Health Promotion in Mental Health Nursing in Australia - Term Paper Example

Introduction Australia is reportedly one of the leading countries in the word in terms of healthcare service provision for its people. Victoria happens to be ranked second in Australia in terms of healthcare service provision. Delivery of healthcare is largely determined by several factors among them the social and political environment. The extent to which these factors influence healthcare service vary from state to the other depending on how they interact with other determinants. One of the Key ways of improving health in a given population is prevention and treatment. Prevention has proved to be more cost saving and effective than treatment. Health promotion has thus merged as an effective in improving the health of a given population. In the state of Victoria, health promotion has received support both financially and politically. One of the areas that have received increased attention in creating public awareness is mental health illness. This paper will thus explore relevant literature on theory and practice on how social-political determinants influence health. The paper will narrow down to how health promotion works in Victoria with special attention to mental health. Health Health is recognized as one of the basic human needs in Australia. Every human being has a right to affordable healthcare according to the World Health Organization (WHO). However, delivery of healthcare services is mainly the role of the government hence access to this right in exposed to numerous competing factors and priorities. In Australia, the different arms of government are responsible for delivery of universal healthcare. Under the Australian Health Care Agreements (AHCA), the state and territory government must provide free in-hospital and ambulatory care. As of 2008, 9% of the Federal gross domestic product or over $3,500 per person per year was directed to healthcare provision. However, the outcomes of these government initiatives vary widely from one group of people to the other and from one region to another. The area of healthcare has undergone numerous reforms. One of the key reforms was the change in the formula of funding from the historical one to an output based formula in 1990s. The social, cultural, economic and political environments have been cited as the most influential determinants of health by WHO (Willis, Reynolds and Helen 2011). This is so because every state government and local authorities develop their unique healthcare delivery systems to suit the local environment. Social determinants The WHO recognizes the social determinants of health as the conditions in which people are born, grow, live, work and age, including the health system. Due to varying social environments, the WHO has developed a framework for identifying relevant social factors that determine the outcomes of health. The Commission on Social Determinants of Health (CSDH) provides a framework to help relevant authorities to identify levels of intervention, clarify their relationships and suggest scopes and limits of policy action in each area. The CSDH also provides key policy directions on how to handle health matters in specified areas. In particular, the role of the health system as a determinant of health has been highlighted especially on its role in reducing health inequalities ((Willis, Reynolds and Helen 2011). Willis, Reynolds and Helen (2011, p. 37) say that that the CSDH was set up to “to mobilize emerging knowledge on social determinants in a form that could be turned swiftly into policy action…..where there are greatest needs.” As such, federal, state and municipal government health policies on social determinants should be based on the ones identified by the CSDH. The WHO recognises the following as the key social determinants of health: income, employment, social gradient, early childhood, access to healthcare, education, secure and affordable food sources, social support, gender, culture and social exclusion (Willis, Reynolds and Helen 211). Other models have been developed by a number of scholars in these field to explain the interconnectedness of the factors and various how they determine the outcome of healthcare practices. Dahlgren and Whitehead (1991) Social Determinants of Health Rainbow has been widely used to depict the social determinants and their relationships and interconnectedness. The rainbow as shown below depicts the following Healthy living conditions (including access to food, water and sanitation), Education, literacy and health literacy, Stress, Early life, Social exclusion, Employment & unemployment, Age, sex and heredity factors, Culture, racism & discrimination and Access to information and appropriate health care. Source: Friel 2009. Social gradient This refers to the varying mortality rates from one social economic group to the other. Research has indicated that mortality rate increases with lowered socioeconomic status. This means that risk factors among the low social income groups increase. However, diseases which were historically more prevalent among high income groups such as diabetes and obesity have been recorded among low income earning groups in Australia in recent times. However, in Australia, obesity is more prevalent among lower socio-economic groups. Such a gradient is also prevalent in tobacco use where prevalence decreases with increasing socio-economic status. Another social gradient which runs in opposite direction to tobacco use and obesity is observable among alcohol users since prevalence decreases with decreasing socio-economic status (Friel 2009). Global practices in healthcare tend to direct more attention to the marginalised group in efforts to promote health equity. Such a move is supported by a study by Kaplan et al who found that variations in income distribution were positively linked to higher mortality rates and higher behavioural risk factors such as poor diet and substance abuse. Another study by Kawachi also indicated that a steeper social gradient led to decreased participation by the people on the lower to social interconnectedness activities (SACCOS 2008). In Victoria and Australia in general, the Aboriginal people and Torres Strait Islanders have often been the target of policies and programs aimed at improving health equity. Data from various sources indicate that life expectancy among these marginalised groups of people is far much lower to that