Health Promotion (CH&EP 803.3)

University of Saskatchewan Department of Community Health and Epidemiology Health Promotion (CH&EP 803.3) Tuesdays, 9:30 A.M. to 12:30 P.M. Room 2753, Royal University Hospital Instructor: Office: Phone: E-mail: Kathryn Green, ScD, Associate Professor Room 2745, University Hospital 966-7839 (w), 343-7363 (h) kathryn.green@usask.ca Description This course will cover the underlying concepts, historical development, principles, and current practice of health promotion. The scope of health promotion activities to be discussed includes work with individuals, small groups, communities, and organizations (policy), tied together by an emphasis on empowerment. The focus of learning is not so much on "how to do" health promotion, as on "how to think" about the complex conceptual, ideological, and political issues which underlie health promotion practice. The required weekly readings come from a variety of sources. Classes will combine lecture, discussion of the readings, and small group exercises, with many sessions featuring guest speakers. Students are expected to prepare for each class by doing the assigned readings and integrating them into their own experience, coming to class with questions and comments, and contributing actively to each session. In this way, students (and the instructor) will learn from each other. Course Objectives By the end of the course, students will: Be aware of the meanings and determinants of health and the implications of this for health promotion practice. Understand the historical context of current approaches to health promotion. Be able to critically analyze health promotion activities in terms of underlying assumptions and ideology. Understand the meaning of empowerment and its role in health promotion. Be familiar with the main strategies of health promotion, the principles underlying them, and how they fit together. Be familiar with participatory approaches to health promotion research and ways of connecting research and action. Know how to use the Story/Dialogue Method as a tool for critical reflection. Be aware of some of the main challenges facing health promotion practitioners today and suggested approaches for dealing with them. 1

Required Texts Reading package, to be purchased from the University Bookstore. A few readings that are not included in this package will be handed out in class or may be copied from the blue folder in the department library. Optional Readings Optional readings and overheads will be available in a blue folder in the CH&E library, Room 2754. You may use the department photocopier at $0.08/page; please do not remove the readings from the library for more than the time it takes you to photocopy them, out of courtesy to your classmates. Evaluation 1. Journal Value: 60% The readings and class discussions, which will center around the readings, are key components of the course. To encourage students to spend time on the readings, actively integrate them with previous learning, and come prepared to engage in a lively and thoughtful discussion of them, each student will be required to keep a journal, to be handed in biweekly. In this journal, students will record their thoughts on the readings, how various readings relate to each other or to previous experiences, questions that they raise, critical analyses, etc. One third of your mark (20 points) will be given about half-way through the term; the remaining 40 points will be based on the whole journal, due on the last day of class. 2. Take-home exam Value: 40% An essay-type exam will be handed out during the last class. Due date to be collectively decided later in the term. Note on participation Related to the first assignment, in each class students are expected to share their reflections on the readings, and to participate in discussion with their fellow students, instructor, and in some sessions, external resource person. To make this process successful, it is important to create an environment in which everyone feels comfortable joining in the discussion, while recognizing that some may find this inherently more difficult than others. Because people taking this course generally come from widely varying backgrounds, and may also differ in their comfort speaking in class, participation will not be marked. I rely on our collective group process skills to ensure that each one will, in general, contribute to the class enthusiastically, fairly, appropriately, and wisely. 2

Topical Course Outline 1) Background a) The concept of health: its meanings and determinants b) Overview of health promotion: values, principles, and strategies c) Central elements of health promotion: power/empowerment and community 2) Individual-level change a) Health-related behaviour change b) Personal care 3) Change in small groups and communities a) Small group development b) Community development 4) Change in organizations and policies a) Healthy public policy b) Coalition building c) Advocacy 5) Societal change (political action) 6) Health promotion research and practice a) Participatory approaches to health promotion research b) Story/dialogue method c) Issues and challenges in health promotion practice 3

