This is a sample thesis paper on Health:
Australia’s approach towards health is gradually moving away from the traditional biomedical model promoted by the medical profession to the adoption of new perspectives. Although the biomedical model of care remains dominant, new aspects towards health care such as the “New Health Movement” and “Public Policy” are becoming widely accepted. These directives encompass the societal determinants of health such as socio-economic status and environmental factors that contribute to inequalities throughout an individual’s lifespan. Governments and health organizations have therefore identified with the necessity for a collaborative inter-sectoral approach from all public domains to gain effective and essential improvements in health care nationally.
The ideology of medicine has had a major influence on how the majority of the population perceives health and the delivery of health care. Crichton (1987) affirms the view of health and health care that society holds is essentially one that medicine has promoted. The western medical perspective of health assumes that illness and health are determined by biological mechanisms. The biomedical approach examines illness by underlying processes within the body that lead to malfunction producing either a temporary and/or permanent disorder (Devitt, Hall and Tsey 2001). The biomedical model is therefore aimed at identifying particular body functions affected in order to restore health by specific treatments (Crichton 1987). This approach towards health care delivery focuses on the health of individuals rather then that of the population and takes a curative dimension rather than a preventative approach.
The biomedical model takes a narrow view in that it does not identify with the social determinants of health. The model sees health as a state in which there is no underlying biological or physiological perspective without anomalies, illness or disease (Irwin 2002, p, 3) and is essentially one that the medical profession has promoted. Duff (1994) argues that the population is in turn suffering and emphasises that concentration on individual behaviour through the biomedical model ignores the underlying economic, political and social processes that shape the choices people make about their individual lifestyle behaviours.
Duff (1994) enforces that there is enormous scepticism regarding the effectiveness of current health care. Of particular concern is the influence that medical technology has had on the health status of the population. The sceptical place emphasis on the fact that a curative medical approach does not take into account the environmental, social, economic and historical factors in which problems emanate. Duff (1994) believes that modern curative medicine is an expensive and inefficient method of utilizing resources. He believes that health care could be managed more efficiently and effectively if the underlying issues surrounding social inequalities were addressed.
The definition of health according to the World Health Organization (WHO) identifies with the beliefs held by Duff. ‘WHO’ defines health as ‘a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity’. Chinmok (2000) reflects further upon the above definition and includes health to be ‘the extent to which an individual or group is able, on the one hand, to realise aspirations and satisfy needs; and, on the other, to change or cope with the environment’.
The above definitions identify health as a resource for everyday life and the basic objective of living. It is therefore a positive concept emphasising both social and physical resources. Turrell (2002) thus states, illness and disease are therefore an ultimate consequence of adverse biological reactions (e.g. hypertension) that occur as a result of changes and/or disruptions in the functioning of various physiological systems. Poorer health therefore disadvantages social groups who sustain or experience ill effects over longer periods of time as a result of physiological and/or biological dysfunction. Brunner (1997) further delineates that changes in health are also brought about by psychosocial processes and behaviours that act independently or inter-dependently as a consequence of exposure to adverse social, physical, economic, and environmental circumstances.
With consideration to the above aspects, the health of all Australians has continued to improve throughout the twentieth century. Mathers, Voss and Stevenson (cited in Turrell 2002) state that life expectancy has increased as a direct response in the reduction of communicable diseases overtime. More recently though, life expectancy has increased due to improved technologies that have allowed for early identification and treatment of diseases. However, against the overall improvement in health, large health inequalities continue to exist between different socioeconomic groups (Turrell 2002). Turrell states that despite substantial reductions in age-standardised death rates between 1985–87 and 1995–97, the size of the mortality gap between the most and least disadvantaged areas widened for many health conditions.
Chinmok (2000) has attempted to narrow and identify with the above concepts by defining health and wellbeing into three stages that focus on improving health outcomes. These include health promotion; prevention; intervention and access to appropriate and affordable primary health care. Chinmok states the major problem that currently faces those dealing with the health of others is to determine at what stage one should intervene in the disease process. The author therefore declares that intervention strategies can be directed and implemented from three influences being upstream, midstream and downstream.
