W4 Flashcards
Desribe the Population Health Approaches
Emerged from Lalonde (1974) report
SDOH influences population health
Policy development led to improved health outcomes- people are healthier and have opportunities to be healthier
Labonte (1993), lists the 3 Major Approaches to Health Enhancement what are they?
- Biomedical
- Socio-environmental
- Behavioural/lifestyle
Describe the Biomedical Approach “Preventative Health Care”
Concept of health is the absence of disease
The health determinant is the physiological risk factor, i.e. Cardiovascular disease
Target populations are high risk groups due to the risk factors
Strategies include screening for risk factors, patient education and immunization
Managed by the health professionals managing the health care
Success criteria measured by the decrease in morbidity and mortality rates as well as decrease in the prevalence of risk factors
Still vital for public health practice
What are the Benefits Issues of the Biomedical Approach?
Can coerce people to change their lifestyle especially if diagnosed with a pre-morbid condition. i.e. Metabolic syndrome, hypercholesterolemia
What are the challenges/issues of the Biomedical Approach?
Doesn’t take social, psychological or environmental factors into consideration
Not all people have the ability to make the behavioural changes needed i.e. Still have high cholesterol, takes the meds, but no change in diet or BMI
Describe the Behavioural/ Lifestyles Approach “ Prevention of Disease/ Disability
Both individual behaviour and parts of the social environment can be modified
Adaptation of behaviours and lifestyle that promote well-being
Health concept is the physical-functional ability and physical-emotional well-being
Health determinant are the lifestyle and behavioural risk factors
Target groups: high risk groups due to the risk factors
List the strategies used in Behavioural/Lifestyle Approach
- Health education
- Health communication
- Social marketing
- Behaviour modification
- Regulatory measures
Important for success:
• Need “buy-in”
• Info shared with the lifestyle change should be directed not just at target populations and individuals, but also at policy change
What are the key points in fostering healthy lifestyles?
Knowledge alone will not change the behaviour
Short term strategies have limited impact
Social marketing may increase the gap between low and high education and socioeconomic status
long term strategies with supportive environments make the best investment to promoting healthy lifestyles
List Clinical Examples of Behavioural/Lifestyle Approach
Help lines and smoking cessation clinics
Tobacco Act: Legal age, 18 you to buy cigarettes -warning labels on cigarette packages
Removal of the sale of tobacco in pharmacies
Retail stores no longer allowed to display cigarettes for sale
Local governments intro by-laws that forbids smoking indoors and outdoor patios
What are the benefits of Behavioural/Lifestyle Approach
Holistic approach to health
Works well for people who are motivated to make changes to their health
Useful to gain essential life skills
What are the challenges to Behavioural/Lifestyle Approach?
Abolishes government involvement in health “personal responsibility”
Can blame the victim
Behaviour independent of the social context
Long term commitment by an individual/ population, no instant results
Socio-Environmental Approaches to Behavioural/Lifestyle?
The environment (both social and physical) is the strongest determinant of health
Community level feeling to health
Source of daily living “I love where I live”
Social well-being “ I love life, my friends and family”
Health determinants are both psychosocial risk factors and socio-environmental risk conditions (poverty)
Target populations are those who live in high risk conditions and environments
Who are the enablers of or an obstacle to healthy behaviour
Strategies include:
5 Ottawa Charter strategies
Empowerment at an individual, group or community level
List the success criteria for community development programming
Includes increased perception of personal health
Strengthened community networks and social support
Mobilization of healthy public policy
What are some clinical examples of Socio-Environmental Approaches?
Smoke-free workplaces, restaurants, bars and some outdoor spaces: encourages people to stop smoking and provides a “cleaner and healthier” environment for those who don’t smoke
What are the Benefits to Socio-Environmental Approach?
