Who promotes health?

Chapter 4. Who promotes health?


Chapter Contents



Agents and agencies of health promotion46


International agencies46


National agencies48


Other local organisations and groups56


Improving your health promotion role57



Summary


In this chapter the major agents and agencies of health promotion are identified, and their roles discussed. Included are international and national organisations, the government, the NHS, local authorities and voluntary organisations. There is an exercise on identifying key local health promoters and the chapter ends with suggestions for practice and an exercise about how you can improve your own health promotion role.

This chapter provides an overview of the people and organisations that support and enable better health. To some extent many lay people are health promoters, because they discuss health matters and offer support, advice and guidance to others. This can happen informally. The unofficial networks of family, friends and neighbours are of great significance in shaping people’s health beliefs and behaviour, in providing healthy living conditions and creating social capital. Health promotion may also occur incidentally. The availability of a wide variety of cheap fruit and vegetables in the summer, for example, means that it is easier for people to choose a healthy diet, so the greengrocer is inadvertently promoting health. These informal and unplanned sources of health promotion are very significant. The aim here, however, is to identify the agents and agencies through which planned, deliberate programmes and policies are delivered.

England, Wales, Scotland and Northern Ireland have public health systems which differ slightly but all countries support the following health policy themes:




• Modernisation: using up-to-date streamlined methods of management and communication in health (Department of Health (DoH)/NHS Modernisation Board 2003 and http://www.dh.gov.uk).


• Equity and inequalities: equal opportunities for everyone and reducing health inequalities between different social groups (DoH 2007).


• Social and economic regeneration: addressing poverty, unemployment, poor living conditions and social exclusion (a sense of not being a part of a community, of not belonging) (http://www.publicservice.co.uk).


• Democratic renewal: ensuring that the process of democracy is applied through all levels of public service (http://www.communities.gov.uk).


• Public involvement: getting people involved with decisions and actions that affect them, such as consulting people about proposed changes to local health services (http://www.publicinvolvement.org.uk).


Agents and Agencies of Health Promotion


Fig. 4.1 identifies a wide range of the most important agents and agencies of health promotion. Most have a variety of health promotion roles.








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Fig. 4.1
Agents and agencies of health promotion.


See Chapter 9, section on working in partnership with other organisations.

An increasing number of agencies work together in collaborative partnerships, in an effort to make their work more effective. Partnership working has been a dominant theme in national and international health promotion and public health directives since the Ottawa Charter (World Health Organization (WHO) 1986). In the UK it has been part of all the national strategies for health (see, for example, Department of Health, 1992, Department of Health, 1999 and Department of Health, 2004) and these have been accompanied by guidance on how agencies could work together for better health (see for example, the Welsh Partnership Forum constitution at http://www.cymru.gov.uk). Government strategies and guidelines continue to focus on the importance of partnerships for health between agencies and across government departments.


International Agencies



The European Community


In 2007 the EU developed a new public health strategy, Together for Health: a strategic approach for the EU 2008–2013 (Commission of the European Communities 2007). The strategy brings together and extends the public health programme and the programme in support of EU consumer policy. As public health and consumer protection policies share many objectives, such as promoting health protection, safety, information and education, the commission aimed, in combining the two programmes, to exploit synergies and to generate greater health policy coherence.

The WHO’s role in promoting health is also discussed in Chapter 1.


The Who


The WHO (http://www.who.int) has a role in guiding both European and global health policy. It has issued many statements in the form of declarations and charters addressing important and broad areas of health promotion and public health-related policy. It coordinates European networks such as Health Promoting Schools and Hospitals, and Healthy Cities. These initiatives are discussed more fully in Chapter 16.


Other International Agencies



The International Union for Health Promotion and Education (IUHPE)


The IUHPE (http://www.iuhpe.org) is half a century old, and is the only global organisation entirely devoted to advancing health promotion and health education. It is a leading global network working to promote health worldwide and contribute to the achievement of equity in health between and within countries. It has an established track record in advancing the knowledge base and improving the quality and effectiveness of health promotion and health education practice, with members ranging from government bodies, to universities and institutes, to nongovernmental organisations (NGOs) and individuals across all continents.

