Public Health And Health Promotion

In this research paper I discussed the role of Public Relations in communicating health and delivering healthy messages to the public or community. It is more or less the same working with other ministries but Ministry of Health (MOH) are more focused on educating and promoting healthy lifestyle.

There are five strategic SMART objectives that as a PR need to be focused and improved on:-

Strategic Objective: Establish & Strengthen Health in All Policies (HiAP)

Strategic Objective: Develop Effective, Quality And Innovative Health Promotion Programmes to reduce Obesity, Unhealthy Diet, Physical Inactivity And Tobacco Use

Strategic Objective: Enhance Inter-Sectoral Collaboration And Partnership

Strategic Objective: Develop Health Promotion Skills & Competencies

Strategic Objective: Strengthen Health Promotion Centre Infrastructure and resources

The challenges and constraints of Health Promotion Centre (HPC) are to be discussed further more in this research paper. As a conclusion of this paper, I also includes the benefits and expected outcomes for the strategies.

Role of Public Relation in Health Communication in Brunei Darussalam

INTRODUCTION

Brunei Darussalam is a moderate Islamic country with multi ethnic racial where understanding diversity management and cultural values may increase the productivity of an organisation and also create harmonization among the three main races in Brunei; Malay, Chinese and Indian (Brunei Tourism website, 2010). Diversity management is unique in Brunei Darussalam through symmetrical approaches to public relations. Understanding cultural diversity and multiculturalism is very important to articulate a sensitive and multi aspect approach to excellent public relations, especially in rapidly developing country like Brunei Darussalam. There is need for professional aid to understand the dominant religious such as Islam, and minority of Christianity and Hinduism as they want to invest to the country. In fact cultural diversity seen as universal concept, as every country has a different religious and tribal groups. Globalisation has given new meaning that should be practiced according to various ethnic groups with different religion and backgrounds.

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Public Relation is about maintaining a good relationship between an organization and public through communications in order to pursue its goals and objectives. The role of public relations can influence the main structure of an organization have practiced. The main responsibility for public relations is to gain publicity from the public using media releases such as newspaper, magazines and sometimes appears as spokesperson for that company or organization. The other responsibility for public relations is to find solutions for supplementary problems as well as a decision makers and policy formation. There are theoretical approaches in public relations. Theories applied in different ways because different theories, different assumptions due to different backgrounds such as culture and influence. According to Grunig and Hunt (1984) “the best theory of public relation is the ‘four model’ ” which explain the development of public relations. The first model is press agency. This is the easiest way to spread propaganda in other to get public attention for their events or products. It is a one way flow of info. Second model is Public information which runs by the government to inform the public on behalf of the organization about its development. Third model is the two ways asymmetric which by all means the power in organization and not to public. Forth model is two ways symmetric where the organizations events or products get feedback from the public. Nevertheless Grunig and White(1984) agreed that public relation is best described in asymmetric ways rather than symmetric ways.

Somecritics of symmetrical worldview- both practitioners and theorists- claimed that the approach is unrealistic or idealistic. They argue that organizations hire public relations people as advocates to advance their interests and not as ‘do-gooders’ who ‘give in’ to outsiders with an agenda different from that of the organization. In short organizations would not hire a public relations person which not practices asymmetrically. (Grunig and White 1992:46)

L’Etang(1996) also argues that symmetry in public relations is inconsistent. He argued:

There is…a problem in the attempt which some make to maintain the idea of ‘symmetry’ alongside the role of public relations as advocate. Surely symmetry and advocacy are in opposition. The only way round this tension is to argue that public relations ensure that all world views are held, i.e that the playing field is level. Whether this sort of pandering to the liberal conscience and justifiable is a matter for debate: a debate which has yet to take place within public relations. (L’Etang 1996:96-97)

