public health promotion

Public Health is often defined as the ‘promotion of health and prevention of disease through the organised efforts of society’. A public health intervention aims to ensure co-ordination between sectors (e.g. in Humanitarian programmes with those involved in food and nutrition, water and sanitation, shelter, health care etc.) and to base its actions on sound public health information which is aimed at the maximum impact for the greatest number of people. Public Health Promotion is the planned and systematic attempt to enable people to take action to prevent or mitigate disease. It combines insider knowledge (what do people know, do and want) with outsider knowledge (e.g. the causes of disease, epidemiology, vector control and communications and learning strategies). As the situation settles people may be less willing to do this but the short term action has prevented unnecessary deaths. The emphasis on action rather than behaviour change can also provide a more empowering approach to working with those affected by disasters by recognising that they are not just victims but that through collective and individual action they are also able to help themselves to mitigate the effects of a disaster. Public Health Promotion stresses the need for a planned and systematic approach to the provision of clean water, improved sanitation, vector control, the provision of essential items such as soap, water containers or bednets and the provision of information and learning opportunities. It depends on a detailed knowledge of what people know, do and think as well as knowledge of environmental health, engineering, epidemiology, communication and learning strategies.

Community participation does NOT simply involve people contributing labour, equipment or money to the project but aims to promote the active involvement of all sections of a community in project planning and decision making. It aims to encourage people to take responsibility for the process and outcomes, both short and long term, of the project. Encouraging participation in an emergency can help to restore people’s self esteem and dignity but achieving participation within a short time frame can present significant challenges. It should be remembered that at different stages of the emergency different levels of participation will be possible and therefore a flexible response is required. Project managers, engineers, public health promoters, vector control officers all are responsible to ensure that Public Health principles are adhered to, that minimum standards are met, that those affected are involved in the response.

Interventions in Public Nutrition and the education component of Food and Nutrition programmes should apply a Public Health Awareness to enable people to take action to reduce health risks. People may be more receptive to information from mass information campaigns but wherever possible discussion and dialogue should form the basis of mobilisation campaigns. Systems of community organization may be involved in promoting public health and in raising awareness. Schools may be functioning, religious groups mobilised and government structures may be involved in the delivery of services.

The process of assessment and analysis, planning, monitoring and evaluation which are as essential in relief as in development work should be organized to mobilise communities. In this respect, to have deeper understanding of what people know, do and think is important. Assessment is carried out by data collection using mapping, focus group discussions and household observation as well as other participatory tools to supplement the acknowledgment. Community structures may have become severely disrupted during an emergency or may be non existent. Mobilising the community to regroup and elect new leaders or representatives if necessary will facilitate any future work with them.

What data is need for assessment?
The list below is an example of some of the initial key information for Public Health Promotion that should be gathered initially. The Public Health Assessment Tool (PHAT) should be consulted for further details of what assessment data is required.
__government structures (health services(including public health)/water supply/education)
__population (numbers and profile), average household size
__mortality and morbidity (including malnutrition)
__basic epidemiology of common diseases which pose a risk to the population (e.g. diarrhoea/malaria) disaggregated by sex if possible
__key informants, opinion leaders (male and female)
__community organisation & structures (women’s groups, water committees, religious institutions, social societies, youth groups, schools, markets, health service etc.), gender roles
__existing outreach workers (Community Health Workers, Social Development extension agents etc.)
__vulnerable groups (disabled, older people, female headed households, ethnic minorities, etc.)
__literacy rates for men and women


Reference: Oxfam Guidelines for Public Health Promotion in Emergencies, 1996