Community Health Nursing:

Definitions:

1) World
World Healt
Health
h Org
Organi
anizat
zatio
ion:
n:
a. Special
Special field
field of nursing
nursing that
that combine
combines s skills
skills of nursing
nursing public
public health…
health…
b. Functio
Functionn as part
part of tota
totall public
public healt
healthh program
program for:
i. Promoti
Promotion on of health
health
ii. Improvement
Improvement of condition
condition
iii.Rehabilitation of illness and disability
2) Jacobsen
a. Learned practice discipline with ultimate ultimate goal of contributing
contributing as individuals
individuals to
promote client’s optimum level of functioning through teaching and delivery of care
3) Dr.
Dr. Rut
Ruth
h B.
B. Fre
Freem
eman an
a. CHN isis a unique
unique blend
blend of nursing and publicpublic health
health practice
practice aimed atat developing
developing and
and
enhancing health capabilities of people. It is involved in entire spectrum of health
services for the community
4) Tinkha
Tinkhamm and Voor
Voorhie
hies,
s, 1972
1972
a. CHN isis a field
field of nursing
nursing inin which
which family
family and commu
communiti
nities
es are pati
patients
ents
b. Unique
Unique blend
blend of nursing
nursing and public
public healt
health
h practice
practice woven
woven into
into human
human service
service
c. “The hall
hallmark
mark of of CHN is that
that it
it is populat
population
ion or aggre
aggregate
gate-foc
-focused
used.”
.”

Philosophy of CHN

Dr. Margaret Shetland:

“Philosophy is based on the worth and dignity of man.”

Ultimate Goal

“To raise level of health of the citizenry.”

Objectives of CHN

1) part
partic
iciipat
pate…
2) cond
conduc
uctt rese
resear
arch
ches
es…
…
3) coo
coordina
dinatte…

Concepts of CHN

• emphasis on importance of “greatest good for the greatest number”

• assessing health needs, planning, implementing and evaluating impact of health services on
population group
• priority of health promotive and disease preventive strategies over curative interventions
• tools for measuring and analyzing community health problems
• application of principles of management and organization of the delivery of health services to
the community

Basic Principles of Community Health Nursing

• family is the unit of care, community is the patient and the four levels of clientele of CHN
are:
○ individual
○ family
○ group
○ community
• goal of improving community health involves multidisciplinary effort
• CHN works not for individual patient, family, group or community. The latter are active
partners, not passive-recipients of care
• Practice of CHN is affected by changes in society in general and by developments in health
field in particular
• CHN is part of community health system, which in turn is part of the larger human services
system

Barangay Health Centers

1 doctor, 1 nurse, midwives, 2 barangay health workers. 1 nurse= 5000 people

Wednesday: check-up and free immunizations

Roles and Functions

• Planner: e.g. IMCI = Integrated management of childhood illnesses

• Provider of Nsg Services: direct nursing care of sick; provides patient continuity of care
• Manager/Supervisor: formulates individual, family, group and community centered care of 
plan; organize work force
• Coordinator of Services: coordinates with individuals, family, group for health related services
provided by GO’s and NGO’s
•  Trainer/health educator/counselor: identifies and interprets training needs of RHM’s, BHW’s
and hilots; resource speaker; IEC materials
• Health Monitor: detects deviation from health of individual, family, group and community
through contact visits with them; use of systematic and objective assessment
• Role model: provides good example/ model of healthful living to public
• Change agent: motivates changes in health behavior of individual, family, group and
community including lifestyle to promote and maintain health. “most difficult role.”
• Recorder/reporter/statisticiain: prepares and submits records and reports
• Researcher: participates/assists in conduct of surveys

Community Health Nursing:

History:

