Over the years, the definition of the term ‘health’ has been a contentious issue, with a wealth of literature demonstrating that professionals in the healthcare field seem to hold contradicting views concerning its authenticity. While some health professionals maintain that a certain definition is precise, others believe that health encompasses a wide point of view, hence attracting non-medical concepts in its definition. This has necessitated a number of organizations in the field of health to underscore factors that contribute to health in order to develop and implement programs aimed at identifying and deterring health discrepancies within the societies through concerted efforts of health education and promotion programs.
The health education and promotional programs have also elicited debates on whether it is appropriate to single out groups or individuals to be targets of health promotion activities. Answering this question necessitates a collection of facts from diverse groups, including the community, the healthcare stakeholders, people in dire need of health care, and the service providers. This will also establish the risks and benefits of targeted approaches of health promotion. For case in point, while assessing the impact of malnutrition in pregnant mothers, it is paramount to assess the impact of the predicament to not only the mother but also the child, as well as the role of the health practitioners and government policies put forth to mitigate the predicament. Thus, a decision on whether to single out individuals or groups to be targets of health promotion calls for a framework that is able to assess the social values within the community, the scale of the issue at hand, and the etiology of the health discrepancy at hand.
Definition of ‘Health’ and ‘Health Promotion’
The term ‘health’ is defined as a state of comfort in physical, mental, as well as social sphere (World Health Organization [WHO], 1986, para.1). But although the World Health Organization is considered as one of the key leaders and organizations in the field of health, its definition of the term ‘health’ is faced with divergent criticism. One of the critics argues that health should not only be defined as a state of physical, social, and mental wellbeing, but should also encompass emotional stability, love for others, adaptation to environmental changes, clear thoughts, high intuition levels, and spiritual embracement (Fink, 2009). However, other critics argue that heath encompasses the ability to recognize a successful venture and that each person has the responsibility of determining his/her own success depending on his/her personal goals, not according to goals put forth by an organization (Hurrelmann, 1996).
Health promotion, on the other hand, is defined as the approach taken by a healthcare program to improve people’s health status as well as increase their control over health discrepancies (WHO, 1986, para. 1). Likewise, health education and promotion programs have taken different approaches. While some have adopted the social approach of decreasing the burden of the disadvantaged members of the community; increasing the health intervention resources; and providing education that endeavors to limits morbidity and morality rates for all community members, others have adopted the targeted approaches, which provides intervention to particular people facing defined health discrepancy.
However, despite the presence of many evolving definition of health and different approaches taken by health education and promotion programs, the practice of the programs has been on the rise since majority of these programs are currently basing their performance not only on the physical and mental wellbeing of the people but also on their social and psychological wellbeing. But while the above are valid assertions of leaders and organizations in defining health and health promotion, the notion that to single out groups or individuals to be the target of health promotion as the panacea to health discrepancies within the community remains unconvincing, given that the risks outweigh the benefits of the approach.
It is imperative to conceptualize a working definition of the terms ‘targeted’ approaches in order to have a better understanding of the extent to which it is able to promote health within a given community. As the name suggests, ‘targeted’ approach is an approach taken by health promotion programs, which seek to come up a strategy that facilitates viable comparison of data relative to morbidity and mortality rate of the disease in question on grounds of on gender, race, age bracket, and social economic status, among other factors (Penelope, 1996).
Thus, the targeted approach is able to analyze the frequency of disease pattern in a given population in qualitative and quantitative manner. However, this approach does not provide profound evidence of the health disparity in question because it emphasizes on analyzing the driving force and the environmental factor contributing to health discrepancies amongst a particular group of people without providing a broader context of the social factors affecting their health (Fortmann & Varady, 2000).
Risks of Targeted Approaches
Poor Knowledge on Social Values of the Community
Successful health education and promotion program calls for adequate knowledge on social values of the community (Barry et al., 2009). For case in point, while promoting health amongst women facing domestic violence, the targeted approach program is unable to extend its health promotion to the children, as it is based on functional model (Penelope, 1996). Thus, in this case, the information gathered during needs assessment aims at attaining health information with regard to allocation of resources for the mistreated women, rather than the felt needs of the members of the community.
Taking such an approach is detrimental to the health education and promotion program since it is unable to carry out an effective needs assessment for the rest of the members of the society with regard to the health discrepancy in question. For case in point, in a domestic violence scene, the approach cannot establish whether the other members of the community are concerned with the protection of the women facing domestic violence and whether such women need assistance. Thus, the program is unable to promote health requirements of the participants through diverse channels, including the community leaders, and more so, the level of cooperation between the health promotion program and the community at large (Feinleib, 2008).
