WP6 Preliminary Literature Review

Results: Institutions

Michał Zabdyr-Jamróz [coordinator]

Alicja Domagała

Iwona Kowalska

Anna Mokrzycka

Maciej Rogala

Stojgniew Jacek Sitko

Anna Szetela

H e a l t h p r o m o t i o n a n d p r e v e n t i o n o f r i s k – a c t i o n s f o r

s e n i o r s

P r o - h e a l t h 6 5 +

K r a k ó w 0 8 - 0 9 . 2 0 1 5

• Collected sources

• Conclusions (incl. SPOFER)

• Definition of Health Promotion –

proposition and dilemmas

• Discussion

Presentation plan:

1. [Initiatives]

Institutional/organisational profile

of selected interventions

(programmes + good practices).

2. [Institutions] Country profiles of

institutions involved in health

promotion for the elderly.

Collected data:

• PubMed search – systematic review: all selected countries; all sectors (24 items/706 publication) + NGO only (13 items/ 40 publications)

– Selected:

• prevention and promotion,

• also studies on interventions, determinants, etc. – to identify institutions performing research on health promotion (E)

• Other sources – narrative review (also inprogress)

Literature reviewed:

• Programmes – abundance of literature devoted to the characteristics, efficiency and performance.

• Each source provides general information on institutions involved, organization, human and financial resources mobilised – not in a systematicway however.

• Gray literature and websites contain information about various programs describing their Institutional factors: legal and extra-legal – some database design present systematically the institutions involved in the activity data:

– E.g. Health Pro Elderly

Conclusions:

• There are well established literature review tools for the interventions analysis (PICO, PICOS) but those are not useful for the institutional and organisational analysis (question frames concern: Population, Interventions, Comparators, Outcomes, Study design) [Systematic Reviews, CDR 2009]

• Lack of systematic institutional analysis on HP for the elderly

• Individual institutions’ charters and declarations present activities profile rather than definitions

• There are several publications on concerned with institutional issues, however for HP in general and rarely specifically for the elderly (most notably: Health Policy Journal):

– Recommendations for better organisational arrangements – Martin Brussig, Nico Dragano, Sarah Mümken, Health promotion for unemployed jobseekers: New developments in Germany, Health Policy, Vol. 114, Issues 2-3, p192–199)

– Austerity as a serious problem:• Amalia A. Ifanti, Andreas A. Argyriou, Foteini H. Kalofonou, Haralabos P. Kalofonos, Financial crisis and austerity measures in Greece:

Their impact on health promotion policies and public health care, Health Policy, Vol. 113, Issues 1-2, p8–12

• GianLuca Quaglio, Theodoros Karapiperis, Lieve Van Woensel, Elleke Arnold, David McDaid, Austerity and health in Europe, Health Policy, Vol. 113, Issues 1-2, p13–19

– Indications of a divide between national and municipal public health strategies:• Marie J. Tallarek née Grimm, Marit K. Helgesen, Elisabeth Fosse, Reducing social inequities in health in Norway: Concerted action at state

and local levels?, Health Policy, Vol. 113, Issue 3, p228–235

• Elisabeth Jansson, Elisabeth Fosse, Per Tillgren, National public health policy in a local context—Implementation in two Swedish municipalities, Health Policy, Vol. 103, Issues 2-3, p219–227

– Claudia B. Maier, José M. Martin-Moreno, Quo vadis SANEPID? A cross-country analysis of public health reforms in 10 post-Soviet states, Health Policy, Vol. 102, Issue 1, p18–25

– Discussion on paternalistic HP: Signild Vallgårda, Nudge—A new and better way to improve health?, Health Policy, Vol. 104, Issue 2, p200–203

– Some advice on institutional solutions: Jonathan Boote, Wendy Baird, Anthea Sutton, Public involvement in the systematic review process in health and social care: A narrative review of case examples, Health Policy, Vol. 102, Issues 2-3, p105–116

• Other appraches to institutions focus on social capital as a determinant of health or sociological analysis of HP:– Penelope Hawe, Alan Shiell, Social capital and health promotion: a review, Social Science & Medicine Volume 51, Issue 6,

15 September 2000, Pages 871–885

– S Nettleton, R Bunton, R Bunton, S Nettleton, Sociological critiques of health promotion, 1995

Conclusions:

• Basing on the institutional approach (functions/goals distinction): what functions are performed within the goal of health promotion for the elderly?[Ryan, Alan, 1970, The Philosophy of the Social Sciences, London: Macmillan]

• Overview of literature – both dedicated to projects and institutions – showed that different institutions can perform a constant set of functions.

