Health Promotion
Policy is written guidance, expectations, or authoritative government action, found in organisations, institutions, and businesses to make sense of the world, to give focus and direction, safety, and structure (Colebatch, 2009). Public policy is created by government policy advisors within think tanks for governing bodies to address citizen’s needs, (Stone, 2008: Abelson, 2018) often in response to The World health Organisation (WHO) 1977, health promotion agenda (Robertson & Minkler, 1994).
Public health in 1920 set out policies to prevent disease through sanitisation, control of communicable diseases, early diagnosis of illness via screening and development through social machinery (Naidoo & Wills, 2009). Healthy policy outlines health goals and aspirations at a local or international level (WHO, 2019).
The Uk Government’s 2019, Advancing our health: prevention in the 2020s (Department of Health and Social Care, 2019), outlined its vision for a healthier society, including ambitions to be a smoke free society by 2030, (an intervention at the top of the Nuffield ladder) will tackle the last six million smokers in England (Hopkinson, 2020: Griffiths & West, 2015). Lesser interventions around nutrition are softer approaches which are heavily educational based, including nutritional labelling on food and beverages and intervention support for obesity which has been criticised for not utilising policy to tax the companies who provide the obesogenic environment difficult to resist by the public (Townsend et al.,2020).
Policy analysts are required to work with stakeholders, such as local authorities, unions, and community groups, to gather evidence through studies and conflicting agendas to come up with the best policy which satisfies the majority (Zheng e al., 2015).
Aside from the social science evidence, there is also a requirement to satisfy government campaign promises and financers which are often the impetus for change (Young & Quinn, 2002). Policy makers work within the communities to collect data, identifying a problem and coming up with the best possible solution, demonstrating thorough consideration of social determinants, and support systems to create change. The behaviour change techniques needed should satisfy the majority financially and politically. Persuasiveness and presentation skills are a policy makers best friend (Naidoo & Wills, 2009)
(Young & Quinn, 2002)
Health policy creation at a local or national level requires a salutogenic focus to understand the complexities of the interwoven web of social, biological, and environmental factors at play (Morgan & Ziglio,2007: Pérez-Wilson, et al., 2021).
Dahlgren and Whitehead (1991) highlighted the importance of social equity when deciding policy. There is a strong correlation between health and socio-economic status. Health inequalities, such as housing, education and employment, influence health and access to health care (Svendsen et al., 2020). COVID 19 and the Ukrainian war has further widened the social divide, with more than 22%, (14.5 million) or 1 in 5 people are now living below the poverty line (Godlee, 2021). Policy can directly affect target groups such as ensuring all children between 5-7 receive free school meals and breakfast clubs to enable the child to focus on their education and receive adequate nutrition to maintain health (Brown & Summerbell, 2009).
Early life intervention policies could greatly support the opportunities a child experiences within health and education, which is evidenced to lead to greater adult health, well-being, and life satisfaction and in turn reducing the cost on services throughout their adult lives. School interventions include wake and shake, sexual health, drug, and alcohol education, and Thrive mental health and well-being support (Iwaniec,2004; pages, 18-20).
(Marmot, 2020).
Policy makers will need to compromise with stakeholders and activists to decide whether intervention is an upstream measure or the current popular neolibertarian paternalistic approach known as nudge: (Thaler & Sunstein,2008: Hausman & Welch,2010), whereby the Government puts responsibility on the individual to be able to resist overindulging in behaviours such as consuming excessive quantities of processed foods, alcohol, and sedentary behaviours, with support via the change 4 life (choice architecture) campaign (Thaler et al., 2014 Bradley et al.,2020). Upstream measures would involve applying legislation policy to global companies who supply the unhealthy produce; however, this does not fit in with the capitalist model (Goodman et al.,2021).
The transition from the medical model which treated ill-health symptoms with medication; where medical staff are viewed as the specialist and prescriber allowing little patient autonomy of the treatment plan, to integrating the social model of self / preventative community-based care, behaviour change and co-creation of the treatment journey, has proved chaotic and often mismanaged due to extra costs, pressure on specialists and the training needed (Leutz, 1999: Shortell, 2021).
Health promotion includes evidenced based medical research, behaviour change, education, empowerment, and social change (Kok et al., 2018). Social change policies work within the environmental determinants of health, with a top-down approach and require lobbying, policy planning, negotiating and implementation from professional bodies and pressure groups, such as alcohol change UK, who applied pressure on the Government to apply a minimal unit price and the battle on food labelling by Laid Bare (O’Cathain et al., 2019: Temple, 2016).
