Health Promotion at the Community Level: New Advances

297 Pages·1998·16.629 MB·English

by  Neil Bracht

HEALTH
PROMOTION
AT THE
COMMUNITY
LEWL
Go in search of people.
Begin with what they know.
Build on what they have.
—Old Chinese proverb
NEIL B R A C HT
editor
H EALTH
PROMOTION
AT THE
COMMUNITY
LEVEL
New Advances
SAGE Publications
<§
International Educational and Professional Publisher
Thousand Oaks London New Delhi
Copyright © 1999 by Sage Publications, Inc.
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Library of Congress Cataloging-in-Publication Data
Main entry under title:
Health promotion at the community level: New advances /
edited by Neil Bracht.—2nd ed.
p. cm.
Includes bibliographical references and index.
ISBN 0-7619-1844-2 (cloth: acid-free paper)
ISBN 0-7619-1304-1 (pbk.: acid-free paper)
1. Health promotion. 2. Community health services—
Citizen participation. I. Bracht, Neil F.
RA427.8 .H494 1998
362.1'0425—dc21 98-40267
08 07 06 10 9 8 7 6 5
Acquiring Editor: Jim Nageotte
Editorial Assistant: Heidi Van Middlesworth
Production Editor: Diana E. Axelsen
Editorial Assistant: Nevair Kabakian
Typesetter/Designer: Marion Warren
Indexer: Virgil Diodato
Cover Designer: Candice Harman
Contents
Foreword ix
Lester Breslow
Acknowledgments xiii
Introduction xvii
PARTI
Advances in the Theory and Practice
of Community Health Promotion
1. Health Promotion at the Community wide Level:
Lessons From Diverse Perspectives 3
Maurice B. Mittelmark
Health Promotion's Diversity 4
Disease Prevention 5
Community Development 5
Ottawa Charter for Health Promotion 6
Cardiovascular Disease Prevention 7
Community Development Approaches 18
Respecting Diversity 26
2. Social Change Theory: Applications to Community Health 29
Beti Thompson and Susan Kinne
General Principles of Communities and Systems 31
General Sociological Perspectives of Change 33
Middle-Range and Process Theories of Change 35
Synthesis and Application to Community Change 40
Measuring Community Change 44
Summary 45
CASE ILLUSTRATION FOR CHAPTER 2
The FoCaS Project: Improving Breast and Cervical
Cancer Screening Among Low-Income Women 47
Electra D. Paskett, Cathy M. Tatum, Ralph D'Agostino Jr.,
Julia Rushing, and Ramon Velez
Methods 48
Results 52
Discussion 56
Assessing Community Needs, Resources,
and Readiness: Building on Strengths 59
Chris Rissel and Neil Bracht
Assessing the Community 59
What Is Community? 60
Assessment Traditions 61
Components of Community Analysis 64
Summary 69
Appendix: Key Community Sectors, Leaders, and
Organizational Contacts 70
CASE ILLUSTRATION FOR CHAPTER 3
Community Capacity for a Breast Screening Program:
The Lee County Experience (1991-1998) 73
John K. Worden, Berta M. Geller, Donna J. Sabina McVety,
Anne L. Dorwaldt, and Catherine M. Lloyd
Community Analysis 74
Establishing the Lee County Breast Screening Program 75
Long-Term Durability of the Program 78
A Final Point 81
A Five-Stage Community Organization Model for
Health Promotion: Empowerment and Partnership Strategies 83
Neil Bracht, Lee Kingsbury, and Chris Rissel
Community Organization 84
The Five Stages of Organizing: A Community Health Promotion Process 89
Overall Challenges to Community Organization
in the Future: Concluding Remarks 103
CASE ILLUSTRATION FOR CHAPTER 4
Lessons Learned From Project Northland:
Community Organization in Rural Communities 105
Sara Veblen-Mortenson, Chris Rissel, Cheryl L. Perry,
Jean Forster, Mark Wolf son, and John R. Finnegan Jr.
Description of Project Northland 106
Community Organization Theory 106
Lessons Learned During Stages 1 Through 4 110
Stage 5: Community Intervention Reassessment and Adjustments 116
5. Mass Media and Health Promotion: Lessons Learned,
With Implications for Public Health Campaigns 119
John R. Finnegan Jr. and K. Viswanath
Media Roles 120
Media Uses 120
Some Lessons Learned and Practical Implications 121
The Future 125
6. Evaluating Community Health Promotion Programs:
Basic Questions and Approaches 127
Phyllis L. Pirie
Types of Evaluation Questions 127
Issues Specific to the Evaluation of Community Programs 132
Carrying Out Evaluation Studies 134
Summary 134
PART II
Cross-National Experiences: Issues in Developing
and Sustaining Community Health Programs
7. Durability of Community Intervention Programs:
Definitions, Empirical Studies, and Strategic Planning 137
Beti Thompson and Carol Winner
Definitions of Durability 139
Past Studies and Examples of Durability 142
Strategic Planning for Durability 144
Applying Strategic Planning Methods 147
Summary 154
8. Maintaining Preventive Health Efforts in Sub-Saharan
Africa: AIDS in Tanzania 155
