LEC 3: Primary Health Care, Population Health, and Health Promotion Flashcards
What is primary health care (WHO, 1978)?
Essential health care services made universally accessible at a sustainable cost to the community/ country
- Delivering “basic (health) package”
- “Basic “list” of services to provide
What are the 8 elements to PHC (Alma Ata)?
- Health education
- Nutrition
- Clean water and sanitation
- Maternal and child health care
- Immunization
- Local disease control
- Accessible local disease treatment
- Provisions of essential drugs
What is primary care?
Direct provision of care at first contact point
What are the 5 philosophical “pillars”/ principles of PHC?
- Accessibility
- Active public participation
- Health promotion and chronic disease prevention and management
- Appropriate technology and innovation
- Intersectoral cooperation and collaboration
5 Pillars of PHC: Accessibility
Universally available to all
- Access/ equity
5 Pillars of PHC: Active Public Participation
People and communities are active partners in their health care
5 Pillars of PHC: Health Promotion & Chronic Disease Prevention and Management
Empower users to take charge of their health
5 Pillars of PHC: Appropriate Technology & Innovation
Develop knowledge, skills, technology, and ideas to facilitate health
5 Pillars of PHC: Intersectoral cooperation & Collaboration
Across all relevant sectors to improve the health of society
- Reframe the health system
- Have more collaboration with other disciplines
What is the goal of PHC?
Philosophical perspective that tires to reorient health care programming to a comprehensive. (w)holistic, system-wide approach
Making a better state of health attainable for everyone
How does PHC trie to “do us out of a job”?
- Moving interventions “upstream” from “downstream”
- Preventative focus; address social issues to prevent illness
- Maximize opportunities for health improvement
- Minimize health harms/ risk to individuals and society
What is the difference between PHC and MDGs?
MDGs are indicators that reflect and integrate with a PHC approach to health services
- PHC the organizational philosophy (why)
- MDGs the indicators to monitor (what, how)
How do legislations shape or support PHC nationally?
Legislation on health responsibilities and funding
- BNA (Constitution) Act in 1867
- The Canada Health Ac tin 1984
How do legislations shape or support PHC in Saskatchewan?
Provincial legislation on health care administration
- The Provincial Health Authority in 2017
- The Registered Nurses Act in 1988
- The Public Health Act in 1978
How do legislations shape or support PHC on reserves health care?
Federal or local Indigenous government
History of the Canada Health Act
1947: SK the first province to implement a universal hospital service plan
1961: All provinces had universal coverage for hospital and physician services
1984: Federal government replaces pervious health acts with the Canada Health Act
What happened in 1961?
Dr. Strike: Dr.’s of the province did not want to be part of medical care
- Went on strike for 23 days
- Nurses and nurse students did most of the work; all hand on deck
- Biggest change, wanted more of a fee for services instead of what the Government was offering
Canada Health Act (1984)
Federal legislation for publicly funded healthcare insurance that set Canadian standards for medically necessary services
- No changes have been made to the Canada Health Act since 1984
What are the 5 concepts to the Canada Health Act?
- Public Administration
- Comprehensiveness
- Universality
- Portability
- Accessibility
Canada Health Act: Public Administration
Required provincial administrative body to be democratically accountable
Canada Health Act: Comprehensiveness
Err on the side of inclusion in the coverage package
- Opposite of private insurers
Canada Health Act: Universality
Insured residents are entitled to the same level of healthcare. There are also no opt outs
Canada Health Act: Portability
Provincial coverage is portable from province to province and is also available to residents travelling abroad
Canada Health Act: Accessibility
Access without financial barriers
- User fees of any type
Universal Medical Coverage
Insured services = medically necessary hospital, physician, and surgical-dental services
Provincial and territorial governments have primary jurisdiction of the administration and provision of health services
What are extended healthcare services that can include charges?
- Long-term care
- Health aspects of home care and ambulatory use
Government Roles in Healthcare: Government of Canada
Canada Health Transfer: Conditional on meeting Canada Health Act criteria
Regulate perspiration drugs and natural health products
Services for certain populations
Government Roles in Healthcare: Provincial & Territorial Governments
Administration and provision of health services including setting priories, administering healthcare budgets, and managing resources
Provide coverage and subsidies for non-insured services
Private Health Insurance and Medicare
Only private health insurance (PHI) permitted must be complementary to the basic universal package (Medicare)
PHI that provides substitutive or faster access is prohibited or discouraged provincial laws and regulations
Privatization medical care can only provide care that is not covered under the Canada Health Act; this is often not the case
Privatization of Financing vs. Privatization of Delivery
In Canada the issue of privatization revolve around the financing of healthcare since the delivery is already largely private
The Ottawa Charter (1986)
A new public health movement shifting from health promotion with individuals toward population health promotion
- Health for all by 2000 and beyond
What are the 8 Prerequisites for health in the Ottawa Charter?
- Peace
- Shelter
- Education
- Food
- Stable eco-system
- Sustainable resources
- Social justice
- Equity
What is the strategy for the Ottawa Charter?
Change in the role of health professionals from expert to using advocacy and mediation in order to enable people to gain greater control over their lives
What are the 5 Ottawa Charter action areas?
- Build health public policy
- Create supportive environments
- Strengthen community action
- Develop personal skills
- Reorient health services
Ottawa Charter Action Areas: Build Health Public Policy
Process of building policy that supports health- make health the easier choice
Health in all sectors at all levels
Legislative, regulatory, organizational and taxation changes
Ottawa Charter Action Areas: Create Supportive Environments
Socio-ecological approach to health
Increase the ability of people to make health promoting choices in the environments where they work, live, learn, and play
Ottawa Charter Action Areas: Strengthen Community Action
Collective actions of communities to improve their health
Ottawa Charter Action Areas: Develop Personal Skills
Supporting personal and social development
Information, education, and life skills
Ottawa Charter Action Areas: Reorient Health Services
Shit to supporting the needs of people in communities
Strengthen protective factors, reduce risk factors, and improve on the SDH
Population Health
Looking at the health outcomes of a whole society
- Health indicators and outcomes on a broad social scale
- Uses SDH approach for programming approach
- Also drawing from Lalonde Report *1974) and WHO’s ALma-Ata (1978)
Health Promotion
Policy and programming approach to health services that works to advance population health
- Reorienting services to encourage the best health possible
- Risk management and prevention of illness and injury
- Building on Ottawa Charter (WHO, 1986)
What are successful health promotion programmes?
- Seatbelts use and legislation on this for cars
- Tobacco/ smoking controls; especially for second hand smoke
Harm Reduction
Harm reduction is about reducing risk and improving health
What is an example of harm reduction?
Supervised consumption sites
- Canadian addiction rates: 13% of population
- 29 programs and growing (BC, AB, ON, QC)
- To provide safe space for IV drug users to reduce risk
- Prevent overdoses, blood-born infections, medical waste
- Build relationships and have access to treatment
What are the impacts of PHHP approach?
Personal health effects
- Sense of control. Ownership of health, partnership with us
- Some people may not be comfortably with this, baby steps
Social efects
- Building sense of community and worth
Economic savings to society and individuals
- Increasing evidence this is huge in scope and money
Workload issues and interdisciplinary collaboration
- Shared decision making between clients and care providers
What can Canadian RNs do?
Use PHC/ Pop Health Promotion perspectives when providing care to clients and families
Advocate and educate on a personal and social level
Community involvement on social justice issues
Work in government and put the voice of nursing in policy
