Primary Health

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Primary Health

• By Dr David Lee
• VUT - Sunbury
• 2001

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Defining Health Illness

• A number of factors that influence how we define
  health and illness
• 1. Community view common beliefs
• 2. Professional view scientific view
• 3. Religious view superstitious view
• 4. Time changes with time

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Defining Health Illness

• Naturalistic view
• Illness Disordered equilibrium/imbalance
• Such imbalances are caused by natural
  forces, e.g.
• extreme heat or cold
• strong emotions such as anger or fear

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Defining Health Illness

• Treatment
• work on the body to restore balance (yin-yang)
  through-
• Herbal remedies
• Change of diet

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Defining Health Illness

• Personalistic view
• Illness is resulted from intervention of an agent
  or entity and as an act of aggression against a
  particular individual
• e.g. an ancestor
• a ghost
• a person
• a witch

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Defining Health Illness

• Illness Not an accident
• Related to cosmology
• Treatment Identify the source of the
  malady
• Intervene to restore social and cosmic
  balance and harmony

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Defining Health Illness

• Scientific View (Medical Model)
• Health is the absence of disease
• The medical history, physical examination, and
  diagnostic tests provide the basis for the
  identification and treatment of a specific illness

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Defining Health Illness

• Medical model thus focused on the physical and
  biologic aspects of specific diseases and
  conditions
• Treatment 1. Diagnostic procedures
• 2. Conservatory intervention
• 3. Surgical intervention

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Defining Health Illness

• Current models of health care throughout the
  western world are being questioned
• Success in medicine in dealing with health
  problems are the result of something more than
  the application of medical knowledge or surgical
  intervention.

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PRIMARY HEALTH CARE

• If health is absence of disease then where and
  how do we deal with
• Chronically ill
• Disabled
• Elderly

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Models of Health

• Ecologic Model
• Health and environment are linked
• Environment has effect on our health

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Models of Health

• Role performance Model
• Healthy people fulfill work and family
  responsibilities
• Unhealthy - do not fulfill society roles
• e.g. unemployment and health

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Models of Health

• The adaptive model
• People adapt to their environment
• Illness failure in adapting
• Mental illness? Substance abuse?

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Models of Health

• Wellness Model
• Focuses on wellness
• Wellness environment society the person
• (the interaction or relationship of all 3
  contribute to ones wellness)

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PRIMARY HEALTH CARE

• Def
• It is a basic level of health care that includes
  programs directed at the promotion of health,
  early diagnosis of disease or disability, and
  prevention of disease

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PRIMARY HEALTH CARE

• 1948 - the World health Organisation (WHO) was
  formed (offshoot of United Nation)
• Purposes
• To promote global stability, establish human
  rights and foster social and economic
  development in the world
• Increase level of health for all

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PRIMARY HEALTH CARE

• Health is
• To be brought to everyone
• More than the absence of disease
• Depends on persons access to health care
• Social justice issues
• Health for all

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PRIMARY HEALTH CARE

• 1977 WHO declared Health for all by 2000
  (Alma-Ata Conference)
• 1978 called for radical change to delivery of
  care - equality

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Ideology of WHO

• Highlight the relationship between health and
  socioeconomic factors
• Importance of people working together
• PHC would be a means to achieving these goals

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PHC Promotes

• Illness care
• rehabilitation
• maternal/child health
• care of the elderly
• promotion of health
• prevention of illness
• self reliance

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PHC Promotes

• Community participation
• collaboration
• integration of health care services
• target groups
• use of technology

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PHC and Nursing

• CAN NURSES PRACTICE PHC?
• Nurses can
• Promote patient independence
• Health promotion / education
• Support alternatives to illness care
• Encourage family involvement
• Encourage community involvement

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PHC and Nursing

• Constraints
• Funding
• Medical dominance
• Task orientation
• Work-load / time
• Management
• Multi-level nursing hierarchy
• Legalities

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Health promotion and health education

• Prevention is better than cure
• Governments have developed programs that aim to
• Reduce the incidence of illness
• Promote good health in the community

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What is health education?

• Health education provides information about
  illness/disease and how to prevent it to
  individuals, groups and communities.

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What is health education?

• It also provides advice to those suffering from
  an illness/disease in order to promote as
  satisfactory a quality of life as possible

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What is health education?