of the average Australian by a difference of 18-20 years. For any health promotion activity therefore, the core group should be the marginalised people in order to bring them to par with the rest of the people. However, the ability of the target population to absorb and utilize knowledge or information given to them is determined by a number of factors. One of them is health literacy and education levels (Willis, Reynolds and Helen 2011). Health literacy and education Education determines greatly one’s possible level of income. High levels of education equip individuals with the skills to deal with day to day challenges and even allow them to participate more vibrantly in the labour market. A survey by the Australian Bureau of Statistics (ABS 2006) showed only 54% of Australians had adequate literacy skills. This implies that health education is likely to be challenged by literacy levels. The mode of disseminating the information should be comfortable with the target audience of the message. Empowerment Empowerment in the health context refers to the ability to live healthy and flourishing lives. There are three main dimensions of empowerment which are psychosocial, material and political. Again, these apply to three main levels of an individual, community and nation. Material empowerment in this case implies that individuals have the financial capacity to access healthcare services such as insurance and medication and that they can also manage to eat balanced meals and have a roof over their heads to protect them from adverse weather. The Victorian government has a critical; role in this as it is the facilitating body that creates employment, establishes housing laws and regulations through various municipal governments (Willis, Reynolds and Helen 2011). Furthermore, the state government is responsible for public health and health promotion activities. Psychosocial empowerment refers to the ability of individuals to be in control of their lives and bodies in particular. This type of empowerment allows individuals the freedoms to choose the type of food they take and any other unique behaviour that they might identify. Furthermore, as a relatively highly diverse state, the people of Victoria should be able to engage in cultural and social practices without government involvement. The government plays a facilitatory role by ensuring that every individual’s empowerment does not affect or threaten the freedom of others (Friel 2009). Political empowerment on the other hand calls for the recognition of individual’s opinion of healthcare policies, engagement and participation in decision making processes. This is most apparent on community-based health programs which are predominantly managed by the people (Blas, Sommerfeld and Kurup 2011). Through these programmes, members of local communities are given an opportunity to participate in delivery of healthcare which is presumed to be in a manner that they would like it to be delivered to them (Willis, Reynolds and Helen 2011). Political environment The political environment of healthcare is very significant in determining the outcomes of healthcare services. In the state of Vitoria, the state government dominates the area as the key body responsible for formulating political organs that provide healthcare services. For instance, the publication of the Australian Charter of Healthcare Rights by the federal government is implemented by state governments including Victoria. The Victorian government is thus responsible for creating awareness among the public on how healthcare applies as a human right. In one of the Brochures printed and circulated widely for public awareness, there are seven healthcare rights identified namely; access, safety, respect, communication, participation, privacy and comment (Department of Health Victoria 2012). There are two main ways in which the political environment influences delivery of healthcare. This is through formulation of policies and implementation of the policies. The Victorian government has at been at the forefront in formulating policies that promote healthcare and support the current healthcare system. Through the Department of Human Services (DHS) and department of Victorian Communities (DVC), the government developed the Cultural diversity guide; planning and delivering culturally appropriate human services (DHS 2006). This plan aims at streamlining health delivery services to be response to cultural and ethnic diversity. This is most appropriate in health promotion activities which involve a lot of communication with the public. The relationship between social determinants and political determinant of health is a very complex one. This is because a political body, state government in this case, forms the health system and funds and has a significant influence on the structures that run any health system. In so doing, the action of the political organ and its affiliates have control on how and to which extent the social determinants of health will affect consumers of healthcare. One of the key responsibilities of the political organ in healthcare is providing health promotion services. The WHO defines health promotion as giving more responsibility to the people over their health. One of the major initiatives of politics in healthcare has been geared towards eliminating the social gradient that is responsible for variation in health from one socioeconomic group to the other. More often than not, any political action on the health sector in Victoria and all over the world is based on the findings and recommendations of the CSDH. In Australia, the federal government adopts such international policies of the CSDH while it is the role of the state and municipal governments to adapt them to the local environment. The two major goals of CSDH, which translates to major goals for state governments, are ensuring health equity and increased health promotion (Willis, Reynolds and Helen 2011). Health promotion The WHO defines health promotion as “the process of enabling people to increase control over, and to improve, their health” (WHO 2012). The Ottawa Charter defined health promotion as a …. The process of enabling individuals and communities to increase control over the determinants of health thereby improve their health. It has come to represent a unifying concept for those who recognize the basic need for change in both the ways and conditions of living in order to promote health. Health promotion