Primary Health Care

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Defining Health

The World Health Organisation (WHO) (1978) defines health as

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‘A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’

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Bircher (2005) defines health as

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“a dynamic state of well-being characterized by a physical and mental potential, which satisfies the demands of life commensurate with age, culture, and personal responsibility”

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The Australian Aboriginal people’s definition of health from the National Health and Medical Research Councils (1998)

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“…Health does not just mean the physical well-being of the individual but refers to the social, emotional, spiritual and cultural well-being of the whole community. This is a whole of life view and includes the cyclical concept of life-death-life (8).”

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In America The Healthy People 2010 Nation wide health promotion and disease prevention agenda reports health as being

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“Individual health is closely linked to community health—the health of the community in which individuals live, work, and play. Likewise, community health is profoundly affected by the collective beliefs, attitudes, and behaviours of everyone who lives in the community”

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The word ‘health’ was derived from

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the old English word ‘hoelth’, which meant a state of being sound, and was generally used to infer a soundness of the body.

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How an individual understands ‘good health'

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is very much a personal perception.

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Models of Health try to

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to simplify health and the the way in which it is viewed.

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The Biomedical Model of Health

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This model is concerned with biological factors that affect health.

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The Biomedical Model of Health

This model is concerned with biological factors that affect health and this has primarily been controlled by:

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Diagnosing,
Treating,
Curing the illness.

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Fairfield infectious diseases Hospital:

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was built in Victoria in 1904 and dealt with managing outbreaks by quarantining patients with infectious diseases. It was devoted to treating patients with fevers and diseases such as typhoid, diphtheria, cholera, small pox, polio and, just before it closed in 1996, HIV/AIDS.

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Social Model of Health:

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Takes into consideration the factors that affect health including the social, economic, cultural and political factors together with biological and medical factors in order to improve in health and wellbeing. It assumes that in order to support improvements in health, the context to which an individual is immersed in is vital
Focuses on:

Preventing and reducing illness
Addressing existing community inequalities and disadvanges

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The social model of health includes:

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Determinants of health and illness influenced by social, economic and environmental factors.
Health promotion in the prevention of diseases.
Involving the community in decision making about health.
Working with other departments outside of health.
Equity.

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Health Belief Model:

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This model assumes that:

A person will change his/her behaviours if they perceive there is a risk to their health.
Perceived risk of becoming ill.
Severity of illness and if it affects their life.
Factors that affect changing the behaviour: cost, inconvenience,
Positive outcomes of behaviour change; will it reverse or minimise current illness.
They will weigh up the benefits if the behaviour was changed:
However we all know that this is not the case.

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The Health Belief Model (HBM)

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is a psychological model that attempts to explain and predict health behaviors. This is done by focusing on the attitudes and beliefs of individuals.

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The HBM was first developed in

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the 1950s by social psychologists Hochbaum, Rosenstock and Kegels working in the U.S. Public Health Services.

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Biopsychosocial Model of Health

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This model focuses on an interdisciplinary approach and was first put forth by psychiatrist George L. Engel in 1977.

It assumes that there is a complex interaction of biological, psychological, and sociocultural factors that affects health and wellness.

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When managing illness and disease the biopsychosocial aspects all need to be taken into consideration;

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Biological: physical aspects that cause the illness
Psychological/behavioural: factors that may contribute to the biological illness or hinder wellness such as lack of self-control, emotional issues, and negative thoughts.
Social: factors such as socioeconomic, culture, poverty, technology, and religious aspects.

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Health Promotion / Health Protection Model of Health

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The health promotion/health protection model of health focuses on the recovery after a person becomes ill or adaptation to the illness allowing the person to move toward optimal health; as sometimes returning to a state of health previous to the illness is not possible. This is done by engaging the person in activities (prescribed activities, recreation, leisure) that promote health and prevent further deterioration, improve quality of life and coping strategies.

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Health Promotion / Health Protection Model of Health

believes that:

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Health is not just an absence of disease but is also a positive dynamic state
Health promotion is the way to focus on improving ones health
The individual is unique in the way in which he/she interacts within their environment to pursue health through health promotion strategies.

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In the Australian context, a commonly used definition from the Australian Primary Health Care Research Institute (APHCRI) is:

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“Primary health care is socially appropriate, universally accessible, scientifically sound first level care provided by health services and systems with a suitably trained workforce comprised of multi-disciplinary teams supported by integrated referral systems in a way that: gives priority to those most in need and addresses health inequalities; maximises community and individual self-reliance, participation and control; and involves collaboration and partnership with other sectors to promote public health. Comprehensive primary health care includes health promotion, illness prevention, treatment and care of the sick, community development, and advocacy and rehabilitation.”

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For the majority of people in Australia receiving health care:

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Primary Health Care (PHC) is a term that is not understood or used.
However Australians may be aware of the shift in health care services, by the different types of health services and health promotion strategies the government now provides or the supports in place for individuals and communities.

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Primary Health Care principles are a set of principles that came out of the:

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Alma Ata conference (Russia). in 1978.

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Declaration of Alma Ata. (Russia).

