Real investment on health is the new Pacific paradigm!
13th National Rural Health Conference
Darwin, Australia
May 24-27, 2015
The pursuit of wellness through sovereignty in health
Stevenson Kuartei, MD
Practicalizing Sovereignty in Health toward Wellness
13thNRHC
Models of providing health services
Mapping out roles and institutions of health
Make the case using the “Salt Story”
Health and Disease
Institutions of health versus diseasesIndicators of health versus diseasesInvestment of health versus diseasesStrategic thinking in health versus diseasesModels of management for health versus diseases
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ModelHEALTH BASED STRATEGIES
Health ProtectionHealth Promotion
DISEASE BASED STRAGIESDisease TreatmentDisease Prevention
Are the health and disease strategies the same?
13thNRHC
The need for policy advice to influence these trends in the social determinants of health will continue to be needed,
and, until provided,...PHD
Health Promotion is about strategic thinking. Who is involved? In health and diseases?
13thNRHC
Here Going somewhere. How do we know where?How do we know we arrived?
D
B
A
C
The strategies should be congruent with the stage of
readiness and be culturally appropriate. PHD
PublicHealthModel
How can we use ENVIROMENT to provide a MANAGEMENT TEMPLATE for health?
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Host
Agent Environment
iea
“Body and soul cannot be separated for purposes of treatment, for they are one and indivisible. Sick minds must be healed as well as sick bodies.”
‐ C. Jeff Miller
Health CareServices
(including Traditional)
Behavioral
Hereditary
HealthEnvironment
Population
SpiritualityAdopted from Henrik BlumPlanning for Health: SocialChange Theory
13thNRHC
13thNRHC Integrated Environmental Approach to Wellness
Pacificans
Sacredness
Natural
Physical
Social/political/cultural
Emotional
Behavioral
Spiritual
Mental
Alignment and Harmonization of People in Palau
Environments
Harmonization of all the environments lead to the State of Health and Well Being despite of the State of Illness!
Edoled
Dikesed
Delongeled
Loltekau
Blekerdeled
Rengud
Uledesued
Lukel
Klaumerang
Disease Health
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Integrated Environmental Approach to Wellness
PacificansDisease Health
State of Wellness
State of Illness
Minimize Disease Agents
Maximize Health Agents
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Integrated Environmental Approach to Wellness
Pacificans
Faith Systems
Knowledge Systems
Political/Cultural/Social Systems
Food security Systems(Agriculture/Fisheries/Commerce)
Development SystemsFamily/Clan Systems
Nationalism / Sense of Belonging Systems Reng System
Disease Health
Examples of Health Promotion Models
IndividualHealth Belief ModelStages of Change‐ Transtheoretical ModelRelapse ModelInformation processing paradigm
InterpersonalSocial learningTheory of reasoned actionTheory of planned behaviorSocial support
Community LevelCommunity organization modelEcological Approaches Organizational Change
13thNRHCHealth promotion messages can be reinforced throughout the most influential stages of children’s lives, enabling them to develop
lifelong sustainable attitudes and skills.PHD
Health and Disease
Institutions of health versus diseasesIndicators of health versus diseasesInvestment of health versus diseasesStrategic thinking in health versus diseasesModels of management for health versus diseases
13thNRHC
•Disease Treatment
•Disease Prevention
Disease
•Health Promotion
•Health Protection
Health
Mortality Control
Morbidity Control
Hosp• Secondary/Tertiary Care
PrimaryCare Clinics
•Primary Care Clinics: Primary/Preventive Care
DOH• Preventive and Promotive Care
ORIENTATION STRATEGIES OUTCOMES LOCATION ROLES LEVEL OF HEALTH CARE
HOSPITAL
COMMUNITY
•COMMUNITY: Primordial/Promotive/Protective Care
Mapping Health Systems
13thNRHC
“The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the
soul, although the two cannot be separated.”‐ Plato
The Alma‐Ata Declaration 1978 Primary Health Care Primary Health Care1. PHC are the key to attainment of the goal Health for All
The Ottawa Charter (Health Promotion) 1986 Health PromotionTo enable, mediate and advocate the following areas:
1.Build healthy public policies2.Create supportive environments for health, 3.Strengthen community action for health, 4.Develop personal skills 5.Re‐orient health services.
Yanuca Island Declaration (Ministers of Health 1995) Health Protection1. Children are nurtured in the body and mind and soul*2. Environment invite learning and leisure3. People work and age with dignity4. Ecology is a source of pride5. The ocean that connects us also sustains us
* Soul added in the Palau Statement 1997
13thNRHC
The WHO Charter defines ‘health’ as a “complete state of physical, mental and social wellbeing”, to which we, in Fiji, add ‘spiritual’ wellbeing and
‘economic’ wellbeing.
Example: The Pacific Story
Pacific Islands‐ Some of the highest prevalence of NCDS
Obesity rates: Some PICS in 90%NCD leading cause of death, admissions, medical referralNCD has intensified in its presentation in the last 5‐10 yearsHave some of the highest prevalence of DMWanigela in PNG has DM rate around 35%
13thNRHC
Western influences affecting indigenous cultural patterns and food ways vary considerably within
and between atolls. PHD
The Salt Story SALT meaning Sodium Chloride
World average daily consumption is 9‐12 gms/day (range 6‐20)People of Lau (Solomon Islands) 10 gms/dayLowest salt intake Yanomamo Indians (Brazil) 3 gms/day
(Big Mac 1.5 gms, Chow Noodles (Suva) 1.7gm; 200 gms Corned Beef (Suva) 1.260 gm/can) each about 1 month of Yanomamointake.
Highest salt intake Akita Perfecture (Japan) 27 gms/dayLowest salt intake in our region: PNG Highlanders at Asaro Valley
around 3 gms/dayINTERSALT Project (Avg. Blood Pressure)
Yanomano Indians 96/61Asaro Highlanders 100/62Akita Japan 151/93
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The Salt Story
Where do we get salt?a. 12% comes naturally with the foodb. 12% added at homec. 75% is hidden in bought food by the food
industry.
Health Promotion (reduce the demand): b & cHealth Protection (reduce the supply): c
13thNRHC
Future assessments of the impact of food‐store centered interventions should examine impacts on diet and food
consumption at the household level, and make linkages with health outcomes. PHD
13thNRHC
In the PacificThe new paradigm is investment in health! (Alma Ata Declaration 1978PHC; Ottawa Charter 1986 Health Promotion, Yanuca Declaration 1995 Health Protection)
Adopting models that deal with health and notdiseases only. (Integrated Environmental Approach to Wellness)
Implementation of Health Promotion and Protectionstrategies, programs, activities measured by healthand not disease indicators.
In health institutions like the Tonga Health PromotionFoundation, Palau Health Foundation and the recentlyRegistered ROCKET-SHIP(Aus)
