One of the two major goals of Healthy People is to help individuals of all ages increase life expectancy and improve their quality of life. The concepts of health promotion and health maintenance provide interventions that contribute to meeting this goal. Many students in health professions begin their studies with a strong interest in care of ill individuals. However, as time progresses, they learn that “well” people need care also. They need teaching to improve diet, reduce stress, and obtain immunizations. They may seek information about how to exercise properly or ensure a safe environment for their children. These examples of care and teaching are components of health promotion and health maintenance.
Health care management is a holistic profession that examines and works with all aspects of individuals’ lives, and has a strong focus on family and community as well. Therefore it should be uniquely positioned to provide health promotion and health maintenance activities. In fact, these activities should be a part of each encounter with families.
The family’s role in children’s health is critical. A thorough understanding of the healthcare conditions that affect children is needed so that health promotion and health maintenance can be integrated within the framework of comprehensive health care. Some children have special healthcare needs and these are integrated into the provision of health promotion and health maintenance.
In order to understand health promotion and health maintenance, it is important to understand the definition of health first. The World Health Organization defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity (World Health Organization, 1996). Health is viewed as dynamic, changing, and unfolding; it is the realization of a state of actualization or potential (Pender, Murdaugh, & Parsons, 2006). This basic human right is necessary for development of societies.
Health promotion refers to activities that increase well-being and enhance wellness or health (Pender, Murdaugh, & Parsons, 2006). These activities lead to actualization of positive health potential for all individuals, even those with chronic or acute conditions. Examples include providing information and resources in order to:
Health promotion is concerned with developing sets of strategies that seek to foster conditions that allow populations to be healthy and to make healthy choices (World Health Organization, 2001).
Health maintenance (or health protection) refers to activities that preserve an individual’s present state of health and that prevent disease or injury occurrence. Examples of these activities include developmental screening or surveillance to identify early deviations from normal development, providing immunizations to prevent illnesses, and teaching about common childhood safety hazards.
Health promotion and health maintenance activities are closely linked and often overlap, but there are some differences. Health maintenance focuses on known potential health risks and seeks to prevent them, or identify them early so that intervention can occur. Health promotion looks at the strengths and goals of individuals, families, and populations, and seeks to use them to assist in reaching higher levels of wellness.
Growth and Developmental Surveillance in Schools
Growth and developmental surveillance provide important clues about the child’s condition and environment. Evaluation of growth, child height, weight, and body mass index are should be calculated at each health supervision visit. Parents should be given the information in written form and interpreted for them. Physical assessment is performed to be sure the child is growing as expected and has no abnormal or unexplained physical findings. Developmental surveillance is a flexible, continuous process of skilled observations that also provides data about the child’s capabilities, allows for early identification of any neuro-logical problems, and helps to verify that the home environment is stimulating. Information may be collected from several sources; for instance, a questionnaire that the parent completes, trigger questions asked during the interview, or observation of the child during the visit. Parents can also be interviewed to identify any developmental concerns they may have about the child or adolescent. When talking with parents, review physical, social, and communication milestones for infants, young children, older children, or adolescents.
Development is a fragile process determined by both innate conditions and environmental influences. Developmental screening of all children using a regular and organized approach is needed, since about 16% of children have some type of developmental delay or disability (Earls & Hay, 2006).
Nutrition is a vital part of each health supervision visit. It makes important contributions to general health and fosters growth and development. Include observations and screening relevant to nutritional intake at each health supervision visit. Eating proper foods for age and activity ensures that children have the energy for proper growth, physical activity, cognition, and immune function. Nutrition is closely linked to both health promotion and health maintenance.
Physical activity provides many physical and psychological health benefits. However, there is growing disparity between recommendations and reality among most of our children. Research by the Centres for Disease Control and Prevention (CDC) using the Youth Media Campaign Longitudinal Survey (YMCLS) of parents and children found that 61.5% of 9- to 13-year old children report that they do not participate in any organized physical activity during hours outside of school. While organized activities are important and consistent forms of exercise, not all children can participate or desire to do so. However, 22.6% of these children reported that they do not engage in ANY physical activity outside of school. Parents noted that barriers to physical activities included transportation problems, lack of opportunities in area, expenses, lack of parental time, and lack of neighbourhood safety (CDC, 2003). As the child grows older, insert questions about sedentary activities such as number of hours spent watching television or playing computer games. See if the child plays sports at school or in the community. Ask about activities in a typical day to measure amount of activity.
