Theoretical framework of HPDP

The health sector has four pillars. These are promotion of health, prevention of disease, curative and rehabilitation. Emerging trends have their focus on promotion of health and prevention of disease (HPDP). Promotion of health is defined as “the process of enabling people to increase control over, and to improve, their health” (WHO, 1998). Health promotion seeks to create awareness and empower people to adequately take care of their health leading to increased quality of life.

Prevention of diseases is defined as “specific, population based and individual based interventions aimed at minimizing the burden of diseases and associated risk factors” (WHO, 2017). This is characterized by the assessment of the risk factors of diseases and making efforts to mitigating them.

These are founded on 6 theories. These are:

• Ecological models
• The health belief model
• Relapse prevention model
• Transtheoretical model
• Social cognitive model
• Theory of reasoned action/planned behavior (NORC Walsh center, 2012)

Health promotion is guided by the Ottawa charter of 1986 and the Jakarta Declaration of 1997. According to the Ottawa Charter, advocacy, enabling and mediation are the strategies for health promotion. Under these three strategies, there are action areas which include:

• Development of healthy public policy
• Provision of health supportive environments
• Strengthening of the community for action
• Personal skills development
• Reorientation of health services(WHO, 1998).

The Jakarta Declaration has five main priorities. These are:

• Promotion of social responsibility for health.
• Increase of investments
• Expansion of partnerships.
• Empowerment of the individual and community capacity
• Provision of infrastructure for health promotion (WHO, 1998)

Primary, secondary and tertiary are the three levels of prevention. Primary prevention is aimed at preventing the manifestation of a disease by targeting the risk factors. Examples include immunization programs, educating on health risks, hygiene, nutrition etc. Secondary prevention in involved with screening and early detection of diseases, this is composed of screening programmes and health checks. Tertiary prevention is focused on limiting the loss of function caused by a disease (WHO, n.d).

The elderly face a number of issues ranging from physical, psychological and social. the top physical health concerns include hypertension, cardiovascular diseases, stroke, diabetes, cancer and respiratory diseases  (Kaldi, 2004). Depression, anxiety, dementia, sleep disorders and substance abuse are among the top psychological concerns that affect the elderly (Morewitz & Goldstein, 2007). Lack of social recognition and isolation are cited as the social problems encountered by the elderly (Lena, Ashok, Padma, Kamath, & Kamath, 2009). These concerns occur in a cyclic manner in that physical issues can cause or exacerbate psychological and social issues and vice versa. Figure 2.0 below shows the most common diseases associated with the elderly.

 

Fig 2.0 Common Geriatric Diseases in US. Adopted from Residents Living in Residential Care Facilities (Caffrey, Sengupta, Park-Lee, Moss, Rosenoff, & Harris-Kojetin, 2012).

In order to help in the management of cardiovascular diseases, cancer, diabetes which are among the top health concerns for the elderly, the following strategies have been implemented.

Health concerns among the elderly

First we have health policy, which aims at creating environmental change that supports HPDP. Public policies have been focused on food and nutrition, tobacco and alcohol abuse and intersectoral collaboration. Policies focused on food and nutrition aim at advocating for healthy eating behaviors by imposing tax on junk food, advocating for nutritional labeling in all foods and on food menus in restaurants. These help the people to be more informed and focus on healthy foods. Intersectorial collaboration is seen by the efforts put in place by the education by making nutrition, HIV/AIDs, hygiene and drug and substance abuse core courses.

Health communication is aimed at creating awareness on health matters. This focuses on changing attitudes, beliefs, knowledge and behaviors. This is done through electronic and print media. Articles, TV programs, radio station programs, and the internet provide information on chronic diseases and ways of self management. Below is an example of a brochure on management of diabete

Health education aims at empowering the community by expanding their knowledge base. For the aging population, it is focused on nutrition, importance of physical activity, effects of tobacco and alcohol abuse, which are risk factors for major chronic diseases. This occurs through lectures, workshops, seminars, classes, webinars etc (NORC Walsh Center, 2015). This helps in increasing their health literacy and encourages healthy behavior change. It helps in increasing social support as they are informed on ways to help one another.

