Healthy Expectations for Scotland - Assignment Example

INTRODUCTION Heath education and health promotion is one of the most vastly growing fields of science. There are many theoretical models for health promotion and health education. There is a greater need for a planned approach for health promotion. The theory has to be applied into practice and the feedback from the practice makes a platform for the theoretical development. "Health promotion and prevention should be central to any transformations of the health care system". (Pender, N. J., 2003). Nursing was mainly concerned with disease treatment in the past. With the new idea of health promotion model, health was given importance on the basis of health education and health promotion from individualized information giving and disease treatment to participatory forms which are based on equity. "Participants' responses to the introduction of health in the curriculum were categorised in one of four ways: pessimism, partisanship, fanschen (to turn over) or marketisation. Their response depended on whether they viewed health as the central nursing philosophy rather than disease or care". (Smith, P. et al, 1999) "Health promotion is not new - the health promotion approach emerged in the early 1970's, although its roots go back to public health at the turn of the last century. In terms of its theory and history, it is linked to primary health care, public health and community development approaches". (Children, Youth and Women's Health Service, 2004) Health promotion got a new face in 1986 with the Ottawa Charter which gave importance to multiple strategies to improve health, from working with individuals through legislation and public policy. Health inequalities and social determinants of health have got more attention since the mid to late 1990's and health promotion now is based upon improving the health of the most disadvantaged in our society. Health is defined in the WHO constitution of 1948 as: A state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity. Health is a resource for everyday life, not the object of living. It is a positive concept emphasizing social and personal resources as well as physical capabilities. Reference: Ottawa Charter for Health Promotion. WHO, Geneva, 1986 Concept of health is a fundamental right to human beings. The pre-requisites for health are peace, sufficient economic resources, food and shelter and a stable eco-system. Thus, understanding of health is the central theme of health promotion and all people should have an access to basic resources for health. In order to have an understanding of health, every system which governs the social and economic conditions and physical environment should take part in the activities which maintain the health and well being of individuals and a holistic approach is required for health promotion. HEALTH PROMOTION Health promotion is the process of enabling people to increase control over, and to improve their health. Reference: Ottawa Charter for Health Promotion. WHO, Geneva, 1986. Health promotion enables people to increase control over the determinants of health and modifying the social, environmental and economic conditions so as to improve their health. The three basic requirements for health promotion are: 1. Advocacy - To create the essential conditions for health. 2. Enable - to achieve their full health potential. 3. Mediate - Between the different interests in society. In order to achieve these goals, we have to build public health policy, strengthen community action for health, create supportive environments for health, develop personal skills, and re-orient health services. "Health promotion includes a technology to strengthen communities' ability to take effective action at the local level. The technology includes methods to map and mobilize local resources, activate citizen, government and corporate participation, plan for and manage positive change, transform neighbourhoods and key institutions such as homes, schools, hospitals and work places into health-promoting environments, evaluate progress and problems, and make required course corrections. The technology builds local capacity for all these actions, so that reliance on uncertain external support is avoided. The technology can be applied in virtually all communities. Experience shows that even the very poorest communities can benefit significantly". (Mittelmark, M. B., 2000) "Health promotion is the science and art of helping people change their lifestyle to move toward a state of optimal health. Optimal health is defined as a balance of physical, emotional, social, spiritual, and intellectual health. Lifestyle change can be facilitated through a combination of efforts to enhance awareness, change behaviour and create environments that support good health practices. Of the three, supportive environments will probably have the greatest impact in producing lasting change". (O'Donnell, M. P., 1989) HEALTH PROMOTION MODEL Health promotion models synthesize research findings from nursing, psychology and public health into an explanatory model of health behaviour. The variables and determinants which are predictive of health behaviour should be given importance by nurses in practice to help people of different cultural backgrounds to adopt healthy lifestyles. By adopting a Health Promotion Model, new directions has arisen in health care focusing more on Health Promotion and Disease Prevention. The essential areas to focus for reforming health care