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Primary health care notes Week 1  Discuss the concepts of health and wellness The WHO (1986, p.1) defines health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”.  Provide an overview of the history and origins of primary health care Primary Health Care (PHC) developed out of a response by the World Health Organization (WHO) to the disparities in health status both within and between countries.  Explore the principles of primary health care

Week 2  Explore the social gradient

 Discuss and analyse the social determinants of health

The SDH consist of a number of overlapping factors that determine health and wellbeing. These include factors that begin at birth, such as biology and genetic characteristics, gender, culture and various family influences on healthy child development. Family influences include having socio-economic resources for parents to provide for their child, parenting knowledge and skills, a peaceful family life and adequate support systems. Social support networks that are inclusive across genders, cultures and educational opportunities are also social determinants. Education Education is a key determinant of health as it fundamentally provides individuals with the knowledge and skills to solve problems and take control of their life circumstances. It also increases the opportunity for a job, income security, and job satisfaction Employment The most important factors shaping people’s social position include employment and working conditions. Education is associated with better health throughout life. Education equips people to achieve stable employment, have a secure income, live in adequate housing, provide for families and cope with ill health by assisting them to make informed health care choices. Early/healthy Child Development Healthy early child development (ECD)—which includes the physical, social/emotional, and language/cognitive domains of development, each equally important—strongly influences well-being, obesity/stunting, mental health, heart disease, competence in literacy and numeracy, criminality, and economic participation throughout life. What happens to the child in the early years is critical for the child’s developmental trajectory and life course (WHO, 2018) Employment and working conditions Employment and working conditions: People who have control of their work circumstances and have less stress or safer work often live longer in comparison to those who do not have control of their work environment and its associated risk and stress. Furthermore, unemployment and underemployment are strongly correlated with poorer health; Income Income and wealth play important roles in socioeconomic position, and therefore in

health. Besides improving socioeconomic position, a higher income allows for greater access to goods and services Gender Gender inequality damages the physical and mental health of millions of girls and women across the globe, and also of boys and men despite the many tangible benefits it gives men through resources, power, authority and control. Culture Culture is a person's upbringing, background, traditions, customs, and the beliefs of their family or community. This play a huge role on overall health because it influences how one may think, feel, act, and value. Physical environments Physical environments play a vital role in overall health. Especially, contaminants in the air, water, food, and soil, which can negatively affect health. Biology & genetics Health services Health services including access and quality of health services can impact health. Barriers to accessing health services include lack of availability, high cost, lack of insurance coverage, limited language access

Week 3 According to the World Health Organization (1986), health promotion is 'the process of enabling people to increase control over and improve their health'. Advocate Good health is a major resource for social, economic and personal development and an important dimension of quality of life. 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 (WHO, ND). 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. 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 (WHO, ND).

1. Explain the relationship between health and place Creating supportive environments is one of the five action areas of the Ottawa Charter because of the undeniable links between people’s health and their environment. This approach to health promotion calls upon us “to take care of each other, our communities and our natural environment” (WHO, 1986). Reciprocal determinism refers to people who are affected by their environment, this highlights the key link between health and place. Through a primary health care perspective, it is important to explore how communities within places or communities of place and promote health and wellbeing through engaging and interacting with their environments. Place can impact physical, social and emotional aspect of health and wellbeing. 2. Describe the global factors that influence community health and wellness The impact of Globalisation    

Global domination by multinational pharmaceutical, technology companies High-income countries privileged over poorer countries—the butterfly effect (global financial crisis in the US affects everyone) Mass migration to cities with subsequent effects on the environment, rural areas Health professional exodus from poor countries.

Strategies for global Health     

access to resources—a fundamental human right human security rather than national security reframe globalisation in terms of social obligations regulate global market forces in a way that is people-centred rather than capital driven develop public policy based on a vision of the world where people matter and social justice is paramount

3. Identify the major aspects of urban life that affect the Community Significant growth in urban cities, there is a need for resources and infrastructure (buildings, roads, etc) to combat crowded housing, food, and water security, air pollution and inadequate social services placing pressure on to manage and sustain social inclusive environments.

Positives and negatives to urban life      

More services, more jobs, more people Higher costs, poverty Inequities Substandard housing, crowding Fewer family supports Crime, pollution

4. Describe economic and social capital in a rural context Positives and negatives to rural life Social connectedness, ‘sense of community’. But:      

Net outflow of services and young people Declining economy, infrastructure, transport, education Shortages of health professionals, family carers Few preventative or medical services Social, cultural isolation Worsening of disadvantage for rural Indigenous people

Rural areas need….     

