What's the difference between health promotion and health education?
One of the main reasons for my relocating from the United Kingdom to New Zealand three years ago was the potential of the government's more recent health policy reforms to influence effective health promotion. I have, however, since found out that sometimes more rhetoric than reality accompanies these proposed reforms. I am encouraged, though, by the government's commitment (currently at $2.2 billion) to the 2001 Primary Health Care Strategy. This strategy is the flagship of New Zealand health service reform and has the potential to profoundly influence the way nursing is delivered in this country. I say that it has the potential to reform nursing care delivery because, even after nearly a decade of implementation, nursing has yet to widely embrace, sanction or influence health promotion reform, to the extent one might hope for or expect. While this editorial is somewhat critical of the nursing contribution to health promotion, I also acknowledge the future is nevertheless encouraging.
Evaluating effective health promotion
Globally, nursing has often been maligned and criticised about its ability to conduct and evaluate effective health promotion activities--both inside and outside the profession. Much of the reason for this is that, while other health disciplines understand what health promotion is, it is well documented that nurses often do not. (1) The traditional mainstay of nursing-based health-related practice remains the provision of "expert-driven", individualised and behaviourally-orientated Lifestyle adaptation programmes. These strategies are normally acute-illness focused, disease risk-based, reactive and opportunistic. They are rarely well planned and hardly ever evaluated for their effectiveness. What is well established is that these types of health-related interventions rarely have any useful or Lasting impact and, if anything, have the potential to actually cause far more harm than good. Giving smoking cessation advice to someone in intensive care who has had a heart attack, for example, may only serve to alienate the client from you and may even stress them out, the Last thing they need. Merely giving information alone, without Long-term planning and follow-up, is next to useless and can set the client unattainable goals. The rates of relapse for smokers without ongoing support is extremely high.
The main problem for nursing is that, if this is the type of activity most nurses perform, believing they are engaged in health promotion, this is not health promotion at all--it is health education.
It is well established in the general health promotion community that there are distinct differences between health education and health promotion. It is vital to acknowledge and understand what this means for health care practice. Health promotion programmes often use elements of health education but, even where these interventions are conducted in a well-planned, resourced, pro-active and empowering manner, health education still exists as a sub-set of overall health promotion activity. Nurses need to be doing something different if they wish to engage in and be recognised for their contribution to health promotion. The article "Helping clients move towards health change" by Wayne Bradshaw (p16-17) is a good example of a nurse involved in effective health education, while the profile of Otara Health on p12-13 is, to my mind, a story about health promotion.
Developing "whole community" programmes
So what is this difference? Health promotion has Little to do with simply giving people health-related information and expecting they will do something constructive with the advice. Instead, it is about developing "whole community" development programmes that particularly target those most in need (usually those of Lowest socio-economic status). It seeks to activate the resources needed to empower communities to identify their own health priorities and gauge and implement strategies needed to overcome identified social challenges. Strategies which promote population health, community development, social capacity, primary health care, health policy and public health initiatives all come under the umbrella of health promotion. Where nurses are involved in these collaborative and multi-disciplinary/agency initiatives they can rightly consider themselves involved in health promotion. The profile of Dahlia Naepi on p18-19 and the story of her struggle to provide quality health care to Pacific people on Auckland's North Shore mirrors at Least elements of this and can be held up as a useful example of health promotion reform in and for New Zealand nursing.
Through my own regional and national networking over the Last three years, I have been pleasantly encouraged by the amount of nursing-related health promotion activity I have witnessed. Most of this activity is centred on health-promoting schools and health-promoting marae--both very good causes. This activity, however, can be expanded to other settings and it would be good to see more networking between regions and more national evaluation of programmes, alongside widespread sharing of results. Nevertheless this activity is still very encouraging and with a wider voice and more publicity, nursing in New Zealand may fast become recognised for offering a valid health promotion contribution.
I Look forward to the day when this position is more the norm than the exception in nursing practice--and when both hospital/institution and community-based health care work seamlessly together, with the interest of the whole community in mind. Educationally, I would also Like to see the contents of this issue of Kai Tiaki Nursing New Zealand resonate with undergraduates and new graduates alike, in the hope that ever-increasing numbers of nurses will be attracted to community-based health promotion careers.
(1) Casey D (2007) Nurses' perceptions, understanding and experiences of health promotion. Journal of Clinical Nursing; 16, 1039-1049.
Dean Whitehead, RN, MSci (hlth ed and hlth promotion), is a senior lecturer in the School of Health Sciences, Massey University, Palmerston North.
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|Publication:||Kai Tiaki: Nursing New Zealand|
|Date:||Aug 1, 2007|
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