Key Principles of Primary Healthcare
- a) Employment is one of the most common socio-political health determinants in New Zealand (Islam, 2019). This determinant is considered to have impact on health and lifestyle of individuals and whanau and/or community. Unemployment in this aspect is found detrimental for both psychological health as well as physical health and unemployed individuals in New Zealand also report very poor health quality than individuals who are employed (Health.gov.nz, 2021). This is directly associated with financial stress, proper job satisfaction and distress in workplace.
- b) Cultural determinants and/or factors can also have both a positive as well as negative impact on health standard and health outcome. Ethnicity in New Zealand, significantly increases risk of the individuals who still follow indigenous approach of living. As the study of Health.gov.nz, (2021), suggests that ethnicity in NZ is directly associated with underlying socio-economic condition of individuals as well as community members it affects them by stimulating stress. Due to chronic stress issue and prolonged financial stress increases risk of both development and progression of some chronic illnesses. In individuals and communities of NZ, cultural determinant for example, ethnicity has been chosen in this aspect.
- c) Aotearoa is considered the current name of Maori for New Zealand. Discrimination is a major health determinant that restricts the access of ethnic groups in Aotearoa/ New Zealand). In this aspect, three ethnic groups of Aoteroa are European, Maori population and pacific peoples. Discrimination in this aspect is known to be associated with cultural competency which is not practically observed in remote healthcare facilities, specifically during providing care to ethnic group of people who do not understand English in a proper manner. Therefore, a miscommunication, lack of access to primary healthcare sectors, emotional bullying and assault are some common occurrence that the above mentioned ethnic groups of New Zealand are commonly experience in healthcare system. Apart from that, the risk and prevalence of chronic illnesses such as hypertension, type II diabetes and cardiovascular illnesses is also found in a higher rate among the chosen groups of population. Lastly, due to discrimination (e.g. linguistic discrimination and cultural discrimination) healthcare providers in primary healthcare facilities do not properly provide disease specific education and discharge education to the patients that leads to further complication and clinical deterioration of the patient. This event is reflected in the mortality rate of the ethnic population of New Zealand.
- d) Income is considered one of the most common health-determinants in New Zealand that has significant impact on the health outcome of an individual who lives in New Zealand. According to the health.govt.nz, (2021), income is considered as the single most essential modifiable health determinant and is strongly associated to both quality health and well-being of individuals. On average, after-tax household income in the stated country reduced between the year 1981 and 1993, with single parent, Pacific and Maori households are still experiencing the major income reductions. Poverty level in New Zealand is also very higher in Maori and Pacific households that restrict them from consulting with physicians, purchasing drugs to manage progression of different chronic illnesses, perform early laboratory testing due to having financial barrier (Chin et al., 2019). All the stated barriers have negative impact on health outcome. Poverty increases financial stress and drives alcohol and tobacco smoking that further increases risk and as well as progression of chronic diseases like cancer, cardiovascular illness, obesity, type II diabetes and hypertension. health.govt.nz, (2021), has shown that both income inequalities and poverty significantly increased in New Zealand over the past ten years. As already stated above, the link between ill health and poverty is apparent with some exceptions including the financially worst-off situation and/or experiences of the ethnic group of population and/or other class of population of New Zealand and the advanced rates of illness as well as death in premature stage.
Primary health care demands a vast knowledge, understanding and set of skill which is qualitatively variable than that needed for the proper management of injury or illness (Behzadifar, Taheri Mirghaed & Aryankhesal, 2017). The main objective of primary healthcare is to work in a collaborative manner with communities and the individuals in them to ensure sustainable improvement in their life-standard. Key principles of primary healthcare in this specific aspect include:
- i) Equity, ii) Access, iii) Empowerment, iv) Self-determination and v) intersectoral collaboration.
Equity in primary healthcare in this aspect can be defined as the systematic approach and framework of healthcare facilities that significantly ensure the healthcare systems are accessible to equitable to the patients who require them most. However, in Aotearoa, New Zealand, individuals are having multiple differences in physiological and psychological characteristics that are not only ignorable but unjust and unfair. The primary healthcare systems in rural NZ do not ensure accessibility and equitability of population from ethnic background (health.govt.nz, 2021). Factors that are majorly associated in this aspect are considered linguistic barrier, cultural barrier and financial constraints.
