Health promotion

The 21st century poses vast challenges for public health, with environmental threats, cultural diversity and an ever aging population. The role of health promotion is as important as ever, within this assignment I will look at the issues we face and the techniques used to alter public perception and behaviour. One definition widely highlighted from the World Health Organisation states that health is ‘a state of complete physical, mental and social well being’ (WHO 1947). This definition encompasses the indicators of poor health but does seem to view health as something that is quite conventional and static. This can be contrasted to a definition from Parsons who defines health as ‘the state of optimum capacity for an individual for the effective performance of the roles and tasks for which they have been socialised’ (Parsons 1971). Here we are viewing health as something maintained to the standard needed for us to perform our lifestyles. Health promotion is of great apprehension not only for the NHS but also many other groups that are involved in health care such as social, environmental and welfare practices. At its core is the intention of empowering individuals and communities to allow greater control of their health by providing information, education and support.

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Varying methods and strategies are used to change people’s perceptions of health, with the aim of working toward the creation of stronger communities and improved future health for all. The health belief model emphasises the function of beliefs and perceptions in human decision making. Originally developed by Rosenstock in 1966 it looks to predict patterns in health behaviour, such as willingness to partake in vaccinations and act upon health advice. It suggests that the factors that govern an individual changing their behaviour are based around an assessment of how feasible change is and the benefits provided. It puts forward the idea that people need relevance or a trigger to initiate decision making (Naidoo, Wills 1994). This model incorporates Bandura’s concept of self-efficacy. This suggests that an individual must believe they have the capability and insight to see an intended behaviour change through (Bandura 1991).

The empowerment model seeks to expand the individual’s capability to control their own health. This model facilitates a move toward change by building an individual’s sense of worth and identity, allowing them to indentify their own health concerns (Naidoo, Wills 1994). It aims to develop decision making and problem solving skills, giving the individual the tools needed to see changes through with independent thought and action. This model can be very effective for young people who sometimes struggle to make independent decisions and are susceptible to peer and environmental pressures. There is a strong relationship between employment and health. The main negative being occupational ill health, this can be an issue for many people working within manual job roles, as well as people working in stressful high pressure environments. It’s shown that having little or no control over work processes and being in lower positions can contribute to ill health (Marmot et al 2006). Unemployment is of a greater risk to ill health than employment, moving people into work can be seen as a health promotion in its own right. Employment brings higher living standards, more disposable income, improved confidence and wellbeing. Gender is still a large determinant, men generally work in more manual roles and take poorer care of their health overall. Loosing work can actually double the risk of a middle aged man dying within the following five years. Evidently there are strong links between employment and men’s wellbeing. Men over the age of 65 are also three and a half times more at risk of developing coronary heart disease than women (DH, 1998). Men’s life expectancy still lags behind that of women and within Europe there are large inequalities in life expectancy. These differences are greatest in men, where as the difference between the best and worst countries for male life expectancy is 17 years, for women it is 12 (BBC, 2013). Clearly there are health inequalities within gender that need to be addressed.

The promotional campaign stoptober is clearly targeted toward working classes; the majority of the subjects pictured are in uniforms that are associated with lower paid roles. There is evidence to suggest that smoking related deaths are higher amongst poorer social classes (ASH, 2006). The branding used is very simple and appeals to people’s logic through the use planning, note making and goals toward quitting. This appeals to the individual and gives a greater sense of empowerment and personal involvement in the process of creating change. The campaign seems to utilise the stages of change model, the process is broken down into stages and encourages involvement in the planning process. Initially encouraging the participant to write down why they are taking part (contemplation) and then take part in a planning process (preparing to change) along with accepting extra support (Prochaska, DiClemente 1992). Evidence from studies shows that when people are involved in a planning process there is a higher probability they will succeed (McLeod, Clark 1993).

There is no mention of the harms of smoking and shock tactics are not used. Raising awareness of the dangers is clearly not enough and more personal tactics are used. With addictive habits highlighting the negative consequences does not seem to help create behavioural change, clearly ‘short term gratification is a greater incentive than long term harm’ (Nanidoo, Wills, 1996, pg 182). There is a very collaborative feel behind the promotional material with comments like ‘you’re not in this alone’ and ‘were with you all the way’. There is clear intent to show that the task of quitting is achievable and by anyone. As Bandura states ‘seeing people similar to oneself succeed by sustained effort raises observers beliefs that they too possess the capabilities to succeed’ (Bandura 1994). This is clearly a core strategy of this campaign, when we see someone succeeding this helps to increase own self efficacy. Health has broad range of definitions and many see health as an all encompassing ideal state. Some however acknowledge that a functional state of health can be achieved despite the presence of illness or disease. The role of health promotion is to help people work towards their personal health potential, at the same time reducing the strain on services. With the recent rises in poverty there is clearly demand for new and effective health promotions. Stoptober meets these needs well by using tried and tested health promotion techniques. It is an effective and socially relevant campaign and last years figures of ‘160 000’ quitters speaks volumes on its success. Word count 1100


ASH (2006) Major Online Mapping Project Shows ‘Iron Chain’ Between Smoking and Deprivation (Accessed 02/11/13)

Bandura, A. (1991). Self-efficacy mechanism in physiological activation and preventing behaviours. Cambridge University press Bandura, A. (1995). Self-efficacy in changing societies. Cambridge University Press BBC (2013) European men lag behind in life expectancy. (Online). Available at: (Accessed 03/11/13) Boseley,S. (2006) Iron chain links smoking and poverty. Guardian. Available at: (accessed 02/11/13) Current Nursing. (2012) Stages of change model (Online): Available at: Davidson, N. Lloyd, T. (2001) Promoting Men’s Health: A guide for practitioners. Harcourt Publishers Naidoo, J. Wills, J. (1994) Health Promotion: Foundations for practice. London. Bailliere Tindall Marmot,M. Wilkinson, R. (2006) Social Determinants of Health, 2nd Edition. Oxford. Oxford University Press. NHS, Smokefree. (2013). Stoptober. (Online).Available at: http://www. (Accessed 25/10/13) NHS, Smokefree (2013) Stoptober (leaflet) (Accessed 14/10/13) Ogden, J. (2012) Health Phychology: A Textbook. Berkshire. Open University Press. Prochaska J, DiClemente C, Norcross, J (1992). In search of how people change: Applications to Addictive Behaviours. American Psychologist, Vol. 47, No 9 Tones, K. Tilford, S. (2001) Health promotion: Effectiveness, efficiency and equity. Cheltenham. Nelson Thornes WHO, (2013). World Health Organisation. (Online).Available at: (Accessed 23/10/13)

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