HLTH 1000 Week 11 Course Reflection Example

From Better Choices to Better Conditions: What Health Promotion Can Claim After One Term, and the One Claim It Cannot Make

Student Name

Walden University

HLTH 1000: Concepts of Health Promotion

Instructor Name

Month Day, Year

From Better Choices to Better Conditions: What Health Promotion Can Claim After One Term, and the One Claim It Cannot Make

Where I Started

In Week 1, I believed that health promotion meant helping people make better choices. If people knew what was healthy and wanted to be healthy, they would act, and the job of health promotion was to give them the knowledge and the motivation. I used the Ottawa Charter's definition, which speaks of "enabling people" to take more control over their health (World Health Organization, 1986, p. 405), and I read "enabling" as teaching.

That view did not survive the term. The reading that changed it most was the health impact pyramid described by Frieden (2010). The pyramid orders public health actions by their reach and by the effort each one asks of an individual. Counseling and education sit at the top of the pyramid, where effort is high and reach is small. Near the base sit changes to the surroundings that make the healthier option the one people get without trying. My Week 1 view placed health promotion almost entirely at the top.

What the Field Can Claim

Three claims now seem well supported to me, in descending order of confidence.

Conditions Shape Outcomes

The strongest claim is that the conditions people live in shape their health at least as much as their choices. My Week 3 analysis of childhood asthma in an older rental district made this concrete. Cockroach allergen in children's bedrooms, mold from leaking pipes and a lease that made complaining risky were not choices any family made, yet they drove emergency visits. Braveman and Gottlieb (2014) call these the causes of the causes, and after working through one case I understand why: every behavior I might have blamed sat inside one of those conditions.

The Levels of Prevention Are Different Things

The second claim is that primary, secondary and tertiary prevention are analytically distinct, and that the distinction is useful. In Week 7, placing the National Diabetes Prevention Program at a level forced me to apply the criterion, the state of the condition when the program acts, rather than the label. The program's lifestyle sessions were primary prevention, but its screening step was also secondary prevention for people found to have diabetes already. I would not have seen that if the levels were just vocabulary.

Campaigns Fail on Assumptions

The third claim is more tentative: campaigns often succeed or fail on the assumptions they make about their audience. In Week 5, I found that Tips From Former Smokers did a great deal right, with plain reading levels and quitlines in several languages, and evidence showed it increased quit attempts nationally (McAfee et al., 2013). Its gaps were in who it assumed could act on the message, especially through medicines that require a provider. I hold this claim less firmly because I examined only one campaign closely.

The Claim the Field Cannot Make

The limit I reached is this: health promotion cannot claim that changing behavior is the same as changing the conditions that produce it. A program can teach someone to use an inhaler correctly, and the child's asthma may still worsen because the bedroom still holds allergens. A program can raise knowledge without changing behavior at all; the evaluations of D.A.R.E. that we discussed in Week 6 found effects on knowledge that did not carry through to drug use (Ennett et al., 1994). Even when a program does change behavior, the conditions that led to the problem are still there for the next person.

This is not an argument that individual programs are useless. My own Week 8 proposal, a blood pressure self-monitoring program in one senior apartment building, works mostly at the level of individual behavior, and I think it is worth doing. But I can only claim that it may help the residents who enroll. I cannot claim that it changes why blood pressure is high in that building, which has to do with things like cost, distance to care and the food available nearby. Rose (1985) made a version of this point decades ago: the causes of illness in individuals and the causes of how common it is across a population are different questions with different answers.

What Changed in How I Read

The change of mind also changed how I read evidence. In Week 1, I would have accepted a program's own description of itself. By Week 6, arguing about D.A.R.E., I had learned to ask what an evaluation actually measured and over what period before deciding whether a program worked, and to name the design so that others could weigh it. In Week 9, critiquing a classmate's cooking class, I found that the most useful question was not whether the content was good but who the schedule, the sign-up form and the language of the handouts would leave out. Both habits come from the same shift: looking past what a program intends to what its design and its evidence actually allow it to claim.

I also learned to read my own work this way, which was less comfortable. My Week 4 issue brief on uninsured adults in Hidalgo County asked for evening enrollment help, a change in conditions that is small but real. If I wrote it again, I would say more plainly that evening hours remove one barrier and leave others, such as cost and eligibility rules, untouched.

What I Expect to Carry Forward

I expect to keep asking, of any program I work on, which test it passes: does it change what people know, or what is available to them? When the answer is only the first, I will treat that as a reason to describe the program's claims modestly, not as a reason to dismiss it. I also expect to write failure conditions into every plan, as I did in Week 10, because stating ahead of time what would count as falling short was the single most useful habit this course taught me.

References

Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It's time to consider the causes of the causes. Public Health Reports, 129(Suppl. 2), 19-31. https://doi.org/10.1177/00333549141291S206

Ennett, S. T., Tobler, N. S., Ringwalt, C. L., & Flewelling, R. L. (1994). How effective is drug abuse resistance education? A meta-analysis of Project DARE outcome evaluations. American Journal of Public Health, 84(9), 1394-1401. https://doi.org/10.2105/AJPH.84.9.1394

Frieden, T. R. (2010). A framework for public health action: The health impact pyramid. American Journal of Public Health, 100(4), 590-595. https://doi.org/10.2105/AJPH.2009.185652

McAfee, T., Davis, K. C., Alexander, R. L., Pechacek, T. F., & Bunnell, R. (2013). Effect of the first federally funded US antismoking national media campaign. The Lancet, 382(9909), 2003-2011. https://doi.org/10.1016/S0140-6736(13)61686-4

Rose, G. (1985). Sick individuals and sick populations. International Journal of Epidemiology, 14(1), 32-38. https://doi.org/10.1093/ije/14.1.32

World Health Organization. (1986). Ottawa charter for health promotion. Health Promotion International, 1(4), 405. https://doi.org/10.1093/heapro/1.4.405