• One institution can perform more than one function

• As a result of the literature review, a set of groups of functions was devised – SPOFER. These are grouped areas of functions, which are assigned in the literature to various institutions engaged in health promotion.

Conclusions:

• (S) Setting – given institution is a health promotion setting;

• (P) Promoter – institution / its personnel implements the program (street-level);

• (O) Organiser – institution responsible for initiation and/or organisation of a given program;

• (F) Financing – institution that provides funding (entirely or partly);

• (E) Expertise source – institution that guarantees evidence based promotion; provides training, guidelines, evaluation, etc.;

• (R) Regulation & control – institution that provides legal regulations and control, supervison, registration or gives obligatory appraoval.

Functions of institutions: S.P.O.F.E.R.

• Categories of functions.

• SPOFER framework can function in a similar way as PICO framework, though it will serve for extraction of organisational data

• Provides simple functions checklist (vide: project questions).

• [in the future] Allows the identification of good organisational practices (when combined with data on effectiveness and efficiency with organisational characteristics)

Data extraction by SPOFER:

• Functions within each HP activity/intervention tend to be distributed among different institutions from different sectors

• Institutions of one sector, while retaining their status, can be active in other sectors –performing various roles.

• In HP for the elderly extensive level of inter-sectors cooperation can be observed.

• This represents a shift in policy model towards concept of good governance / stewardship promoted by Ottawa [WHO 1986] and Bangkok [WHO 2006] Charters of HP

Conclusions:

• When it comes to HP programmes: Public authorities, both central and local, tend to carry out following functions: financing (F),regulating and control (R: registering), and organising (O: creating a framework for action, coordinating).

• Research Institutes perform the function of providing expertise (E) – especially when evaluating initiatives already undertaken. Also, their bioethical committees provide approvals (R).

• Different countries have a wide range of HP activities.

Conclusions:

Definition of Health Promotion

Proposition for the WP6,

based on specificity of the subject

• Various existing approaches – mostly oriented on types of interventions

• Various interventions use their own definitions.

• Even institutions adopt their own definitions.

• So far, however, we do not have analytical tool to systematically study them from the institutional perspective.

• literature focuses on HP content rather that institutional arrangements

Definition of Health Promotion –

for the institutional analysis:

• „Structural analysis of health promotion

approaches:

– conservative (health persuasion techniques),

– reformist (legislative action for health),

– libertarian (personal counseling for health) and

– radical pluralist (community development for

health) concepts”

[„Overview on health promotion for older

people” (2008, p. 20)]

For instance:

• WP6 requires definitions that accommodates the widest possible range of activities actually performed under the term „PH”, all possible aspects (practices) in order to be operationalised and serve as an analytical tool – hence the „umbrela apprach”.– K. Tones, Health promotion a new panacea, Joumal of the

Institute of Health Education, 23(1), 1985, pp. 16-21

• It must cover not only activities but also the aspects of management, organisation, actors’ involvements, functioning, etc. – hence: policy oriented definitions, most notably:– The Ottawa Charter for Health Promotion (WHO 1986)

– The Bangkok Charter for Health Promotion in a Globalized World (WHO 2005)

Goals of the definition of health promotion

for the institutional analysis:

• (R) Human rights and solidarity basis (constitutions, doctrine, international law); legal and regulatory guarantees (monitoring, control)

• (E) Evidence based addressing of determinants of health;

• (O, S) Policies, actions and infrastructure

• (O, S) an inherently political enterprise: state action, power, heteronomy, redistribution of wealth,

• (O, F) sustainable policies investment;

• (O, F) Multi-level coalition building: local; national; international (global);

• (O, S) Inter-sector coalition building: public; private; nongovernmental and civil society;

• (P) Promoter–beneficiary coalition building;

• (O, E) Capacity: policy development, leadership, practice, knowledge transfer and research, and health literacy

Key points of The Bangkok Charter

refer to SPOFER functions:

Goals of the definition:

It also should:

• Include normative aspect present in

international declarations

• include various approaches to HP:

traditional/modern, etc. (Downie et al. 1990,

Beattie, 1991);

• allow an operationalisation into an analytical

tool

• Frame of the definition based on the one

proposed by: Jill Maben, Jill Macleod Clark,

(Health promotion: a concept analysis, Journal

of Advanced Nursing, 1995, 22, pp. 1158-

1165).

• This frame is a concise presentation of relevant

aspects

• Definition is rearranged and amended in

reference to newer publications.

