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Population Health for Nurses

15.1 Defining Health Promotion and Disease Prevention

Population Health for Nurses15.1 Defining Health Promotion and Disease Prevention

Learning Outcomes

By the end of this section, you should be able to:

  • 15.1.1 Define health promotion.
  • 15.1.2 Define disease prevention.
  • 15.1.3 Differentiate between health promotion and disease prevention.

The terms health promotion and disease prevention are often used together to describe a mechanism for improving health outcomes. Although the U.S. Department of Health and Human Services (n.d.-a) Healthy People 2030 initiative states that “promoting health and well-being and preventing disease are linked efforts that encompass physical, mental, and social health dimensions” (para. 6), health promotion and disease prevention are two individual processes. Though their functions overlap, they are separate and distinct entities.

A Closer Look at Health Promotion

Organizations define health promotion in different ways. The Ottawa Charter for Health Promotion, described in detail later in this chapter, offers the most widely accepted description of health promotion:

Health promotion is the process of empowering people to increase control over, and to improve, their health (World Health Organization [WHO], 1986). This must involve addressing physical, mental, and social well-being. In order to accomplish health promotion, an individual or group must be able to identify and realize goals related to health, satisfy needs, and change or cope with the environment. Health, according to the WHO (1986), should be seen not as the objective of living but instead as a resource for everyday life. Clearly, health promotion is a responsibility of the health sector. Sectors are critical, distinct parts of society. We must view health promotion as not just the responsibility of the health sector but as an obligation of multiple sectors, such as the environmental, educational, and technological sectors as well as others (WHO, 1986, para. 1).

The process of health promotion includes activities for individuals, the community at large, and populations at increased risk of negative health outcomes. Health promotion is empowering for individuals and communities, and it can be used in both active and passive ways. For instance, adding fluoride to public drinking water is a passive form of health promotion at the community level. Brushing teeth and getting regular dental assessments are active forms of health promotion at the individual level.

Health Promotion Behaviors

Health promotion behaviors aim to improve the well-being, mental health, and quality of life of individuals and communities (Walker et al., 1995; see Table 15.1). There are six dimensions of health promotion behaviors that describe certain behaviors by which a person engages with their health. These dimensions empower (or not) a person’s control over and improvement of their health.

Dimensions Definition Individual-Level Example Community-Level Example
Responsibility An active sense of accountability for one’s well-being; incorporates attention to one’s health, educating oneself about health, and using informed consumerism when seeking professional assistance A client asks their provider for information about a prescribed medication, including side effects and interactions North Carolina’s Community Health Coalition (2023) connects leaders and practitioners in medicine, education, mental health, faith organizations, law, finance, the military, and social advocacy to achieve the goal of health equity for all.
Physical Activity Regular participation in light, moderate, and/or vigorous activity, either specifically for the purpose of fitness and health or incidentally as part of daily life A person chooses to take the stairs rather than the elevator LIFE: Living well through Intergenerational Fitness and Exercise (Rural Health Information Hub, 2022) combines exercise and video games to encourage fun and safe physical fitness among older adults in rural areas.
Nutrition The informed selection and consumption of foods essential for sustenance, health, and well-being, including a healthy diet as recommended by the U.S. Department of Agriculture (USDA) A shopper examines a nutrition label on a pre-packaged meal prior to making a purchase Meals on Wheels America (2021) visits seniors to deliver nutritious meals and perform safety checks, supporting seniors’ independence and dignity.
Interpersonal Relations Communicating to achieve a sense of intimacy and closeness within meaningful relationships with others; includes the sharing of thoughts and feelings via verbal and nonverbal messages Two friends meet to share experiences they had throughout the previous week, including the highs and lows of everyday life The National Health Education Standards in the United States specifically include interpersonal communication as an essential element of effective health education in grades K–12 (Centers for Disease Control and Prevention [CDC], 2019b).
Spiritual Growth Creating inner resources through the following:
Transcending: Opens one to the possibility of creation and change, connecting with their most balanced self and feeling inner peace
Connecting: A feeling of harmony and wholeness within the universe
Developing: One maximizes their potential for wellness; can occur through searches for meaning, finding a sense of purpose, or working toward life goals
A college student practices daily meditation Austin Public Health (2023) offers Walking with Faith, in which members of all ages increase their physical activity, spiritual growth, and cultural awareness as they take virtual tours through various countries.
Stress Management Identification and mobilization of both psychological and physiological resources to control or reduce tension The CEO of a large company takes 15 minutes each morning to practice mindfulness meditation Thrive! is a comprehensive University of Michigan (2023) stress management and prevention program that aims to foster employees’ psychological well-being by energizing the work climate, enhancing relationships, and maximizing personal strengths.
Table 15.1 Six Dimensions of Health Promotion Behaviors (See Walker et al., 1995.)

