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Overview of Health Promotion 

Overview of health promotion (© 2009 CAMH) This section has been adapted from the CAMH Knowledge Exchange.

This section is for health care professionals looking for practical health promotion information to use with clients.

Focus on wellness

Imagine a continuum from well to unwell. Where would your health status fit? Where would the health status of groups or populations that you belong to (e.g., based on age, gender, sexual orientation, culture, race, spirituality or income status) fit? It’s likely that some of your health-related variables would fall along the well end of the continuum, others would fall closer to the unwell end and still others would fall somewhere in the middle. The same would be true for the collective health of populations you belong to. The same would be true for clients you work with.

The continuum is dynamic, not static. A person’s, a group’s or a community’s health and well-being can fluctuate along the continuum in response to various changing influences, such as risk and protective factors, and social determinants of health.

Regardless of where health-related variables fall on the continuum, there are ways to improve a person’s or group’s overall well-being. Some of the ways are within an individual’s control, while others are dependent on the kinds of supports provided by society and on who has access to those supports.

Practise health promotion 

“Health promotion is for everyone” is an oft-stated phrase. In practical terms, it means that everyone’s health can be improved – including the health of people with addiction and/or mental health problems. The World Health Organization defines health promotion as “the process of enabling people to increase control over, and to improve, their health.”

Health promotion benefits everyone – whether the person is healthy, is at risk for developing difficulties (such as a substance use problem) or has an existing health problem (such as depression).

1. Module 1: “Definitions and Concepts” of the Ontario Health Promotion Resource System’s (OHPRS) HP-101 online course
   This module introduces health promotion definitions and concepts.
2. Module 7: “Values” of the OHPRS’s HP-101 online course (See above)
   This module provides a more detailed discussion of health promotion values.

A health promotion approach to health differs from the biomedical approach to health in several ways, including:

1. taking a holistic approach to health
2. recognizing clients as partners in their health care
3. focusing on strengths and assets
4. addressing social determinants of health
5. advocating for systemic changes
6. using multiple strategies to achieve optimal health.

Taking a holistic approach to health 

A health promotion model takes a holistic approach to health. For example, if a client is experiencing depression, a clinician would focus on all aspects of the person’s life – not just on the symptoms of depression and how to alleviate or get rid of them. How is the person’s diet? Does he or she get regular exercise? What else is going on in the person’s life? Is the person a recent immigrant or refugee? Has the person experienced or witnessed traumatic events, such as sexual or physical abuse, war or natural disasters? Does the person have a supportive family and friends? What about community supports, such as educational and employment opportunities, day care for children, and safe, affordable housing?

Recognizing clients as partners in their health care 

A health promotion approach enables clients to exert greater control and be partners (and usually the lead partner) in determining what is best for them. Can a client with a substance use problem decide, or be part of the decision-making process to determine, which approach to take toward getting healthier? For example, can he or she choose from a harm-reduction approach, abstinence or some other approach.

Focusing on strengths and assets 

A health promotion approach focuses on strengths and assets: on what people have, not on what they lack. Everyone has areas of their lives in which they consider themselves to be weak or not very skilled. It can be useful to acknowledge these deficiencies, but it’s not useful to focus on them. It’s far more important to concentrate on and develop clients’ individual capacities and resilience to enhance their well-being and accomplish their goals.

It is also important to focus and build on the strengths, assets and capacities of the families and communities in which people live

Addressing social determinants of health 

The biomedical approach to health tends to concentrate on individuals’ genetic and biological makeup and their health and safety practices as causes of their health problems. The focus is thus on what people can do to reduce or eliminate the problems.

A health promotion approach, on the other hand, points to physical and (especially) social factors that may be beyond individuals’ control yet contribute to their level of well-being. A health promotion approach enhances protective factors for positive health and reduces risk factors for poor health. And it addresses the determinants of health – the range of personal, social, economic and environmental factors that determine the health status of individuals and populations.

Your role as a clinician is to help clients address the risk factors (e.g., lack of safe, appropriate housing) and protective factors (e.g., working with their strengths) and the social determinants of health that influence their well-being. Your role also includes helping clients navigate through various systems to find the supports they need.

