HEALTH CARE STRATEGIES HEALTH CARE SERVICES HEALTH PROMOTION ILLNESS PREVENTION DIAGNOSIS AND TREATMENT REHABILITATION HEALTH

ALTH CARE SERVICES 1. HEALTH PROMOTION - designed to: reduce risk of illness maintain maximal function promote good health habits Examples Prenatal nutrition classes Exercise classes Stress management classes 2. ILLNESS PREVENTION -designed: to reduce risk factors in an effort to avoid - primary, secondary or tertiary health prevention Examples No Smoking Programs Controlling the breeding of insects Education programs on AIDS prevention Immunization Immunization Schedule The following schedule is to be used in order to provide maximal immunity to the seven Expanded Program on Immunization (EPI) diseases before a childs first birthday.

VACCINE BCG

MIN. AGE AT
ST

NO. OF DOSES 1

1 DOSE Birth or any time after birth

MIN. INTERVAL BETWEEN DOSES

REASONS BCG given at the earliest possible age protects against the possibility of infection from other family members An early start with DPT reduces the chance of severe pertussis

DPT

6 weeks

4 weeks

VACCINE

MIN. AGE AT
ST

1 DOSE OPV 6 weeks

NO. OF DOSES

MIN. INTERVAL BETWEEN DOSES

REASONS

4 weeks

The extent of protection against polio is increased the earlier the OPV is given

Hepatitis B

6 weeks

4 weeks

An early start of Hepatitis B reduces the chance of being infected and becoming a carrier At least 80% of measles can be prevented by immunization at this age

Measles

9 months

3.

DIAGNOSIS AND TREATMENT Commonly used services of health care Usually sought once a person feels ill or a problem is indicated Examples Teaching about breast self-breast examination (early diagnosis) Vision-screening programs at schools Treatments provided in any health care setting

4. REHABILITATION - Restoration of a person to their: highest level of functioning maximizing abilities and independence Programs have extended beyond helping those with illness or injuries to the nervous system Rehabilitation programs Cardiovascular Pulmonary Chemical-induced impairments Involves the patient, family, and the entire health team - individualize a rehabilitation program for the patient Provided in various settings like: - hospital, home, healthcare home, outpatient setting HEALTH PROMOTION An approach and philosophy of care which: reflect awareness of the multiplicity of factors affect health and which encourages everyone to value independence and individual choice (Wilson Barnett 1993) Health promotion is basically an - activity in the health and social fields - not a medical service

FIVE KEY PRINCIPLES FOR HEALTH PROMOTION (WHO)

1. It involves the whole population in the context of their everyday life, rather than focusing on people at risk for specific diseases. 2. Its action is directed toward the causes or determinants of health to ensure that the total environment which is beyond the control of individual is conducive to health 3. It combines diverse, but complementary methods or approaches Communication Education Legislation Fiscal measures Organizational change Community development Spontaneous local activities against health hazards 4. It aims particularly at effective public participation - supporting the principle of self-help movements and encouraging people to find their own ways of managing the health of their community 5. Health professionals -particularly in primary health care have - an important role in nurturing and enabling health promotion THREE WAYS IN WHICH PRACTITIONERS PROMOTE HEALTH (WHO) ADVOCACY ENABLEMENT MEDIATION 1. ADVOCACY Represents the interest of disadvantaged groups and may mean speaking on their behalf lobbying to influence policy Example Evidence on individual and community health needs should be collected health promoters should work to empower the people - to negotiate changes in their personal environment and their right to health 2. ENABLEMENT Health promoters should act as catalyst/medium and give control to the community - to ensure equal opportunities to enable all people to achieve their full health potential 3. MEDIATION Health promotion requires coordination and cooperation by many agencies and sectors Health promoters mediate between different interests By providing evidence and advice to local groups By influencing local and national policy through lobbying, media campaigns and participation in working groups HEALTH PROMOTION Includes increasing individual knowledge Functions of the body and ways of preventing illness Raising competence in using the health care system Raising awareness about the political and environment factors that influence health Encompasses/includes interventions which differ in aims and purposes and in the role accorded to the practitioner Set of activities clearly intended - to prevent disease and ill health - to educate people to a healthier lifestyle Encompasses interventions which differ in aims and purposes and in the role accorded to the practitioner

To address the wider social and environmental factors which influence peoples health Encompasses interventions which differ in aims and purposes and in the role accorded to the practitioner Set of principles - to orient health workers towards addressing inequality and promoting collaboration and participation

APPROACHES OF HEALTH PROMOTION Model of health promotion attempts - to delineate/explain a contested field of activity - show how different priorities and strategies reflect different underlying values APPROACHES OF HEALTH PROMOTION THE MEDICAL APPROACH BEHAVIOR CHANGE THE EDUCATIONAL APPROACH EMPOWERMENT SOCIAL CHANGE 1. THE MEDICAL APPROACH a. Focuses on activity - to reduce morbidity and premature mortality b. It seeks to increase medical interventions - prevent ill-health and premature death c. Portrayed as having three levels of interventions PRIMARY INTERVENTION Prevention of the onset of disease through risk education Immunization Non-smoking campaigns SECONDARY INTERVENTION Preventing the progressing of disease Screening and other methods of early diagnosis TERTIARY INTERVENTION Reducing further disability and suffering in those already ill Preventing recurrences of an illness Rehabilitation, patient education, palliative/soothing care 2. BEHAVIOR CHANGE Adopt healthy behaviors - the key to improved health Make real improvements to their health - by choosing to change their lifestyle Complex relationship between individual behavior and social and environment factors Response to the condition in which people live and the causes of these conditions Unemployment Poverty 3. THE EDUCATIONAL APPROACH Provide knowledge and information Develop the necessary skills so that people can make an informed choice about their health behavior Based on a set of assumptions about the relationship between knowledge and behavior By increasing knowledge, there will be a change in attitude which may lead to changes in behavior