Poor Dissemination of Information with the Health Stakeholders
Promoting health through target approach limits the chances of coming up with a program that represents the needs of the entire community and a program that would facilitate proper dissemination of health information (Olinky, 2005). This creates a barrier for the success of health promotion in addressing health discrepancies, especially for discrepancies that have not been positively accepted by the members of the community. For case in point, AIDS is a disease that is socially unaccepted within some of the communities. Thus, carrying out a health education and promotion program that targets the AIDS patients as the only participants may not help the affected participants attain psychological and social health.
More so, while taking into account that the core of health education and promotion program is to provide empowerment for people suffering from health discrepancies, targeted approach is vulnerable to inequity principle when it comes to provision of social services and amenities in the community. Thus, the participants may be at risk of experiencing inequality while accessing social amenities due to poor power relationships between the people with health disparities and the other members of the community (Bandura, 2004). Since the targeted approach is not based on defining health on social context with other members of the society, it jeopardises the need of the participants as they relate with other members of the society.
Lack of a Clear Definition of Health Problems
A targeted approach does not provide a profound definition of the problem in question, given that it does not take into consideration the diverse definition of the problem that would help to curb the health disparity using a number of views from diverse participants. For case in point, in the health promotion and education for prevention of tobacco smoking, doctors can help the program achieve its goals since they have dealt with a considerable number of patients infected with cancer caused by smoking. Lawyers, on the other hand, can help the health education and promotion program to review the proposed government regulations for tobacco and make certain that tobacco companies do not evade them (Kelecher, 2007, p.31 ). Thus, failure to incorporate health education and promotion program with diverse participants, who help in the management of social relation, creates room for unclear definitions of problems.
Low Levels of Community Participation With Regard To Health Care Practices
A targeted approach does not provide room for community participation programs that promote health, such as the community capacity building and community development practices. Thus, while using the targeted approach, the health education and promotion programs lack the position of addressing health in relation to the environmental factors that hinder disease prevention and eradications. These factors include the type of the food embraced by the community; water and sewage systems within the community; technology factors; poor conservation of natural resources such as forests; working conditions such as the level of noise, space arrangement; and the social environment factors within the community (Fleming & Parker, 2007, p.24).
Community participation is critical in health education and promotion programs since it involves professionals and grassroots leaders from community organizations who act as the key stakeholders of health within the community settings (Fleming & Parker, 2007, p.34). The coalition of health professionals and grassroots leaders enables the health education and promotion programs and the entire community to find a common ground that leads to effective control of health disparities. The low levels of community participation, which characterize the targeted approach, hinder the success of health education and promotion programs in both planning and educating, thereby creating little awareness amongst the members of the community. More so, according to Fleming & Parker (2007, p.35), a targeted approach has little impact when it comes to attracting funds and resources from the government and other health stakeholders simply because such organizations are more concerned with enacting policies that benefit the entire community as opposed to targeted approaches.
Benefits of Targeted Approaches
Comprehensive Knowledge on Characteristics of People Experiencing the Health Disparity
One of the benefits of using targeted approach in the health promotion and education program is the fact the program is in a position of analyzing the frequency of disease pattern in a given population (Kelecher, 2007, p.35). More so, the program is in a position of analyzing the people who are very likely to be infected with the disease in question, their age, their gender, and their socio-demographic terms, among others variables. For case in point, the program attempts to define the characteristics of women who have fallen victims of domestic violence and other problems experienced by such women.
More so, the program is able to create conditions for sustainability of the program since the health patterns of a community, which are subject to changes, are surveyed overtime and quantified. This helps in creating a sustainable a community project that helps to meet the present and the future needs of the people of the community (llert, 1996). In turn, this provides the health education and promotion program with comprehensive knowledge on the resources required to cater for the current demand aimed at mitigating health disparities. More so, this eliminates assumption of community needs and the prevalent rate of a disease within the community. The fact that the research is able to identify the characteristics of people in dire need of health education and promotion helps in management of project resources.
Knowledge on the Scale and Distribution of the Condition
Kelecher (2007, p.35) affirms that targeted approach creates room for estimating the spatial distribution of the health disparity in question. The estimate of numbers provides the program with knowledge on the effort required to mitigate the health disparity. The distribution of the health disparity, on the other hand, helps to establish whether the health disparity in question is concentrated or dispersed in different regions across the community. While it is, indeed, true that adopting targeted approaches can jeopardize the psychological health of the participants, this approach is beneficial as far as intervention strategies are concerned.