Topics by Session 1. September 14 Introduction The concept of health Determinants of health 2. September 21 Overview of health promotion Values, principles, and strategies 3. September 28 Central elements of health promotion Power/empowerment Community 4. October 5 Political action Ron Labonte, Professor of CH&E and Director of SPHERU 5. October 12 Individual-level change Personal care Health-related behaviour change 6. October 19 Small group development Florence Graham, HOPE Cancer Help Centre (http://www3.sk.sympatico.ca/hopecent/) 7. October 26 Community development Len Usiskin, Quint Development Corporation( http://www.quintsaskatoon.ca) 8. November 2 Healthy public policy Sue Delanoy, Communities for Children, (http://www.members.shaw.ca/cmmties_children/index.html) 9. November 9 Coalition building Linda Bell and Vanessa Charles, Saskatoon Anti-Poverty Coalition 10. November 16 Advocacy Ann Coxworth, Saskatchewan Environmental Society (http://www.environmentalsociety.ca) 11. November 23 Participatory Approaches to Health Promotion Research Lewis Williams, Director of the Prairie Region Health Promotion Research Centre 12. November 30 Story/Dialogue Method 13. December 2 Issues and challenges in health promotion practice 4

Readings by Topic (within each topic, in suggested order of reading) Meanings and Determinants of Health Rootman I, Raeburn J. The concept of health. In Pederson A, O'Neill M, Rootman I (eds): Health promotion in Canada: provincial, national & international perspectives. Toronto: WB Saunders, 1994:56-71. [Optional; in blue folder] Frank JW. The determinants of health: A new synthesis. Current Issues in Public Health 1995; 1:233-40. [Optional; in blue folder] Health Canada website: http://www.hc-sc.gc.ca/hppb/phdd/determinants/ http://www.hc-sc.gc.ca/hppb/phdd/overview_implications/01_overview.html Overview of Health Promotion Saskatchewan Health. A population health promotion framework for Saskatchewan health districts. Population Health Branch, January 1999. [9 copies to hand out; newer, slightly revised version available at http://www.health.gov.sk.ca/ic_pub_3793_skhlthframewk.pdf] Health Canada. Health promotion in Canada: A case study. Ottawa: Minister of Public Works and Government Services Canada, 1997. [Optional; access at www.hc-sc.gc.ca/hppb/healthpromotiondevelopment/ pube/hprpte.pdf or in blue folder] Raeburn J, Rootman I. People-centered health promotion: What is it? In J. Raeburn, I Rootman, People-centered health promotion. Rexdale, ON: John Wiley & Sons, 1997:3-15. Green LW, Poland BD, Rootman I. The settings approach to health promotion. Chap. 1 in Settings for Health Promotion: Linking Theory and Practice, BD Poland, LW Green, I Rootman, eds. Thousand Oaks, CA: Sage Publications, 2000. [not in readings package] Power/Empowerment and Community Wallerstein N. Powerlessness, empowerment, and health: Implications for health promotion programs. American Journal of Health Promotion, 1992:6(3):197-205. Labonte R. Health, power and the bureaucracy: Transforming professional practice. In Best H, Sellers ET (eds), International Images of Health: Perspectives, Power and Practice. Victoria, Australia: University of Ballarat, 2000: 43-60. Norton BL et al. Community capacity: concept, theory, and methods. In DiClemente RH, Crosby RA, Kegler MC (eds), Emerging Theories in Health Promotion Practice and Research. San Francisco, CA: Jossey-Bass, 2002: 194-227. Walter C. Community building practice: a conceptual framework. In Minkler M (ed), Community organizing and community building for health. New Brunswick, NJ: Rutgers University Press, 1997:68-83. 5

