**4. Health promotion and prevention**

Health promotion is a broad concept that looks beyond the treatment and cure of illnesses. It is a behavioral social science that looks into the biological, environmental, psychological, physical and medical sciences in order to promote health and aid in the prevention of diseases. Health promotion is effectively achieved when an individual, group, institution, or community actively engages in conversation in order to change the audience's perspective, attitude and behavior to health. Health promotion is critical due to the rippling effects it has on the improvement of overall health, reduction in premature deaths, and financial turmoil associated with medical costs for the patient and their employer. The goal of health promotion is to improve health for the individual, families, communities, cities, states and ultimately the nation. The World Health Organization (WHO) dissects health promotion into 3 elements, good governance of health, healthy cities and health literacy [51].

Good governance of health focuses on the political aspect of health promotion where local, state and federal governments play a role in their constituents' health. Ideally, the government should keep health as a main priority where they align their policies to benefit the health of its constituents. For example, these policies should focus on providing healthy school lunches for children, reducing air and water pollution, promoting exercise and general safety precautions. The WHO states when local government can focus on promoting healthy lifestyles at the municipal level it can create a healthy city with many resources. The cities can focus on community

health preventions and health facilities where the local population can be screened for chronic illnesses. Health literacy is having the knowledge and understanding on how to make good choices and engage in positive habits to avoid chronic illnesses [51]. It describes how efficiently a patient can understand and monitor their disease for changes.

Health literacy is important because through disease prevention and health promotion the patient can make rational decisions when caring for their own health. A cross-sectional questionnaire study investigated whether there was an association between health literacy and chronic retinal disease [52]. The study revealed the majority of the patients with chronic retinal disease had a low level of health literacy. Sixty- five percent of patients with AMD, 73% of diabetic macular edema patients, and 63% of patients with retinal vein occlusion were shown to have low levels of health literacy.

Consequently, a low level of health literacy also influences the prognosis of the chronic retinal disease considering these conditions require self-monitoring, self-medication and self-care [52]. For example, knowing the importance of taking prescribed medicines at the appropriate dosage and time, monitoring their condition with the assigned home equipment and knowing when it is pertinent to see their provider before their scheduled appointment if new symptoms arise. Health promotion plays a major role in health literacy since these patients will be better equipped to care for their disease if properly educated. Poor health literacy is associated with poorer prognosis such as patients with uncontrolled diabetes who develop diabetic retinopathy with potential damaging effects to the retina and vision [32, 33, 52]. Another example is a patient who continues to eat unhealthy foods causing inflammation in their system, lives a sedentary lifestyle and smokes cigarettes will be more at risk for progressing to advanced AMD which causes irreversible vision loss [52].

Chronic retinal diseases demand self-management from the patient, including self-monitoring and adhering to their providers' recommendations. If this care is not maintained, vision may be negative. In order for health promotion to be effective, it must be delivered in a way the patient can grasp and understand the information. Primary care providers need to be effective communicators, avid listeners and genuinely sympathize with patient concerns. Health promotion is founded on patient-centered care with the idea health involves more than just the illness. The overall health of an individual is influenced by factors outside the health care system [11]. These outside factors include socioeconomic conditions, patterns of food consumption, demographic patterns, learning environments, and family patterns [11]. To maximize patient outcomes, the health care provider should take into consideration and include the outside factors making up the identity of the patient in their management. This approach will ultimately allow the patient to have control of their health and have a sense of responsibility to maintain it.

Health promotion has been effectively implemented with communicable infectious diseases such as sexually transmitted diseases. For example, in targeting vulnerable communities, schools held seminars where they discuss safe sexual practices and the consequences of unprotected sex such as pregnancy and sexually transmitted diseases [11]. With the increasing trend of chronic non-communicable diseases, such as hypertension, type 2 diabetes mellitus and high cholesterol, health promotion has taken a larger role in attempting to combat these conditions. The increasing incidence of these chronic conditions can be due to the increasing availability of jobs where the employees primarily work sitting at a desk in front of a computer. This type of work environment can lead to a sedentary lifestyle which is worsened when coupled with poor eating habits. In a broader view, the economy also suffers due to the widespread sedentary lifestyles that ultimately lead to chronic illnesses [11].

*Health Promotion for AMD and the Role of Nutrition DOI: http://dx.doi.org/10.5772/intechopen.103835*

Other factors play a role in this health crisis such as poverty, low education and stress [11]. Consequently, these factors lead to increased risk of high blood pressure, high blood glucose, abnormal serum lipids, high waist-hip ratio, and abnormal lung function. These biological risk factors lead to chronic non-communicable diseases such as heart disease, stroke, cancer, and chronic lung disease. Therefore, health promotion is key to preventing and targeting established illnesses along with medical interventions to attain good health. Health is influenced by social, economic, political forces, cultural identities and discrepancies within communities that are more susceptible to chronic health conditions. These factors ultimately will influence the health of these vulnerable communities and their future. Thus, health promotion is vital in educating communities on the adverse effects of modifiable risk factors and the tools needed to prevent chronic conditions. An important factor of health promotion is that it allows the person to take control of their health by targeting the root of the problem that is exacerbating the illness.
