John M. Raeburn

People-centred health promotion

Introduction: people-centred health promotion - what is it? PCHP - the key essentials placing PCHP in the theoretical and political spectrum. Basic concepts, issues and approach: the overall aim of PCHP - health and wellbeing in a quality of life context empowerment community development cultural dimensions spiritual dimensions. The practice of PCHP - applying PCHP principles: general considerations and introduction to the people system the people system - a general guide the people system - outcome evaluation case studies 1 - community push and the Birkdale-Beachhaven Community Project case studies 2 - superhealth case studies 3 - the North Shore Community Health Network and the other way project towards a PCHP society.

From public to planetary health: a manifesto.

This manifesto for transforming public health calls for a social movement to support collective public health action at all levels of society—personal, community, national, regional, global, and planetary. Our aim is to respond to the threats we face: threats to human health and wellbeing, threats to the sustainability of our civilisation, and threats to the natural and human-made systems that support us. Our vision is for a planet that nourishes and sustains the diversity of life with which we coexist and on which we depend. Our goal is to create a movement for planetary health. Our audience includes health professionals and public health practitioners, politicians and policy makers, international civil servants working across the UN and in development agencies, and academics working on behalf of communities. Above all, our audience includes every person who has an interest in their own health, in the health of their fellow human beings, and in the health of future generations. The discipline of public health is critical to this vision because of its values of social justice and fairness for all, and its focus on the collective actions of interdependent and empowered peoples and their communities. Our objectives are to protect and promote health and wellbeing, to prevent disease and disability, to eliminate conditions that harm health and wellbeing, and to foster resilience and adaptation. In achieving these objectives, our actions must respond to the fragility of our planet and our obligation to safeguard the physical and human environments within which we exist. Planetary health is an attitude towards life and a philosophy for living. It emphasises people, not diseases, and equity, not the creation of unjust societies. We seek to minimise diff erences in health according to wealth, education, gender, and place. We support knowledge as one source of social transformation, and the right to realise, progressively, the highest attainable levels of health and wellbeing. Our patterns of overconsumption are unsustainable and will ultimately cause the collapse of our civilisation. The harms we continue to infl ict on our planetary systems are a threat to our very existence as a species. The gains made in health and wellbeing over recent centuries, including through public health actions, are not irreversible; they can easily be lost, a lesson we have failed to learn from previous civilisations. We have created an unjust global economic system that favours a small, wealthy elite over the many who have so little. The idea of unconstrained progress is a dangerous human illusion: success brings new and potentially even more dangerous threats. Our tolerance of neoliberalism and transnational forces dedicated to ends far removed from the needs of the vast majority of people, and especially the most deprived and vulnerable, is only deepening the crisis we face. We live in a world where the trust between us, our institutions, and our leaders, is falling to levels incompatible with peaceful and just societies, thus contributing to widespread disillusionment with democracy and the political process.

Self-modeling: Rapid skill training for children with physical disabilities

After more than three decades of studies, video is still a vaguely understood medium for training. In this study, self-modeling (self-observation of videotapes that show only adaptive behavior) was compared with videotaping only, using a within-subject type of design. Subjects were 18 boys and girls aged 5 to 13 years with various disabilities including cerebral palsy and spina bifida. Each child was assigned two target behaviors for potential intervention. One behavior was treated with video self-modeling and the other was videotaped without further intervention, resulting in a significant treatment effect. Self-model recordings were produced by planning and selectively editing two minutes adaptive-oly behavior, which subjects reviewed on six occasions over two weeks for a total of 12 min intervention. Progress was confirmed one year later. The study supports the efficacy of self-modeling for selected behaviors of these children with physical disabilities, and suggests further investigation of structured video replay as an active agent of change.

A question of balance: prioritizing public health responses to harm from gambling

AIM To provide an overview on the nature and importance of public health approaches to the global expansion of commercial gambling. METHOD Three key areas of public health activity are examined: harm minimization, health promotion and the political determinants for change. FINDINGS The rapid proliferation of gambling experienced in many countries is driven by the commercial development of new products orientated around continuous and rapid mass consumption. This is particularly the case with ongoing refinements to electronic gambling machines and the development of new gambling technologies using the internet and mobile telephones. So far responses to negative impacts have, on the whole, focused upon individualized treatment interventions. A public health approach to gambling offers a broad range of strategies to tackle the wider implications of gambling expansion: harm reduction provides evidence-based strategies for managing identifiable harm; health promotion focuses upon communities building their capacity, knowledge and resilience with regard to the attractions of gambling, and action on the political determinants sets out to increase the accountability and reduce the conflicts of interest that influence government resolve in managing their gambling environments. CONCLUSION In this new environment of mass consumption, efforts in developing treatment responses to problem gambling need to be balanced with, at least, equal efforts in developing public health responses. With the expansion of commercial gambling occurring globally, international agencies could play a critical role in supporting public health initiatives.