The IUHPE decentralises its activity through regional offices and works in close cooperation with the major intergovernmental and NGOs such as WHO, UNESCO, UNICEF, to influence and facilitate the development of health promotion strategies and projects.

The IUHPE has four goals:




1. Advocate for health: to advocate for actions that promote the health of populations throughout the world.


2. Build knowledge of effective health promotion and health education: to develop the knowledge base for health promotion and health education.


3. Improve effectiveness of policy and practice: to improve and advance the quality and effectiveness of health promotion and health education practice and knowledge.


4. Build capacity for health promotion and health education: to contribute to the development of capacity in countries to undertake health promotion and health education activities (http://www.iuhpe.org).


European Public Health Alliance (EPHA)


The EPHA (http://www.epha.org) is a network of NGOs (NGOs are organisations that are independent of government control) and other agencies actively involved in protecting and promoting public health. EPHA’s mission is to promote and protect the health of all people living in Europe and to advocate for greater participation of citizens in health-related policy making at the European level.


World Federation of Public Health Associations (WFPHA)


The WFPHA (http://www.wfpha.org) is an international, nongovernmental, multiprofessional and civil society organisation bringing together public health professionals interested and active in safeguarding and promoting the public’s health through professional exchange, collaboration and action. It is the only worldwide professional society representing and serving the broad area of public health, as distinct from single disciplines or occupations (such as the IUHPE). The Federation’s members are national and regional public health associations, as well as regional associations of schools of public health.


National Agencies



The Government


Government departments in the UK (and their devolved counterparts in Wales, Scotland and Northern Ireland), such as the Department of Health, the Department of Work and Pensions, the Department for Education and Skills (DfES), the Department of the Environment, Food and Rural Affairs and the Department of Transport, Local Government and the Regions, have an interest in and responsibility for the promotion of health and therefore have to take account of the impact of legislation and economic and fiscal policies on health.

The national public health strategies for health in England, Wales, Scotland and Northern Ireland demonstrate a commitment towards the pursuit of improved health and a reduction in health inequalities, rather than focusing just on treatment services and health care. To this end, key units have been established, for example, neighbourhood renewal (http://www.neighbourhood.gov.uk) and the social exclusion taskforce (http://www.cabinetoffice.gov.uk) to produce national directives to be implemented locally by partnerships of health services, local authorities, and voluntary and community organisations.

See Chapters 1 and 7 for more on national strategies for health.

The UK government has also taken a lead in tackling health issues such as drug misuse (DoH 2008a) and teenage pregnancy (Department for Children, Schools and Families (DCSF) 2007, DoH/DfES 2008). In relation to drug misuse, for example, its aims are to increase the safety of communities from drug-related harm, to reduce the acceptability and availability of drugs to young people and to reduce the health risks and other damage related to drug misuse. Multiagency drug action teams produce local plans, coordinate work and bring together a wide range of people and agencies to work at a local level.


Other National and Local Agencies



Non-governmental organisations


There are a number of NGOs concerned specifically with public health in the UK, such as The Royal Society for Public Health, the UK Public Health Association and The Institute of Health Education and Health Promotion.


The Royal Society for Public Health (RSPH)


The RSPH (http://www.rsph.org.uk) is an independent organisation dedicated to the promotion and protection of population health and wellbeing. It advises on policy development, provides education and training services, encourages scientific research, disseminates information and certifies products, training centres and processes. The RSPH is the largest multidisciplinary public health organisation in the UK and is an independent charity formed in 2008 by the merger of the Royal Society of Health (RSH) and the Royal Institute of Public Health (RIPH). Shaping the Future of Health Promotion is hosted and led by the Royal Society for Public Health (in collaboration with the Faculty of Public Health, UK Public Health Register and Institute of Health Promotion and Education). This important project derived from the main recommendations of the 2005 report Shaping the Future of Public Health: Promoting Health in the NHS (DoH/Welsh Assembly Government 2005). Through this project the RSPH advocates for the importance of specialised health promotion within public health and supports the specialised health promotion workforce.