The upstream approach described by Chinmok (2000) as the tertiary phase would more likely have the greatest impact on differentials amongst a vast population. However, Chinmok (2000) identifies that changes at a societal-level are both politically sensitive and difficult to achieve. In contrast, policies and interventions focusing on midstream factors may benefit targeted groups but are unlikely to reduce inequalities at a national level. Chinmok (2000) further states midstream efforts may improve psychosocial health by altering behaviour but is not likely to alter the social and economic conditions that give rise to the initial problems. Downstream efforts therefore focus more at a micro level such as consultations with General Practitioners. Turrell (2002) states that although this approach addresses the needs of individuals it does not disseminate to the health inequalities experienced nationally. Turrell further adds that although approaches differ in impact, attempts to tackle health inequalities should focus simultaneously on all three levels of influence.
Bennett (1996) states health inequalities derive from societal conditions associated with varying levels of housing, employment, education and income. In response, Turrell (2002) asserts that inequalities will not be reduced primarily by actions taken within the health sector. A collaborative inter-sectoral approach from all public sectors will be needed to achieve an effective response within disadvantaged groups acquiring poor health standards.
Diez-Roux (2000) argues that social, economic, physical, and environmental contexts exert an independent influence on health. Diez-Roux states that evidence suggests the tackling of health inequalities should focus on both the contexts and individuals by taking a social–ecological approach. Turrell (2002) affirms that recent policies and interventions have largely focused on non-contextual aspects achieving limited success in the reduction of socio-economic health inequalities. Kawachi and Marmont (cited in Turrell 2002) conclude that this individualised approach has actually widened health inequalities between social groups. The authors state that health promotion programs attempting to change individual behaviour have generally only benefited those considered socio-economically advantaged. Turrell (2002) relates this to the constraints of disadvantaged groups who experience sustained social and economic circumstances hindering behavioural change.
Baum and Keleher (2001) state that national efforts aimed at improving health inequalities need to be governed by policies and interventions directed at those considered socio-economically disadvantaged. A National approach therefore requires a life course attack if the status of inequity is to improve throughout Australia. Baum and Keleher (2001) assert that disease risk accumulates longitudinally over an individual’s life-span with the worst health experienced by those with greatest cumulative exposure to social and economic adversity.
Public health and healthy policy are therefore crucial for promoting and protecting health with its infrastructure aimed at preventive measures. Baum and Keleher (2001) imply that for public health to be successful it needs to be economically, geographically, and culturally accessible. Turrell (2002) states that a successful universal system encompasses the biomedical curative model as well as primary and community aspects of care. Australia in an attempt to achieve such an approach developed the initiative “Australia’s Health in the Year 2000 and Beyond” in order to complement current approaches to health care and future national initiatives.
‘Australia’s Health in the Year 2000 and Beyond’ was implemented as part of a cooperative between the Commonwealth, State and Territories aimed at improving the health of all Australians by reducing inequalities within society (Chinmok 2000). The initiative represents an agreement between governments on the aims, principles and frameworks guiding the future development of the Australian health system. The initiatives health promotion directive enables individuals to increase control over their own health encouraging individuals to reach a state of complete physical, mental and social well-being (Chinmok 2000).
Australia’s health policy is therefore a positive concept that emphasises the availability of social and personal resources that support and enhance an individual’s functional capacity (Chinmok 2000). Health promotion therefore extends beyond health care and places health on the agenda of policy makers. As a consequence, responsibility and accountability is introduced for policy makers through legislation, organisational acceptance and fiscal measures (Chinmok 2000). Health policies are therefore a coordinated action fostering health through improvements in societal equity. The aim of the process is thus to empower the community by providing individuals with ownership and control of their own endeavours (Chinmok 2000).
NSW Health (2001) states this is attainable as health promotion supports personal and social development through the provision of information and education that enhance life skills. By so doing, individuals are able to exercise more control over their own health by enabling choices that are conducive to health. The responsibility for health promotion is therefore shared among Individuals, community groups, health professionals, health institutions and governments. Health care organisations must therefore accommodate the health promotion perspective extending their role beyond that of providing clinical and curative services. Chinmok (2000) adds that the adoption of such a process will support the needs of individuals and communities gaining a healthier lifestyle by opening channels between the health sector and the identified social, political, economic and environmental factors of disadvantaged groups such as ‘Aborigines and Torres Strait Islanders’.
