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Okay, we're ready now. Thank you. Great. Thank you, everybody for joining. Although the title for today's lecture says it's sexual health, I'm teaching sexual health one week and public health principles on another week. So this week, the lecture is on one of the very important public health, um, principles and and practice. And it's around health promotion. Um, we we will go through what health promotion means. Um will describe the responsibilities of health and well being for the population, give examples of health promotion activities and review models of health promotion and theories of behavior change. Um, we will also look at, um, how the models of health promotion and theories of behavior change actually work in practice. And if you get around to doing some, um, examples, Um, we will, um, work as a group or or I will talk you through, um, as to how the health promotion, um, sort of principles work around us. Um uh, every day on a day to day basis unknown to us, um, we all seem to Bye bye, laws. Um and and you might wonder, how did they all come by? And that's because of the principles around health promotion, which is basically making sure that we've got the right sort of approach and messaging and everybody does something, um, so that it prevents bigger groups of population to undergo any harm. Next slide, please. Thank you. So what is health promotion? So health promotion is the process of enabling people to increase control over determinants of health and thereby improve their health. Now, that is pretty jargon E. And it's a bit war worthy. Um, but what does this actually mean? So evidence tells us smoking is not good for the human health. Okay, um, it's now very, very well established that, um, long term smokers have significant number of, um, ill health and issues going forward. Now, we'll just we'll just stay on the first slightly slight three just on the just. Just stay on the first on the on three. I'll tell you when to move. Yes, that one. Thank you, Claudia. I'll tell you when to move. Um however, we still see people smoking around us, and, um however, um, all of the campaigns that has happened over the years over the decades, um, has had an impact because many people have given up smoking. Uh, people have realized the the disadvantages of smoking and even every day in my clinical practice and my public health practice, I find, um, families who smoked for years. But then the younger generation have given up smoking. Now, how is that possible? That was possible because we looked at the evidence, and the evidence suggested that smoking is injurious to health. And then we used health promotion principles to actually make sure that the normal person on the ground on our our neighbors are workers. Um, are people on manning? Our supermarkets are all aware and are are spreading that message, and that is how health promotion actually works. So you're enabling the people to increase control over their determinants of health. So do we say that we've stopped everybody from smoking? No. We're giving people the choice to say Here is the evidence. This is how it works. And then if you still choose to smoke, then it is your choice. But at every encounter, we'll keep telling you that it's probably not the best choice that you can make. And we know for sure there is again established evidence that stopping smoking definitely improves health of people. It doesn't matter. You could have smoked for 10 years. You give it up now, you still gained more years of good health. Next likely. Thank you. So, um, if you just keep clicking, then all of the all of the examples will come up. So as you look around you and and you might wonder Well, really, what does this actually mean? Um, this actually means that, um there is lots of policies around us that we, uh we abide by which come through the health promotion principles. So, for example, the buckle up sign that you got right on that, um, on that, uh, slide there. So whenever we get up in the car, it's by almost default. It's almost a reflex that we put our, uh, seatbelts on. How did that come by That came by through evidence That again, Because of people not abiding and not putting seatbelts on in cars or the seat belts, we're not even available in cars. Um, in in years past, um, people, um, were having lots of accidents and injuries, which were, um, life limiting and was causing them long term harm. So we got out the legislation so that everybody has to. Now buckle up and put the seatbelt on, which means we've now got a health promotion message that goes across and it's now legislated. So it's a collective and social responsibility for us to do that, and that prevents us from having accidents. But then the smoking example or, you know, how much alcohol do I take or do I eat healthy? Do I eat greens and and and, you know, do I eat five my fiber day? All of those, um, are individual responsibility. So, for example, as I say, you know I am. I'm overweight. I need to lose weight. Um, and there is a lot of health promotion material to tell me what to do to lose weight, take my 30 minutes of exercise every day to eat healthy, eat five portions of fruit and veg, and you've got that a slide right in the middle, which is what proportion you need to have on your plate. And but it's up to me to do it. But to do it regularly. So there is help Promotion. Um, messages can be collective where it can be a legislation. It can be, um, something that's happening and everybody has to abide by it. And then it has to be an individual. So, for example, if you look at what happened during the covid pandemic period, we had the collective national mandate of washing your hands, keeping your distance and wearing a mask. Why did we have to do that? We didn't have a vaccine. We didn't have a treatment for covid. Covid was spreading fast, and we needed something to make sure that if we abided by these laws, the evidence said that we could cut down the spread of, uh, of infection of covid. So we made it into a mandate. We made it into a legislation and you had to do it. And, you know, in countries, um, you know, you you could be fined, um, if you if you didn't wear a mask in the public place or, um, you know, if