Week 8: Global and planetary health

WHO definition of health

“ A state of complete, mental and social well-being rather than a mere absence of disease or infirmity”

• The extent to which an individual or group is able to realise aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal resources as well as physical capabilities

LaLonde Report

• Was the first significant government report to suggest that health care services were not the most important determinant of health 

• After reviewing the evidence the report suggested that there were four “health fields” 

  1. Lifestyle 

  2. Environment

  3. Health care organization 

  4. Human biology 

• That major improvements in health would result primarily from improvements in lifestyle, environment and our knowledge of human biology 

• Leads away from the “victim blaming” lifestyle approach to the multi facet community approach 

Ottawa charter: health promotion

supported the socio-environmental approach to health

• prerequisites for health

• advocate

• enable

• mediate

Prerequisites for health

• Peace, shelter, education, food, income a stable ecosystem, sustainable resources, social justice and equity 

Advocate

• Political, economic, social, cultural, environmental, behavioural and biological factors cna all favour health or be harmful to it 

  • Aims at making these conditions favourable through advocacy for health

Enable

• Achieving equity in health 

Mediate

• Coordinated action by all concerned 

Social awareness 1960-1970

•  participants were educated on social and health inequities

Empirical concepts 1970-1990

• when evidence base on health inequities and the mechanisms behind then began to solidify

Distinct research approach 2000-present

• researching specific area to see how they have changed and are still applicable to the social inequity|

Major models of health

• These approaches lead to different definitions of problems, different strategies, different target groups, and different people responsible for the activities of promoting health 

  • medical model (traditional)

  • behavioural model (lifestyle)

  • Socio-environmental model (structural)

Socio-environmental model (structural)

• 1980’s- Health and social structures are linked 

  • Strong relationship between personal health behaviours and social and physical environments

  • Responsibility shifted towards society rather than individual (social justice and equity) 

  • Aligned with upstream thinking 

    • Ex: living and working conditions were perceived as barriers to engaging in healthy behaviours 

  • The ottawa charter for health promotion supported this approach to health  

    • Ex: poverty, unemployment, isolation, pollution, stressors, Hazardous living/working conditions

Medical model (traditional)

• Represents a stability orientation to health, dominated western thinking for most of the twentieth century. It emphasizes that medical intervention restores health. Health problems are defined primarily as physiological risk factors- physiologically defined characteristics that are precursors to or risk factors for disease. 

• Ex: CVD, Cancer, HIV/AIDs, CVA, Diabetes. Obesity 

Behavioural model( lifestyle)

• 1970’s progressing from medical focus to understand what contributed to health and illness 

  • 1974 Lalonde report- shifted emphasis from medical-> behavioural 

  • Defined health determinants (4 health fields) as lifestyle, environment, human biology and organization of health care 

  • Focus on lifestyle behaviours that contribute to chronic disease 

  • Aim to decrease the behavioural risk factors (smoking, lack or exercise, diet) 

  • Responsibility is on the individual to adapt to health- enhancing behaviours 

  • Ex: smoking, poor eating habits, lack of activity , substance abuse, lack of life skills 

Health promotion

• 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 realize aspirations to satisfy needs, and to change or cope with the environment 

Primary prevention

• Activities protect against a disease before signs and symptoms occur (pre-pathogenesis stage of disease) 

• Intent: reduce of eliminate causative risk factors (risk reduction)

  • Ex: encourage exercise and healthy eating to prevent individuals from becoming overweight

Secondary prevention

• Activities promote early detection of disease once pathogenesis has occurred, so that prompt treatment can be initiated to halt disease and limit disability 

• Intent: early identification (through screening and treatment) 

  • Ex: check body mass index (BMI) at every well checkup to identify individuals who are overweight or obese

Tertiary prevention

• Activities are initiated in convalescence stage of disease and are directed toward minimizing residual disability and helping people to productively with limitations 

• Intent: prevent sequelae (stop bad things from getting worse) 

  • Ex: help obese individuals lose weight to prevent progression to more severe consequences

Assumptions of a population health approach

1. Health is a resource for everyday living the determinants of health are key, complex and interrelated 

2. The focus is upstream 

3. Health is the business of all 

4. Evidence guides decision making 

5. Accountability is increased 

6. Management of health issues is horizontal 

7. Involves multiple strategies, settings, systems and sectors 

The Epp report: A Framework for health promotion (1986)

Concepts from the Ottawa Charter were incorporated 

• Become Canada’s blueprint for WHO’s “health for all 2000)

• Identified three major challenges: 

  1. Reducing inequities 

  2. Increasing prevention 

  3. Enhancing coping mechanisms

• The report acknowledged disparities in health: between low/high income, and that living and working conditions were “social determinants of health” 

WHO commission on social determinants of health (2007)

•  Identified 3 overarching recommendations to reduce health inequities nationally and globally: 

  1. Improve daily living conditions 

  2. Tackle the unequal distribution of power, money and resources 

  3. Measure and understand the problem and assess the results of action

Most urgent challenges from: world health organization

1. Elevating health in the climate debate 

2. Delivering health in conflict and crisis 

3. Making healthcare fairer 

4. Expanding access to medicines 

5. Stopping infectious diseases 

6. Preparing for epidemics 

7. Protecting people from dangerous products 

8. Investing in the people who defend out health 

9. Keeping adolescents safe

10. Earning public trust

Global health, international, public health: Koplan et al (2009)

• suggest that global health overlaps with concepts derived from the disciplines of public health, global health, and international health 

• Each of these domains shares several common characteristics: 

  • A population-based and preventative focus

  • Work with marginalized populations 

  • A focus on multidisciplinary and interdisciplinary approaches 

  • Acknowledgement that health is a public good 

  • An emphasis on systems and structures, and participation with key stakeholders 

Grootijan & Newman (2012): relevance of globalization to nurses 

• Two broad characteristics of nursing prac in globalized world

  1. Sustainability for nurses 

  2. social justice and equity and nursing 

3 essential attributes of what nurses need to know to practice in globalized world: Grootijan & Newman (2012)

1. Understand the environment 

2. Prioritize health promotion 

3. Response to the globalization of health by including global considerations in their actions locally