If the answer to any of the questions posed below is “no,” what can you, other clinicians, allied service providers or your agencies do to address these issues at an individual and systemic level to help the clients you are working with?

 

Social determinants of health include the following interconnected factors:

1. Income: Do people have enough money for the necessities of life and more?
2. Employment: Do people have meaningful work? Do people have some control over the work they do and the environment in which they do it? Do people make enough money through their work to provide for themselves and their families? Are people doing work that reflects their training and education (e.g., is a physician from Somalia working as a physician in Canada)? Are qualified people hired regardless of their race or gender?
3. Education: Are people sufficiently educated and trained to enter the workforce? Do people need to upgrade their skills? Are there opportunities for older adults to engage in life-long learning?
4. Housing: Do people have access to affordable, appropriate housing? Do people live in a safe neighbourhood?
5. Food: Do people have access to a range of healthy, affordable foods?
6. Culture and race: Do people live in a society that accepts and celebrates cultural differences?
7. Equity: Does everyone have equal access to opportunities to acquire an education; get a good, meaningful job; and make sufficient money to adequately support themselves and their families?
8. Inclusion: Do people feel welcome and a sense of belonging in a neighbourhood, school or workplace regardless of their religion or spiritual beliefs and practices, culture, sexual orientation or abilities?
9. Prejudice and discrimination: Are people’s lives free from racism, sexism, ageism and other forms of prejudice and discrimination? Are people with addiction or mental health problems subject to attitudes and behaviours that deny them access to appropriate health care, employment and housing? Do people with addiction mental health problems avoid seeking help for their problems because they feel ashamed and don’t want others to know they have these types of health problems?
10. Peace: Are people free from violence in their homes, schools, workplaces and the broader community?

Advocating for systemic changes 

A health promotion model advocates for improvement in ecological and systemic variables that enhance health: empowerment, equity, inclusion and respect. At the individual level, clinicians can work with clients in ways that honour these principles.

1. Empowerment: Enable people and communities to take greater control of and responsibility for their health. For example, do you or your agency work with clients with a substance use problem to help them decide which approach to take toward becoming healthier? Can they choose from a harm-reduction approach, abstinence or some other approach?
2. Equity: Do clients have equitable access to services offered? For example, do you or your agency accept clients with a substance use problem, with a mental health problem, with both?
3. Inclusion: Do you or your agency provide supports and remove barriers for people with addiction and/or mental health problems seeking treatment? Can people with disabilities access your space? Is child care available? Do you offer culturally appropriate services, including interpretation services?
4. Respect: Do you or your agency honour clients, regardless of why they are coming to see you? Do you have the same compassion for someone with a substance use problem as you do for someone with cancer? Do you have the same compassion for someone with schizophrenia as you do for someone who had a heart attack?

Using multiple strategies to achieve optimal health 

A health promotion approach recognizes the need for multiple strategies across different sectors (e.g., education, legal, corrections) to achieve optimal health. People’s health is affected more by sectors outside the health care sector than by the health care sector itself.

Everyone’s health is affected by their personal choices as well as by the physical and social environments in which they live. Clients’ health can be enhanced through changes they make to optimize their health (e.g., walk daily), through changes to the environments in which they live (e.g., have access to recreational activities and social supports) and changes to the systems (e.g., health system, education system) society puts into place. Applying best research evidence and successful clinical practices will enhance the effectiveness of the various strategies employed.

Strategies to promote everyone’s health 

Using multiple strategies across different sectors is the most effective way to enhance people’s health. The strategies need to be holistic and take into account people’s social, cultural and economic situation.

1. Module 5: “Strategies” of the Ontario Health Promotion Resource System’s HP-101 online course (See above)
   This module provides more detail and examples of health promotion strategies in action.
2. Managing Mental Well-Being
   The Wellness modules produced by B.C. Partners for Mental Health and Addictions Information help individuals and their families develop good mental health knowledge and skills so they can maximize their quality of life and manage the normal ups and downs of life. Module topics are: mental health matters; stress and well-being; social support; problem solving; anger management; getting a good night’s sleep; eating and living well; and healthy thinking.

Mental health promotion 

Mental health promotion is an integral part of the broader area of health promotion, focusing on people’s mental health. Creating living conditions and environments that support people’s mental health enables them to adopt and maintain healthy lifestyles, thereby increasing their chances of experiencing better mental health.