Knut-lnge Klepp, Melkiory C. Masatu, Philip W. Setel,
and Gro Th. Lie
AIDS in Tanzania 157
MUTAN 157
Target Communities 159
HIV/AIDS Prevention Efforts in Arusha and Kilimanjaro 160
Lessons Learned and Future Challenges 172
9. Asia and Western Pacific Approaches to Health Promotion:
Current Opportunities and Programs 175
Rhonda Galbally, Bridget Η.Ή. Hsu-Hage, and Chris Borthwick
Social and Political Background 175
Social, Cultural, and Political Systems 175
Literacy 176
Economic Growth 176
Health Issues 176
The Influence of International Agencies 180
Health Promotion Approaches and Practices 180
Health Promotion Research 184
Future Directions 184
10. Health Promotion Developments in the Nordic
and Related Countries 187
John G. Maeland and Bo J. A. Haglund
The Nordic Countries: Moving Toward the Postindustrialized Society 188
Developments in Health Promotion 190
Community Accident Prevention Programs 192
Challenges for Health Promotion in a Late-Modern Society 196
11. Health and Health Promotion in Latin America:
A Social Change Perspective 199
Abel Arvizu Whittemore and Janet R. Buelow
Latin America: A Brief Overview 199
Issues Affecting Health Promotion 204
International Organizations and Health Promotion Programs 206
Health Promotion in Latin America 208
12. Emerging Public and Private Health Sector Partnerships:
Selected U.S. Experiences 219
Lee Kingsbury
Public Health and Private Health Care Partnerships:
Opportunities and Challenges 222
Public Health and Private Health Care Partnerships:
Potential Barriers 224
Partnership Issues: There Are No 10 Steps to Success 225
Summary 228
References 229
Index 257
About the Editor 269
About the Contributors 271
Foreword
/Λ modern, international movement termed health promotion has emerged out of the historical
need for a fundamental change in strategy to achieve and maintain health. During the initial era of
public health, concern about communicable diseases appropriately dominated thinking. That led
to the "cleanup" campaigns of the 19th century and, later, to the discovery of microbiologic agents
of disease and the development of means for their control. Breaking the chain of infection became
the focus of attention, later supplemented by strengthening people's resistance: sewage disposal,
water treatment, pasteurization of milk, food protection, and avoidance of crowding. These actions,
directed at preventing the spread of infectious agents and bolstered by immunizations against
specific diseases, proved remarkably effective against the major health problems of the day.
But another day has brought new health problems, a new system responsible for their origin,
and a new set of requirements for their control. The current major problems, mainly the chronic
diseases of middle and later life, arise out of conditions to which people are exposed when they
enter modern industrialized life and out of their response to those conditions: plenty of calories,
especially in the form of fats; lessened demands for physical exertion and heightened demands on
the psyche; easy access to tobacco and excessive amounts of alcohol; and motor vehicle transport.
Interaction of people with that new milieu constitutes the system that has generated present-day
epidemics such as cardiovascular disease, cancer, chronic respiratory disease, cirrhosis, trauma,
and diabetes.
Again, scientific progress has disclosed enough about the nature of the current human-envi-
ronment-disease system for the social organization of health advance. Breaking the chain of
infection and building human resistance to it will no longer suffice. It has become necessary (a) to
establish health-protective social policies concerning those aspects of life in industrialized societies
that seriously jeopardize health and (b) to help people cope with such conditions of life so long as
they exist.
In former times, social action against principal health problems consisted largely of erecting
physical barriers to the transmission of disease agents and providing immunizations. It also
included attention to the medical needs of mothers and children. Education of people concerning
personal hygiene, such as hand washing and sputum control, and other aspects of health played
some role. The situation, however, induced action mainly toward environmental protection.
Now recognition has grown that people's behavior in their present milieu and the conditions
of life that influence behavior, rather than direct physical exposure to biological disease agents,
constitute the major health issue. The social environment—especially access and encouragement
IX