• Early Christian era: virgins, noblewomen and plebeians took care of sick
• Phoebe: 1st visiting nurse
• Mr. William Rathbone:
○ Philanthropist who first thought of public health nursing
○ District nursing service in Liverpool in 1859
○ More emphasis on midwifery
○ Forerunner of public health nursing system
• In the USA:
○ Public HN developed from visiting nursing service under missionary societies and
visiting nursing associations
○ 1877: women’s board of NY mission established 1 st visiting nurses

History of Public Health

• Babylonians
○ Understood need for hygiene
○ Developed medical skills
• Egyptians
○ Developed variety of pharmaceutical preparations
○ Constructed earth privies and public drainage system
• Hebrew Mosaic Law
○ Maternal health, communicable disease control, protection of food, water, waste and
sanitary disposal
• Greeks
○ Linked health to environment
○ Wealthy people value personal cleanliness, exercise, diet and sanitation
• Romans
○ Viewed medicine from a community health and social medicine perspective
○ Emphasized regulation of medical practice
○ Provision of pure water
○ Sewage systems, public food preparation
○ Women visited and cared for the sick
• Christianity
○ Brought idea of personal responsibility
○ Started the care for the sick
• Middle Ages
○ Poor sanitary conditions
○ Increase in communicable diseases (cholera, bubonic plague, smallpox)
○ Religious convents and monasteries established hospitals
○ Started movement of health education and personal hygiene
 • Renaissance
○ Health practices were influenced by recognition of human dignity and worth
○ Elizabeth Poor Law: established 1601, guaranteed medical services to poor and lame
individuals
• Industrial Revolution
○ Advances in transportation
○ Religious women started to provide nursing care in institutions and homes

Milestones in history of public health

• 1601- Elizabeth Poor Law

• 1617- Sisterhood of Dames de Charite organized by St. Vincent de Paul
• 1789- Baltimore Health Department
• 1798- Marine Hospital Service, nuns visited poor
• 1813- Ladies Benevolent Society of Charleston, South Carolina founded
• 1836- Lutheran deaconesses provided home visits in Germany
• 1851- Nightingale visited Kaiserwerth, 3 months of nursing training
• 1855- Quarantine Board, established in New Orleans; beginning of tuberculosis campaign in
US
• 1859- district nursing established by William Rathbone
• 1860- Florence Nightingale Training School for Nurses established in St. Thomas Hospital in
London
• 1864- Beginning of Red Cross

Community Health Nursing Historical Background in Philippines

• 1901- Act 157, est. Board of Health of Philippines

• 1905- Act 1407, est. Bureau of Health, under Department of Interior
• 1912- Fajardo Act (Act 2156) – Sanitary Division, forerunner of present Municipal Health
Offices; President of Sanitary division took charge of 2 to 3 municipalities. Philippine General
Hospital sent 4 nurses to Cebu
• 1914- School of Nursing rendered by Filipino Nurse employed by Bureau of Health in
  Tacloban, Leyte
• 1915- Philippine Health Service; Reorganization Act 2462 created. Office of Inspector General
and Office of District Nursing headed by Dr. Rosario Pastor, a nurse and physician
• 1915-1918- Ms. Perlita Clark took charge of Public Health Nursing Works
• 1919- 1st Filipino Nurse Supervisor was appointed, 84 PHN’s assigned in 5 health stations
• 1927- Office of District Nursing abolished and changed to Section of Public Health Nursing
• 1930- Section for Nursing
• 1941- Outbreak of war, PHN’s were assisted to take care of sick and wounded
• 1942- 31 nurses as POW’s at Bilibid Prison, released to Director of Bureau and Health, Dr.
Eusebio Aguilar
• 1948- 1st training center of Bureau of Health organized in cooperation with Pasay City Health
Department
• 1950- Rural Health Demonstration and Training Center by DOH
• 1958-1965- RA 977 abolished Division of Nursing
○ Annie Sand= nursing consultant, Office of Secretary of Health
 Founded DOH National League of Nurses Inc.
○ RA 977created 8 regional offices in country increased to 11 then to 16

Primary Health Care (Basic Health Care)

Definition

1) Worl
WorlddHHea
ealt
lth
h Org
Organ
aniz
izat
atio
ion:
n: “ess
“essen
enti
tial
al heal
health
th care
care made
made univ
univer
ersa
sall
lly
y acc
acces
essi
sibl
ble
e to
to
individuals and families by means acceptable to them, through full participation and
at cost that the community and country can afford at every stage of development.”

