Analysis of Healthcare Models

• The biomedical and social model for health
• The Ottawa Charter for Health Promotion
• VicHealth and VicHealth funded projects

Many models of health exist thorough out the world. When a government or organisations is determining the most appropriate model to implement factors such as cost, ability to achieve desired outcomes and feasibility must be considered. The models of healthcare that play the largest role in the health of Australians are the biomedical and social models of health.

The biomedical model of health

The biomedical model of health focusses on optimum physical health for individuals. This model focusses on diagnosis and treatment of health conditions, with the goal of returning people to their pre-condition healthy state. This model relies heavily on hospitals, pharmaceuticals and medical technology to achieve this goal and is an expensive model. The biomedical model is widely accepted and forms the basis of health care throughout the western world.

Advantages and disadvantages of the biomedical model of health

Advantages

1. Increases populations life expectancy as treatments advance
2. Effective at treating common problems and returning people to a healthy state
3. Can lead to advances in medical technology
4. Can improve the quality of life for people with chronic conditions via medications etc.

Disadvantages

1. Use of advanced medical technology and the health system to diagnose and treat conditions is costly for governments
2. Does not address factors that lead to the development of particular health conditions
3. Not all health conditions can be cured, however they can often be managed via behaviour modification which this model does not consider
4. Paying for medications and treatment via the biomedical approach can be expensive for individuals

The social model of health

The social model of health focusses on influences that can lead to poor health. It aims to improve health and wellbeing by directing efforts towards addressing social, economic and environmental determinants of health. Instead of an individual approach, this model focusses more broadly on communities and populations in an attempt to promote optimal health.

There are five key principles to the social model of health:

1. Addresses the broader determinants of health

   Factors such as gender, socioeconomic status, culture, physical environment, education and ethnicity can influence the health of people. The social model of health looks beyond the biological determinants and focuses on how health and wellbeing can be influenced by such broader determinants.

2. Acts to reduce social inequities

   Quality of healthcare, access and use of healthcare should be equal across all groups in the community. The social model of health acts to ensure socioeconomic status, gender, race, locality or physical environment do not reduce equity.

3. Empowers individuals and communities

   When people gain increased control over decisions and actions influencing their health they become empowered. The social model of health acts to empower and this may occur through increased health knowledge and can happen on an individual basis or collectively as a community.

4. Acts to enable access to healthcare

   Health care and health information should be accessible and affordable to meet people’s needs. Social determinants that can influence this access include socioeconomic status, cultural barriers and education levels. The social model assists to lower such barriers to enable access to health care.

5. Involves intersectorial collaboration

   The government, non-government organisations and the private sector should work in a partnership to address the broader determinants that influence individual’s health. Greater community health has positive implications for all sectors and collaboration should be sought between such groups.

Acronyms are often a handy way to remember much of the knowledge covered in the HHD course. The acronym AREAS or IDEAR may be used to remember the principles of the social model of health.

AREAS

• Addresses
• Reduce
• Empowers
• Acts
• interSectorial

IDEAR

• Intersectorial
• Determinants
• Empowers
• Access
• Reduce

Closing the gap campaign – demonstrating the principles of the social model of health.

Since 2006, Australia’s peak Indigenous and non-Indigenous health bodies, NGOs and human rights organisations have worked together to achieve health and life expectation equality for Australia’s Aboriginal and Torres Strait Islander peoples. This is known as the Close the Gap Campaign.

The Close the Gap Campaign partners have developed targets to support the achievement of Indigenous health equality over many areas. Key targets include those to support:

• significant reductions in the rates of Aboriginal and Torres Strait Islander death and illness from diseases and chronic conditions;
• the delivery of the necessary primary health care services for health equality to Aboriginal and Torres Strait Islander communities, particularly by Aboriginal Community Controlled Health Services;
• big improvements to housing (so that it supports good health) in Aboriginal and Torres Strait Islander communities;
• a dramatic increase in the availability of fresh and healthy food supplies in Aboriginal and Torres Strait Islander communities; and
• significant reductions in the rate of smoking among Aboriginals and Torres Strait Islanders.
• The Closing the gap campaign reflects the principles of the social model of health in the following ways:
• Addresses the broader determinants of health: The program is attempting to address determinants such as behavioural practices, such as healthy food consumption, and social influences, such as housing, that impact on the health of indigenous people.
• Acts to reduce social inequities: Social inequalities such as access to healthcare are being addressed in this program.
• Empowers individuals and the community: Providing an increase in the availability of fresh and healthy food supplies, allows individuals and communities the choice to engage in health behaviour. In conjunction with education regarding the benefits of these foods, this program will attempt to empower people so they feel they have control over their health.
• Acts to enable access to healthcare: Increasing access to primary healthcare services, including delivery of these services by Aboriginal and Torres Strait Islanders where possible, reduces barriers that may prevent indigenous people from achieving optimal levels of health.- Involves intersectorial collaboration: In this campaign government and non-government organisations are working together and therefore there is the ability to influence a broad range of social factors that influence indigenous health.