you were out and about with symptoms. But at the end of the day, it was up to the individual to wear it, to wear a mask to wash their hands, um, to cover their face or to stay away if they were symptomatic. So although there was a collective mandate that if you all did the same thing, then we'd go down, the infection rate would go down. But individually, everybody had their responsibility as well to do their bit. Next slide, please. So I don't know whether you've seen this, um, this diagram before, But basically, what this diagram tells us is that, um we are in the middle. So we are in that red blob red circle, and we are defined by our age, our sex, our demographics, our families, we come from, um you know, um, what are bringing we've had, you know? Are we deprived? Are we Are we, uh however, Well, the, um, all of that is in that red blobs. So that describes us as an individual. However, every day working around us are different things that affect the way we do. So, um, individual lifestyle factors. So I could be very rich, but never and and have all of the wealth in the world and have access to the best food available. But I decided to just gorge on pizza, smoke every day, not move at all, sit in my cushion and count my pennies. Um, or gold bullion. Should I say now, do you think I'll live longer? Do you think I'll live a healthy life? I wouldn't because although I might be wealthy, I might be I might be able to access the best of everything. Um, I am making poor choices because I am choosing to make my individual lifestyle factors work against me having a better house. So however, you could be in a very poor household, you know, scrapping at, uh, trying to get three major meals for your Children. But every time you're spending your money, you're making sure that you're getting the the right foods for them, that it's not processed food. You're you're getting the right vegetables. Um, and you're making that individual choice for yourself. So what I'm trying to say is, you could be whoever you are, but your individual lifestyle factors are working on the choices that you make. Then there's a social and community networks. Of course, our friends, family communities tell us what to do and what not to do. If I join a running club, the chances are I will continue to run because I will let my colleagues down if I don't run. But if I choose to join my mates down the street. Who do we'd or you know, gambling or any of the other things that we know for sure the evidence suggests doesn't do much good to our health. Then we will follow their their advice, and we will continue to engage in that kind of activity because we are part of communities and as human beings we are part of networks and of families. And then the green bit are all of the other things that also affect who we are. And then outside of it is general socioeconomic cultural, environmental conditions. I mean, I feel humble to teach you today, but I cannot understand the um you know the difficulties. Some of you are probably in in different parts of the world where you're experiencing different kinds of atmospheric, different kinds of socioeconomic factors that's affecting our individual lives. It's, uh, it's a little bit cushy for me to sit here in my study and teach you today. But each of you are individually experiencing all of those conditions which is then affecting the choice that you're making, which then in in in in turn will impact on your health. So the reference is there It's a pretty well established evidence based model which basically says to us that as individuals, we are, um, sort of a product of everything that's affecting us. And and that is called the socioeconomic effects. The social social determinants which impact on our lives and which impact on our everyday living and impact on the choices that we make every day. Next slide, please. Thank you. So when we say we want to make a health in promotion intervention, who should we aim our interventions at? Should it be at the individual level, or should we be at a societal level, or should we be at a national level or should be at, uh, global level? So the vaccination, um, example. So we need to get our covid vaccine now. That was at a global level, but it was at the end of the day after every individual to actually engage with their vaccination program in their country and get there, get themselves vaccinated. So who should we actually came at? That next slide, please. So this is again a theory, and it's called the Rose hypothesis. So what the Rose Hypothesis basically says is that if we can make big groups of people change their choice, Um and we move, we move a small, we move them to move a small shift. So say 100,000 people today decide to stop smoking. We will make bigger gains at a population level in improving cardiovascular health, improving lung health. Improving hypertension issues include improving maternal health, improving child health. Um, but there are certain people who are significantly high risk we who are at that red bit of the triangle now they already have existing conditions. And, um, if they make a change like if I get all of my 100 patient's with chronic obstructive pulmonary disease to stop smoking, they will still make a shift in those 100 people. But the shift will not be as great, but there is opportunity for them to still make better gains in their in their lifestyle, in their health and in their lifestyle. So basically, the bell curve shift in population level depends on who is making that choice and how many. And so therefore the question still rises. Which intervention should be target at national level or at big population level, and which interventions do we target at individual level because it depends on where you are. You could be a healthy person and we say, Don't take up smoking and you don't take up smoking. That means you are already expanded. Your life expectancy. You could be a smoker already with COPD, and we give you the information. Don't stop. Don't smoke. Stop smoking. You still stop smoking. You could still get gain so it depends on who and how we target our health promotion messages again, The references on the slide when they come to you, have a look at it and read and see if there's anything that