Health And Rehabilitation: Using Ottawa Charter And Te Pae Mahutonga Frameworks For Health Promotion

The Systems Approach in Health Care

Health promotion can be simply described as a due process that empowers people to increase control over their health and wellbeing. This is made possible by empowering people on the choices and consequences of every decision they take in their lives by analyzing the potential health impacts and risks that are associated with the decisions. According to Eldredge, Markham, Ruiter, Kok Fernandez, & Parcel, (2016), health promotion is mainly centered on improving people’s health by being able to gain control; over behavior, lifestyle and diet. In this process individual reaction towards their environment becomes a key area of development. This paper analyses how the Ottawa charter and Te Pae Mahutonga can be used as frameworks for health promotion to ensure an effective systems approach.

The systems approach in health care is a framework that highly esteems and prioritizes patient safety and the quality of healthcare provided in a facility. The systems approach utilizes policy frameworks to arriving at common goals and objectives to which all activities are geared towards. This is due to the perceived contribution of these qualities towards improving patient safety and quality of health care.

The system approach comprises of four levels which include the patient; also known as the individual, the health care providers, health facility and the economic and social political environment of health care. Duckett, & Willcox, (2015) explains that the health systems approach utilizes four strategies which include identification, description, alteration and implementation. After operationalizing the changes, the health care system can then be assessed to identify the successes and the gaps in the quality of care that still require attention. According to Edelman, Mandle, & Kudzma, (2017), the assessment and evaluation process may be achieved by evaluating patient safety and quality of care in three perspectives which include effectiveness, efficiency and equity.

The Ottawa charter refers to an international agreement that was arrived at in the first international conference on health promotion held in Ottawa, Canada. The conference was organized by WHO as a response to various expectations that were aimed at achieving another global health movement. The main aim of the conference was based on achieving universal health by the close of the 20^th century. The Ottawa charter focused on better health promotion strategies to achieve this primary objective. The conference defined health promotion as enabling people to improve and increase control over their health to attain a recommendable state of complete physical, psychological and social health explains Came, McCreanor, Doole, and Simpson, (2017). The conference also identified various prerequisites for health to be the basic needs of man, education, income and social justice as well as a stable ecosystem and a sustainable environment (Waterworth, and Thorpe, 2017).

The Ottawa charter was able to identify 3 strategies to health promotion which includes advocate, enable and mediate (Lovell, Kearns, and Prince, 2014). The Ottawa charter advocates for improvement of quality of life in the social, economic and political pillars of life. The main argument is that the improvement of all these factors is the basic prerequisite for improving health. The main reason behind this argument is the assumption that people fail to access quality health due to social economic and political constraints and therefore improvement of the quality of life in these aspects will no doubt lead to better access to health.

The Ottawa Charter

The second strategy focuses on enabling a just fair and equitable environment for achievement of health care. This focuses on reducing differences and inequalities in the provision of care and the prerequisites to good health. Justice and fairness in the health care environment inculcates diversity and therefore offers suitable care to patients across cultures. Justice and fairness also enhances equitable distribution of resources and access to services, infrastructure and good living standards that facilitates prevention of diseases and access to disease prevention measures such as vaccination. Finally, the last strategy focuses on mediation between health care providers and other pillars of the society such as government, charitable organizations and the community based on the fact that health promotion cannot be achieved by healthcare providers alone but by the collaboration of efforts from all these stakeholders (Thompson, Watson, & Tilford, 2018).

According to Beddoe, and Deeney, (2016), the Ottawa charter also identified several areas as a priority for action in health promotion efforts. These include, formulation of healthy public policies, enhancing supportive environments, strengthening community actions, developing personal skills, reorientation of health services and moving into the future.

The strategies and action areas of the Ottawa charter have been incorporated in the project, smoking prevention among Maori women of Bay of Plenty to enhance health promotion in various ways. These include; economic, environmental and social cultural factors. Economically, the project seeks to develop healthier habits in the region as opposed to smoking through education and sensitization on the effects and dangers of smoking. This refers to the action area of formulating health public policies.

The project also proposes for reduction in cigarette sales as a way of forcing people to seek other alternatives as opposed to smoking which is a potential health risk and also an economic challenge due to the cost of cigarettes and treating cancer. The reduction of cigarettes is one way in which the action area that seeks to enhance supportive environments. The project is also focusing on cultural norms that may assist people in living healthy lifestyles these include ways in which women in the region can be empowered to quit smoking through observing smoking as a defiant behavior. In the environmental aspect, the project seeks to address the potential harm caused by smoking to the environment including the passive smokers who may also suffer the effects of smoking caused by friends, relatives and colleagues who smoke.

The Te Pae Mahutonga refers to a constellation of six stars also known as the southern constellation that brings together six different elements of health promotion among the Maori people of New Zealand. The Te Pae Mahutonga is a framework for improving public health with six significant components. The first four are the main health promotion goals while the other two are prerequisites for effectiveness in health care. The Te Pae Mahutonga is based on the Maori philosophy Te where tapa ha and it was developed by Do Mason Durie in 1982 explains Durie, (2009). The Te Pae Mahutonga is an essential health framework based on its applicability on all health related issues including physical and mental wellness (Came, McCreanor, Doole, & Rawson, 2016).

