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Module C2:
Application of a public health framework to the health of young people aged 10 to 19
Entry scenario
The entry scenario addresses a variety of issues and problems associated with the module topic. It may be used at the beginning of the course to stimulate the students to identify their own needs and interests. The results may be utilized by the individual to assess own learning process, or be integrated with class objectives.
1. You are working as a senior paediatrician in a city where there is a large petroleum chemical plant that is the single major employer of the immediate population. Your patients include young people with respiratory infections. Recent news stories raise the question of the dangers to the population of the ammonia from the chemical factory. You become aware that the respiratory diagnoses you are making may relate to this public health concern. What considerations will you make in deciding your course of action?
2. The hospital data of your country show an increase in admissions of injured adolescents with high alcohol blood level. Recent entry of your country into the E.U has resulted in a decrease of the price of all alcoholic beverages. The legal age at which an adolescent can purchase and consume alcohol in a public place is 16. The son of the minister of health was recently admitted in a hospital in semi-coma with a 2%0 alcohol level. Your new minister of health has been lobbied both by the wine makers and the main alcohol control group to take action. You, as the director of public health, are asked to advise your minister.
General Goals for Learners
by completing the module the participant will be able to :
- Understand the core concepts of public health
- Consider the health problems of adolescence within a public health framework
- Utilise a public health framework to develop effective action to improve the health of young people
Goal 1: Understand the core concepts of public health
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Training objectives
Key topics to be covered
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Educational Methodology
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Activities, Issues, and Questions
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Pertinent resources
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KNOWLEDGE
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A.Select/produce a definition of ‘public health’ that best illustrates how PH serves the goals of adolescent health, giving consideration to the following elements: -Population focused -Health concerns of an entire community -Determinants of injury, disease and health -Ecological model -Focus on population outcomes -Promotion of healthy practices and behaviours -Prevention orientation: primary, secondary, tertiary
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Class discussion using the Visualisation in participatory programming (VIPP) technique
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As introduction to the topic, each participant writes on a separate sheet each 3 concepts that for them define public health. These sheets are then pinned on the wall in clusters according to the common ideas. Compare the different concepts with some commonly held definitions of public health, such as: ‘Health is a state of complete physical mental and social wellbeing and not merely the absence of disease or infirmity.’ (WHO) ‘The art of using science in the context of politics, to achieve optimal health for the greatest number of people.’ (Anonymous) ‘The science and art of preventing diseases, prolonging life and promoting health through organised efforts of society.’(Acheson) ‘Promoting the ability to resist the strains and stresses of a physical, mental and social nature, so that they do not lead to a reduction in life-span, function or well-being.’ (Kohler) Discuss how ‘public health’ relates to the purposes of adolescent health and what distinguishes it from the clinical approach.
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Website 1, Parts III and IV
Ref 1
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B. Describe the scope of public health practice, using the wheel (annex 1)
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Group discussion
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Divide the participants into four groups. Each group is assigned four spokes of the wheel at left to do the following exercise. Using one of the entry scenarios or the scenario in annex 2, discuss how a public health person would take action according to the sixteen areas in the wheel. After the group work, reconvene the class to put ‘the wheel together’ with each group presenting an action they would take for each spoke of their wheel.
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Annex 1, 2
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Goal 2: Consider the health problems of adolescence within a public health framework
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Training objectives
Key topics to be covered
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Educational Methodology
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Activities, Issues, and Questions
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Pertinent resources
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KNOWLEDGE
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A. List the major threats to health (morbidity and mortality) of young people in general (e.g. accidents) -prevalence -impact on health
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Interactive lecture. Group discussion
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Participants bring and present epidemiological data from their own country/region, by gender and age.
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Module C1
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B. Consider the multifactorial determinants of major health related behaviours of young people and their long-term impact on health -determinants -ecological model -role of politics and profit motives
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Using an ecological model (see Annex 3) discuss how the determinants of health (including gender, biological, psychological and sociological/political/legal, socio-economic, geographic influences) impact the causes of mortality and morbidity and how these influences vary over time and in different settings. Discuss the relationship between young people’s behaviours and their future adult behaviours and health status.
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Annex 3
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Goal 3: Play an active part in developing effective public health action to improve the health of young people
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Training objectives
Key topics to be covered
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Educational Methodology
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Activities, Issues, and Questions
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Pertinent resources
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SKILLS
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A. Identify the major sources of information concerning effective public health interventions in the field of adolescent health
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Mini lecture Group discussion
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Lecturer briefly reviews search approaches and presents some results from using Cochrane and other data bases, pointing out the limitations of transferring interventions into different contexts (i.e. cultures). Discuss the criteria for assessing the evidence of effectiveness of an intervention. Also, discuss criteria for assessing interventions that have not been evaluated. (See reference 3)
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Ref 2 Website 2: go to SAMHSA Websites 3, 4 Ref 3
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KNOWLEDGE
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B. Understand the impact of policy and policy making in the process of developing and implementing interventions
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Participants write down policies for their countries that affect adolescent health-related behaviours. Pin up these policies under groupings of ‘national’, ‘regional’ or ‘local’, noting whether policies are guidelines or grounded in law. Does a policy affect institutions or professional conduct? Do different countries have opposite policies for the same behaviour and why? Compare the impact the policies would have on the development and implementation of public health initiatives for adolescents. What kinds of policies facilitate and what kind hinder effective interventions for adolescents?
