Different Levels of Health Promotion Essay
Compare and contrast the three different levels of health promotion (primary, secondary, tertiary). Discuss how the levels of prevention help determine educational needs for a patient.Different Levels of Health Promotion Essay
The three levels of health promotion include primary, secondary, and tertiary. All levels are equally important and key in preventing disease and providing starting points for health care providers to offer patients positive, effective change. All levels are important in nursing because nurses are able to take part in almost every step of the promotion. Within the three levels of promotion, there are five steps. These steps include “health promotion and specific protection (primary prevention); early diagnosis, prompt treatment, and disability limitation (secondary prevention); and restoration and rehabilitation (tertiary prevention)” (Edelman & Mandel, pg. 18).
Get Help With Your Essay
If you need assistance with writing your own essay, our professional essay writing service is here to help!
Primary prevention includes “health promotion and specific protection” (Edelman et al, pg. 18). In primary prevention, the main focus is to avoid the development of the disease and to focus on interventions to maintain a healthy life. “Its purpose is to [also] decrease the vulnerability of the individual or population to disease or dysfunction” (Edelman et al, p. 14). Nurses must do their part in encouraging preventative and appropriate interventions to improve patient health. Primary prevention also involves two further subdivisions that include health promotion and health protection. An example of health promotion would be educating a patient on their health or on nutrition. This type of promotion includes any type of education that would promote a healthy lifestyle. Health protection would be anything that would protect the patient from a disease. For example, health protection can include administering immunizations to reduce exposure the influenza virus this winter.Different Levels of Health Promotion Essay
Secondary prevention refers to activities like screening and early diagnosis that aid in treatment of the existing health problem, disease, or harmful situation. “Secondary prevention ranges from providing screening activities and treating early stages of disease to limiting disability by averting or delaying the consequences of advanced disease” (Edelman et al, p. 18). It is during secondary prevention when “early detection occurs in the window of time just before symptoms are apparent, which fosters early treatment and delays onset of more serious symptoms” (Murray, R., Zentner, J., Yakimo, p. 42). The difference between primary prevention and secondary prevention is simple. In primary prevention, the focus is more on how to prevent or decrease the probability of the disease or problem before it precedes and allots different suggestions to promote a healthy lifestyle. In secondary prevention however, the preventative methods are more focused on the actually screening and encourages early detection and treatment before a serious disease occurs.
Tertiary prevention is the last level of promotion that promotes health. “Tertiary prevention refers the person to optimum function or maintenance of life skills through long-term treatment and rehabilitation” (Murray et al, p. 42). This form of prevention involves treatment, rehabilitation, prompt treatment, and patient education. Usually, tertiary prevention is used when the disability or disease cannot be reversed or is permanent. This level of prevention is easier to look at more as treatment rather than prevention. At this point, the disease has already been established, and the main focus is to minimize the detrimental effects of the disease process and maintain optimal health. It is important that the nurse “ensure[s] that persons with disabilities receive services that enable them to live and work according to the resources that are still available to them” (Edelman et al, p 19). In primary and secondary prevention, the treatment is geared more towards preventing the actual disease and early diagnosis and detection. In tertiary treatment, the focus turns toward the reduction of any further complications once the disease process has already progressed. All three levels are equally important to prevent disease, but also have a key impact in health promotion in nursing.Different Levels of Health Promotion Essay
Health promotion and purpose for nursing
Health promotion is “behavior motivated by the person’s desire to increase well-being and health potential” (Murray et al pg. 42). Individually, patients must find that motivation to ensure and attain optimal health. Nurses, as well as many other health care providers play an important role in motivating and encouraging patients to maintain and strive towards better health. Here is where nurses can use all skills learned to use primary, secondary, and tertiary prevention to encourage healthy lifestyles.