Community action and involvement in health “bottom up approach” –ppl. Stand up and say we are not going to live in this type of environment, we will not tolerate contaminated water, so its community driven
More likely that individuals will take a vested interest in their health when doing it collectively
Collaborative efforts with the health professionals, community members and stakeholder
What are the challenges to Socio-Environmental Approach?
Healthier lifestyles are difficult to adopt when your environment is not conductive to being healthy
Don’t take into account individual differences responses to the changes
Vested interests by others or poor relationships can deter health promotion activities
Slow to build healthy public policy
Need community “buy-in”
What are the nursing implications for the Socio-Environmental Approach?
In biomedical model, nurses take on health preventative roles and can similarly share the role in a behavioural/lifestyle model
In the behavioural/lifestyle approach nurses are educators, counsellors and life coaches
In socio-environmental approach, nurses act to empower people, communities, collaborator with community groups in promotion of health, health prevention and health protection
Describe the upstream/downstream approach
Downstream often associated with the medical model
Upstream interventions are intended to help people maintain or improve their health before it is compromised and to focus on wider influences on health inequalities
List some of the Downstream Features
Short term, individual-based interventions after the health issue is identified
• Microscopic view
• Examines individual responses to health and illness
• Emphasis on individual behavior and lifestyle
• Manage problems as they come along
List some of the upstream Features
Focus on modifying economic, political and environmental factors that are precursors to poor health
• Macroscopic view
• Looks at factors in the population that affect health
• Emphasis on social, economic and environmental precursors
• Nursing interventions are aimed at social and environmental variables
• May involve social or political action
Desribe the Population Health Promotion Model (PHPM)
PHPM was developed by Health Canada an effort to bridge the gap between population health and health promotion
The PHPM reflects the socio-environmental perspective
The model combines the Ottawa Charter strategies, determinants of population health, and potential interventions
Focus is on public policy that responds to the health disparities
A limitation of the PHPM is that it does not provide an explanatory model regarding the exact pathways between the determinants of health and health status
What is the view of Health Promotion from a Population Health Perspective?
Empowerment for populations:
- Enabling reflection: understand their oppression
- Developing meaningful strategies: change
- As nurses we can help reflect and connect them
“Bottom up” approach:
- health promoters work with groups
- part of the group
- Consciousness raising, liberation, & empowerment
- Helping groups understand the political, social, historical, & economic impediments to health
Describe the evolution of Primary Health Care
1st described in The Alma Ata in 1978
Essential health care, based on practical, scientifically sound methods
Universally accessible
Full participation from communities
Education, adequate food supply, safe water and sanitation, maternal child health, immunization, prevention of disease, appropriate treatments and essential drugs are essential elements of PHC
4 sets of reforms have been proposed including:
- Universal coverage
- Service delivery accessible to the community
- Public policy
- leadership
- intended to promote CHN action towards socially just health system change
- Despite efforts towards social justice in Canada, large cities, Ottawa, Vancouver and Toronto are reporting significant increases in homelessness, people without health care access
Describe Primary Health Care vs. Primary Care vs. Health Promotion vs. Population Health
Primary care person-centered approach to providing care, continuity, comprehensiveness and integration of services
Health promotion is the process of enabling people to increase control over and improve their health
Population health refers to health outcomes and their distribution in the population
Whats the CHN Role in Primary Health Care?
Observing the strengths and gaps in the current health care system, advocating for change
Educating individuals and communities and engaging in PHC activities
CHNs share a close relationship with individual and community clients
Work in multiple roles to create the environments and capacity needed to achieve health for all
Use exploratory dialogue to assist others to question the status quo and provide the basis for a shared vision and plans for action
Nurses are the largest group of health care providers in PHC
Describe Equality in Health for All in terms of social justice, community development & empowerment
Social justice is a principle that would allow everyone to have equality of opportunity for health
Equality of opportunity for health is influenced by political, social and economic structures
Community development: people/communities should control factors that affect their lives.
Empowerment: people/communities achieve control, political efficacy, improved community life, and social justice
Coalition formation and political advocacy