The theories then divided into two parts; Rhetorical Theory and Critical Theory. Rhetorical theory is a convincing dialogue about public relations role. It is suggested as dialogue relationship which allows deliberation of written text or language use and their ethics. According to Heath, ‘Rhetoric is symmetrical because each idea placed in the marketplace or public policy arena stands on its own merit.’ (Heath 2001:49)

Critical theory is the power which influences communication. It is about social critiques, political and corporate structures as well as institutional. The theory tries to search for social changes-postmodernism which includes political, cultural, social and economic views. According to Holtzh` ausen, she revisits the concept of the public relation practitioner as keeper of the corporate conscience. She argues that the responsibility for keeping organization abreast of postmodern thinking importantly resides in public relations department. She stated that:

Postmodern theories urge public relations practitioners to acknowledgeable the political nature of their activities and to be aware of the power relations inherent in everyday practice. Public relations is about to change or resistance to change, these political acts are manifest in the everyday use of organizational language and symbolism and are influenced by the organization’s cultural and social environment. This redefines the boundary spanning role. Instead of claiming objectivity, practitioners are forced to choose which side they are on. (Holtzhausen 2000:110)

Public relations required skillful practitioners. Certain skills that needed in these areas are strong analytical skills and communication skills in other to catch the attention of public. Great interpersonal skills, self confidence, self and priority management skills, knowledgeable in financial industry and update with current issues will complete the criteria to be a Public relation practitioners. Integrity and commitment to ethical practice, equity and diversity will also help to gain public attention and expectations on the benefits from the products or events that we are promoting. In communicating health messages to the public is very hard because, we need to do survey about the community at first rather than approaching them directly. Most medical officers do not have the skills or knowledge on how to approach the community creatively. This is when Public Relations practitioners came forward to help them communicating with the public from explaining medical matter great in details and too wordy transformed into simple and creative which is easy to understand by the public.

WHAT IS PUBLIC HEALTH AND HEALTH PROMOTION?

Public Health is a science of protecting and improving the health of communities through education, promotion of healthy lifestyles and research for disease and injury prevention (www.whatispublichealth.org). Public health or societal health refers to the link between health and the way a society structured which includes the basic infrastructure necessary or health- shelter, peace, food and income; and the degree of integration or division within society( Naidoo J. &Willis J, 2000,p.7). Not only that, in public health it also includes Environmental Health referring to the physical environment in which people live.

Health promotion was defined in the Ottawa charter (WHO 1986) as being centrally concernedwith empowering people to take greater control over their health and thus includesa range of strategies to strengthen communities, develop supportive environments and inform and educate about health issues.Ottawa Charter for Health Promotion (WHO 1986) can be defined into 5 action areas, namely:

• Building healthy public policies

• Creating supportive environments

• Strengthening community action

• Developing personal skills

• Reorienting health services towards prevention

1.2 THE RELATIONSHIP BETWEEN PUBLIC HEALTH, HEALTH PROMOTION AND PUBLIC RELATIONS.

Public Health and Health promotion professions embody and tolerate conflicting ideas of why and how health should and could be approved. The meaning of public health and health promotion are contested and open to misunderstandings such as the explaining the methods for reducing health and promoting well being and fundamentally in the motivation for such interventions. Whereas Public Relations is a person who represent the agency as a spokesperson or a guide on how to communicate health messages to the public or target audience by implementing tactics and strategies as well as evaluating the success of the program.

RESEARCH

2.1 HEALTH PROMOTION CENTRE (HPC).

Health Promotion Centre (HPC) is a centre that serves the needs of public by providing health information, camps and other recreational developmental activities for the public. HPC also supports and encourages the growth and development of healthy lifestyles among the community through their health messages, gallery, workshop, youth camps and health screening.

The roles of HPC:-

Educational role: Impart Knowledge and increase awareness of public on various aspects of health

Change agent: facilitate behaviour change amongst clients/target groups through the empowerment (knowledge and skills) and advocacy.

Instill value: inculcate the practice of healthy lifestyle in the population and also caring attitude towards health among children and youth.

