HEALTH PROMOTION

&

PRIMARY HEALTH CARE

BY:

MR. J.C. FRANK M.SC (N)

ASSISTANT PROFESSOR

HEALTH PROMOTION AND

PRIMARY HEALTH CARE

HEALTH PROMOTION

At the beginning of the 20th century, a new concept,

the concept of health promotion began to take shape.

It was realized that public health had neglected the

citizen as an individual and that state had a direct

responsibility for the health of the individual.

DEFINITION:

“Health promotion is the process of enabling

people to increase control over and to improve

health.” It is not directed against any particular

disease, but is intended to strengthen the host

through a variety of approaches (interventions).

GOALS OF HEALTH PROMOTION

To create environments that allow all

the ability to access all needed services.

To equip with the skills to determine their own

health needs.

INTERVENTIONS AREA IN HEALTH

PROMOTION:

1. Health education

2. Environmental modifications

3. Nutritional interventions

4. Lifestyle and behavioral

changes

HEALTH EDUCATION

This is one of the most cost-effective

interventions. A large number of diseases

could be prevented with little or no medical

intervention if people were adequately

informed about them and if they were

encouraged to take necessary precautions in

time.

HEALTH EDUCATION

CONTT……

The targets of educational efforts may

include the general public, patients,

priority groups, health providers,

community leaders and decision-makers.

ENVIRONMENTAL MODIFICATION

A comprehensive approach to

health promotion requires

environmental modifications,

such as provision of safe water;

installation of sanitary latrines;

control of insects and rodents;

improvement of housing etc.

ENVIRONMENTAL MODIFICATION

The history of medicine has shown that many

infectious diseases have been successfully

controlled in many countries through

environmental modifications.

NUTRITIONAL INTERVENTIONS

These comprise food distribution and

nutritional improvement of vulnerable groups:

child feeding programmes,food fortification;

nutritional education,etc.

Legislation measures

Law related to prevention of motor vehicle accidents

Laws related to control of environmental pollution

Laws related to maintain food hygiene

Laws related to alcohol use/ tobacco use/ drug abuse

Laws related to crime

LIFE STYLE AND BEHAVIOURAL

CHANGES

The conventional public health measures or

interventions have not been successful in making in

roads into lifestyle reforms. The action of prevention

in this case, is one of individual and community

responsibility for health.

LIFE STYLE AND BEHAVIOURAL

CHANGES

The efforts are directed towards discouraging

from adopting harmful lifestyles eg. Smoking,

eating patterns, lack of exercise, alcoholism etc.

PRINCIPLES

Health promotion involves population as a whole in the context of their

everyday life.

Health promotion is directed towards action on the determinants of

health.

It includes communication, education, legislation, fiscal measures,

organizational change and local activities against health hazards.

It aims public participation.

It is basically an activity in health and social field and not a medical

service.

Preventive, protective and promotive measures are

required to achieve health. These measures have to

be adopted continuously to remain healthy.

Maintenance strategy

NUTRITION

EXERCISE

HYGIENEREDUCE STRESS

SAFE ENVIRONMENT

PRIMARY HEALTH CARE

INTRODUCTION:

With increasing recognition of the failure of existing

health services to provide health care, alternative ideas

and methods to provide health care have been

considered and tried. The concept of primary health

care came into limelight in 1978 following an

international conference in Alma-Ata, USSR

DEFINITION:

“Primary health care is the essential health care made

universally accessible to individuals and acceptable to

them, through their full participation and at a cost the

community and the country can afford.”

ELEMENTS OF PRIMARY HEALTH CARE:

The Alma-Ata conference outlined 8 essential components of

primary health care.

“MAD PEPSI”

Maternal and child health care, including family planning. (m)

Appropriate treatment of common diseases and injuries (a)

Provision of essential drugs. (d)

Promotion of food supply and proper nutrition (p)

Education concerning prevailing health problems and the

methods of preventing and controlling them. (e)

Prevention and control of locally endemic diseases. (p)

An adequate supply of safe water and basic sanitation (s)

Immunization against major infectious diseases.(i)

PRINCIPLES OF PRIMARY HEALTH

CARE

PRINCIPLES

EQUITABLE DISTRIBUTION

COMMUNITY PARTICIPATION

APPROPRIATE TECHNOLOGY

INTER SECTORAL

COORDINATION

PRINCIPLES OF PRIMARY HEALTH CARE:

EQUITABLE DISTRIBUTION:

The first key principle in the primary

health care strategy is equity or equitable

distribution of health services.

EQUITABLE DISTRIBUTION

CONTT……

Health services must be shared equally by all

people irrespective of their ability to pay, and all

must have access to health services.

At present health services are mainly concentrated

in the major towns and cities resulting in inequality

of care to the people in rural areas.

EQUITABLE DISTRIBUTION:

CONTT……

The worst hit are the poor and the needy

and vulnerable groups of the population in

rural areas and urban slums. This has been

termed as social injustice.

The failure to reach the majority of the

people is due to inaccessibility.

EQUITABLE DISTRIBUTION:

CONTT……

Primary health care aims to redress this

imbalance by shifting the centre of gravity

of the health care system from cities to the

rural areas and bring these services as near

people’s homes as possible.

COMMUNITY PARTICIPATION:

The overall responsibility of the central and state

governments, the involvement of individuals,

families, and communities in promotion of their

own health and welfare, is an essential ingredient

of primary health care..

