Theoretical and methodological principles of forming a healthy lifestyle
1. Global relevance of the problem of human health and ways to solve it
In recent decades, world science has included the problem of health in a broad sense in the circle of global problems, the solution of which determines not only the quantitative and qualitative characteristics of the future development of humanity, but even the very fact of its further existence as a biological species.
Today, the problem of health threats is considered by the world community as the seventh additional to the six previously identified threats of a planetary scale (the threat of world war, environmental disasters, contrasts in the economic levels of the countries of the planet, demographic threat, lack of resources on the planet, the consequences of the scientific and technological revolution of scientific and technogenic origin). In this regard, scientists use such a definition as an anthropological catastrophe. The essence of this phenomenon is connected with the biological law that each biological species becomes extinct if the conditions of existence to which it has been adapted for millennia in the course of evolution change. It so happened that until the beginning of the 20th century, the conditions of existence of mankind were formed mainly by the natural environment. It was to these conditions that the human body adapted biologically, during the previous evolutionary period. But since the time when man covered the entire planet with his activities (the 20th century), he began to significantly change nature, that is, those conditions of existence to which he was adapted in his historical and biological development. Objective studies testify to the scale of changes in natural conditions in the last quarter of a century. Well-known data on the increase in the concentration of carbon dioxide in the atmosphere, the threatening size of ozone holes, extremely increased radio radiation, soil destruction, water and air pollution. Due to changes in the natural environment, some species of flora and fauna are completely disappearing. Biologists assure that in the next 25-30 years, approximately 20% of living species will disappear. So, scientists raise the question - is man an exception to this biological law? Don't medical statistics indicate that the incidence and mortality rates have been increasing since the second half of the 20th century, indicating that negative processes are already taking place? Moreover, for the most part, human activity not only did not prevent the formation of the prerequisites for an anthropological catastrophe, but on the contrary, contributed to their development, because it radically changed the living conditions to which humanity had adapted for centuries.
The global significance and relevance of the problem caused concern among leading representatives of world science, especially in areas related to health. Since 1977, WHO has initiated an international campaign called "Health for All", within the framework of which the collection and systematization of information on existing health threats began. Based on the results of the work, the International Conference on Priority Measures for Health Protection (Alma-Ata, 1978) was convened, which proclaimed the relevant Declaration. For certain reasons, the main principles of the Alma-Ata Declaration (justice, equality, awareness, overcoming national borders, etc.) did not become widespread in Soviet society. Meanwhile, activities in leading countries continued, and in 1980, WHO proclaimed a global strategy "Health for All by the Year 2000", which contained 10 provisions, 6 principles and 38 tasks aimed at preventing health threats. The goals and principles of this strategy determined the ideological directions by which WHO's activities were to be determined in the following years.
Research developed within the framework of this strategy has revealed the existence of an effective means of preventing threats to human health and achieving the goals set by the health policy for all. A system of measures that has entered the global scientific lexicon under the name health promotion has been recognized as such a means. The literal translation of this phrase suggests several interpretations (promotion, encouragement of health, health promotion, stimulation, health support, etc.) that do not fully correspond to the content of the system of measures in question. Therefore, professional translators use quite a variety of options as a lexical analogue, for example, "health propaganda", "health promotion", "healthy lifestyle promotion", etc. Taking into account the somewhat contradictory attitude of domestic society to the term "propaganda", specialists cooperating in the Ukrainian-Canadian project "Youth for Health", the basis of which is the health promotion system, have recently agreed to use the expression "healthy lifestyle formation" (HLS).
A milestone event for the world community was the First International Conference on Health and Well-being in 1986 (Ottawa, Canada), which adopted the Ottawa Charter, which is well-known in the world. The main theses, provisions and principles of this Charter have become program imperatives that guide the world community in modern activities to solve health problems. Since the Ottawa Conference, work on Health and Well-being has become extremely active in the world.
From 1986 to 1997, four representative international forums were held under the auspices of WHO (Australia, 1988, Switzerland, 1989, Sweden, 1991, Indonesia, 1997), each of which was dedicated to a different pressing problem of Health and Well-being. The Fifth World Conference on Health and Well-being (Mexico, 2000) paid special attention to the issue of investment in health. This aspect of health and well-being is considered so important that in 1995, more than 350 representatives from different countries launched the so-called Verona Initiative, which resulted in a special program of the WHO European Office. The program, called "Investing in Health", determined as the first conclusion of its five-year operation that health should be a top political priority for governments of all European countries. The activities of this program have gained wide political resonance in the world thanks to conferences-meetings of interested parties (1998, 1999, 2000).
Recommendations, declarations, statements, and other documents approved by the aforementioned forums have formed a certain attitude to health issues in all influential international institutions. Thus, out of the 19 fundamental provisions of Part I of the European Social Charter adopted by the member states of the Council of Europe, 6 directly and 8 indirectly relate to health issues. After the Sundsvall Declaration (Sweden, 1991), the International Monetary Fund and the World Bank, when developing their credit policies, take into account, among other socio-economic factors, the state of health of the country's population in general and activity in the direction of the Health Fund in particular. It can be assumed that at this time the intentions and actions of the world community regarding the Healthy Lifestyles Fund, first proclaimed by the Ottawa Charter and developed by a number of subsequent documents, in particular the Adelaide Recommendations (Australia, 1988), have determined the place of the policy of a healthy lifestyle in the process of developing general political decisions, and since then the governments of developed countries have been trying to harmonize their policies with the ideology of health as widely as possible.
In recent years, activities with the Healthy Lifestyles Fund have been intensified in Ukraine. Thus, in accordance with the "Memorandum of Understanding between the Government of Ukraine and the Government of Canada" regarding the Canadian Cooperation Program in Ukraine, the project "Youth for Health. Ukraine-Canada" has been implemented since 1998, the financing of which was undertaken by the Canadian International Development Agency, and the management and coordination - by the Canadian Society for International Health. The partners on the Ukrainian side are the Kyiv City State Administration, the Ministry of Education and Science of Ukraine, the Ministry of Health of Ukraine, the State Committee for Youth Policy, Sports and Tourism of Ukraine, the Ukrainian Institute of Social Research, and some other state and public organizations. The first results of the project are to be published by the International Scientific Conference "Youth for Health", which will be held in Kyiv in November 2000.
2. Modern understanding of human health and its main components
The formation of a healthy lifestyle during its almost 25-year history has gone from the initial accumulation of facts and evidence to the development of a holistic theory. Currently, FHLZH acts as an independent scientific discipline, which has all the relevant components inherent in it - its own theory, methodology, technique, ideology, principles, etc. Introduction to this discipline requires certain knowledge of the modern understanding of the phenomenon of human health in general. Below are some basic concepts that will be useful for understanding the theory and practice of FHLZH.
It should be noted that the phenomenon of human health throughout the history of human development has attracted the attention of many researchers, who have developed a large number of various characteristics of this phenomenon. Scientists use many definitions and indicators of different content, which highlight various aspects of the health phenomenon (health profiles, its levels, components, etc.). The scope of this publication does not allow for a sufficiently complete acquaintance with all the existing works, therefore, the manual provides those concepts of health characteristics and their definitions that directly relate to the content of the Ottawa Charter or correspond to it in spirit and principles.
The concept of health. Modern studies of the phenomenon of human health have revealed the limitations of a purely medical approach, which defines health as the absence of disease. The prevalence of such a definition up to this time is explained by the fact that it has also been used in practical medicine for a long time. If a person who consulted a doctor did not show symptoms of the disease, he was considered healthy. That is, in the practice of treatment, especially in the primary links of the health care system, the fact that the absence of symptoms of the disease does not mean the presence of good health was not given priority.
