RHP&EO is the electronic journal of the International
Union for Health Promotion and Education
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My five resources in health promotion a cocktail that changed over time [Français]By Irina Dinca Dinca, I. My five resources in health promotion a cocktail that changed over time. Reviews of Health Promotion and Education Online, 2001. URL: reviews/2001/9/index.htm. A bit of contextIt was difficult to decide upon my five favourite health promotion resources, although for totally different reasons than the ones of the previous writers in this series. First, the history of health promotion and health education in Romania has begun about eleven years ago. Before, in the communist era, there was a very well developed system of what was called then hygiene education, which was very authoritarian and had little to do with what I learnt since then about health promotion and health education. Therefore as my career in these fields has only lasted for ten years or so, I thus can hardly go back before this period - when thinking about resources. Secondly, when I tried to go back to the books that I felt made a change into my recent professional life, it was very difficult to get them. We used to have copies at the National Center for Health Promotion and Programs library (the only one of this kind in Romania) that I coordinated until one year ago but the books were borrowed by somebody else when I tried to access them to write this paper. I thus had to dig into my memory in trying to remember the five resources that made the most impact upon my nervous cells Thirdly, I humbly confess that this is my third article or so, written in an international magazine. It thus took much longer than I initially estimated to get it done! In this part of the world, publishing or writing about our experiences isnt something usual. So, here it is, and I decided to utilize the following categories to reflect upon my resources
Human touchI remember my first assignment in health promotion: it was a workshop on sexual health, organized by WHO-EURO in 1990 in Romania. My role was as translator. Why translator? After graduating from the Faculty of Medicine and becoming a MD, I did my internship in different units, looking for the most appropriate and appealing specialty to work in. Trying my way to resuscitate and ventilate patients in a desperate attempt to become an anesthesiologist in a maternity hospital, I heard about family planning. Working with healthy people oh, what could a physician do about this ?? My first opportunity was thus as translator. It was then, attempting to translate funny words like health promotion, health education, assertiveness, advocacy or self-esteem that I decided that hospital work was not for me. Instead of spending long night shifts in the hospital, what a young blonde told the participants about HIV/AIDS prevention struck me as a possible career: her words, full of profound meanings, made a click in my head. This health promotion business was something new in Romania, nobody had heard of, but I sensed it had a huge future Working with healthy people and helping them to stay healthy: this was the first health promotion message I got at the beginning of the 90s, a message that changed my professional life forever. After more than ten years, within health promotion, my love is still in the area of family planning and reproductive health though, for professional as well as for personal reasons: I was one of the many persons affected by the repression in this field during the Ceausescus time. Two illegal (at that time) unsafe abortions, as well as seeing your best friend with a septicemia due to self-induced abortion can mark your life forever a personal reason to believe that helping people to stay healthy was the right choice. BooksDue to the circumstances mentioned earlier, it was the most difficult part of my search for meaningful resources. The first one that came into my mind was the New Public Health by Ashton and Seymour (1988). In my view, the five principles of health promotion listed in it set the scene in very concrete terms whereas for the Ottawa Charter, I needed a longer time to get to the meanings of words. In Ashton and Seymour's book, I found that the way health promotion could be implemented was quite straightforward as described in their Liverpool experience. Communicating the concrete meaning of health promotion and health education has probably been the most difficult task to accomplish in my role as educator and advocate for this field. My introductory lesson to postgraduate students (either in Master in Public Health, Competency in health management or Competency in health education the only programs currently existing in Romania where health promotion and health education can fit so far) is also the most difficult: what are health promotion, health education, and how they are different from the previous hygienic education perspective (and if we need to make this difference) are real challenges to accomplish. The abstract level of these concepts makes it difficult for participants to understand and for me to explain. At another completely different level in working with policy and decision makers, when advocating for funds (especially) for health promotion and health education programs - I need to explain to these experts, who are most of the times medical clinicians, what I mean by these fancy words Ashton and Seymour provided me with a most practical tool to do so. ArticlesIn Romania, there is a national health promoting network including about 150 people in a country of more than 22 million