Attraction site: a place to visit for a family outing and for tourists.

Its main objective is to develop and focus on national health promotion programmes in the country and to ensure that health promotion and chronic disease prevention activities are carried out systematically and effectively. The vision is to realize Ministry of Health (MOH) vision 2035 ´Together Towards a Healthy Nation’. The mission statement is ‘Empowering People towards Healthy Living through Effective Health Promotion’. (Personal Interview with Senior Medical Officer, 2010)

2.2 ROLES OF PUBLIC RELATIONS AND MEDIA AT HPC

The role of Public Relations practitioner in this centre is to communicate health messages or practicing health communication. Health communication is a notion of awareness raising and education about risk and protective factors linked to chronic conditions such as diabetes and cardiovascular disease. The use of mass and multimedia and other technological innovations to disseminate useful health information to the public, increase awareness of specific aspects of individual and collective health as well as importance of health in development (WHO, 1996). Health promoters need communication skills and strategies to inform, educate, enable, mediate, advocate, persuade, negotiate and facilitate. In order to have this health promoters need a range of functional communication skills in their professional toolkit (Murphy B, 2006). Functional communication skill sets tend to be anchored now, while strategic communication is more future focused. It also a process of hitting right target with the right level of information that suits and resonates with the market as well as engaging the participants in a process so that it is shared activity rather than one-way sharing information. In order to strengthen the links within and beyond the health sector, health promoters must develop and practise ways to strategically communicate our ideas in a language that the intended audience can understand and embrace for example using common language that understood by others (Murphy B, 2006). For example the use of Facebook and Twitter. These two social networking are the best way to commuincate and ideas with the intended audience nowadays. Facebook is a social networking site that enables users to share photos and videos. It also has a status update tab where people can post information (Facebook, 2010). Facebook is available for both personal and business use. Businesses can set up a Facebook fan page so Facebook users can become a fan and follow the organisation’s updates. Facebook is efficient for businesses as it enables users to send invitations virtually and those who have been invited can chose to send a RSVP or decline the invitation on the spot. Whereas “Twitter is a real-time information network powered by people all around the world, which lets you, share and discover what’s happening now.Twitter asks, “What’s happening?” and spreads the answer across the globe to millions, immediately” (Twitter, 2010).Twitter is a social networking site that uses a system similar to the short messages system or SMS, where people can share information from all over the world. The SMS has a 140-character limit, and the messages sent through are called ‘Tweets’. Other people can forward these Tweets; this is called ‘Retweets’. People who follow other people’s tweets are called ‘Followers’. Twitter is not only limited to personal use. Businesses can also sign up to this networking site to start networking with other Twitter users that might be interested in their business. HPC currently has a Twitter account .

Facebook and Twitter are FREE communication tools which allow two-way interaction between interested parties and the communicator, a beneficial addition to an organisations website which is mostly one-way communication. Fans and followers are made from a pre-qualified audience who have already identified that they are interested in a concept, and therefore are more likely to react to promotions and positive communication. Facebook and Twitter also act as a platform to answer questions and launch promotions instantaneously with nil or limited material cost. Another example of effective way of communicating and sharing information with the audience is via A strong and informative website and regular e-newsletter communication are beneficial assets for any organisation, as they represent a cost-effective, fast method for one-way communication with current and potential members.The target audience is pre-qualified, having made a choice to visit the HPC’s website, or sign up for the e-newsletter.

Health promotion is directed towards improving the health status of individuals and population. During this modern era, it was transmitted by the mass and multimedia which has positive and negative implications for health. Communication underpins virtually all health promotion action. With this in mind, a broad range of functional communication skills need to be developed and practised by those seeking to work in the health promotion field. Good communicators have the ability to convey complex concepts in a language that speaks to the intended audience. They use metaphors and analogies to make sense of the ideas. As health promotion seeks to strengthen its links within and beyond the health sector, we must develop and practise ways to strategically communicate our ideas in a language our audience understands and embraces. There’s a needs to understand the social model of health as well as the determinants of health and their impacts on population. It also includes planning and evaluating strategies on approaching a diverse group with multicultural background with respects.