But according to modern ideas, health is no longer considered a purely medical problem. Moreover, the complex of medical issues constitutes only a small part of the health phenomenon. Thus, the generalized results of studies of the dependence of human health on various factors convince that the state of the health care system determines, on average, only about 10% of the entire complex of influences. The remaining 90% falls on ecology (about 20%), heredity (about 20%) and most of all - on the conditions and lifestyle (almost 50%). That is, the purely medical aspect is not the main one among the variety of influences on human health, and therefore, the medical definition of health as the absence of disease does not correspond to the realities of life.
Modern science shows that human health is a complex phenomenon of global significance, which can be considered as a philosophical, social, economic, biological, medical category, as an object of consumption, capital investment, as an individual and social value, a phenomenon of a systemic nature, dynamic, constantly interacting with the environment, which, in turn, is constantly changing. Based on this, it is clear how difficult it is to define health in full, if at all possible - the history of the development of health science has about eight dozen different definitions.
The definition of health, set out in the preamble to the WHO Charter (1948), is generally accepted in international communication: "Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity."
The concept of spheres or components of health. World science assumes a holistic view of health as a phenomenon that integrates at least four of its spheres, or components: physical, mental (mental), social (social) and spiritual. All these components are inseparable from each other, they are closely interconnected and it is together, in the aggregate, that determine the state of human health. For the convenience of study, to facilitate the methodology of researching the phenomenon of health, science differentiates the concepts of physical, mental, social and spiritual health, but in real life there is almost always an integrated influence of these components.
Physical health is determined by such factors as individual features of the anatomical structure of the body, physiological functions of the body in different conditions of rest, movement, environment, genetic heritage, levels of physical development of organs and systems of the body.
The sphere of mental health includes individual features of human mental processes and properties, for example, arousal, emotionality, sensitivity. The mental life of an individual consists of needs, interests, motives, incentives, attitudes, goals, imaginations, feelings, etc. Mental health is associated with the peculiarities of thinking, character, abilities. All these components and factors determine the peculiarities of individual reactions to, so to speak, the same life situations, the likelihood of stress, and affects.
Spiritual health depends on the spiritual world of the individual, his perception of the components of the spiritual culture of humanity - education, science, art, religion, morality, ethics. Human consciousness, his mentality, vital self-identification,
attitude to the meaning of life, assessment of the realization of one's own abilities and opportunities in the context of one's own ideals and worldview - all this determines the state of the individual's spiritual health.
The social health of the individual depends on economic factors, his relations with the structural units of society - the family, organizations through which social ties occur - work, recreation, everyday life, social protection, health protection, security of existence, etc. In addition, it is necessary to take into account interethnic relations, the difference in incomes of different social categories of society, the level of material production, technology and technology, their contradictory impact on health in general. These factors and components create a sense of social security (or insecurity), which significantly affects human health. In general, social health is determined by the nature and level of development inherent in the main spheres of social life in a certain environment - economic, political, social, spiritual. It should be emphasized once again that in real life all four components - physical, mental, spiritual and social - act simultaneously and their integrated influence determines the state of human health as a holistic complex phenomenon. The concept of health levels. Modern theory and practice of the FHSL, adopted in leading countries that initiate the raising of health issues to a planetary level, distinguish six levels of health of the world community, structured according to quantitative criteria - from an individual to humanity as a whole. The first level is individual, i.e. the health of an individual person. The second level is defined as the level of health of a certain group of people. This concept refers to the closest, relatively constant environment of a person - his family, relatives, friends, acquaintances, with whom he communicates daily. That is, this circle of communication, where a person is almost daily, constantly influences him with his behavior. And vice versa, with their behavior, communication, attitude to life manifestations, members of this environment influence a person in the opposite direction. It is here, in the closest environment, that positive and negative impact on health, both in a direct and figurative sense, in all areas of health - physical, mental, spiritual, social. The sum of influences through individuals from a person's closest environment largely shapes his way of life, creates a certain mental environment, determines spiritual values, and the level of social responsibility. In turn, a person as a member of the environment has the opportunity to positively or negatively influence this particular group of people in the following way: by personal example, providing information or attitude to actions and processes taking place in his environment. The complex of influences, factors and living conditions in the immediate environment determines the level of health of a certain group of people.
The third level is the level of the organization. If the previous level is not defined as a formal structural formation of society, the third level of health is the health of formally defined organizations. Considering that the vast majority of people interact with various organizations of society (spheres of production, services, science, culture, religion, legal and social institutions, etc.) and thereby influence the health of employees (as well as in the opposite direction, the organization influences the health of an individual), this level is structured separately. The peculiarity of mutual influences at this level is that the significance of the influence is significantly determined by the authority and power of the person, his place in the organization.
It is clear, for example, what impact the leadership style of top management in organizations has on the mental health of employees (stresses that can be caused) or how the healthy (or unhealthy) lifestyle of managers, their personal habits and inclinations affect the lifestyle of subordinates, are reflected in their physical health. The fourth level of health is the health of the community. In this context, the concept of a community is defined mainly by territorial criteria - a village, settlement, district, microdistrict, town, city, that is, the closest society where a person lives for a long time of his life. A community can also be formed by ethnic or professional characteristics, political or religious beliefs, etc. Each community has its own characteristics regarding cultural values, habits, traditions, communication, everyday life, work, recreation, and, naturally, these characteristics determine the state of health of people. The next, fifth level is the country level, and the last, sixth, is the level of the whole world.
Such a structuring of health levels should emphasize the world community's understanding of the connection between individual and public health, which determines the interdependence and mutual determination of all levels. That is, the health of a certain group of people who make up his immediate environment and the health of organizations that, in turn, either consist of such groups or the person (groups of people) is connected to them depends on the individual health of a person. The health of the community to which they belong depends on the health of groups and organizations, and the health of the country as a whole depends on the health of the community as a whole. The health of countries, thus, determines the health of the whole world. It is clear that the above direct connection (from person to humanity) also operates in the opposite direction (from humanity to person). The interdependence and interdependence of all levels of health determines the position proclaimed by the countries - the modern leaders of the FHZH:
- each person bears a certain share of personal responsibility for the health of all humanity;
- all humanity is to some extent responsible for the health of each person.
In practical politics, this approach determines the need to be guided in the development of health measures by the principle
that, on the one hand, the state is responsible for the health of its citizens, and on the other, - the citizen is responsible for the health of his country. A certain novelty of such an approach for society lies in the unusual awareness of the thesis of the personal responsibility of a citizen for his own, and even more so - for public health. This thesis is not traditional for the domestic mentality, given the long-standing habit of relying on the state for all the cardinal problems of the structure of social existence. Therefore, the formation of the appropriate consciousness is one of the important tasks of the FHZH.
The concept of prerequisites for good health. The theory of FHW includes eight factors as the main prerequisites or factors, the presence of which enables each person to realize their health potential - peace, shelter, social justice, education, nutrition, income, a stable ecosystem, sustainable resources. These factors are defined by the Ottawa Charter.
Peace. The above-described division of health into six levels (from personal to global) determines the expediency of understanding the concept of peace more broadly than the absence of a state of war at the state level. It is obvious that the absence of peaceful relations in the family, conflicts with the immediate environment, at work or in another organization where a person works, the presence of conflicts in the community or between communities (interethnic, interfaith) significantly harm all components of health - physical, mental, spiritual, social.