Other programs that are based on the social model of health include the “Swap it, Don’t stop it” initiative, the Quit campaign and the SunSmart program. A progressive society, such as Australia’s, does not choose to use either the biomedical model of health or the social model of health, but incorporate both approaches to strive for optimal levels of health within their population.

The Ottawa Charter for Health Promotion

One of the most significant contributions to the evolution of Public Health occurred at the First International Conference on Health Promotion held in Ottawa, Canada in 1986. Stemming from the social model of health this conference saw the development of The Ottawa Charter for Health Promotion. The Ottawa Charter is a framework to assist governments and organisations around the world when developing health promotion strategies.

The Ottawa Charter recognises that in order for health gains to occur the following basic conditions and resources must be available:

• Peace
• Shelter
• Education
• Food
• Income
• A stable eco-system

   

• Sustainable resources
• Social justice and equity

The Ottawa Charter also outlines that the following three basic prerequisites are the foundation for health promotion:

1. Advocate

   Political, economic, social, cultural, environmental, behavioural and biological factors can all favour health or be harmful to it. Health promotion action aims at making these conditions favourable through advocacy for health.

2. Enable

   Health promotion focuses on achieving equity in health. Health promotion action aims at reducing differences in current health status and ensuring equal opportunities and resources to enable all people to achieve their fullest health potential.

3. Mediate

   Health promotion demands coordinated action by all concerned: by governments, by health and other social and economic sectors, by nongovernmental and voluntary organization, by local authorities, by industry and by the media. Professional and social groups and health personnel have a major responsibility to mediate between differing interests in society for the pursuit of health.

Priority / Action Areas of the Ottawa Charter for Health Promotion

When health promotion strategies and programs are devised by governments or organisations there is the intent to achieve various health outcomes. The following priority or action areas are recommended for use by The Ottawa Charter for creating a health promotion program. Not all areas need be addressed in every strategy.

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Build Healthy Public Policy

This action area asks governments and organisational policy makers to be aware of the health consequences of their decisions and to accept their responsibilities for health. Policies that involve taxation and legislation can influence the behaviours of individuals, leading to either positive or negative influences on health. For example a legislation that prevents people from smoking indoors at a restaurant, can then make it easy for a family to decide to go out for dinner and not put the health of their family members at risk. Health promotion encourages health to be on the agenda for policy makers in all sectors and all levels.

Create Supportive Environments

This action area recognises the link between health and our societal and natural environment. Changing patterns of life, work and leisure have a significant impact on health. Work and leisure should be a source of health for people. The way society organises work should help create a healthy society. Health promotion generates living and working conditions that are safe, stimulating, satisfying and enjoyable. Protecting natural and built environments and conserving natural resources is an important part of health promotion given the influence they can have on maintaining health. For example, work places that have natural lighting and fresh air support the health of their staff.

Strengthen Community Actions

This action area recognises that community participation in setting priorities and making decision on the direction of health matters can lead to empowerment. When a community feels like its voice is being heard this can lead to increased participation and engagement in health promotion activities. For the community to draw on its human and material resources to promote good health it requires access to information, learning opportunities and funding support.

Develop Personal Skills

To increase options for people to exercise more control over their health personal and social development needs to occur. Providing information, education and opportunities for skill development whether that be at school, home, work or in the community will allow for learning and development of personal skills to occur.

Reorient Health Services

This action area recognises the need for the health promotion message to be shared amongst more than doctors and hospitals it needs to be shared among individuals, community groups and governments also. For example, if new medical knowledge exists regarding limiting the prevalence of childhood obesity, medical staff should be encouraged to share this information at community forums and via school visits.

SunSmart program – demonstrating the Ottawa Charter priority / action areas.

Cancer Council Victoria and the Victorian Health Promotion Foundation first funded SunSmart in 1988 in Victoria.Since inception the program has prevented more than 100,000 skin cancers and saved thousands of lives making it one of the most successful programs in Australia. Today SunSmart is a multi-faceted program recognised for providing leadership and innovation in ultraviolet radiation (UV) protection. Programs operate in each state and territory of Australia by respective Cancer Councils, all using common principals but tailored to jurisdictional priorities. The sun protection message is currently Slip! Slop! Slap! Seek! Slide!