The last strategy is environmental strategies. These involve the alteration of the physical, economic and social aspects that affect health. These address community health. They help in bringing people aboard in the management of diseases and their risk factors. The collaboration between policy makers and the community have a huge impact as the policies are effectively implemented. An example of this is the allocation of smoking free zones that helps to counter smoking habits and most especially second hand smoking.

These strategies have brought about positive health outcomes in that they have helped in the reduction of alcohol and tobacco abuse among the elderly, promotion of healthy feeding habits and physical activity. These have led to the reduction of incidence and prevalence in asthma, arthritis, cancer, diabetes, cardiovascular diseases and stroke leading to reduced disease burden to the individual, community, nation and globally. Increased quality of life has been brought about by self management strategies leading to improved functionality in school or work. The reduction of risky behaviors like excessive drinking has led to a reduction in road traffic accidents (Merkur, Sassi, & McDaid, 2013).

HPDP strategies

HPDP faces a lot of barriers. Poverty is one major barrier that affects HPDP strategy  implementation like screening, training, advertisements and advocacy This has led to many governments holding back on such programs. Low literacy affects the uptake of these strategies by the community. Individuals may predispose themselves to diseases due to lack of knowledge on nutrition and other risk factors. Inaccessibility to healthy foods promotes unhealthy eating habits that predisposes one to NCDs. Inaccessibility of health services makes one miss out on screening and other health services (NORC Walsh Center, 2012). These barriers affect HPDP strategies and lead to increased incidence and prevalence of diseases, increased mortality rates, reduced quality of life and life expectancy and increased health expenditure.

The training programme will help in educating the CHVs on HPDP strategies in management of major health concerns. The collaboration of CHVs will make health services like screening, counseling more accessible hence far reaching. The CHVs will also be to bring about social support as they can rally their community members to support these causes. This will help manage social isolation that predisposes one to depression.

Conclusion

HPDP are key form of care that should be implemented as they bring about creation of awareness, empowering and educating of the community and behavioral changes that help reduce the incidence and prevalence of diseases.

Caffrey, C., Sengupta, M., Park-Lee, E., Moss, A., Rosenoff, E., & Harris-Kojetin, L. (2012, April 12).   Residents Living in Residential Care Facilities: United States, 2010. Retrieved March 7, 2018, from Centers for Disease Control and Prevention: https://www.cdc.gov/nchs/products/db91.htm

Kaldi, A. R. (2004). A Study on Physical, Social and Mental Problems of the Elderly in District 13 of Tehran. Middle Eastern Journal of Age and Ageing , 322.

Lena, A., Ashok, K., Padma, M., Kamath, V., & Kamath, A. (2009). Health and Social Problems of the Elderly: A Cross-Sectional Study in Udupi Taluk, Karnataka. Indian Journal of Community Medicine , 131-134.

Merkur, S., Sassi, F., & McDaid, D. (2013). Promoting health, preventing diseases: Is there an economic case? Copenhagen: World Health Organization Europe Regional Office.

Morewitz, S. J., & Goldstein, M. L. (2007). Aging and Chronic Disorders. Boston: Springer.

NORC Walsh center. (2012, April 5). Health Promotion and Disease Prevention Theories and Models. Retrieved March 7, 2018, from Rural Health Information Hub: https://www.ruralhealthinfo.org/community-health/health-promotion/2/theories-and-models

NORC Walsh Center. (2012, April 5). Rural Health Information Hub. Retrieved March 7, 2018, from Barriers to Health Promotion and Disease Prevention in Rural Areas: https://www.ruralhealthinfo.org/community-health/health-promotion/1/barriers

NORC Walsh Center. (2015, April 5). Rural Health Information Hub. Retrieved February 7, 2018, from Health education: https://www.ruralhealthinfo.org/community-health/health- promotion/2/strategies/health-education

WHO. (2017). Assessment of essential public health functions in countries of the Eastern Mediterranean Region. Cairo: World Health Organization.

WHO. (n.d). EPHO5: Disease prevention, including early detection of illness. Retrieved March 7, 2018, from World Health Organization: https://www.euro.who.int/en/health-topics/Health- systems/public-health-services/policy/the-10-essential-public-health-operations/epho5-disease- prevention,-including-early-detection-of-illness2

WHO. (1998). Health Promotion Glossary. Geneva: World Health Organization.

WHO. (2009). Interactions of the ICF-components for healthy aging . Geneva: World Health Organization