The Healthy Settings Approach

Introduction

Definition of standards of healthy settings is an integral part of trying to aid in an individual’s well-being by generally improving the quality of their health. Health settings can be said to increase one’s control over the nature of environment of exposure by adhering to cultures and regulations governing such places (Lewallen et al., 2015). Settings may include hospices, colleges etc. This paper focuses on development of healthy settings approach, elements that define it, a successful practical scenario and an analysis of its limitations.

The development and context of healthy settings approach

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The need to know and establish a protocol of reaching out to different defined populations is in part a reason as to why health promotion and awareness practice is modeled around common settings such as hospitals. They offer an ease of accessibility and adoption of mechanism that allow their implementation (Lee et al., 2019). Note that place and context are adjustable aspects of health progress. The Ottawa Charter (Dooris, 2016) is credited for giving rise to healthy setting approach. It emphasized that quality life is achieved and sustained by actual people who exist in some settings and in so doing; they work, learn, love and sometimes play. This initiative prompted the WHO to adopt the healthy setting approach and do away with deficit model of disease which had been in use for some time (Dyment et al., 2017). WHO appreciated the health potentials associated with it. What better way than to adopt an analysis method that used a promotion that maintained how people lived their lives? It was termed as suitable as it maintained positive identity in terms of place and self. With the steering of WHO, this new approach was quickly adopted and developed. From “Beyond Health Care” meeting convened in Toronto (1984) to flagging of Healthy Cities (1987) to global adoption as the new guideline on public health in the context it was used. In Europe, development continued through practical implementation in settings such as Colleges and Prisons (Thompson et al., 2018). Importantly, the Jakarta Declaration (Baum, 2016) played a huge role in cementing the foothold of this approach by postulating that considering health promotion as infrastructural projects, then settings would be likened to structural foundations. It opined that offering platforms for implementation of well-researched ideas was key. Context on the other hand despite being important, is recognized in promotional texts but is always left out when scheduling, implementing and assessing.

The theoretical elements of the healthy settings approach

Here, we study various theories of healthy settings approach which have been developed into models with complete sets of guidelines. Note that each theory addresses a specific part in the settings approach and therefore all the three are important for this purpose.

The health settings approach appreciates multi-disciplinary cooperation. Health is affected by the interplay of personal, structural and environmental factors. It focuses on populations rather than individual entities. Salutogenesis takes the place of illness and supportive context obtained by embracing holistic approach. This perspective ensures that healthy settings approach is not just regarded as norms followed by some people in some places at some times but more as a system of relationship sets which exist in predefined structures to influence behavior (Gatherer et al., 2018).

This view point appreciates dynamism of systems and complex processes take in inputs to give out outputs. Here, we acknowledge consistent relationship between different constitutive components of the complex systems studied. It makes a suggestion that quality health rendered by settings directly influence health quality of members and are affected by varied aspects of environment (Larsen-Freeman, 2018). This theory further states that the settings are not “simple machines” but erratic systems whose output are hard to predict because the systems are open (working of one particular setting is not limited to parameters found in there). Settings have no limitations and negative outputs may have been directly as a result of inputs of an external setting. It appreciates how individuals are limited to one setting and how the effect of one may prove dominance over others. There are sub-parameters in all settings which show inconsistency in all members at different times of exposure. Finally, settings may share some parameters and differences are associated with variation in level of functionality (Fortune et al., 2018).

Health setting approach uses this approach to advance and run new guidelines in settings. The approach should be multi-faceted and methodologically interwoven in its initiatives so that settings can have norms, normal way of life and effective environments of operation that promotes quality of life of individual members and community at large. Models have been created to build on theories so that they may be practically implemented (conceptualization to operationalization). Embracing value additional approach that factors in the right mix of peak operation, top-down and down-up commitment and engagement respectively has been prioritized (Brownson et al., 2017)

Here, a short summary of the status quo and problems faced as a result, are discussed. The general observation is a positive result. What exactly does this setting approach do? It fosters and appreciates relationship between members of settings, it allows these relationships to be analyzed, it focuses on both internal and external reactions when considering settings, allows these spheres of relationship to be modeled in all levels while taking account of their effects and provides an avenue to tap into all these spheres. These merits are premised on principles of the theories of health setting approach and limited to them because of little evidence (Sallis et al., 2015). Despite the sound steps and achievements this approach is created to follow and achieve respectively, there is a lacking since the comprehensive initiatives have not been converted into well documented research. Taking effectiveness in schools into context, as it stands, there is variation in school environment and that it is relatively new and various instruments are being studied. Interestingly, the complicated nature of school has made it hard for researchers as the only way to gain deeper comprehension of some matters require simplification of some complex parameters or leaving them out all together (Golden et al., 2015). The report further states that study of schools are complex but achievable provided we understand this complexity and channel time and effort resources whilst focusing on more than one aspect of the setting(curriculum, extra-curriculum, community etc.). The proponent of this observation followed with utmost support for this approach. A conclusion is made that general evidence cannot be relied upon for purposes of making rational decision. Therefore, though effective, effectiveness has been explained through belief and faith than actual assessment through research (Holt et al., 2015).