you want to ask about that next. Likely thank you. So the targeted approach is is that when we target our health promotion messages to particular people? So, for example, HIV, we know HIV is prevalent in certain populations. So all of the safe sex advice, the prep advice, which is pre exposure prophylaxis advice if we target it to everybody, makes little sense, right, because, um, you know, the cohort of population who, um, are more prevalent to get HIV are probably not going to receive it or not going to receive it in the way that will impact on the their decision making or their choices. Um, however, if we target the message we targeted to their lifestyle, their ways of working where they actually congregate, Um, then the chances are we'll be able to get some messages to them. So the targeted approach works. Um, and it works because the subject is motivated. So, you know, um uh, you know, people who are more exposed to the risks that lead them to develop HIV would be motivated to find out. How can I, um, probably stay away from HIV? Um, but still live a fulfilling life? Um, sometimes the clinicians get involved. So I was talking about the COPD patient who still smokes now when they go in to have their clinician, um, consultation with the consultant and the consultant's says, Mr uh, Mr. Smith, you are still smoking your chronic obstructive pulmonary disease, only going to get worse. You need to give up smoking. Um, um, that might have a bigger impact then. And so there is that advantage. I mean, I have a great example where, um uh, an ambulance worker who was attending a 60 year old man who'd complained of chest pain and called the ambulance. And whilst he were, he was giving um giving him the medication and and looking after him, he whispered in this gentleman's your stop smoking that's going to kill you one day. And that did the trick when the person who was a smoker for over 20 years came to see his physician after having recovered a quite a significant heart attack, um, had actually given up smoking, which means he was now in a change stage. Now he could get better health outcomes for the rest of the years that he lived, provided he didn't pick up smoking again. So the physicians do have a big impact. So when you all become doctors, you remember you are very powerful to make a health promotion message work. The cost effective use of resources is very important as well. So because, as I said, HIV related information to HIV patient's means that we can use our, um, the relatively small amount of funds and resources targeting a particular group and the benefit to risk ratio is favorable. Um, so we know for sure that if even four people change and give up If there's got COPD give up on their smoking, then it's likely that those four people will benefit quite long term. How about the difficulties are Where do we find them? How do we know how many people are at risk of exposure? So it's it's It's quite a bit of a task to go and find, um, who are at risk of exposure for HIV or say, um, any of the other infectious diseases because you need to find them to Then give them the message message. Um, and it's it's kind of almost radical. Some, I mean, so COPD patient's. If they've not taken up smoking, they would have given more. They would have got better health outcomes. However, they are now smokers, and they are already with COPD, So chances are we have not been able to address that upstream, so that means that they will probably get less benefit, um, limited potential for individual and at population level. So so when we when we take small cohorts again, the chance of impacting on bigger population is not achieved. Um, sometimes it can be stigma and labeling. So, for example, I was talking about the HIV cohort if you suddenly all the time in the eighties where when we were growing up constantly target a specific group of, um, people with specific messaging, then there's some stigma and labeling for it, and and And that might not go in your favor with health promotion messages. So there are always has to be a balance around who you do it and how you do it. Um, in in that approach. Next slide, please. So there are opportunities for targeted approach. Next slide, please. Um and we talked about some of those examples. Now, we're moving to population wide approach. So, you know, putting your seatbelt on. Taking your covid vaccine, Um, taking your childhood vaccination? Um, not smoking in public places. Um, you know, uh, staying away from fire hazards, as in, you know, not keeping your fire does open some of these things. We do it at a population level. Why? Because we need a radical approach. We know the evidence works. If everybody does it, there is, um, there is an important impact, and it's behaviorally also appropriate. However, the small benefit to the individual because there's a prevention paradox you could get fatigued from actually hearing the same thing. Don't smoke. Don't smoke. Don't smoke. Don't smoke. Everybody around you is smoking. You kind of think. OK, well, really. Is that such a big, big, big problem? You're seeing that with vaccination now, aren't we? We You know, we've done so well. We've taken our boosters. And now even my colleagues who are clinicians are saying, Really, I don't want to take another booster again. I'm not taking my vaccine anymore. Is that right? Is that wrong? Of course it's not right because we're getting new and new strains of covid vaccine. So if you don't take our boosters, we are unlikely to be protected from them. But people are becoming lax because people are thinking Okay, well, now there's a treatment. Covid is milder. Do I actually need to worry? But maybe we need to, because if you're vulnerable, you are likely to get more severe covid. But, you know, those are the kind of the disadvantages. There's poor motivation of the subject. As I said, poor motivation of the physician to do it. You've got a 10 minute appointment time. You're going to actually take a lot of time to go through the same thing because you're kind of thinking, Well, they should know smoking is bad for them. So why do I need to use my time, um, in my COPD clinic to treat attain them again? And then we get this thing about the nanny state, you know, whatever. Um, you