History of Health Promotion Practices

This assignment will look at the history behind health promotion and how practices from the past have been used to build the foundations of the care received today. Looking at the aspects of health promotion which has been around for years and considering the medical and social breakthroughs that have happened decades ago and how they have progressed in health and treatment over time. Covering the population growth in Britain in the 18th century, that affected the standards of living that promoted the improvements of sanitation along with the progression of the nation. Taking into account their misconception of how diseases spread, and legislation that was introduced to promote vaccinations for healthier communities. If you lived in a different area of the world or even the same country it could impact on the health care you received. Explaining the different organisations and acts implemented to help provide better health throughout the world.

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This assignment will be focusing on individuals suffering with schizophrenia and the side effect that antipsychotic medication has on weight gain, evaluating previous treatment and looking at alternatives to medication. Devising a care package which will help individuals make life style changes, using approved teaching techniques to help implement and accurately record the progress, designed to promote compliance with treatment of Schizophrenia and a better health and wellbeing for the individuals suffering from the illness..

The term health promotion is relatively new but the concept of promoting good health has evidence of its practice throughout history dating back to 5000BC. The Ancient Indians used Ayurvedic practices. Ayurvedic which came from the ancient Indian language that translates into “science of life”, believed that all aspects of life can impact on your health (Chopra & Doiphode.2002). In 2700bc Chinese would use a form of medicine and pay close attention to hygiene. This was enhanced further in 460BC with the Greeks believing health is recognised by physical attributes, appearance and social environments and they would promote communities to adapt practices that support a healthier way of life, advising on diet, alcohol consumption, maintaining calm and focusing on self-control.  The Greeks also had theories that the weather and geological location had impacts on health (Tountas, 2009). This was outlined in one of the earliest public health texts called On Airs, Water and Places by a Greek physician Hippocrates. This text was intended to be a guide for settlers searching out new environments to help prevent them from developing illnesses (Porter. 1999). In 200BC the Egyptians developed sanitation systems by collecting rainwater to use for disposing waste, and washing facilities promoting regular bathing (Kushwah, 2007) for a better quality of health. Galen a Roman Empire physician’s philosophy on health was a state’s responsibility not an individual’s influence, focusing on providing sanitation, clean water and clean streets with adequate housing. Health was described as “a condition in which we neither suffer pain nor are hindered in the functions of daily life such as taking part in government, bathing, drinking, eating and doing other things we want.”        

From these historic medical achievements, the modern-day terminology Health Promotion was introduced, focusing on 3 crucial stages in the 19th century. The first stage was in the West area identifying the need to improving sanitation. This was part of a wider development to improve public health measures. Britain’s living conditions were inadequate in the 19th century there was epidemic outbreaks of disease such as cholera and typhoid. In 1848, cholera alone killed around 53,000 people in England and Wales (Snow,2002).  This was due to a rapid population increase in the 18th century increasing by 107 million over 90 years (de Vries, 1984). One of the reasons behind this increase in population was the industrial revolution, Britain was the heart of the industrial revolution meaning the occurrence of this was greater in Britain at than other parts of Europe. Small towns became large cities due to the population increase, people moving from the countryside seeking employment. This resulted in poor living and working conditions because the housing and sanitation could not meet the demands of a growing population. Edwin Chadwick carried out a report in 1842 on the sanitation in towns and city’s outlining the impact of overcrowding and the spread of diseases due to poor living standards (Chadwick, 1843).It was widely believed disease came from miasma which means an unpleasant smell or atmosphere gases, these beliefs were eventually ruled out by a British physician John Snow in the Victorian times. Snow found that cholera was a waterborne disease, due to his finding and recommendations for the governing body to help provide clean water and better sewage disposal that Chadwick put forward. The second half of the 19th century sanitarian changes were implemented (Hamlin, 1998. Chadwick 1843). The wealthier population and governing body took it upon themselves to clean up the water supply by the removal of sewage (Melosi, 2000). These changes were not solely focusing on the wellbeing of others; there was a hidden political advantage to improving public health, which brings us to the second stage. Between 1900 -1970’s they moved away from environmental and towards social, believing that an individual’s mental illness and behavioural traits were inherited. The government attempted to limit the reproductions of these individuals, if you were diagnosed with a mental illness you were classed as unfit to have children and sterilised (Bashford, 2012). The nation’s health affected the wellbeing of the economics’, politics and social aspects. If you had a diagnosis of a mental health illness back then you was unable to work and thus be unable to provide income for your household. This also prevented you from joining the army and protecting the nation; this was highlighted during the Boer war in 1899 and caused concern for politicians. Leading to the development of a series of public health policies that introduced compulsory vaccinations for example treating smallpox (Hennock,1998; Durback, 2005).

