health promotion settings
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Health Promoting Settings
Milka Donchin MD, MPH
Braun School of Public Health& community MedicineJerusalem
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Main activities in Health Promotion
Settings
programs
training
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The setting-based approach
A setting is a social system in which people live,
work, learn, love and play
Characterized by a particular organizational culture,
structure, functions, norms and values.
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The setting-based approach
A setting is the context
withinwhich and throughwhich
health occur
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The setting-based approach
A holistic and socio-ecological model of health
Focus on populations, policy and environments
Protect human rights, equity and social justice
sustainability
Community participation
Enablement and empowerment
Cooperation
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The setting-based approach
Key elements:
A healthy working and living environments
Integrating health promotion into the daily
activities of the setting
Reaching out into the community
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The setting-based approach
Underpinned by:
Health for all
Ottawa Charter
Agenda 21
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Sustainable Development
'development which meets the needs
of the present without compromising
the ability of future generations to
meet their own needs'
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Principles for Sustainable Development in Israel
(partly)
Agenda 21 Integrated Resource
Management
Inter-generational andIntra-generational
Equity
Environmental andSocial Justice
Accountability and
Transparency
Eco-Efficiency
Polluter Pays
User Pays
SustainableConsumption
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The first
health promoting settingHealthy cities
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One in which residents, business, non-
governmental organizations and the
municipal government work together to
ensure a viable and livable city.
A Healthy City
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Israel network of healthy cities
Established in 1990 with 4 cities
In 2012 50 cities & local authorities,
& 4 regional authorities
Covers >50% of the population in Israel
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Israel Network of Healthy CitiesIn operation since 1990
A unit of theUnion of Local Authorities
Ministries
Health
Education
Environment
Welfare
Sports
Cities
Local councils
Regional councils
Institutions
School of Public Health, Jerusalem
Israel cancer Association
Nature protection society
Community centers association
4 HMOs
Beterm
Enosh
Milenium
Association of cardiologistsIMA
Individuals
A member of the European Network
of National Healthy Cities Networks , lead by WHO
Members of the Network
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Membership Criteriafor cities
A formal decision of the city council to adopt HFA principles
Nominate a multi-sectoral steering committee
Nominate a city health coordinator
A commitment to prepare a city health profile
A commitment to prepare a strategic health development
plan based on the profile
A commitment to cooperate with the networks activities.
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The Healthy City mode of action
Steering
committee
City profile
Strategic planning for health& sustainable development
Health
promotionprojects
Action plans in city settings
Sustainable
development
projects
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Identify needs of the population
Determine inequalities in health
Identify desires and aspiration of the citizens
City health profile
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All Healthy Cities are committed to preparing a City
Health Profile as a basis for their strategic planning
for Health for All and Sustainable Development
The profile includes:
data on the state of health of the population
socio-economic and environmental determinants
Identification of social and health inequalities
Mapping of the services in the city and their usage
City Health Profiles
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The profilea joint effort
Expert
network team
collect data
from national
sources
facilitators and
consultants to thecity coordinators
and their teams
City
coordinator &
local team
collect data
from municipalsources
Define determinants
for inequalities andvulnerable groups
CBS
provide population
random samples and
weights for populationestimates
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Selected results
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Selected characteristics
AshP-TN-Z
567Socio-economic cluster
303331Median age
16.28.85.6% of families with 4+
children
55.961.370.2% entitled to
matriculation certificate
of 12thgraders
49.625.715.7% elderly receiving
supplement income
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Participated in the surveysaged 22+
AshP-TN-Zcity
539414489N
86.266.277.9Response rate
2006-72007-82008Year of conducting
the survey
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Selected characteristics of the
population in geographical areasP-T Ash
S i l it l
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Social capital
Trust people Mutual support
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Women aged 50+ performed
screening mammography (%)
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Self assessment of health by areas in cities and age
P di f i h l h d d
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Predictors of assessing health as good-very good
Logistic regressionin P-T -PC.IOR
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Predictors of assessing health as good-very good
Logistic regressionin N-Z-
PC.IOR
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Environmental and social nuisances
P-TN-Z
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conclusions
Variation in population composition exists within and
between cities
Inequalities between geographical areas in each city
are determined by the population mix as well as bytheir physical and social environments
Predictors of self assessment of health are not
identical in different cities.
A city health profile should be performed in each city
as a basis for identifying and prioritizing needs and as
a basis for evaluating the implementation of a health
equity policy.
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Strategic health development plan
Based on needs assessment
Integrates public desires and aspirations
Has a participatory planning process
Is integrated in the city action plans
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Haifa
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Schools &kindergartensCommunitycentersWorkplaces
Healthservices
Deprived
neighborhoods
municipality
Narrowing gaps, answer needs,
improving quality of servicesReduce
injuries
Improve theenvironment
Awareness
Reduce
smoking
Physical
activity
Haifa - a healthy city
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Towards an active city
The Haifa forum for healthy & active living
Steering committee
Sharing knowledge and experience
Mapping needs & assets
Political commitment
Participatory planning process
Determinants of physical activity
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Determinants of physical activity
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multi-component interventions that are adapted to the
local context were found to be the most successful.
What works?
Effective interventions invariably involved participants
in the planning and implementation stages, such as
involving the workers themselves in workplace
interventions, and community leaders in community
and..
WHO, 2009
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Evaluation framework
WHO global strategy on diet, physical activity and health: a framework tomonitor and evaluate implementation, 2008
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Health promoting hospitals - HPH
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Health promoting hospitals
The health promoting hospitals (HPH) project and
network facilitates change to promote total quality
management of the hospital.
It produces evidence to help hospitals achieve their
health mission and to support cooperation and
exchanges of experience between participating
hospitals.
http://www.euro.who.int/healthpromohosp
http://www.euro.who.int/healthpromohosphttp://www.euro.who.int/healthpromohosp -
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Health promoting hospital-hospitals
promote human dignity, equity and solidarity,and professional ethics, acknowledgingdifferences in the needs, values and cultures
of different population groups; be oriented towards quality improvement, the
well-being of patients, relatives and staff,protection of the environment and realization
of the potential to become learningorganizations;
The Vienna Recommendations, adopted at the 3rd Workshop of National/Regional HealthPromoting Hospitals Network Coordinators, Vienna, 16 April 1997
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Standards of a HPH
1. A hospital has a written policy for health
promotion. This policy must beimplemented as
part of the overall organization quality system
and is aiming to improve healthoutcomes. It is stated that the policy is aimed at
patients, relatives and staff.
2. describes the organizations' obligation to ensurethe assessment of the patients' needs for health
promotion, disease prevention and rehabilitation.
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Universities
Teaching health promotion in all schools of
public health
Health promotion university
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J. Orme and M. Dooris, HEALTH EDUCATION RESEARCH, 2010, 25: 425437
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thanks