Models of health

The social model of health acknowledges the effect of social, economic, cultural and political factors and conditions on a person’s state of health and wellbeing. Use of the model aims to improve health outcomes, prevent and reduce illness and address the inequalities and disadvantage that exist within the community. Community healthcare, as a part of primary healthcare, is informed by the values and principles supported in the AlmaAta Declaration on Primary Health Care (World Health Organization, 1978) and the Ottawa Charter for Health Promotion (WHO, 1986).

The social model of health recognises:

The biomedical model of Western tradition views health as the absence of disease. Health and disease are opposites, extremes on a linear continuum. Disease is caused by specific agents or pathogens. Thus, the biomedical focus is the diagnosis and treatment of those pathogens and the curing of disease. Assessment factors are a list of biophysical symptoms and signs. The person is certified as healthy when these symptoms and signs have been eliminated. When disease does exist, medical diagnosis is worded to identify and explain the cause of disease.

The accurate diagnosis and treatment of illness is an important part of healthcare but the medical model has limiting boundaries. The public’s concept of health has expanded since the 1950s. Now we view health in a wider context. We have an increasing interest in lifestyle, personal habits, exercise and nutrition, and the social and natural environment. Wellness is a dynamic process, a move towards optimal functioning. Different levels of wellness exist, with optimal health described as ‘high-level wellness’. Wellness is a direction of progress. Healthcare providers serve to maximise the person’s potential, to assist the person to grow towards high-level wellness.

Consideration of the whole person is the essence of holistic health. Holistic health views the mind, body and spirit as interdependent and functioning as a whole within the environment. Health depends on all these factors working together. The basis of disease is multifaceted, originating both from within the person and from the external environment. Thus, the treatment of disease requires the services of numerous providers.

A natural progression to health promotion and disease prevention now rounds out our concept of health. Guidelines to prevention emphasise the link between health and personal behaviour. Reports from the Department of Health and Ageing, Australian Government (2009) and the New Zealand Public Health Advisory Committee (2006) assert that the majority of deaths among Australians and New Zealanders under age 65 are preventable. Prevention can be achieved through counselling by primary care providers which is designed to change people’s unhealthy behaviours related to smoking, alcohol and other drug use, lack of exercise, poor nutrition, injuries and sexually transmitted infections. Health promotion is a much broader concept than disease prevention. Health promotion was defined in the Ottawa Charter for Health Promotion (WHO) (1986) and includes building public health policy, creating supportive environments for healthy living, strengthening community action, developing personal knowledge and skills and reorienting the healthcare system (Talbot and Verinder, 2010).

Quality and safety

Once a person accesses the healthcare system for treatment of illness, a number of factors pose potential risk for harm. Examples include increasing age, comorbidity and the increasing use of complex technology, the use of numerous and complex interventions during an episode of illness, movement between community and hospital health sectors giving rise to possible duplication of, or gaps in, care and/or communication breakdown. The Australian Charter of Healthcare Rights describes the rights of patients and other people using the Australian health system. One of the principles of this Charter recognises that every person has the right to the highest standard of care (Australian Charter of Healthcare Rights, 2008). While the solutions to decreasing risk to the person are complex, improving the use, availability and communication of health information is critical to the provision of high quality and safe care (The Australian Commission on Safety and Quality in Healthcare, 2009). Quality and safe care of patients and clients requires that nurses assess in order to determine care needs. Assessment is conducted in collaboration with the patient and the multidisciplinary healthcare team to achieve positive goals and health outcomes for the recipient of care.

Life span considerations

It is important to consider health assessment from a life cycle approach, no matter what clinical context you are working in. First, you must be familiar with the usual and expected developmental tasks for each age group (Ch 3). This alerts you to which physical, psychosocial, cognitive and behavioural tasks are important for each person. For example, if you are assessing a 6-year-old child with asthma, your approach will need to take into account the developmental tasks for that child’s age group which include mastering skills that will be needed later as an adult, building self-esteem and a positive self-concept, adopting moral standards and taking a place in a peer group. This knowledge will guide how you approach the collection of subjective and objective data. The data from the physical examination is more accurate when you consider age-specific information about anatomy, method of examination, normal findings and abnormal findings. For example, an average normal respiratory rate for a 6-year-old child is 21–26 breaths per minute.

Cultural and social considerations

The population of Australia is in excess of 22 million; New Zealand in excess of 4 million. The Australian community now includes people from about 200 countries (Department of Foreign Affairs & Trade, 2009). Similarly, the New Zealand population includes people from over 145 countries (Department of Immigration, 2005). As mentioned above, cultural and social considerations are critical to health assessment: there is an introduction to these concepts in Chapter 3 and the concepts are threaded throughout the text as they relate to specific chapters.