Health promotion as the new public health

Physical, mental and social wellbeing

The World Health Organization defines health as “a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity”.

Health is therefore holistic as it includes dimensions such as physical, emotional, spiritual, sexual, social, mental, societal, environmental and global health.

For example:

• physical health focuses on fitness and not being ill;
• mental health is concerned with a sense of good feeling and the ability to cope;
• emotional health has to do with expression of love and relationships;
• spiritual health is concerned with the ability to practise one’s moral and religious beliefs;
• ability to achieve an expression of sexuality is defined by sexual health;
• Social health deals with support from family and friends.

In addition, Naidoo and Wills stated that while societal health links health and the society including the infrastructures that promote health like shelter, food and peace, environmental health highlights how the relationship between man and his environment impacts on his health.

Dahlgren and Whitehead’s rainbow model was designed to describe the root causes of social inequities in health, and differentiate the determinants of the overall population health from the determinants of social inequities in health, so that appropriate policies aimed at narrowing the health gap will be well directed.

According to Dahlgren and Whitehead, at the centre of the human life are age, sex and genetic factors which are unmodifiable, and have great influence on health.

However, factors like lifestyles, social interactions among persons, living and working conditions, food availability, access to goods and services, socio-economic, cultural and environmental conditions also impact on health outcomes but can be modified, for example through policy formulation and legislation.

Alcohol misuse, smoking and physical activity are examples of modifiable behavioural factors.

These rainbow-like layers of health determinants describe interactions among people whose lifestyles revolve around social norms and networks, and which are affected by the living and working conditions, social, economic and cultural environment.

According to Wilkinson, further grouping of the above factors describes them as:

• positive factors – when they play a role in health maintenance, for example, good housing, socio- economic empowerment, food security and emotionally stable relationship;
• protective factors – when they stop risk factors or facilitate resistance to diseases, for example, social support, a sense of direction and purpose in life, and healthy diets such as high intake of fruit and olive oil;
• and finally risk factors – which cause health issues and diseases that are preventable, for example, polluted air and smoking.

Health promoting scene

According to Awofeso, health promotion represents the “New Public Health”.

This concept was said to have evolved over the years culminating in the transformation of the primary health care into health promotion.

The aim of this evolution, according to Awofeso, was to devise means of addressing the emerging and new health threats.

Many theories and concepts have been introduced to explain health promotion and what it sets out to achieve.

For example, the pathogenic concept is concerned with identification of the cause of ill health, the risk factors and the treatment of ill health, while the salutogenic concept focuses on how people cope in difficult situations.

According to Naidoo and Wills, the pathogenic theory is the most predominant, and more commonly practised by trained health professionals in western countries.

The salutogenic concept is a relatively new concept that was introduced about 39 years ago by late Dr. Antonovosky to answer questions about people being able to stay alive and live a healthy life in spite of many health challenges facing them.

Medical profession focuses more on the pathogenic concept which has been the basis for clinical practice.

The salutogenic concept has therefore expanded the knowledge and understanding of health promotion and its relevance in healthy living.

The usefulness of salutogenic concept is derived from what Antonovsky called the sense of coherence which explains why some individuals stay healthy even in very difficult situations.

Sense of coherence comprises three components:

• the ability to understand environmental challenges;
• ability to manage situations;
• and the ability to remain motivated.

Sense of coherence is regarded as a coping resource, and therefore coping strategies such as self-esteem, social skills, family support, self-reliance, self-confidence and motivation have been identified to make sense of coherence strong, thereby brightening the chances of one surviving a harsh condition while maintaining a healthy life.

“If my hypothesis that the sense of coherence is decisive in facilitating movement toward health is correct…, the implication is that it may provide a powerful, comprehensive and systemic theoretical guide for research, and ultimately for action, in the promotion of health” Antonovsky

Wellness

It is noteworthy that both pathogenic and salutogenic concepts of health promotion complement each other in ensuring optimal health and wellbeing.

It may be necessary to consider, at this juncture, the general resistance resources concept, which is depended upon by sense of coherence.

According to Lindstrom, general resistance resources are biological, material and psychosocial factors which help individuals cope with challenges of life while the sense of coherence is the ability to make use of these factors.

There are divergent views on the salutogenic approach to public health, with some researchers admitting some limitations in the ability of sense of coherence to address public health issues holistically.

For example, Ericksson admitted that it is strongly associated with especially mental health.

Another research by Garcia-Moya et al. observed that most researches only dwelt on how the sense of coherence is related to health outcomes.

In addition, family is described as pivotal in bringing about strong sense of coherence.

However, only few researches focused on the dimensions of family in relation to Sense of Coherence.

There is little information on the place of family influences in health promotion, an indication for further studies in the area of salutogenesis.

It is therefore hoped that health promotion will be widely accepted as an independent concept devoid of the encumbrances of the previous public health eras to pave way for its use in addressing public health issues radically.