inhabitants. Most people belonging to this network are physicians, some specialized in public health and other GPs; a few are psychologists, specialists in languages (it was believed that a specialist in languages was the most efficient in transmitting messages in health), nurses, sociologists. Obviously these few people cannot cope with all the health education tasks required by all the population, and health promotion is not really included in their responsibilities. So, family physicians should and could play a very important role in transmitting health education messages to their patients, but they are not properly trained to do so. An article by Elizabeth Arborelius, Ingvar Krakau and Sven Bremberg (1992) titled Key factors in health counseling in the consultation, gave me an excellent insight on how to allow GP's to contribute more efficiently to help their clients. To be honest, this has not really materialized yet but in my view, we are almost there. Within a new USAID-supported initiative on Expanding and integrating reproductive health services in the primary health care, a special attention in the post-graduate training of GPs is given to the client-centered approach. In this initiative, implemented through John Snow Inc., a U.S. company where I work as the Advocacy/Partnership Coordinator, I propose to use Arborelius et als. paper as a resource for participants in the training process (and, I can also say, for the trainers, too). Background PapersI come from a country where communicable diseases have been kept under a strict control. Romania has a very good immunization rate and it was even higher more than ten years ago, when this intervention was compulsory and children were tracked thoroughly. I believe that in health promotion, we still carry the ideas and mentality from the communicable disease model of epidemiology and public health. One of my biggest challenges is thus to explain to decision-makers the differences and/or similarities between disease prevention (social medicine as we often call this field in Romania) and health promotion. A paper presented by Sylvie Stachenko (1996) at the Second Meeting of the European Committee for Health Promotion Development stayed in my folders for a rather long time, until I got her points. Today I find her paper more than obvious but there was a time (not long ago, as she presented this paper in 1995) when I kept thinking: what does this lady mean ? The Lalonde report that she mentioned didnt mean anything to me, nor many other ideas and concepts mentioned in her paper. After a while, I found the Lalonde report and it opened new areas for me, concrete issues I could take further to argue with the Romanian decision makers and with the health promotion practitioners. Most importantly, for me, Stachenko's paper was another tool that helped me to transform the abstract Ottawa Charter principles into practical initiatives as implemented in Canada, linking the clinical interventions of the medical profession with public health and health promotion actions. This is but one example of how the tons of papers I bring back from international meetings can sometimes reveal themselves invaluable whereas at the outset, they just seemed extra weight in my suitcase. Electronic resourcesAs a physician (although my initial intent was to go for graduate training in psychology, which unfortunately wasnt available as it was forbidden for 22 years in Romania), no matter my wide opening to public health and health promotion issues, I confess I need to learn more about other areas, e.g. employment, social assistance, work, not to mention economy and/or agriculture, trade etc., all these being topics that have an impact on health. Moreover, being an advocate for health promotion in my own country, I have been involved in getting together on a regular basis with the Ministry of Health and Family, the Ministry of Education and Research as well as the Ministry of Youth and Sports. Almost two years ago, I read on an electronic discussion list about the IUHPE position on World Trade and Population Health, an initiative led by Prof. Labonté (1999). In a country with a rather conservative health education perspective, such a subject seemed shocking to me. At the outset I didnt participate to the electronic debate that went on worldwide in reaction to Prof. Labonté's brief. After a while, after watching the TV coverage events related to economic globalization, and reading several times what it was all about, I suddenly realized that this topic was also part of my daily work. This is a good case that illustrates the importance for us, in Romania, of being electronically linked to the latest debates in the field; once more, it might take time for some issues to prove relevant to our daily work, but being exposed to the debates makes us think, react and eventually use some of this information if it looks appropriate, ConclusionWhen you have a lot of needs in front of you, as we clearly do in Romania, the temptation to try to know and do everything at the same time will clearly come up. And this is even more so when you work in health promotion, a topic that is preoccupied with everything all the time with the totality of our lives, in fact. After a while, I realized that trying to do everything could not work and, rather, that doing well in certain specific areas was a better choice. Because health promotion is also each one of us, with special needs at certain times, I also found that the resources that helped me most in this difficult venture also varied according to needs and times References
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