A roof over your head. It is advisable to understand this concept more broadly than the presence of any home. A certain level of living conditions, stability of property relations, the presence of other factors that create a sense of confidence in the future regarding the protection of one's own property from possible natural or social disasters are required. The level of development of social institutions, the activities of which provide a sense of security for the individual and his property (law and order, accidents, emergency situations, etc.) is also important.
Social justice, equality, impartiality. The presence of these prerequisites for health guarantees all citizens equal opportunities for access to the services of social institutions, equal civil, property, social rights, the impossibility of
restrictions on the legitimate rights and interests of a person by any power or authority structures. The presence of these prerequisites creates in a person a sense of security and confidence in the future, and also provides equal (within the framework of the legislation) potential opportunities for the realization of needs and abilities, the acquisition of appropriate social status regardless of racial, national, religious, property, sexual, age characteristics. Regardless of the degree of use of these opportunities by specific individuals, the very fact of their presence in society has a positive effect on the state of individual and public health.
Education. Studies have proven that in a developed society, the level of health is largely related to the level of education. The higher the educational level of a certain social environment, the better, as a rule, the generalized health indicators in it. Naturally, caring for one's own and public health is impossible without knowing why it is necessary and how to do it. Moreover, it is advisable to understand the concept of education in this context not only as purely valeological education, but more broadly - as general education in general. The broader the knowledge of the basic natural science, philosophical, and humanitarian principles, the more opportunities there are to create a systemic understanding of the health problem in society in general.
In addition, the concept of education should be understood comprehensively: both as providing information, and as teaching methods, techniques, and skills of a healthy lifestyle, and as upbringing in the spirit of the unconditional priority of the values of individual and public health in all its manifestations, spheres, and levels.
Nutrition. This concept is considered not only utilitarian, as a means of eliminating hunger or minimally supporting the body's vital functions. It involves providing high-quality drinking water, the necessary amount of vitamins, trace elements, proteins, fats, carbohydrates, products of increased biological value, phytoproducts, special products and food additives, etc., which should improve health and counteract the natural aging process.
Profit. This concept assumes the availability of financial opportunities to ensure not only the minimum needs of existence, but also to create in society services and goods necessary for a healthy lifestyle, ensuring the ability to consume them.
Stable ecosystem. This refers not only to the stabilization of normal ecological conditions where they have not been damaged by previous production activities, but also to the restoration of damaged ecological formations in order to prevent further disruption of the planet's ecological balance. Only active restoration activities can ensure the achievement of a stable planetary ecosystem with optimal physical and chemical parameters for the existence of humanity in the future.
Sustainable resources. The concept includes not only the prevention of depletion of energy resources, minerals, and production raw materials. This refers to balanced management taking into account the financial and material resources of countries, communities, individuals, unused production resources, materials and tools, intellectual resources, and the potential of public and private initiatives. The initial thesis is this - the more various resources are in the assets of a certain structural entity (person, community, organization, region), the greater the potential opportunities for directing these resources to health measures.
It should be noted that the mere fact of the presence (or absence) of some prerequisites does not mean the presence of good health outcomes. Countries with approximately the same level of the specified factors may have different indicators of population health and vice versa. For example, the health of Canadians is on average better than the health of Germans, although the socio-economic prerequisites are similar. This is the result of the targeted policy of the Health Fund, which has been applied in Canada for a long time. It is obvious that in Ukraine it is also possible to achieve positive results, despite the temporary lack of resources, provided that the Health Fund system is implemented, which primarily requires the development and adoption of such political and managerial decisions, both at the state and local levels, that are consistent with health needs.
The concept of a healthy lifestyle. Numerous studies of the concept of lifestyle from the standpoint of social sciences define this category as follows. Lifestyle is human activity in general, in particular, a set of essential features that characterize the activities of peoples, classes, social groups, individuals, which (activity) is determined by the conditions of a certain socio-economic formation, the method of production, the standard of living, the set of natural-geographical and socio-historical conditions, value systems inherent in individual individuals, social groups, society as a whole. From this philosophical platform comes the definition that a healthy lifestyle (HLM) is everything in human activity that concerns the preservation and strengthening of health, everything that contributes to the fulfillment by a person of his human functions through the mediation of activities to improve the conditions of life - work, rest, everyday life. A simpler representation is provided by the modern valeological view of HLS - the so-called health formula, which means all human actions directly aimed at or indirectly affecting the formation, preservation, strengthening, consumption, restoration and transmission of health - FZZSVP.
The components of a healthy lifestyle include various elements related to all areas of health - physical, mental, social and spiritual. The most important of them are nutrition (including high-quality drinking water, the necessary amount of vitamins, trace elements, proteins, fats, carbohydrates, special products and food additives), life (quality of housing, conditions for passive and active recreation, the level of mental and physical safety in the territory of life), working conditions (safety not only in the physical but also in the mental aspect, the presence of incentives and conditions for professional development), physical activity (use of physical culture and sports, various health systems aimed at increasing the level of physical development, its maintenance, recovery after physical and mental stress). Of great importance for a healthy lifestyle are people's awareness and the possibility of access to special preventive procedures that can counteract the natural aging process, proper environmental conditions, and a sufficient health care system. In addition, there are many other components of HLS, which relate mainly not only to physical and mental, but also to social and spiritual health (absence of bad habits, prevailing worldview on the priority value of health, etc.).
3. Theoretical principles of the formation of a healthy lifestyle
The above ideas about human health, a healthy lifestyle, some of their characteristics logically lead to the fact that achieving a high level of realization of the potential of personal and public health cannot be achieved by spontaneous, extra-systemic efforts of several enthusiasts or several groups of people, if it is not supported by a system of scientifically based measures, which are a natural part of the state and public policy of the country. Such a system is HLS. For its implementation in the life of the country, it is necessary that knowledge about HLS at the first stage of activity is mastered by those persons who are closest to the process of developing and making managerial and political decisions at all levels of government and, moreover, are the most organized part of society. Therefore, it is advisable for civil servants who are involved in the preparation of influential decisions to have an idea of the theoretical foundations of the FHL.
The concept of forming a healthy lifestyle. The world community defines the FHL as the process of applying efforts to promote the improvement of health and well-being in general, in particular, effective policies, the development of appropriate programs, the provision of appropriate services that can support and improve existing levels of health, and enable people to increase control over their own health and improve it.
The concept of the ideology of the FHL. The FHL is based on certain ideological principles. Firstly, this is the idea of the priority of the value of health in the worldview system of human values, secondly, the perception of health not only as a state of absence of disease or physical defects, but somewhat more broadly - as a state of complete well-being. Thirdly, this is the idea of a holistic understanding of health as a phenomenon that inextricably combines its four spheres - physical, mental, social and spiritual. In addition, this is the idea of the so-called redistribution of responsibility. It means that the control of lifestyle should be carried out by the state, the community (society), and the person himself. A person gives himself a certain responsibility for controlling his own life, takes personal responsibility for actions, decisions, and their consequences. Similarly, the community takes on some responsibility for the health of its members. That is, the state delegates part of its power to the community and the individual. Accordingly, this idea also involves directing a certain part of the resources and rights of control from the state to communities and individuals. Also, a certain share of responsibility for health falls on the person himself and the community where he is, although the main responsibility for the health of society lies with the state.