Conceptual Framework 

• Goal: Health for all Filipinos and Health in the hands of th epoeple by the year 2020
• Mission: to strengthen the health care system by increasing opportunities and supporting
conditions wherein people will manage their own health care.
 • Concept: Primary Health Care (PHC) characterized by partnership and empowerment of 
people shall permeate as core strategy in effective provision of essential health services

Legal Basis

• Letter of Instruction (LOI) 949: signed on Oct. 19, 1979 by then Pres. Ferdinand E. Marcos
• Historical Background
○ 1974- WHO and UNICEF conducted a joint study
○ 1975- World Health Assembly passed a resolution giving priority to the development
of PHC
○ 1977- World Health Assembly decided that main target of government and WHO is
the attainment of the level of health that would allow or permit them to lead a
socially and economically productive life by year 2000
○ September 6-12, 1978- 1st International Conference on Primary Health Care in Alma
Ata, USSR
○ 1979- WHA launched global strategy to attain health for all
○ 1980- PHC endorsed for implementation by respective regional community

Why Philippines Adopted PHC

1) magni
magnitud
tudee of
of heal
health
th proble
problems
ms
2) inadequa
inadequate te and unequ
unequal
al distri
distributi
bution
on of healt
health
h resource
resources
s
3) incre
increase
ased d cost
cost of
of medic
medical
al care
care
4) isolation
isolation of health care activities
activities from other developmental
developmental activities
activities

Principles of PHC

1) Accessibility,
Accessibility, acceptabili
acceptability, ty, availabilit
availability, y, and affordability
affordability of of health
health services
services
a. Health
Health servic
services es are delivere
delivered d where
where people people live
live and work
work
b. Development
Development of indigenous indigenous or resident volunteer volunteer health
health workers
workers to provide health
care with an ideal ration of 1:10-20 households
c. Use of low low cost,
cost, approp
appropriat
riate e technolo
technology gy sustaina
sustainable ble by commun
community ity
d. Combined
Combined utili utilizati
zation
on of traditio
traditionalnal medicin
medicines es and essentia
essentiall drugs
2) Partnership
Partnership between
between community
community and health health agencies
agencies in in provision
provision of
of quality,
quality, basic and
essential health services
a. Community
Community needs and prioritie priorities s are basic for for planning
planning health
health services
services and
and activities
activities
b. Training curriculum
curriculum of community
community health health workers
workers I based
based onon community
community health
problems and task analysis of community health workers
c. Regular
Regular supervi
supervisionsion and
and periodic
periodic evaluati
evaluation on of communit
community y health
health workers’
workers’
performance by health staff to community
d. Developm
Development ent of promotiv
promotive, e, preventive
preventive,, curative
curative and rehabili
rehabilitat
tative
ive care
e. Recogni
Recognition tion of role
role and traditio
traditionalnal healers
healers in deliver
delivery y of health service
services
s
3) Commun
Communit ity
y Parti
Partici
cipat
patioionn
a. Awareness building and consciousn consciousness ess raising
raising on health
health and development
developmental al issues
issues
b. Commu
Communit nity y buildi
building
ng and
and orga
organizniziningg
c. Plannin
Planning, g, implement
implementatio ation,n, monitorin
monitoring g and evaluat
evaluation ion done
done by community
community
d. Communit
Community y discussio
discussions ns done
done through
through small small group
group discus
discussion
sionss
e. Selecti
Selection on of communit
community y health
health workworkers ers by
by communi
community ty
f. Foun
Founda datition
on ofof heal
health
th com
commi mittttee
ees s
g. Establis
Establishmenhmentt of commucommunity nity health
health organorganizat
izations
ions
h. Mass healthhealth campai
campaigns gns andand commun
community ity mobiliza
mobilizationtion
4) Sel
Self-r
f-reli
eliance
nce
a. Communit
Community y genera
generatestes support
support for health health care
b. Mobil
Mobilizaizatition
on ofof healt
healthh resou
resource rces s
c. Trainin
Training g of communi
community ty leaders
leaders on on leadersh
leadership ip and manag
manageria
eriall skills
skills
d. Incom
Income-g e-geneeneratrating
ing proje
projectctss
5) Recognit
Recognition
ion of inter
interrela
relatio
tion
n of health
health and devel developmeopment nt
a. Convergence
Convergence of health, food, nutrition nutrition,, water,
water, sanitation
sanitation and population
population services
services
b. Integration
Integration of PHC into national, national, provincial,
provincial, municipal and barangay barangay development
development
plan
6) Soci
Social
al Mobi
Mobililiza
zati
tion
on
a. Establis
Establishmenhmentt of effeceffective
tive health
health referr
referral al system
system
b. Multi-se
Multi-secto ctoral
ral and inter-di
inter-discip
sciplina
linaryry linka
linkages
ges
c. Integration,
Integration, Education,
Education, Communica
Communication tion (IEC) support using multimedia
multimedia channels
channels
d. Collaboration
Collaboration among government government agencies, non-government non-government organizations
organizations and
community groups
7) Dece
Decentntra
rali
liza
zati
tion
on
a. Real
Realloclocat
ation
ion ofof budget
budgetar ary y resourc
resources es
 b. Advoc
Advocacy
acy for
for poli
politi
tical
cal wil
willl and suppo
support
rt
c. Re-or
Re-orie
ienta
ntati
tion
on of hea
healt
lth
h profes
professio
sion
n