This stems from the fact the traditional medical model, which is normally adopted by the targeted approach, endeavors to eliminate the conflict of resources within the health education and promotion program (Kelecher, 2007, p.146). This model highlights that the most common human resource conflict that can arise in a healthcare education and promotion is the lack of balance of resources for the targeted group. Thus, the program facilitators are cognizant of the fact that failure to observe the likely effects that can result from under allocation of resources can hinder the realization of the community goals.
Empowering the Targeted Population
Targeted approach aims at empowering the target population to achieve their social, psychological, physical or psychosocial health. This approach is suitable for the elderly people suffering from chronic diseases such as arthritis, diabetes, and hypertension, among others (King & Farmer, 2009). The success of such an approach is attributed to the fact that the promotion and education program is provided for the elderly who depict similar patterns of learning (Ewles & Simnett, 2003, p.232). This approach is beneficial because it facilitates autonomy amongst the elderly, empowers them through group participation, helps them share experiences and health information with the other participants experiencing the same health disparities.
As a result, the elderly group is in a position of experiencing increased self worth in social events and able to change their negative attitude towards of getting old by engaging in active participation. Besides the elderly, the self-management model, which is normally adopted by the targeted approaches, empowers the target population in a number of areas, including planning of nutritional programs, smoking termination programs, and weight reduction measures, among others (Binns, Mueller, & Ariza, 2007)
This paper has clearly demonstrated that even though a number of benefits result from targeted approaches of health promotion activities, it is not appropriate to single out groups or individuals to be the target of health promotion activities, as the risks of doing so outweigh the benefits. This claim is based on the grounds of health management habits, which explicitly express that health management habits cannot be achieved by targeting one aspect of health, but rather, the physical, social, psychological, and emotional health, among others.
The analysis of the literature reviewed suggests that even though a number of health care education and promotion would like to save on cost and help the affected members of the community improve their health status, the goals of the program cannot be achieved without a socially oriented approach. This entails carrying out a needs assessment of not only the people in dire need of the health care education, but all members of a given community. In doing so, the program achieves psychological empowerment for people suffering from health disparity, empowerment of the health education and promotion program, as well cooperation with other members of the community and government policies.
Bandura, A. (2004). Health Promotion by Social Cognitive Means. Health Education & Behavior, 31 (2), 143-164.
Barry, M. M., Allegrante, J.P., Lamarre, M., Auld, M. E., & Taub, A. (2009). The Galway Consensus Conference: international collaboration on the development of core competencies for health promotion and health education. Global Health Promotion, 16 (2), 6-9.
Binns, H., Mueller, M., & Ariza, A. (2007). Healthy and Fit for Prevention: The Influence of Clinician Health and Fitness on Promotion of Healthy Lifestyles During Health Supervision Visits. Clinical Pediatrics, 46 (9), 780-786.
Ewles, L., & Simnett, I. (2003). Helping people to Learn. New York : Bailliere Tindall.
Feinleib, M. (2008). The Epidemiologic Transition Model: Accomplishments and Challenges. Annals of Epidemiology, 18 (11), 865-867.
Fink, A. (2009). Toward a New Definition of Health Disparity. Journal of Transcultural Nursing, 20 (4), 349-357.
Fleming, M. L., & Parker, E. A. (2007). Health promotion: Principles and practice in the Australian context. St Leonards, NSW, Australia: Allen & Unwin.
Fortmann, S. P., & Varady, A. N. ( 2000). Effects of a community-wide health education program on cardiovascular disease morbidity and mortality: the Stanford Five-City Project. American Journal of Epidemiology, 152 (4), 316-23
Hurrelmann, K. (1996). Health education as an integral part of health promotion: Theoretical models and examples for programs in school. The School Field, 7, 154-168.
llert, G. A. (1996). Non-governmental organizations in international health: past successes, future challenges. The International Journal of Health Planning and Management, 11(1).
Kelecher, H. (2007).Empowering and health education. South Melbourne, Vic.: Oxford University Press.
Kelecher, H. (2007). Reframing health promotion. South Melbourne, Vic.: Oxford University Press.
King, G., & Farmer, J. (2009). What older people want: evidence from a study of remote Scottish communities. Rural and Remote Health, 9 (2).
Olinky, R. (2005). Thresholds in epidemiological models. Tel Aviv: s. n.. Penelope, H. (1996). Needs assessment must become more change-focused. Australian and New Zealand Journal of Public Health, 20(5), 473-478.
World Health Organization (WHO). (1986). Web.