Critical analysis and limitations of the healthy setting approach

It is viewed as a major task to gather evidence in a manner that is consistent with and relevant with complicated nature of health setting approaches. This problem has necessitated adoption of qualitative and quantitative analysis to widen the scope and nature of evidence material handled. Thus, we establish how the gathered material will be relevant to the point of how and what is used; and under what circumstances what can be adopted or not. Aside from the problem of finding the right balance of evidence that touches on the right proportion of effectiveness, some other problems have affected how obtained data conform to some coherence and how much effort is invested. This approach is associated with both theoretical understanding and practicability that hinder conclusive study on both. Conceptual variation captures the confusion in addressing settings approach with the closely related health promotion in settings. Practical considerations in this context highlight the difficulty of fully implementing theoretical understanding into practice. Size and type of setting limits readiness with which projects are implemented in various settings necessitating for adjustments which may be done to capture change in number of members or operation schedule. Standards and accreditation dictate that difference between settings that lack a known program of operation and those with established ones must always be shown (De Leeuw et al., 2015). Also, as it stands, most of evidenced gathered are those that focus on single risk factor as opposed to a more comprehensive multiple factors involving a series of different settings for the same. Complexity arises when the need to analyze all three theories arises. Ecological complexity is seen when despite an ecological perspective depending on relationship between many elements within it; such relationship sets are given shallow analysis or omitted altogether. Again, if it were to be captured, the interwoven relationships of processes involved make the process complex. The remedy is to adopt non-linear methods that focus on the whole picture showing all relationships and interactions within and outside of settings to involve all parameters, processes and people found there. Important implication of the challenges for the future is an introduction of innovative tools of theory and methodology. These are complexity theory and critical realism. The former insists on emergent nature of adaptation whereas the former seeks to establish the defining logic but has a variable expression. These two are game changing for overcoming limitations (De Bot, 2017).

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Conclusion

Healthy setting approach’s importance is seen when it is adopted and developed by WHO to replace the previous model of deficit of disease. Development is explored to show how the approach reached the whole world to be used by all settings. This paper also captures all the three theoretical models and problems faced. We see how complexity theory and critical realism can be used to overcome limitations.

Self assessment

Unlike the previous submission, I have tackled all sections of the assignment. Failure to do so in my last paper was due to limited understanding of the requirements of the paper. This was in part due to my poor management of time which greatly affected the time I had to read and understand the question before answering. I have employed the use of quality reference materials to help with my research since quality heavily depends on literature used. I have mentioned what needs to be done to help with research in future. Given the complicated and vast nature of health setting approach analysis, a robust method needs to be adopted to cope with such developments. They are critical realism and complexity theory. Finally, my word economy has helped me to both achieve the threshold of less than 1600 words and capture all my points. This was effective on my part.

References

Lee, A., Hancock, T., Chu, C., & Kiyu, A. (2019). WHO Healthy Settings and Global Health Development'. SDG3–Good Health and Wellbeing: Re-Calibrating the SDG Agenda: Concise Guides to the United Nations Sustainable Development Goals (Concise Guides to the United Nations Sustainable Development Goals). Emerald Publishing Limited, 83-102.

Dooris, M. (2016). International perspectives on healthy settings: critical reflections, innovations and new directions.

Dyment, J., Emery, S., Doherty, T., & Eckhardt, M. (2017). Move Well Eat Well: Case study of a successful settings-based approach to health promotion. Health and Wellbeing in Childhood, 283.

Holt, M., Monk, R., Powell, S., & Dooris, M. (2015). Student perceptions of a healthy university. Public Health, 129(6), 674-683.

Thompson, S. R., Watson, M. C., & Tilford, S. (2018). The Ottawa Charter 30 years on: still an important standard for health promotion. International Journal of Health Promotion and Education, 56(2), 73-84.

Fortune, K., Becerra-Posada, F., Buss, P., Galvão, L. A. C., Contreras, A., Murphy, M., ... & de Francisco, A. (2018). Health promotion and the agenda for sustainable development, WHO Region of the Americas. Bulletin of the World Health Organization, 96(9), 621.

Gatherer, A., Møller, L., & Hayton, P. (2018). Achieving sustainable improvement in the health of women in prisons: the approach of the WHO Health in Prisons Project. In Women prisoners and health justice (pp. 85-98). CRC Press.

Golden, S. D., McLeroy, K. R., Green, L. W., Earp, J. A. L., & Lieberman, L. D. (2015). Upending the social ecological model to guide health promotion efforts toward policy and environmental change.

Sallis, J. F., Owen, N., & Fisher, E. (2015). Ecological models of health behavior. Health behavior: Theory, research, and practice, 5, 43-64.

De Leeuw, E., Green, G., Dyakova, M., Spanswick, L., & Palmer, N. (2015). European Healthy Cities evaluation: conceptual framework and methodology. Health promotion international, 30(suppl_1), i8-i17.

De Bot, K. (2017). . Complexity Theory and Dynamic Systems Theory. Complexity Theory and Language Development: in celebration of Diane Larsen-Freeman, 48, 51.

Larsen-Freeman, D. (2018). Resonances: Second language development and language planning and policy from a complexity theory perspective. In Language policy and language acquisition planning (pp. 203-217). Springer, Cham.

Baum, F. (2016). The new public health (No. Ed. 4). Oxford University Press.

Brownson, R. C., Baker, E. A., Deshpande, A. D., & Gillespie, K. N. (2017). Evidence-based public health. Oxford University Press.

Lewallen, T. C., Hunt, H., Potts‐Datema, W., Zaza, S., & Giles, W. (2015). The whole school, whole community, whole child model: A new approach for improving educational attainment and healthy development for students. Journal of School Health, 85(11), 729-739.

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