Nursing roles and responsibilities
The role of the nurse in health care promotion can be demanding, and tiresome, but in the end is simply gratifying. Nurses must take on many different roles to ensure that the patients are promoting and maximizing they health. These roles may include: educator, advocate, provider of care, researcher, care manager, and consultant. By incorporating all these different roles, nurses teach people how to remain healthy. “Nurses must have an evidence-based understanding of the significant effect that can be made through health promotion interventions and communicate this understanding to the public at large” (Murray et al, pg.42). The goal is for people to become more aware of lifestyle changes that can consequently worsen their health status and make the lifestyle changes to maintain a healthier lifestyle.Different Levels of Health Promotion Essay
Nurses can assist in promoting health in many different ways. Nurses are the educators in providing patients and their families with the proper resources to maintain a healthy life. Whether it means teaching on nutrition, immunizations, or diseases, nurses provide most of the teaching. Nurses can also be advocators by making sure the patient is receiving what they are entitled to in the health care system and from their provider. The nurse is to “go to” person when the provider is not available. Nurses also aid in providing the delivery of care, consulting the patient when any problem exists, and researching and relaying message to the provider when a problem or question exists. For example, in Healthy People 2010, nurses must take on the role in all of these situations to promote a healthier, better lifestyle.
Find out how NursingAnswers.net can help you!
Our nursing and healthcare experts are ready and waiting to assist with any writing project you may have, from simple essay plans, through to full nursing dissertations.Different Levels of Health Promotion Essay
Implementation methods for health promotion
In order to implement health promotion, nurses are taught to properly find alternative methods that personalize every patient in contact with their delivery of care. Not all forms of health promotion are done by the bedside nurse, but can also be encompassed by the clinic nurse and the community nurses. These levels of promotion can be brought on by the clinic and community nurse by offering different presentations regarding what is directly affecting the specific community. By involving the community in different methods of health care promotion and prevention, the nurse is doing his/her part to assist in primary and secondary promotion. Then, if the assistance is needed, tertiary prevention can be used. The nurse must learn to encompass and become familiar with every aspect of prevention and promotion in order to do his/her part in preventing and promoting healthier lifestyles. In order to facilitate and accommodate to patients needs, evidence based practice is key. There are many articles that can justify and help solidify the need for prevention and promoting in patient lifestyles.
Compares the three levels of health promotion prevention
The article that I found from the Grand Canyon University Library discussing primary prevention is called Opportunities for the Primary Prevention of Obesity during Infancy. This article discusses the opportunities that physicians have to decrease and prevent obesity during infancy. The article proved that through “early intervention and prevention, great promise [holds] for interrupting the vicious cycle of obese children becoming obese adults who subsequently have obese offspring themselves” (Paul, Bartok, Downs, Stifter, Ventura, and Birch). Evidenced proved that if providers instructed parents on different strategies to promote healthy behaviors, that the infants will have long lasting obesity preventive effects. By using primary prevention, obesity during infancy and possibly throughout the lifetime may be decreased by primary intervention.Different Levels of Health Promotion Essay This article would be beneficial to nursing practice because throughout pregnancy, nurses would be able to show how vital it is to continue to maintain and continue to show healthy eating habits to pregnant mothers and their children to potentially avoid obesity and other health problems for the child.
The second article that I found from the Grand Canyon University Library discussing secondary prevention was called Running nurse-led secondary prevention clinics for coronary heart disease in primary care: qualitative study of health professionals’ perspective. This article was based on a nurse led trial that used secondary prevention to improve coronary heart disease and lower all-cause mortality during a four year follow up. This article emphasized on how this clinic was run by nurses and whether or not it was effective. Studies showed how it was viewed “positively by most healthcare professionals that had been involved in running them, but barriers to their implementation had led most to stop running them at some point” (Campbell & Murcia). It also proved that although it might have been effective, many of variables interrupted in proving the study effective. Issues like lack of space and staff shortages, funding training, and communication arose within the practice and eventually ended the study. The study still showed how effective the nurses ran the clinic and seemed to be able to do their part in preventing and lowering the occurrence of coronary heart diseases.Different Levels of Health Promotion Essay
The third article I found in the Grand Canyon University Library on tertiary prevention is called Applying epidemiologic concepts of primary, secondary, and tertiary prevention to the elimination of racial disparities in asthma. This article emphasized the importance in prevention in asthma. It stated that the “primary prevention targets reductions in asthma incidence; secondary prevention is the mitigation of established disease and involves disease detection, management, and control; and tertiary prevention is the reduction of complications caused by severe disease,” (Joseph, Williams, Own by, Saltzgaber, and Johnson). This article is good because it is able to illustrate all of the effects of proper primary, secondary, and tertiary prevention. The article showed how by managing, and understanding the disease, “changes that could reduce asthma morbidity in US minorities and ultimately mitigate disparities” (Joseph, et al).Different Levels of Health Promotion Essay