Thus, the ideological principles of the formation of a healthy lifestyle (FZSZH) demonstrate a significant difference between the modern approach adopted at the international level and the traditionally familiar to Ukrainian society. These ideological principles of the FHJ define the ideas of advocacy, mainly proclaimed by the Ottawa Charter:
- FHZH concerns not only officially specialized health care structures or the provision of HL services, but goes far beyond them, touching on the problems of general well-being;
- health is the main resource for public and personal social and economic development, an important measure of the quality of life, an indicator of human competitiveness;
- political, economic, social, cultural, behavioral and biological conditions of existence - all of them can either promote health or harm it. It is possible to make these conditions favorable by taking measures regarding FHZH;
- the application of the ideology of FHZH in itself is not a guarantee of positive changes, because people are unable to achieve their fullest health potential if they are unable to control all the factors that determine their health. Therefore, the policy of FHZH should determine areas of activity where control of the real situation is required;
- HLP interventions should aim to reduce disparities in health status and ensure that people have equal opportunities and resources to achieve their full health potential.
Concept of HLP principles. The first and most important HLP principle is partnership. It is understood that the preconditions and prospects for good health cannot be achieved by the efforts of specialized structures alone. HLP requires coordinated action by all stakeholders: governments, health sectors and other social and economic sectors, non-governmental organizations, local authorities, industry and the media. People from all walks of life are also involved in this process - individuals, families, communities. Health care personnel take on the main responsibility for mediating the direction of all these diverse interests in society towards improving general health. Two main theses of the partnership principle:
1. The FHZH is effective when it uses partnership relations with all interested forces - organizations and individuals from all spheres of life, and not only with specialized structures related to health problems;
2. Specialized medical structures related to health are leaders, initiators, organizers and are responsible for mediating in establishing partnership relations with other forces from all spheres of life.
Another principle of the FHZH is adaptation. This means the need for maximum adaptation of FHZH activities (programs, events, initiatives) to the local conditions of its implementation, that is, to the needs and capabilities of individual groups of people, communities, organizations, regions, countries, taking into account the peculiarities of their social, economic and cultural structure.
The goal of the FHW is to promote health in the broad sense of well-being and health for all, at all levels, in all areas, with all determinants (prerequisites).
The main mechanism of the FHW is that the FHW empowers individuals (groups of people, communities) with the ability to positively influence health problems. Creating the understanding through the means of the FHW that only individuals (groups, communities) themselves, first and foremost, and not the state or special institutions, have the right to choose behavior (the right to initiatives, decisions, actions), significantly increases control over one's own life activities and, accordingly, increases the potential for positive influences on health problems.
The concept of FHZH strategies. In practical activities, when developing FHZH measures, attention is paid to ensuring that the content of these measures covers as fully as possible some aspects of the activity, which are usually defined as the main FHZH strategies. These are separate areas of activity as part of a holistic, preferably comprehensive measure, which are recognized as the most effective from the point of view of achieving the final result. The more strategies out of the eight main ones that a separate measure can combine, the more chances it will have for success. It is customary to define the following strategies:
· identification by the participants of the measure of general patterns and specific problems related to aspects of personal and public health;
· provision of information about the current state and opportunities for improving those specific health issues that are the main ones in the content of this measure;
· promotion of the development of consciousness and activity of those local communities and groups of people who are most affected by this health problem, management and coordination of their own efforts in the direction of solving the problem on the basis of self-government;
· development and achievement of changes in organizational support of health care activities - improvement of health care services, application of modern management tools in solving specific problems, which this measure is aimed at;
· formation of health policy as a necessary part of the activity to educate the correct value orientations of individuals and the community where the measure is carried out;
· advocacy of the rights of individuals (groups, communities) to a healthy lifestyle by using legislative opportunities, actions of self-government, finding a compromise with those structures of production, business, etc. that hinder people;
· inter-sectoral cooperation (partnership with everyone who can be useful in taking the measure);
· self-help and mutual help (instilling personal skills of healthy lifestyle and public activity on health issues, development of the desire and ability to help members of the immediate environment, community, etc.).
The concept of measures for the FHL. There are five large groups (or complexes) of measures for the health-promoting health system by areas of activity. These are the formation of a health-promoting policy, the creation of a favorable living environment for people (natural and social), increasing community activity, developing personal human skills, and reorienting health services towards prevention. Measures for each area are taken according to certain fundamental provisions.
The formation of a health-promoting policy requires:
· joint efforts of all managers at all levels of all branches of government, all sectors of the public and private sectors and public organizations; their awareness of responsibility for the state of public health, for the consequences of their decisions; a combination of various complementary approaches for the benefit of public health, inter-sectoral coordination of actions, and the organization of joint inter-sectoral measures;
· application of legislative and fiscal mechanisms to stimulate actions aimed at improving the health of the population; initiating and developing special measures for taxation of business entities in accordance with their impact on public health; developing organizational changes in the public administration system to optimize the efforts of various structures for the benefit of public health;
· striving for a more even distribution of income in favor of low-income categories of the population, fair social policy, and promoting equalization of conditions and opportunities for people to lead a healthy lifestyle;
· creating circumstances under which the range and quality of goods and services will be more in line with the interests of people's health, and the environment will be cleaner and more pleasant to live in;
· identifying obstacles in the policy of promoting public health and developing means of eliminating them;
· striving, when preparing important political decisions, to find such options for a compromise between the interests of people's health and the interests of production, business, urbanization, etc., which (options) would be acceptable to politicians at the highest echelon of power, realistic for implementation and popular among the population, that is, would facilitate politicians' difficult (almost always) choice of decisions in favor of public health.
Creating a favorable environment implies the following provisions:
· the human environment consists of a social and natural environment. The relationships between these environments are complex and interrelated. Therefore, improving health cannot be achieved by measures limited to one type of environment - either social or natural. The inextricable link between man and his environment, the relationship between the two components of the environment (social and natural), the relationship between the four components of human health (physical, mental, social, spiritual) - all together determine the need to build measures for FHL on the basis of a socio-ecological approach to health;
· any measures for FHL cannot be significantly effective if they do not take into account the general guiding principle for the whole world, individual countries, nations, regions, communities and individuals - all kinds of encouragement of mutual support. People should take care of each other, about their immediate environment (its social component - small communities, the ecological component - everyday contacts with physical, chemical, biological factors of the natural and artificial environment). In the opposite direction - communities should take care of their members, their environment. Finding ways to encourage such mutual support, providing it to strong and powerful people - policymakers, is an important part of the FSL. In the future, the FSL has the prospect of extending such a "chain of care" from individuals and communities to the whole world. Activities on the FSL should emphasize in every way that the preservation of natural resources in every corner of the world is a global responsibility of humanity as a whole and the personal responsibility of those communities and people closest to those corners in particular;
· the patterns of life, work and leisure significantly affect health. Despite their diversity and constant change, the FSL puts forward such a principle with which it coordinates its activities - work and leisure should be a source of health. The activities of the FSL are aimed at ensuring that the way of organizing work adopted in society does not hinder, but helps to improve health. FSL measures should contribute to the achievement of living, working and recreational conditions that are safe, stimulating, satisfactory, pleasant;
· protection of the natural and artificial environment, conservation of resources is the main content of the ecological component of the socio-ecological approach to health. The use of this approach in determining FSL measures will not be objective if there is no constant truthful information about the real state of the environment, its impact on biological beings, especially considering that due to human activity and the elements, this state and impact are constantly changing. Therefore, an important direction of FSL measures is awareness of the need and organization of activities for systematic assessment (monitoring) of the impact of the constantly changing environment on human health, especially in the areas of human labor, the use of potentially hazardous technologies, energy production, urbanization, etc. FSL promotes systematic assessment and publication of its results, assumes that the assessment prompts actions that would create conditions for improving people's health.
