University professor and physician Trevor Hancock has urged society to rethink the role and effectiveness of health care as a determinant of our health. According to his December 2014 article in Canadian newspaper Times Colonist “…as a society we should be investing more in creating social conditions and environments that make people healthy, rather than in increasingly expensive high-tech care.” This is very sound advice, according to HPF’s senior health promotion strategist Dr Viliami Puloka.
Traditionally, we have given hospitals, doctors and the health care system the responsibility to look after our health. “That relationship seemed to work well in the days where most of our health issues were largely acute infective processes that required urgent but short term medical interventions by doctors and nurses,” says Viliami. “However, the major health problems we face today are not acute infections from a single organism treatable with antibiotics, but chronic conditions with multiple risk factors that lie outside the remits of the existing health care system.”
Dr Hancock’s article highlights two main points that are very relevant to the situation in New Zealand. Firstly, the importance of shared responsibility for the management of people’s health; between the individuals themselves, the wider community and health care providers. This is particularly critical in the management of chronic conditions, such as diabetes and obesity, where the individual has to make healthy choices and behaviour modifications in order to be well. The role of health care providers here is to support and empower individuals to make these healthy choices. Secondly, the importance of enabling-environments where healthy choices are the easy choices. These enabling-environments must include socio-economic and political environments. Dr Hancock refers to these as the upstream – or health – determinants that are outside the reach of the individuals and the jurisdictions of the health system.
As in Canada, we here in New Zealand have identified these health problems and their solutions. The solutions include cost-effective ‘upstream’ strategies such as community health promotion. However we have, to date, failed to address the processes that prevent individuals from benefitting from these upstream approaches. “We have been busy rescuing half-drowned people downstream. It is time that we work with our leaders putting in place policies and legislations to prevent people from falling into the river in the first place.”
Author: Viliami Puloka
Editor: Jo Lawrence-King
6 January 2015