Nurses’ Role in Health Promotion

As mentioned earlier, health promotion is often an intersectoral endeavor (WHO, 2023a)—that is, one that involves several sectors of society and that can occur within or outside the health care sector. Actions taken by health, education, housing, and local government sectors collaborating to enhance population health use an intersectoral approach (Oxford Reference, 2023). Because nurses can serve in a variety of roles in interprofessional practice, including care provider, educator, consultant, and advocate, they are in a unique position to contribute to intersectoral collaboration. Health promotion can involve the following:

  • Assisting a client in developing personal health promotion behavior skills (individual)
  • Assisting the community in strengthening actions to achieve better health (community)
  • Creating supportive environments within society (population or public as a whole)
  • Advocating for the adoption of public health policies (population or public as a whole)

Throughout the health promotion process, as nurses assist clients in developing personal health promotion behavior skills, they serve as care providers and educators. Assessment data may indicate the need to develop a client’s personal health promotion behaviors. The nurse assumes the role of educator during the implementation stage. Effective education for change requires the nurse to have a good grasp of evidence-based practice and other scientific knowledge as well as educational theory, the teaching-learning process, and models specifically related to health behavior change (see Theories and Models). The nurse must support individual, and therefore social, development by educating, informing, and improving clients’ life skills (WHO, 2023a). When a client is informed and knowledgeable, they have the ability to make choices that can positively influence their health and their environment (WHO, 2023a). The nurse educates the client about their current situation and provides anticipatory guidance to help them meet and cope with health challenges as they move through the stages of the lifespan (WHO, 2023a). The role of the nurse as an educator is one of the most critical roles in health promotion. The nurse may also need to serve as educator in order to create supportive environments for health.

The nurse serves as consultant and advocate by performing community health promotion activities. Such activities strengthen clients’ actions to achieve better health, resulting in environments that support better health (Iriarte-Roteta et al., 2020). A community is complex, frequently changing, and made up of interconnecting parts from which health cannot be separated. Planners can seek input from a public health nurse to understand the health and illness experiences of the community and implement beneficial changes for community health (American Public Health Association [APHA], 2022). For instance, a city council may request input from a public health nurse prior to installing a new splash park for children.

Nurses have a responsibility to advocate for access to health care, health promotion, disease prevention, and any other health-related issues. A variety of professional groups, including the American Nurses Association (ANA, 2015), the American Association of Colleges of Nursing (2021), and the International Council of Nurses (2021), support the nurse’s role as policy advocate. According to the ANA (n.d.), “Advocacy is a pillar of nursing.”

A Closer Look at Disease Prevention

Disease prevention involves undertaking specific population- and individual-based interventions geared toward decreasing the burden of both communicable and noncommunicable diseases and their associated risk factors (WHO Regional Office for the Eastern Mediterranean, 2023). The hallmark of communicable diseases is that they spread from one person to another, from an animal to a person, or from a surface or a food to a person (CDC, 2022). They may include pandemics and infectious disease outbreaks, vaccine-preventable diseases, human immunodeficiency virus (HIV), viral hepatitis, sexually transmitted infections (STIs), tuberculosis (TB), and others (see Pandemics and Infectious Disease Outbreaks). The CDC (2022) broadly defines noncommunicable diseases as chronic conditions that do not result from an acute or infectious process. Chronic diseases meet one or both of the following criteria: a disease that lasts 1 year or longer and requires ongoing medical attention or a disease that limits the activities of daily living. Noncommunicable diseases include chronic diseases such as heart disease, cancer, diabetes, and others, as discussed in The Health of the Population.