Mental health promotion benefits everyone – whether the person is healthy, is at risk for developing difficulties (such as a substance use problem) or has an existing health problem (such as depression). Mental health promotion is a holistic, or ecological, approach to health that focuses on the physical, mental, emotional and spiritual well-being of individuals, families and communities.

Mental health problems are associated with a wide range of other health conditions. Keep in mind, too, that people from different backgrounds or cultures may have differing ideas about what it means to be mentally healthy or mentally unhealthy.

Refer to Practise Health Promotion for more information about using mental health promotion principles in your work. Replace the word health with mental health to make the information relevant to promoting mental health.

Strategies to promote mental health 

The following resources provide more detailed information and practical advice on implementing effective mental health promotion strategies.

1. Mental Health: Strengthening Mental Health Promotion
   This World Health Organization fact sheet discusses mental health, mental health promotion and interventions to promote mental health.
2. Mental Health Promotion Tool Kit: A Practical Resource for Community Initiatives
   This mental health promotion tool kit, produced by the Canadian Mental Health Association, outlines practical ways to promote mental health in diverse communities.
3. Evidence of Mental Health Promotion Effectiveness: Strategies for Action (PDF only)
   This 2005 supplement to Promotion & Education, the international journal of health promotion and education, contains several articles outlining evidence of the success of mental health promotion practices, including strategies for action.

Recovery 

Health promotion values and strategies provide a strong foundation for people recovering from mental health and/or addiction problems.

Recovery refers to the ways in which people with a mental health or addiction problem experience their lives by focusing on positives: health, hope, choices, equity, respect, supports and optimizing their quality of life. More specifically, recovery is about empowerment (having control over one’s life); self-determination and personal responsibility; having one’s expertise valued; reaching one’s potential; engaging in meaningful activities, such as education and work; being included in community life; and having a voice in one’s treatment plans.

Promoting clients’ health at the same time as you treat their mental health or addiction problems increases the likelihood that they will progress toward their recovery goals.

1. Recovery from Mental Disorders
   This fact sheet, developed by B.C. Partners for Mental Health and Addictions Information, explains what recovery means and outlines assumptions and activities that support recovery from mental health problems.

Stigma 

Stigma refers to negative attitudes (prejudice) and negative behaviour (discrimination) toward people with mental health and/or substance use problems.

The following stigma-related resources address how prejudice and discrimination affect people with mental health or substance use problems, along with steps everyone can take to reduce stigma.

1. Stigma: Understanding the Impact of Prejudice and Discrimination on People with Mental Health and Substance Use Problems
   Mental health and substance use problems are health problems – just like cancer, arthritis, diabetes and heart attacks. So why are people with mental health and/or substance use problems looked upon differently?
   This brochure discusses why people develop mental health or substance use problems, explains the effects of stigma on people with mental health or substance use problems, and suggests important steps everyone can take to reduce prejudice and discrimination against people with mental health or substance use problems.
2. Stigma and Mental Illness
   This fact sheet, developed by the Canadian Mental Health Association, discusses stigma and its effects on people with mental health problems.
3. Stigma 101
   Stigma is not just about hurting someone’s feelings. Stigma is about prejudice, discrimination and the violation of a person’s human rights. This online tutorial provides information about stigma and the impact that it has on people.

Populations 

Some people with mental health and/or addiction problems fall within groups of people who have specific issues and needs based, for example, on their age, gender, sexual orientation or culture. The following pages outline health promotion information and resources tailored for:

1. Children and youth
2. Ethnocultural and racialized communities
3. Women.

Children and youth 

Many mental health problems appear when people are young: one in five children and youth in Canada has a mental health problem. Some young people develop problems with substance use and with gambling. And some have a combination of mental health and addiction problems.

Health promotion information and resources related to children and youth are outlined on the following pages (some resources address the general population of children and youth while others focus on young people or their families who are experiencing mental health and/or addiction problems):

1. Building resilience
2. Young women and depression.
3. Building resilience 

Adapted from T. Barankin & N. Khanlou, Growing Up Resilient: Ways to Build Resilience in Children and Youth (© 2007 CAMH)

Resilience involves being able to recover from difficulties or change – to “bounce back” and function as well as before and then move forward.

