Concepts of Health, Health Care And Health Promotion.
South Bank University
Number: 9905890
May 2000: Group 3
Unit 6
Concepts of Health, Health Care
and
Health Promotion.
Personal Tutor: Alma Ramanuth
Word Count: 1,647
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Concepts of Health, Health Care
And
Health Promotion.
?
Unit 6
CONTENTS
TITLE PAGE 2
CONTENTS 3
ASSIGNMENT ESSAY 4
APPENDIX 14
REFERENCE 15
BIBLIOGRAPHY 19
Word count (excluding references and charts) 1,647
"Making the healthy choice the easier choice"
(Milio1986 cited in Naidoo J, Wills J. 2000: 84)
Health promotion has come a long way since the 'Band of Hope' lectured young people on the "virtue of abstinence ", in the late eighteen hundreds (Naidoo J, Wills J. 2000: 72). The emphasis was on reform or damnation, after nearly a century of telling people what not to do attitudes began changing.
The World Health Organisation (WHO) recommend "advocacy, enablement, and mediation " as effective methods (Baric L. 1996:129), defining modern health promotion as,
"...the process of enabling people to increase control over, and to improve, their health." (Ewles L, Simnett I. 1999: 23)
Nurses are ideal health promoters as they are present at significant moments in their patients' lives (DoH 1999:132); they have long been required to be competent in
"advising on the promotion of health and the prevention of illness..."
(Statutory Instrument cited in Perry A. 1997: 58).
But what is health? The1948 WHO definition of health as,
"...a state of complete physical, mental and social well-being, and not merely the absence of disease and infirmity" (Hogston R, Simpson P. 1999:27)
has been openly questioned, as most people who consider themselves 'healthy' would not say they had 'complete' well-being. Many diabetics and asthmatics live 'healthy' lives despite their 'illnesses'.
As the concept of health differs between individuals, it may seem easier to define ill health using Miles' definition, (cited in Perry A. 1997: 232)
"...ill health represents a breakdown in the normal, expected state of health, a situation where things go wrong, a deviation from how things should be, and usually are."
This again raises debate, with views on 'normal' differing widely between social classes and cultures.
Accepting that health is multidimensional encompassing physical, mental, emotional, social and spiritual factors, their significance influenced by the society and environment (Ewles L,Simnett I.1999:7) the WHO revised it's definition.
" [health is] the extent to which an individual or group is able, on one hand, to realise aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is therefore, seen as a resource for everyday life, not an object of living; it is a positive concept emphasising social and personal resources, as well as physical capacities." (Naidoo J, Wills J. 2000: 23)
The many theories of health lead to many approaches to health promotion. Tones and Tilford described empowering people to make their own choices as "central to the ideology and practice of health promotion" (Naidoo J, Wills J. 1998: 245).
The traditionally approach has been medical, implemented in three stages; using family planning as an example,
* Primary: prevention by education; contraception methods
* Secondary: early treatment; providing emergency contraception
* Tertiary: reduction of ill effects; advice and counselling on unplanned pregnancy (DoH 1993: 67).
The control in this model is with the medical profession and to be successful requires the patients to be compliant (Naidoo J, Wills J. 2000: 93).
The other models greater emphasis is placed on empowerment and accepting the different values and beliefs target groups may hold. For instance a health promoter may discourage unprotected sex to prevent sexually transmitted disease (STD's), but the client may see unsafe sex as an expression of love and trust (Kenworthy N. et al 1996:153).
Aims, activities and values of five approaches,
Aim
Activity
Values
Medical
Freedom from medically-defined disease and disability
Promotion of medical intervention to prevent or ameliorate ill-health
Patient compliance with preventive medical procedures
Behaviour change
Individual behaviour conducive to freedom from disease
Attitude and behaviour change to encourage adoption of 'healthier' lifestyle
Healthy lifestyle as defined by health promoter
Educational
Individuals with knowledge and understanding enabling well informed decisions to be made and acted upon
Information about cause and effects of health-demoting factors. Exploration of values and attitudes. Development of skills required for healthy living
Individual right of free choice. Health promoter's responsibility to identify educational content
Client-centred / Empowerment
Working with clients on the ...
