Module Four - Lecture notes 6.7.8.9 PDF

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Module Four: Health Promotion Tuesday, 19 February 2019 11:59 AM

Lesson Six: Individual and lifestyle approaches to health promotion Activity 6.1 Health promotion should include a wide range of actions and interventions at different levels. What does this look like for immunisation? (two examples) 1. One example of an intervention to increase immunisation rates is having "reminders" sent out to people by their GP's letting them know that they or their children need to get a certain vaccination soon. This could be done through letters, calls, or texts. Given the importance of vaccination, I would not suggest using just one channel of communication as that could easily be ignored and make vaccinations seem like an "added bonus", rather than a tool that is responsible for saving millions of lives worldwide. When it is time for me to get a pap smear, I receive a letter from the National Cervical Screening Programme and a text from Family Planning every few months until I make an appointment. 2. Another example of an intervention is banning unvaccinated children (as in children who can be vaccinated but are not, not children who cannot be vaccinated for medical reasons) from public spaces, or fining their parents. Last month, I read articles about this happening in Italy, New York, and California. Italy had this intervention specifically for schools, while the American states had it for public spaces. Italy's vaccination rates increased to 95%. In the American states, parents filed lawsuits until the bans were repealed instead of just getting their children vaccinated. Schools are a good place to start, and I think this idea should be implemented in NZ. I like the idea of banning unvaccinated children who can be vaccinated but aren't from public spaces too but there are several practical issues that arise such as: how to identify unvaccinated children in the wider public space, perceived violations of religious freedoms, resources to enforce the ban, public outcry of NZ becoming a "nanny state." There is another intervention that I find interesting and wanted to mention: In Australia, welfare payments are reduced by $28 per child until the recipient's children are vaccinated. A news article that I found on the topic mentioned that this increased vaccination rates from 1-2 percent in some areas, which I found interesting because I would have expected the rates to be higher due to the incentive of having the financial penalty lifted. It is sad that some parents would rather risk their child's life and go without a substantial amount of extra money rather than vaccinating their children; death and poverty are more preferable than autism - despite the fact that the link between vaccines and autism has been disproven time and again! (https://www.abc.net.au/news/2018-09-13/vaccinations-no-jab-no-pay-takeseffect/10169684)

Activity 6.2 Applying the Stages of Change model How can we practically apply the stages of change model in health promotion practice? Identify two different forms of intervention that would help individuals move from their current stage of change to the next stage, using obesity as an example. 1. Contemplation to active changes One example of an intervention against obesity could be showing the consequences of continuing to be obese e.g. Premature deaths due to an increased risk of cancers and heart disease, showing comparisons of an obese person's organs to a health person's organs (particularly the heart), etc.

(image showing the size of a brain compared with the heart of an obese person - a healthy heart is only supposed to be half the size of the brain but the heart is almost bigger.) Seeing the consequences of prolonged obesity on their health may help the client to see that the cons of continuing an unhealthy lifestyle outweigh the pleasure derived from eating poorly and living a sedentary lifestyle. As a formerly obese person, I think that focusing on the physical consequences rather than the social consequences of obesity would be far more effective as focusing on the social consequences may lead to continuing an unhealthy lifestyle and gaining even more weight as an act of retaliation. Using images such as the example of the brain and the heart would be useful in proving to the client that obesity is dangerous and that the health professional is not trying to "fat shame" them. 2. Active changes to maintenance An intervention that should be implemented is a programme that partners the client with an expert who is well versed in sustainable weight loss, rather than just telling the client to lose weight and leaving them to it. The expert would sit down with the client to discuss their budget and food likes/dislikes, then help them to develop an easy, affordable meal plan that is healthy, filling, and at an appropriate caloric level (rather than eating the absolute minimum or taking "fat burning supplements", which leads to a relapse.). Next, the expert and client would discuss ways that the client could become more active such as walking more or going to the gym once a week. The expert needs to emphasise that this is a lifestyle change, not just a programme to drop once the excess weight is lost. The expert would check in on the client weekly, then fortnightly, then less frequently until the client feels confident enough to continue the healthy lifestyle on their own. This would make the client feel supported, confident, and accountable as they are not taking this journey by themselves.