know, there is a public campaign. Um, uh, you know, a lot of people, um uh, push back and say, Well, the state is not here to police what my choices are. I should have the rights to take my own, um, own decision about my own choice. Next, like please. So we talked about some of those examples of opportunities for population wide approach. And as I said, vaccination, um, the the seat belts, all of those are attack level. Next slide, please. Okay, so let's just keep that slide. We talked about prevention paradox. Okay, so we're now going to think about some models of health behavior. So how do people change? And and that is what the health promotion principles are actually based on now, um, the health promotion. So there's there's, you know, big experts who develop health promotion programs and what they billed it on is to first understand what actually motivates a health related behavior. So, you know, you come from a family of nonsmokers. Um, you know how injurious smoking is to the health. You know, you don't want to develop long term conditions from smoking, but you go to university and all of your spreads are smoking. So you are, or the household is smoking. Where you where you're you know, you've joined. Um, and you kind of think. Okay, well, let me try one. And then you kind of say, Oh, no, this looks good. And I'm stressed at at my university, this course is very stressful, and and, you know, um, smoking gives me that relief. Let me take the other one. And before you know it, you are smoking more than 10 a day or you're smoking some amount of cigarettes a day, which, for example, you would have not taken up, say, if you were in a nonsmoking household. And maybe you've not done that for the rest, for for the, uh, right up to the time that you've actually gone to university. So understanding what actually motivates a health related behavior is important. So there's a health belief model. There's a social learning theory. Um, um, there's a theory of planned behavior. There are stages of change. Um, and then so these are some of the models. Um, and the references around there were probably not going to get time to go into details for each of them. But what each of them basically talks about is that the health promotion programs have to pick you up at a certain stage in your behavior or approach. And it might be the right time for you to pick up on that health promotion message, depending on where you are. So I got pregnant moms who give up smoking when they're pregnant because they know that smoking is injurious not only to them but their baby. Now which mom wants to harm their baby now, that's why then they give up their smoking after just before they're pregnant. But then as the pregnancy progresses because pregnancy is nine months, you know, they're they're craving comes back, you know, they're struggling with the big baby inside them. They're having other problems, you know, vomiting or not being able to sleep. Then they decide. Okay, Well, one smoke might not be such a bad thing. And then before you know it, they're going back into their normal routine Now in pregnancy, at every appointment we check and make sure moms are not smoking, we get them into blow into a carbon monoxide, uh, monitor. Um, and if it is showing up, if their moms are smoking, we're still giving them advice. We're still giving them support to see if they can smoke. Stop smoking, because we know for sure how significantly injurious. Um um, nicotine is to the pregnancy and the placenta and the baby. But if the mom is not in a position to receive that message, then there's unlikely chance that we're going to be able to influence that at all. So in parts of United Kingdom where I live, um, the smoking, um, in pregnancy rates are very, very high. Huge amount of investment goes in, and very little actually works because possibly women are not in that position of change. So the health promotion programs and the and the theory behind health promotion is actually to pick you up at the time when you're ready to change. So you know, how are those moms who are giving up are doing a great job. I told you about the patient who was having the big heart attack when he had the heart attack. And he was with his ambulance paramedic. Um, And then he realized that if I continue to smoke, I might not survive another heart attack. And that was when he decided to give up his smoking. And that's how he was in that place of change. Moving on next slide, please. Okay, so this is one of the models, and this is the health belief model. Okay, so this starts from individual perceptions, so individual perceptions are perceived susceptibility of a seriousness of a disease. Now, as I said, when the pandemic started, we were all scared of covid want we We were really, really scared. We were staying away. We were, you know, wearing a mask, washing our hands, changing our clothes during that all the time. Why we thought, Oh my God, if I contracted it, you know the chances of surviving is extremely, extremely hard. But then three years, four years down the line, now a percept success, stability and the seriousness of the disease is changed because we majority of being vaccinated. There is some herd immunity in the community. The covid, um, infections that we're getting are not that serious. More importantly, what we know is if you get covid and even if it's serious, we now have the drugs to treat it. So the percept perceived susceptibility of sick seriousness of the disease has changed in the course of the pandemic. Now, how is this going to affect our health promotion activity? So when they're four, we were promoting the covid vaccine in the beginning of the of the pandemic when we just we just got the vaccine, you know, there was, you know, vaccine riots. There was like people wanting to clamber and get the vaccine. Whereas now we are seeing, you know, vaccination centers sitting pretty empty because people are thinking, Well, is it as serious as it sounds? I've been vaccinated three times over. Do I still need the vaccine? So as you can see, the individual perception then changes as to how you're going to accept a health promotion promotion message. Then there are other modifying factors and we were talking about