Friday, September 01, 2006

Health Promotion in Schools, Worksites and Communities

Health promotion in schools

Schools are an ideal place to undertake health promotion activities due to the large numbers of young people all in one place. Further if healthy behaviours can be encouraged in early life, the more likely we are to have a healthy population in later years. One area of significant concern has been over drug use. In the last 20 or so years there have been large numbers of drug education programmes put in place, in theory to combat the rising use of drugs in the younger population. Education would seem to be an effective method since the target population is often still in education and are aware of how to learn from standard educational practices.

Young people constitute one of the high risk groups who experiment with or recreationally use legal and illicit psychoactive substances. Within this age group, primary prevention initiatives are the most appropriate in motivating young people to avoid drug experimentation. The aim of preventive health education in schools is to raise young people's awareness of the facts about drug misuse and associated risks, emphasise the benefits of life-styles and develop skills needed to make informed and responsible decisions to resist drug misuse (Department of Health 1995).

The Tackling Drugs Together (1995) report on A Strategy for England 1995-1998 has been introduced by the government to tackle drug misuse. One of the aims of the strategy is to reduce the accessibility (demand) and availability (supply) of drugs to young people. The objectives of the strategy are:

  • To discourage young people from using drugs.
  • To raise awareness among staff, governors and parents of issues related to drug misuse.
  • To ensure that schools offer effective programmes of drug education and the availability and accessibility of a range of services: advice, counselling, treatment, rehabilitation and after care services.

The plan of action in relation to young people and substance misuse includes the training of teachers, the support of innovative projects in drug education and prevention, the development of school policies on managing drug related incidents and drug education. Other initiatives focus on new (Government) interdepartmental publicity campaigns with advertising and media expertise, and role models aimed at helping young people to resist drugs. (Rassool, 1998)

However according to De Haes (1987) from a review of various studies, which themselves have selectively identified drug education programmes that fit the criteria for decent research (reliable, use of control groups and follow-up studies), it can be concluded that they have either had no significant effect or in some cases a detrimental one. In other words by discussing and enlightening young people about drug abuse some of them have taken an active interest!

It can also be concluded that “…programmes paying attention to young people, who they are and how they live, teaching them how to overcome day-today difficulties and so forth, are effective not only in reducing drug use, but also in reducing other rebellious or attention-seeking behaviour.” (De Haes, 1987)

Thus we need to adopt a balanced view to drug abuse bearing in mind these factors –

  • All substances have an effective, toxic and lethal dose.
  • All drugs have varied effects
  • Drug use can only be viewed in light of the legal status of the drug
  • Experimenting is a part of adolescence
  • Every user has there own history
  • There is a distinction between recreational, occasional, regular, and heavy/compulsive use
  • Drug use can be negatively influenced by the intervention of others
  • Destructive drug use is related to other destructive behaviour

(Nowlis 1975)

To add confusion to this debate there are four main perspectives through which people look at the ‘problem’ of drug abuse –

  1. Moral-Legal Model. Drugs are prohibited by law, therefore drug use is a crime and so users and sellers must be prosecuted.
  2. Disease/Public Health Model. Drugs are harmful to the body, people using them have a kind of illness, they need medical treatment.
  3. Psycho-Social Model. Users have personality disturbances/problems. They need psychotherapy to help them.
  4. Socio-Cultural Model. Users are the victims of a badly organised and unjust society. Society need to change before any decrease in drug abuse will be seen.

According to De Haes (1987) all of these models contain some validity. Therefore only a view which takes account of them all can be useful. What he claims we do know is that programmes which pay attention to young people in their maturation phase are more effective than simple drug information programmes. Thus helping young people to develop the skills they need to deal with difficulties they face would be a crucial first step in reducing drug use. Such programmes could easily incorporate the essence from each model to address the issue and be of use to young peoples lived experience.