Access: Access in primary healthcare facility is classified as the scope or ease with which individuals/ patients or communities get an ability to utilize proper services based on their needs (health.govt.nz, 2021). For example, in NZ, some primary healthcare centres are there that covers a wide range of healthcare services from people of almost any cultural and religious background. The services provide by the NZ are clinical diagnosis, health education, evidence-based treatment, screening and disease prevention (Glass et al., 2019).
Empowerment: Considering this principle of primary healthcare, the healthcare professionals who work this field will empower patients, care providers as well as family members when they are once presented to the emergency department Behzadifar, Taheri Mirghaed,& Aryankhesal, 2017). In NZ, considering the prevalence of chronic disease burden, physicians and other healthcare professionals (nurse staffs) empower patients, therefore, they can get adequate motivation to bring some specific change; for example, in term of self-management of blood glucose or falls prevention (health.govt.nz, 2021). Without providing proper training, it is considered very difficult to expect improvement in patient quality. In this specific aspect, therefore, for the above stated intervention too, an evidence-based intervention will be required.
- iv) Self-determination: In healthcare facility or more specifically in primary healthcare facility, the theory of self-determination is a common theory of human motivation that specifically emphasizes the degree to which traits and characteristics of patients is autonomous vs. behaviours that is relatively controlled by patient (Migliorini, Cardinali & Rania, 2019). While promoting chronic disease management plan by following behavioural change intervention, the self-determination segment is followed in order to motivate and engage the patient in his/her plan of care and therapeutic intervention. In primary care facilities of NZ, self-determination of patient is facilitated by healthcare professionals (e.g. physicians and nurses). It is most commonly observed in chronic disease patients, where nurse staffs initially organise a motivational interview approach assessing and evaluating self-determination (govt.nz, 2021).
- v) Intersectoral collaboration: In the literature of healthcare, the term ‘intersectoral collaboration’ is considered very essential due to the complexity and complications of health determinants that makes it challenging for one organise to deal with all public health issues. Involvement of a multi-dimensional team is a major example of intersectoral communication. In the primary healthcare facilities of NZ, intersectoral collaboration is followed appropriately. For example, if a patient is suffering from type II diabetes, cardiovascular issue, hypertension, overweight and asthma, it is not possible to develop care plan for all the disease progression by alone. To solve the issue and to ensure patient’s gradual recovery and wellbeing, the health professionals of primary health facilities, NZ follow evidence-based action.
Considering all the above mentioned facts and findings it can be stated that the principles of primary care hospital are very essential to ensure gradual recovery of patient and sustainable development/ improvement. The NZ government is prioritizing health service and upgrading facilities and system environment, therefore, for physicians the task will be little easier to stay adhere to all the above mentioned principles of primary healthcare facilities and services. The healthcare professionals also have some other major roles (e.g. mitigating discrimination within care environment, staying adhered to national care guidelines and to ensure appropriate accessibility of both the patient and his/her family members into the care facility.
In this segment of the study, the author is going to choose a current major issue in New-Zealand and to develop an evidence-based program plan to ensure gradual recovery and wellbeing of patients. A very common disease in New Zealand is obesity where in recent times, the progression and prevalence of the condition is immensely increasing in aged population of NZ due to not having physical activity and good dietary intervention. The vision of the project is to:
Challenges in Primary Healthcare Accessibility and Equity in New Zealand
Vision: Enable nursing staffs of primary healthcare centres to learn more and implement skills for managing the development and progression of obesity. In this aspect, it is also added that early screening of participants in health promotion programme also helps in reducing prevalence of obesity and associated complications in adults.
Background: Obesity is one of the most common chronic diseases emerging in a rapid rate mostly in adult population. Lifestyle factors including sedentary lifestyle, consumption of snack and dependence on takeaways some of the times and some other external factors significantly participate in the development and progression of the condition (Norman et al., 2021). Therefore, considering this gap, an evidence-based health promotion approach will be developed that will focus on reduction of chronic disease burden in New Zealand.
Challenges: 1) Challenges of the health promotion project includes linguistic barrier. As all the participants are from different cultural background and some of them cannot properly communicate in English, project coordinator and other stakeholders may experience trouble while handling the participants (Osae-Larbi, 2016).
- ii) Another major challenge of the health promotion program dietary intervention to manage progression of obesity (e.g. DASH diet) as due to having cultural barrier, not all the participants will prefer following the said clinical protocol (Pestoni et al., 2019).
Future plans: To reduce the burden of chronic diseases in primary care hospitals.