SunSmart seeks to influence individual sun protection behaviours, those with responsibilities for protecting others and broader environmental change. SunSmart also aims to promote and improve the awareness of a balanced approach to UV exposure and the link with vitamin D.

• Building Health Public Policy: The program is an advocate for change and implementation of SunSmart recommendations in schools , workplaces and local government areas.
• Create Supportive Environment: Encouraging schools, workplaces and governments to provide shaded areas for people when they are outdooea creates an environment that supports the SunSmart approach.
• Strengthen Community Actions:By working with various groups in the community, such as early childhood centres and sporting clubs, to reduce UV exposure the program is reducing the risk of skin cancer.
• Develop Personal Skills: The Slip, Slop, Slap, Seek, Slide advertising campaign is teaching people strategies to decrease their risk of developing skin cancer.
• Reorient Health Services: Working with a variety of groups and individuals across the health sector improves knowledge and skills that people have for reducing UV exposure.

Other programs that incorporate the Ottawa Charter priority / action areas include the “Swap it, Don’t stop it” initiative, the Quit campaign and the Closing the gap campaign.

An acronym to assist remembering the first word of each Ottawa Charter action area is “Bad Cats Smell Dead Ratsâ”.

VicHealth

The Victorian Health Promotion Foundation, more commonly referred to as VicHealth was established in 1987 and works in partnership with organisations, communities and individuals to make health a central part of daily living. The focus of VicHealth is primarily on health promotion and prevention of health conditions for Victorians. VicHealth does not implement programs but advocates and financially support health promotion initiatives.

The mission of VicHealth is to build the capabilities of organisations, communities and individuals in ways that:

• change social, economic, cultural and physical environments to improve health for all Victorians;
• strengthen the understanding and the skills of individuals in ways that support their efforts to achieve and maintain health.

The mission of VicHealth guides the selection of the organisations strategic priorities, which reflect the Tobacco Act 1987 and are founded on principles of equity. The priorities for focus in the VicHealth strategic framework are:

• Reducing smoking
• Improving nutrition
• Reducing harm from alcohol
• Increasing physical activity
• Increasing social and economic participation
• Reducing harm from UV exposure.

VicHealth reflects the social model of health by participating in business activities that draw on the Ottawa Charter. Health promotion actions that VicHealth are involved in are activities that:

• Create and use knowledge acquired through research and evaluation.
• Create environments that foster good health.
• Encourage the development of systems that support and sustain health.
• Communicate about priority health issues.
• Develop communities which are inclusive, accessible, equitable and safe.
• Support organisations to plan, implement and evaluate health promotion activity.
• Facilitate participation and skill development.
• Contribute to, and advocate for, healthy public policy and regulation.

VicHealth also reflects the social model of health via its Key Result Areas (KRA). These are the targets they have set for the organisation over a particular period.

VicHealth Key Result Areas

KRA 1 Health inequalities

1.1 Improve the physical and mental health of those experiencing social, economic or geographic disadvantage.

1.2 Contribute to closing the health gap between Indigenous and non- Indigenous Victorians.

KRA 2 Participation

2.1 Increase participation in physical activity.

2.2 Increase opportunities for social connection.

2.3 Reduce race-based discrimination and promote diversity.

2.4 Prevent violence against women by increasing participation in respectful relationships.

2.5 Build knowledge to increase access to economic resources.

KRA 3 Nutrition, tobacco, alcohol and UV

3.1 Create environments that improve health.

3.2 Increase optimal nutrition.

3.3 Reduce tobacco use.

3.4 Reduce harm from alcohol.

3.5 Reduce harmful UV exposure.

KRA 4 Knowledge

4.1 Produce, synthesise and translate practical health promotion knowledge.

4.2 Evaluate health promotion

practice.

KRA 5 Communications

5.1 Develop, implement and evaluate marketing and communications approaches to improve health.

5.2 Develop evidence on effective social marketing.

5.3 Provide accurate, credible and timely information to stakeholders on health

promotion issues.

KRA 6 Business operations

6.1 Ensure effective business and risk processes and systems.

6.2 Develop high-performing people in a healthy and sustainable work environment.

6.3 Operate transparently and with accountability.

VicHealth funded projects

VicHealth’s programs and projects focus on improving the health of all people in Victoria, including addressing differences in health status between population groups. Programs are guided by the latest evidence and there is an attempt to invest in a range of activities in sectors as diverse as sport and active recreation, the arts, education, planning and built environment, community and local government. These programs promote changes in policy and practice that can influence people’s ability to sustain a healthy lifestyle.

Activities supported since the Foundation’s establishment in 1987 have contributed significantly to public health improvements in Victoria. The reduction of smoking prevalence among adults is one of the success stories in the effectiveness of comprehensive, well-funded and sustained programs for improving health.