system are quality of care, access to care and tracking and documenting of health promotive care. GOVERNMENT POLICIES IN HEALTH PROMOTION Government policies are constantly emphasizing on the role of prevention in public health activity, but the opportunities for prevention of health are not fully utilized. A core principle behind the public health practice is the need to concentrate on the common risks to health based upon a current evidence base. The United Kingdom introduced new social policy reforms for establishing a modern welfare state in the country by starting the National Health Service and a series of social safety provisions for their citizens following the Second World War. Besides this, the health inequalities exist due to differences in opportunity, access and resources. The interventions researched focuses mainly to modify individual behavioural risks and little attention has been given to social groups that need to be reached. Also, little research is conducted about how to tackle some of the wider social, economic and environmental determinants of health. The costs and benefits of different policy options are not well studied. There is also political influences and guidance alongside scientific evidence for public health policy decisions. "The 2002 UK Treasury review described above recognized this problem. It attempted to identify a balanced mix of interventions, across and within departments and service, using good evidence where it was available and giving high priority to those areas with the strongest evidence base. At the same time, scientific and political judgments were used in areas where good quantitative evidence on the success of interventions is weaker but there is good qualitative material". (HM Treasury/Department of Health, 2002). "These 'judgments' formed the basis for an ambitious Programmed for Action to tackle health inequalities described in the foreword by British Prime Minister Tony Blair as a whole series of cross-departmental actions that will address the root causes of poor health and inequalities". (Department of Health, 2003). "Policy-making is an inherently political process, and the timing of decisions is usually dictated as much by political considerations as the state of the evidence". (Black, 2001) "Those who are poorer less educated and have less access to public services and a quality environment, suffer worse health than the population as a whole". (Fukuda et al., 2004). The UK Government's NHS plan insist on great amount of increased activity in medicine and surgery and this could be achieved by increasing the incentives to stimulate doctors. Relatively small incentives will influence the behaviour and increases activity and more attention will be given to care for patients. As the current health reform gives more importance to creation of integrated care for patients, Government policies are carefully designing to change the payment mechanisms of physicians UNDERSTANDING ON INFLUENCES ON HEALTH A behaviour which helps to promote health protects and prevents diseases. Thus, an empowering behaviour indicates a positive healthy life style. Many diseases are reported to arise out of health risk behaviours especially alcoholism. "Information educates; education has been known to empower because it enables the individual to make informed decisions about her health, avoid health risk behaviours and maintain health". (Wumbee, S. L. 2007) Some of the health risk behaviours are alcoholism, prostitution, stress and excessive smoking. These are so risky that they are known to cause incurable diseases and even death. Alcoholism is connected with many diseases like liver cirrhosis, jaundice, peripheral neuropathy, liver failure etc. Moderate consumption is associated with prevention of formation of blood clots and thus prevents stroke. But heavy intake is riskier for many diseases when these benefits are considered. Healthy and nutritious eating habits prevent many incurable chronic diseases like diabetes and hypertension. Fatty foods which are rich in LDL and monounsaturated fatty acids increases bad cholesterol in the body and increases the body weight leading to obesity, thereby increasing risk factors for the life taking diseases like atherosclerotic heart diseases and hypertension. So, understanding of health risk factors and thereby modifying one's behaviour is important step in patient care. UTILISATION OF HEALTH MODEL "Health promotion comprises efforts to enhance positive health and prevent ill-health, through the overlapping spheres of health education, prevention, and health protection". (Downie, R.S. et al, 1990) Health promotion enhances positive health and prevents ill health, through collective involvement of health education, prevention and health protection. Health education (e.g. educating school children about bad effects of smoking) is to communicate with individuals aiming to change beliefs, knowledge, attitudes and behaviour in a direction towards improvement of health. Disease prevention (e.g. avoiding alcohol) means specific interventions done in order to avoid contact with risk factors which produce disease. Three levels of prevention are done: primary, secondary and tertiary prevention. Health protection includes all the collective activities against factors which are beyond the control of the person. "Legal or fiscal controls, other regulations or policies, or voluntary codes of practice aimed at the prevention of ill-health or the positive enhancement of well-being." (Tannahill, A. 