Preventive Care

Another term for disease prevention is preventive care. According to the U.S. Centers for Medicare and Medicaid Services (CMS, n.d.), preventive care involves routine health care screenings, check-ups, immunizations, and counseling to prevent illness, disease, or health-related problems. Healthy People 2030: Preventive Care gives examples and connects preventive care to the Healthy People 2030 Objectives, as described in detail in Planning Health Promotion and Disease Prevention Interventions.

Healthy People 2030

Preventive Care

Healthy People 2030 Preventive Care Objectives focus on a broad range of goals, such as increasing the number of community health organizations that offer prevention services; increasing screening for various forms of cancer, depression, newborn hearing, and osteoporosis; promoting vaccinations; and increasing health care access and quality. Other topics include heart disease and stroke, oral health, pregnancy and childbirth, sensory or communication disorders, and sexually transmitted infections.

Nurses’ Role in Disease Prevention

Nurses play an enormous role in disease prevention. The nurse’s role as educator is especially important to prevention, as nurses are qualified to provide information, training, and education about a range of health-related, preventive topics. When people are educated about health behaviors, they experience better health outcomes (Zajacova & Lawrence, 2018).

The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP, 2023), a branch of the CDC, indicates that 6 in 10 Americans live with at least one chronic disease. These largely preventable diseases are the leading causes of death and disability in the United States. For instance, tobacco use can lead to several forms of cancer. Diets high in sodium can lead to hypertension. Preventive care such as smoking cessation and dietary education can help prevent these chronic diseases from occurring. Nurses can educate their clients about these and other disease-preventing behavior changes. Recall Deanna from the case scenario. The nurse at the community health screening helped to identify a potential chronic health problem for Deanna and then provided Deanna with information she could use to help prevent the development or progression of hypertension.

Nurses apply evidence-based practice to prevent disease (see Evidence-Based Decision-Making). Using evidence from correlational or causal studies to examine the relationships between diseases and behaviors or risks for these diseases, the U.S. Preventive Services Task Force (USPSTF, 2021) makes recommendations about the effectiveness of clinical primary and secondary preventive services based on available evidence. These recommendations inform effective nursing practice. For example, nurses may inform clients of USPSTF recommendations for colorectal cancer screenings in adults and older adults, tobacco smoking cessation in adults, and folic acid intake by pregnant persons to prevent neural tube defects.

The Distinction Between Health Promotion and Disease Prevention

While the functions of health promotion and disease prevention overlap and they share many goals, they have differences. Disease prevention focuses on specific efforts at reducing the development and severity of chronic diseases and other morbidities. While health promotion efforts can lead to such a reduction, health promotion can also occur unlinked to disease and simply be used to promote overall well-being. Some examples of health promotion that is unlinked to prevention of a specific disease may include the following:

  • Physical activity campaigns to encourage regular exercise
  • Nutrition education regarding balanced diets and portion control
  • Stress management workshops to enhance mental well-being
  • Workplace wellness programs to support employees’ physical and mental health
  • Smoking cessation programs to promote a smoke-free environment
  • Mental health awareness campaigns to reduce stigma
  • Environmental health initiatives to promote clean air, clean water, and safe living

Another distinction between health promotion and disease prevention relates to the strategies used for each. Health promotion interventions often involve education, awareness campaigns, behavior change programs, and community engagement to encourage healthy behaviors and create supportive environments for health. Disease prevention strategies more specifically target known risk factors or disease processes.

Another distinction often occurs at the conceptual level. In this case, health promotion is primarily concerned with the social determinants of health (SDOH) (WHO, 2023a). SDOH, as described in Social Determinants Affecting Health Outcomes, are “the conditions in the environments where people are born, live, learn, work, play, worship and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (USDHHS, n.d.-b). Therefore, various sectors typically collaborate with the health care sector to contribute to addressing SDOH. For example, the WHO Regional Office for the Eastern Mediterranean (2023) describes the collaboration of the governmental sector (policy development), the tobacco manufacturing sector, the education sector, and the health care sector in combating tobacco use. Disease prevention, in contrast, has primarily been concentrated within the health care sector (WHO Regional Office for the Eastern Mediterranean, 2023).

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