The Australian Institute of Health and Welfare (2001) state that nowhere is health inequality more evident than in the health of the Australian indigenous population. Hayman (1997) confirms that the current health status of both Aborigines and Torres Strait Islanders is rivalling that of many third and forth world countries. The latest available data from the AIHW (2001) reveals that Aboriginal men and women have life- expectancies 15-20 years lower than non-indigenous Australians with perinatal and infant death rates three times higher than the rest of the population. Despite the inconsistency in statistical data regarding the number of indigenous hospitalized episodes, Aboriginal rates of hospitalisation and disease burden continue to be substantially higher per-capita than in non-indigenous Australians (AIHW 2001).
Aborigines and Torres Strait Islanders therefore generally suffer poorer health than other Australians when compared against a range of indicators (Australian Bureau of Statistics 2001). As a consequence government and non-government organisations are placing significant resources in to understanding the complex range of socioeconomic, environmental and historical factors contributing to indigenous inequalities (Macer 1998). The Australian Bureau of Statistics (2001) concludes that inequities in health will continue to deteriorate among our indigenous natives if Australia pursues with the current approach towards indigenous health. Baum and Keleher (2002) state that new public policy needs to address the areas of housing, unemployment, education, geographical location, health service access and transport in order to ameliorate socio-economic health differences. This belief is in contrast to earlier opinions that behavioural changes were all that was needed to improve the health status of our indigenous population (McPherson 1992, p. 121).
However, current approaches such as the ‘New Health Movement’ and ‘Public Policy’ recognise that there are many influences causing ill health in which the individual has minimal control over. McPherson (1992, p122) states that recognition of the above mentioned entities has lead to comparable changes in health with greater emphasis being placed on the social factors determining health. In 1986 the principles behind the Ottawa Charter outlined a ‘New Public Health Movement’ recognising that socio-economic factors impinge upon both individuals and populations (McPherson 1992, p.122). Hence, the ‘New Public Health Movement’ extends beyond the traditional concepts of health care and encompasses ‘Healthy Public Policy’ creating and enforcing social, economic and environmental conditions attributing to healthy living.
The ‘New Public Health Movement’ therefore seeks to amalgamate traditional public health concerns such as the physical environment (sanitation, nutrition, living conditions) with the broader social, economic and environmental concerns of today’s lifestyles (McPherson 1992, p. 122). The ‘new public health movement’ in conjunction with ‘illness prevention’ and ‘health promotion’ challenges the individual curative approach of the biomedical model. These three dimensions direct our attention to areas outside those traditionally seen as health related such as transport, housing, industry and employment opportunities.
It is therefore imperative that new health movements and policy be directed at establishing good health and life skills in infancy. This will encourage individuals to maintain attitudes that prosper optimal health throughout their life-span. Chinmok (2000) states recent evidence indicates that significant inequalities exist within the health status of children in Australia. The Australian Bureau of Statistics (2001) adds that investing in the health of children is seen by governments and communities as a practical way of improving the health of the overall population. Turrell (2002) outlines that governments are making enormous attempts to understand the impact that socioeconomic inequality has on individuals at both early and critical stages of development to overcome the current differentials within health standards.
Governments actions though at this time remain focused on addressing the identifiable inequalities leading to poor health over the life course. An example of this is the current immunisation program directed at young Australians. Chinmok (2000) states that despite its immediate success, immunisation rates for measles, mumps and rubella remain well below acceptable levels in accordance with the United Nations International Children’s Emergency Fund (UNICEF) goal of 90% for the year 2000. Chinmok asserts that although the Australian percentage of immunized infants has increased over recent years percentages still remain lower than desirable. As late as 1993-94, the UNICEF report “Progress of Nations 1993-94” confirmed the above mentioned by identifying that 26 out of 28 industrialised nations reported immunisation rates higher than Australia despite implemented governmental strategies.
In conclusion, inequalities in health can thus be said to be inequalities rooted within societal attitudes. Therefore, the closing of the health gap between socially and educationally disadvantaged individuals and the more advantaged individuals requires a policy that will improve access to health enhancing goods and services that facilitate a supportive environment. Public accountability is therefore a crucial element for the growth of healthy public policy. Governments and other health controllers are ultimately accountable to the individuals they represent through policies or lack of policies. Many of the current health inequalities cannot be immediately rectified by the present health care approach. Health promotion efforts are therefore essential and require an integrated approach to both social and economic development from all sectors. At the same time, governments have increasingly come to accept that much of the illness and injury in the community is potentially preventable, and that a complex mix of social, cultural and environmental factors is vital to the maintenance of health. The common aim is therefore to raise the health status of Australians to equal the best in the world.
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