People who are resilient can effectively cope with, or adapt to, stress and challenging life situations. They learn from the experience of being able to effectively manage in one situation, making them better able to cope with stresses and challenges in future situations. In other words, dealing with challenges can help us grow and can make us stronger. Rather than merely bouncing back, we’re better prepared than we were before to face challenges that lie ahead.

How can we build resilience in children and youth?

Resilient children can be encouraged to become more resilient. And children who seem to have less resilience can be helped to develop it.

There are many ways to promote resilience. Use the following tips to create and build protective factors and strengths that will enhance the resilience of the young people you interact with.

Strengthen personal skills

1. Learn to recognize differences in young people’s temperaments so that you can help them to adapt to new situations and you can respond to each person based on his or her unique needs, abilities and skills.
2. Encourage young people to express their feelings, and then respond respectfully to their feelings. Emphasize that experiencing a range of emotions – whether pain, fear, anger or anxiety – is human, but that we don’t need to act out these emotions (e.g., by getting angry in a way that is hurtful).
3. Help young people to see how communicating their feelings to someone who is sensitive (i.e., someone whom they trust and feel understands them) can make a positive difference in their lives.
4. Consider young people’s age and developmental stage and their capacity to respond to a situation when helping them deal with their emotional states.
5. Pay close attention to young people’s words and actions so as not to underestimate the emotion they are feeling or overestimate their ability to cope.
6. Listen carefully and talk young people through situations to help them develop skills to handle future stress. When children and youth express sad thoughts to a sensitive adult, for example, they can get the support they need to heal.
7. Young people who have difficulty controlling their tempers may benefit from  a referral for anger management training – they can learn techniques to control the physical reactions that anger causes as well as the intensity of their angry feelings.
8. Counter young people’s negative thinking with other, more encouraging ways of seeing their situation.
9. Let young people know that failure is acceptable and sometimes unavoidable and that they can move on or perhaps try again.
10. Help young people set positive goals and maintain self-discipline to see projects through to the end.
11. Help young people develop their problem-solving and decision-making skills. Emphasize that problem solving is a skill that develops over time, with practice and involves a series of steps. For example, when young people face a problem or issue, help them identify a positive outcome, search for alternatives to reach the outcome and select the best alternative to reach their goal.
12. Help young people anticipate and plan how they will deal with difficulties so they have an easier time overcoming challenges.
13. Make young people aware of various coping strategies. If one thing doesn’t work for them, help them discover that they can find something else that does.
14. Encourage young people to do simple, pleasurable activities to reduce stress and relax, such as listening to their favourite music, playing with a pet, taking up a sport or hobby or going for a walk or run.
15. Encourage young people to develop supportive relationships with peers, coaches, clergy or other positive influences. Having such friendships can help young people to be more adaptable because friendships have a positive affect on our mental health. Friendships make people feel valued, give them someone to share with and confide in, give them encouragement and support, and offer them role models – in short, friendships allow people to function at their best.

Honour diversity

1. Encourage young people to pursue activities that interest them, without concern for whether those activities are usually done by girls or boys.
2. Show sensitivity and respect for all cultures and traditions – and teach young people to do the same.
3. Connect young people to culturally appropriate services if they are available.
4. Educate yourself about the various groups to which Canadian young people belong, particularly when you are working with children and youth from a background you are unfamiliar with.

Strengthening families

Families vary in terms of the challenges they face, the internal and external resources available to them, and how well they respond to difficulties. Healthy, well-functioning families provide many of the elements young people need to succeed in life: love, acceptance, stability, a safe home environment, nutritious food, effective communication, guidance and support.

1. Strengthening Families for the Future : Children in families where a parent has experienced substance use problems are at increased risk of developing problems themselves. The Strengthening Families for the Future program was designed specifically for these children (ages 7 to 11) and their parents. It is also a valuable resource for working with any family. This web page provides information about the program and how to bring it to your agency or community.

    2. Young women and depression

Hear Me, Understand Me, Support Me: The title of this guide embodies the stated wishes of young women with depression or at risk of developing depression. Beginning     in early     adolescence and continuing into adulthood, girls and women are more likely than boys and men to experience depression. Following are several resources from the guide that honour health promotion principles and practices to guide you in your work with young women around issues of depression, as well as associated hopelessness, isolation, sadness, suicidal thoughts and negative body image.