The UK Public Health Association (UKPHA)


The UKPHA (http://www.ukpha.org.uk) is an independent voluntary organisation which aims to be a unifying and powerful voice for the public’s health and wellbeing in the UK, focusing on the development of healthy public policy at all levels of government and across all sectors. Their mission includes three aims:




1. To combat health inequalities and work for a fairer, more equitable and healthier society.


2. To promote sustainable development, ensuring healthy environments for future generations.


3. To challenge anti-health forces, collaborating with business to promote health-sustaining production, consumption, employment and socially responsible products and services.


The Institute of Health Promotion and Education (IHPE)


The IHPE (http://www.ihpe.org.uk) was established to bring together professionals on the basis of their common interest in health education and health promotion with a view to sharing experiences, ideas and information. It is a professional association with a recognised role in the field of prevention and management of illness and promotion of health. Its activities have been mainly concerned with health education, and following the Declaration of Alma Ata (WHO 1978) they also include health promotion. The IHPE has been in the forefront of health promotion developments with special contributions to the advancement of a settings approach.


Voluntary organisations and pressure groups


There are many voluntary organisations concerned with health promotion, some of which have regional and/or local branches. Examples of these are The Advisory Council on Alcohol and Drug Education (TACADE) (http://www.tacade.com) and the National Association for Mental Health (MIND) (http://www.mind.org.uk). Most of these organisations produce educational material, and some run training courses for professionals and/or the public. Some organisations act mainly as pressure groups, such as Friends of the Earth (http://www.foe.co.uk).


Professional associations


Professional associations, such as the British Medical Association (BMA) (http://www.bma.org.uk), the Royal College of Nursing (RCN) (http://www.rcn.org.uk), the Chartered Institute for Environmental Health (CIEH) (http://www.cieh.org) and the Faculty of Public Health (FPH) (http://www.fphm.org.uk) have been highly influential in policy and legislative changes and in the practice and training of their members in health promotion.


Trade unions


Trade unions are active in promoting health and safety at work, both through negotiating workplace conditions and through their health and safety representatives (Barbeau et al 2005). In the UK, The Health and Safety Executive (HSE) (http://www.hse.gov.uk) also oversees the implementation of health and safety at work legislation.


Commercial and industrial organisations


These have a role in safeguarding public health. Examples include companies providing water and refuse removal companies. In recent years in the UK, some facilities with a public health protection function have been privatised, which has raised public health dilemmas. For example, should water companies have the right to cut off supplies to consumers who do not pay their bills, when a possible consequence of this is the occurrence and spread of infectious diseases such as dysentery?


Manufacturers and retailers


Manufacturers have increasingly taken the health and safety aspects of their products into account. These include manufacturers of children’s toys, food manufacturers and producers of green eco household products. Large supermarket chains have made a wide range of healthy options available to the public, such as fat-reduced and low-sugar foods. These trends are often as a result of increased consumer demands, reflecting heightened awareness of health issues (House of Commons 2002).


The mass media


Health promotion is undertaken by national and local mass media organisations, including television, radio, newspapers and magazines (Hubley & Copeman 2008), and through the Internet many people have easy access to a huge range of health information (Korp 2006).

See Chapter 11 for more about mass media in health promotion.


Churches and religious organisations


Churches and religious organisations play an important part in developing values, attitudes and beliefs that affect health. Kramish Campbell et al (2007) show how church-based health promotion can influence members’ lifestyle at multiple levels of change and produce significant impacts on a variety of behaviours.