Definition of Health Promotion –

proposition:

Health promotion (as a core function of public health) is the process of improving people’s health status by enabling them – individually but also within a community and trough the polity (WHO 1986) – to increase control over their health and its determinants (Dean & Holstein, 1991).Health promotion is a unifying concept encompassing various activities (prevention, education, policy) that should: respect human autonomy (Downie et al. 1990, Beattie,

1991); be sustainable, evidence-based, as well as adjusted to the specificity of the target group and its local context(WHO 1986). It should be performed as a concerted action of various entities from all sectors and on all levels of governance thus effectively engaging all available resources (WHO 1986, 2005).

Composition of the definition:

…is the process of improving people’s health

status by enabling them – individually but also

within a community and trough the polity – to

increase control over their health and its

determinants. Health promotion is a unifying

concept encompassing various activities …

- [an umbrella term] (K. Tones, Health promotion a new

panacea, Joumal of the Institute of Health Education,

23(1), 1985, pp. 16-21)

Aspects of the definition:

[PH sensu largo]

[PH core]

The Concept of Health Promotion :

DIS

EA

SE

TR

EA

TM

EN

T

DIS

EA

SE

PR

EV

EN

TIO

N HEALTH

EDUCATION

PO

LIC

Y /

RE

FO

RM

HEALTH

MARKETING

[PH+]

… [prevention] This includes – though is not

limited to – the prevention of disease for the

purpose of raising awareness of the issue and

fostering an ability to cope with illness or

disease. …

Aspects of the definition:

… [education] Crucial part of – and necessary prerequisite to – health promotion is a sustainable health education through information-giving, advice, support and skills training. Its goal, i.e. the healthy behavioral or lifestyle change, requires respect for the individual autonomy and self-esteem. Thus health education should not be limited to 'top-down' authoritative persuasion expecting a passive compliance (traditional approach). Instead it should include a more participatory, two-way relation between the health promoter(s) and promotion addressee(s) - „modern approach”

- [Respecting human autonomy] (Downie et al. 1990, Beattie, 1991)

Aspects of the definition:

… [policy] In its broader form it is also concerned with the wider health impacts of public policies and legislations or – for that matter – of non-decisions. Health promotion means “making healthier choices easier choices” (Dennis et

al 1982) by promoting value of health in all policies (WHO

1986, Cribb & Dines 1993). It thus avoids victim-blaming, since an unhealthy behavior might be a result of personal and societal circumstances (stress and poverty, poor infrastructure, lack of access – or too easy access – to goods and services) rather than individual choices (Maben

& Clark 1995). The most radical approach to health promotion encompasses notions of people’s empowerment, equity, collaboration and participation, and involves social and environmental change (Aggleton & Whitty 1986, Naidoo & Wills 1994, French 1990, Caplan & Holland 1990,

Tones et al 1990). …

Aspects of the definition:

…[HP] should: … be sustainable, evidence-based, as well as adjusted to the specificity of the target group and its local context. It should be performed as a concerted action of various entities from all sectors and on all levels of governance thus engaging all available resources.

[governance] Health promotion activities should engage all communities’ resources (including human and social capitals), and be a result of a concerted action of various actors (public, for-profit, non-profit), from all sectors (healthcare, education, etc.) and on all levels of governance (from local to global) (WHO 1986, 2005).

Aspects of the definition:

Health promotion (as a core function of public health) is the process of improving people’s health status by enabling them – individually but also within a community and trough the polity – to increase control over their health and its determinants. Health promotion is a unifying concept encompassing various activities (prevention, education, policy) that should: respect human autonomy; be sustainable, evidence-based, as well as adjusted to the specificity of the target group and its local context. It should be performed as a concerted action of various entities from all sectors and on all levels of governance thus engaging all available resources.

Definition of Health Promotion

[proposition]

• R.S. Downie, G. Fyfe & A. Tannahill A, Health Promotion Models and Values, Oxford University Press, Oxford 1990

• A. Beattie, Knowledge and control in health promotion a test case for social policy and social theory [In] M. Calnan, M. Bury eds. The Sociology of the Health Service Gabe, Routledge London and New York 1991

• A. Cribb & A. Dines, What is health promotion? [In ] A. Dmes & A. Cribh (eds.), Health Promotion Concepts and Practice, Blackwell Scientific, Oxford 1993, pp 20-33

• K. Dean, B.E. Holstein, Health promotion among elderly. [In]: Health promotion research. Towards a new social epidemiology. Ed. By Badura, B., Kickbusch, I. WHO. Regional Publications. European Series 37, 1991, pp 341- 363.