1985) Health promotion can be provided in hospital nursing practice through research, project management, health policy development, and prevention and health education. "Nurses are a power-house for change and are in the vanguard of Government and WHO initiatives that promote healthy lifestyles in the general public". (Maglacas 1988) Tannhill's model can be used for helping the educational preparation of nurses and also for promoting new approaches to health workers. This model is useful in that it recognizes both the positive and negative elements of health and proper attention is given to common people and groups through a comprehensive and holistic approach. Evidence-based health care has given rise to a group of people called as health Promotion Specialists as evidence based practitioners has to find the evidence, appraise and implement it. These Specialists are advisors, consultants, researches, project leaders, policy development officers, trainers and advocates and they play the role of helping health workers like doctors, nurses, teachers, community representatives, etc. PATIENT NEEDS AND DESIRES FOR HEALTH PROMOTION A patient centred approach is needed in primary care for effective communication, partnership and health promotion. Psychosocially unwell patients will have a strong preference for patient centred care. The important benefits of patient centeredness communication are improved communication and the problems of the patient without creating much anxiety to the patient. This approach helps to identify the most important problem of the patient and helps to understand the person as a whole. This approach also helps to increase the patient doctor relationship. The realistic use time is also an important benefit of this approach. This approach helps to identify the priorities and preferences other than treating the patient merely on theoretical basis. The components of communication include listening to the patient with enough time, exploring their concerns and giving them the correct explanation to their problems. Finally there is an added advantage of health promotion and to explain to them how to stay healthy and how to reduce the risk of future illness. Patient care would be cheaper, effective and according to the individuals' desires if physicians, nurses and health care planners knew more about patient preferences in health related matters like their need for nutritive foods, reducing obesity etc. For the effective delivery of health care according to patient preferences, patients should be able to formulate and express preferences that these preferences must be made to known to the clinician at the time of care, and these statements inform care activities. Every patient is expected to access health services and a carer who will consider his needs and desires for health promotion. If the patient is in need of help in any matter of health or treatment, it will be explained in a way that is easy to understand. Also, the patient has the right to comment or complaint over the care he had received. The health professionals will be keeping and accurate and un-to-date records of the care that is given to the patient and the information's can be kept confidentially. "We will do so by: involving patients and members of the public in the decision-making process; listening to the individual views of patients and their carers and families; encouraging input from patients' councils or forums; carrying out surveys of patients; working closely with patient groups and communities; learning from complaints which patients make; and Acting on the feedback we receive from patients". (Neil, E. 2003) ACCESSING CURRENT HEALTH INFORMATION The health department has to give more choice to the patients about where and how a patient needs the healthcare. There must be more flexibility in the functioning of the healthcare system. In fact the healthcare system must be more patient cantered. The fully electronic booking system for appointment is an important step in facilitating a patient cantered healthcare.. An ideal healthcare system must reflect the patient priorities, faster treatment, more certainty regarding the time at which they can get each services. The patient should be able to given appropriate knowledge about the complications of diabetes, thrombosis and superadded infections. The variation in the standard of care must be kept as less as possible and above all the citizens of the country must have an equal opportunity to choose. Decision theory and health informatics helps to elicit subjective values and make them accessible in a clinic in a manner which drives health choices. For both patients and physicians, it is very useful to have computer-based elicitation and reporting tools for easy regular check up for blood glucose levels. The informatics group should provide computer-based applications which support physicians in the complex task of integrating patient preferences with scientific knowledge, clinical practice guidelines, and the realities of current health care. "In 1998, the United Kingdom National Health Service released Information for Health 1998 - 2005: An Information Strategy for the Modern NHS. The strategy commits the NHS to: lifelong electronic health records for every person in the country; round-the-clock on-line access to patient record and information about best clinical practices for all NHS clinicians; genuinely seamless care for patients through GPs, hospitals and community services sharing information across