisation. Health in All Policies Training Manual. Geneva: WHO, 2015.