The National Health Service (NHS)



The structure of the NHS


The NHS, established in 1948, has been reorganised on a regular basis, usually as a new government is voted into power. The most significant and fundamental reorganisation happened in the 1990s, starting with the National Health Service and Community Care Act reforms (DoH 1990). During the 1990s, a key feature of the NHS was the internal market and the division into purchasers and providers. Local health authorities were the purchasers, who decided what health care was required and purchased it, setting and monitoring contracts with provider local hospitals and community services. These providers became NHS trusts, in competition with one another to win contracts from the purchasers. The election of a new government in 1997 brought an approach which emphasised integrated care, and working in a spirit of cooperation. The New NHS: Modern, Dependable (DoH 1997) set out the plan for the health service, with partnership, quality and performance at the heart of the NHS, a focus on improving health and wellbeing, and tackling the root causes of ill health and inequalities. A separate White Paper was published for Scotland (DoH/Scottish Office 1997). In a shift towards a primary care-led NHS, primary care groups (PCGs) were set up in the late 1990s. These were basically groups of GP practices that worked closely with local authorities, especially social services, to assess local health needs and develop local health services. The NHS Plan (DoH 2000) set out a further programme for reform, investment and expansion of the NHS, including a central role for the wider public health function, including health promotion.

See below for information on primary care trusts.

Shifting the Balance of Power Within the NHS – Securing Delivery (DoH 2001) set out further change with a power shift to frontline staff. Primary care groups were given additional responsibilities to run services; they developed into primary care trusts (PCTs) with a responsibility to work closely with social services.

Larger strategic health authorities replaced the existing smaller health authorities in England in 2002. Strategic health authorities support the PCTs and NHS trusts in delivering The NHS Plan, to build capacity and support performance improvement, ensuring that all NHS organisations work together to meet government targets. (See http://www.nhs.uk for an interactive timeline which details milestones in the history of the NHS from its very beginning in 1948 to the present day.)

In 2002, the Department of Health was refocused. Figs 4.2 and 4.3 show the overall structure of the NHS in England. At the top in Fig. 4.2 is the Secretary of State for Health, the government minister in charge of the Department of Health, responsible for the NHS in England and answerable to Parliament. The Department of Health and the NHS Executive are responsible for the strategic planning of the health service as a whole. Under the Department of Health are strategic health authorities which plan health care for the population of the region they cover.








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Fig. 4.2
The structure of the NHS in England since April 2002.

(Figure adjusted from Office of Health Economics website:http://www.ohe.org/page/knowledge/schools/hc_in_uk/nhs_structure.cfm. Reproduced with permission).








B9780702031397000044/f3.jpg is missing
Fig. 4.3
The structure of the NHS.

(Sourcehttp://www.nhs.uk/NHSEngland/aboutnhs/Pages/NHSstructure.aspx. Seehttp://www.nhs.ukfor further details on the diagram and the structure, core principles and history of the NHS. Reproduced with the permission of NHS Choices).

Health services are divided between primary and secondary. Primary care services include general medical practitioners (GPs), dentists, pharmacists, opticians, district nursing and numerous other services. Secondary care includes not only hospitals but also ambulances and specialised health services for the mentally ill and the learning disabled, as shown in Fig. 4.2.

Services are provided by NHS organisations called trusts. NHS trusts supply secondary care. PCTs provide primary care services and are responsible for buying almost all of the health care, both primary and secondary, required by the local populations they serve (see more on PCTs and NHS trusts under Agents of Health Promotion, below).

The structures in Scotland, Wales and Northern Ireland differ. In the interests of keeping the text in this book short, the terms used are applicable to England but readers in all countries will need to familiarise themselves with the structure in the country where they work by undertaking Exercise 4.1.

EXERCISE 4.1
What’s on your patch? Finding out about your local NHS and agents and agencies of health promotion



Exercise 4.1 is designed to help you to find out how your local NHS is organised and to identify the health promotion agents and agencies which are important for your work. There is much to gain by having good local knowledge of health promoters you can refer clients to or work with in partnerships.




1. Find out about the structure of the NHS in the area where you work:




▪ What is the name and function of the local organisation with responsibility for public health? (This will be your local primary care trust/care trust or its equivalent in Scotland, Wales or Northern Ireland. Try http://www.nhs.uk for information.)

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Apr 17, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on Who promotes health?

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