SETTINGS FOR HEALTH PROMOTION
David Stevenson
Inspirational and effective health promotion programs and services may be offered in many different settings where healthy lifestyle habits can be developed, nurtured, and sustained. The unique characteristics and strengths of environments where people live, learn, work, relax, recover, and worship can be used in teaching, modeling, and supporting positive health behaviors. Although set- tings may be very different, characteristics common to all effective health promotion programs include competent and enthusiastic leadership, a feeling of being welcome and safe, camaraderie among participants and with staff, involvement and adherence to proven programs and ser- vices, and measures of success leading to a sense of achievement. Health promotion programs and settings also offer excellent opportunities for professional and volunteer leaders to make a positive effect on the health and well-being of others. Let’s explore diverse settings where healthy lifestyles can be developed, promoted, and supported (Breckon, Harvey, & Lancaster, 1998; Floyd &
Allen, 2004).
The Home
An individual’s place of residence is likely to be the most important setting for the development of positive health behaviors. Including time for sleep, most individuals spend twelve to fifteen hours at home each day (U.S.
Department of Labor, 2011). The development of new technology including improved access to information
LEARNING OBJECTIVES After reading this chapter, the student will be able to:
. Identify the major settings where health promotion occurs.
. Describe each setting and the opportunities where health promotion
professionals can promote health.
. Discuss how the major settings reach people in different places.
. Explain how the settings complement each other.
. Describe how the targeted behaviors are uniquely incorporated into the settings.
. Summarize opportunities for employment and
volunteerism in various health promotion settings.
(the Internet), expanded opportunities for entertainment (cable televi- sion), and new opportunities to interact with others using social media have led to more time being spent in the home. Also contributing to this trend is an expanded use of business technology and home-based offices, enabling individuals to work from home while reducing costs for employees and employers (Matthews et al., 2008). It is also known that more individuals are using their home as a place to exercise. In fact, the Sport and Industry Fitness Association (www.SGMA.com) reports that the purchase of home exercise equipment far outpaces the purchase of exercise equipment by commercial health clubs and other institutions.
Family
Relationships with those held most closely in a person’s life can have a profound effect on one’s health and wellness. It is understood, therefore, that an individual’s family or those whom they live with will play a vital role in their well-being (Umberson, 1987). To explore this concept, we must recognize that society’s understanding of the word family has changed dramatically since the 1950s. In addition to the traditional family of parents and children, today’s home often supports a new definition of family.
Multigenerational families, foster homes, same-sex families, group homes, and homes supporting individuals with disabilities are a few examples of the diversity in the composition of today’s modern family.
In families led by adults, the modeling and leadership offered by a parent, guardian, or caregiver is critical to the healthy development of the child (Golan & Crow, 2004). Children who live in a household where healthy foods are served, where fun physical activity is modeled and encouraged, where access to screen time (television, computers, hand-held devices) is limited, and where the day begins after a good night’s sleep will have a great foundation for lifelong well-being. Inversely, living in a home with easy access to unhealthy foods, where little physical activity takes place, where In 2010, the US Department of Health and Human Services launched Healthy People 2020 (www.HealthyPeople.gov) presenting new objectives for improving the health of all Americans.
Many of the health promotion settings and concepts presented in this chapter, such as early childhood centers, schools, work sites, physical activity, policies, and structural environments, are included in the new national objectives for improving health and well-being.
family members are glued to screens in a motionless state for many hours each day, and where family members start the day without proper rest can have a devastating effect on the health and well-being of all in the home.
Physical Space
The physical space of the home may also support or detract from an individual’s pursuit of a healthy lifestyle. Modern inventions designed to minimize physical exertion have achieved their goal. Conveniences such as the power garage door opener, washing machine, TV remote, and self- propelled lawn mower facilitate the completion of life’s daily chores, often with just the lift of afinger. The physical requirements of daily chores for many in modern American society have been reduced to such an extent that exercise must be intentionally pursued to maintain health and wellness.
Many leading health experts have pointed to this physical inactivity crisis as a major contributor to the epidemic of overweight and obesity taking place in developed countries (van Sluijs, McMinn, & Griffin, 2007).