 The 3rd and the most recent phase is classed as “new public health” this new approach focuses on prevention, risk and environment, and of health promotion being a national and international movement (Mold & Berridge 2013). After the Second World War in 1944, European nations developed health services to promote better health throughout Europe. In 1948 the introduction of a global health organisation was implemented within the United Nations called the World Health Organization (WHO). Their initial focus was on communicable diseases such as tuberculosis and malaria, the health of women and children, sanitation and nutrition, with a goal of promoting health throughout the world. Their principle on health is “a state of complete physical, mental and social well-being and the absence of disease and infirmity” (WHO,1948).

In Britain the focus was around health education and the prevention of diseases more than health promotion, this laid the foundations for the creation of the national health services (NHS). Legalisation was drafted up by the Prime Minster and the Minister of Health (MOH) called the White Paper, which detailed that health and wellbeing would overall be the responsibility of the minister of health, yet locally the responsibility would lie on that areas local authority and county’s council to organise health services provided for their area (MOH. 1944. Mold & Berridge 2013).

In 1984 WHO moved towards social factors with the main goal of enabling people to take control of their health and maintain and improve lifestyle looking at social aspects such as housing, employment, working conditions and wages (WHO,1984). In 1986 WHO sponsored the first international health promotion conference in Ottawa Canada, outlining that individuals require supportive environments and good economic resources for a healthier way of life and better wellbeing. This became an essential document called the Ottawa charter for health promotion (Scriven, Speller. 2007). Health is not only linked to physical state, and governments legislation has a curtail impact. Today’s society individual’s have different opinions on good health and wellbeing, some believe that regular exercise, healthy eating, and not smoking or indulging to much in alcohol is a healthier way of life, they don’t consider that employment, social network, disabilities and the are an individual lives in can have an impact on health. Different countries have access to better health care than others; this is what is known in the United Kingdom as the “postcode lottery” even different cities in the same country can have better health care than others (CSDH 2008).

In 2014, the welsh government implemented the Social Services and Wellbeing act (2014), legally defining perimeters for promoting better wellbeing and support for individuals who required care, and offered additional support to carers in Wales, this gave individuals more control over their care (social and wellbeing wales act 2014). Since being implemented, WHO have included mental wellbeing in the definition of health; they have been addressing barriers of mental health over the past 5 years, pointing out the importance mental state has on not only health but the community and the Nation. Mental health is determined by many social, psychological and biological factors, some of which can be linked with poverty. Research by Holzer et al, (1986) found people suffering from schizophrenia are 8 times more likely to live in low income households. These findings are still being found 26 years later, showing every 4 out of 10 people living in low to mid income countries suffer mental illness (Funk, Drew, & Knapp, 2012). This highlights two specific areas as a cause to poor mental health, social causation and social selection ( Costello et al, 2003: Das et al., 2007). Social causation states that mental illness can be a result of stress or deprivation, decreasing an individual’s access to the treatment and help they require. Whereas social selection revolves around individuals being unable to move out of poverty due to family circumstances for example; being born into a poorer family with bad ethics and living conditions, poor education that can result in not obtaining qualifications employers are looking for, or not seeing the need to seek employment due to the environment they have been raised in (Costello et al, 2003). Goran Dahlgren and Margaret Whitehead found that your environment; social network and lifestyle impact your development in life effecting your health and wellbeing (Dahlgren, Whitehead. 2007).

Mental health has previously been treated in many ways. In medieval times suffers of mental illness’ were beaten and burnt at the stake. In the 19th century mental health was treated by locking up mentally ill people with other unwanted social behaviours in large institutions/asylums, this treatment was not effective resulting in patients becoming institutionalized (WHO,2005). The second half of the 20th century mentally ill patients were treated in hospitals as apposed to institutions (Taylor, 2010), and advances in medication such as antidepressants and antipsychotics, along with new legislation such as the Human Rights Act (1998) were introduced to safeguard mentally ill patients (WHO, 2001).