represents a mediating strategy between people e and their environments, combining personal choice with social responsibility for health to create a healthier future (Fleming and Parker, 2007 p. 9). Conventionally, health promotion efforts have been directed to communicable and non-communicable diseases. Among the non communicable diseases which have received wide attention include obesity, tobacco use, poor nutrition, cancer, cardiovascular diseases, diabetes and acute respiratory conditions. Behavioural risk factors such as smoking and substance abuse are often addressed. National reports in Australia have indicated that these behavioural risk factors increases towards the lower social hierarchy weighed down by economic restraints (VicHealth 2010; Dwyer and Eagar 2008). Such a scenario does not give much direction of policy but rather raises more questions. There are three major approaches to health promotion: medical; lifestyle or behavioural; and socio-environmental. Each of these approaches targets a specific combination of determinants and seeks to promote health through a unique set of strategies and interventions. Furthermore, the effectiveness of each approach has to be evaluated against a unique combination of health indicators. Nonetheless, each of these approaches is insufficient in isolation. The best result in promoting public health is by integrating them to provide a comprehensive approach to promoting health. Therefore, any effective health promotion drive must balance the attention and resources between treatment, rehabilitation and the prevention of physiological risk factors, with strategies focussing on individual risk factors and socio-environmental risk conditions (Brise 1998). The most preferred response to such as scenario has been increased health promotion messages. Various studies around the world have shown a greater link between health literacy levels and incidence of disease. The aim of health promotion thus aims at increasing health literacy levels to enable the most exposed persons, who happens to the people on the lower end of the social gradient to take an active role on their health. However, in discussion paper titled the health promotion priorities for the state of Victoria indicates that health promotion efforts should be Implemented across the whole population, not just those at risk of specific diseases, directed towards improving people’s ability to control the factors that determine their health and should be part of a process, involving a mix of individual and population responses from a number of stakeholders, which aim to improve health (Victoria Health 2006). On the contrary, a number Briser (1998) and Fleming and Parker (2007) indicates that health promotion messages should be directed to the affected and the ones at risk. Mash compares health promotion messages o marketing by indicating that marketing messages should be directed to potential consumers who are in need of the identified need in the market. Targeting the whole population without identifying a niche market could lead to wasted resources and dilution of the intended message. One area that requires intense health promotion attention is mental illness and health as a precursor to a plethora of other diseases. Before embarking on health promotion in mental health, it is important to address the core values and principles of health promotion as indicated by Briser (1998). First on the lists is empowerment. Empowerment, which is also mentioned as a social determinant for health earlier in the paper pertains to increasing the control over determinants of health. This can imply economic empowerment and political empowerment which all combine to give an individual or society the confidence and ability to tackles issues affecting them, in this case health challenges. The second core value is public participation. This allows individuals and communities to define, analyze and act upon the issues affecting their lives and specifically their health. The third core value is acknowledging the determinants of health. Health should be recognised as an aspect which is determined by lifestyles and not just mere genetics. The fourth core value of health promotion is to reduce social inequities and injustice such that every member of the society benefits from a health supporting community or government. Finally, health promotion should facilitate intersectoral collaboration. Mental health promotion In Australia in general, mental health issues are largely depression issues and depression co-morbidity related. An estimated one in five people in Australia are affected by a mental health problem (Commonwealth Department of Health and Aged Care 2000). About 12 percent of the total disease burden in Australia is attributed to (Department of Human Services 2005c). Treating such cases costs the federal government excess of $3 billion annually (AIHW 2004b). This is because mental health is significantly connected to physiological health. This means that mental health disorders spill over to other physiological diseases. For instance, numerous studies have concluded that a number of cardiovascular complications are related to depression and stress. Furthermore, a numerous suicide and homicide cases have been attributed to mental disorders (Bunker et al. 2003). This indicates that we Australians with Victorians included might not be aware of the extent of mental health and its larger impact on societal and individual health. The WHO (2012) defines health promotion as “the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions.” This definition is based on a new approach towards health adapted by WHO in 1996 which viewed health as an outcome of health system as opposed to mere absence of disease. This definition emphasizes on the need to increase funding to disease prevention and health promotion activities which in the long term lower the demand for treatment and rehabilitation. On the contrary, many health systems including the Victorian Health System dedicate a larger portion of their budget to treatment and rehabilitation with health promotion taking a secondary role (Dwyer and Eagar 2008). Nonetheless, there are positive strides made in the recent past that seem to have elevated the place of health promotion in Victorian healthcare system. Key among these is the identification of health as a basic human need. In fact the Victorian department of health has listed seven rights to health