Improved access to services Appropriate service and care models Adequate and appropriate health workforce Collaborative service planning and policy engagement with community partners Strong leadership & governance (Perkins et al. 2012)

Week 4 Social justice means the rights of all people in our community are considered in a fair and equitable manner. Some health examples of social justice are as follows:    

Information designed to educate the public about healthy lifestyles should be provided in languages that the community can understand. Health policies should ensure that all people have equal access to health care services. People living in isolated communities should have the same access to clean water and sanitation as a person living in an urban area. People of low socioeconomic backgrounds should receive the same quality of health care as a person of higher socioeconomic background’.

 Explain the Millennium Development Goals in context of Primary Health Care The Millennium Declaration and its Goals breathed new life into the values of equity and social justice, this time with a view towards ensuring that the benefits of globalisation are more evenly distributed between countries (WHO, 2018). The United Nations Millennium Declaration, signed in September 2000 commits world leaders to combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women. The MDGs are derived from this Declaration, and all have specific targets and indicators.

 Introduce and discuss the Sustainable Development Goals The Sustainable Development Goals (SDGs), otherwise known as the Global Goals, are a universal call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity. The 2030 Agenda for Sustainable Development, adopted by all United Nations Member States in 2015, provides a shared blueprint for peace and prosperity for people and the planet, now and into the future. These 17 Goals build on the successes of the Millennium Development Goals, while including new areas such as climate change, economic inequality, innovation, sustainable consumption, peace and justice, among other priorities. The goals are interconnected – often the key to success on one will involve tackling issues more commonly associated with another (United Nations Development Programme, n.d.)

 Introduce the concept of sustainability The concept of sustainability is about using resources wisely in a way that not only protects the environment in which we live here and now, but also takes account of the needs of our planet’s inhabitants in the future (Ballard, 2013).  Explore the National Health Priority Areas The NHPAs were established in response to the World Health Organization’s Global Strategy for Health for All by the year 2000. They sought to focus public attention and health policy on these areas that were considered to contribute significantly to the burden of disease in Australia (Australian Institute for Health and Welfare, 2018).  Explain the concept of burden of disease Burden of disease analysis measures the combined impact of morbidity (non-fatal burden) and mortality (fatal burden) to assess and compare the health loss from different diseases and injuries in a population. The 9 NHPAs agreed by the Australian Health Ministers’ Advisory Council (AIHW, 2018) between 1996 and 2012 were:

Week 5 Cultural Sensitivity Cultural sensitivity is one of the six primary health care principles. Health professionals’ cultural reflexivity influences the delivery of culturally safe practice. Cultural awareness, self-reflection and knowledge of beliefs relates to the attainment of cultural sensitivity. Being responsive and respectful to the way an individual or groups cultural norms shape health and health behaviours contributed to cultural safety. Cultural safety is where recipients of health care feel safe as a result of actions from health professionals (Clendon & Munns, 2019). Cultural Competence Cultural competence is the ability to understand, communicate, and effectively interact with people across cultures. Cultural competence encompasses; being aware of one's own world view, developing positive attitudes towards cultural differences and gaining knowledge of different cultural practices and world views. In other words, being inclusive to other’s voices. Health professionals gain authentic understanding of health issues as a basis for planning care or cultural competence (Clendon & Munns, 2019). Culturally Competent Health Systems and Organisations      

Acknowledge diversity Provide culturally appropriate care Enable self-determination and reciprocity Hold governments and health planners accountable for meeting needs of all cultures Manage from a culturally competent evidence base Recognise need for culturally competent training

Cultural Inclusion The most compelling mark of an inclusive society is the respect conferred on its Indigenous people. However, in many countries, Indigenous people are treated as outsiders. This can have a profound impact on the health and wellbeing of these populations. Systematic Bias Systematic bias can occur when the health of Indigenous people is analysed according to norms established in the non-Indigenous population. It can occur when the blame for social and health problems is attributed to cultural

characteristics instead of inequalities in the health system. Systematic bias can stereotype Indigenous people, resulting in their exclusion from making decisions about health care. Cultural Conflict versus Harmony The relationships between people of differing cultures does not always go so smoothly. The following terms are central to the conflict or harmony debate.     

 

Acculturation is where people from one culture adopt the values, attitudes and behaviours of another culture Integration is the blending of cultures. Rejection and/or assimilation is abandoning a culture to become part of the dominant culture. Marginalisation is non-acceptance of a culture by the dominant culture. Culture conflict occurs where people are not committed to similar goals or ambitions, and where decision-making is not based on similar principles and philosophies (McMurray & Clendon, 2015). It erodes social and cultural capital by causing disharmony. Social capital means trust, reciprocity, participation and belonging. Cultural capital is power and resources that help people maintain social capital in a way that values cultural understandings.