1. Caring for the mind, body and spirit
   This tool, developed by clinicians, suggests practical, holistic ways to encourage young women to take action to minimize the potential effects of depression in their lives.
2. Determinants of young women’s health
   This section includes a “health and life framework” tool that clinicians can use with young women to help identify the specific factors that affect their personal well-being.
3. healthy helping relationship
   This section focuses on how to talk to young women about depression; how to provide information, understanding and support through the therapeutic relationship; and clarifying issues about medication.
4. Dos and don’ts for clinicians
   This section offers a list of dos and don’ts – identified by young women – for the people who work with them in therapeutic relationships.
5. Attitude and approach
   This section, developed by service providers, identifies ways to work with young women in an atmosphere of trust, respect and empowerment.
6. Reference chart of issues or concerns for young women
   This chart is a handy reference tool for quickly assessing the particular issues or concerns that may affect young women you are working with in a therapeutic relationship. Issues are grouped under the following headings: identity, lifestyle, relationships, friends, family, school and society.

Ethnocultural and racialized communities 

People who have come to Canada as immigrants or refugees – and those living in racialized communities – can face unique challenges. In addition, these challenges can change over time with, for example, increased length of residence in Canada and revised public policies.

Colour of Poverty

This set of fact sheets addresses racialized poverty and how it intersects with various aspects of people’s lives, including education, health, employment, income, justice, immigration, housing and food security.

Women 

This section addresses mental health and substance use issues from the perspective of women’s lives. Women’s bodies are different from men’s, and their life experiences are different too.

Understanding and acknowledging the context of women’s lives enhances women’s well-being, more effectively addresses mental health and/or addiction issues that may arise, and speeds up the recovery process.

Healthy alternatives to substance use

If you are a clinician working with women who have substance use issues, you’ll want to incorporate health promotion strategies into your treatment plans. Information on this topic is available in the CAMH book The Hidden Majority: A Guidebook on Alcohol and Other Drug Issues for Counsellors Who Work with Women.

Self-care strategies for postpartum women

In Postpartum Depression: A Guide for Front-Line Health and Social Service Providers, Lori Ross and colleagues (2005) provide some self-care strategies to help mothers during the postpartum period.

A mother with postpartum depression may not, at first, feel well enough to do many of the self-care activities. After treatment begins to take effect, however, she will have more and more energy, and will gradually be able to initiate self-care.

Young women and depression

Hear Me, Understand Me, Support Me: The title of this guide embodies the stated wishes of young women with depression or at risk of developing depression. Beginning in early adolescence and continuing into adulthood, girls and women are more likely than boys and men to experience depression. Following are several resources from the guide that honour health promotion principles and practices to guide you in your work with young women around issues of depression, as well as associated hopelessness, isolation, sadness, suicidal thoughts and negative body image.

1. Caring for the mind, body and spirit
   This tool, developed by clinicians, suggests practical, holistic ways to encourage young women to take action to minimize the potential effects of depression in their lives.
2. Determinants of young women’s health
   This section includes a “health and life framework” tool that clinicians can use with young women to help identify the specific factors that affect their personal well-being.
3. healthy helping relationship
   This section focuses on how to talk to young women about depression; how to provide information, understanding and support through the therapeutic relationship; and clarifying issues about medication.
4. Dos and don’ts for clinicians
   This section offers a list of dos and don’ts – identified by young women – for the people who work with them in therapeutic relationships.
5. Attitude and approach
   This section, developed by service providers, identifies ways to work with young women in an atmosphere of trust, respect and empowerment.
6. Reference chart of issues or concerns for young women
   This chart is a handy reference tool for quickly assessing the particular issues or concerns that may affect young women you are working with in a therapeutic relationship. Issues are grouped under the following headings: identity, lifestyle, relationships, friends, family, school and society.

Resources 

This section contains an annotated list of health promotion resources you can use in your work or suggest to clients.

Substance use

1. Low-Risk Drinking Guidelines. This brochure outlines the maximum amount of alcohol men and women should drink per week to minimize risks to their health.

