Recommendations to Change Public Health Priorities Essay

Recommendations to Change Public Health Priorities Essay

Changing Public Health Priorities: Implementing Socioeconomic Determinants of Health to drive Policy Action

The “medicalization” of public health systems receives the bulk of funding yet socio-economic determinants of health play an equal, if not increased, role in determining population health. How public health agencies use funding to provide public health services is a huge concern not only for every public health practitioner but also for every citizen. The Trust for America’s Health (TFAH) 2013 report provides an overview to the recent expenditures of the states’ public health services funding, examining the advantages and disadvantages on such expenditures.

The TFAH report gives an overview of how the health services expenditures of both federal and state are distributed (latitudinal direction) and how these amounts changed in the recent years (longitudinal direction). Recommendations to Change Public Health Priorities Essay. The major findings include both federal and state funding has been cut to inadequate levels in recent years, and there is wide variation in health statistics by state. For example, the amount of federal funding spent to prevent disease and improve health in communities ranged significantly from state to state, with a per capita low of $13.72 in Indiana to a high of $53.07 in Alaska. It is now considered more and more important to create a disease prevention mechanism, for example, the new Prevention and Public Health Fund provides $12.5 billion in mandatory appropriations over 10 years to local communities to improve health and reduce illness rates, which included Community Transformation Grants (CTGs) to allow local communities to tackle their most serious problems, including obesity and tobacco, using evidence-based prevention programs tied to strict performance measures.


Much research has been done by local public health agencies revealing the change of expenditures of funds on medical services in recent years. Massachusetts is a prime example, HPC (Health Policy Commission) 2013 and AGO (Office of Attorney General) 2013 showed that high health care costs are driven primarily by provider prices, which vary significantly among providers within individual payer networks as well as across the commercial market overall and there is evidence even showing such increment of price is not predicted by quality of care. Also in CHIA (Center for Health Information and Analysis) 2013 and AGO 2013, the authors argued that market leverage of providers influences health care costs in a cyclical process by determining provider prices, payments, and patient volume. Because of this, policy makers have drawn attention to the trend of provider consolidation and its potential impact on market leverage and health care costs. Recommendations to Change Public Health Priorities Essay.

A shift away from “Medicalization”: Prioritization of Key Socioeconomic Determinants of Health

There are many socio-economic determinants of health, some of which are being addressed and some which could use increased advocacy. Overall, the U.S. performs well in having policies that ensure an equitable right to work for all racial and ethnic groups, regardless of gender, age or disability (Heymann 2004). The U.S. is also one of 117 countries guaranteeing a pay premium for overtime work. However, the U.S. lags behind many other countries in addressing socio-economic gradients of health. For example, the U.S. guarantees neither paid leave for mothers nor paid paternity for fathers in any segment of the work force; moreover, the U.S. does not guarantee the right to breastfeed, even though breastfeeding is proven to reduce infant mortality. The U.S. also lacks a maximum length of the work week, a limit on mandatory overtime per week, and provides only unpaid leave for serious illnesses and family care through the Family Medical Leave Act (FMLA), which does not cover all workers.

In order to address health disparities caused by modifiable socioeconomic determinants of health, we prioritize three key issues needing advocacy in the health policy arena: mandatory paid sick leave, minimum (aka “living”) wage laws, and access to cost effective nutritious foods.

Health Impact Assessments: Facilitating an Evidence-based Shift in Public Health Policy

In order to change public health priorities there needs to be a political will to act; this is not always the case when dealing with socioeconomic determinants of health as they are often complex, multi-faceted issues whose outcomes may take a lifetime to track (Kelly 2007). Because health policy making can be a rapid action environment driven by competition for usually scarce resources coupled with pressure from the public, there is a need for evidence-based, sustainable strategies.

Health impact assessments (HIA) can facilitate the shift to public health policy to help develop a comprehensive action plan addressing social determinants of health.Recommendations to Change Public Health Priorities Essay.  These assessments provide an overarching analysis of the issue in political, social, and community contexts, examines cost/benefits analysis, and lays out options for action.

For example, HIAs addressing our three key socioeconomic determinants of health found:

  • Sick leave: Staying at home when infected could reduce by 15–34% the proportion of people impacted by pandemic influenza (HIP 2009). Without preventative strategies, more than 55,000 people in the state could die in a serious pandemic flu outbreak.
  • Minimum wage: A living wage was estimated to result in decreases risk of premature death by 5% for adults and for offspring, a 34% increased odds of high school completion, and a 22% decrease in the risk of early childbirth (Bhatia and Katz 2001). Without a living wage, workers have increased adverse health outcomes contributing to health care burden and are less sell-sufficient requiring public assistance. .
  • Access to healthy food options: Access to affordable, healthy foods help citizens of low income communities to consume a healthful diet and maintain a healthy weight, reducing their risks of heart disease, hypertension, diabetes and cancer (PPS). Without access to fresh produce in low-income communities, reduction of nutrition-related heart disease, hypertension, diabetes and cancer will not be adequately addressed.

Health impact assessments are a tangible, actionable tool to assist policy makers in shifting their public health policy focus to address socioeconomic determinants of health a top priority.

American Public Health Association Public Health ACTion: Advocacy for an Increased Emphasis on Socioeconomic Determinants of Health

The American Public Health Association (APHA) enacted the Public Health ACTion campaign (PHACT) in order to generate advocacy groups and actions to reach out and communicate directly with Congress and government officials about public health issues in order to make a difference. The PHACT campaign action kit is designed to be a starting block for anyone who wishes to either make a difference themselves or organize a group to do so together. The thinking is that the more people who commit to these actions and reach out toward members of Congress, the more positive change we may see.