This purpose of this paper was to inform the reader of the different levels of health promotion and the role that nurses must play in encouraging this care. Nurses can do their part in promoting a healthier lifestyle for their patients by using alternative methods of prevention. Primary prevention involves health promotion and protection, secondary prevention involves screening and early diagnosis, and tertiary prevention focuses on treating the actual disease and preventing any further complications. It is important for nurses to understand that the role they play on patient health care is vital. Patients rely on nurses to help alleviate and advocate for them when any sort of ailment or sickness occurs. In order for nurses to promote health they must become familiar with the different ways of helping to prevent and promote healthier lifestyles. The articles that were chosen in this article illustrated the different positive effects of prevention and the different ways nurses and health care providers can promote a healthier lifestyle.Different Levels of Health Promotion Essay
Primary, secondary and tertiary levels of Health Promotion
In excess of ten years, health promotion and prevention has been the main focus of healthcare professionals in general, but nurses in particular. Health promotion is “the art and science of helping people discover the synergies between their core passions and optimal health, enhancing their motivation to strive for optimal health and supporting them in changing their lifestyle to move toward a state of optimal health (Edelman & Mandle, 2010, p. 14). Basically it is saying that it is the approach used to augment a sense of health in addition to reducing occurrences of…show more content…
In conjunction, there are a few coincidental interventions of the previous health promotion in which nurses dispense knowledge relating to diseases and how to avoid aggravation. The main characteristic is that this populace has previously had the illness and requires aid in decreasing exacerbations of said illness or disease. As an illustration, it is secondary to “help individuals who use tobacco with successful cessation” to prevent lungs, heart and pregnancy complications (Tingen, Andrew & Stevenson, 2010, p. 182). As far as senior, or elder, abuse is concerned, neighborhood nurses are amid the earliest ones to recognize the episode as a result of continual residential visits. When elder abuse is suspected, the nurse corroborates this with the appropriate screening tools like Indicators of Abuse Screen and the Hwalek-Sengstock Elder Abuse Screening Test (Phelan, 2010). Subsequently, it is occasion to designate an acceptable organization for safety and treatment (Phelan, 2010).Different Levels of Health Promotion Essay
This assignment proposes to discuss the role of the nurse in health promotion. To facilitate the discussion in the delivery of primary, secondary and tertiary levels of health promotion, the health risk of tobacco smoking in relation to Lung Cancer has been chosen. National policies will be explored in relation to smoking and how these influence the delivery of health promotion by the nurse. The barriers to health promotion will be identified along with ways in which these may be overcome.
The intention of the World Health Organisation (WHO) to achieve “Health for All” by the year 2000 was published in their Ottawa Charter, the outcome of which was to build healthy public policy, create supportive environments, strengthen communities, develop personal skills and reorient health services. They identified key factors which can hinder or be conducive to health; political, economic, social, cultural, environmental, behavioural, and biological (WHO 1986).Different Levels of Health Promotion Essay
The current health agenda for the UK aims to improve the health of the population and reduce inequalities with particular emphasis on prevention and targeting the number of people who smoke (DH 2010).
Inequalities in health have been extensively researched and although attempts have been made to overcome these, there is evidence to support that the divide between the rich and the poor still exists in society. Marmot (2010) highlighted the lower social classes had the poorest health and identified social factors such as low income and deprivation as the root causes which affect health and well being. Increased smoking levels were found to be more prevalent in this cohort. Bilton et al (2002) suggests the environment an individual lives in can have an adverse effect on health in that it can influence patterns of behaviour. For example, families living in poor housing conditions, in poverty or in an environment away from a social support network can suffer psychological stress; which in turn can prompt coping behaviours such as tobacco smoking (Blackburn 1991, Denny & Earle 2005).Different Levels of Health Promotion Essay
Smoking is a modifiable risk factor to chronic disease such as Cancer of the Lung, with 90% of these cases being the result of smoking (Cancer Research UK 2009) it is the single biggest preventable cause of premature death and illness and is more detrimental to the poorer in society. Responsible for 80,000 lives per year, the huge financial burden on the NHS to treat illness associated with smoking is estimated at £2.7 billion each year (DH 2010). This illustrates the huge opportunity for public health to address the wider issues associated with inequalities and to target people who smoke. Various White papers have demonstrated the Government’s commitment in reducing smoking figures and preventing uptake, both at individual and population levels, through health promotion activity, empowering individuals and enabling them to make healthier lifestyle choices (DH 2004, DH 2006, DH 2010).Different Levels of Health Promotion Essay
Health promotion is a complex activity and is difficult to define. Davies and Macdowall (2006) describe health promotion as “any strategy or intervention that is designed to improve the health of individuals and its population”. However perhaps one of the most recognised definitions is that of the World Health Organisation’s who describes health promotion as “a process of enabling people to increase control over their health and its determinants, and thereby improve their health (WHO 1986).