Appropriate health promotion strategies are especially effective to combat the current rapid rise of chronic diseases which represents a major challenge to global development. Chronic diseases include heart disease and stroke (cardiovascular disease), cancer, diabetes and chronic respiratory diseases which claim 35 million lives every year. Together they are the leading cause of death worldwide and have overtaken the number of deaths due to infectious diseases. This represents 60% of all deaths globally, with 80% of deaths due to NCDs occurring in low- and middle-income countries, and about 16 million deaths involving people under 70 years of age. These diseases also undermine the economic development in many countries leading to a worsening of poverty and illnesses. The global burden of these non-communicable diseases (NCDs) continues to grow. Tackling it is one of the major challenges for development in the 21st century. Unless addressed, the mortality and disease burden from these health problems will continue to increase. WHO estimated that without action, total deaths from chronic diseases will increase by 17% between 2005 and 2015. For those with chronic disease, it can affect every aspects of their life and over time can cause further complications that can further lead to deterioration of their quality of life, participation in activities and even their work performance. There will also be the increasing burden to the costs of health care as well as the psychological and socio-economic impacts to the families and carers. However proven cost-effective strategies exist to prevent and control this growing burden. The causes (risk factors) of chronic diseases are well established and well known, ie, unhealthy diet, physical inactivity and tobacco use. These risk factors, which are the same for males and females are largely modifiable. If uncontrolled, they will lead to intermediate risk factors such as raised blood pressure, raised blood sugar levels, abnormal blood lipids, overweight and obesity. The major modifiable risk factors, in conjunction with the non-modifiable risk factors of age and heredity, explain the majority of new events of heart disease, stroke, diabetes, chronic respiratory diseases and some important cancers. The relationship between the major modifiable risk factors and the main chronic diseases is similar in all regions of the world. There are also other risk factors for chronic diseases but they account for a smaller proportion of these diseases. These include harmful alcohol use and some infectious agents that are responsible for cervical and liver cancers.

Preventing or delaying illness and death from chronic diseases is possible. At least 80% of all cardiovascular diseases and type 2 diabetes and over 40% of cancers could be avoided through healthy diet, regular physical activity and avoidance of tobacco use. Although death is inevitable, it does not need to be slow, painful or premature. Most chronic diseases cause the sufferers to become progressively ill and debilitated, especially if their illness is not managed correctly. Chronic disease prevention and control helps people to live longer and healthier lives. In addition, due to public health successes, populations are aging and increasingly, people are living with one or more chronic conditions for decades, thus worsening the burden of chronic diseases. This places new, long-term demands on health care systems. Not only are chronic conditions projected to be the leading cause of disability throughout the world by the year 2020 but if not successfully prevented and managed, they will become the most expensive problems face by our health care systems.

In Brunei Darussalam, the situation of chronic diseases is following the global trend. The Ministry of Health reported in 2009 that cancer is the top leading cause of death with 24.6 deaths per 100,000 population whereas heart disease and diabetes mellitus comes second and third accounting for 23.9 and 18.4 deaths per 100,000 population respectively. In addition, this data is further supported by the preliminary findings of the Ministry of Health’s Integrated Health Screening and Health Promotion Programme for Civil Servants

which was launched in 2007. Early findings showed that:

• 64.3% of the subjects screened were either overweight or obese

• 55.2% has high blood cholesterol

• 14.7% has hypertensio

• 14.2% has high blood sugar.

The above data shows an increase in the proportion of subjects with are overweight or obese when compared to the data obtained by the National Nutritional Status Survey 1997 which showed only 44.5% of the subjects then were either overweight or obese. Therefore, preventive strategies in Brunei Darussalam need to focus on comprehensive, integrated,multi-level, multi-intervention approaches aimed at reducing the negative impact and consequences of chronic non-communicable diseases. Simultaneously, the management of NCDs requires well-coordinated and integrated services at primary, secondary and tertiary levels which focus on curative, preventive, promotive and rehabilitative aspects holistically.

