‘Health promotion is the process of enabling people to increase control over, and to improve, their health’ (WHO, 1986). Health here is viewed as a resource and health promotion is aimed at increasing the control of people over this resource and improve equity for all. Over the years, health promotion campaigns have taken the individual and lifestyle approach and not considered the social determinants that could be the cause of people’s health status. The World Health Organisation’s Ottawa Charter and Durie’s Te Pae Mahutonga instead looks at the broader holistic picture and uses intersectoral collaboration.
Using multiple health promotion strategies is more effective, achieving better and more sustainable population health outcomes. There are three approaches to health promotion: individual and lifestyle, community and settings-based, and environmental and structural. The individual and lifestyle approach is the most commonly used when addressing the public health challenge of cardiovascular disease (CVD). CVD is amongst the leading causes of morbidity and mortality in New Zealand, especially among Maori and Pacific (Ministry of Health (MoH), 2015).
We will look at the individual and lifestyle approach and the link to CVD and discuss whether other approaches to health promotion should also be employed to better target all aspects of CVD. The individual and lifestyle approach looks at the individual’s choices and behaviours that need changing to decrease risks of any diseases. The main factors of CVD are smoking, obesity, exercise, physical activity and unhealthy diet which are all linked to the individual and their lifestyle choices. There are also other underlying determinants including poverty, stress and hereditary factors.
Although there are no national programmes for CVD, there have been primary and secondary interventions designed to reduce and manage the risk rates of CVD. Te Whare Tapa Wha empowers health professionals to look at other factors other than just their physical condition when consulting with them. Health professionals also need to consider what the patient believes in and what is important to them as this creates a stronger bond between the patient and the health professional. (http://www. bpac. org. nz/BPJ/2014/September/cvrisk. aspx )
Smoking is strongly associated with CVD and is the most preventable cause. While smoking is a lifestyle choice, we also need to engage with communities to decrease the rates of smoking-related CVD cases in NZ. The rate of smoking amongst the population is approximately 25% (MoH, 2002b). However, amongst Maori it is much higher: 44% for men and 51% for women (MoH, 2002b). Society has changed its views on smoking in recent decades. In the 1980s, smoking was used as a social interaction and even doctors were seen in advertisements smoking.
Doctors now strongly advise against smoking as they have better understanding of the many consequences for the population’s health. There have been many anti-smoking campaigns designed to raise awareness of this public health challenge and to try and make smokers think twice before taking their next cigarette. Other public health interventions include Quitline, a service providing professional advice to those who want to quit smoking, as well as the promotion of alternative therapies involving the use of cigarette replacements like e-cigarettes and vaping.
Therefore, we can see that we need to tackle this challenge at a community and setting based as well as a structural approach. People with obesity are those with a BMI of 30 or above. People with obesity have a higher risk of developing CVD. The rate of obesity in New Zealand is rapidly increasing; New Zealand is now one of the top 5 countries with the highest rates of obesity. More and more children are being diagnosed as obese at a young age where they tend to be extremely self-conscious about their weight and physical appearance.
The direction of the current health policies is only making it harder for these individuals because many Government initiatives and programs designed to target obesity end up blaming the individual for their bad health and wellbeing. (http://www. radionz. co. nz/news/national/315773/researchers-urge-rethink-over-anti-obesity-efforts ). Taking the individual and lifestyle approach to reduce the rates of obesity and cases of CVD, people are expected to limit their sugar intake, increase consumption of wholefoods (fruits, vegetables, nuts and wholegrains), and more regularly take part in physical activity (http://www. ho. int/mediacentre/factsheets/fs311/en/ ).
This is a lot of responsibility for an individual, especially if their access to resources and services are limited. Therefore, we cannot put all of this burden on the individual. As a community, we need to ensure resources and services are affordable and accessible to all to ensure equity and equality. As a nation, we need to consider strengthening policies and implementing regulations and taxes on products which are high in fat, sugar and salt to reduce the intake of these foods.
We also need to creating programs that benefit the population’s health, investing in walking tracks and cycle pathways to encourage physical activity, as well as providing healthier meal options at. The ‘WHO Global Strategy on Diet, Physical Activity and Health’ states that all sectors of health need to act at a global, regional, and local level to improve the health of the population. The approach that the Ottawa Charter uses is comprehensive and encourages individuals and communities to act together.
The Health Promotion Agency (HPA) supplies resources around nutrition and physical activity to assist people who work with families and communities. Their work reflects the Ministry of Health’s guidelines on food and nutrition. The HPA provides suggestions for individuals and families around healthier food options and ways to be more active. The HPA promotes drinking water, more movement in the workplaces, produces affordable and time-efficient meal plans for families, and has introduce the Health Star Ratings on products.
The Health Promotion Agency is a great organisation that raises awareness amongst the population on nutrition and physical activity, two factors strongly linked to CVD. They are targeting individuals to make a difference in their lifestyle but it is also impacting on the community in a positive way because there is more engagement with one another (http://www. hpa. org. nz/what-we-do/nutrition-and-physical-activity ). For lifestyle approaches to be effective in reducing risk factors for CVD, social, structural, environmental and individual approaches need to be considered.
Campaigns can make a difference to social norms by improving health literacy and encouraging individuals to make a positive change. Affordability and accessibility of health services are important factors in not only whether people will exhibit positive changes in behaviors, but also in whether these changes will be long term. With collective responsibility and action, it will be easier to individuals to implement lifestyle modifications and the government and health sectors will benefit from the resulting decrease in mortality and morbidity rates due to CVD.
It is necessary to go to a higher level and look at environmental and structural approaches. In conclusion, managing cardiovascular disease in New Zealand needs to have more initiatives using inter-sectoral approaches as no single health promotion approach by itself is enough to solve this leading cause of mortality in New Zealand. While individuals need to make better lifestyle choices, they need a supportive environment, provided by a community that is willing to make changes to assist them and these communities need policies to help them support these individuals in making and sustaining changes to their lifestyles.