If we look at this in relation to the nurse’s role in smoking cessation and giving advice to a patient, this can be seen as a positive concept in that with the availability of information together with support, the patient is then able to make an informed decision, thus creating empowerment and an element of self control. Bright (1997) supports this notion suggesting that empowerment is created when accurate information and knowledgeable advice is given, thus aiding the development of personal skills and self esteem.Different Levels of Health Promotion Essay
A vital component of health promotion is health education which aims to change behaviour by providing people with the knowledge and skills they require to make healthier decisions and enable them to fulfil their potential. Healthy Lives Healthy People (2010) highlight the vital role nurses play in the delivery of health promotion with particular attention on prevention at primary and secondary levels. Nurses have a wealth of skills and knowledge and use this knowledge to empower people to make lifestyle changes and choices. This encourages people to take charge of their own health and to increase feelings of personal autonomy (Christensen 2006). Smoking is one of the biggest threats to public health, therefore nurses are in a prime position to help people to quit by offering encouragement, provide information and refer to smoking cessation services.
There are various approaches to health promotion, each approach has a different aim but all share the same desired goal, to promote good health and prevent or avoid ill health (Peate 2006). The medical approach contains three levels of prevention as highlighted by Naidoo and Wills (2000), primary, secondary and tertiary prevention.Different Levels of Health Promotion Essay
Primary health promotion aims to reduce the exposure to the causes and risk factors of illness in order to prevent the onset of disease (Tones & Green 2004). In this respect it is the abstinence of smoking and preventing the uptake through health education and preventative measures. One such model of prevention is that of Tannahill’s (1990) which consists of three overlapping circles; health education for example a nurse may be involved in the distribution of leaflets educating individuals or a wider community regarding health risks of smoking, prevention, aimed at reducing the exposure to children, for example, in 2007 the legal age for tobacco sales increased from age 16 to 18 years in an attempt to reduce the availability to young people and prevent them from starting to smoke (DH 2008), health protection such as lobbying for a ban on smoking in public places.
If we look at this in relation to the role of the school nurse, this is a positive step when implementing school policies such as no smoking on school premises for staff and visitors, as this legislation supports the nurse’s role when providing information regarding the legal aspects of smoking. Research demonstrates that interventions are most effective when combined with strategies such as mass media and government legislation (Edwards 2010). Having an awareness of such campaigns and legislation is essential to aid best practice and the nurse must ensure that knowledge and skills are regularly updated, a standard set by the Nursing and Midwifery Council (NMC 2008).Different Levels of Health Promotion Essay
Croghan & Voogd (2009) identify the school nurse’s role as essential in the health and well-being of children in preventing smoking. Many people begin to smoke as children, the earlier smoking is initiated, the harder the habit is to break (ASH) and this unhealthy behaviour can advance into adulthood. Current statistics illustrate that in 2009 6% of children aged 11-15 years were regular smokers (Office for National Statistics 2009). These figures demonstrate the importance of prevention and intervention at an early stage as identified by the National Service Framework (NSF) for Children, Young People and Maternity Services (DH 2004). Smith (2009) highlights the school nurse as being in an advantageous position to address issues such as smoking and suggests that by empowering children by providing support and advice, this will enable them to adopt healthy lifestyles.