Increasing community activity depends on the realization that:
· the main "driving force", potential, environment for the development and implementation of the FHL in all developed countries of the world is the community (local territorial, ethnic, religious, cultural, etc.). It is thanks to the community's activity in determining priorities, making decisions, planning strategies and implementing measures to improve health that the FHL is implemented. Hence, the primary task for the FHL is to in every way contribute to the strengthening of communities, their development and directing efforts to health problems in such a way as to activate the human and material resources available in the community, to encourage community members to self- and mutual help through flexible systems, initiatives, organizational formations within the community;
· FSL activities are able to increase community activity if they can provide access to the necessary information, training in health-improving skills, and financial support.
The development of personal skills is mainly aimed at information and educational activities aimed at increasing people's ability to make the right choice, strengthen health control, learn skills and abilities to direct efforts to their own health, to a healthy environment. FSL should make people able to constantly, throughout their lives, learn ways to improve their health, resist chronic diseases, injuries, and premature aging. FSL provides (takes appropriate measures) for this work to be carried out in all components of the social environment (educational institutions, housing, work, recreation, public events) through all possible institutions (educational, professional, commercial, charitable, voluntary) of all forms of ownership (state and non-state).
The reorientation of health services should be based on the principle of expanding the sphere of responsibility of the specialized health system in the direction of the FHL itself, going beyond the boundaries of treatment. This approach involves:
· placing responsibility for the FHL on individual individuals, professional organizations, public associations of specialists related to the field of health, as well as on governments, other authorities in general, which are involved in the creation of a favorable (or unfavorable) policy regarding health in the broad sense of its phenomenon;
· granting health services broad powers, the possibility of using these powers in the direction of attention to cultural needs, influence on social, political, economic components of the physical environment;
· paying attention to health research, changes in the system of professional education and health care practice to form organizational and behavioral changes that will contribute to the reorientation of the efforts of the specialized system from being limited to therapeutic actions to the priority of the total needs of a person as a holistic personality.
In general, the fundamental provisions of all five groups (complexes) of measures of the Health and Well-Being Framework are contained in the final theses of the Ottawa Charter:
"Health is created and lost by people in the situations of their everyday lives: where they study, work, have fun and love. Health is created in the process of caring for oneself and others, the ability to make decisions and gain control over the circumstances of one's own life and to ensure such a situation that the society in which a person lives creates conditions for good health for all its members."
4. Methodology and techniques for forming a healthy lifestyle
Since the adoption of the Ottawa Charter, the problem of implementing its provisions and principles into the practice of the Health Promotion Fund in different countries of the world has arisen. Numerous studies have proven the need to develop a certain methodology for the Health Promotion Fund, which would be able to serve as an indicator that determines the algorithm for the Health Promotion Fund in general, that is, to determine the procedure for substantiating, planning and assessing the effectiveness of the Health Promotion Fund.
To date, several schemes and models of the philosophical and methodological level have been developed, which are aimed at solving the problem of the methodology for the Health Promotion Fund. This material is quite complex for independent study and is more interesting for those who directly develop specific Health Promotion Fund projects than for public administrators who prepare and make fundamental generalized decisions that directly or indirectly affect public health. Therefore, the manual provides only a brief description of the aforementioned schemes and models in order to create a general idea of the nature and scope of work that should be carried out when planning and developing Health Promotion Fund projects.
Of the many scientific achievements of the modern theory of FHL, four models most fully characterize its methodological principles:
· conceptual-philosophical level model - a general model of planning and assessing a healthy lifestyle;
· model of a methodological approach to planning FHL activities - a scheme of planning and substantiating FHL;
· general methodological features inherent in the most successful examples of implementing FHL in the lives of different communities - principles of the most successful FHL practices;
· applied level model, illustrating the use of general methodological provisions in specific conditions - the Canadian model of FHL among the population.
The general model of planning and assessing a healthy lifestyle was created by scientists from the Center for Promoting a Healthy Lifestyle at the University of Toronto. This model methodologically identifies and structures the principles and provisions of the Charter according to the following categories: goal, values, mechanism, determinants of health, etc.
The goal of the FHW is to improve well-being in general, health in a holistic sense, and not just treatment, prevention of individual diseases, and reduction of morbidity and mortality.
The core values of the FHW are health as a positive and holistic category, social justice, equality, and universal participation in solving health problems.
The core mechanism of the FHW (the empowerment mechanism) is the most effective way to achieve the goal of the FHW, which should increase the ability of individuals and communities to control the determinants of health and other factors that can affect health.
Determinants of health are broader than purely medical factors that determine the level of health - macro-level factors, namely: income inequality, social status, social support networks, education, employment and working conditions, physical environment, biological and genetic characteristics, personal skills and abilities to prevent harm to health, healthy childhood development, medical care.
Two generalized tasks of the FHW:
· to promote the growth of the capacity of individuals and communities to control the determinants of health, other influential factors;
· to create and maintain institutional and physical environments that will promote the positive use of the purpose, values, mechanism, determinants, priority areas of activity of the FHW.
The main principles of planning the FHW:
· close interconnection between all components of the FHW measure (initiative) proposed for implementation;
· planning the initiative in the direction from the level of the general conceptual principle to the level of specific actions (if the realities of life require planning the initiative in the opposite direction - from below, from the level of specific actions, it is advisable to determine the place and direction of this initiative relative to the higher level - the level of generalized elements.
For example, if training a certain contingent in certain means of preventing certain harm to health is planned and implemented, it is advisable to determine which general goals of the FHZH and core values it (training) corresponds to, within which determinants and areas of activity it will affect);
· clear definition of the goal and objectives of all levels (higher, middle, direct);
· directing the initiatives (measures) of the FHZH of lower levels to the final achievement of the goal and objectives of the FHZH of higher levels (general goals and objectives);
· coordination of the FHZH initiatives with its core values, building measures on these values, their multiplication and improvement;
· using the core empowerment initiatives as the most effective way to achieve the goal of the FHL (for example, increasing the capacity of individuals and communities through training or providing means of control over the determinants of health);
· setting a specific goal for each FHL initiative, namely: to weaken or eliminate (if possible) factors of negative impact on health and vice versa - to strengthen (create, if possible) factors of positive impact; take into account the potential impact of health determinants on the implemented initiative and foresee appropriate strategies for prevention, use or adaptation; help individuals and communities to take into account the determinants of health, foresee their possible negative impact and teach appropriate actions (overcome, prevent, adapt);
· directing initiatives to different types of activities. The more (if possible) priority activities are integrated, the greater the likelihood of obtaining positive results, the more significant the results themselves;
· use of various integrated strategies in each FSL initiative - they support each other, which increases the likelihood of obtaining a positive result and its significance;
· planning of FSL initiatives in accordance with clearly understood ideas about the cause-and-effect relationship between the goals and objectives of the FSL and the applied strategies and activities;
· realism of planning, i.e. taking into account resource constraints;
· planning of FSL initiatives based on modern scientifically sound knowledge, using research data and assessments specific to a particular initiative.
Main principles of FSL assessment:
The principle of the "assessment-planning" relationship - i.e. the quality of the assessment of the FSL initiative depends on the quality of the conceptual planning scheme chosen for this initiative, and on the possibility of objectively assessing the elements (processes) of the model built during planning.