age, sex, ethnicity, personality, socioeconomic knowledge. So you're a young person, you're 18 you're kind of saying the risk of me actually dying of covid is pretty less so. Do I actually need to keep taking my vaccines? I mean, the young people were not even taking their vaccine in the in the beginning of the pandemic as much because the evidence suggested that they were stronger and they were fitter, and they were probably able to survive. Um uh, Covid. So So Those are the factors then they affect how you how you receive a health promotion message, perceived threat of the disease. So, as I said, the beginning of the pandemic, we were so scared. So So that impacted on us actually receiving any message. You know, um, you know, wear your mask, wash your hands. Just basically, we took it up by the book by the Bible because we were really, really scared that that that the covid was going to kill us and then accused to Axion education symptoms and media information also then also help you perceived threat of disease. So I spent a huge amount of time during the pandemic trying to talk to communities to take them away from the messages that were coming around the vaccination program around covid through tiktok through So sh media through WhatsApp groups, which were not true. So sometimes, you know, you have to really, really go in and and make sure that the messaging is right. It lands adequately. Um, and it's not confusing people. So when we had clear messages in the pandemic around, uh, washing your hands, wearing your mask and keeping your distance, it was pretty cool. Three things know it. Everybody abided by it. Then it started to get a little bit confused. When it says Watch for your threat, you know, do this, do that. And then it starts to become a little bit confused and a bit muddled. That's the time. Then people get confused and start to look at sources of information from everywhere else. The media has a big, big, uh, important place in health promotion messages. So if the if the if the, um messaging is not right, it's not evidence based. The chances are you'll do more harm in the health promotion messages. And then what is the likelihood of Axion? What would you do? So you now listened? Oh my God, Yes, absolutely. There's a vaccine. I am at risk of, um, covid. So you go and take your, um, your vaccine. However, if you are one that have been bombarded by tiktok videos which saying the vaccine is going to do so much harm to you and your your you know, you kind of think OK, well, I will. I'm not sure I want to believe the the government or the the national or the and messages around pro vaccination. Um, I'm more inclined to know more before I take my vaccine. Then you will not take the vaccine. So basically, the benefits versus the actual barriers, uh, you know, might affect your behavioral change and the like. New behavioral changes? Yes. You're convinced the health promotion message has worked for you. You go and take your vaccine. So as you can see just one health promotion message just around covid just around covid vaccination, you can apply some of these established, well established models to develop health promotion programs again, the references there on the slide so you can look it up and read it up yourself. And I'm happy to answer any questions even after this lecture. If you need it. Next slide, please. Now this is another one. This is the one that is used, actually by W h O as well as, um, for our our national programs as well. So, um, so knowledge and skills. So basically, we are the capability. So I want to promote something I need to be targeting the actual, um, skills of, uh, and the knowledge of the population. So say, for example, I was trying to promote something in sub Saharan Africa. Um, and, uh, anything around say, hygiene or whatever, I will use pictures rather than lots of worthy messages to get some messages across the same message, but using pictures so that people understand. Whereas if you're trying to promote, um, antigambling messages to the high, um, highly educated, you know, um, City city people in London, then you have to use a completely different language. So the knowledge and so it's very important that the health promotion messages, um, are targeted based on the knowledge and the skills of the people opportunity, we use every opportunity possible. Um, and there are some opportunities that lie outside, um, the individual, um uh to access. But that's why every opportunity to give the right messages important motivation. We talked about where you are in your cycle of actually accepting a promotion message. So, you know, conscious goals and decisions making as well as habits and emotional responses. So, you know, if you're well motivated and wanting to lose weight, then you all take up the messages from Weight Watchers or any of the weight losing Uh uh, sort of, um, you know, uh, programs. However, if you're not motivated, then like me, you will struggle because I struggle on a day to day basis to stay away from my pizza and my chips and whatever it is that's going because I think, Well, that's my my choice, and I'm doing it and maybe I'll do some exercise tomorrow to make up for it. And then all of these things then lead to developing a behavior and making a behavior change. So it's not just one day you switch on or you switch off after a health promotion message. There's a huge amount of factors that impact on whether you're going to change your behavior. Next slide, please. So, again, what are the things that, um, you know, risk your behavior and intervention so familiar? It with the outcome perceived personal control, the demographics, that urine. And I think we've been discussing some of it. And then when we talk about risk, we are not always very clear about the harm and the benefit and the harm to others. So as I said, you know, over the course of the pandemic, the the harm of covid um and the perception of covid has changed. So now the covid vaccination programs have to be different and have to be more hard hitting and have to come out still clearly to say why it's still important and why it's still important to stay safe and take your vaccine. But we have to do that as the perception in the community and and populations change. And they