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C. Identify the stakeholders and others who can implement effective public health interventions. Be knowledgeable about advocacy (see module).
D. Consider the factors which are likely to influence the implementation of effective public health interventions in the field of adolescent health
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Objectives C and D: role play with group discussion
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For Objectives C and D: role play entry scenario 2 with participants taking the different parts of parents, politicians, health professionals, wine makers, alcohol control group and young people. What concerns and influencing factors (e.g. political willingness, economic, cultural, religious, and other social factors) does each group bring to the discussion? How can these be integrated in the process of formulating a response to the problem? Suggest criteria to evaluate and prioritise interventions such as cost, effectiveness, political expediency, and expected outcomes. Propose strategies to address the political and profit interests in alcohol consumption. Consider the value of including national and local politicians, leaders of businesses, religious leaders, sporting figures, and young people themselves to implement an intervention.
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Module C3
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ATTITUDE
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E. Review one’s own personal preparedness and willingness to be involved.
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Discussion in pairs
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Briefly discuss in pairs what personal factors (e.g. time, professional reputation, beliefs about role) affect one’s ability and willingness to participate in public health initiatives for the health of young people. Reflect on the role of the health professional in society.
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References
- Ad Hoc Work Group of the American Public Health Association (1987) Criteria for the development of health promotion and education programs. Amer J Public Health 77: 89-92
- 2.Anonymous (1986) Ottawa chart for Health Promotion; an international conference. Health and Welfare Canada, Ottawa, p 4 pp
- Ansari Z, Carson N, Ackland M, Vaughan L, Serraglio A (2003) A public health model of the social determinants of health. Soz-Präventivmed 48: 242-251
- Antonovsky A (1986) The salutogenic model as theory to guide health promotion. Health Promotion International 1: 1-18
- Bandura A (1986) Social foundations of thoughts and action: a social cognitive therory. Prentice Hall, Englewood Cliffs
- Blum R (1998) Healthy youth development as a model for youth health promotion. Journal of Adolescent Health 22: 368-375
- Bond L, Patton G, Glover S, Carlin JB, Butler H, Thomas L, Bowes G (2004) The Gatehouse Project: can a multilevel school intervention affect emotional wellbeing and health risk behaviours? J Epidemiol Community Health 58: 997-1003
- Elliot D, Mihalic S (2004) Issues in disseminating and replicating effective prevention programs. Prevention Science 5: 47-53
- Gallagher KM, Stanley A, Shearer D, Mosca C (2005) Implementation of youth development programs: promise and challenges. J Adolesc Health 37: S61-68
- Harden A, Garcia J, Oliver S, Rees R, Shepherd J, Brunton G, Oakley A (2004) Applying systematic review methods to studies of people's views: an example from public health research. J Epidemiol Community Health 58: 794-800
- Hedberg V, Klein J, Andersen E (1998) Health counseling in adolescent preventive visits: effectiveness, current practices, and quality measurement. J Adol Health 23: 344-353
- Kelder S, Perry C, Lytle L, Klepp K (1995) Community-wide youth nutrition education: long-term outcomes of the Minnesota Heart Helth Program. Health Education Research 10: 119-131
- Kelly J, Somlai A, DiFranceisco W, Otto-Salaj L, McAuliffe T, Hackl Kea (2000) Bridging the gap between the science and service of HIV prevention: Transferring effective research-based HIV prevention interventions to community AIDS service providers. Amer J Public Health 90: 1082-1088
- Lin V (2004) From public health research to health promotion policy: on the 10 major contradictions. Soz-Präventivmed 49: 179-184
- Lupton D (1995) The Imperative of Health. Public Health and the Regulated Body. Sage Public, London
- McIntyre P (2001) Adolescent friendly health services (draft report). World Health Organisation, Child and Adolescent Health, Geneva, p 43 pp.