Lesson Seven: Community and settings-based approaches to health promotion Activity 7.2 Community and settings-based approaches for immunisation We've learnt that health promotion should include a wide range of actions and interventions at different levels. What does this look like for immunisation? Have a think about some interventions that could be implemented for immunisation using a settings-based or community approach. HPV Vaccinations recently became funded for boys and men aged 9-26. The vaccine has been free to girls and women for years so men could think that getting the HPV vaccines is unnecessary. An intervention to convince boys and men that they should get vaccinated should be implemented in the community. A community needs to be defined. For this example, I would use men aged 18-26 as they are more likely to be sexually active than 9-17 year old boys, but unlikely to receive vaccinations since they have aged out of the year 7 and 8 group who typically receive them. I have already noticed some posters in the Family Planning waiting room that lets men know that the HPV vaccine is now free to them, but many men do not go to Family Planning clinics so they would not see the posters, and the posters do not provide much incentive to get vaccinated: the slogan is something along the lines of "The HPV vaccine is now free to men aged 9-26", but why should they get vaccinated? I think that there should be posters and ads on social media that emphasises or creates an "attractiveness" to women of men who are vaccinated against HPV; although many men with HPV will not experience any symptoms, they can still pass the virus onto women which will make the men "undesirable" and unlikely to get laid. Men who are vaccinated, however, could be portrayed as attractive and very desirable because they care about women (and themselves) enough to get a vaccination that is perceived by many men as "unnecessary." These campaigns should also make men aware that there is a chance that they could develop genital warts or cancer of the anus, penis, or throat.

Lesson Eight: Structural approaches to health promotion Activity 8.1: Reflective Reading Below is a selection of articles which discuss structural approaches in health promotion from Aotearoa New Zealand and Australia. Choose one of the following four articles, and briefly discuss the findings. What did you find interesting about your chosen reading? Please do not write a summary of what is in the articles, but rather what you got out of them. What issues do they raise? What do you agree with, or not agree with? How do they affect you and your work? Why? There is no set length for lesson answers. There may be quite a variation in the length of your responses (50 – 500 words). We want to see that you are engaging thoughtfully and reflectively in your reading. You are not required to use APA referencing in these lesson answers, but please do refer to the articles you critique.

Friel, S., Hattersley, L., Ford, L., & O’Rourke, K. (2015). Addressing inequities in healthy eating. Health Promotion International, 30(S2), ii77–ii88. doi: 10.1093/heapro/dav073

One of the first points mentioned in this article is that people's diets are a product of their broader daily living conditions including where they are born, where they live, learn, work, and age. I agree with this point because if you look at lower income communities e.g. Manurewa, you will notice that there are fast food restaurants everywhere whereas higher income communities such as Newmarket do not even have so much as a McDonald's. Manurewa is a predominantly low income, Maori and Pasifika community. This means that there are already two social determinants that predispose the community to obesity but nothing is done to prevent fast food chains from setting up shop in an area already so densely populated with them. The second point of interest raised is that across the globe, people with less money, less education, insecure work, and poor living conditions are more likely to experience food insecurity, eat unhealthy diets, and have higher levels of dietary related disease. I personally have experienced this to a degree; When I first started studying in 2015, I would only have about $15 left over after paying rent. This meant that I needed to make my money go as far as possible, which lead me to living on foods that were cheap such as instant noodles, chocolate, fizzy drinks, and chicken nuggets. This lead me on a path to obesity, poor joint health, and chronic cholecystitis. I also noticed that many of my peers, who also moved out of their family home for education, gained extra weight and less income. Fortunately, the student allowance has increased dramatically and I have also found part time employment which allows me to eat a healthy, balanced diet but not all students or low income people are as privileged as I am. The issues that the article raised for me is that unhealthy foods are increasingly targeted towards low income people and healthy foods are being priced out of the reach of those who need it the most. How did something as basic as fruits and vegetables become more expensive than complex, processed foods such as chocolate and instant noodles? Also, where is the education for low income groups on how to eat healthily whilst on a low income budget? I feel that this would be highly beneficial not just for parents but also for the children who will grow up and have to work their way up to a decent income - assuming that they are able to do so.