are controlled by the perceived idea of risks rather than what we know as the evidence based approach. Okay, next slide, please. Okay, you can just do this. Okay, so this is again another theory, and again, the theory is at the bottom. And this then helps us to understand, um, where we put our effort in. So on the x axis, you've got degree of targeting the intervention according to individuals baseline risk of the disease. So you know somebody's got a high risk of breast cancer or, um, somebody's got a high risk of cervical cancer. Then we need to target it in a way that, um it's a high risk condition, but it has to be targeted to women. It has to be targeted to women in the reproductive age group. Since how do we do that? Do we do it as as a mask or or do we do it in a targeted way? So the X axis X axis is where, um, you know, it's at population level or or just, um, targeting it at people who are at high risk and and the Y axis. You've got a low agency or a high agency. So basically, you know what effort you put in. Okay, so let's just take example. So if you want to make, um, uh, everybody in your population, um, have a great teeth and not have carries, then you will talk about Florida ation of the tap water because we know evidence that florid ation health with tap water, and you'll preach that or you give that message to everybody in your community However, if you want obese Children, um, to lose weight, um, and have healthy food, then you will target that message only to those Children or to their parents. And we give them some advice and support alongside sort of other sort of therapies, which will help them to, uh um, the other things are. So, for example, nutrition labeling. Um, the the nutrition labeling will help us to understand that What kind of fats or fibers or other things that we've got in our pack. Next slide, please. Sorry, I'm getting some chat. So let me just go to the chat and see what is being said. Um, okay, very much. It's a good, very experience for our feet. Okay. Yeah, This this, uh, this talk, although, was title sexual health. Um, but I am teaching a public health lecture, and it's around health promotion. So, um uh, please bear that in mind when you give your response, because you might be confused if you come to listen to a sexual health lecture. Um, next time, I'll try and combine a sexual health topic with the public health topic. Apologies for today. Because of short time, I could only do a public health lecture today. So big apologies from me. Okay, So, medium on the mass versus small group and individual, I think we've been talking about it all the time. So, um, you can see for sure that these are some of the UK based health promotion. So, um, the the promotion material getting girls into doing exercise that came from some of the Olympics and now most most recently, been emphasized by our Linus is winning the World Cup. Um, so getting girl girls to do more physical activity is quite important. Smoking is right on there. So there you go. Uh, you know, it's it's it's really important in in the UK, we are actually putting health promotion messages on the on the packets of cigarettes which basically, um um then has bigger impact is what we've seen on the right hand side, you can see, um, the basic life support, um, basic life support. What we found is that teaching basic life support to the masses helps save lives. Because if somebody collapses in the middle of the street by the time an ambulance gets to them, it might be well too late. But if every everybody in the community knows, um, life support. Then they can get, um, basic life support started before the ambulance gets on their next, like, please. Okay, so, uh, yes. So this is another way of developing communication and health education. So basically, um, you can be seen. Be heard. Um, you can attract attention so you can stand on the street corners and give messages out. The message has to be understood, be accepted, and then has to result in changed behavior. So as I was explaining to you with examples all the way through this lecture, it's important to be very, very clear. There's nothing that you take away from this, um, lecture today. Learn one thing to to develop a health promotion message around anything wherever you are. You know, um, you know, don't keep your ear pods on for too long because of some pollution into your years, which could affect your hearing. If you keep the message is very, very clear and simple. The chances are you'll get a big success from your health promotion programs. But of course, the person accepting the message has to be in a position to change their behavior and that's the way these things work. Next slide, please. Okay, so any public health program needs to be evaluated, including our health promotion programs, too. So the way we evaluate any public health program or any program for that matter is we use the principle of all the ease. So evaluation is a process by which we judge worth or value of something. No point doing a health promotion program if only two people change their behavior. Um, you need to be quite up front when you're planning a health promotion program to say how many people will you reach? How many people will, uh, likely to change? And what impact will they have on the overall outcome of the population? So, for example, if masses take up the covid vaccine, the chances are that we will break down the infection spread of covid, which means there'll be more life saved, which means and less hospital admission's, which means there is going to be less impact on our health systems who have to continue to function anyway to look after all of the other things that people are going to be ill with. So it's important to make those um, uh, sort of plans Well, up advance when you're developing health promotion program, and then when we we can't we put a continuous evaluation cycle in so that we're evaluating As we're going along, the program has to be also a valuable so in in the covid vaccination program. The way we knew that we would have successes, we'd be able to count how many people have had the covid vaccine. We'd be able to count how many people have been taking up the message of, um wearing a mask. Because we can visually count