NICE (2010) suggest school based interventions to prevent children smoking aimed at improving self esteem and resisting peer pressure, with information on the legal, economic and social aspects of smoking and the harmful effects to health. Walker et al (2006) argue self esteem is determined by childhood experiences and people with a low self esteem are more likely to conform to behaviours of other people. This can be a potential barrier in the successful delivery of health promotion at this level, with young children exposed to pressure to conform; they are more likely to take up unhealthy behaviours such as smoking (Parrott 2004). The nurse can overcome this by working in partnership with teachers and other staff members to promote self-esteem by ensuring an environment conducive to learning, free from disruptive behaviour which promotes autonomy, motivation, problem solving skills and encourages self-worth (NICE 2009).Different Levels of Health Promotion Essay
Despite the well known health risks to tobacco smoking, unfortunately 1 in 5 individuals continue to smoke (DH 2010). Whitehead (2001) cited in Davies (2006) argues the nurse must recognise and understand health related behaviour in order to promote health. Therefore, when delivering health promotion the nurse needs to be aware of all the factors which can affect health, some of which can be beyond individual control. Smoking cessation is one of the most important steps a person can make to improve their health and increase life expectancy, as smokers live on average 8 years less than non smokers (Roddy & Ross 2007).
Secondary prevention intends to shorten episodes of illness and prevent the progression of ill health through early diagnosis and treatment (Naidoo & Wills 2000). This can be directed towards the role of the practice nurse in a Primary Care setting, where patients attend for treatment and advice that have symptoms of illness or disease as a result of smoking, such as Bronchitis. Nice guidelines (2006) recommend that all individuals who come into contact with health professionals should be advised to cease smoking, unless there are exceptional circumstances where this would not be appropriate, and for those who do not wish to stop, smoking status should be recorded and reviewed once a year. It is therefore essential the nurse maintains accurate and up to date record keeping.Different Levels of Health Promotion Essay
Smoking cessation advice can be tailored to the specific individual and therefore it is important that the nurse has the knowledge and counselling skills for this to be effective. The process of any nursing intervention is ultimately assessment, planning, implementing and evaluating (Yura & Walsh 1978), this applies to all nurses in any given situation including health promotion. One such method of smoking cessation which can be used as an assessment tool is known as the 5 ‘A’s approach, ‘ask, assess, advise, assist, arrange’ (Britton 2004). “Ask” about tobacco use, for example how many cigarettes are smoked each day, and “assess” willingness and motivation to quit, taking a detailed history to assess addiction. Objective data can be obtained using a Smokerlyser which measures Carbon Monoxide levels in expired air (Wells & Lusignan 2003). These simple devices can be used as a motivational tool to encourage cessation and abstinence. Castledine (2007) suggests the principle of a good health promoter is to motivate people to enable them to make healthier choices; this is made possible by the ability to engage with individuals at all levels. Individuals who are not motivated are unlikely to succeed (Naidoo & Wills 2000). “Advise” patients to stop smoking and reinforce the health benefits to quitting, “assist” the patient to stop, setting a quit date and discussing ways in which nicotine withdrawal can be overcome. Being unable to cope with the physical symptoms of withdrawal can cause relapse and be a barrier to success, therefore it is essential the nurse possesses a good knowledge base of the products available to assist in reducing these symptoms if she is to persuade people to comply with treatment, such as the use of nicotine replacement therapy (NRT). NRT is useful in assisting people to stop smoking and has proved, in some instances to double the success rate (Upton & Thirlaway 2010). NRT products are continually changed and updated; therefore the nurse must ensure she has the knowledge and skills to identify which products are available, the suitability, how it works and any potential side effects. Identifying triggers and developing coping strategies is useful for maintenance of a new behaviour, measures such as substituting cigarettes for chewing gum and changing habits and routines are just some of the ways in which self control can be achieved (Ewles & Simnett 1999). Finally “arrange” a follow up, providing continual support and engagement. For patients who do not wish to stop smoking, advice should be given with encouragement to seek early medical treatment on detection of any signs and symptoms of disease. Good communication skills are essential to the therapeutic relationship between the nurse and a patient and these must be used effectively by providing clear, accurate and up to date information. The nurse should be an active listener and encourage the patient to talk, using open-ended questions helps demonstrate a willingness to listen, listening and showing concern for a patient’s condition demonstrates respect (Peate 2006).Different Levels of Health Promotion Essay The use of medical jargon and unfamiliar words can be a barrier to communication and should be avoided as these can affect a patients understanding. Leaflets can reinforce information provided by the nurse and increase patient knowledge, however the nurse must ensure these are in a format and language the patient can understand. Lack of literacy skills can prevent a patient reading and understanding the content of a leaflet, the nurse can assist with this by reading and explaining to them.