Countries are now conscious of the fact that the

universal coverage by primary health care

cannot be achieved without the involvement of

the local community

There must be a continuous effort to secure

meaningful involvement of the community in the

planning, implementation and maintenance of health

services, besides maximum reliance on local

resources such as manpower, money and materials

.In short, primary health care must be built on the

principle of community participation (or

involvement).

INTER SECTORAL COORDINATION:

There is an increasing realization of the fact that the

components of primary health care cannot be

provided by the health sector alone.

INTER SECTORAL COORDINATION

CONT…

The declaration of Alma-Ata states, primary health care

involves in addition to the health sector, all related sectors

and aspects of national and community development, in

particular agriculture, animal husbandry, food, industry,

education, housing, public works, communication

and other sectors”

INTER SECTORAL COORDINATION

CONTT……

This requires strong political will to translate values

into action, an important element in intersectoral

approach is planning –planning with other sectors to

avoid unnecessary duplication of activities.

APPROPRIATE TECHNOLOGY:

Appropriate technology has been defined as

“technology that is scientifically sound, adaptable to

local needs, and acceptable to those who apply it and

for those for whom it is used, and that can be

maintained by the people themselves in keeping with

the principle of self reliance with the resources the

community and the country can afford”

APPROPRIATE TECHNOLOGY

CONTT……

The term appropriate is emphasized because in

some countries, large luxurious hospitals that are

totally in appropriate to the local needs are built,

which absorb a major part of the national health

budget, effectively blocking any improvement in

general health services.

This also applies to use of costly equipment,

procedures and techniques when cheaper,

scientifically valid and acceptable ones are

available, viz, oral rehydration fluid.

ROLE OF NURSES IN PRIMARY

HEALTH CARE

Assessing the health status of individuals and

communities.

Health Education

Food Supply And Proper Nutrition

Water supply and basic sanitation.

Maternal and Child Health Care including Family

Planning.

Immunization

Treatments of Minor

ailments.

Mobilizing community

involvement.

Providing integrated health

care including the treatment of

emergencies and making referrals.

LEVELS OF PREVENTION

PRIMORDIAL PREVENTION

PRIMARY PREVENTION

SECONDARY PREVENTION

TERTIARY PREVENTION

PRIMORDIAL PREVENTION

This primary prevention is purest in its sense.

It implies prevention of the emergence or development of

risk factors in population groups in which they have not yet

appeared.

The main intervention in primordial prevention is through

individual & mass education

PRIMARY PREVENTION

Primary prevention can be defined as “action taken prior to the

onset of disease, which removes the possibility that a disease

will occur”.

It signifies intervention in the pre pathogenesis phase of a

disease or health problem.

Primary prevention may be accomplished by measures designed

to promote general health & well being, & quality of life of

people or by specific protective measures.

1. HEALTH PROMOTION

General Health promotion

Health education

Environmental modifications

Nutritional interventions

Lifestyle and behavioural changes.

2. SPECIFIC PROTECTION

Use of Specific immunization (BCG, DPT,MMRvaccines)

Chemoprophylaxis (tetracycline for Cholera, dapsone

for Leprosy, Chloroquine for malaria,etc.,)

Use of specific nutrients (vitamin A for Children, ironfolic acid

tablets for Pregnant mothers)

Protection against accidents (Use of helmet,seatbelt,etc.,)

Protection against occupational hazards.

Avoidance of allergens.

Protection from air pollution.

SECONDARY PREVENTION

Secondary prevention can be defined as “action which halts the progress

of a disease at its incipient stage & prevents complications”.

The specific interventions are early diagnosis & prompt treatment.

Secondary prevention attempts to arrest the disease process, restore health

by seeking out unrecognized disease & treating it before irreversible

pathological changes have taken place & reverse communicability of

infectious diseases.

Objectives of secondary prevention:

Complete cure and prevent the progression of disease process.

To prevent the spreads of disease by curing all the known cases.

To prevent the complications and sequel of disease.

To shorten the period of disability.

INTERVENTIONS:

Individual and mass case-finding measures.

Screening surveys(urine examination for diabetes,etc.,)

Selective examination

TERTIARY PREVENTION

When disease process has advanced beyond its early stages, it is still

possible to accomplish prevention by what might be called “tertiary

prevention”.

It signifies intervention in the late pathogenesis phase.

Tertiary prevention can be defined as “all measures available to reduce or

limit impairments & disabilities, minimize suffering caused by existing

departures from good health & to promote the patient’s adjustment to

irremediable conditions.

REHABILITATION:

Medical rehabilitation: (restoration of Bodily Function).

Vocational rehabilitation:( restoration of the capacity to earn a

livelihood)

Social rehabilitation: (restoration of family and social

relationship).

Psychological rehabilitation: (Restoration of personal dignity

and confidence)

BIBLIOGRAPHY

Basheer.P. Shebeer,KhanYaseen, Advance Nursing Practice,

1st Edition, EMMESS, Medical Publisher,2012.Pp:689-93

Basavanthappa. BT, Community Health Nursing, 1st

Edition, Jaypee Brothers Medical Publishers,Pp.99-103.

Park.K, Textbook of Preventive and Social Medicine,17th

Edition, M/S BanarsidasBhanot Publishers,Pp.10

http://www.ncbi.nlm.nih.gov/pubmed/19305227