Personal Training
Services provided by apersonal trainerin the home or other venues can offer the encouragement, support, and guidance necessary for improvement of an individual’s health and wellness. Excellent personal trainers possess soundinterpersonal communication skills, knowledge in exercise science, and understand how to inspire individuals to adopt and maintain healthy living habits. Personal trainers should be certified in emergency response including cardiopulmonary resuscitation and often possess certification through the American College of Sports Medicine (www.ACSM.org), National Strength and Conditioning Association (www.NSCA.com), YMCA (www.YMCA.net), National Academy of Sports Medicine (www .NASM.org), or other certifying organizations. Chapter 11 provides more detail on personal training certifications and other health promotion related certifications.
According to the National Association of the Remodeling Industry (www.NARI.com), adding or renovating a home exercise space offers the owner a major advantage—convenience. As the number of home exercisers continues to grow, the dedication of space forfitness activities in the American home is becoming more common.
physical space the physical makeup of the home, office, or other environment; changes to one’s personal space can make daily activities easier to complete, but require less physical movement, making exercise a task to be intentionally pursued personal trainer afitness professional involved in exercise prescription and instruction; motivates clients by setting goals and providing feedback and accountability
interpersonal communication skills the process by which people exchange information, feelings, and meaning through verbal and nonverbal messages;
message content can be seen as equally important as how it is said, including the tone of voice, facial expressions, gestures, and body language
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Physical Safety
Serious accidents can take place in the home, particularly involving young children and older adults. Special precautions can be employed to minimize safety risks in the home by installing adequate lighting and skid protection, limiting access to stairways, securing hazardous chemicals, and ensuring safe access and use of ladders, appliances, and swimming pools. Safety measures in homes where older adults live may include walking surfaces free of obstructions such as extension cords, grab bars in bathrooms enabling safe use, access to handrails and other support around stairways, and communications systems that can be easily accessed in case of an emer- gency. Excellent home safety tips are offered by organizations such as the American Association of Retired Persons (AARP) and the National Associ- ation of Home Builders (NAHB).
Communities
Defined as families and individuals living or working in close proximity and who share common services,communitiesserve as an excellent setting for the promotion of health. Grassroots community health initiatives have proven to be very effective in reducing health risks and promoting healthy lifestyles (Kaiser Permanente, 2008). Strategies and programs developed by not-for-profit organizations, schools, health care providers, and local gov- ernment agencies have led to community-wide health promotion opportu- nities including the following:
• Health education through community health fairs and seminars
• New opportunities for physical activity through community walks and fun runs, expanded green spaces, bike lanes, and better sidewalks
• Easier access to healthy foods grown in community gardens or sold at local farmers’markets
We have also learned that comprehensive community wellness initiatives developed and offered by organizations working in partnership will expand and strengthen the impact desired in improved community health (Perkins, 2002). Not-for-profits, schools, health care providers, and government agencies each bring unique and complementary strengths to providing a comprehensive and collaborative approach to address community health and wellness. When working together, these organizations can have a powerful impact on the lives of many. Funding for community health programming can be particularly challenging because few health and wellness initiatives generate revenue from the users. Local health departments wishing to communities
defined as families and individuals living or working in close proximity and who share common services
develop and implement health promotion strategies and programs are often able to secure necessary funding through government grants and support from generous foundations wishing to improve community health. One such organization is the Robert Wood Johnson Foundation (www.RWJF.org), which has funded many community health promotion initiatives throughout the United States.
Health Fairs
A community health fair offers an excellent example of organizations coming together to assess the health of local residents and to offer educational services to improve health and well-being.
Local hospitals often play a leadership role in organizing health fairs, which can be held in community gathering places such as senior centers, shopping malls, recreation centers, libraries, employee cafeterias, and schools, to name a few. In addition to local hospitals, partners in community health fairs often include physician groups, physical therapy and chiroprac- tic groups, public health departments, weight management groups, and educational and research organizations including the American Heart Association and American Cancer Society among others. Working in an open-space setting where individuals can move from booth to booth, health fair participants can visit with providers in a relaxed and more comfortable environment that contributes to a sense of community.
