Health

What do people often write on birthday cards? „Happy birthday, a successful new year, and stay healthy above all!” Health seems to play an important role for a good or even happy life. A famous German Philosopher – Schopenhauer – said once: “Health is not everything, but without health everything is nothing". These are examples for the importance health has for many people.

If you try to describe health in a few words, you will discover that this is difficult. Maybe one of the reasons why a general definition is difficult is that everyone has very personal perceptions of health. Personal experiences and individual character traits play an important role in everybody’s definition of health. Please find some notions of health in the overview below. Some definitions focus on the physical functioning of the “human machine”, others define health as the absence of illness. Others define it more globally and focus on human well-being under varying experiences and viewpoints (e. g. our own body, emotions, relationship to other people).

The differing perceptions of health can be related to differing behaviour patterns. People who feel that they have no influence on their health, because it depends on coincidence or higher powers, will probably not fight to improve and maintain their health. But people who feel that their health is at their own responsibility will probably tend to avoid damaging behaviour and will try to support their health actively.

The World Health Organization (WHO) created the best-known definition of health: “Health is a situation of complete physical, social and mental well-being and not as the absence of illness or ailment.” (World Health Organization 1946)

Important in this definition is the holistic claim. In those years, it was not self-evident to put the mental and also the social well-being on one level with the physical well-being as a condition for health.

Health promotion

What does health promotion mean? The World Health Organization provided a well-known definition for that as well:

""Health promotion is the process of enabling people to increase control over, and to improve, their health." (WHO 1986).

This guiding principle has been applied in our project about skin diseases and sexually transmitted diseases. Thus the pupils will be able to learn and to make experiences how to improve their health on some areas of health at their choice.

In the so-called Ottawa Charter for Health Promotion (1986), the WHO suggests three basic action strategies and five key action areas for Health Promotion.

		The three action strategies of Health Promotion are: to advocate, to enable and to mediate. These three action strategies are described in further detail on the WHO website. Please access the site here.
		The WHO identifies as the five key action areas for Health Promotion: 1. Build Healthy Public Policy, 2. Create Supportive Environments, 3. Strengthen Community Actions, 4. Develop Personal Skills and 5. Reorient Health Services. These five key action areas are described in detail on the WHO website. Please access the site here.

The action area „Develop Personal Skills“ is especially important for deducting a mission in the field of education for health. The Ottawa Charter explains that „Health promotion supports personal and social development through providing information, education for health and enhancing life skills.”

Salutogenesis

"What makes people sick?" This is a very important question in medical science. Scientists try to understand the aetiology of diseases and to influence it in a positive way. Psychologists as well traditionally deal with morbid influences from this perspective, e. g. in the case of stress. In the recent past, the reversion of the question has expanded the perspective.

"How do people stay healthy?". This is the critical question a scientist came to by coincidence. He had noticed that, among a traumatized group of women from a concentration camp in Germany during World War II, some women stayed healthier than others. The classical perspective („What is making them sick?“) investigated the group of mentally and physically severely traumatized women. Antonovsky, however, by examining the group of women who had stayed more healthily, tried to find reasons that had enabled them to cope better with the stressors. Antonovsky defined stressors as challenges in life that humans must cope with.
Furthermore, he wanted to verify if these reasons were also valid for other people. The critical question is if a person has resources of resistance to counter stressors. It’s a well-known phenomenon that many people are exposed to the same germs, but only a part of them fall sick. In a wave of common cold, some people get a cold while others do not. This phenomenon is usually explained with a better state of the powers of resistance of some people, which prevent a transmission of the germs. But why do some people have stronger or weaker powers of resistance than others? The concept trying to explain the origin of health and illness is called the „concept of salutogenesis“ (i. e. of the origin of health).

Stressors, resources of resistance and the continuum of health and illness. Antonovsky’s basic idea in his salutogenetic approach is that every human possesses healthy and ill parts. From his view, health and illness are two poles of a continuum.
The health of humans depends on the stressors they are exposed to and the resources of resistance they possess to counter them. The balance between straining and protective factors determines the health state (see image below).

Effect of stressors: They create a situation of stress that can or cannot be coped with and may lead to health (salutogenesis) or illness (pathogenesis) (continuum of health and illness).

Continuum of Health and Illnes Antonovsky described his basic ideas in a metaphorical description; please read a quotation below: "...my fundamental philosophical assumption is that the river is the stream of life. None walks the shore safely. Moreover, it is clear to me that much of the river is polluted, literally and figuratively. There are forks in the river that lead to gentle streams or to dangerous rapids and whirlpools. My work has been devoted to confronting the question: ´Whereever one is in the stream - whose nature is determined by historical, socio-cultural, and physical environmental conditions - what shapes one's ability to swim well?" (Antonovsky, 1987, p.90)

The salutogenetic approach focuses on the way in which a person copes with stressing factors positively. Here are some examples for resources of resistance that allow a positive coping with stressors:

• Sufficient powers of resistance (immune system ) of the body against pathogens and other stressors,
• The capacity to avoid stressors actively (to evade them through health-conducive behaviour / prevention),
• Intelligence and mental flexibility to be able to adapt to living conditions or to actively change them,
• Material resources to ensure protection, nutrition, shelter etc.
• Social support in social networks (e. g. friends, family, co-workers).

According to Antonovsky, an individual with a strong Sense of Coherence reacts to demands (stressors) by considering them as challenges and activating his/her sources of resistance. Someone with a weak Sense of Coherence, however, will soon consider the demand as overload.
Sense of Coherence, then, is a positive and active self-image about one’s own capabilities of coping that is combined with the confidence to be able to control and organize one’s life.
The stronger the Sense of Coherence, the higher is the probability to cope with stressors successfully and with positive effects for one’s health. Thus it is a challenge for health promotion projects in schools to help teenagers develop a positive Sense of Coherence.

HAPA model

Health education often does not show the desired success. Many risky behaviours seem to be very resistent to change, and educational interventions are often not widely accepted (e. g. smoking cessation, healthy diet).

Therefore it is important to analyze the cognitive processes that lie between the message of health promotion and health relevant behaviour. The model described below may contribute to answering the question how to proceed from the educational intervention to the desired health-literate behaviour, and in which crucial points of this process failure may be possible.
There are a number of models which try to explain the origin of human health behaviour and the possibilities to influence this attitude. There is a model integrating the elements of many other models: the HAPA model, developed at the end of the 1980s by Ralf Schwarzer in Berlin. It continues the concept of Antonovsky’s salutogensis model. The HAPA model describes various phases which an individual must pass completely in a positive sense to be able to adopt and maintain the desired behaviour (by abandoning harmful behaviour or by adopting health-conducive behaviour).

Please see the phases in the image below. A more detailed description of this model can be found on the following website: http://www.hapa-model.de/

As the self-efficacy expectancies are considered to play an essential role for adoption and maintenance of a health-relevant behaviour, the conditions under which this desired behaviour can be initiated and influenced by teachers or other multipliers are outlined in this overview.
Perceptions of self-efficacy are constructed in the course of life from four different sources: (1) information resulting from own successful actions, (2) experiences resulting from social comparison with others, (3.) convincing verbal feedback by important others and (4.) physiological and affective conditions.

Literature

Please look into the following references list if you would like to deepen your knowledge about health and promotion.

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