To assist in the assessment process the nurse may utilise a model of behaviour such as Prochaska & DiClemente’s stages of change model (1984). This works on the assumption that individuals go through a number of stages in order to change behaviour, from pre -contemplation where a person has not considered a behaviour change, to maintenance, when a healthier lifestyle has been adopted by the new behaviour. The stage a person is at will determine the intervention given by the nurse; therefore it is essential that an effective assessment takes place. Walsh (2002) highlights patient motivation as central to success using this model, in that a patient will have more motivation; the more involved they are in planning the change.Different Levels of Health Promotion Essay
Despite the health promoting activities mentioned and the increasing public awareness of the health risks to smoking, there are people who continue to smoke and some further develop illness as a consequence. Lung cancer has one of the lowest survival rates, and as little as 7% of men and 9% of women in England and Wales will live five years after diagnosis (Cancer Research UK 2011). Acknowledging this, the governments “Cancer Plan” aimed to tackle and reform cancer care in England by raising awareness of the signs and symptoms of cancer by investing in staff and extending the nurses role (DH 2000). This involves further training and education for nurses to develop their skills and knowledge to enable them to provide the treatment and/or advice required. This was succeeded by “Improving outcomes: a strategy for cancer” the aim being to enable patients living with cancer a “healthy life as possible”. The government pledged £10.75 million into advertising a “signs and symptoms” campaign to raise awareness of the three cancers accounting for the most deaths, breast, bowel and lung, to encourage the public to seek early help on detection of any symptoms (DH 2011). Currently no results are available on the effectiveness of this intervention due to its recent publication, however, one national policy that has had a positive effect on the health of individuals and the population is that of the “smoke-free England” policy implemented in 2007 prohibiting smoking in workplaces and enclosed public places. Primarily this policy was enforced to protect the public from second hand smoke; however, on introduction of the law smoking cessation services saw an increase in demand by 20%, as smokers felt the environment was conducive to them being able to quit (DH 2008). This policy also extended to hospital grounds, and the nurse must ensure a patient who smokes is aware of this on admission and use every opportunity possible to promote health.Different Levels of Health Promotion Essay
Tertiary prevention aims to halt the progression, or reduce the complications, of established disease by effective treatment or rehabilitation (Tones & Green 2004). A diagnosis of cancer can cause great distress and a patient may go through a whole host of emotions. Naidoo and Wills (2000) suggest the aim of tertiary prevention is to reduce suffering and concerns helping people to cope with their illness. The community nurses role has been identified as pivotal in providing support for patients and families living with cancer (DH 2000). The World Health Organisation describe Palliative care as treatment to relieve, rather than cure, the symptoms caused by cancer, and suggest palliative care can provide relief from physical, psychosocial and spiritual problems in over 90% of cancer patients (WHO 2011).
Assessment and the provision of health education and information at this stage remains the same as that in secondary prevention, and it is not uncommon for the two to overlap. Providing advice and education on symptom control may alleviate some of the symptoms the patient experiences, for example breathlessness is a symptom of lung cancer (Lakasing & Tester 2006), and relaxation techniques may reduce this (Cancer Research UK 2011), therefore the nurse may be involved in teaching these techniques to the patient and family members. Continual smoking despite a lung cancer diagnosis can exacerbate shortness of breath and reduce survival rate (Roddy & Ross 2007), therefore the nurse can use this opportunity to reinforce the risks of smoking. However, the nurse must use her judgement effectively and be sensitive to the patient’s condition, as the willingness to learn and respond to teaching can be affected by emotional state (Walsh 2002). Establishing effective pain control is essential in the care of a cancer patient and this may involve discussion with the patients GP if medication needs adjusting. A referral to specialist help lines such as those provided by Macmillan cancer support may be useful in assisting a patient and/or family to cope with cancer, these services can be accessed in person or by telephone. These are just two examples of collaborative working and demonstrate the importance of inter-professional working.Different Levels of Health Promotion Essay
In conclusion, with the emphasis of health promotion concerning prevention of illness and disease, the role of the nurse is essential in raising awareness and providing education and advice to individuals to facilitate behaviour change. The complexities of health promotion indicate the extensive competences a nurse must possess to empower and motivate individuals. However, governments also have a responsibility to promote and protect health and are pivotal in introducing national policy to build “healthy publics” and environments conducive to health. Different Levels of Health Promotion Essay
Use the following coupon code :