Health promotion (Oxford, England)最新文献

Publishing a major policy document on public health every decade has become a worthy tradition in the Netherlands. In accordance with this tradition, the Memorandum health 2000 was published last year. This article describes and analyses the health policy, with the emphasis on health education, prevention and facet policy. Facet policy refers to strategies applying to all areas that are outside the scope of public health policy but have a health component or dimension. The model presented in the policy document incorporates all relevant factors in health care: physical environment, social environment, lifestyle, state of health, health care system and current resources. The factors affecting health care have been described before, but the Memorandum health 2000 goes further than this. The document presents these factors in a single integrated model, which highlights the relative importance of each individual factor. This is an unprecedented achievement in Dutch government policy.

During the 1980s increasing attention has been given to the view that a vast array of public policies have great potential for health promotion and that this potential ought to be developed. After briefly discussing the basis for this concept and its policy implications, this article turns to a major corequisite for making healthy public policy a political reality: learning how to do it. Where healthy public policy exists, how did it happen? This is a question that calls for a new generation of policy studies, one that is relevant to advocates of healthy public policy within and outside governments. An ecological framework of policy-making is proposed for such studies, delineating the social climate, key players, and strategic action. From it, operational indicators and study methods are suggested, in order to learn some general principles, within a real-world context, of how to develop public policies that are healthful.

The Dutch obstetric system is traditionally characterized by extensive primary health services, supported by more specialized care. Midwives and GPs are responsible for normal deliveries, obstetricians for the deliveries considered high risk. Home deliveries are fairly common. Over the last decade this relatively positive approach to reproduction has threatened to give place to methods that seem to oppose the goals of health promotion. The percentage of home deliveries has declined from 57% in 1970 to 35% in 1985. The distinction between normal and pathological pregnancies and deliveries has become more blurred. A growing number of women with a normal pregnancy are giving birth in hospital. In sparsely populated regions, primary health care is inadequate, but this explains only part of this development. As far as parents-to-be have a choice, little is known about their considerations and about the role of different professional groups in how they choose. Between the various medical professions, competition arises about the division of tasks and about the hierarchical relation to one another. The role of obstetricians has become more important, GPs are losing ground, while midwives retain their share in practising obstetric care. Rivalry between different professional groups has been stimulated by the decline in the birth rate and the increase in the number of professionals. The increased number of pregnant women whose pregnancy and delivery is defined as 'pathological' reflects the continuing process of medicalization. Different developments may explain this process: the increase in hospital births, progress in medical science, the older age of women having their first baby.(ABSTRACT TRUNCATED AT 250 WORDS)

Health policy can be described as policy directed at the determinants of health, i.e. biological and environmental factors, lifestyle and the health care system. This type of policy now has become a policy objective in an increasing number of countries. In this article mental health is placed in the broad context of this policy. The central question is: can the mental health field grasp the opportunity of a growing interest in prevention and health promotion in general, as major objectives of health policy? Or will it stay more or less isolated from the mainstream of current developments? Answering this question means looking at the conditions of health policy. For health policy it is required that a definition be given of health problems and "causing" conditions. There should further be available intervention possibilities of a preventive and intersectoral character and also preventive strategies. It is stated that there is enough standardized information on mental health problems and experience with community-based research to let mental health participate in drawing up a community diagnosis. It also appears possible to construct an ecological health status model for mental health. Research on the factors in this model shows a shift in focus from risk populations to risk situations, e.g. unemployment, industrial disability, divorce and isolation. Further it is recognized that the search for causal factors is substituted by that for precipitating factors. Social-demographic factors, taken alone, are not precipitating factors. What matters is the combination of an underdeveloped coping mechanism, little social support, and prolonged stressful conditions or sudden stressful events.(ABSTRACT TRUNCATED AT 250 WORDS)

There are many arenas within which health promotion may be located. This paper addresses the issues involved in the development of health promotion in one such arena: the community health movement. This movement is complex and dynamic. When reference is made to non-statutory health action, or to community involvement in health, this complexity may not be fully appreciated. There is a tendency for the range of activity to be reduced to its most "visible" form: self-help activity. However, there is more to the community health movement than this. A typology is offered here in which three levels of community-based activity in Britain are identified. These are referred to as self-help groups, community health groups and community development health projects. The breadth and range of this activity reflects the inability of formalized health care to tackle many of the underlying causes of ill-health. Each type of community health activity exists as a declaration of this failure, but some forms of activity may be welcomed by the health professions whilst others may not. In particular the numerically small community development health projects offer a significant challenge to formal health care because they seek to encourage collective health activity by those who are least in control of their own health. It is within the context of developing strategies for health promotion that community health action is most relevant. National and local strategy documents suggest that community involvement is essential for the successful promotion of health. Fully comprehensive participation by community groups signifies a major shift in our perceptions of health and health care. An appreciation of the existing range of health action in communities is an important starting point for medical health professionals engaged in this task.

A basic objective of the "Community Study Stuttgart", a part of the German Cardiovascular Prevention Study (GCP), which began in April 1984 and will end in December 1991, is to develop and utilize globally applicable intervention measures through which cardiovascular risk factors can be reduced effectively under the population's living conditions in the Federal Republic of Germany. Vital elements of intervention include exerting influence on individual health behaviour as well as creating and developing community structures and provisions to foster health. The intervention is directed towards behaviour in the sectors of nutrition, physical activity and (non-)smoking, but psychosocial constellations will also be taken into consideration. The long-range goal of the study is a reduction in the incidence of ischaemic heart diseases and cerebrovascular diseases (as well as the ensuring reduction in total mortality) among the community populations as compared to the average population of the same age in the Federal Republic of Germany. The intervention concept is based on a broadened pathogenetic chain in which the so-called classic somatic risk factors for cardiovascular diseases have been supplemented by behaviour-related psychosocial factors and living conditions which influence health behaviour. Each of the target variables is significant in itself within the intervention concept. In the study, it is assumed that the community framework is of essential relevance to daily life and affects community members' knowledge, attitudes and opportunities for realization. On the basis of scientific studies on the lifestyle concept, an intervention concept was developed which centres on the population of defined communities.(ABSTRACT TRUNCATED AT 250 WORDS)