Meditation training and essential hypertension: A methodological study

Meditation training appears to be a promising psychological approach to the control of hypertension. However, most studies to date have had serious deficiencies. This study attempted to correct many of these deficiencies. Forty-one unmedicated hypertensives referred by general practitioners were randomly allocated to three groups. The treatment group (SRELAX) underwent training procedures based on Transcendental Meditation; a placebo control group (NSRELAX) underwent identical training but without a mantra. Both procedures were compared with a no-treatment control group. The results showed modest reductions in blood pressure in both SRELAX and NSRELAX groups, compared with the no-treatment controls, with diastolic percentage reductions reaching significance (p<0.05). There was considerable subject variation in response, with overall a mean decline in diastolic blood pressure of 8–10% on 3-month follow-up. Possible indicators to predict the response of subjects are considered and reasons for the similarity in the effectiveness of the SRELAX and NSRELAX conditions are discussed.

Toward a sense of community: Comprehensive community projects and community houses

Comprehensive Community Projects (CCPs) and their associated community houses represent use of the community psychology philosophy in an attempt to recreate an “old-fashioned” sense of community in the context of modern suburban communities. In this paper, the history of the CCP in New Zealand is traced, and key aspects of its organization are discussed. The CCP is related to principles and practice of community psychology, especially community control, developing a sense of community, and the role of community psychologists. Evaluation issues are raised, and results available so far are presented. In terms of overall community participation, the CCP appears to be a striking success.

A simple systems model for community programs

A simple model for general application to the planning and evaluation of community programs is presented. It is based on a systems approach and consists of seven procedural steps: overview, need assessment, goal-setting, resource organization, action, reviews, and outcome statements. Feedback information is used to correct and improve system performance. Two examples of the model in use are given to illustrate both its application and its generality. These concern the management of individual patients in a community-oriented psychiatric ward program and the organization of a comprehensive community development project. The feature common to these applications is the ability of the model to reduce complex endeavors to a few manageable steps, with no loss of comprehensiveness.

Strengthening the Evidence Base for Mental Health Promotion

Mental health promotion is concerned with achieving positive mental health among the general population and addresses the needs of those at risk from, or experiencing mental health problems. The focus of this multidisciplinary area of practice is on enhancing the strengths, competencies and resources of individuals and communities, thereby promoting positive emotional and mental well-being. The underlying principle of this approach is that mental health is a positive concept, which is important in its own right and is an intrinsic component of the broader health promotion agenda. Building on the basic tenets of health promotion, (WHO, 1986) mental health promotion shifts the focus from an individual disease prevention approach towards the health actions and wider social determinants that keep people mentally healthy. Mental health promotion emphasizes that mental health is created where people live their lives and that the everyday contexts or settings, such as the home, school, workplace and community, is where mental health is created and promoted. Mental health promotion is moving onto the global political agenda and there is a momentum behind international and national developments in terms of policy, research and practice in many countries (Marshall-Williams, Saxena & McQueen, 2005). It is therefore critical that there is a strong evidence base to support best practice and policy in meeting the global challenge of promoting population level mental health (WHO World Report, 2001; WHO, 2002a; WHO, 2004a, b) and reducing the increasing burden of mental disorders worldwide (Murray & Lopez, 1996; WHO, 2003). This chapter considers how current progress in demonstrating the effectiveness of mental health promotion can be further strengthened in order to best support international practice and policy.

Unstress: A low-cost community psychology approach to stress-management: An evaluated case study from New Zealand.

This research concerns an attempt to design and evaluate a 10-week, lay- led, low-cost stress-management program for dissemination at the community level. It is based on community needs assessment, empowerment, community control and other community psychology principles, and is combined with a cognitive-behavioral approach to stress management derived from health psychology. An evaluated trial reported here covers a 5-year period involving 61 groups, 15 leaders, and 448 respondents in 14 different community locations. On all measures, significantly positive results were obtained, and these were maintained or increased over 12-month follow-up. These results, plus the low dropout rate (16%) and high participant satisfaction (90%), suggest that this is a successful program that owes much of its strength to a community psychology approach.

Community Push: A Community-Oriented Evaluation Programme in a Psychiatric Ward*

Evaluation of mental health programmes is a neglected area in New Zealand. This paper describes a community-oriented, experimental programme designed to provide a model for evaluation in the context of an inpatient psychiatric unit. Its primary objective is to improve patient care. This is achieved by emphasizing real-life needs, and dealing with these by a series of clearly specified steps involving goal-setting. Community resources, especially volunteers, are used. A variety of evaluative data are produced and the overall result is a “self-correcting” programme which is appreciated both by patients and staff.