to inform the public on what they are entitled to through Australia’s universal health system. The rights are listed access, safety, respect, communication, participation, privacy and comment. Residents of the state of Victoria are entitled to accessing safe and high quality healthcare which should be livered in a respectful manner. Again, residents are entitled to be informed about costs and treatment openly. Residents have a right also to participate, comment and raise concerns where appropriate with privacy being observed. Through health promotion activities, the right of participation is amplified (VicHealth 2010). Participation in healthcare through health promotion activities is recommended widely by past studies. In response to this, Victorian government increased funding to the department of health to $13.7 billion for the 2012/13 financial year. Of this $883 million will be dedicated to acute care services and $364 million to aged care. This will be achieved through the opening of short-stay beds in a new Psychiatric Assessment and Planning Unit at Sunshine Hospital, which will provide accelerated access to specialist psychiatric assessments and short-term treatment; funding for new acute adult mental health beds to ease demand pressures on emergency departments and the shortage of inpatient beds; and funding to modify, refurbish and redevelop community-based mental health infrastructure, with priority given to works that support service delivery reform and innovation (VicHealth 2010). The Victorian department of health increased funding to the mental health to boost access to mental healthcare in the 2012/13 financial year budget by allocating $7 million for the second stage of New Mental Health beds. It is apparent that health promotion activities play a secondary role by budget allocations. However, the health promotion paper by the Victorian department of health lists mental wellbeing and social connectedness as one of the priorities. The other priorities listed in the paper are physical activity, food and nutrition, tobacco, alcohol and other drug issues and healthy weight. The WHO states that the overall aim of health promotion is to achieve health for all and enhance societal and individual wellbeing. This approach to health must take a holistic approach that includes holism of health and its determinants. As aforementioned in the paper, addressing health without addressing the determinants of health can be a futile effort. Therefore, any health promotion efforts must be considerate of the social-political determinants of mental health illness (Cattan & Tilford 2006). In Victoria, the task of health promotion has also been delegated to other departments such as the Office for Children and Department for Victorian Communities (VicHealth 2006). Democracy or political participation according to Wise (2007) is critical determinant in mental illness healthcare and nursing which is often overlooked. The author argues that political empowerment is an overriding factor in influencing the course of socioeconomic factors. This is because the politicians who hold power influence socioeconomic trends in the state through economic policies enacted. In the same manner, the political arm of the government appoint persons to head organs that affect the healthcare system and the policies enacted by these individuals have a far reaching effect on health promotion activities and strategies employed. Conclusions From the discussion above, it is apparent that healthcare cannot be delivered arbitrarily without respect to the environment. The social political environment is one area of the healthcare environment that has a far reaching effect on the policies, strategies and structures adapted and even how the target population benefits. For the state of Victoria, as is the whole of Australia, the greatest challenge in the delivery of care is the steep social gradient. This has influenced other areas such as empowerment of the people and participation. Without a sense of participation, it is hard to deliver health promotion strategies. Again, the Victorian Health department believes in carrying out health promotion across the board as opposed to targeting the most vulnerable and those facing high risk. In the case of mental health, there is no concrete strategy that this study identified which has been adapted by the department. Instead, much of the attention in mental healthcare is dedicated to treatment as opposed to prevention through health promotion. References Barry, M. & Jenkins, R. (2007). Implementing mental health promotion. Sydney: Elsevier. Blas, E., Sommerfeld, J. and Kurup, A. (2011). Social determinants and approaches to public health: from concept to practice. Retrieved online from, http://www.who. Birse, E. (1998). The role of health promotion within integrated health systems: A position paper by The centre for health promotion Department of Health Victoria. Retrieved online from, http://www.health.vic.gov.au Cattan, M. & Tilford, S. (2006). Mental health promotion. Syndye” Mcgraw Hill. Department of Health Victoria. Retrieved online from, http://www.health.vic.gov.au/healthpromotion/downloads/discuss_paper.pdf Dwyer, J. & Eagar, K. (2008). Options for reform of Commonwealth and State governance responsibilities for the Australian health system. A paper commissioned by the National Health and Hospitals Reform Commission. Fleming, M. L. and Parker, E. 2007. Health Promotion: Principles and Practice in the Australian Context, 3rd ed. Sydney: Russell Books. Friel, S. (2009). Health equity in Australia: A policy framework based on action on the social determinants of obesity, alcohol and tobacco. The Australian National Preventative Health Taskforce Healy, J. (2011). Improving Health Care Safety and Quality: Reluctant Regulators. Ashgate publishing: Melbourne. South Australian Council of Social Service, (2008). The Social Determinants of Health. SACOSS Information Paper December 2008 Vichealth. (2006). Health promotion priorities for Victoria: A discussion paper. Retrieved online from, http://www.health.vic.gov.au WHO. 2012.Health promotion. Retrieved online from, http://www.who.int/topics/health_promotion/en/ Wise, D. and Sainsbury, P. 2007. Democracy: the forgotten determinant of mental health. Health promotion journal of Australia. 18(3), 177-183. Willis, E., Reynolds, L. and Helen, K. (2011). Understanding the Australian Health Care System. Sydney: Elsevier. Read More