Prevention of Illness

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Prevention of Illness

• Fundamental Concepts Part 2

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• (Larrabee's Law) Half of everything you hear in a
  classroom is crap. Education is figuring out
  which half is which.
• Akin's Laws of Spacecraft Design
• Dave Akin, Professor, University of Maryland

• Amen!
• Marions corollary

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Achieving HealthThe Evolution of an Idea

• Required readings by Smith and Young Higgins
  provide more discussion of this topic
• As long as humans have existed, they have
  attempted to explain why some people become ill,
  and others do not

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• Until the scientific revolution (18th century)
  these explanations involved complex interactions
  of
• Fate
• Climate
• Humours
• Astrological phenomenon
• Divine retribution

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Health as a Biomedical Construct

• Cartesian Revolution René Descartes (1596-1650)
• Associated with empiricism scientific method
• The belief that the mental and physical are
  deeply different in kind

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• Profound consequences for medicine health care
• Separation of mind body
• Conceptualization of body as a machine
• Primacy of bio-medicine

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• Disease the consequence of malfunctioning of the
  body
• Belief (hope) that each disease might have a
  specific etiology
• We have the technology . . . We can fix him.

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Health Wealth

• Relationship between health outcomes and
  socio-economic status also has been long known
• Explanations for this relationship vary

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• Theory of Natural Social Selection
• Healthy people upwardly mobile
• Unhealthy people downwardly mobile
• The sick are poor because they are sick

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• Materialist Theory
• Health inequities a consequence of material
  (economic) deprivation
• The poor are sick because they are poor

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Health Behaviour

• Cultural Behaviouralist Theory
• Health outcomes influenced by differences in
  knowledge, attitudes behaviour
• Emphasizes health education

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• Each theory suggests how the problem of health
  inequities should be solved
• Natural Social Selection
• Provide health care to the sick
• Examples?
• Implications

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• Materialist
• Provide financial security to all
• Examples?
• Implications?

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• Behavioural
• Change individual risky behaviours
• Examples?
• Implications?

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• More complex approaches to achieving health have
  also emerged
• Many originally focussed on the health care
  system
• Emphasized bio-medical approaches

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• Levels of Prevention Leavell Clark (1965)
• Primary Prevention
• Seeks to prevent disease occurrence
• Health promotion
• Specific protection

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• Secondary Prevention
• Seeks to identify disease early
• Screening
• Early disease detection
• Treatment

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• Tertiary Prevention
• Seeks to limit disability
• Rehabilitation
• Re-integration into society
• Proposed that primary prevention the major
  responsibility of community based health care

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• Canadians have had a profound impact on theory
  development in health promotion
• Lalonde A new perspective on the health of
  Canadians (1974)
• Context of report was the rising cost of health
  care in Canada

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• Health Field Concept
• Human health influenced by
• Human biology
• Environment
• Lifestyle
• Health care organizations

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• Least influential component was health care
• Argued for a fundamental re-structuring of
  Canadian society to promote health of Canadians

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• World Health Organization Alma Ata (1979)
• Health For All by 2000
• Concept of Primary Health Care PHC

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• PHC is essential care (promotive, preventive,
  curative, rehabilitative and supportive) focussed
  on preventing illness and promoting health
• Both a philosophy an approach to providing
  health care services

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• PHC values
• Social justice
• Equity in health

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• Five principles of PHC
• Accessibility
• Public participation
• Health promotion
• Appropriate technology
• Intersectoral cooperation

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• PHC targets the social, political economic
  determinants of health
• Primary care focuses on
• Individual access to health care
• Restructuring of health care system only
• Changing range of practitioners who are
  gatekeepers to the system

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• World Health Organization Ottawa Conference
  (1986)
• 1st International Conference on Health Promotion
• Ottawa Charter for Health Promotion (WHO)
• Defined health promotion
• the process of enabling people to increase
  control over, and to improve their health

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• Set out pre-requisites for health
• peace stable eco-system
• shelter sustainable resources
• education social justice
• food equity
• income

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• Health promotion actions
• Create supportive environments
• Strengthen community action
• Develop personal skills
• Reorient health services

