Health Promotion Strategies for Smoking Cessation

health Promotion Strategies for Smoking CessationDrawing on appropriate literature, provide a critical digest of the application of wellness packaging philosophies, principles and uprisees underpinning public wellness practice in proportion to a relevant topic (e.g. any public wellness constitution in the UK)The chosen public health topic is pot. The student has selected this subject because it is a current issue of particular relevance because of the prohibition to premises neat smoke- free if they are open to the public, due to be enforced in England in July 2007 (Health Act 2006). Smoking is also an important topic because it has been identified as the single most signifi chamberpott public health problem in the UK (Royal College of Physicians 2000) approximately 114,000 smokers in the UK die as a result of dope (Action on Smoking and Health 2005). The treatment of sess- related conditions costs the National Health do (NHS) up to 1.7 billion per year with an estimat ed cost of 1.7 million to British fabrication every year as the result of lost working hours caused by smoking- related illness (Gommans 2005).According to Tannahill (1985) health packaging is a broad concept which encompasses health education and health prevention. Health education refers to working with groups and individuals to promote healthy deportments, whereas health prevention refers to strategies which prevent ill- health such as immunisation. public health is defined asThe science and art of preventing disease, prolonging life and promoting health through organised efforts of society (Acheson 1988)This definition implies a collective approach besides public health has been criticised as being medical examinationly dominated (McPherson 2001).Philosophies of health promotion provide a framework for exploring our rationale and justification for wanting to lurch health- related behaviour. Seedhouse (2002) refers to health promotion as a pattern endeavour in other word s health professionals are required to make judgments active if, how and when to intervene in relation to the health behaviours of patients, clients and service users, taking into account individual expects and priorities. In some cases health behaviours repair not exactly the individual but others, also this applies to the effects of secondary smoking, for example. Taking into account the secondary effects of health behaviours may impact upon the moral endeavour of health professionals and health policy makers. Moral judgements underpin the work of health professionals the student recalls an incident when a lady aged 100 who had smoked all of her braggart(a) life and who clearly did not have long to live, asked to be helped to smoke a cigarette. This simple act gave her pleasure and it seemed irrational and unkind not to serve to her request. Moral judgements are not always straightforward.Philosophical principles applicable to health promotion include logic the study of re asoned argument (Naidoo and Wills 2000a). Our arguments for changing health-related behaviour are enjoin- based involving for example, the type of statistics more or less smoking highlighted in para 1 of this page. on that point is a large body of evidence which supports the argument that smoking is damaging to health and yet, as discussed further on (para.2, p.4), it can be seen that individuals do not always respond to logical reasoned argument in relation to modifying health- behaviours.Epistemology, another philosophical principle, is concerned with the debate about truth, in this case exploring what health really means. There are different models of health including the medical and social models. The medical model is concerned with the categorisation of illness and disease and with specific medical interventions given by the expert (the health professional) to the patient, who has traditionally been a passive recipient of this expert advice and intervention. A social model o f health involves a broader interpretation of health which is influenced by a range of determinants, such as age, gender, socioeconomic factors, education and environment. Within this model, strategies to improve health status adopt a wider perspective than the medical model, seeking to address the aforementioned determinants. In relation to health promotion, the medical model might not take into consideration, factors which affect the individuals behaviour such as their socioeconomic status. There is evidence that smoking behaviour is more prevalent among more disadvantaged socioeconomic groups (Gulliford et al 2003). It is important therefore to take into consideration this and other, factors when developing health promotion strategies and not to reduce the issue to one of the giving and receiving of nurture with an assurance that behaviour will be modified as a result.Health promotion philosophies are also concerned with ethics. The theory of ethics is divided into two main ca tegories deontological and consequential. Deontology is concerned with our duty to behave according to a set of moral principles. On page 1, paragraph 5, the issues/ dilemmas involved for health professionals in qualification moral judgements, were referred to. Consequential ethics are based on the premise that a judgment about whether an action is right or wrong is dependent on its end result, in other words whether the ends justify the means. This has some kindle implications for health promotion. Further on (p.4) some health promotion strategies are discussed including a debate about the use of ordinance, i.e. enforcement, to bring about health- related behavioural change. As stated earlier (para.1, p.1) this issue is of particular relevance to smoking. The argument for enforcement is that the end result of reducing smoking behaviours and resultant improvement in health status as well as savings made to the cost of healthcare, justifies the prohibition formula.Broad approache s to health promotion reflect the models of health referred to (para. 2 on this page) and are categorised by Naidoo and Wills (2000b) as medical/ preventative behavioural change educational empowerment and social change. Within the medical approach there are three aims of prevention primary, secondary and tertiary. To apply these specifically to smoking the primary take aims to prevent smoking behaviour before it begins, the secondary level is concerned with preventing the recurrence of a smoking- related illness or disease by encouraging the patient to give up smoking and the tertiary level is about promoting quality of life within a chronic condition such as diabetes, in which case the message would be that the individuals quality of life would be optimised if they do not smoke.The behavioural approach focuses on lifestyle issues (Laverack 2004) Emphasis is placed upon the individuals responsibility for health which does not take into account factors outwith the individuals cont rol and as such, this approach has been criticised for being victim- blaming (Tones and Tilford 2001), shifting responsibility away from the government for example, in relation to individual health status.The educational approach is less about placing responsibility on individuals in relation to their health- related behaviours and more about giving information and facilitating people to make informed choices about their lifestyle choices. This approach relates to the rational- empirical scheme depict further on (para. 2, p.4) as it is based on the assumption that giving people information will lead to attitudinal and behavioural change. As will be seen, this does not always happen. This approach is also dependent on a level of concordance from the individual, for example a commitment to attend regular