The Nation Health Service (NHS) treats approximately 220,000 patients suffering with schizophrenia (DSM V) in England and Wales (HQIP and The Royal College of Psychiatrists. 2012). Antipsychotic medication is a substantial improvement to previous treatment of mental illness, however evidence based practice (EBP) has shown, some of the medication can cause substantial weight gain particularly when treating schizophrenia. The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) carried out a study that showed patients treated with olanzapine had an average weight gain of 4.2 kg over the duration of 18 months, resulting in a 7% or more increase in the body mass on 30% of patients (Lieberman at el, 2005). Neovius et al. (2007) found similar results over a 5-year study of patients treated with risperidone. Brandt et al. (2000) discovered a relation to schizophrenic’s physical health such as cardiovascular disease, hypertension, diet related diabetes and emphysema as a result of additive behaviours such as smoking and poor diets (Marder at el. 2004). Different forms of antipsychotics can affect the time it takes for the weight gain to become a cause for concern, Olanzapine can induce weight gain in as little as 10 months whereas Clozapine takes 46 months (Henderson at el, 2000), as well as the physical conditions mentioned earlier. This weight gain can cause further mental illness such as depression resulting in the individual having low motivation to participate in activities, impacting on compliance of the patient taking their medication resulting in a relapse of mental state.

Treating weight gain to prevent a relapse in mental state with other medication such as fluoxetine for depression (DSM V) and phenylpropanolamine as appetite suppressant has little effect on patients using Olanzapine, Clozapine and Risperidone (Borovicka at el, 2002). Strategies that have been effective in tackling weight is exercising regularly, diet alterations and counselling on habits and behaviours. According to the National Heart, Lungs and Blood Institute (NHLBI) the treatment of obesity in adults is a two step process, first is to access the severity of the weight gain and document it, secondly implementing a treatment plan involving a healthy diet and exercise. There is many different types of teaching and learning of new skills, one of them is the Cone Of Learning (Dale, E. 1969) which this health promotion will follow due to the nature of the mental illness obtaining effective compliance with tackling weight gain can be challenging as many patients who suffer with schizophrenia smoke excessively and have poor diets, and can be very guarded, paranoid and subconscious and easily distracted. Approaching the matter of their physical health with empathy to circumstances in an in a constructive way by including practical activities can help to keep the patients interested and promote compliance. The interaction between the patient and healthcare professional is beneficial in helping to obtaining current lifestyle, culture, interests and abilities this information will help to implement long lasting change to their diet and activities promoting a better health and wellbeing. During these session patients will have their weight documented on the Malnutrition Universal Screening Tool (MUST) chart and the body mass index (BMI) accurately measured weekly. Using the Eatwell guide (Public Health England. 2018) as reference for dietary intake both the patient and the healthcare professional will construct a healthy meal plan and a exercise routine working within the individuals limitations accessing appropriate activities focusing on their abilities, incorporating hobbies where applicable to promote compliance. During their admission they will carrying out independent cooking once a week with activities nurses accessing their skills and advising on food choices as opposed to eating processed meals, giving practical experience in hospital to use once discharged back into the community. Weekly one to one sessions allows the patient to see their progress via the MUST chart and gives time to review diet plans using visually aids such as the Eatwell plate (Public Health England. 2018). Patients can see the appropriate amount of food to consume and their nutrition values. Discussions regarding lifestyle choice such as alcohol consumption and smoking will be reviewed and supported, offering to help cut down or quit with the Help to Quit Scheme (Public Health Wales 2018). 

History has shown evidence of promoting Health through the decades, focusing around good sanitation, personal hygiene, diet and location but not mental health. WHO recognised mental health and its impact on wellbeing which was previously overlooked; this welcomed the creation of antipsychotic medication, to treat individuals with Schizophrenia. A side effect of the treatment is weight gain and the associated health risks that included, resulted in individuals taking more medication to counteract this with little effect, leading to a noncompliance with treatment. The overall goal to this health promotion is to promote a healthier way of life and to tackle weight gained through treatment of Schizophrenia without the use of extra medication instead using physical activities and healthy eating. Following the Cone Of Learning (Dale, E. 1969), as a guide to help the healthcare professional teach and the patient to learn in a hospital setting and provide the skills to improve their health and wellbeing 

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