Strategies of PHC

1) reorientation
reorientation and reorganizati
reorganization on by local government
government code of 1991 or RA 7160
2) effective preparation
preparation and
and enabling
enabling process
process for health action at all
all levels
levels
3) mobilization
mobilization of people to know
know their
their communities
communities and identify
identify basic
basic health
health needs
needs
4) developm
developmentent of util
utilizat
ization
ion of techn
technolo
ology
gy
5) organiza
organizatio
tion
n of commu
communitinities
es arisin
arising
g from
from needs
needs
6) incr
increa
ease
se oppor
opportu
tuni
niti
ties
es

Essential Components of Primary Health Care

1) Multi
Multi-Se
-Sect
ctora
orall Approa
Approach ch
a. Intr
Intras
asececto
tora
rall link
linkag
ageses
b. Inte
Inters
rsec
ecto
tora
rall link
linkag
ageses
2) Commun
Communit ity
y part
partici
icipat
patio
ionn
a. Iden
Identitify
fy prob
problelemm
b. Iden
Identitify
fy solu
soluti
tion
on
c. Mobi
Mobililizi
zing
ng reso
resoururce
cess
d. Barriers
i. Lack of motimotivat
vation
ion
ii. Indifference
Indifference on part of community
community
iii.Resistant to change
iv.Bureaucracy of government
v. Lack of managerial
managerial skills
skills
vi.Dependence on part of community
3) Appr
Approp
opri
riat
atee Techn
Technol olog
ogy y
a. 6 criteria:
i. effectiv
effectivenes
eness s and safety
safety
ii. less complex
complex
iii.less costly
iv.broader scope of technology
v. acceptability
acceptability to local culture
culture
vi.feasibility
4) Comm
Commun unit
ity
y invo
involvlvem
emen entt
a. Invo
Involv
lvem
emen entt leve
level:
l:
i. Indiv
Individu
idual
al
ii. Family-monitor
Family-monitor growth and development
development of child and able to address to
problems in government
iii.Community- organizations formed to promote health development

