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Learning objectives and graduate capabilities



Public health problem

An issue, condition or disease that:

  • Affects a significant number of people
  • Is a large burden in terms of morbidity, quality of life and cost (individual and society level)
  • Has significantly increase recently or is predicted to increase in the future
  • Is perceived as a threat by the public
  • Is feasible to act on at a community or public health level


Case: Cathy

  • 24 year old pregnant single mother w/ vaginal thrust
  • Fourth pregnancy - now in first trimester
  • Treatment involves not only medical but also biopsychosocial aspects of health promotion for Cathy and her unborn child
  • Note: look at wikipedia:Sudden infant death syndrome

Public health problems

  • Overweight/obesity
  • Diabetes (uncontrolled as FBG is 10mm/L)
  • Postnatal depression
  • Domestic violence, previous miscarriage, nature of conception, how does she feel about the child?
  • Smoking
  • Sedentary lifestyle
  • Anemia (pregnant woman should be 110-140 g/L)
  • Poor diet
  • Low SES - e.g. no prenatal care

Ecological model of public health

  • Outer = community/societal level
  • Interpersonal = peer pressure, parental support
  • Intrapersonal = awareness, attitudes, etc

Traffic accidents


  • Consider which are intrapersonal, interpersonal, community
  • Speeding
    • Risk taking personality
      • Awareness/education
    • Peer pressure
      • Awareness/education
    • Driving experience
      • Licensing regulations
  • Driver fatigue
    • Work place policies, work load etc
    • Lack of rest stops
    • Attitude
  • Driving under the influence
    • Peer pressure
    • Easy access to alcohol
    • Culture of drinking
    • Lack of laws and policy which act as deterrents
    • Untreated substance abuse problem
      • Access to education
      • Mental illness
      • Access to treatment services
  • Community factors
    • Road
      • Speed limit
      • Signage
      • Quality of road
    • Vehicle
      • Safety features
      • Mechanical condition
      • Etc
    • Broader environment (physical, economic, policy, laws)

Cathy in ecological model of public health


  • Common contributing factors to various problems
    • Low SES (intrapersonal)
    • Family support (interpersonal)
    • Age (unremedial)
    • Sedentary lifestyle (intrapersonal)
    • Diet (intrapersonal and community)



Health promotion definition

File:Health Promotion Strategies pre reading.pdf

  • Health promotion
    • The process of enabling people to increase control over, and to improve their health
    • Set of planned activities addressing a PH problem
    • Addresses structural barriers - e.g. more bike paths, more stairs
    • Addresses both awareness and the broader social determinants
  • Education for empowerment = provide information that enables people to change their health activities
  • Education without empowerment = just providing information (doesn't address their health literacy - their ability to interact with the doctor, the information, and to critique information)
    • Involves engaging with the information

Example: Traffic accidents

  • Advocacy for truck drivers
  • Safe rest stops
  • Modify the environment
  • Adequate regulation

Ottawa charter

  1. Strengthening community action
  2. Developing healthy public policy
    • Subsidized public transport
    • Increased public funding for physical fitness areas for children
    • Banning junk food advertising targeted to children
    • Policies in GP to routinely screen children for BMI and taking early interventions
  3. Developing personal skills
    • Teaching children in school about healthy eating habits
    • GP practice: whenever a child is brought asking about their eating habits and educating parents on healthy lifestyles
  4. Creating supporting environments
    • Healthy foods sold in school canteens
    • Healthy food options available in public food outlets
    • Waiting areas in GP clinics to have areas for active child play
  5. Reorienting health services
    • GPs getting involved in school health programs
    • Health care providers carrying out research on childhood obesity
    • Health Services providing outreach programs in the community to educate people on childhood obesity and healthy lifestyles

Health promotion strategies and methods

Health promotion activities for Cathy's gestational diabetes w.r.t. Ottawa charter

Contributing factors/problems HP Strategy Focus Method Interventions
High crime area
  • Neighbourhood watch
  • Increased policing
  • Increased lighting, security publicity
  • Bus services/ trains with guards
  • Increased employment
  • Increased school completion
Populations/communities Community strengthening
  • Appoint neighbourhood watchdogs
  • Increased police funding and more stations
  • Funding education
  • Increased low-level jobs
  • New street lights and security lights
Job conditions (long shifts) Public policy - max shift length Populations Healthy public policy
  • Retribution for employers
  • Rewards for compliant workplaces

Summary of health promotion

  • Multidisciplinary/interprofessional
  • Creates bonds with other disciplines/professions with whom we work
  • Supported by foundation framework: Ottawa charter
  • Strategies and approaches are numerous
    • Focus on people and population groups within their environments
    • Address social, environmental, economic and political factors that influence patient health through:
      • Building personal skills, empowerment, involving family and community, advocacy, strategic partnerships
  • Key: Use multiple strategies, working with multi-disciplinary teams and in partnership with other sectors


External links