This is a preview of the whole essay
Patient compliance with preventive medical procedures
Behaviour change
Individual behaviour conducive to freedom from disease
Attitude and behaviour change to encourage adoption of 'healthier' lifestyle
Healthy lifestyle as defined by health promoter
Educational
Individuals with knowledge and understanding enabling well informed decisions to be made and acted upon
Information about cause and effects of health-demoting factors. Exploration of values and attitudes. Development of skills required for healthy living
Individual right of free choice. Health promoter's responsibility to identify educational content
Client-centred / Empowerment
Working with clients on the clients' own terms
Working with health issues, choices and actions which clients identify. Empowering the client
Clients as equals. Clients' right to set agenda. Self-empowerment of client
Societal change
Physical and social environment which enables choice of healthier lifestyle
Political/social action to change physical/social environment
Right and need to make environment health-enhancing
[Source: Ewles L, Simnett I. 1999: 43]
Tannahill uses overlapping spheres to illustrate the multidimensional nature of health promotion.
The prevention sphere attempts to protect good health by screening for, immunising against and providing help for known health risks. The education sphere focuses on empowering communities and individuals to take control of there own health needs. The health protection sphere concentrates on legal and financial aspects to shape the environment in which communities live (Pike S, Forester D. 1995: 40).
[Source: Downie et al cited in Naidoo J, Wills J. 2000: 107]
A young person's first contact with sexual health promoters may be in any of the domains but their response is likely to follow Prochaska and DiClemente's 'Process of change' model. A 'revolving door' is a good an analogy of the model; people will not enter the door until they know were it leads. Once in the door it may take several turns to negotiate the exit successfully
(Ewles L, Simnett I. 1999: 263)
[source: Ewles L, Simnett I. 1999: 264]
Pre-contemplation: a quarter of the British population is sexually active before their 16th birthday (Durex: 2000) they may be unaware of the risks of unwanted pregnancy and STD's.
Contemplation: made aware of the risks they have entered the 'door'; they may still choose to ignore or reject the risks.
Commitment: when they have accepted the risks and the need to change they progress,
Action: active changes in behaviour and attitudes to sex like seeking contraception.
Maintenance: peers may support or sabotage the new behaviour, at this stage there are two outcomes exit or relapse,
Exit: if the individual is encouraged to maintain the new safer lifestyle they exit the cycle.
Relapse: a relapse may occur for a variety of reasons, social pressure, emotional state or lack of access to services; the 'door' continues round and hopefully by the next turn they will be able to exit. (Primary Care Unit 1994: Handouts C1-C12)
The Social Exclusion Unit (SEU) report Teenage Pregnancy (1999) found that the UK has the highest conception rate for under16's in Western Europe resulting in around 56,000 live births a year.
[Source: ONS in SEU 1999: 12]
The SEU found three main reasons teenagers become pregnant,
) Low Expectations of education and employment
2) Ignorance of contraception and the responsibilities of parenthood
3) Mixed messages from media, peers and parents.
These factors tend to be found in children from lower social classes, experiencing higher deprivation (FPA 1993: factsheet 5A). The 'clusters' of factors produce a "gateway effect" to unhealthy behaviour. American studies identified a 'gateway' between "alcohol, smoking marijuana and early sexual intercourse" (Aggleton P. 1996: 10, 85). The English teen-magazine '19' found that 10% of sexually active teenagers reported being drunk their first time, and 71% being "too drunk to care" when asked why they hadn't used condoms (Barrier Protection Digest 2000: 32). Research shows that in 50% of 'first times' no contraception was used (Ulyatt L. 2000: 29).
The SEU launched a National campaign with three main goals to,
* halve the rate of conceptions among under 18's,
* see a downward trend in the conception rates in under 16's by 2010,
* reduce the social exclusion of teenage parents and their children.
They recommend improvements in sex education in schools, more involvement of parents, clearer guidelines on contraception, implementation of a national helpline and support for teenage parents to finish their education and find suitable housing and employment (SEU 1999: 91).
This campaign is included in 'Our Healthier Nation' as a 'Local priority target'. (DoH 1998: 80)
The 1994 conception rate for under 20-year-olds in Redbridge and Waltham Forest Health Authority (RWFHA) was 57.7 per 1000 lower than in England and Wales at 58.6 (Newman M, et al 1997a: 24). Between 1989-91 and 1992-94 the under 16's rate increased 7% in RWFHA against a national drop of 14% (Newman M, et al 1997a: 20). The overall rate of conceptions in under 18's (1995-97) for Redbridge is lower than Waltham Forest and the London average, however the percentage leading to termination is higher.