Tannahill’s model highlights the interplay between the three constructs needed to safeguard communities, e.g., an educational campaign to encourage uptake of COVID 19 vaccine and masks, masks used in the prevention for contracting COVID 19, and the vaccine to avoid hospital admissions (Gandhi et al., 2020). Health protection during COVID 19 included a blanket requirement to be immunised to enter establishments and restrictions on flying in and out of the UK, thus protecting the wider population and overriding individual autonomy Capraro et al.,2021).
There are ethical principles for policy makers to adhere to when making judgements to improve health. A framework of ethical principles consists of:
· Respect for autonomy will allow people to make decisions for themselves, wherever possible (Beauchamp and Childress, 2013).
· Beneficence is the will to do greater good (Naidoo and Wills, 2016)
· Non-maleficence is the agreement to do no harm; the Nuremberg code was established after World War 2, when people were given experimental medicines (Annas, 2018).
· Justice in health promotion refers to practitioner’s working to the best of their ability within a society where health inequalities are widening (Brown et al., 2019). They can support those who are disadvantaged to make lifestyle changes and challenge health discrimination targeting interventions to those in need, e.g., disadvantaged single breast cancer survivors who lack physical, psychosocial, and financial support would need more intervention to eat nutritious food, exercise and provide care for their children, to aid recovery, Quality of Life and prevent future episodes, in comparison to a financially secure wife with an abundance of social support. Justice would require supporting the disadvantaged woman to give an equal chance of maintaining future health (Dixit et al., 2021).
Seedhouse, D. (2008). Ethics: the heart of health care. John Wiley & Sons.
The Seedhouse ethical grid is another guide to use when planning to apply policy. Asking questions and ensuring that any policy made should “do unto others as you would have them do unto you”. Evidence for intervention must be strong and non-biased (Resnik, 2011).
There are on-going political debated questions around how much responsibility the individual needs to take and the level of Government intervention / legislation. How far should the Government regulate the economy, restrict consumer choice, and reduce inequalities? And should the Government shape society and how people connect? (Calman, 2009).
Practitioners can affect policy through effectively engaging with service users, often the hard to reach, vulnerable and isolated individuals (Pearson et al., 2003). By listening and observing gaps and identifying further needs; a practitioner may collaborate, design, implement and evaluate small interventions, becoming catalysts for change (Eldredge et al., 2016: Page 54-67).
Intervention Mapping Steps (Bartholomew et al., 1998).
Projects need much allocated time, evidenced based research, funding, and evaluation. Using The three logic models through the planning stage to identify the complex issues, possible solutions and identifying pathways to gain a clear rationale for the interventions. Intervention mapping has been used successfully in hundreds of schemes such as: physical activity in deprived areas, Stress prevention in children, HIV prevention and sun protection (Eldredge et al., 2016: page 171-188).
(Cooksy et al., 2001).
Practitioners may also feedback to senior management who intern write reports and evidence outcomes, costs and client feedback for policy research and Government data collection (Milat, 2014). Implementation of health policy on the ground should work within a framework of valuing diversity and aspiring to a cross-cultural approach, respecting autonomy, dignity, worth and social justice Walker, 2006).
References
Abelson, D. E. (2018). Do think tanks matter? Assessing the impact of public policy institutes. McGill-Queen's Press-MQUP.
Bartholomew, L. K., Parcel, G. S., & Kok, G. (1998). Intervention mapping: a process for developing theory and evidence-based health education programs. Health education & behaviour, 25(5), 545-563.
Bradley, J., Gardner, G., Rowland, M. K., Fay, M., Mann, K., Holmes, R., ... & Moynihan, P. (2020). Impact of a health marketing campaign on sugars intake by children aged 5–11 years and parental views on reducing children’s consumption. BMC Public Health, 20(1), 1-11.
Brown, A. F., Ma, G. X., Miranda, J., Eng, E., Castille, D., Brockie, T., ... & Trinh-Shevrin, C. (2019). Structural interventions to reduce and eliminate health disparities. American journal of public health, 109(S1), S72-S78.
Brown, T., & Summerbell, C. (2009). Systematic review of school‐based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obesity reviews, 10(1), 110-141.
Capraro, V., Boggio, P., Böhm, R., Perc, M., & Sjåstad, H. (2021). Cooperation and acting for the greater good during the COVID-19 pandemic.
Colebatch, H. (2009). Policy. McGraw-Hill Education (UK).
Cooksy, L. J., Gill, P., & Kelly, P. A. (2001). The program logic model as an integrative framework for a multimethod evaluation. Evaluation and program planning, 24(2), 119-128.
Department of Health and Social Care. (2019). Advancing our health: prevention in the 2020s.
Dixit, N., Rugo, H., & Burke, N. J. (2021). Navigating a path to equity in cancer care: the role of patient navigation. American Society of Clinical Oncology Educational Book, 41, 3-10.