Mental health

General

1. Evidence of Mental Health Promotion Effectiveness: Strategies for Action
   This supplement issue (PDF only) of the international journal Promotion & Prevention presents articles reporting evidence of the effectiveness of health promotion initiatives.
2. Exploring Positive Mental Health
   This 2009 report is part of the “Improving the Health of Canadians” series from the Canadian Institute for Health Information. Unlike many other reports that address mental health problems, this report focuses on positive mental health—including how positive mental health is linked to overall health, and strategies that may be effective at promoting positive mental health among individuals, families, specific groups (e.g., based on age or gender) and communities.
3. Prevention of Mental Disorders: Effective Interventions and Policy Options
   This 2004 report (PDF only) by the World Health Organization focuses on primary prevention. It highlights the relationship between the prevention of mental health problems and the promotion of mental health, and looks at the individual, social and environmental determinants of mental health problems. The report suggests ways to reduce stress and enhance resilience across the life span, from childhood to older adulthood, and also addresses issues relating to the workplace and to refugees. Specific mental health problems addressed include conduct disorders, aggression and violence; depression; anxiety; disordered eating; substance use problems; psychosis; and suicide.

Children and youth

1. Best Practice Guidelines for Mental Health Promotion Programs: Children and Youth
   This website provides health and social service providers with evidence-based approaches to applying mental health promotion concepts and principles with young people from seven to 19 years of age.
2. Raising Resilient Children and Youth
   Resilience is an important aspect of mental well-being. This brochure (as well as an associated book) offers practical tips – at the individual, family and environmental levels – for increasing resilience in the children and youth you work with.

Talking to children

The “What Kids Want to Know” brochure series prepares adults to talk to children about difficult, confusing situations related to parental substance use and mental health problems. The brochures list common questions that children have, along with suggestions for how to answer their questions.

1. When a Parent Drinks Too Much Alcohol . . . What Kids Want to Know
   Children have a lot of questions and fears when a parent drinks too much alcohol. Alcohol problems easily become the family secret that no one talks about; it's also a problem that affects the whole family. This brochure lists common questions children have about their parent's alcohol problem, as well as suggestions for how to answer their questions.
2. When a Parent Has Bipolar Disorder . . . What Kids Want to Know
   Children have a lot of questions when someone in their family is sick. If a parent has bipolar disorder, children need some explanation and support, geared to their age, to help them understand. This brochure helps prepare clinicians and other people (whether they are the well parent, the parent with bipolar disorder, a grandparent or another adult in the child's life) to talk to children about bipolar disorder. It lists common questions children have about their parent's bipolar disorder, as well as suggestions for how to answer their questions.
3. When a Parent Is Depressed . . . What Kids Want to Know
   Children have a lot of questions when someone in their family is sick. This brochure helps prepare clinicians and other people (whether they are the well parent, the parent with depression, a grandparent or another adult in the child's life) to talk to children about depression. It lists common questions children have about their parent's depression, as well as suggestions for how to answer their questions.
4. When a Parent Has Experienced Psychosis . . . What Kids Want to Know
   This brochure helps clinicians and other adults begin talking to children about psychosis in language that is geared to the child's age. It raises and answers the most common questions children have when their parent has psychotic symptoms, which can occur in a number of mental health disorders (including schizophrenia, schizoaffective disorder, bipolar disorder, major depression and posttraumatic stress disorder).
5. When a Parent Dies by Suicide . . . What Kids Want to Know
   When a parent dies by suicide, children's questions can be especially difficult to answer. How adults should talk to a child about suicide depends on the child's age and ability to handle the information. Children can often understand more than adults assume. It is important to answer even the smallest questions. This brochure prepares clinicians and other adults to take the first step in talking to children about suicide. It will also help in explaining the suicide of other family members or friends.

Concurrent disorders

1. Beyond the Label: An Educational Kit to Promote Awareness and Understanding of the Impact of Stigma on People Living with Concurrent Mental Health and Substance Use Problems
   This kit (PDF only) has been developed to support people working in the fields of mental health and/or substance use by providing them with an interactive framework to discuss, learn, understand and reflect on the impact of stigma on people living with concurrent (also known as co-occurring) mental health and substance use problems.