Planning and evaluation are a single process where both components are interconnected and mutually dependent. Each stage of planning requires an assessment that adjusts the plan according to the feedback principle. New planning takes into account the previous assessment and requires the next one, and so on, throughout all stages. Planning provides an opportunity for assessment, which, in turn, provides for new planning.
The principle of checking the completeness of the implementation of the initiative in relation to all elements of planning is the need to check the degrees:
- the degree of achievement of the goal and objectives that were defined in the initiative;
- the degree of use (reflection) of the values defined in the initiative;
- the degree of success in applying the core mechanism of the Health and Well-being Fund - empowerment;
- the degree of consideration of the determinants of health identified during the planning of the initiative, the correctness of the choice of those determinants that are most relevant to the main problem of this initiative;
- the degree of combination of one or more general areas of activity of the FSL and specific strategies defined by planning, their mutual support in relation to the main problem of this initiative.
The principle of sequential tracking of planning stages is that the evaluation tracks (mainly in the reverse direction - from lower levels to higher) the effectiveness of actions and elements at the lower level, checks the intermediate level of effects, determines the overall results and consequences of the applied FSL initiative.
The principle of hierarchical verification of the effectiveness of contributions, which provides that the evaluation of FSL initiatives includes checking the contributions of each element of the lower level to achieve the corresponding element of the higher level.
The principle of functional diversity of assessments is that the evaluations of FSL initiatives perform several functions - determine the effectiveness of initiatives, contribute to the development and implementation of initiatives, determine the consequences and total impact of initiatives, apply various methodologies, methods, procedures.
Assessments check not only the consequences and impacts, but also the processes leading to them and focus in each specific case on different components of the initiative - the goal, mechanisms, tasks, types of activities, results. Assessments concern different elements of planning at different hierarchical levels.
The general model of planning and assessment of the FSL is a philosophical and methodological tool in accordance with which various methods and schemes for planning measures (initiatives) of the FSL are developed. Scheme of planning and justification of the FSL. One of the planning methods, the most widespread in the practice of the FSL, was proposed by the authors of the previously described general model of planning and assessment of the FSL under the name of the scheme of planning and justification of the FSL.
The content of this methodology is that the developers of a specific FSL measure are offered a certain scheme of nine positions, according to which a document is drawn up that plans the FSL initiative in a certain form. Such a plan for the FSL is developed for the community, consumers, managers, FSL specialists, that is, for those who will implement these plans, and for those who allocate funds for implementation - governments, organizations, individuals, etc. Therefore, this document is a kind of "business plan", based on the assessment of which funds are allocated (or not allocated) for FSL activities. Given this, in world practice it is customary to carefully approach the development of such plans. Such planning is a rather complex operation and requires a certain amount of knowledge in FSL and other scientific disciplines (sociology, valeology, pedagogy, medicine, jurisprudence, economics, etc.). Therefore, such plans are developed, as a rule, by a group of specialists of different specialties.
Principles of the most successful practices of the FSL. The modern methodology of the FSL operates with the idea of the phenomenon of the most successful practices.
The International Symposium on the Effectiveness of the FSL (Canada, 1996) determined the status of the Center for Promoting Healthy Lifestyles of the University of Toronto as a Collaboration of the WHO Center with the FSL. It was then that a working group was specially created at the Center to study the most successful practices of the FSL, which, based on the results of the analysis of existing world experience, developed significant methodological material.
Definition: "The most successful practice in the FSL is a sequence or several sequences of individual actions and behaviors that are most likely to lead to the achievement of the goal of the FSL in a given situation and are compatible with the values of the FSL."
So, the most successful practice is a certain algorithm (sequence of actions), although the need to adapt to the situation determines a certain variability of this algorithm, because situations (more precisely, their conditions and circumstances) are constantly changing. Hence the understanding of the most successful practice not as any one, but as several successful practices that may exist. That is, the algorithm of the most successful practice of the FSL can vary depending on the situation. Such an understanding of the concept of the most successful practices has both its benefits and risks.
The benefits of developing and implementing any FSL initiative within the framework of a clearly defined algorithm of the most successful practices are in achieving the goal of the FSL, increasing the accuracy of calculations and the level of awareness and the ability to think critically, and in activating learning.
Risk - a decrease in the level of creativity, the emergence of a reason for limiting funding, a decrease in tolerance for the long duration of the FSL processes, a decrease in the role of the client.
Understanding the concept of the most successful practices as a phenomenon not of unlimited freedom, but limited by a certain algorithm is the result of research, which found that all the most successful practices were formed according to the same, clearly defined principles.
As a result of the research, seven basic principles of the most successful FSL practices were identified.
FSL values. The most successful FSL practices are based on core values, in particular equality and empowerment, which (values) guide all aspects of FSL practice. These values focus on social justice, ethical aspects of FSL. Other FSL values relate to the ecological component, respect for the environment in a broad sense. FSL values should guide the identification of the goal, objectives, and processes of FSL and be reflected by them.
FSL processes. The most successful FHQ practices apply processes that are compatible with the values of the FHQ and enable the achievement of its (FHQ) goals and outcomes. This, in particular, requires the FHQ to pay attention to the ethical aspect of the content of the processes of implementing initiatives and likely outcomes. The methods and means used should be compatible with the goals and values of the FHQ. It is necessary to identify and take into account the factors of possibility (and impossibility) of fulfilling the tasks of the FHQ. As priority results, the FHQ considers those that positively affect the quality of life in general, and are not limited to local factors of a medical nature. To develop the goal and objectives of the FHQ, the standards of the SQMS should be applied, that is, the goal and objectives should be Specific, Measurable, Attainable, Relevant (appropriate, relevant to the case), and Timely.
Existing and new knowledge. The most successful FHQ practices build on and increase knowledge about the relevance and effectiveness of the FHQ. The FHW should collect, verify, synthesize facts regarding its effectiveness, to process, implement and evaluate its own initiatives. The assessment of the processes, results and impacts of the FHW initiatives requires the identification, processing and implementation of evaluation procedures and tools (qualitative and quantitative, experimental and natural). The FHW provides conditions for continuous learning, constant reflection and criticism of its goals, objectives, values, strategies and impacts in order to improve the results of its (practice) implementation, because this is the only way to achieve the best results. The FHW should improve access to current information and fundamental knowledge about itself and health problems in general, and itself should be constantly replenished with this knowledge and information. The FHW should identify the diversity of the most successful practices, determine their range, context, situational characteristics.
Available resources. The most successful practices effectively use available resources to achieve the goal of the FSL, study the resource potential. At the same time, the attention of the FSL focuses on such types of resources as human (skills, competence, ability, knowledge, experience, motivation, energy, interest); professional (knowledge in the field of FSL of individuals and organizations, practitioners and researchers, specialists of official structures and amateurs, owners of means of traditionally recognized and non-traditional influences); public (ability, experience, knowledge, community support, collective actions, the existing power and authority of the community, additional power and authority that the community acquires as a result of endowing its members with the ability through the core mechanism of the FSL); financial (private, public, state); time.
Theoretical understanding of health and its determinants. The most successful FHW practitioners themselves reflect the theoretical understanding of the phenomenon of health in all its integrity and complexity, and also contribute to this understanding around them. FHW should clearly define the theoretical foundations of their practice, and practice, in turn, should be compatible with the theoretical understanding of all aspects of the phenomenon of health, in particular, such as the positive (or negative) direct impact of determinants and individual factors on health and the indirect impact of broader factors of a social and economic nature; the holistic nature of health in all its areas; the relationship between levels of health - individual, groups of people, organizations, communities, countries, humanity as a whole; intervention strategies that contribute to improving health.