Two VicHealth funded programs are outlined below, accompanied by potential health outcomes of each project and how they reflect the social model of health:

1. VicHealth’s Arts About Us program encourages dialogue about the benefits of cultural diversity and the harm caused by race-based discrimination. Arts About Us currently provides three-year funding to 16 community and arts organisations that have partnered with VicHealth. Each project is working with various organisations to create and showcase art that strengthens cultural understanding, celebrates cultural diversity and generates discussion about the effects of race-based discrimination.

   Potential health outcomes of this program include;

   • Breaking down the social isolation that people involved in the program may have experienced, thus leading to improvements in peoples social health.
   • Building social connectedness for community groups and individuals that come together in such a program is positive for social health.
   • Building the self-esteem of people whose art may be displayed is positive for social health.
   • Raising community awareness of race-based discrimination may possibly lead to less discrimination and therefore has associated mental health benefits.
   • Economic benefits may stem from people whose art skills are recognised. Resulting employment may have associated health benefits for these people.

   How this program reflects the principles of the social model of health;

   • Strengthening cultural understanding and raising awareness of issues such as race-based discrimination aims to reduce social inequalities.
   • Celebrating diversity aims to empower individuals and communities so they have the confidence to participate in the community.
   • Culture is a broad determinant of health that is being targeted in this program.
2. As of November 1, 2011, it is now against the law in Victoria to serve alcohol in a private home to anyone under 18, unless their parent or guardian has given permission. The teen drinking law web resource launched by VicHealth, the Australian Drug Foundation and the Victorian Government is aimed at parents, adults and young people and gives practical information about the new law change.

   The website encourages parents and children to discuss alcohol consumption, provides information on short term and long term harm that may result from alcohol and how to reduce these risks.

   Potential health outcomes of this initiative include;

   • Raising community awareness of the new law may reduce the degree of underage alcohol consumption with associated health benefits.
   • Social health benefits may result when parents and their children communicate about alcohol consumptions and the associated risks.
   • Physical health benefits may result when young people are educated on safe consumption of alcohol.
   • Mental health benefits may result when parents are reassured that there is a law protecting their children from accessing alcohol from other adults.

   How this program reflects the principles of the social model of health;

   • Teaching young people and adults about alcohol consumption addresses the broader determinants of health, particularly education.
   • When young people are educated about alcohol and its effects they are empowered to take control over the decisions that they make in their lives.

For further practice on how VicHealth reflects the principles of the Social model of health, head to the VicHealth website. Here you will find examples of many VicHealth funded programs. Identify several programs and make connections with the principles of the Social model of health. Get your teacher to read over your responses.

Glossary

Biomedical model of health – Focuses on the physical or biological aspects of disease and illness. It is a medical model of care practised by doctors and/or health professional and is associated with the diagnosis, cure and treatment of disease.

Mission – A statement defines what an organization is, why it exists, its reason for being.

Ottawa Charter for Health Promotion – Developed by the World Health Organization this approach attempts to reduce inequalities in health. The Ottawa Charter for Health Promotion was developed from the social model of health. It considers health promotion as the process of enabling people to increase control over, and to improve, their health. The Ottawa Charter identifies three basic strategies for health promotion which are enabling, mediating, and advocacy.

Social model of health – A model that attempts to achieve improvements in health and wellbeing by directing effort towards addressing the social, economic and environmental determinants of health.

VicHealth – Is a Victorian government body that works with organisations, communities and individuals to promote health and prevent illness according to its priorities.

Revision check checklist

• Can you explain the biomedical model of health?
• Can you explain the social model of health including the five principles?
• Can you explain the Ottawa Charter including the five priority action areas?
• Do you know VicHealth’s mission and strategic priorities?
• Do you know the potential health outcomes of a VicHealth funded project and how this project reflects the social model of Health?

Revision Questions

1. List three examples that represent a biomedical approach to health?
2. Outline two features of the biomedical model of health?
3. The QUIT campaign attempts to reduce the prevalence of smoking through assisting smokers to quit and not resume smoking. Describe how the QUIT campaign reflects two of the action areas of the Ottawa Charter?
4. Explain the role of VicHealth in promoting health?
5. VicHealth supports the Darebin Northern Interfaith Respectful Relationships Project. This project engages faith leaders and communities in Melbourne’s north to raise awareness of the problem of violence against women. The project helps faith and community leaders build their capacity to undertake primary prevention work. It incorporates a range of activities, including using scripture and teachings to promote respectful relationships, White Ribbon Day initiatives, interfaith declarations and peer mentoring programs.
6. Explain, using evidence, two principles of the social model of health that are reflected in this program.