- Michaud P, Blum R, Slap G (2001) Cross-cultural surveys of adolescent health and behaviour: progress and problems. Soc Sci Med 53: 1237-1246
- Oakley A, Fullerton D, Holland J, Arnold S, France-Dawson M, Kelley P, McGrellis S (1995) Sexual health education interventions for young people : a methodological review. BMJ 310: 158-162
- Patton G, Glover S, Bond L, Butler H, Godfrey C, Di Pietro G (2000) The gatehouse project: a systematic approach to mental health promotion in secondary schools. Australian and New Zealand Journal of Psychiatry 34: 586-593
- Pentz M (2003) Evidence-based prevention: Characteristics, impact, and future direction. Journal of Psychoactive Drugs 35: 143-152
- Pentz M (2004) From follows function: designs for prevention effectiveness and diffusion research. Prevention Science 5: 23-29
- Raphael D (2000) The question of evidence in health promotion. Health Promotion International 15: 355-367
- Resnick MD (2000) Protective factors, resiliency, and healthy youth development. Adolescent Medicine: State of the Art Reviews 11: 157-164
- Sallis J, McKenzie T, Kolody B, Lewis M, Marshall S, Rosengard P (1999) Effects of health-related physical education on academic achievement: project SPARK. Res Q Exerc Sport 70: 127-134
- Shepherd J, Harden A, Rees R, Brunton G, Garcia J, Oliver S, Oakley A (2005) Young people and healthy eating: a systematic review of research on barriers and facilitators. Health Educ Res
- Sowden A, Arblaster L (2000) Mass media interventions for preventing smoking in young people. The Cochrane Library, Oxford
- Sowden A, Arblaster L (2000) Community interventions for preventing smoking in young people. The Cochrane Library, Oxford
- Victora C, Habicht J, Bryce J (2004) Evidence-based public health: moving beyond randomized trials. Amer J Public Health 94: 400-405
- Whitelaw S, Baxendale A, Bryce Ca (2001) "Settings" based health promotion: a review. Health Promotion International 16: 339-353
- World Health Organisation (1993) The European Network of Health Promoting Schools. World Health Organisation, Copenhagen
- World Health Organization (1993) The Health of Young People. World Health Organization, Geneva
- World Health Organization (1999) Programming for adolescent health and development. World Health Organization, Geneva
Websites
- European strategy for child & adolescent health and development: http://www.euro.who.int/childhealtdev/
- Training resources in the field of public health : www.unssc.org/web1/programmes/rcs/cca_undaf_training_material/tot05/resources/VIPPUNICEFBangladesh.pdf
- Resources in gthe field of substance use :www.nih.gov go to: Substance Abuse and Mental Health Services Administration (SAMHSA) list of effective interventions
- Databank in the field of evidence based medicine, prevention and health promotion: www.cochrane.org
- US based databank on public health: www.mchb.hrsa.gov & www.nahic.ucsf.edu & http://childstats.gov/
- European Public Health Association: http://www.eupha.org/
- World Health Organisation / Child and adolescent Health and Development: http://www.who.int/child-adolescent-health/
- Evidence based health care. CASP CD-ROM and workbook. Obtainable from: Update Software. www.update-software.com
Annex 1: ‘Scope of Public Health Wheel’ definitions
The PH Interventions Model, commonly called "The Wheel of Interventions," focuses on 16 population-based interventions, each of which can be performed at 3 different levels of practice: individual and family-focused interventions, community-focused interventions, or systems interventions. A 17th intervention, case-finding, is focused at the individual and family level only. The PHN Interventions Model, developed by public health nurses at the Minnesota Department of Health, describes the scope of public health practice (Keller, Strohschein, Lia-Hoagberg, & Schaffer, 1998; Rippke, Briske, Keller, & Strohschein, 2000). The PHN Interventions Wheel defines the varied leadership roles of health professionals on individual, community and systems levels and speaks to the need for multidisciplinary teams that encompass the array of skills and knowledge for all aspects of public health. It embraces health professionals’ capacity to envision and provide a unifying force that creates synergy among a host of disciplines and resources. All Minnesota public health nursing departments throughout the state, as well as across the nation, have adopted the PHN Wheel as their framework for practice.
Keller, L, Strohschein, S, Lia-Hoagberg, B, & Schaffer, (1998). Population-based public health nursing interventions: A model from practice. Public Health Nurs, 15(3), 207-215.
Rippke, M., Briske, L., Keller, L., & Strohschein, S. (2000). Public Health Nursing Interventions II. MN Department of Health, Section of Public Health Nursing, June 2000.
Annex 2: scenario:
You are a primary care clinician whose office is in a deprived part of a large city. On a regular basis (averaging three a week) you are seeing young women aged between 14 and 17 who are pregnant, a majority of which want to have an abortion. After six months of referring these cases to the local hospital gynaecology clinic, you realise that if anything the problem is getting worse. A review of your case records confirms your impression. You begin to realise that you should have a greater role in preventing these girls from getting pregnant in the first place, particularly as a large number of them attend local schools in which you provide services. Where do you go from here in order to improve the situation?
Annex 3: Ecological Model for Adolescent Health and Behaviors
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