Targeted Community Initiatives
The Young Men’s Christian Association (the Y) offers an excellent model aimed at improving community health through the Diabetes Prevention Program (www.ymca.net/diabetes-prevention) supported by local Y staff leadership and in partnership with a national health insurer. The goal of the program is to identify and coach those at risk for type 2 diabetes through education and coaching programs over the course of one year. The program is multifaceted because local Ys work with health care providers and other local organizations to encourage participation and program adherence.
Another example of an excellent community health initiative can be found in urban biking programs through which physical activity is increased and the use of automobiles is decreased, thereby reducing traffic congestion and carbon emissions. Effective collaborations among biking enthusiasts, local government, bicycle manufacturers, and local bike shops have led to improved biker safety including new bike lanes, the availability of bikes for rent at convenient locations, and improved awareness and acceptance of bicycles in cities and towns.
health fair an educational and interactive event designed for outreach to provide basic preventive medicine and medical screening to people in the community or employees at a work site COMMUNITIES 275
Farmers ’ Markets and Community Gardens
Farmers’markets and community gardens are great examples of settings for health promotion. This is especially true in urban areas that may be struggling to provide residents with easy access to healthy foods. Growers who bring their harvest and other goods to a local community serve many purposes in addition to providing a variety of healthy food at reasonable prices. The opportunities to learn about the health benefits of different foods, for socialization (also a component of good health!), and to stimulate the local economy are all positive benefits of farmers’markets. Community gardens also expand a community’s healthy food choices, promote social- ization, and increase physical activity.
Volunteer Opportunities
Programs and services designed to strengthen community health and wellness offer exciting opportunities for volunteerism. Offering one’s time to work at health fairs, lead a community wellness initiative, or support a farmers’market or community garden can lead to great personal satisfaction and program success, and can positively affect the program’s financial picture. National health organizations, including the American Heart Asso- ciation (www.Heart.org), American Lung Association (www.Lung.org), American Cancer Society (www.Cancer.org), and many others, offer excel- lent volunteer development opportunities.
Early Childhood Centers
It is well accepted that a significant portion of an individual’s development takes place in the early years of life. Bonding with loved ones, learning how to socialize with other children, and developing learning skills are all characteristics of healthy development at a young age. The early childhood setting, which can include full- and part-day child care as well as nursery or prekindergarten programs, also offers an excellent opportunity to teach, model, and provide opportunities for healthy activities that can lead to positive lifetime habits. Characteristics of early childhood programs that offer excellent health promotion components include the following:
• Validation of a child’s current health status before entering a program including a health history, preenrollment physician clearance, and proper immunizations
• Leadership from staff members who teach and model positive health behaviors including proper hygiene and safety
• Opportunities for physical play that are embedded in the early child- hood program experience
• Offerings of healthy andflavorful foods
• Opportunities for health examinations including vision and hearing assessments
Hygiene and Safety Habits
Quality-based not-for-profit and for-profit early childhood centers, includ- ing nationwide providers such as the Y and KinderCare, incorporate intellectual, physical, social, and emotional development into their curricu- lum for preschool children. In most states, child care teachers and support staff are required to meet stringent certification requirements in all areas of child development and administration including components of healthy development through physical activity, nutrition, and proper safety prac- tices. Excellent child care organizations encourage modeling by their staff in proper hygiene, such as hand washing, proper handling of food, and how to protect others when sneezing or coughing. Staff members are required to follow safety practices thereby demonstrating to children how to avoid accidents. Special attention is given to the safe use of sharp objects such as scissors, toys, arts and crafts supplies, and the proper use of equipment including playgrounds, sports gear, bicycles, and tricycles.
Physical Activity
Quality-based child care programs will include scheduled times for struc- tured physical activity and free-play time for children throughout the day.
