Health Promotion as a Foundation for Reciprocal Care and Collective Action

Craig Stephen and Christa Gallagher

The World Health Organization’s (WHO) World Health Assembly declared in 1977 that a major goal of governments around the world should be to ensure that all people can attain a level of health that would lead them to live a socially and economically productive life (WHO, 1981). This was the start of a Health for All movement. Health for All set out to evenly distribute resources for health and make essential health care accessible to everyone. Health promotion, the process of enabling people to increase control over and improve their health, is a cornerstone of Health for All. One Health has reminded society that Health for Us (people) cannot be achieved without attending to the Health of Them (animals and ecosystems). The UN 2030 Sustainable Development Goals affirmed that healthy environments and healthy animals are essential for human health and human rights. Other sectors are also responding to the calls for healthy equity across people, animals, and environments. Agriculture is acting on consumer concerns about the inherent value of farmed animal health while attending to the economic health of farms and protecting human health through on-farm food safety and security. Processes enlarging people’s choices to lead long and healthy lives and enjoy decent standards of living (known as the human development agenda) are realizing that functional and sustainable ecosystems are needed for human health, wellness, and cultural well-being. The Health for All movement can no longer only include people in the category of “all” if its founding goals are to be achieved. Health for All needs new principles and new ways of knowing and measuring health as an interdependent resource shared by people, animals, and ecosystems. This chapter introduces some core concepts of health promotion and explores how they may be applied in a One Health world.

HEALTH PROMOTION GUIDING PRINCIPLES AND VALUES FOR AN INTERCONNECTED WORLD

The pace of social and ecological changes, the interconnections and interdependencies of species and ecosystems, and the problems this complexity creates require prompt attention. In a world of concurrent interacting harms, tackling one disease in one species at a time is neither practical nor efficient. We cannot always rely on the next new problem to inspire action. Health promotion needs to focus on promoting health across species in advance of harm and ensure that action to promote the health of one species does not adversely impact the health of others (see Chapter 3 for more discussion on interspecies health equity).

The concept of health is conceived and applied differently depending on the species, context, and culture (see Chapter 2). Promoting the health of chickens in a subtropical extensive farm, for example, will involve different goals, priorities, and partners than promoting the health of marginalized poor people in an urban inner- city environment. Health promoters must be sensitive to the variety of health goals that arise from the differing opinions of what constitutes health and its determinants. There are, however, commonalities between how one could approach health promotion in such diverse situations. Health promotion generally sees health as more than being physically and mentally well. It includes the ability to use skills, knowledge, and resources that give individuals or populations the ability to manage and even to change their surroundings and circumstances to feel well and live a fulfilling life. Health promotion builds capacity to cope with the circumstances of everyday living.

Health promotion was founded on principles of justice, equity, empowerment, and self-determination (Davies, 2013). Health promotion has the dual task of improving health and increasing opportunities to have more control over it. It tries to make it easier for people to make good choices that lead to healthier conditions by equipping them to make healthy choices while also creating conditions that make those choices easier. Promoting health means improving, advancing, supporting, encouraging, and placing health higher on personal and public agendas. Health promotion that uses a true socio-ecological perspective must mediate relationships between people, animals, and their environments by linking the actions individuals take in their own interest with outcomes that help the other domains. In doing so, it creates the social and environmental conditions conducive to health for all.

Health promotion primarily takes place outside of the health care sector. Let us clarify that sentence. There is a difference between most of clinical care (which can be conceived as disease service) and health promotion. Health promotion can be interested in the question of why some people or animals have better access to and benefit from clinical care services. This might involve questions of why some marginalized people fail to receive the care they require. It may involve asking why non-charismatic wildlife species fail to get the protective services they need or why people in poverty have less access to veterinary care for their animals. Many of the impediments to access to care, such as cultural biases, economic opportunities, or geographic location, fall outside of the diseases service sector. Broadly speaking, health promotion takes place outside of the health care clinical service sector because the personal, social, and environmental determinants of health are generally also found outside of that sector.