The action kit starts out with a timeline for 2014 corresponding to important congressional dates and what actions can be taken at each step of the way. This is a great way to get an overall picture of this year’s campaign and organize what actions need to be accomplished and when. The campaign takes place mostly in the summer and the plan outlines the three areas of focus for 2014: protecting public health funding, protecting public health funding under the ACA, and stopping gun violence. The fact sheet details the reasons why these areas were chosen and goes into what actions correspond to each area of focus. A ten-minute long phone script is provided after each focus so that a single advocate can call Congress to share these issues.

Lastly, the campaign action kit outlines various other ways of taking action. These include getting a group of a few people and organizing a meeting with members of Congress to deliver a target message and discuss these issues. Recommendations to Change Public Health Priorities Essay. Using social media, letters to the editor or an op-ed to deliver messages are also discussed. This action kit provides a well-rounded approach to presenting target public health issues to Congress and to the public so that our voices can be heard.


Bhatia, R., & Katz, M. (2001). Estimation of Health Benefits From a Local Living Wage Ordinance. American Journal of Public Health, 1398-1402

Center for Health Information and Analysis. Annual Report on the Massachusetts Health Care

Fries JF,Koop CE,Beadle CE,Cooper PP,England MJ,Greaves RF,Sokolov JJ, andWright D., Reducing health care costs by reducing the need and demand for medical services. The Health Project Consortium. N Engl J Med.1993 Jul 29;329(5):321-5.

Health Policy Commission. 2013 Cost Trends Report (2013). Available at Retrieved on March 11, 2014.  Recommendations to Change Public Health Priorities Essay.

Heymann, Jody, Jeffrey Heyes, and Alison Earle.The Work, Family, and Equity Index: How Does the United States Measure Up?. McGill University, Institute for Health and Social Policy, 2008.

Human Impact Partners (HIP). (2009). A Health Impact Assessment of The Healthy Families Act of 2009 summary of findings. Retrieved from

Kelly, M.P., et al. The social determinants of health: Developing an evidence base for political action (2007). World Health Organization, Geneva.

Market (August 2013). Available at Retrieved on March 11, 2014.

Office of Attorney General Martha Coakley. Examination of Health Care Cost Trends and Cost Drivers – Report for Annual Public Hearing (April 2013). Available at Retrieved on March 11, 2014.

Project for Public Spaces (PPS). Farmers Markets as a Strategy to Improve Access to Healthy Food for Low-Income Families and Communities. Available at

Trust for America’s Health. Investing In America’s Health: A State-by-State Look at Public Health Funding and Key Health Facts. Robert Wood Johnson Foundation. April 2013. Recommendations to Change Public Health Priorities Essay.

Extra Credit: Blog letter

Most people associate public health with health care and medical professions. But public health is a much broader field than that, spanning multiple disciplines. So shouldn’t public health policy reflect this? Much of public health policy is aimed at increasing access to health care for certain populations, providing health screenings, or other medicalized solutions. While these solutions are helpful, perhaps the public would be better served by combing them with policies that target social, economic, or environmental causes that contribute to the health gap that exists in today’s population.

The WHO defines social determinants of health as “the conditions in which people are born, grow, live, work and age.” Social determinants of health are influenced by the distribution of wealth, power, and resources and lead to health inequalities between subgroups in a given population.Recommendations to Change Public Health Priorities Essay.

If we want to decrease health inequalities, we need to shift the priorities of public health policies. You might be wondering how you can affect this kind of change. The key is to be vocal, which you can do in several ways. First, and perhaps most simply, you can use social media to get others informed and involved in shifting public health priorities. Like, comment on, or reblog public health blogs that advocate for the adoption of social determinants of health into health policies. Second, you can write op-ed articles, call in to local radio stations, or write letters to the editor to raise the awareness of the importance of social determinants of health and health inequalities. Third, you can send letters to your legislators. There are multiple sites that provide form letters, such as this site, or you can write your own letter. Here is a good reference for actions you can take to reach out to your legislators.

Here are some other sites you might find interesting and useful in learning about the importance of social determinants of health and how to influence change in public health priorities:

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. Recommendations to Change Public Health Priorities Essay.

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


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. Recommendations to Change Public Health Priorities Essay. 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.

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. Recommendations to Change Public Health Priorities Essay. 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. Recommendations to Change Public Health Priorities Essay. 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.


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 ( 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


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.



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. Recommendations to Change Public Health Priorities Essay. 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)


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.Recommendations to Change Public Health Priorities Essay.  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.Recommendations to Change Public Health Priorities Essay.  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. Recommendations to Change Public Health Priorities Essay. 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. Recommendations to Change Public Health Priorities Essay.

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


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. Recommendations to Change Public Health Priorities Essay. This has proven to be the main hindrance for the centre in reaching their target audience.

SWOT Analysis

Financial support from government (MOH)

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

Access to MOH supports, financial and activities.


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. Recommendations to Change Public Health Priorities Essay.


International presence

Government collaboration

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


Lack of support

Lack of workforce

Unconducive environment

Misunderstanding about the concept of health promotion

Competing priority areas


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. Recommendations to Change Public Health Priorities Essay.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.  Recommendations to Change Public Health Priorities Essay.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.Recommendations to Change Public Health Priorities Essay.  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. Recommendations to Change Public Health Priorities Essay.