them. We can visually see them. So the program has to be valuable as well. The effectiveness of the pro Graham is making sure that it has the intended effect in the real world. So, as I said, you could run millions and and run a health promotion program of anything but only three people change. Then that is not effective program. So it's very important to make sure that we're evaluating the effectiveness and changing around program as we're going along. It has to be efficacy. Uh, efficacy of the program and the efficiency of the program is also important. Um and then the efficacy is that in the ideal world, of course, people will change. But, you know, under optimal conditions, could people change? And that's how the efficacy, that's how we, uh uh, calculate the efficacy of the program. And then, of course, efficiency is, um have we used the pound the the currency that you're using to promote, make go the widest mile and make sure the differences to everybody rather than small groups of people. Next slide, please. Okay, so, health promotion in a pandemic. Now, this is very important. We, you know, still haven't been declared completely out of the pandemic were still there. Um, the heightened status has been reduced a little bit. So in England, in Scotland, in Wales, in w h O in Australia, health promotion methods are use health promotion programs that developed by using this, um, program of work. So it's it's got an acronym. It's a S r o M E as a Rome. And this is how health promotion programs are developed. So you might think Hang on a minute. How did the whole kind of where your mask wash your hands as stay at a distance? Come about? It was because there are national bodies who use principles to develop the programs based on evidence, and then they roll it out. So the first things we have got to assess the need. So we need to assess need was in our face. We had were a pandemic, or it was spreading widely. We knew we it's, uh we knew it was a respiratory disease. We knew it, uh, it spread from touch. We needed to get some messages across. Um, when the vaccinations came around, we knew that the vaccinations work. We knew it worked in certain groups of people. We knew how it worked on certain groups of people. So we need to understand that need stakeholders are very important stakeholders, not just the people who are receiving the information. Stakeholders are the government, the transport, the healthcare workers, the people who will deliver the vaccine, the people who will make the masks that you know. So why'd range of stakeholders who need to be involved? Um, as a health promotion message. So, for example, how can things go wrong? So if you if you remember, you know, in the beginning of covid, we started to say yes, wear a mask, but suddenly there was a mask shortage because everybody was going out and looking for masks. People were buying masks from everywhere, and the healthcare workers were in the frontline. Um started to suffer because they did not have enough masks or the right mask because, you know, we panicked and and we gave the message out without actually checking whether there's enough stock of all of the PPE. It came in due course, but it needed to be managed and planned. Resources are very important. Health promotion message cannot run on empty. They have to be resourced. They have to be funded. They have and they need to have big pounds and for people to take right paychecks to say the impact is not going to happen tomorrow. This is not like take a paracetamol and you'll feel better tomorrow. This will need a lot of years of intervention and a lot of people to take up the message to make it happen. Objectives should be clear very upfront. So covid vaccination. We want to reduce the number of covid cases in the hospitals. We want to reduce use the deaths from covid in certain groups of people who are at high risk objectives clear right up front and the methodology. Then how are you actually going to promote your health promotion? Is it going to only be doctors talking about this in their clinics? Know this is going to be in the media. Is it going to be in different languages? Is it going to be in print form? Is there going to be some posters? Is it going to be as part of Netflix movies that we watch? So the methodology has to be all devalue developed. And then the evaluation, as I talked about, is very, very important. Right? From the word go, you need to continue to evaluate health promotion messages. And so this if you don't remember anything again, remember this because this is something that's used across it will be something that your country uses to develop any health promotion messages, most certainly in England and Scotland and in Wales is something that the example or we use all the time next slide, please. Okay. I think that brings me nicely to the end of my lecture. And, um, there are some additional resources around health promotion. Um uh, topics if I go on to the next slide, please. It just talks about the Whitbread, uh, model, but you got the reference there. Next slide, please. This is another model foresight model Next slide, please. Yep. So these are all the models that I've talked about of planned behavior, change stages of change. This is very important, so people can be in the different spaces whilst they're changing. So I'm a smoker. I want to change. So, yes, I'm thinking, but I'm thinking Okay. Well, I don't want to change today. I don't want to change. Tomorrow, I'm receiving the messages. I mean, that three contemplation stage, and then you get to the contemplation stage and you think, right? I'm now 50 years old. I smoked for most of my life. Um, and if I keep smoking, I might have a heart attack. So you're contemplating of changing? You're not quite changing. Then you're thinking right. Let me go and find out More information. Let me Google. Who are my people? Who will be able to help me if I decide to change. Okay, so you Google and you find out a little bit more about what the people who can help you. So that's your preparation. And the Axion is You make that phone call and you talk to somebody and say I smoked for 20 years of my life. I'm now in my fifties. I am really scared. I'm going to die of a heart attack. I'm going to be