Eldredge, L. K. B., Markham, C. M., Ruiter, R. A., Fernández, M. E., Kok, G., & Parcel, G. S. (2016). Planning health promotion programs: an intervention mapping approach. John Wiley & Sons.
Eldredge, L. K. B., Markham, C. M., Ruiter, R. A., Fernández, M. E., Kok, G., & Parcel, G. S. (2016). Planning health promotion programs: an intervention mapping approach. John Wiley & Sons.
Godlee, F. (2021). Covid 19: Widening divisions will take time to heal.
Goodman, S., Armendariz, G. C., Corkum, A., Arellano, L., Jáuregui, A., Keeble, M., ... & Hammond, D. (2021). Recall of government healthy eating campaigns by consumers in five countries. Public Health Nutrition, 24(13), 3986-4000.
Griffiths, P. E., & West, C. (2015). A balanced intervention ladder: promoting autonomy through public health action. Public Health, 129(8), 1092-1098.
Hausman, D. M., & Welch, B. (2010). Debate: To nudge or not to nudge. Journal of Political Philosophy, 18(1), 123-136.
Iwaniec, D. (2004). Children who fail to thrive: a practice guide.
Kok, G., Peters, L. W., & Ruiter, R. A. (2018). Planning theory-and evidence-based behaviour change interventions: a conceptual review of the intervention mapping protocol. Psicologia: Reflexão e Crítica, 30.
Leutz, W. N. (1999). Five laws for integrating medical and social services: lessons from the United States and the United Kingdom. The Milbank Quarterly, 77(1), 77-110.
Li, C., Zheng, H., Li, S., Chen, X., Li, J., Zeng, W., ... & Daily, G. C. (2015). Impacts of conservation and human development policy across stakeholders and scales. Proceedings of the National Academy of Sciences, 112(24), 7396-7401.
Mahase, E. (2019). Prevention green paper lacks ambition, say critics. BMJ: British Medical Journal (Online), 366.
Marmot, M. (2020). Health equity in England: The Marmot review 10 years on. Bmj, 368.
Milat, A. J., King, L., Newson, R., Wolfenden, L., Rissel, C., Bauman, A., & Redman, S. (2014). Increasing the scale and adoption of population health interventions: experiences and perspectives of policy makers, practitioners, and researchers. Health Research Policy and Systems, 12(1), 1-11.
Morgan, A., & Ziglio, E. (2007). Revitalising the evidence base for public health: an assets model. Promotion & education, 14(2_suppl), 17-22.
Naidoo, J., & Wills, J. (2009). Foundations for Health Promotion E-Book. Elsevier Health Sciences.
O’Cathain, A., Croot, L., Sworn, K., Duncan, E., Rousseau, N., Turner, K., ... & Hoddinott, P. (2019). Taxonomy of approaches to developing interventions to improve health: a systematic methods overview. Pilot and feasibility studies, 5(1), 1-27.
Pearson, T. A., Bazzarre, T. L., Daniels, S. R., Fair, J. M., Fortmann, S. P., Franklin, B. A., ... & Taubert, K. A. (2003). American Heart Association guide for improving cardiovascular health at the community level: a statement for public health practitioners, healthcare providers, and health policy makers from the American Heart Association Expert Panel on Population and Prevention Science. Circulation, 107(4), 645-651.
Pérez-Wilson, P., Marcos-Marcos, J., Morgan, A., Eriksson, M., Lindström, B., & Álvarez-Dardet, C. (2021). ‘A synergy model of health’: an integration of salutogenesis and the health assets model. Health Promotion International, 36(3), 884-894.
Resnik, D. B. (2011). What is ethics in research & why is it important.
Seedhouse, D. (2008). Ethics: the heart of health care. John Wiley & Sons.
Shortell, S. M. (2021). Reflections on the five laws of integrating medical and social services—21 years later. The Milbank Quarterly, 99(1), 91.
Svendsen, M. T., Bak, C. K., Sørensen, K., Pelikan, J., Riddersholm, S. J., Skals, R. K., ... & Torp-Pedersen, C. (2020). Associations of health literacy with socioeconomic position, health risk behavior, and health status: a large national population-based survey among Danish adults. BMC Public Health, 20(1), 1-12.
Thaler, R. H., & Sunstein, C. R. (2008). Nudge: improving decisions about health. Wealth, and Happiness, 6, 14-38.
Thaler, R. H., Sunstein, C. R., & Balz, J. P. (2014). Choice architecture. The behavioural foundations of public policy.
Walker, M. (2006). Towards a capability‐based theory of social justice for education policy‐making. Journal of education policy, 21(2), 163-185.
World Health Organization. (2019). Global action plan on physical activity 2018-2030: more active people for a healthier world. World Health Organization.
Young, E., & Quinn, L. (2002). Writing effective public policy papers. Open Society Institute, Budapest.
