Models and approaches to health promotion

Chapter 5 Models and approaches to health promotion


The diversity in concepts of health, influences on health and ways of measuring health lead, not surprisingly, to a number of different approaches to health promotion. Chapter 4 began to explore the concepts of health education and health promotion. In this chapter, five different approaches will be discussed:

These approaches will be examined in terms of their different aims, methods and means of evaluation. These approaches have different objectives:

All of the approaches reflect different ways of working. Identifying the different approaches is primarily a descriptive process. The framework is descriptive – it does not indicate which approach is best, nor why a practitioner might adopt one approach rather than another. A number of theoretical frameworks or models of health promotion are outlined, discussed and assessed in relation to practice in the latter part of the chapter.

It is common for a practitioner to think that theory has no place in health promotion and that action is determined by work role and organizational objectives rather than values or ideology. We have argued elsewhere that practitioners should be aware of the values implicit in the approach they adopt: ‘Values thus determine the way in which the world is seen and the selection of activities and priorities and how strategies are implemented’ (Naidoo & Wills 2005, p. 13).

Models of health promotion are not guides to action but attempts to delineate a contested field of activity and to show how different priorities and strategies reflect different underlying values. They are useful in helping practitioners think through:

The medical approach


This approach focuses on activity which aims to reduce morbidity and premature mortality. Activity is targeted towards whole populations or high-risk groups. This kind of health promotion seeks to increase medical interventions which will prevent ill health and premature death. This approach is frequently portrayed as having three levels of intervention:

The medical approach to health promotion is popular because:

As we have seen in Chapter 1, the medical approach is conceptualized around the absence of disease. It does not seek to promote positive health and can be criticized for ignoring the social and environmental dimensions of health. In addition, the medical approach encourages dependence on medical knowledge and removes health decisions from lay people. Thus, health care workers are encouraged to persuade patients to cooperate and comply with treatment.

Public health medicine is the branch of medicine which specializes in prevention, and most day-to-day preventive work is carried out by the community health services which include specialist community public health nurses and district nurses.


The principle of preventive services such as immunization and screening is that they are targeted to groups at risk from a particular condition. Whilst immunization requires a certain level of take-up for it to be effective, screening is offered to specific groups. For example, in the UK cervical screening every 3–5 years is offered to all women aged 25–64.

For screening to be effective for the condition or disease:

The UK National Screening Committee oversees screening policies and gives advice based on available evidence. For more details visit

Preventive procedures need to be based on a sound rationale derived from epidemiological evidence. The medical approach also relies on having an infrastructure capable of delivering screening or an immunization programme. This includes trained personnel, equipment and laboratory facilities, information systems which determine who is eligible for the procedure and record uptake rates, and, in the case of immunization, a vaccine which is effective and safe. It can be seen then that the medical approach to health promotion can be a complex process, and may depend on the establishment of national programmes or guidelines.

Having screening or immunization facilities available is only effective if people can be persuaded to use them.


Evaluation of preventive procedures is based ultimately on a reduction in disease rates and associated mortality. This is a long-term process and a more popular measure capable of short-term evaluation is, for example, the increase in the percentage of the target population being screened or immunized.

Although there appears to be a close correlation between immunization uptake and a decline in disease rates, the example of whooping cough suggests some caution is needed. In 1974 80% of children were vaccinated against whooping cough. Following media publicity about the safety of the vaccine, immunization rates fell and did not reach 80% population coverage again until 1987. There were major whooping cough epidemics in 1977–1979 and 1981–1983, suggesting that immunization had contributed to the decline in notifications. However, the overall decline in mortality from whooping cough was occurring before the vaccine was introduced in 1957, suggesting that better nutrition, living conditions and medical care may also be significant.

Behaviour change

The educational approach

Mar 21, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on Models and approaches to health promotion
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