able to change. And so that's that. Oh, has my slide disappeared, know, and then you make the change, and then you maintain it. But unfortunately, you can relapse back as well. And then you go back to the pre contemplation phase. So these are the stages of change, and this comes from humans. Um, so if you look at this reference, this comes from human psychology and how we actually except change. I think I'm coming very close to the end of my lecture. Um, this is, uh this is a health promotion message that goes out. It's very prevalent in England. Fast is, um, for people to recognize stroke early and making sure you get a support in very early because we know for sure if the support comes in early, long term, um, implications of stroke can be avoided. So this this is again another one you might want to look it up. Very familiar in England with this next one, please. So, as I said, international health promotion happens if I keep if you keep going. Um, yeah, I think the next couple of slides just keeps coming back to the same principle, so I'll stop there. Um, there was an exercise, but I think we run out of time. Um, but, um, have a think about by yourself, um, and see if there is anything that you want more information on, and I'm happy to provide that I'm going to put my email address in the chat if anybody wants to contact me separately. Um, once you've gone through it again or have reflected on it and want to ask more messages, then I'm very happy to answer that for you. My email is on the chat box. I will stop there and see if there's any burning questions. Thank you, doctor, for your time and lecture, guys, please do fill in the feedback form. Unfortunately, I haven't been monitoring the chat, so just give me a moment. Um, so I've got a question here saying, How do you define fast food and processed food. What is the maximum amount of these foods per week? Can we eat so not harmful to our health? Oh, doctor, you've muted yourself. Sorry. Yeah. Good question. Um, I think all processed food is fast food. Why? Because it's quickly available. You don't have to do anything to cook it. So anything that comes out of a packet out of a jar are usually processed because, um, they've either been put into, um, some kind of preservative, um, to, uh And also, there have would have been some, uh, flavoring stuff added to it, too, to make it taste better. Um, you know, um, and and they're definitely not fresh. So any fast food is processed. Really? Now, what quantities do you want to take it, Um, and and is there, uh, is there, uh, kind of, uh, an amount that you take it safely? Well, there isn't there. Uh, if you go go back to my slides, you'll see that there is, uh, there is a chart around a third and a third and a third. If you go right to the top, right to the top, right to the top. That one? Uh, no. The one before that. Just go. Right, Right, right. Um Oh, yes. Yeah. This one. If you could just expand this, we're just going to Yeah, that's the one. There you go. So if you can see on there on this chart, you can see what you need in a plate to have a balanced diet. So a third and a third and a third and then a part of it is dairy. So a third of your diet should have, um, fresh fruits and vegetables. A third of your diet should have grains. Then you should have dairy as a portion of your diet. And the rest of it can be other things that you can have. So basically, it will guide Google it. You should come in. You should have that. It will come up, and then you'd see that this plate gives you real good guide as to what a balanced diet should look like. Does that answer your question? Yes, Doctor. That was clear. Thank you. Okay, good. What was the other question? Does anyone have any other questions? Please Feel free. Does choc does chocolate health died? Uh, there is the dark chocolate, which, ideally is hasn't got any added sugar, which can be beneficial. Uh, but not in big quantities. Everything in moderation. Um, And, um, so that is that is okay, but, you know, again, chocolate in moderation should be good. Anything that's got added sugar only is going to add to sort of inflammation within your system, which probably is not good for you. So, yes, unfortunately for us, chocolate in moderation rather than as a part of your diet, Doctor. Just a question. How do you objectively measure your health promotion campaign? Do you have, like, a local group that does this for you in the UK or how do you know it's working? Yes. So, yes. In the in the United Kingdom, we have got national bodies. Uh, well, it used to be called public Health. England. Um, now it's devolved into each of our regions in the form of, um Well, there is. It's called Oh, Head. Um, and basically, the national programs are evaluated by a group of experts and stakeholders who sit at a national body and and do that? Yes, there is, uh, an objective way of doing it. The principles are the same, you know, with my slide, which talks about So we look, we look at effectiveness, efficiency, um, and and all of those evaluation principles. So we use those principles, but it's done at a national level to make sure that the campaign is making the right, um, impact. And if it's not, then it needs to be changed. That's one. Yeah. There you go. Does that answer your question? Yes, Doctor. Thank you. Yeah. Cool. So if you look up to organizations in again, Google will tell you Oh, head O h I d. Um, uh, if that's an acronym, um, and then the other one is u K H s A. So those are the two organizations the U K h S h s A. Do all the campaigns around the infectious disease. Oh, head does everything else. Thank you, Doctor. You're very clear and informative. Many thank you's in the chat as well. Ok, great. OK, stay safe, guys. And if there's any questions, do please drop me a line. I'm very happy to answer your questions, and hopefully you'll all be, um you'll all be, um very good doctors when you grow up. Take care. Bye. Thank you. Thank you, Doctor. Thank you, everybody. I hope you all feel in the feedback form. The certificate is there now, so please ensure you feeling. Fill in the form and download your certificate. The meeting will end in a few seconds just so you can download. Thank you, Doctor. Thank you. Everybody stay safe. Bye bye.