Sensitivity to power and authority. The most successful FHW practitioners are aware of and take into account problems of power and authority, and contribute to the widest possible distribution of power and authority. The FSL prioritizes practices, processes and structures that empower individuals and communities, and continuously critically examines the dynamics of power and authority among stakeholders and partners. The FSL develops and implements policies that reduce the impact of power and authority disparities. The FSL promotes the development (redistribution) of relationships and authority between individuals and groups with greater power and authority and less powerful individuals and groups (e.g. professionals and clients). The most successful FSL practices engage in ongoing engagement and dialogue with the widest possible range of individuals and structures to whom the FSL initiatives can access.
Diversity sensitivity. The most successful FSL practices recognize, respect and embrace diversity in all its forms. The FSL focuses on diversity among communities and individuals involved in or affected by the FSL, and actively encourages them (communities, individuals) to identify acceptable forms of diversity for themselves. The FSL focuses equally on all forms of Romaness - disciplines, people, ideas, theories, cultures, places, stakeholders, behaviors, meanings, roles, socio-economic status, education, faith, sexual orientation, gender, language, age, etc., determining its priorities in relation to specific initiatives and situations.
The Canadian model of FSL among the population. The modern methodology of FSL is implemented in many regions and communities according to various programs, schemes, models. One of the well-known, most interesting models of FSL among the population was developed by the Ministry of Health Canada and is used in the province of Saskatchewan. The principle approach to using this model is that it does not indicate a single way to solve the problem, but instead provides many options that can be used to approach their solution. Such a model is one of the tools that helps to understand the FHW among the population and direct the work of responsible persons in this direction.
The model is described by four rhetorical questions:
1. Who shapes the health levels in the society where it is desirable to introduce the FSL initiative, that is, with whom it is possible to interact, who are possible partners.
2. What is the object in relation to which it is possible to implement measures, that is, the area where measures can improve health and well-being.
3. How can measures be taken to positively influence the problem from the standpoint of improving health.
4. Why is it necessary to resort to measures, why is it necessary to solve this problem.
The content of possible answer options determines the methodology of the model. Thus, the first component of the model ("Who") is individuals and entities (community) with whom it is possible to cooperate when developing the FSL initiative:
- person - that is, the individual to whom the initiative is directed and with whom it is necessary to cooperate;
- family - formal or informal ("family" from the support group), relatives, the closest everyday environment;
- community - an entity defined by geography (town, city, etc.), by common interest (church, club, etc.) or by any other characteristic;
- sector or system - social structures (healthcare, education, law enforcement, etc.), economic (labor, business, services, etc.), age groups (elderly, youth, etc.);
- society as a whole - residents of a province, region, country.
The general principle of this component of the FHL model is as follows: the more levels the initiative covers, the greater the likelihood of achieving positive changes.
The second component ("What") - determinants of health. There are ten of them in the model: income and social status, social support network, education, working conditions, environment, biological and genetic characteristics, level of personal health, choice of attitude to personal health, skills for overcoming negative phenomena, healthy development in childhood, medical services.
The focus of the measures used by the model is based on research on the above determinants. Thus, according to research, people with higher incomes are healthier than people with average incomes, who, in turn, are healthier than people with low incomes. Moreover, higher incomes mean better health not only because they allow them to buy "health" (housing, food, services, etc.), but primarily because they determine greater choice and a sense of control over life decisions. This sense of control is the main factor of good health from the group of factors related to income and social status. Social status also affects health by primarily determining the level of control a person has over life circumstances. In addition, social status affects the ability to act and make independent choices, and the feeling of this ability is also a factor in health. It has been proven that diseases such as cancer, cardiovascular diseases, strokes, etc. occur more often, the worse the job (in the sense of social status and income) a person has. So, the higher the social status and income, the healthier a person is in the personal aspect, and in the aspect of public health is determined by the difference in income. Researchers assure that the smaller the gap between the rich and the poor, the better the health of the country's population. Moreover, the dependence is such that even a small economic gain or a slightly higher social status is a significant factor in improving health.
A social support network in Canadian practice is people who, if necessary, can, want and are potentially able to provide assistance to an individual, and also, by the very fact of their existence and friendly everyday attitude, eliminate the feeling of loneliness, create a sense of confidence in the future, security, and the availability of moral support. This is the closest environment - family, friends, local community, etc. Studies prove that people who have strong social support from their closest environment are better able to overcome difficulties and problems, and control stress. In addition, a strong social support network gives a person faith in his ability to help on his own behalf when someone needs it.
Education. The fundamental position on which the idea of education as a determinant of health is based is that in any society, achievements in education improve health. Formal education in educational structures or informal - in families, communities, society improves employment opportunities, increases income, social status and equips people with skills to overcome personal and social problems. Less educated people are deprived not only of opportunities, abilities, aspirations and hopes, they have worse health and a shorter life.
Favorable working conditions are considered not only as the presence of a safe workplace in physical and mental aspects (although this is also important for health), but first and foremost (and this is most important) as the degree of opportunity and the amount of control that a person has over production decisions. According to research, this is the factor that has the greatest impact on health. The more control over work decisions, the better health, and vice versa - unemployment is a prerequisite for poor health because it is not only a decrease in income, but above all a loss of self-esteem, preoccupation with family and social problems.
The environment is understood as a complex of ecological (land, air, water) and social (housing, human environment, safety, free movement) factors, the impact of which on health is considered obvious.
Biology and genetics are factors of character, a selection of external and internal features of the organism, independent of the will of a person, inherited from parents. But, as confirmed, the idea of these factors as such, which are not subject to influence, that a person is doomed to them for life, turns out to be incorrect. The thesis is refuted that good personal biology and genetics in themselves are the key to health regardless of behavior, and worse heredity will certainly cause diseases. In addition, the initial bad character does not mean a final verdict - the choice of a healthy lifestyle can avert inherited danger.
The choice of attitude to personal health is a personal decision that directly affects a person's health, primarily behavior in everyday life (rational nutrition, physical activity, absence of bad habits). Coping skills mean how people cope with certain problems and difficult life situations. It is necessary to strive for a "healthy" choice in all cases, that is, a choice that harms health as little as possible and, if possible, improves it. But the complexity of the problem lies in the fact that personal choice and the way of overcoming situations are significantly determined by the social, economic and political environment. Hence the main position of this group of elements of the model is to coordinate practical initiatives of the FZH with the theoretical requirement of forming the aspirations of all members of society to create it (society) in such a way that a healthy choice is the easiest choice in all situations.
Studies on healthy development in childhood have revealed a significant degree of its connection with health in adulthood, depending on the characteristics of family behavior. Cruelty, neglect, instability in the family have a rather negative impact on health and well-being throughout life, and vice versa - any positive consequences are due to a healthy and caring family environment in childhood.
Canadian researchers determine the specific weight of medical services as no more than 25% in the system of determinants of the health phenomenon in general. Such an extremely high percentage (researchers from other countries, as a rule, give no more than 10%) is due to the exceptionally high level of the Canadian health care system.
In general, the principle position of the "What" component in this model is that there is no single factor responsible for the health of the population. Health is a consequence of the interaction of all the identified determinants together.
