Health promotion (Oxford, England)最新文献

Self-help groups hold the potential for helping many people adjust to health difficulties and life stresses. Self-help clearing-houses represent a community-centred approach to developing and realizing this potential. Several papers describing specific clearing-houses have been published, but a comprehensive survey of these organizations has not yet been completed. This article reports the results of such a survey, in which a majority of existing North American clearing-houses participated. Clearing-houses were found to have evolved rapidly in the last ten years, to the point that they now provide an array of informational, educational, and consultative services to catchment areas that contain over 70 million people. Although clearing-houses offer a unique perspective on the self-help movement and may make important contributions to physical and mental health, they also face technical, philosophical, and funding issues. Considering their tenacity and the robust rate at which they are being established, however, it seems likely that these and other problems will be solved, and that clearing-houses will become an established feature of the human services landscape.

Given the present circumstances and considering the foreseeable development of medical knowledge, the primary prevention of AIDS is the sole field of health policy in which the spreading of the disease and the subsequent number of victims can be reduced. AIDS prevention as a time-stable behaviour control in potentially risky situations is therefore primarily a task which has to be tackled in a social scientific manner. It has to be handled on the basis of available medical knowledge of infectious disease situations. Viewed realistically, the prospective goal is not the elimination of the disease, but the greatest possible reduction and minimization of risk, both individually and epidemiologically. Proceeding from realistic estimates of the desired and undesired effects of health policy measures, this principle is being applied through the strategy (achieved through informational campaigns) of encouraging the use of condoms when having sexual intercourse in non-monogamous relationships and of informing intravenous drug abusers of the need to employ sterile hypodermic needles. Elements of this preventive strategy are discussed under four central questions: What should/must be learn? Who should/must learn? What objective and subjective factors facilitate or hinder this learning? How can this learning process most optimally be organized? The efficiency-reducing interference of other kinds of strategies (e.g. orientation toward zero risk concepts, repression, and mass screening for HIV-anti-bodies) is thereby worked out.

This paper discusses the effects of the arms race on health, in the absence of nuclear war. High levels of military expenditure are inextricably linked to unemployment, poverty, starvation and ill health. Alternatives to the escalation of military expenditure are possible; health promotion can be involved in wider public health initiatives towards economic and industrial conversion to peaceful, socially useful production. The interests of the health and scientific communities have traditionally transcended narrow chauvinism and nationalism. World Health Organization activities such as work towards primary health care and the Expanded Programme on Immunization actively involve international co-operation, demystify potential enemies and promote health and peace.

The municipality of Arjeplog, Sweden, is an example of extensive and successful community participation in the aims of health promotion. At the health care centre, personnel from diverse departments meet on a regular basis to discuss patient needs and exchange knowledge on medical and social matters. Care groups exist in order to enable specialists to discuss and meet community needs: a psychiatric group, a rehabilitation group, a home care group, a child and family care group, etc. The municipality's resources include an old person's home which runs a day centre, A nursery, adult evening colleges, sports clubs, and services such as Alcoholics Anonymous, all serve as centres for the health promotion movement. Preventing ill health among the elderly and encouraging short-term visits to the centre has resulted in the need for hospital beds remaining steady despite an increase in the number of elderly people in the municipality. Preventive work in the form of health education has taken place in schools and through study circles specially formed by health education leaders. Public lectures have been successful and met with requests for further talks. Visits to the outpatient clinic have dropped by about a quarter. Arjeplog has one of the lowest number of people on the sick list in Sweden and the duration of diseases is lower than average. People are generally aware of what a healthy lifestyle involves and often take measures to prevent ill health. A Health Council has been formed and is to initiate future health work through work groups set up to meet health problems identified collectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Vorarlberg--Austria's most western province with a population of about 325,000--has always implemented forms of social policy in which the principles of subsidiarity and solidarity play an important role. This is reflected in the structure of the organizations traditionally providing social services as well as in the more recent programmes the government has developed for social policy. This paper discusses two cases in point: the private associations for home care (Krankenpflegerverbände)--which now exist in 65 Vorarlberg communities and cover 85% of the population in the province--offering nursing services at home to members or to persons who are willing to join the organization when they need care, and the new organizational model, called Gesunder Lebensraum Vorarlberg (GLV), which is successfully operating in a few pilot communities. GLV has spawned umbrella organizations, run by volunteers, and offering a variety of social services relevant to the elderly, for example visiting services or neighbourhood help in case of emergencies. The volunteers get organizational help from a profit-making firm financed by the government. The Vorarlberg models can be interpreted as a step towards demedicalization and deinstitutionalization of health care for the elderly. Nevertheless, they also show the problems that arise when professionals and volunteers must cooperate. The models may lead to savings for the governments involved, although details are still subject to future empirical investigations.

The summary and recommendations of a group set up by the Health Education Bureau, Ireland and reprinted here with the Bureau's permission. They deal with the health policy aspect of health promotion. Though average life expectancy has improved in Ireland, there is room for improvement, Health promotion policy must aim to make healthy choices easier and to provide a healthier environment. Increased expenditure has not led to the expected improvement in the health of the population, the bulk of current spending being on curing illness and on care. A comprehensive food policy and strategies for modifying dietary habits is required and must involve a multi-sectoral, health-conscious approach. The role of the health minister should be extended to include shared responsibility for health promotion with health boards at local level. An overall plan should be produced regularly and its progress monitored annually. A health promotion council should be established to coordinate expertise and experience from different public and private sectors. The scope of the HEB should be broadened to include wider environmental issues. The government should seek to ensure that national, legislative and structural measures to promote health are reflected in EEC institutions.

In Sweden different commissions have been working on legislation, prevention programmes and financing, and have aimed at implementing the Health For All strategy at national level. National programmes for cardiovascular diseases, cancer, accidental injuries, etc were established by parliamentary resolution in 1985. The role of health education has been extended: from the earlier concern with matters of individual lifestyle the focus has shifted towards motivating the community as a whole to take an active interest in its health. There is good public support in the areas of legislation, knowledge and awareness, international development (WHO), and public policy. Despite the existence of legislation, strong official policy and a good organizational structure, strong efforts are still needed to turn health promotion into general practice. National, regional and local bodies as well as non-governmental and private organizations are showing an increasing interest in health promotion. Health promotion strategies are used in traditional fields such as alcohol and smoking as well as other sectors such as education, employment, culture, social welfare, town and house planning, transport and environmental protection. There has never been such a positive basis for the further development of health promotion policy in Sweden though there are a number of potential conflicts and problems related to knowledge, organization, attitudes, financing, distribution of power, etc. These are outlined broadly as "The organizational trap", "Modification or revolution?" and "Individual or public responsibility for health?".