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As a result of the lack of improvement in health worldwide, delegates from 134 countries met in Alma Ata (Russia) in 1978. The delegations aim was to address the issues of world health & to develop solutions.
The Declaration of Alma-Ata on International Primary Health Care (PHC) was formulated at this meeting.

"Primary health care seeks to extend the first level of the health system from sick care to the development of health. It seeks to identify problems at an early stage. Primary health care services involve continuity of care, health promotion and education, integration of prevention with sick care, a concern for population as well as individual health, community involvement and the use of appropriate technology." (WHO 1978 Alma-Ata declaration)

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This Declaration of Alma Ata is a recognised policy to promote the concept of PHC.

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The declaration was seen as the blueprint for PHC in all countries. The declaration urgently recommended governments, health workers & communities to protect & promote the health of all individuals in the world. In Australia the Australian Health Ministers’ Council endorsed it in 1988.

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Thus the concept Primary Health Care was born which Keleher (2001) considers it to be:

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“…both a philosophy and a system response to reducing health inequities and ameliorating the effects of disadvantage but primary care reforms seem to have little to do with the increase in concern about health inequities.”

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Concepts of PHC Include:

1: Accepted & appropriate methods & technology.

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based on the needs of the community that is affordable

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Concepts of PHC Include:

2:

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Requires assessment, planning & evaluation strategies

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Concepts of PHC Include:

3: Basic essential health care

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looking at public policy & education, immunisation & screening, acute facilities, community health & rehabilitation.

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Concepts of PHC Include:

4: Accessibility:

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Universally geographically, financially & culturally accessible as well as being appropriate for the community.

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Concepts of PHC Include:

5: Community participation:

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to identify health care needs & the expectation that they will be heard & respected.

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Concepts of PHC Include:

6: Collaboration:

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between health resources with in the community. Community care responsibility is a shared cooperation between religious groups, aid agencies & government services such as: housing, child protection, education, employment & training, child care etc.

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Health promotion was a concept developed by:

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the World Health Organisation (WHO) in 1986.

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Primary care should include the following:

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health promotion
illness prevention
care of the sick
advocacy
community development
health in the primary care sectors.

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The key components of management of chronic disease in primary health care involve:

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patient self management, systematic and planned evidence based care, and coordination and continuity of care. These overlap in terms of their processes and impacts. (UNSW Research Centre for Primary Health and Equity, 2005)

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The Ottawa Charter.

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In 1986 the first international WHO meeting on Health Promotion due to growing expectations of public health world wide occurred
They established the Ottawa Charter which was aimed at the action to achieve ‘Health for all by the year 2000’
It built on the principles of the Alma Ata Primary Health Care Declaration
Has been a source of guidance & inspiration in health promotion
The aim was not to eradicate disease or to have good health for all, but to attempt to reduce the inequities in health care by removing the social and economic barriers

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Five steps are set out in the Ottawa Charter for Health Promotion that is essential for success:

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Build healthy public policy
Create supportive environments
Strengthen community action
Develop personal skills
Reorient health services

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The Ottawa Charter (1986) defines health promotion as:

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"…the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social wellbeing, an individual or group must be able to identify and to realise aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to wellbeing."

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The Jakarta Declaration:

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When the deadline for “Health for all” was reached (the year 2000), it was acknowledged that the goal was an unrealistic one. The concept of PHC actually highlighted that ‘community’ rather than the experts, were the important partners in creating and sustaining health. In 1997 the fourth international conference on health promotion was held in Jakarta

It created an extension to the ‘Health for all by the year 2000’ with the Jakarta Declaration of ‘Health for all in the 21st Century’

It focuses on priorities of global health policies for health promotion in the 21st century and addresses the significant social determinants of health.

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Priorities for health promotion in the 21st Century:

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Promote social responsibility for health
Increase investments for health development
Consolidate & expand partnerships for health
Increase community capacity & empower the individual
Secure an infrastructure for health promotion

The Jakarta Declaration calls on governments to promote health initiatives that foster and sponsor networking within & among countries in order to build a global health promotion alliance.

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The eight National Health Priority Areas that significantly contribute to the burden of health are:

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Arthritis & Musculoskeletal
Cancer,
Cardiovascular disease,
Injury,
Mental health,
Diabetes
Asthma
Obesity

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The five key topic areas identified by Victoria are:

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Physical Activity
Food and Nutrition
Mental Wellbeing and Social Connectedness
Tobacco, Alcohol and Other Drug issues
Healthy Weight

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In 1982 the Action on Disabilities in Ethnic Communities (ADEC) was formed to:

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to assist ethnic children with a disability to access services and has expanded considerably since then.

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Department of Health and Ageing (2012) report that "At the core of an effective and high performing health care system is good access to clinically appropriate services. Essentially this means being able to see the right health professional, at the right time, in the right place, and in a manner that is affordable and culturally appropriate." (para 1.)

The department of Health and Ageing (2012) have also identified that there are gaps that some individuals experience that compromise the access and equity to appropriate health care resources :

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Location and workforce availability: health services are restricted
Service delivery: access issues due to poor integration and inflexibility.
Affordability: inability or unwilling to access and pay privately or meet out-of-pocket costs for subsidised services.
Specialised needs: physical and cultural barriers for individuals requiring access to specialised treatments, are in the disadvantaged and/or marginalised populations.