Therefore,there are five strategic SMART objectives that as a PR need to be focused and improved on:-

Strategic Objective 1: Establish & Strengthen Health in All Policies (HiAP)

Strategic Objective 2: Develop Effective, Quality And Innovative Health Promotion Programmes to reduce Obesity, Unhealthy Diet, Physical Inactivity And Tobacco Use

Strategic Objective 3: Enhance Inter-Sectoral Collaboration And Partnership

Strategic Objective 4: Develop Health Promotion Skills & Competencies

Strategic Objective 5: Strengthen Health Promotion Centre Infrastructure and resources

2.3 CHALLENGES & CONSTRAINTS OF THE HEALTH PROMOTION CENTRE (SITUATIONAL ANALYSIS)

One of the biggest challenges faced by HPC is the lack of awareness amongst the general and target public as well as lack of media promotions on spreading health messages which includes misunderstanding about the concept of health promotion, competing priority areas, manpower, budget, unconducive environment, behaviour and others. This has proven to be the main hindrance for the centre in reaching their target audience.

SWOT Analysis

Strengths

Financial support from government (MOH)

Social network such as facebook and twitter containing information about their organisation.

Access to MOH supports, financial and activities.

Weaknesses

Lack of financial resources to invest in media activities and others

Need more sponsorship

General public unaware of HPC’s existence

No official website

Private partners

Building maintenance

Opportunities

International presence

Government collaboration

Increasing the skill set of staff to other field such as communication-media, public relations and etc.

Threats

Lack of support

Lack of workforce

Unconducive environment

Misunderstanding about the concept of health promotion

Competing priority areas

Culture.

Local evidence has shown that, there is a huge burden of NCDs especially cancer,cardiovascular diseases and diabetes, in Brunei Darussalam. Without definitive action to address these diseases, they will continue to grow exponentially and lead to more people living with poor quality of life and dying prematurely. This, in turn, will have a negative social and economic impact on families, communities and the country as a whole.

Being the lead organization that has been entrusted to initiate and coordinate the actions, HPC, from the very start, has several challengesand constraints to deal with. To be able to manage the situation effectively and efficiently, HPC has to convince all relevant stakeholders and partners that only a comprehensive, integrated approach has the best chance of success in the prevention and control of these NCDs.

Comprehensive action requires combining population-wide approaches that seek toreduce the risks throughout the entire population with strategies that target individuals at high risk or with established disease and also addressing the social and economic determinants that would affect their health directly or indirectly. The National Health Promotion Blueprint 2011-2015 will be launched on March 2011 aims to use such an approach.

Before adopting such a strategy, many factors that will affect the outcome of this approach have to be considered. Some of these factors are:

The needs of the target population and individuals as well as the requirements ofthe stakeholders and partners.

The resources e.g. human capital, financial, technical, physical and other infrastructure etc, and their management, that are needed for HPC to carry out their tasks effectively.

The process of planning, implementing, monitoring and evaluating the initiatives and programmes. However to ardently follow the strategic framework, HPC will encounter many challenges and constraints. Strategies need to be developed to overcome or reduce these barriers which may impede the successful implementation of this Action Plan. These include:

1. Misconception about health promotion

Health promotion is defined as “the process of enabling people to increase controlover and improve their health” and is also defined as “any combination of educationaland environmental supports for actions and conditions of living conducive to health”where these processes have been clearly explained in several key health promotion documents. As such health promotion is not just ‘educational and provision of information’. It is a continuing process that involves action at every level of society andnot just a series of ‘ad hoc’ educational activities. One of the challenges is to change the mindset of all stakeholders to convince them that everyone has an important role to play in promoting health from policy-makers and leaders, in Government, organized medical and health services, non-government and private organizations and communities, to individuals. This role will not only be educational in nature but also supportive and enabling for people to practice healthy lifestyles. HPC’s role is to lead, support, facilitate and empower communities and individuals to practise healthy living but it cannot do it alone. All stakeholders have a shared responsibility for health. Hence for HPC to fulfill its role effectively, it must be given a clear mandate and extent of authority from the rele- vant authorities to expediently carry out its designated functions in health promotion in general and particularly in the execution of this strategy.

