To be most successful, public health interventions need to address all the direct and indirect influences on children’s’ and young people’s health and take action on many fronts including public policy, local communities and families, and children themselves.
There is evidence that multi-factorial interventions with coordinated inputs at national and local community levels are more effective than interventions at one level only, because they recognize the complex interactions of the individual, social, economic and environmental factors that influence people’s behaviors.
Availability of relevant and reliable data on the target population
Reliable, relevant data are needed to judge the success of any program. Data collection is the starting point to knowing whether, at population level, a health promotion intervention should be instituted and whether it is effective. Such data collection needs to be at the national and regional or local level to assess epidemiological prevalence, political willingness, health-system capacity and community preferences. The indicators to be used should be scientific, robust and comparable.
As already stated, socio-economic factors are the major determinants of health in children, young people and adults. They have a profound effect on both mortality and morbidity ranging from birth defects through many childhood diseases, health-related behaviors and life expectancy. Socioeconomic conditions have to be taken into account when implementing any public health intervention because if the population is of high economic status then the prevalence of a given health problem may already be low and the intervention may not reach a significant level of benefit. If, however, the population is of low economic status the intervention may have a more significant effect.
There are many ways in which poverty affects health, including unemployment, debt, resources and fuel poverty, poor housing, environment, nutrition and education, and psychosocial effects such as social exclusion and feelings of powerlessness and deficits in social support and social capital, services access, availability and use. It appears that poverty can exert a negative influence on the development and intellectual aspects of children’s health independently of the educational levels of the parents. Research indicates a clear association between parental education – particularly maternal – and health outcomes in children in developed countries.
Education is not only associated with greater earning capacity, but also with enhances of self esteem and confidence. Although most developed countries tend to have high levels of literacy there are also marked variations in the availability of education across all social and gender groups. Poverty itself would seem to have a direct effect on child health through loss of self esteem and increased chances of mental illness. Other possible effects include iron-deficiency anaemia, suboptimal maternal nutrition influencing embryonic growth of the foetus.
Governmental policies and programs (national and local) will have an effect on the levels of poverty and socio-economic inequality within the population. In the field of nutrition for instance, research shows that among low-income families affordability was the most important factor in food choice. Further, other research studies suggest that low income not only restricts the ability to buy foods rich in protective nutrients, but it also limits access to the shops where healthy foods may be purchased more cheaply. Political support in terms of resources and public support for specific public health interventions are both crucial to their success. The willingness of governments not only to enact legislation concerning public health matters (for example, safety belts use) but to ensure that such legislation is enforced is important (for example, if no resources are provided to enforce the law and monitor the wearing of safety belts then the intervention may not be effective). Furthermore, governments can have a profound effect on health interventions via pricing and taxation policies and these can be effective for reducing both alcohol and tobacco use and there is evidence that such measures may be more effective than educational policies
National and health system factors
Within each country there is a need to consider how to adapt a public health intervention to local needs, for example, how far regional needs in child health should be taken into account at the national level, or how resources are redirected to prevention programs with a high political profile for example, AIDS prevention programs. Other national factors include the degree of development and organization of a country’s health system (national systems versus local private systems); its health system strengths, weaknesses, infrastructure, current coverage and utilization; health care seeking patterns influenced by socioeconomic and cultural factors; the various financing options, and human and financial resources; the human and other resources available; the acceptability and availability of non-governmental resources.
Mass media programs
There is some evidence for the effectiveness of mass media advertising programs. The education of the population, the duration over which the programs are delivered and their intensity all appear to be important factors, as well as the credibility of the source of the information.
School health education
Health education in schools has been used extensively in health promotion programs because of a perceived ease of access to large populations of young people. However, by itself, such promotions have been shown to have little effect on outcomes in many areas. For example, research indicates little evidence of effectiveness of such programs in reducing smoking uptake.
Therefore, in many European countries there has been a move away from dealing with single-issue interventions towards programs teaching young people social skills for handling pressure to smoke, drink, take illegal drugs, etc. At present, the evidence for the effectiveness of the programs is scarce, mostly because of lack of appropriate research.
Poverty and socio-economic inequalities remain the greatest barriers to health in children, young people and adults. Many public health interventions are targeted at the health and development of children and young people because of the potential for quality life-years to be saved. The evidence about the effectiveness of such interventions is variable and needs to be critically examined as some may not be generalized or sustainable. Interventions carried out or supported by governments are more likely to be successful, as are multi-factorial interventions. When generalizing an intervention found to be effective under specific conditions, a number of target-population factors should be taken into account, including the socioeconomic and political circumstances, the degree of government support that can be expected, culture and religion, and type of health service delivery system.