Concepts of Primary Health Care

1) PHC represen
represents ts suppleme
supplementar ntaryy healt
healthh system
system
2) Equip community
community with capability
capability to solve
solve its own problems
problems by conducting
conducting trainings
trainings
3) Come into
into being
being onlyonly when communi
community ty recogni
recognizeszes and accept
accepts s problems
problems
4) Governme
Government nt official
officialss don’t work
work in place
place of communi
community ty and vice
vice versa
5) Communi
Community ty involv
involvemeementnt is the hear
heartt and
and soul
soul of PHCPHC
6) Good healt
healthh is related
related to to living
living condit
conditions
ions and
and lifesty
lifestyle
le
7) Provide opportunity
opportunity to underprivileged
underprivileged majority
majority to develop
develop to
to an acceptable
acceptable level
level
a. Basi
Basic c mini
minimamalilist
stic
ic need
needs:s:
i. Food
ii. Clothin
Clothing g
iii.Shelter and clean environment
iv.Health
v. Education
Education and information
information
vi.Security of life
vii.Means of livelihood
8) Communi
Community ty must take take its role
role and respon
responsibi
sibilit
lity
y to develop
develop basic
basic needs
needs
9) PHC activi
activitie
tiess must be in in harmony
harmony with with existin
existing g institut
institution
ion
10) PHC activities
activities must be flexible in its application
application
11) Must be related to public
public health services
services and technical support
support levels of public…

Elements of Primary Health Care

1) Education
2) Loca
Locall
lly
y Ende
Endemi
mic
c Dise
Diseas
ases
es
 a. Filariasis
b. SchiSchist
stos
osom
omiaiasi
siss
3) Esse
Essent
ntia
iall bas
basic
ic drug
drugs s
a. Cotrimo imoxazo
xazolle
b. Amoxicillin
c. Rifampicin
d. Isoniazid
e. Ethambutol
f. Paracetamol
g. Pyra yrazina
zinami
mid de
h. Oresol
i. Nifedipine
4) Mate
Materna
rnall and
and Chil
Childd Heal
Healthth Car
Caree
5) Expan
Expanded
ded pro
progra
gram m of immu
immuniz nizat
atio
ionn
a. BCG-BCG- bacbacill
illus
us calme
calmett tte
e gue
guerin
rin
b. OPV-OPV- oral
oral poli
polioo vac
vacci
cine
ne
c. AMV-AMV- antanti-
i-me
measasle
less vacc
vaccinine
e
d. DPT-DPT- dypth
dyptheri
eria
a pert
pertuss
ussisis tet
tetanu
anus s
e. Anti-Hep B
6) Nutrition
a. IDD-IDD- iodi
iodine
ne def
defici
icienc
ency y di
disor
sorde
derr
b. IDA-IDA- iron
iron defic
deficien
iency
cy anemia
anemia
c. PEM-PEM- prot
protein
ein energ
energy y malnu
malnutr trit
itio
ion
n
7) Treat
Treatmen
mentt of of comm
common on disea
diseases
ses
8) Safe
Safe wate
waterr suppl
supply y and
and sanit
sanitat
atio
ion
n
9) Preventi
Prevention
on and contcontrol
rol of leadi
leading
ng communi
communicabl cable
e diseases
diseases
10) Promoti
Promotion
on of dental
dental health
health
11) Elderly and
and disabled’s
disabled’s physical
physical and mental
mental health
health

The Philippine Healthcare Delivery System

• Health Care System- organized plan of health services

• Health Care Delivery- rendering services to people
• Health Care Delivery System- network of health facilities and personnel which carries out task
of rendering health care to people
• Philippine Health Care System- complex set of organizations interacting to provide an array
of health services
• RA 7160
○ Local Gov’t Code of 1991
○ Provides for decentralization
○ Places in local gov’ts to manage health care system