2. Low priority towards the role of health promotion in the management of NCDs

Traditionally organized medical and health services have implemented a range of services to tackle NCDs e.g. Hospital- or clinic-based nutritional programmes, tobacco control programmes etc. However due to diverse needs and priorities, most of the resources for these interventions are directed towards attending to acute problems and urgent needs of patients with NCDs. Less priority is given to the incorporation of preventive health care into the overall management of these patients.

As pointed out earlier, a collaborative management approach, with preventivecomponents in the care of the patients with NCDs that involves the patients, their families and health care partners, is more cost-effective than the traditional approach and achieves better health outcomes.Therefore, one of HPC’s functions here is to help facilitate the routine incorporation of preventive and promotive care into curative services especially in the management of chronic diseases.

This strategic framework includes the reorientation of the health care services for a more holistic approach in the effective prevention and management of chronic conditions. It calls for a partnership among patients and families, health care teams and community supporters. This approach will work best if each patient is informed, motivated and prepared to manage their health and able to work with the other partners. This partnership should be influenced and supported by the Ministry of Health and other health organizations, the broader community and the policy environment to ensure a sustainable positive health outcome.

3. Lack of skilled manpower

There is a lack of human capital in HPC, both in numbers and skills. This willundoubtedly impact the performance of HPC with its many roles and functions to fulfill. Besides the current health professionals to carry out the day-to-day operations of HPC, there is a dire need for more specialized personnel who have the professional and technical skills and expertise to enable HPC to perform its many functions including overseeing and coordinating health promotion programmes and activities in general and in particular, initiatives identified. These personnel include:

I. Public Health Professionals and / or Allied Health Professionals who are trained in Health Promotion, Programme Management, Epidemiology, Biostatistics including Research Methodology and other similar fields.

Such human capital are needed to ensure a more effective and efficient planning, implementation, monitoring and evaluation of all relevant health promotion programmes and initiatives in the country. They will also form the core group will drive the development of a supportive surveillance system and promote a research culture in HPC as part of its strategies to produce scientific evidence to support and rationalise policies, strategies and approaches relating to healthy lifestyle and particularly, NCD prevention and control

II. Sociologists and Psychologists

As health promotion, in a large part, deals with individuals and their families and the larger communities, HPC needs personnel who are well trained in the principles of Social Science. Social determinants have a great impact on health in any society including the creation of inequities in health. This type of expertise is essential to assist HPC in advocating and framing evidence-based policies and programmes, across the whole of society, that can influence the social determinants of health and improve health equity.

On the other end of the scale is the understanding and influencing of human behavior.Psychologists are needed in the formulation of programmes which directly impacts on human behavior such as healthy eating, increasing physical activity and losing weight. They are critical in motivating individuals to change for better health outcomes.

III. Public Relation / Communication / Media personnel

To carry out effective health promotion, information must be effectively disseminated through traditional and new media. Social marketing is a recognized strategy to educate the public generally. Personnel who are trained to deal with and communicate with individuals, communities and the media, are definitely an asset to this type of work.

IV. IT and technical personnel

An important part of HPC’s function is the creation, production, dissemination and display of various health-related information using different formats, styles and materials, in an interesting and appealing manner that would capture the attention of the audience. HPC needs innovative, artistic and creative personnel who are skilled in IT and the use of pertinent software.

4. Training and capacity building for HPC staff

At present, there are less than 50 staff members who are as