Health promotion tries to understand and influence social and environmental capacity to be healthy rather than target biomedical or technical interventions to take people, animals, or environments out of a diseased state. Health promotion perspectives and tools fall across a spectrum ranging from understanding human behaviour that influences the need for, access to, and use of clinical services to work on the moral and political environments that influence health equity (Davies, 2013). Regardless of where health promoters sit in this spectrum, they serve the needs of the population as a whole in the context of their daily lives. They seek opportunities to promote action to protect and sustain the root sources of health.

Once we advocate for a model of health promotion that sees Health for All as an interspecies and intergenerational activity, it becomes increasingly complex to understand, implement, and evaluate multifaceted health promotion efforts. There is no guarantee that all the authors of this book share the same perspective of health promotion, nor do they recognize a shared set of values and principles that drive their actions at the animal-health-society interface. Despite these differences, there are shared core values, perspectives, and methods that resonate across fields, disciplines, and approaches that work at the human-animal-environment nexus (Table 4.1).

A growing number of fields look at the complex of physical, social, economic, and environmental relationships that determine health, but they emphasize different aspects of those relationships. EcoHealth, for example, goes beyond health promotion’s “traditional” emphasis on the social determinants of health and uses a transdisciplinary approach to examine the ecosocial aspects of health. Global health research uses equity-centred, problem-focused, systems-based approaches to find upstream determinants that could make people more resilient to social and ecological factors impacting their health (Stephen and Daibes, 2010). For example, significant attention has been placed on women’s empowerment as a path to food security. This can be illustrated by a study in Bangladesh that found increases in women’s empowerment were positively associated with calorie availability and dietary diversity at the household level (Sraboni et al„ 2014). While little is written about health promotion in veterinary medicine, the field has adapted and applied some core concepts and methods familiar to health promotion in its efforts to promote sustainable food systems, deliver disease control programmes, and protect wildlife health. Conservation science applies some of the values, perspectives, and tools found in health promotion in order to achieve conservations goals. Community-based conservation projects, for example, need to pay attention to how people, and especially poorer people, are enabled to take more control over their own lives and secure a better livelihood in the face of conservation

TABLE 4.1

Ten Perspectives Shared by Many Allied Health Disciplines Trying to Promote and Protect Health of Different Species in Different Situations

People and animals exist in multiple scales, from the individual to group, community, population, and ecosystem level, and from local to regional to global scales. Health is affected by and affects relationships within and across these scales

The knowledge, culture, resources, skills, and processes people bring with them to a health promotion situation are valued. Those being asked to make a choice or implement an action need to actively participate in the health promotion process

People construct their knowledge and worldviews differently based on their culture, experience, and expertise. There is not one truth that will work for everyone, so health promotion needs to be pragmatic and adaptive

New knowledge has its own merits but without the capacity to mobilize knowledge to the people who can act to make the necessary changes, little will come of it

Health outcomes like longevity or lack of disease are not the end goals. The goal is to sustainably allow individuals or populations to fulfil their purpose, whether social, ecological, or otherwise, and therefore have a good life

Relationships between those who have power and those who do not should not result in differences in health that are unnecessary', avoidable, unfair, or unjust

Health promotion is context specific. Activities and interventions need to account for local circumstances and conditions

Health improvements depend on the development of an environment that is conducive to and supportive of healthy choices and actions

Social forces and social relationships are critical determinants of what we value as being healthy and why we undertake health-promoting activities

Health promotion directs actions towards the socio-ecological determinants of health. It requires co-operation across multiple sectors and combines diverse but complementary' approaches

Sources: Adapted from Gregg and O'Hara. 2007: WHO. 1984.

actions (Berkes, 2004). Although the term health promotion may not be widely used outside of the human population health and public health fields, its core values and concepts are found wherever the goal is to help people take actions to protect health by proactively addressing the social and environmental obstacles to making and implementing healthy choices.

 
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