Political Action Labonte R. Healthy public policy and the World Trade Organization: A proposal for an international health presence in future world trade/investment talks. Health Promotion International 1998:13(3):245-56. Anti-globalization movement. From Wikipedia, the Free Encyclopedia. Access at http://en.wikipedia.org/wiki/antiglobalization Barlow M, Clarke T. Militant roots. In Global showdown: How the new activists are fighting global corporate rule. Toronto: Stoddart, 2001: 21-50. Individual Level Change Minkler M. Personal responsibility for health: Contexts and controversies. In Callahan D (ed), Promoting Healthy Behavior: How Much Freedom? Whose Responsibility? Washington DC: Georgetown University Press, 2000: 1-22. Research Unit in Health and Behavioural Change, University of Edinburgh. Health-related behavioural change. In Changing the Public Health. Toronto: John Wiley & Sons, 1989:67-86. Frolich K, Potvin L. Collective lifestyles as the target for health promotion. Canadian Journal of Public Health 1999;90(Supp 1):S11-14. Sallis J, Owen N. Ecological models. In Glanz K, Lewis FM, Rimer BK (eds): Health behavior and health education: theory, research, and practice. (2 nd ed) San Francisco: Jossey-Bass, 1997:403-24. Small Group Development Levine M. An analysis of mutual assistance. American Journal of Community Psychology. 1988; 16:167-83. Farquharson A. Self-helpers and professionals. In Romeder J-M. The self-help way: Mutual aid and health. Ottawa: Canadian Council on Social Development, 1990:113-124. Ewles L, Simnett I. Working with groups. Chap. 13 in Promoting Health: A Practical Guide (5 th Ed.) Toronto: Balliere Tindall (Elsevier Science Ltd.), 2003. Travers KD. Reducing inequities through participatory research and community empowerment. Health Education & Behavior 1997;24:344-56. Brown S. Participant Experiences of HOPE Cancer Help Centre, Inc. Saskatoon: HOPE, 2003: 4-34. Community Development Minkler M, Wallerstein N. Improving health through community organization and community building. In Glanz K, Lewis FM, Rimer BK (eds): Health behavior and health education: theory, research, and practice. (2 nd ed) San Francisco: Jossey-Bass, 1997:241-69. Checkoway B. Core concepts for community change. Journal of Community Practice. 1997; 4:11-29. Kreuter MW, Lezin N. Social capital theory: implications for community-based health promotion. Chap. 9 in DiClemente RH, Crosby RA, Kegler MC (ed. s), Emerging Theories in Health Promotion Practice and Research. San Francisco, CA: Jossey-Bass, 2002. Minkler M, Pies C. Ethical issues in community organization and community participation. In Minkler M (ed), Community organizing and community building for health. New Brunswick, NJ: Rutgers University Press, 1997:120-36. 6

Guillory B, Willie E, Duran E. Analysis of a community organizing case study: Alkali Lake. Journal of Rural Community Psychology. 1988;9:27-35. Flick L, Reese C, Rogers G, Fletcher P, Sonn J. Building community for health: Lessons from a seven-year-old neighbourhood/university partnership. Health Education Quarterly 1994;21(3):369-80. Healthy Public Policy Draper P, Dennis J. Valuing health: social and political implications. In Abelin A, Brzezinski ZJ, Carstairs VDL (eds). Measurement in health promotion and protection. WHO 1987:66-73. Raphael D. Addressing the social determinants of health in Canada: Bridging the gap between research findings and public policy. Policy Options 2003;March:35-40. [Download PDF file at http://www.irpp.org/po/ Click on back issues then March 2003. ] Rasmussen KA. The policy making process in Canada. In Saskatchewan Provincial Health Council: Healthy public policy development--science, art, or chance? April 29 and 30, 1996, Regina SK, Conference Proceedings. Saskatoon: Prairie Region Health Promotion Research Centre and Regina: Canadian Plains Research Center. 1996: 7-16. Lavis JN, Sullivan TJ. The state as a setting. Chap. 8 in Settings for Health Promotion: Linking Theory and Practice, BD Poland, LW Green, I Rootman, eds. Thousand Oaks, CA: Sage Publications, 2000. Webb K, Hawe P, Noort M. Collaborative intersectoral approaches to nutrition in a community on the urban fringe. Health Education and Behavior. 2001;28(3):306-19. Coalition Building Wandersman A, Goodman RM, Butterfoss FD. Understanding coalitions and how they operate. Chap. 16 in Community Organizing & Community Building for Health, M. Minkler, ed. New Brunswick, NJ: Rutgers, 1997. Butterfoss FD. 2001 SOPHE Presidential Address: The power of partnerships. Health Education & Behavior 2002;29(2):162-9. Green LW. Caveats on coalitions: In praise of partnerships. Health Promotion Practice. 2000;1:64-65. Butterfoss FD, Whitt MD. Building and sustaining coalitions. Chap. 13 in Community Health Education Methods: A Practical Guide (2 nd ed), RJ Bensley & J Brookins-Fisher, eds. Toronto: Jones & Bartlett, 2003. Advocacy Wallack L, Dorfman L. Media advocacy: a strategy for advancing policy and promoting health. Health Education Quarterly. 1996;23:293-317. Ewles L, Simnett I. Changing policy and practice. Chap. 16 in Promoting Health: A Practical Guide (5 th Ed.) Toronto: Balliere Tindall (Elsevier Science Ltd.), 2003. Wass A. Working for change in communities and organisations. Chap. 7 in Promoting Health: The Primary Care Approach (2 nd ed). Toronto: Harcourt, 2000. Lachenmayr S, Baukema M. Impacting health policy through legislative advocacy. Chap. 14 in Community Health Education Methods: A Practical Guide (2 nd ed), RJ Bensley & J Brookins-Fisher, eds. Toronto: Jones & Bartlett, 2003. 7