• Through providing information, health education
  aims to facilitate voluntary actions conducive to
  health that is, it encourages people to alter
  their lifestyles or behaviours to produce
  healthier outcomes

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Health education programs

• QUIT
• aims to arm smokers with the knowledge of
  smokings effect on the lungs and cardiovascular
  system.
• It also contain information on support groups and
  useful strategies to help break the habit.

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Health education programs

• Safe sex campaign
• Informs the population of the likelihood of
  contracting AIDS or other sexually transmitted
  diseases via unprotected sex

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Health education programs

• The National Drug Offensive
• Aims to prepare teenagers for adulthood by
  encouraging a drug-free lifestyle

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Health education programs

• The National Heart Foundation
• Publishes information and holds seminars to
  educate the community on the need for a healthy
  diet and lifestyle.

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Health education programs

• The Asthma Foundation
• Promotes prompt treatment and encourages even
  occasional sufferers to seek assistance.
• It also encourages strategies to control the
  frequency and severity of attacks as opposed to
  only treating the acute stages

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Health education programs

• The National Mental Health Program
• Aims to reduce the social stigma associated with
  mental illness by specifically targeting
  schizophrenia

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Limitation of health education

• Narrow focus
• They focus on disease/illness prevention
  (immunisation programs etc), but may not
  acknowledge the socioeconomic factors that
  influence health in society

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Limitation of health education

• Dominance of the biomedical model
• The dominance of health care professionals in the
  production and dissemination of information may
  exclude or devalue many who are not recognised by
  the medical establishment eg. Homeopaths,
  osteopaths, natural therapists, nurses, mothers
  and self-help groups

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Limitation of health education

• Biomedical model forms the basis of funding
• education,
• research,
• strategies to improve health
• Neglect the broader social causes of ill health
  eg. Pollution, dispossession and cultural
  alienation (migrants and aboriginals)

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What is health promotion

• It is an approach to promote a healthy life
  style.
• It is the process of enabling people to increase
  control over, and to improve, their health.

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What is health promotion?

• Health promotion is a combination of
• Educational (health education)
• Environmental (social, political and economic)
• supports which are conducive to health

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What is health promotion?

• It addresses
• Illness or disease
• factors that influence the health of people eg.
• Poverty,
• Substance abuse,
• Racial intolerance etc

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Health promotion strategies

• Addressing issues identified in living
  environment
• (eg. Falls in old folks home)
• Educate and given the community control of all
  aspects of their health
• financial,
• information distribution
• Strategies employed and
• Methods of health care delivery including natural
  therapies

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Health promotion strategies

• Gender specific issues
• Womens health
• Children residential care
• Mens health

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Benefits of health promotion

• Health promotion addresses the underlying issues
  which may be affecting not only health but the
  individuals ability to access and act on
  information
• It addresses access and equity issues

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Benefits of health promotion

• It is health focused and is broader than the
  biomedical approach
• It empowers individual to make changes

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Benefits of health promotion

• It is more than disease prevention
• It encourages
• Education
• Community involvement
• Empowerment

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3 levels of health promotion

• Primary health promotion
• Precedes disease or dysfunction
• Narrow immunise children
• Broad increases access to affordable and
  appropriate child care facilitites

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3 levels of health promotion

• Secondary health promotion
• Halts the disease process and shortens the
  illness span.
• Early diagnosis breast screening programs

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3 levels of health promotion

• Tertiary health promotion
• Aims to restore the optimum level of function
  when disease is present.
• Stablisation
• rehabilitation

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Strength and Weakness of Existing Nursing
Education

• Becoming more holistic
• less loyalty to medical model
• Vs
• Nursing jargon
• Multi level nursing training and registration
• State differences
• Territorial e.g. ICU Vs general medical ward

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Strength of Nurses Attitudes and Values

• Non-discriminatory
• respect for the ill
• ability to care/nurture - art of nursing
• largest group in health care system
• can be united (1986 Vic strike)
• knows that a knowledge base is essential

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Weakness of Nurses Attitudes and Values

• Ignorance of PHC
• Apathy
• conservative / task orientated
• values - aligned to biomedical model
• low self esteem

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Health Education / Promotion

• Principle Prevention is better than cure
• Education provides advice to those suffering
  from illness e.g.
• Promotion advertise and selling the idea