the NHS information highway; fast and convenient public access to information and care through on-line information services and telemedicine; and the effective use of NHS resources by providing health planners and managers with the information they need" (Department of Health and Human Services, 2000) MULTI-AGENCY STRATEGIES The different agencies usually work together to provide the best possible outcome for the people. The most key aspect of multi-agency strategies is the capability to share the information collected among them. There is greater access to shared information in the form of patient records and prescription information. There will be periodic updates on the latest development in illness and their treatment. There should be effective implementation of these strategies helpful both to the patient and the doctors. The most important challenge is the confidentiality of the patient information and this is to be taken care of. "Policy documents at local, national and international level continue to call for greater multi-agency and multi-professional working. These calls are based on three arguments: (1) health and illness are created and influenced by multiple factors outside of health service policy, (2) health improvement requires collaboration between statutory, voluntary and private sector organizations, and (3) efficiency and effectiveness are aided when duplication of effect is avoided and service transition is as seamless as possible. However, there remains limited process-orientated research that has explored the difficulties and challenges faced during multi-agency and multi-professional work". (Pavis, S. Et at, 2003) CONCLUSION Health promotion enables people to utilize their health potentials and stay healthy. For this, people need information in order to achieve a self directed change for healthy living. To make self change possible, one must modify one's behaviour through self observation, self instruction, self reinforcement and self evaluation. "In our view, the key to future tobacco control success lies in maintaining, at a minimum, and expanding, if possible, tobacco control as a broadly based social movement. As important as it is to maintain and expand the institutional/professional tobacco control structure, it is equally important to nurture an active grass roots, volunteer tobacco control coalition. The former brings visibility, political clout, and fundraising capacity; the latter reinforces social norms, establishes a stable movement foundation, and facilitates change at the local and state levels. Success at both levels is needed to avoid the relapse stage." (Jacobson, P. D. & Banerjee, A. 2005) REFRENCES Black, N. (2001) Evidence-based policy: proceed with care. British Medical Journal, 323, 275-279. Department of Health and Human Services, 2000. Toward a National Health Information Infrastructure. Interim Report. [Accessed 9 Apr 2008] Available at: http://www.ncvhs.hhs.gov/NHII2kReport.htm Department of Health (2002) Tackling Health Inequalities: the Results of the Consultation Exercise. Department of Health, London (http://www.doh.gov.uk/healthinequalities). Department of Health (2003) Tackling Health Inequalities: a Programme for Action. Department of Health, London (http://www.doh.gov.uk/healthinequalities). Downie, R.S. et al, 1990. Health promotion models and values. Oxford, England: Oxford University Press. Fukuda, Y., Nakamura, K. and Takano, T. (2004) Wide range of socioeconomic factors associated with mortality among cities in Japan. Health Promotion International, 19, 177-187. Jacobson, P. D. & Banerjee, A. 2005. Social movements and human rights rhetoric in tobacco control. Tobacco control, BMJ, 14 (2), p. 45-49. [Accessed 6 Apr 2008] Available at: http://tobaccocontrol.bmj.com/cgi/content/full/14/suppl_2/ii45 Maglacas, A.M., 1988. Health for all: Nursing's role. Nursing Outlook, 36(2) p. 66. Mittelmark, M. B., 2000. What is Health Promotion Debate with Members of Parliament, European Union, IUHPE. [Accessed 4 Apr 2008] Available at: http://www.iuhpe.org/adddownloads/on_mittelmark.pdf Neil, E. 2003. Healthy expectations for Scotland. Patient Rights and Responsibilities, A draft for consultation. [Accessed 9 Apr 2008] Available at: http://www.scotland.gov.uk/consultations/health/prrc-00.asp O'Donnell, M. P., 1989, Definition of Health Promotion. American Journal of Health Promotion, 3.3 (5) [Accessed 3 Apr 2008] Available at: http://www.healthpromotionjournal.com/ Pavis, S. Et at, 2003. Multi-agency, multi-professional work: experiences from a drug prevention project. Health Education research, Oxford Journals, 18 (6), p. 717-728. {Accessed 9 Apr 2008] Available at: http://her.oxfordjournals.org/cgi/content/abstract/18/6/717ck=nck Pender, N. J., 2003. Most frequently asked questions about the Health Promotion Model and my professional work and career. [Online] [Update 4 Aug 2006] [Accessed 3 Apr 2008] Available at: http://www.nursing.umich.edu/faculty/pender/pender_questions.html Smith, P. et al, 1999. Health promotion versus disease and care: failure to establish "blissful clarity" in British nurse education and practice. Social Science and Medicine, 48 (2), p. 227-239. [Online] [Accessed 3 Apr 2008] Available at: http://www.sciencedirect.com/science_ Tannahill A. What is health promotion Health Education Journal 44(4): p.167-8. Wumbee, S. L. 2007. Health Promotion and Positive Healthy Lifestyle (1). The Ghanian Times, [Online], 6 Apr 2008. 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