The Health Communication Unit at the Centre for Health Promotion, University of Toronto. Developing Health Promotion Policies, Version 1.0. [Optional. Access at http://www.thcu.ca/infoandresources/publications/policyworkbook.march04.v1.0.pdf] Participatory Approaches to Health Promotion Research Rappaport J. Research methods and the empowerment social agenda. In P Tolan, C Keys, F Chertok, L Jason (eds), Researching community psychology. Washington, DC: American Psychological Association, 1990:51-63. Wallerstein N, Duran B. The conceptual, historical and practice roots of community based participatory research and related participatory traditions. In Minkler M, Wallerstein N (eds), Community-Based Participatory Research for Health. San Francisco: Jossey-Bass, 2003:27-52. Israel B, Schulz A, Parker EA et al. Critical issues in developing and following community based participatory research principles. In Minkler M, Wallerstein N (eds), Community-Based Participatory Research for Health. San Francisco: Jossey-Bass, 2003:53-76. Frankish CJ, George A, Daniel M, Doyle-Walters M, Walker M. Participatory health promotion research in Canada: A community guidebook. Ottawa: Minister of Public Works and Government Services Canada, 1997. [Optional; in blue folder] Roe KM, Minkler M, Saunders FF. Combining research, advocacy, and education: the methods of the Grandparent Caregiver Study. Health Education Quarterly. 1995; 22:458-75. Williams L, Labonte R, O Brien M. Empowering social action through narratives of identity and culture. Health Promotion International, 2003; 18:33-40. [Access online] Story/Dialogue Method Labonte R, Feather J. Handbook on using stories in health promotion practice. Ottawa: Minister of Supply and Services, 1996, reprinted by Prairie Region Health Promotion Research Centre, 2000. [Reading required; can be purchased or found in blue folder] Labonte R, Feather J, Hills M. A Story/Dialogue Method for health promotion knowledge development and evaluation. In Edmondson R, Kelleher C (eds), Health Promotion: New Discipline or Multi-discipline? Portland, OR: Irish Academic Press, 2000: 95-113. Issues and Challenges in Health Promotion Practice Robertson A. Health promotion and the common good: Reflections on the politics of need. In Callahan D (ed), Promoting Healthy Behavior: How Much Freedom? Whose Responsibility? Washington DC: Georgetown University Press, 2000: 76-94. Labonte R. Health promotion and the common good: Towards a politics of practice. In Callahan D (ed), Promoting Healthy Behavior: How Much Freedom? Whose Responsibility? Washington DC: Georgetown University Press, 2000: 95-115. 8