Health promotion in worksites

Given that for people in full time employment the place they spend most time outside of the home is in their workplace. Thus it makes sense to encourage positive health behaviours in such settings, however the direct costs involved mean that this is often only viable for larger companies.

The work place is an ideal environment for the capture of sizeable numbers of adults as recipients for promotional information on health and prevention of the use and misuse of tobacco smoking, alcohol and drugs. In a review of current approaches to health promotion in the work place and their effectiveness in preventing and controlling alcohol and drug related problems, the WHO (1993) drew attention to the need for workers' participation in programme development and implementation, and for the needs of specific occupational groups and the diversity of cultural settings to be taken into account. Compared to other countries, the UK has a low rate of work place health promotion practice (Fhilo et al., 1993) and only 40% of the work places studied were involved in health promotion (Health Education Authority 1993).

However, health promotion activities are slowly being introduced in the work setting. For instance, the occupational health service of British Rail developed an advisory unit for those with an alcohol or drug problem in 1992 (McHugh 1995), and a new and updated drug and alcohol policy was introduced in 1993 with the full support of the trade unions.

Another good example of health promotion in a workplace (this time in the USA) is outlined below -

Johnson & Johnson is the USA's largest producer of health care products. They began the Live for Life program in 1978, and it is one of the largest, bestfunded, and most effective worksite programs yet developed (Fielding, 1990; Nathan, 1984). The number of employees covered by the program has grown over the years and now exceeds 31,000. The health goal of the program is to help as many employees as possible live healthier lives by making improvements in their health knowledge, stress management, and efforts to exercise, stop smoking, and control their weight.

For each participating employee. Live for Life begins with a health screen—a detailed assessment of the person's current health and health-related behavior, which is shared with the individual later. After taking part in a lifestyle seminar, the employee joins action groups for specific areas of improvement, such as quitting smoking or controlling weight. Professionals lead sessions of these action groups, focusing on how the employees can alter their lifestyles and maintain these improvements permanently. Follow-up contacts are made with each participant during the subsequent year. The company also provides a work environment that supports and encourages healthful behavior: it has designated no-smoking areas, established exercise facilities, and made nutritious foods available in the cafeteria, for example.

Evaluation of Live for Life involves ongoing studies, using quasi-experimental research methods. These studies generally compare the health and behavior of employees from different Johnson & Johnson companies that either did or did not offer the Live for Life program (Fielding, 1990; Nathan, 1984). All the employees studied completed a health screen in the initial year and then again in later years. Compared with the employees at the companies where Live for Life was not offered, those where it was have shown greater improvements in their physical activity, weight, smoking behavior, ability to handie job stress, absenteeism, and hospital medical claims.

(Sourced from Sarafino, 1994).

Health promotion in communities

Often health promotion is 'done to' people, as in advertising campaigns, workshops, etc, however an alternative approach is to get groupings of people to work together for their own benefit in regards to improving their health and the health of others close to them. This means that health promotion officials may only play a minor, certainly a less central, role in such health promotion activities.

A good example of health promotion undertaken in and by communities is the WHO's Healthy Cities Project, which attempts to combine a community focus with an acknowledgement of the need to challenge pervasive inequalities in society. Set up in the mid-1980s, the Healthy Cities Project has involved over 400 communities to date. Its aim is to promote health in the urban context by identifying and counteracting aspects of urban life which impair health. Consistent with a collective action model of health promotion, this requires the active involvement of local communities, representatives of whom meet on a regular basis for a period of one year in order to identify health objectives and targets for change. This is followed by a two-year period of implementation and evaluation.

For example, in one German city, the community group identified weight as a health problem in the community and decided to approach butchers in the city with the request to develop a new low-fat sausage (Conner, 1994). In addition, the Healthy Cities Project aims to develop new ideas in public health. For example, research into the impact of poor housing on health (Hunt, 1993) found that levels of mould in the air had a direct and independent effect upon the health of children living in the dwellings. This study's findings were used to campaign for changes in housing conditions.


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