Te Pae Mahutonga

The Te Pae Mahutonga frameworks include Mauriora, Nga Manukura, Te Mana Whakahaere, Te Oranga, Toirora and Wairora. Mauriora refers to cultural identity (Warbrick, Dickson, Prince, & Heke, 2016). The understanding of cultural identity among the Maori and among other ethnic groups is important in providing health services as health care providers are able to solve ethical dilemmas more appropriately, adhere to the real needs and not the perceived needs and handle patients in a way that is acceptable to their culture and set standards. Culture is also important as it helps healthcare providers to foster and cultivate personal and professional morals and values that increases patient satisfaction (Came, McCreanor, Doole, & Simpson, 2017).

 Nga Manukura refers to leadership. Leadership is also an essential tool in health promotion. This is so because leadership is able to set policies, laws and guidelines that improve quality of care and ensure that these guidelines are followed to the latter to ensure high quality and safety care in the healthcare set up. In addition, coordinated leadership fosters trust in the leadership that ensures workers satisfaction and achievement of set objectives (Waterworth, & Thorpe, 2017).

Te Mana Whakahaere refers to autonomy. Autonomy is an important tool in health promotion because it sets the pace for the informed consent process and it enables patients to have increased control over choices and decisions regarding their health and lifestyle. Te Oranga refers to participation in society. This framework recognizes that people have to belong to a society and the society has direct influences to people’s health and wellbeing. Therefore it calls for the participation of the society and health workers to achieve health goals and demands (Tonks, Thorpe, Jeffries, Waterworth, Molloy, Holmstead-Scott, & Reynolds, 2017).

Toirora and Wairora which refers to healthy lifestyles and environmental protection respectively can be considered to be among the prerequisites to good health as identified in the Ottawa charter. Healthy lifestyle is important in prevention and cure of lifestyle diseases such as cancers, diabetes and some cardiac infections. A healthy environment is also necessary for health promotion as the hygiene of the environment may help prevent certain communicable diseases and hospital acquired infections as well among other diseases such as cholera and typhoid explains Berghan, Came, Coupe, Doole, Fay, McCreanor, & Simpson, (2017).

The six elements of Te Pae Mahutonga have also been incorporated within the project to enhance health promotion. This is through incorporation of cultural identity, participation in society and environmental protection. In addition, the project also focuses on autonomy of the individual. This is through the approach of individual guidance and sensitization on the health risks and focus on how smoking can be reduced at the personal level. This is because individuals are empowered to make decisions over their lives. Cultural identity is observed when the culture is empowered to make norms that defy smoking while participation in society refers to involving all people smokers and non-smokers in social activities to be able to solve some of the issues that may predispose people to smoking, help to warn potential smokers and also engage leadership in developing principles that and policies that address smoking.

In conclusion, it is important to highlight that both the Ottawa charter and Te Pae Mahutonga are important frameworks that can be used for health promotion in New Zealand. This is because both contain principles and frameworks that are applicable in almost all situations and those that focus on empowering all areas of a community using a systems sort of approach to health care.

References

Beddoe, L., & Deeney, C. (2016). Discovering health social work in New Zealand in its published work: Implications for the profession. Aotearoa New Zealand Social Work, 24(1), 41-55.

Berghan, G., Came, H., Coupe, N., Doole, C., Fay, J., McCreanor, T., & Simpson, T. (2017). Te Tiriti o Waitangi-based practice in health promotion. STIR.

Came, H. A., McCreanor, T., Doole, C., & Simpson, T. (2017). Realising the rhetoric: Refreshing public health providers’ efforts to honour Te Tiriti o Waitangi in New Zealand. Ethnicity & health, 22(2), 105-118.

Came, H., McCreanor, T., Doole, C., & Rawson, E. (2016). The New Zealand Health Strategy 2016: whither health equity?. New Zealand Medical Journal, 129(1447), 72-77.

Duckett, S., & Willcox, S. (2015). The Australian health care system (No. Ed. 5). Oxford University Press.

Durie, M. (2009). Maori knowledge and medical science. Psychiatrists and traditional healers: Unwitting partners in global mental health, 237-249.

Edelman, C. L., Mandle, C. L., & Kudzma, E. C. (2017). Health Promotion Throughout the Life Span-E-Book. Elsevier Health Sciences.

Eldredge, L. K. B., Markham, C. M., Ruiter, R. A., Kok, G., Fernandez, M. E., & Parcel, G. S. (2016). Planning health promotion programs: an intervention mapping approach. John Wiley & Sons.

Lovell, S. A., Kearns, R. A., & Prince, R. (2014). Neoliberalism and the contract state: Exploring innovation and resistance among New Zealand health promoters. Critical Public Health, 24(3), 308-320.

Sallis, J. F., Owen, N., & Fisher, E. (2015). Ecological models of health behavior. Health behavior: Theory, research, and practice, 5, 43-64.

Thompson, S. R., Watson, M. C., & Tilford, S. (2018). The Ottawa Charter 30 years on: still an important standard for health promotion. International Journal of Health Promotion and Education, 56(2), 73-84.

Tonks, A., Thorpe, A., Jeffries, C., Waterworth, C., Molloy, H., Holmstead-Scott, I., … & Reynolds, R. (2017). Translating the Okanagan charter for practice in Aotearoa New Zealand tertiary education settings.

Warbrick, I., Dickson, A., Prince, R., & Heke, I. (2016). The biopolitics of M?ori biomass: towards a new epistemology for M?ori health in Aotearoa/New Zealand. Critical Public Health, 26(4), 394-404.

Waterworth, C., & Thorpe, A. (2017). Applying the Okanagan Charter in Aotearoa New Zealand. JANZSSA-Journal of the Australian and New Zealand Student Services Association, 25(1), 1338.