sessions as part of an educational programme.The empowerment approach reflects the normative- re-educative strategy described further on (para. 4, p. 4) and entails giving people th e means to have increased control over the determinants that affect their health status. This involves lodge participation, a collective approach which is embedded within the philosophy of public health. According to Laverack (2004) there can be different interpretations of what constitutes a community. We tend to think in legal injury of a geographical community a locality. It might be more effective in health promotion terms to think of a community as a group with shared characteristics, such as young people. The reality of community participation is that it tends to be more evident among communities who are meliorate and higher up the socioeconomic scale. People who are disadvantaged are less lilkely to be motivated to participate in health- related programmes- they may witness marginalised and are preoccupied with the issues that their situation presents, such as concerns about housing and income health promotion is not viewed as a priority, and smoking might be used as a me ans of helping them to cope with adversity (Hanson Hoffman 1998).This leads onto the notion of the social change approach. This is quite a complex concept that involves health promotion initiating and driving social change in order to improve conditions that are conducive to health (Erben et al 2000). affable change would involve making the sorts of improvements that would place health issues more firmly on everybodys agenda. There are many factors that contribute to social change such as legislation and shifts in ideas about codes of behaviour. For example, attitudes about sexual behaviour have changed over the years, contributing to health issues such as increased incidence of sexually transmit disease and a rise in teenage pregnancies (Measor et al 2000). There is some indication that social attitudes to smoking have changed (Moonie 2005) which is arguably, a positive development some smokers report that they feel like social pariahs The social change approach is underpinned by an acknow conductgement of the complexity of what influences health- related behaviours and can be colligate to the social model of health, discussed in para. 2, p.2.Specific health promotion methods are quite diverse including giving information in a didactic manner, for example via talks to large groups lobbying local health and Government authorities making use of the mass media (for example there is currently a television information advertisement about the early signs of myocardial infarction) working with groups teaching social or life skills that are related to health status publicity events, e.g. health fairs facilitating community groups enforcing health regulation one to one advice and education networking and liaising with other workers instructing on specific techniques, such as self-administration of insulin facilitating self help groups and enabling health promotion by the provision of support services such as childcare and interpreting facilities (Naidoo and Wills 2 000c). Most of these methods can be adapted for use with smoking cessation.The change strategies framework by Bennis (1976) can be applied to health behavioural change and is of particular relevance to anti- smoking legislation. It includes three strategies for bringing about change which are based on different assumptions about piece behaviour, and which, when applied to health promotion, involve three distinctly different approaches. The first strategy (rational- empirical), is based on the supposition that knowledge is power. Within this strategy it is assumed that an individual will modify their health- related behaviour in rejoinder to receiving reliable and valid information. For example, if the government or a health professional issues advice about the dangers of smoking, the individual should reduce or cease their smoking habit. It is well- known that this ofttimes does not happen even some health professionals smoke, despite their level of knowledge about the dangers (Mc Kenna 2001). The reasons for this are usually related to dependence. It is also possible that human beings adopt Freudian mental defence mechanisms, which are maladaptive coping strategies used (in this instance) to circumvent evidence of the negative consequences of a health- related behaviour, such as smoking. These include denial, intellectualisation (which involves citing contradictory evidence), or rationalisation, among others (Lupton 1995). Resorting to these defences can undermine the power of knowledge and evidence, however valid and reliable it is.The second strategy (power- coercive) involves the use of legislation and policy change in order to enforce health- related change. A good example of this is the anti- smoking legislation referred to in paragraph 1, page 1. There is some evidence to demonstrate that no- smoking policies do have the effect of reducing smoking behaviour (Brigham et al 1994). There has been criticism of the legislation as it is seen by some as an in fringement of the individuals right to choose. However this view is countered by the argument that the health of non- smokers can be adversely affected by cigarette smoke, and these people have the right to be protected (HM Treasury 2004). It appears that many non- smokers feel that they should be safeguarded from the effects of passive smoking (Pilkington et al 2006).The first two strategies adopt a top- down approach whereas the third strategy (normative- re-educative) is based on the assumption that an individual is more credibly to change their health- related behaviour if they have had involvement in bringing about the change if they feel empowered. This approach underpins some of the health promotion strategies referred to in para. 1 of this page for example facilitating community groups. However as discussed earlier (para. 2, p.3), it seems likely that community participation and empowerment might be of limited time value within certain groups, such as people who are disadv antaged or marginalised.In conclusion, it appears that a multi- faceted approach needs to be adoptive in order to address health- behaviours which are harmful to health, in this instance smoking. The starting point is that there is incontrovertible evidence that smoking is harmful to health, and can lead to premature death, as cited in para.1, p.1. The question of whether we have the right to choose to smoke can be challenged because of the evidence- base that demonstrates that smoking can affect the health of others (para. 3, p. 4). However it is important to recognise that people who smoke need adequate support and resources in order to be able to stop. There is breathing evidence that legislative and policy change can reduce smoking behaviours (para. 3, p.4) and it will be interesting to see the outcomes of the current legislation (para. 1, p. 1). However, smokers also need clear, unambiguous messages about the effects of smoking, consistent support from health professionals and accessible information about smoking cessation services (Kerr et al 2006).ReferencesAcheson D. Independent interrogatory into Inequalities in Health Report. London Stationery Office 1988.Action on Smoking and Health Factsheet No. 2. Smoking Statistics Illness and Death. ASH 2005.Bennis et al The formulation of Change Holt Rinehart and Winston 1976Brigham J, Gross J, Stitzer M and Felch L Effects of a restricted work-site smoking policy on employees who smoke. Am J Public Health. 84(5) 1994 pp. 773778.Department of Health. Health Act 2006. Part 1 Chapter 1. 2006.Erben R, Franzkowiak P and Wenzel E. 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