- b) Two major action plans of Ottawa Charter health promotion project plan includes develop personal skills and develop healthy public policy (Fry & Zask, 2017). As in this study obesity has been chosen as a chronic source of disease and both the stated action plans according to the model proposed by Ottawa Charter will be helpful. For example, in development of personal skills, trainer will provide guidance, appropriate training on developing a comprehensive understanding on early signs, symptoms and cues of obesity and overweight; therefore, the patients who are at risk factors of developing obesity and associated complications, will be able to self-manage the diseased condition with following guidelines shared by trainers (Fry & Zask, 2017). On the other hand build health public policy incorporates the importance of exercises (e.g. aerobic, stretch building exercise and mild to moderate weight lifting exercise depending on patient’s age, other comorbidities and ongoing medications. Nutritional intervention on the other hand, needs also to be performed in a precise manner, when the participants will be provided with a diet chart depending on BMI and other anthropometrical assessment findings that suggest abnormalities.
- c) An underpinning theory of the developed health promotion project that aligns well with the project developed is considered ‘behaviour change theory’ which significantly derives from both behavioural theory and psychological theory with the foundation that the two elements of health-associated characteristics are i) the intention to avoid physical illness, ii) the trust and confidence that a particular health action will prohibit the further progression of the disease and lastly, the trust that a particular health action will prohibit, helps in recovery and wellness (Rejeski & Fanning, 2019). Behavioural change theory or model specifically focuses on impact of behaviours and lifestyle on disease development and progression and therefore, to modify the lifestyle further in order to mitigate the risk (Rejeski & Fanning, 2019).
Reference
Behzadifar, M., Taheri Mirghaed, M., & Aryankhesal, A. (2017). Primary Health Care: An Important Approach for Health Sector, Missed in Iran’s Health System Evolution Plan. Iranian journal of public health, 46(9), 1307–1308.
Chin, M. H., King, P. T., Jones, R. G., Jones, B., Ameratunga, S. N., Muramatsu, N., & Derrett, S. (2018). Lessons for achieving health equity comparing Aotearoa/New Zealand and the United States. Health policy (Amsterdam, Netherlands), 122(8), 837–853. https://doi.org/10.1016/j.healthpol.2018.05.001
Fry, D., & Zask, A. (2017). Applying the Ottawa Charter to inform health promotion programme design. Health promotion international, 32(5), 901–912. https://doi.org/10.1093/heapro/daw022
Glass, D. P., Kanter, M. H., Jacobsen, S. J., & Minardi, P. M. (2017). The impact of improving access to primary care. Journal of evaluation in clinical practice, 23(6), 1451–1458. https://doi.org/10.1111/jep.12821
health.govt.nz. (2021). LOCATING NURSING IN PRIMARY HEALTH CARE:. Health.govt.nz. Retrieved 21 March 2022, from https://www.health.govt.nz/system/files/documents/publications/det-health.pdf.
Islam M. M. (2019). Social Determinants of Health and Related Inequalities: Confusion and Implications. Frontiers in public health, 7, 11. https://doi.org/10.3389/fpubh.2019.00011
Migliorini, L., Cardinali, P., & Rania, N. (2019). How Could Self-Determination Theory Be Useful for Facing Health Innovation Challenges?. Frontiers in psychology, 10, 1870. https://doi.org/10.3389/fpsyg.2019.01870
Norman, K., Chepulis, L., Burrows, L., & Lawrenson, R. (2021). Adult obesity management in New Zealand general practice: a review. Journal of primary health care, 13(3), 249–259. https://doi.org/10.1071/HC20135
Osae-Larbi J. A. (2016). Bridging the language barrier gap in the health of multicultural societies: report of a proposed mobile phone-based intervention using Ghana as an example. SpringerPlus, 5(1), 900. https://doi.org/10.1186/s40064-016-2602-x
Patient empowerment can lead to improvements in health-care quality. (2017). Bulletin of the World Health Organization, 95(7), 489–490. https://doi.org/10.2471/BLT.17.030717
Pestoni, G., Krieger, J. P., Sych, J. M., Faeh, D., & Rohrmann, S. (2019). Cultural Differences in Diet and Determinants of Diet Quality in Switzerland: Results from the National Nutrition Survey menuCH. Nutrients, 11(1), 126. https://doi.org/10.3390/nu11010126
Rejeski, W. J., & Fanning, J. (2019). Models and theories of health behavior and clinical interventions in aging: a contemporary, integrative approach. Clinical interventions in aging, 14, 1007–1019. https://doi.org/10.2147/CIA.S206974
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