Levels of Health Care Facilities

1) Pri
Primar
mary le
level
vel
a. Composed
Composed of baran
barangay,
gay, munici
municipal
pal and
and medicare
medicare health
health facilit
facilities
ies
b. 1st contact emergency care
c. rural health units, chest clinics, malaria eradication
eradication units,
units, schistosomi
schistosomiasis
asis control
control
units, puericulture units, private clinics, company clincis
d. earl
earlyy symp
sympto toma
mati tic
c stag
stage
e
2) Seco
Second
ndar
ary
y leve
levell
a. Consists of district
district health
health care
care institutio
institutions
ns with capabilities
capabilities and
and facilities
facilities for cases
with hospitalization
b. Smaller non-departmental
non-departmentalized ized hospitals
hospitals including emergency and regional hospitals
hospitals
3) Ter
Tertiary le
level
vel
a. Highly
Highly techn
technolog
ological
ical and sophisti
sophisticat
cated
ed servic
services
es
b. Specialized
Specialized centers,
centers, regional health care institutions
institutions and
and provincial
provincial health care
centers

Multi-Sectoral Approach to Health

• Intersectoral
○ Sectors most closely related to health
○ Agriculture, education, public works, local governments, social welfare, population
control, private sectors
• Intrasectoral

Restructured Healthcare Delivery System

 Rationale

• healthcare system serves only small portion of rural population

• diseases do not require sohphistication
• some problems can be handled by other postiions besides MHO (Municipal Health Officer)

Solutions

• 3 levels of health care provided by RHU (rural health unit) staff, with referral and supervisory
system support
• redefinition of roles and relationships among RHU staff 
• establishment of satellite health centers in selected barangays

Features of DOH reorganization

• 1958- RA 1082
○ 1st Rural Health Act
○ employment of more physicians, dentists, nurses, midwives and sanitary inspectors
assigned to RHU’s
○ 1st 81 rural health units
• 1972- RA 5435
○ defined authorities of regional directors for more meaningful decentralization
○ 13 regional health offices
• 1974
○ IBRD- RHCDS implemented RHM were sent to BHS to man BHS
○ Midwives were trained and roles expanded
• 1982- EO 851
○ integrated public health and hospital systems with emphasis on importance of 
putting together promotive, preventive, curative and rehabilitative components of 
health care
○ utilization of BHW
○ implementation of DOH impact programs

Role of Society in RHCDS

• participation in information drive of HCDS

• identifying
identifying problems
• identify sources

Local Health Board

• propose annual budget

• identify problems
• identify what programs
• Chairman, vice-chairman, chairman of committee on health, DOH representative, NGO
representative

Two-way referral system

Referral- intervention to direct client to another healthcare facility to continue his/her treatment

Population

BHS Midwife BHS BHW

Sanitary Inspectors RHU Midwife

PHN

Physician

Secondary Health Care Facility

 Tertiary Health Care Facility

Types of Health Care Systems

1) Tradit
ditional
nal
a. E.g.
E.g. cli
clien
entt prov
provid
ider
er
2) Non-
Non-Tr
Trad
adit
itio
iona
nall
a. Holi
Holist
stic
ic Hea
Healtlth
h Cent
Centerers
s
i. Believes that time,
time, space and encouragement
encouragement can help people
people find strength to
deal with problems confronting them
ii. Spiritual,
Spiritual, physical and psychological
psychological care
iii.Acts:
1. Past
Pastor
oralal coun
counse
seli
ling
ng
2. Stre
Stress
ss redu
reduct
ctio
ionn
3. Parenting
4. Diet
Dietar
ary y cond
condit
itio
ioni
ning
ng
b. Fai
Faith Healin ling
i. Believes that
that disease is a state
state of mind so one can
can alter his state
state of mind so he
will be healed
c. Chiropractic
i. System of manipulation treatment which teaches that all diseases are caused
by impringement on spinal column and corrected by spinal adjustment
ii. Daniel Palmer-
Palmer- founder
founder
d. Acupuncture
i. Insertion
Insertion of needles into
into selected body parts
parts to control
control pain
e. Acupressure
i. Finger pressure
pressure to control
control pain
pain in body parts
parts
f. Kinesiology
i. Study of movement
movement which applies
applies principles
principles of anatomy to movement
movement
g. Reflexology
i. Systematic
Systematic massage
massage of soles of of feet
ii. Applies same principles
principles as applied in acupressure
h. Massage
i. Relieves tension,
tension, enhances flexibility
flexibility and creates
creates coordination
coordination between mind
and body
i. Homeopathy
i. Use of variety of herbs, drugs
drugs and chemicals that when used used in small quantities
quantities
can cure or prevent disease caused by same substance in larger doses