Organized programs are led by trained professionals and may include activities ranging from group games to swimming lessons. Fair play, sportsmanship, safety, and the joy of physical activity are modeled and rewarded by staff leaders. Equally important to a child’s well-being and development is time spent in free play (Ginsburg, 2007). Also referred to as free-range play or recess, unstructured playtime enables children to have fun and enjoy physical activity while expressing themselves, building new relationships, exploring new environments, and developing new skills and abilities.
Nutrition and Healthy Eating Habits
Proper nutrition and healthy eating are vital components of the early childhood experience. Many children enrolled in a full-day child care program will eat two to three meals and one or more snacks during their
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time at the center. To ensure a healthy diet, special care should be given to developing a menu that is well balanced, flavorful, and age appropriate.
Serving food to young children that tastes good including fruits and vegetables will begin good eating habits that can last for a lifetime. For those children who bring food to the center, staff members are encouraged to educate parents or guardians about proper nutrition for a developing child. Serving an occasional meal to the entire family at the early childhood center will enable families to spend time together while enjoying a healthy meal and reinforcing good health habits. It will also give staff time to interact with parents or guardians on a more relaxed basis (other than drop off or pickup). Serving food also presents opportunities to teach children about safe ways in which to handle and store food and the postmeal procedures for cleanup and dishwashing.
Health Assessments
Early childhood programs serving low-income families, such as Head Start (www.acf.hhs.gov/programs/ohs), offer important opportunities to assess the health and wellness of the preschooler. Often required by the organiza- tion’s curriculum or licensing agency, health assessments may include annual on-site examinations for general health, vision, hearing, dental, and speech. These services offer a valuable benefit to the child and the family who may be uninsured, underinsured, or may not have the funds to pay for or the ability to schedule regular health assessments.
Schools
The use of the elementary, middle, and high school settings to positively affect health habits and future success holds tremendous potential for students, as well as faculty, staff, and members of the community. It is well established that early development of positive health behaviors will likely lead to better health and well-being as an adult and that good health and physicalfitness benefit children in many ways including their ability to learn and perform academically (Chomitz, Slining, McGowan, Mitchell, Dawson, & Hacker, 2009).
Quality-based health promotion in a school setting involves far more than what traditional physical education classes typically address. Charac- teristics of an effective school-based health promotion program include the following:
• Support from the school principal and governing board who are committed to each child’s health, education, and development through health assessments
a plan of care that identifies the specific needs of the client and how these needs will be addressed by the health care system or skilled nursing facility; in an early childhood setting may include annual on- site examinations for general health, vision, hearing, dental, and speech
health and wellness policy development, curriculum structure, and program funding
• Guidance and support from faculty members and staff to teach and reinforce positive health habits throughout the school day
• Opportunities throughout the day for children to get up and move their bodies; special emphasis is based on progressive physical education programs that teach lifetime fitness skills and daily recess when children can physically play in an unstructured environment
• Offerings of healthy andflavorful foods in the school cafeteria
• Active involvement by the school nurse or health care team to ensure that children have received appropriate exams and screenings and have been identified for follow-up based on their health history or physical exams
• Celebration of improvements in individual and group health, wellness, andfitness with a special emphasis on participation
• Use of school buildings and grounds after traditional school hours (evenings and weekends) to support public recreation, exercise, and other wellness programs
Academics and Health
Elementary and secondary schools are experiencing significant challenges because many of the demands of modern society are placed at their door- steps. Funding support, increased costs, curriculum demands, political pressures, student performance, the education achievement gap, graduation rates, and aging facilities are but a few of the problems facing today’s school boards and administrators. Although improved health and wellness are known to strengthen academic performance, many school systems have reduced or eliminated time dedicated to physical education, health, wellness, and other time for physical activity including recess (National Association for Sport and Physical Education, 2009). Part of this challenge relates to the fact that teachers and administrators are accountable for student academic performance and not necessarily for the health and well-being of the student.
Time, therefore, is spent on curriculum, classes, and programs that will improve academic test scores. There are exceptions to this trend, and many school districts fully recognize the great value of health promotion in the school setting. These schools offer daily physical education, excellent health education curriculum and programs, and free time for physical activity (recess). Sadly, many school districts have reduced time devoted to these important components of elementary and secondary education.
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