While oral health may seem to require the knowledge of a specialist, many implications relate to general health care. Oral health is important because teeth assist in language development, impacted or infected teeth lead to systemic illness, and teeth are related to positive self-image formation. Children are affected by tooth decay and pain that interfere with activities of daily living such as eating, sleeping, attending school, and speaking. Health promotion to dental health by teaching about oral care and access to dental visits should be done. Health maintenance activities relate to prevention of caries and illness related to dental disease.
Eye and Vision
Eye exams for children are extremely important, because 5 to 10 percent of preschoolers and 25 percent of school-aged children have vision problems. Early identification of a child's vision problem can be crucial because children often are more responsive to treatment when problems are diagnosed early.
Infants should have their first comprehensive eye exam at 6 months of age. Children then should have additional eye exams at age 3, and just before they enter the first grade — at about age 5 or 6. For school-aged children, an eye exam every two years is recommended if no vision correction is required. Children who need eyeglasses or contact lenses should be examined annually or as recommended by the optometrist.
Mental and Spiritual Health
Mental and spiritual health is important concepts to address in health promotion and health maintenance visits. Parents can be encouraged to keep a record of mental health issues to bring to health supervision visits. This helps them understand that the healthcare professional is willing to partner with them to assist in dealing with mental health. Suggest topics such as child and parental mood, child temperament, stresses and ways that family members manage stress, or sleep patterns. Be alert for signs of depression, stress, anxiety, and child abuse/neglect. Both health promotion and health maintenance goals related to child and family mental health should be established. Health promotion goals relate to adequate resources to meet family challenges, protective factors such as involvement in extended family and the community. Teaching stress reduction techniques such as meditation, relaxation, and imagery, as well as providing resources for yoga or other techniques, is helpful. Health maintenance goals relate to prevention of mental health problems.
The spiritual dimension is a connection with a greater power than that in the self, and guides a person to strive for inspiration, respect, meaning, and purpose in life (Murray, Zentner, Pangman, & Pangman, 2005). Spiritual health is seen in the large context as those entities that provide meaning in life.
Disease prevention strategies focus mainly on health maintenance, or prevention of disease. Some health disruptions can be detected early and treatment for the condition can begin. Screening is a procedure used to detect the possible presence of a health condition before symptoms are apparent. It is usually conducted on large groups of individuals at risk for a condition and represents the secondary level of prevention. Examples include developmental screening, blood pressure screening, and vision/hearing screening. Most screening tests are not diagnostic by them but are followed by further diagnostic tests if the screening result is positive. Once a screening test identifies the existence of a health condition, early intervention can begin, with the goal of reducing the severity or complications of the condition.
Like eating well and exercising, immunization is a foundation for a healthy life. Getting vaccinated is a safe and necessary part of keeping you and your family healthy. Vaccinations are incredibly important, because immunization doesn't just protect you; it also protects everyone around you. When you get vaccinated against a disease, you build up your immune system, making you stronger and more resistant to that disease. No matter how healthy you are, if you haven't had the vaccine, you don't have the antibodies to protect you if you are ever exposed to the disease.
Immunization is an important component of public health because it prevents many people from becoming sick with a communicable disease, reducing the risk to themselves and others. Immunization is another way to prevent children against common communicable diseases. Getting vaccinated not only prevents children from getting sick but also reduces the risk to those with less protection; like infants or people with chronic diseases.
Encourage health promotion activities
Families often need health education and counselling to promote healthy behaviours in their own child. Examples of focused health education and counselling may be information about environmental control to limit sedentary behaviours, dietary changes to increase fruit and vegetable intake, and switching to low-fat dairy products. Patient education and counselling are most effective when the family understands the relationship between a behaviour change and the resulting health outcome. When identifying that a family would benefit from a change in health behaviour, consider the family members’ perceptions about the health change, barriers and benefits to change, and plan interventions to enhance the possibility for change.
Steps in promoting patient education and counselling include:
Periodic Health Check-up
Periodic health check-ups and screenings with health care provider are key to maximizing the chance of living a longer and healthier life. Not only can they help prevent health problems before they start, but regular check-ups may also help discover health problems early enough to increase chances of successful treatment and recovery. Regular health checkups can help to identify the risk factors for common as well as rare diseases, both acute and chronic. Getting examined periodically can help in the detection of diseases that could be asymptomatic in the initial stages.
Prof (Dr) Sukumar Mukherjee, MD, FRCP (Lond), FRCP (Edin), FICP, FIAMS, FSMF,
Ex Prof. & HOD, Medical College Kolkata.
Pampita Chakraborty, MSc.Microbiology
Ph.D Research Fellow, IPGME & R and SSKM HOSPITAL, Kolkata-700 020