PSYCHOLOGICAL THEORIES OF LEARNING INVOLVES THREE ASPECTS Cognitive (information and understanding)

Affective (attitudes and feelings) Behavioral (skills)

4. EMPOWERMENT Helps people to identify their own concerns and gain the skills and confidence to act upon them Community empowerment Promote health through groups of people by identifying their concerns and working with them to plan a program of action 5. SOCIAL CHANGE Referred to as radical health promotion Acknowledges the importance of the socio-economic environment in determining health Its focus is at the policy of environmental level Aims to bring about changes in the physical, social and economic environment which will have the effect of promoting health

THE NEED FOR PHILOSOPHY OF HEALTH PROMOTION Health promotion involves decisions and choices that affect other people which require judgment to be made about whether particular courses of action are right or wrong Philosophical debate helps to clarify what it is that one believes is most and how one wants to run ones life THREE MAIN BRANCHES OF PHILOSOPHY LOGIC The development of reasoned argument EPISTEMOLOGY The debate and discussion of truth such as the meaning of health ETHICS The formal study of the principles on which moral rules and values are based TWO TYPES OF ETHICAL THEORIES DEONTOLOGICAL ETHICS Greek word deoto meaning DUTY We have a duty to act in accordance with certain universal moral values CONSEQUENTIAL ETHICS Based on the premise that whether an action is right or wrong depends on its end result ETHICAL PRINCIPLES Help to clarify the decisions that have to be taken at work Decisions Guided by trying to do the best for the most number of people Guided by an overriding concern for peoples right to determine their own lives Guided by other ethical principles or a professional code of conduct FOUR WIDELY ACCEPTED ETHICAL PRINCIPLES (Beuchamp and Childress 1995) RESPECT FOR AUTONOMY Respect for the rights of the individuals and their right to determine their lives BENEFICENCE Doing good NON-MALEFICENCE Doing no harm JUSTICE Being fair and equitable

Provide a framework for consistent moral decisions-making and fundamental principles in health promotion Health promoters need to be clear that what they do involves certain values and principles about what is good health and health promotion

PREVENTION Planning for and the measures taken to forestall the onset of a disease or other health problem before the occurrence of undesirable health events Ultimate aim of medicine 3 DISTINCT LEVELS OF PREVENTION PRIMARY PREVENTION SECONDARY PREVENTION TERTIARY PREVENTION PRIMARY PREVENTION To decrease probability of illness by health promotion Any health education/ promotion program aimed specifically at fore-stalling the onset of illness or injury Personal hygiene Good nutrition Environmental sanitation Using gloves when there is potential for the spread of disease SECONDARY PREVENTION Preventive measures that lead to an early diagnosis & prompt treatment of a disease or an injury to limit disability and prevent more serious pathogenesis Personal & clinical screening and exams BP Cholesterol BSE (Breast self-exam) TSE (Testicle self-exam) TERTIARY PREVENTION Level that health educators work to re-train, re-educate and rehabilitate the individual who has already incurred disability, impairment or dependency Educating the patient after lung cancer surgery Working with an individual who has diabetes to ensure that the daily insulin injections are taken

HEALTH STATUS Healthy Disease, Illness, or Injury

LEVELS OF PREVENTION Primary prevention

Secondary prevention Disability, Impairment, or Dependency Tertiary prevention Death

COMMUNICABLE DISEASE MODEL HOST Any susceptible organism that can be invaded by the agent Plants, animals and humans AGENT Pathogen Must be present for a disease to spread Bacteria, virus COMMUNICABLE DISEASE MODEL HOST

ENDEMIC Occurs regularly in a population as a matter of course EPIDEMIC An unexpectedly large number of cases of disease in a population PANDEMIC An outbreak of a disease over a wide geographical area, such as a continent

AGENT

ENVIRONMENT

RISK FACTORS 2 CATEGORIES OF RISK FACTORS 1. MODIFIABLE Changeable or controllable Sedentary lifestyle, smoking & poor dietary habits Things that individuals can change or have control over 2. NON-MODIFIABLE Not changeable or uncontrollable Age, sex, inherited genes Things that individuals cannot change or do not have control over

REDUCTIONIST MODEL OF HEALTH Health - a simple matter of illness or its absence Data on deaths and illnesses - used as surrogate measures of health Mortality and morbidity rates - most common means of assessing a populations health USES OF EPIDEMIOLOGY Examine the distribution and patterns of health and disease in populations by Showing the scale of the problem Showing the natural history and etiology of the condition Showing causation and association Identifying risk Showing effectiveness

HEALTH RISK REDUCTION 1. COMMUNICABLE DISEASE Illness caused by some specific biological agent or its toxic products Can be transmitted from an infected person, animal, or inanimate reservoir to a susceptible host 2. NON-COMMUNICABLE DISEASE Cannot be transmitted from infected host to susceptible host EPIDEMIOLOGY AND HEALTH PROMOTION EPIDEMIOLOGY Study of the occurrence and spread of disease in the population Study of the distributions and determinants of disease and injuries in human population Concerned with the health status or more usually the ill-health status of the population