The next component of the model indicates Why measures should be taken. This understanding, that is, understanding why it is necessary to actively act in the field of FHL regarding a specific problem, is not based in the model on general considerations regarding the values of humanity in general. Decision-making on the implementation of initiatives, their content and characteristics is determined by evidence, research, evaluations, experimental training, taking into account the available resources and values of the FHZ. To make decisions from the mass of information accumulated, objective, verified by research, evaluations and experience are taken into account. Attention is focused on those evidences that explain not only why measures should be taken, but also ensure that the initiatives are aimed at those problems that are most important for a real positive impact on health in this situation. The last component of the model ("How") is the definition of strategies for implementing FHZ measures. The model provides for five such strategies - strengthening community measures; developing public policy; creating a favorable environment; developing personal skills; reorienting health care.
These strategies are traditional for all models built on the principles of the Ottawa Charter, but Canadian research and experience highlight interesting features and obstacles that those who implement them overcome. Thus, strengthening community measures requires giving communities the opportunity to manage their own destiny, that is, to apply the ideas of self-government in the direction of health issues. But this is one of the most difficult strategic directions of the Health and Wellbeing Fund to implement, because it involves transferring to the community not only part of the power to influence the health of its members (this may be declared by government structures in theory and not implemented in practice by referring to the insufficiency, for example, of the regulatory framework). This strategy also involves transferring to the community certain material means of influencing the health of its members - for example, certain property or the right to dispose of a certain part of local budget expenditures. It is clear that measures in this direction may encounter resistance from government structures. One of the components of this strategic direction of the FZH may be the training of community leaders, that is, initiators (from among the most active members of the community) of the health movement, dialogue with the authorities on solving public health problems.
The development of a state health policy includes the initiation by the FZH of any political measures of the state that promote a healthy lifestyle, and this primarily refers to local measures at the local level. For example, a number of measures of local authorities initiated by the FZH to provide political, regulatory and material support for the efforts of school teachers to create an atmosphere of intolerance to negative manifestations of youth behavior (hooliganism, violence, smoking, alcohol use, drugs, etc.) on the territories of educational institutions is qualified as an achievement in the field of developing a state health policy.
Creating a favorable environment is a strategy that involves initiating measures to positively influence the physical, social, economic, and spiritual environment in which people live, work, and play. The most effective measures are those of a local scale, such as a local crime prevention program in a particular community involving partners from various sectors - culture, business, sports, and, of course, law enforcement.
Personal skills development is a strategy for increasing people's opportunities to make favorable choices. For example, the FZLZH widely initiates special school programs that teach young people to counteract negative social phenomena (temptations of a material or sexual nature, physical and mental pressure from elders or peers, etc.).
Reorientation of medical care is a strategy for shifting medical priorities from purely curative to preventive measures. For example, the FZLZH can initiate the creation of jobs where measures to encourage smoking cessation, alcohol use, etc. are sponsored or supported from health budgets.
In principle, the Canadian (Saskatchewan) model, which is in question in this case, does not indicate exactly which measures should be taken in which situation. It (like other models of the FSL) provides a diverse choice of paths to the goal, helps to consider the causes, work out the research, and choose approaches to eliminating the problem. The value of the model lies in the fact that it clarifies the content and sequence of actions for planning the FSL, provides an understanding of planning tools, and prevents fundamental errors that may arise from unclear knowledge of the methodological principles of the FSL. On the contrary, resistance to the modern methodology of the FSL not only ensures the successful implementation of initiatives, but also enriches the theory and the most successful practices. The material presented in this section on the theoretical and methodological foundations of the FSL is not purely theoretical scientific knowledge, divorced from practice. The theory of the FSL is the basis of many projects that have been implemented and have justified themselves both in social and economic terms in some developed countries of the world. The experience of implementing these projects has identified several important provisions.
Thus, the effectiveness of many local FSL programs is inversely proportional to the size of the local community. Presumably, the smaller the community, the easier it is to control the behavior of its members, the less time it takes to implement healthy initiatives, the faster, better and longer-lasting effects can be achieved (by the way, this is one of the factors that affects the price of housing. The advantage when choosing is housing located at a certain distance from overly urbanized centers, such as one that has a localized ecologically and socially "clean" microenvironment, equipped with a health-friendly infrastructure).
Another important factor in the effectiveness of the FSLZH is the factor of the widest possible use of the partnership principle. This is one of the most important conditions for the successful implementation of FSLZH projects. The need for joint efforts of the widest possible range of specialists and supporters of FSLZH from various state, private and public structures, families, communities and communities is due to the very complex nature of the health phenomenon, which covers almost all aspects of life. The effectiveness of the use of partnership resources is clearly demonstrated by the implemented FSLZH projects. In particular, the experience of the USA, where special FSLZH projects have been developed, focused mainly on youth, is useful in this aspect. These projects are designed to positively influence the state of physical, mental, social, spiritual health of young people on the basis of partnership with various municipal, public, private, religious and other structures. Those who implement them seek to instill in the public consciousness the idea that any institutions (public, state, private) are able to effectively mobilize youth to become a useful part of society. Moreover, this is profitable work. For example, business flourishes only in those areas that are viable, and vice versa - no area will be viable without a successful business. In turn, the viability of the area, its future are largely determined by the state of youth, their desire (or indifference) for better development in the social, spiritual, mental and physical sense. Hence - the direct interest of business in supporting the development of youth. The partnership between business and youth is mutually beneficial - youth in business projects of its support acquire life and professional skills, and business establishes deeper and more productive relationships with the local community. This experience proves that when such relationships are strong, they can develop in unexpectedly interesting directions, useful for both business and community.
Naturally, such considerations apply not only to business structures, but also to state and public institutions. Thus, public youth institutions in a number of countries in some cases build their work on the ideological basis of evidence "from the opposite". For example, when the opinion prevails in the local community that youth, united in peer groups, are capable only of destructive actions, youth institutions initiate the orientation of youth informal groups towards socially useful activities. Of course, this requires a certain intervention strategy (ideological processing of leaders, granting youth groups certain rights and powers at the local level, material and technical means for useful actions. But, according to the activists of the FZZH, these efforts are beneficial. The initiators of the FZZH promote as a principle thesis that in all cases of partnership, the benefit is mutual, that is, both partners win. Working in the union, partners become stronger, their increased energy and ability to take positive actions objectively create a stronger and better community for all its residents.
Conclusions
1. The problem of health in its broad sense, both in the personal and social dimensions, has acquired a planetary significance in our time and is considered as one that poses a danger to the further development of humanity.
2. It is possible to avert the probable danger by forming a healthy lifestyle for individuals, communities, countries, and the world as a whole.
3. The formation of a healthy lifestyle is a complex, a multifaceted process that requires the joint efforts of as many people as possible, various organizations, and above all - the appropriate state policy. At the same time, the formation of a healthy lifestyle is a scientific and practical discipline with its own theory, methodology, techniques and means.
4. Knowledge and practical skills in the formation of a healthy lifestyle should be as widely distributed in society as possible, they should be guided by them when developing and making management decisions at all levels of all branches of government, all sectors of the public sector. It is also necessary to influence the private sector and public organizations by all means in the direction of monitoring, controlling, promoting and directing activities for the benefit of the health of the population.
5. The most effective way to embody the ideological values of health in the minds of the population is the initiation by state authorities and local self-government bodies of various local projects limited by local scales, in particular the scales of primary administrative-territorial structures and individual organizations. Such projects, if they are developed and implemented taking into account the main The provisions of the theory and practice of forming a healthy lifestyle can be quite effective, despite a certain lack of resources that exists in the world today.