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• Achieving Health For All A Framework for Health
  Promotion (HW Canada, 1986 The Epp Report)
• Health challenges
• Reducing inequities
• Increasing prevention
• Enhancing coping

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• Health promotion mechanisms
• Self care
• Mutual aid
• Healthy environments

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• Implementation strategies
• Fostering public participation
• Strengthening community health services
• Coordinating healthy public policy

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• Both reports set out the theoretical distinctions
  between illness prevention health promotion
• Conceptualized health care system with 4 spheres
  of activity
• Health Promotion Treatment
• Prevention of Illness Rehabilitation

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• Determinants of Health
• Further elaboration of Lalondes Health Field
• Many approaches to this idea exist
• Some are more bio-medical than others
• Many are embedded in larger theoretical
  frameworks

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• Population Health Model (Health Canada)
• Determinants of health
• Income social status
• Social support networks
• Education
• Employment working conditions

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• Physical environment
• Biology genetic endowment
• Personal health practices coping skills
• Healthy child development
• Health services

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• Winnipeg Regional Health Authority Population
  Health Assessment Framework
• Determinants of health
• Social environment
• Gender
• Culture
• Health services

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• Healthy child development
• Personal health practices coping skills
• Biology genetic endowment
• Physical environment
• Employment working condition
• Education
• Social support network
• Income social status

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• Toronto Charter (Raphael et al, 2004)
• Social determinants of health
• Early childhood development
• Education
• Employment working conditions
• Food security
• Health care services

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• Housing
• Income its equitable distribution
• Social exclusion
• Canadian women
• Aboriginal people
• Canadians of colour
• New Canadians

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• Social safety nets
• Unemployment job insecurity

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Community Health Nursing
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History of the Practice

• Important to understand origins of community
  health nursing
• What lessons can you drawn from the reading by
  McKay?

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Roles Standards of Practice

• Covered in detail in Chapter 4 of text
• Many forms of nursing are included under the
  general category of community health nurse
• public health nurse
• home health (home care) nurse
• community health centre/outreach nurse
• outpost/rural nurse

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• parish nurse
• occupational health nurse
• Some of these practices require specific
  certification

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• Definitions of public health nursing
• Canadian Public Health Association
• An art science
• Synthesizes public health nursing knowledge
• Goal to promote and preserve health of
  populations

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• American Public Health Association
• Directed to community or populations
• Concerned with environmental, social personal
  factors affecting health
• Targets resources to those at greatest risk

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• 4 client levels
• -individual
• -family
• -group
• -community
• At all 3 levels, ultimate goal is to change the
  health status of the community

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• Canadian standards of practice
• Promoting health
• Building individual/community capacity
• Building relationships
• Facilitating access equity
• Demonstrating professional responsibility
  accountability

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• Practice settings
• official public health agency
• clients home
• schools
• streets
• community health centres
• outposts
• churches
• worksites

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• Roles
• direct care provider advocate
• educator enabler
• supervisor/manager mediator
• researcher/evaluator facilitator
• disaster responder catalyst

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Disaster Nursing

• Three phases of a disaster
• Disaster preparedness
• The disaster
• Disaster recovery

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• Emergency management has 5 levels
• 1) the individual organization
• 2) local responders
• -fire, police, health care system
• 3) provincial response
• -usually under auspices of EMO

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• 4) national response
• -generated from appropriate federal agency
• 5) international response
• -WHO
• -UN
• this one isnt in the reading

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• Roles in disaster situations are unpredictable
• Some aspects of the experience, however, are
  predictable
• -more about that in the epidemiology class

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• Fundamental nursing responsibilities
• -promote health
• -prevent illness
• -restore health
• -alleviate suffering

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Future Trends/Challenges In Community Health
Nursing

• Greater theoretical underpinnings for the role
• More focus on health promotion
• More at-risk populations
• Increased community assessment for real
  potential health risks
• More complex patterns of client referral

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• More diversity in sites where services provided
• More capacity to respond to disasters other
  global threats to health
• Increase in communicable disease control
• Greater emphasis on culturally appropriate care