Health Promotion, Health Maintenance, and Disease Prevention

Health Promotion

• Defintion
○ WHO- “Health promotion includes encouraging healthy lifestyles, creating supportive
environments for health, strengthening community action, reorienting health
services to place primary focus on promoting health and preventing disease, and
building healthy public policy.”
○ Pender, 1996- “Health promotion is a behavior motivated by the desire to increase
well being and actualize human health potential.”
• Health promotion includes any activity that helps people to change or maintain lifestyles that
support a state of optimal health or balance of physical, emotional, social, spiritual and
intellectual health.
• Prominence of health promotion came about as a result of changing patterns of health and
corresponding emphasis on “lifestyle” as a factor.
• PHE (Public Health Education) can only have impact on PH only if joined other sectors and
brought multiples social forces to bear.
• Green- “Behavioral changes that health education is able to effect can only be maintained if 
supportive environment were provided via: political, economic, social, biological and other
sectors.”
• 1st use of term, health promotion- 1945, Henry E. Sigerist
○ Defined 4 major tasks of medicine
 Promotion of health
 Prevention of illness
 Restoration of the sick
 Rehabilitation
 ○ Sigerist: “Health is promoted by providing a good labor condition, education,
physical culture and means of rest and recreation.”
 Concepts used and found in Ottawa Charter for Health Promotion which
occurred 40 years later
• 1986, WHO, Health and Welfare Canada and Canadian Public Health Association organized an
International Conference on Health Promotion
○ later known as Ottawa Charter
○ Guiding principle in health promotion efforts currently

Ottawa Charter for Health Promotion

• “Process of enabling people to increase control over and to improve their health”
•  To reach a state of complete physical, mental and social well-being , an individual or group
must be able to identify and to realized aspiration; to satisfy needs and to change and cope
with environment
• Health promotion is not just a responsibility of the health sector, but goes beyond healthy
lifestyles to well-being.
• Prerequesite for Health
○ Peace
○ Shelter
○ Education
○ Food
○ Income
○ A stable eco-system
○ Sustainable resources
○ Social Justice
○ Equity
• In order to operationalize the concept of Health Promotion, the Charter recommended the
following areas.
○ Build Health Public Policy
 Coordinated action that leads to health, income and social policies that
foster greater equity
○ Create Supportive Environment
 Societies are complex and interrelated
 Overall guiding principle is the need to encourage reciprocal maintenance
to take care of each other, our communities and our natural environment
 Conservation of natural resources throughout world should be emphasized
as a global responsibility
 Changing patterns of life; work and leisure leave a significant impact on
health
 Systematic assessment of health impact of rapidly changing environment,
especially in areas of technology, works, energy production and
urbanization
○ Strengthen Community Action
 Setting priorities, making decisions, planning strategies and implementing
 Heart of this process is Empowerment of communities
 Community development helps to enhance self-help and social support, to
develop flexible system for strengthening public participation in and
direction of health matters
○ Develop Personal Skills
  Through providing information, education for health and enhancing life
skills
 Enabling people to learn throughout life, to prepare themselves for all of its
stages and to cope with chronic illnesses and injuries
○ Reorient Health Services
 Health services are shared among individuals; community groups, health
service institutions and government