995-97
Number of
conceptions
Rate per 1000
aged 15-17
Percentage leading
to a termination
Redbridge
387
31
60
Waltham Forest
569
53
53
London
7,040
50
51
[Source: ONS cited in RWFHA 2000a: 50]
RWFHA have produced a local area profile giving an overview of existing services and highlighting areas for improvement, confirming links between higher rates of teenage pregnancy and areas of higher deprivation within the authority (RWFHA 2000d: 3).
Existing services vary between the boroughs with Redbridge appearing to be the 'poorer relation'. Neither borough provides agencies dedicated to reducing teenage pregnancy. The health authority fund a Brook Advisory Centre in Leytonstone who provide an outreach worker to three schools in Waltham Forest and one in Redbridge, and are developing 'drop-in' centres across the authority. Of the five family planning clinics in Redbridge only the two Brook sessions at John Telford are specifically for young people (Newman M. et al 1997b:150).
The current provision is spread across many separate agencies, with each having their own focus; there is little co-ordination of services.
The profile found that in preventative services,
* Sex education in schools was inconsistent, generally "too little, too late".
* Sex education from parents is virtually non-existent.
* Young people encountered barriers accessing services,
* Lack of policy regarding advice and contraception for under 16's,
* Extreme difficulty in accessing condoms for young people.
* Little activity aimed at boys and young men.
In support services,
* The system is too complicated,
* Lack of information and support around options,
* Lack of childcare prevented mothers continuing their studies or returning to work. (RWFHA 2000d: 5-6)
RWFHA have recognises that working with other agencies will benefit the community, allowing pooling of knowledge, resources and funding. Their 'Action plan' includes a 'partnership' agenda involving professionals from the health service, the community and the voluntary sector working to a common blueprint (RWFHA 2000b: 30).
The aims of their recommendations for improvement, and the agencies involved can be related to the domains of Tannahill's model,
? Preventive services: better access and availability to primary care; GP's, GUM and Family Planning Clinics for contraception and screening for STD's
? Preventive health education: better sex / relationship education in schools (restricted by the national curriculum) training for youth-workers and school nurses.
? Preventive health protection: access to condoms in youth clubs / schools at nominal cost; targeting of high-risk groups by youth-workers.
? Health education for preventive health protection: a co-ordinated service offering 'one-stop' advice and support provided by specialist from social services, housing department, careers advisors; create a young peoples forum.
? Positive health education: development of healthy attitudes towards sex, teaching 'lifeskills' with the aim to raise self-esteem; development of "near-peer" education; involving youth offenders teams / voluntary groups.
? Positive health protection: develop borough guidelines on social / health education in schools. Develop a policy on youth sexual services and contraception particularly >16's and condoms; funding for youth orientated sexual health projects and training.
? Health education aimed at health protection: midwife / health visitor lead antenatal / parent-craft classes aimed at young parents. Publicity / advertising of the availability of advice and rights to screening, contraceptive / termination services.(RWFHA 2000a: 56)
For the national target to be achieved I suggest greater emphasis be placed in the boroughs schools by tapping into the £10m Government pledged to develop school programmes (Kenny C. 2000: 10). They should follow the lead of the many successful 'school nurse' lead schemes across the country e.g. mock radio phone-ins in Taunton (Little L. 2000: 14), and www.lets-talk-about-sex.co.uk in Cheshire (Pickersgill F. 2001: 15).
The Health Education Authority recommend sex education to encourage self-awareness and esteem, a sense of moral responsibility, and provide the skills to make informed decisions and maintain relationships (HEA 1994a: 4).
Brook agrees; early sex education encourages children to delay their first sexual experience (Brook Advisory Centres 1997: 4) and does not encourage sexual experimentation (French K. 2000: 13). This is supported by evidence that countries with the lowest rates of teenage pregnancy have effective sex education programmes (Newman M. et al 1997a: 22). Providing the essential factors for sexual health of,
"freedom from fear, shame, guilt and false belief ..." ( WHO cited in White C. 2000: 15).
Appendix. Redbridge and Waltham Forest Health Authority Wards.
Waltham Forest. Redbridge.
[Source: Redbridge & Waltham Forest Health Authority 1998: 61]
Map of London showing the Location of Redbridge and Waltham Forest Health Authority.
[Source: Redbridge & Waltham Forest Health Authority 2000b: 6]
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Brook Advisory Centres. (1997) Making sex education easier. London, Brook Publications.
DoH. (1993) Targeting Practice: The contribution of Nurses, Midwives and Health Visitors. London, Department of Health.
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Unit 6- Concepts of Health, Health Care and Health Promotion.- 9905890
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