WHAT IS HEALTH PROMOTION?

Health promotion encourages people to follow a healthy lifestyle and to take control of their health. The Ottawa Charter for Health Promotion includes underlying concepts such as community development, empowerment, and advocacy. Canada is a leader in the health promotion field, and has played a key, international role in its history and development. Examples of health promotion programs and initiatives include

• The Ontario Heart Health Program
• The Ontario Tobacco Strategy
• The Ontario Physical Activity Strategy

STROKE PREVENTION AND HEALTH PROMOTION PARTNERS IN THE COMMUNITY

Preventing stroke in Ontario will require a multifaceted approach that goes beyond a specific focus on cardiovascular disease, diabetes or transient ischemic attacks (TIAs). A growing body of evidence suggests that the most effective prevention strategies are those that actively engage the communities they are intended to serve. Current trends in health promotion research and practice support a collaborative approach to disease prevention, that include population-based awareness and educational strategies designed to:

• Inform the public about stroke risk factors
• Motivate individuals with modifiable risk factors to address them
• Convince individuals without behavioural risk factors to avoid them

In Ontario, there are many community-based organizations working to promote health and reduce the risk factors associated with stroke and cardiovascular disease.

The Ontario Heart Health Program illustrates this community based health promotion approach.

The Ontario Heart Health Program is a comprehensive, health promotion program that uses a collaborative, community process to enable individuals and communities to address factors that contribute to the development of healthy lifestyles and environments. For example, across the province in 37 communities, heart health coordinators work in coalitions with community members. Each year, coalition members meet to share the work from the previous year, and to identify needs and opportunities for the coming year. By focusing on both the needs and capacities within their own communities, coalitions initiate health promotion interventions to help build healthier community members. For example,

• A coalition may place considerable time and resources in school based initiatives that are helping to keep children healthy. Programs such as Quality Daily Fitness, and school breakfast programs partner with school staff and volunteers and others to help school aged children develop healthy lifestyles.
• Another coalition may use resources to raise awareness of workplace wellness and build partnerships between employers, employees, unions and other health professionals to identify health issues and find ways to reduce cardiovascular risk factors in the workplace.
• Coalitions located close to scenic areas may develop and market free walking trails to promote physical fitness.
• Coalitions which have a high population lacking resources for nutritious food may promote community gardens, grocery shopping tours and community kitchens.

By identifying local strengths and needs, coordinators leverage support for healthy lifestyle initiatives to address local needs.

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PRIMARY PREVENTION OF STROKE

Primary prevention of stroke uses an individually-based clinical approach to disease prevention in otherwise healthy individuals who have modifiable risk factors. Primary prevention is usually implemented in the primary care setting, and the physician, advanced practice nurse, or the patient may initiate a discussion of stroke risk reduction. Common topics for these discussions include the importance of managing risk factors by:

• stopping smoking
• being physically active
• eating a healthy, low-fat diet
• taking appropriate medications to reduce specific risks such as high blood pressure

SECONDARY PREVENTION OF STROKE

Through the Ontario Coordinated Stroke Strategy, a number of hospitals have been funded to develop secondary prevention clinics. Individuals who have experienced a transient ischemic attack (TIA) or a stroke are candidates for secondary prevention. Secondary prevention strategies encompass:

• use of medications to lower blood pressure and cholesterol
• surgical interventions
• support in making lifestyle changes