Global Health Promotion

Theories and strategies of social mobilization, capacity building, mass and interpersonal communication, as well as risk communication and behavioral change were used to develop health education and promotion campaigns to decrease and prevent injuries and infectious diseases among the survivors of the Wenchuan earthquake in May 2008. We evaluated the effectiveness of the campaigns and short-term interventions using mixed-methods. The earthquake survivors’ health knowledge, skills, and practice improved significantly with respect to injury protection, food and water safety, environmental and personal hygiene, and disease prevention. No infectious disease outbreaks were reported after the earthquake, and the epidemic level was lower than before the earthquake. After a short-term intervention among the students of Leigu Township Primary and Junior School, the proportion of those with personal hygiene increased from 59.7% to 98.3% (p < 0.01). Of the sampled survivors from Wenchuan County, 92.3% reported to have improved their health knowledge and 54.9% improved their health practice (p < 0.01). Thus, health education and promotion during public health emergencies such as earthquakes play an important role in preventing injuries and infectious diseases among survivors.

While there is already consensus in the scientific community about the deleterious effects of TV exposure, especially through TV advertisements, on children’s beliefs, preferences, and food intake, the link between TV and children’s eating behaviors is under-studied in Peru, a country experiencing a steady economic growth in recent years and currently with a status of upper-middle-income country. Following research about the effects of media exposure on childhood obesity, we report on a qualitative study of TV viewing and the eating habits of children attending elementary schools in Lima, the capital. Data from eight focus groups with 38 boys and girls between 6 and 11 years old, eight focus groups with 36 female caretakers, and in-depth interviews with two fathers provided consistent information about children’s eating habits and media viewing patterns. After dual coding the entire corpus of qualitative data, we found that children watch a great deal of TV during the school season: children watch as early as when they wake up in the morning, then during lunchtime (after returning from school), and then again after completing their homework from 5 pm to 9 pm or 10 pm. Survey data from the parents showed that, on average, children watch about 5 hours of TV on weekdays and more during a weekend-day. This large amount of exposure is concerning, especially because the focus groups revealed that children (1) recall a number of TV advertisements involving food items, (2) request food items seen on TV, and (3) are able to buy food for themselves, which usually involves chocolate, candy, or potato chips. Boys and girls reported different favorite TV shows, suggesting differences in exposure to TV content related to food. In addition, some families reported drinking sodas frequently, underlining a behavior that should be discouraged by public health officials.

Health promotion programs are commonly viewed as value-free initiatives which seek to improve health, often through behavior change. An opposing view has begun to emerge that health promotion efforts, especially ones seeking to impact health policy and social determinants of health, are vulnerable to political contexts and may depend on who is in power at the time. This community-based participatory research study attempts to understand these interactions by applying a conceptual model focused on the power context, diverse stakeholder roles within this context, and the relationship of political levers and other change strategies to the sustainability of health promotion interventions aimed at health policy change. We present a case study of a health promotion coalition, New Mexico for Responsible Sex Education (NMRSE), as an example of power dynamics and change processes. Formed in 2005 in response to federal policies mandating abstinence-only education, NMRSE includes community activists, health promotion staff from the New Mexico Department of Health, and policy-maker allies. Applying an adapted Mayer’s ‘power analysis’ instrument, we conducted semi-structured stakeholder interviews and triangulated political-context analyses from the perspective of the stakeholders.

We identified multiple understandings of sustainability and health promotion policy change, including: the importance of diverse stakeholders working together in coalition and social networks; their distinct positions of power within their political contexts; the role of science versus advocacy in change processes; the particular challenges for public sector health promotion professionals; and other facilitators versus barriers to action. One problem that emerged consisted of the challenges for state employees to engage in health promotion advocacy due to limitations imposed on their activities by state and federal policies. This investigation’s results include a refined conceptual model, a power-analysis instrument, and new understandings of the intersection of power and stakeholder strategies in the sustainability of health promotion and health in all policies.

Communities are characterized by common interests, common ecology, and common social system or structure. These characteristics, qualities, and processes involved in the community affect both health behaviors and health outcomes during disease outbreaks. Hence, health promotion theorists and practitioners emphasize working ‘with’ rather than ‘on’ communities. They believe health promotion, with all its experiences in community mobilization, empowerment, and health literacy programs, should be part of disease prevention and control efforts from the very beginning. Health promotion knowledge needs to be fully integrated into infectious disease control, especially in the context of outbreaks.

The ongoing outbreak of the Ebola virus in West Africa is the largest on record; it has undermined already fragile healthcare systems and presented new challenges to contain the spread of the disease. Based on our observations in the field and insights from referenced sources, we aimed to identify key experiences of community engagement and social mobilization efforts in the current Ebola response. We concluded that there is no excuse not to actively involve local people and that the United Nations (UN) agencies and other partners did learn from their earlier mistakes to make a genuine attempt to better engage with communities. However, bottom-up approaches have not been widely implemented during the response and the reasons for not doing so must be further assessed. Health promotion can make an important contribution, because it shows how to enable people to take more control over their lives and health. This commentary can provide a guide to agencies to understand an appropriate way forward when the next Ebola outbreak inevitably occurs.