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Critically analyse the impact of the National Health Promotion Strategy 2000-2005 in the context of overall health provision and the relevance to Public Health Nursing
The National Health Promotion Strategy addresses a new orientation towards illness prevention and reduction of use of secondary and tertiary care services. Its key focus on aspects of community, health and the individual, and the intersections between these disparate elements, is suggestive of a great capacity for improvement in key areas of health. This essay will look at this in relation to health provision and Public Health Nursing in Ireland.
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Lifestyle Choices and Health, Population Approach and Major Determinants of Health
The strategy considers the particular lifestyle factors and choices which appear to affect health in the Irish population, and examines key sectors and sub-groups of the population in relation to particular health needs. This is nothing new, and nursing in the community setting, in primary care and in longer term tertiary care has long incorporated specialist provision for specific health-needs population groups (Watkins et al, 2003). However, health promotion at local and population levels may be focusing on a means of changing public opinion as well as personal choices, and there may be considerable resistance. Research might be needed into identifying where the greatest resistance is and in developing strategies specifically to overcome this.
Determinants of health remain related to issues such as socio-economic status and location, access to health services, level of education, and the like. These are wider public-health related issues, and ones which require longer term strategic changes and longer term investment of resources. However, it might be that targeting the settings described below may contribute to this. The policy/practice interface may change with time, with emergent social forces and changes in the economic climate, and so it may be important to build in a degree of flexibility and scope for growth. Community organisations may play a key role here, but again, the funding of these is still indeterminate and poses questions for longer term sustainability.
Bringing health promotion into a range of community settings in a more proactive way seems a very positive step forward. Public health as a concept is very much about every sector of the community (Cowley, 1995), and public health programmes are historically very much concerned with areas of greatest need (Ewles, 2005). However, the strategy would need to overcome the professional/cultural hegemonies of different settings, and set out ways in which inter-professional and inter-agency communications and collaborations can be fostered. Breaking down the barriers between health services, community settings, organisations and agencies may be challenging. An incorporation of primary care principles and models (Starfield, 1995), into other settings might be particularly challenging. There may be a real need to identify expertise in relation to professional knowledge of the identified settings and to use this expertise, as a means of delivering the strategy and as a means of educating a wider range of professionals to meet identified needs. This could form part of the community health needs assessment, a mapping of existing resources and expertise against needs, and might perhaps form a more realistic component of the implementation of the strategy. However, this would have to be carried out on an individual level as well, which could in itself pose a significant resource question, in relation to who will go and collect the information about individual employee/professional expertise and capability available in each location, setting or district. The coordination of such a comprehensive garnering of existing resources presents yet another challenge.
Challenges and Strengths
While the strategy has a strong community focus, medical models still dominate much of the rhetoric. Medical models and community-focused health promotion do not necessarily sit well together (Carr, 2007). The issue of resources is also challenging, because while it will contribute to developing a skilled and responsive workforce, this itself must be resourced, as well as changes and expansions in service provision.
The topics focused on are unsurprising, and are key areas of health promotion need across the developed world. All of these are public health concerns for the general population, but although there is reference to mental health, there is not enough of a focus here on wellbeing and what constitutes wellbeing for different sectors of the community, social, racial, cultural or other. Similarly, it is important to look at the intersections between the different topics, such as education and eating, socio-economic factors and healthy eating or lifestyles, and the like. This constitutes a major need for investigation and evaluation as an ongoing component of the plan, drawing on academic resources as well as healthcare service resources.
Public Health Nursing
The role of the public health nurse in Ireland is that which is most suited to deliver on all the above key areas of the strategy (Chavasse, 1995). However, the limitations of current systems might mean that public health nurses are being asked to be jack of all trades, and master of none. There may be a need to specialise in order to meet the needs of specific population sub-groups (Poulton et al, 2006; Barlow et al, 2007; Foxcroft et al, 2004). Public Health Nursing may provide a model of healthcare provision which can be used to develop services in line with the Strategy (Clarke, 2004; Markham and Carney, 2007), and contribute to the development of community health profiles, but extra resources will be required to ensure they can do this as well as carrying out their patient-facing role (Clarke, 2004; Cowley, 1995). Public Health Nurses can also provide a means of disseminating good practice, service innovation, change and innovation. However, the considerable demands would suggest there is a need to examine the current models of provision and supervision of these key members of staff.
Acheson (1988) defines public health as a community endeavour, ‘the art and science of preventing disease, promoting health and extending life through the organised efforts of society.’ This is a very laudable sentiment, but it still remains to be seen if the priorities of those in power, in society, those who define policy, are able to meet the needs of all those who constitute that society, without prejudice, or inequality. The history of health services would suggest otherwise.
Acheson, D. (1988) Committee of Inquiry into the future Development of the Public Health function. HMSO, London. Acheson, D. (1988) Independent Inquiry into Inequalities in health. The Stationery Office, London.
Barlow, J., Davis, H., McIntosh, E. et al (2007) Role of home visiting in improving parenting and health in families at risk of abuse and neglect: results of a multicentre randomised controlled trial and economic evaluation Archives of Disease in Childhood 92 229-233.
Carr, S.M. (2007) Leading change in public health – factors that inhibit and facilitate energizing the process Primary Health Care Research & Development (2007), 8 : 207-215 Cambridge University Press
Chavasse, J. (1995) Public Health Nursing in the Republic of Ireland. Nursing Review 14 (1) 4-8.
Clarke, J. (2004) Public Health Nursing in Ireland: A Critical Overview *. Public Health Nursing. 21(2):191-198,
Cowley, S. (1995) ‘Health-as-process: a health visiting perspective’. Journal of Advanced Nursing. 22: 433-441.
Department of Health and Children (2001) Primary Care: a New Direction. Available from: http://www.dohc.ie/publications/pdf/primcare.pdf?direct=1 Accessed 10-11-08.
Department of Health and Children (2005) National Health Promotion Strategy 2000-2005 Dept. of Health Available from www.dohc.ie Accessed 17-11-08.
Ewles, L. (2005). Key Topics in Public Health. London. Churchill Livingstone.
Foxcroft, D.R., Ireland, d., Lister-Sharp, D.J. et al (2003) Longer-term primary prevention for alcohol misuse in young people: a systematic review Addiction 98 (4) 397-411.
Markham, T. and Carney, M. (2007) Public Health Nurses and the delivery of quality nursing care in the community Journal of Clinical Nursing 17 (10) 1342-1350
Poulton, B., McKenna, H., Keeney, s. et al (2006) The role of the public health nurse in meeting the primary health care needs of single homeless people: a case study report Primary Health Care Research & Development 7 (2) : 135-146
Starfield, B. (1994) Is primary care essential The Lancet 344 1129-1133.
Watkins, D., Edwards, J. & Gastrell, P. eds. (2003). Community Health Nursing: Frameworks for Practice. 2nd ed. p.35. London, Baillière Tindall.
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