Activity 8.2 Structural approaches for immunisation We've learnt that health promotion should include a wide range of actions and interventions at different levels. What does this look like for immunisation? Have a think about some interventions that could be implemented for immunisation using a structural approach.

In activity 6.1, I wrote about how in certain places (e.g. Australia, Italy, New York, etc.) there are penalties for not vaccinating your children such as fines, exclusion from education, welfare penalties, and outright being banned from public spaces as a method of promoting vaccines. After completing today's activities, however, I have learned that these are known as structural approaches. Today's answer will be a recap. In Italy, there is the Lorenzin law; parents who send their unvaccinated children to school can be fined up to 500 euros (NZ$835) and children under the age of six can be turned away. This law was introduced in response to an increase in measles cases. This lead to the vaccination rate increasing from less than 80% to 95%. (source)

I personally think that this law, or a similar one, should be introduced in New Zealand. Yes, there is the issue that it could be unethical to force unwilling parents to vaccinate their children. However if you think about it, it is even more unethical to condemn a child to the horrors of polio and whooping cough just because the parent refuses to believe that vaccines are necessary in eradicating preventable disease.

Lesson Nine: Health promotion overview Activity 9.1 There are a range of sources below which look in detail at the application of the Ottawa Charter in different areas, and other examples of health promotion action. Choose one of these articles or videos that looks interesting to you and one you would like to focus on in depth. Now, reflect on the video or reading: What did you find interesting? Please do not write a summary of what was covered, but rather what you got out of it. What issues did it raise? What do you agree with, or not agree with? How do they affect you and your work? Why?

Billboard Bandits Bill Snow was inspired to create B.U.G.A U.P. when he saw an aboriginal man trying to quit smoking under a billboard that had an ad for tobacco on it. This sentence reminded me of last week's lesson when I thought about how unhealthy products such as fast food and alcohol seem to be densely populated and advertised in communities that already struggle with overrepresentation in negative health statistics. Obviously the aboriginal man doesn't want to smoke because he describes tobacco to Snow as poison, but there is so much advertising that he can't help but be tempted. Another interesting point raised for me is that Ric Bolzan described spray painting over tobacco adverts as a "visual assault." It could be argued that the advertisements themselves are a "visual assault" on the health of the public because we are constantly bombarded by unhealthy images that evoke temptation so what B.U.G.A. U.P. is doing would be more accurately described as "visual defence." Another interesting point raised for me is that B.U.G.A. U.P. is not actually an organisation with meetings, but a movement developed in response to "corporate thuggery" that anyone could join with "a can of spraypaint and [their] conscience." The movement became so widespread that the advertisements for tobacco had to be moved from ground level to on top of buildings. The companies saw the message of the public but rather than listening and pulling their advertisements, they just shifted the advertisements up. However, that wasn't enough for the public as telescopic mechanisms for spraypainting were developed. The B.U.G.A. U.P. movement remind of Robin Hood, but they deface the "corporate thugs" to give life to the poor. The quote that sticks out most to me is from Dr. Arthur Chesterfield-Evans; "I think I've saved more lives with a can of spraypaint than I have with a scalpel, because prevention is much better than a cure." And I completely agree because if it weren't for the B.U.G.A. U.P. movement then perhaps tobacco advertising would be more rampant and we wouldn't have decreasing rates of teenage smokers and smoking would still be widely considered to be socially acceptable and cool.

Potential Exam Questions     

Outline and discuss community development in health promotion. Outline and discuss with examples the five action areas of the Ottawa Charter. Outline Te Pae Mahutonga and discuss with examples. Using obesity as an example, compare the individual and lifestyle health promotion approach with the structural health promotion approach. Using obesity as an example, compare the individual and lifestyle health promotion approach with the community and settings-based health promotion approach....