1. Identify how culture impacts on the health and wellbeing of Indigenous Australians An Indigenous person’s understanding of health and wellbeing is holistic, symbolic, spiritual and ecological. Indigenous people experience a mind, body, spirit connection to their land. They refer to the land as their ‘Mother.’ Aboriginal health does not mean the physical wellbeing of an individual, but refers to the social, emotional, and cultural wellbeing of the whole community. Due to this lack of understanding in Indigenous culture engagement is crucial. According to Hunt (2013) engagement is described as a relationship built on trust and integrity. It is a whole-of life view and includes the cyclical concept of life-death-life (NACCHO Constitution, 2011. p.5). 2. Understanding the impact of historical Australian policies on Indigenous health outcomes The Impact of Colonisation Historical evidence demonstrates that Indigenous peoples have been living in this land that we call Australia for 65,000 years. Since British colonisation there has been disregard, and in many cases, active suppression of Indigenous knowledge being expressed, generated and passed on. As a result, limited understanding of Indigenous culture, has been reflected in regard to Indigenous people’s values, beliefs and prejudices (National Health and Medical Research Council, 2020). Eddie Mabo was a Torres Strait Islander man who fought to overturn the legal notion that gave the British ownership of Australia. For over 200 years, Aboriginal land rights had been denied, but the Mabo decision in 1992, led to the Native Title Act, which legally recognised Aboriginal and Torres Strait Islander native title for the first time.

The Stolen Generations Between 1910 – 1970, many Indigenous children were forcibly removed from their families as a result of various Australian government policies. It is estimated that between 1-3 of every 10 Indigenous children had been forcibly removed from their families. Those children removed spent their lives in institutions, foster homes and adoptive families. There were also tragic disclosures of the ongoing medical, psychological and emotional problems, addictions, mental illness, incarceration, violence, self-harm and suicide that haunted the Stolen Generations. 3. Identification of the impact of social determinants on Indigenous peoples Social determinants of health are the conditions in which people are born, grow, live, work and age. According to McMurray and Clendon (2015) there are 10 social determinants of health. Indigenous peoples also include additional social determinants. These include;    

History Land Culture Racism

There are 6 core values that have been identified as being important to all Aboriginal Torres Strait Islander Peoples (National Health and Medical Research Council, 2018).

Intergenerational disadvantage is as disadvantage that is induced by the attitudes, social circumstances or economic limitations of a person’s parents. This disadvantage can be identified in terms of poverty, employment, and lack of access to opportunities that other children may have. A survey conducted by the Australian Bureau of Statistics identified the impact of intergenerational disadvantage for children of adults who were impacted by the ‘Stolen

Generation.’ The survey identified that children living with adults impacted by the ‘Stolen Generation’ were more likely to:      

have missed school without permission in the last 12 months live in a home not owned by a family member report having been treated unfairly at school for being Indigenous have experienced stress in the last 12 months live in a household that had cash-flow problems in the last 12 months have poor self-assessed health. (Australian Bureau of Statistics, 2016).

Empowerment and Self-Determination Efforts to tackle violence in Indigenous communities have only made minor improvements. However, restorative justice and cultural approaches to healing after violence or trauma are seen as a positive step towards a resolution, as they are empowering instead of retraumatising people. Mental health therapies and treatments should be culturally embedded. Supporting Indigenous communities to 'flourish' is an importantapproach to improving mental health. ‘Flourishing’ refers to a sustainable state of mental wellbeing or positive mental health (McMurray & Clendon, 2015). This approach involves connection to land, to other generations, and access to supports for health. Another approach to addressing behavioural problems such as alcohol or substance abuse involves the use of preventative programs aimed at strengthening capacity and social capital.

4. Understand the ‘Closing the gap’ strategy and its relationship to the determinants of health, primary health care principles and Ottawa Charter for Health Promotion Closing the Gap is a government strategy that aims to reduce disadvantage among Aboriginal and Torres Strait Islander people with respect to life expectancy, child mortality, access to early childhood education, educational achievement, and employment outcomes. It is a formal commitment made by all Australian governments to achieve Aboriginal and Torres Strait Islander health equality within 25 years. Closing the Gap was developed in response to the call of the Social justice report 2005 and the Close the Gap social justice campaign. In March 2008, Australian governments and Aboriginal and Torres Strait Islander people agreed ‘to work together to achieve equality in health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by the year 2030′ when they signed the Indigenous health equality summit statement of intent. To monitor change, the Council of Australian Governments (COAG) has set

measurable targets to monitor improvements in the health and wellbeing of the Aboriginal ...