Discussion Question Health Promotions

LITERATURE REVIEW Goetzel (2009) reported that in 2006 health

spending in the United States (US) exceeded two trilUon (iollars. Of that total, three-fourths of that spending was directed toward treating chronic diseases. Almost two-thirds of growth in healthcare spending is attributable to American’s worsen health habits, particularly the epidemic rise in obesity. The US healthcare delivery system favors paying for

Summer 2012

treatment of chronic diseases rather than preventing them. There is growing recognition that for the US to continue to be an economic leader worldwide, supported by a healthy and productive workforce, attention needs to be diverted from cure of diseases and redirected towards health promotion and disease prevention. Goetzel concludes that prevention is a key element of comprehensive health reform strategy aimed at improving the health of Americans and reducing the social and financial burdens imposed by preventable illness. Moreover, a great amount of money can be saved by promoting riealth and educating the pub he on preventing many health problems such as obesity, which is an epidemic worldwid^ causing several preventable healthproblems (Goetzel, 2009). Discussion Question Health Promotions

The International Council of Nurses (ICN) (2009) reported that health-promoting actions performed by nurses working in diverse settings provide ideal opportunities for health promotion with a goal of creating healthy homes, schools, cities and workplaces. Individually and through national associations, nurses, along with other healthcare providers, can be effective in paving the road for good health through health promotion.

According to Maurer and Smith (2009), pubhc health nursing evolved from visiting nursing and district nursing, and included home health nursing. The term community health nursing came to be used in place of pubhc health nursing in the last decades of the twentieth centxiry. The beginning of the twenty-first century presents yet another transition, in that the terms community healtn nursing and pubhc health nursing are often linked together in community/public healm nursing, and there is a movement to return to the term public nealth nursing (Maurer & Smith, 2009). Cost-effectiveness and health promotion are concepts that must be focused on by all healthcare professions. The following are examples of several research studies which were (lone regarding this important health issue.

A study on smoking prevention and cessation among Dutch students was done to analyze cost- effectiveness of health promotion programs by Vigen, Baal, Hoogenveen, Wit, and Feenstra (2007). The analysis presented in this study showed that the school program to prevent smoking in adolescents is cost- effective. It is a common dilemma that health promoters are more interested in evaluating the process of program implementation and clinical outcomes rather than in analyzing programs’ cost effectiveness, which is the main concern of health economist. For policy makers, cost-effectiveness is very important information, because investing in the promotion of pubhc health in the near term may result in large future health gains and saving in costs of care (Vigen et al., 2007).

Hagberg and Linholm (2006) conducted a review of the current knowledge concerning the cost-effectiveness of healthcare-based interventions aimed at improving physical activity. The conclusion of their study was that promotion of physical activity can be cost-effective with different methods and in different settings, but there remains a lack of evidence for specific methods in specific populations. Price (2(JO6) made an important observation that there is a competition between health professionals focused on care and health professionals focused on prevention and health education for consumers and for revenue of healthcare. Discussion Question Health Promotions

Another study, done by Frick, MiUigan, White, Serwint, and Pugh (2005), performed an economic

analysis, which is a tool available to facilitate efficient resource allocation. The authors mentioned that projects which save lives appeal to poHcymakers and the puDÜc, and health promotion programs that primarily afiect morbidity or quality or life require dociunentation of economic benefit to have a reason for implementing it. Nurses often practice health promotion education in commtmities, which positively affects the communities’ health. Examples of such efforts include breastfeeding education as cited by the following studies and authors (Pugh, Milligan, Frick, Spatz, & Bronner, 2002), hypertension prevention and control (Hill et al., 2003), coronary heart disease (Allen et al., 2002), obesity and diabetes control (D’Eramo-Melkus et al., 2004). Frick et al. (2005) observed that all of these examples are nurse administered and they represent public health interventions that are focused on changing health behaviors, particularly promoting positive health behaviors, relevant to morbidity (Frick et al., 2005). A World Health Organization study was done by Mock, Kobusingye, Anh, Afukaar, and Arreola-Risa (2005) showed that motor vehicle accidents (MVAs) resulting in injury have become a major health problem globally, causing more than one milhon deaths each year. Although MVA is usually aproblem of rich countries, 90% of deaths caused by MVA occur in poor countries. Furthermore, rates of mortality caused by MVA are increasing rapidly in these poor countries; during the years 1975-1998, mortality rates of MVA were increased for instance by 79% in India, 237% in Colombia, 243% in China, and 384% in Botswana. During the same period mortahty attributable to MVA decreased in most of the countries with high income. In countries which are poor and with low income, MVA is the second leading cause of death for young adults of working age. Mock and associates stated tnat costs of treatment for these injuries result in high econonaic losses which can reach to 1-2 % of the gross domestic product in these countries (Mock et al., 2005).

Mock et al, (2005) also reported that there are many strategies which are low in cost that can enhance and control mjuries in the poor countries. All of these strategies require sufficient human resources, and in some cases, specific categories of human resource need to be developed. MVA can be prevented through training and education. In addition to human resource development, broader environmental and mobility management issues must be considered. Furthermore, they have noted that MVAs disproportionately burden poor populations, so they beheve tnat addressing issues of equahty is a necessary component of MVA control.

Vaccination, another mode of health promotion, also has a great effect on budgets and the economy of health organizations worldwide. Zhou et at. (2003) conducted an economic analysis of health promotion of Hepatitis B Vaccinations performed for Vietnamese- American children in Houston and Dallas between the years 1998-2000 to detect hepatitis B vaccination of Vietnamese-Americans children bore betweenl984- 1993. Findings showed that the measurable impact of most pubhc nealth interventions is usually relatively small, and may often be statistically nonsignificant. In this instance, the interventions produced statistically significant increases in complete vaccination coverage. In 24 months, 1176 (13.5%) completed the series of 3 Hepatitis B doses with media intervention and 390 (6.9%) with community mobüization. The impact of both education strategies was cost-effective as well as cost-beneficial. Nationwide in cities with relativelyDiscussion Question Health Promotions

Journal of Cultural Diversity • Vol. 19, No. 2 Summer 2012

high concentrations of Asian and Pacific Islander populations (APIs), media education and community mobilization could be adopted to substantiaUy increase API childhood and adolescent hepatitis B vaccination coverage (Zhou et al, 2003).

Reardon (1998) stated that research data supporting the cost benefit of worksite Wellness programs is promising, although conflicted and Umited. Researching IBM’s company health promotion program documented that interventions provided in a health promotion program at IBM led to significantly lowered employee risk factors such as high cholesterol levels and elevated blood pressure, which would in the long term prevent more costly care for heart disease.

The studies that have been reviewed have proved that health promotion is highly cost-effective. F’opulation’s needs for health services are rising due to several preventable health problems, such as, ot̂ esity, diabetes, hypertension, and other chronic diseases. By educating people about health promotion strategies, targeting pnysical activity, vaccination, safe driving, smoking, and many other growing health concerns, health workers can promote the health status of communities and populations. Increases in health expenditures make this a high priority for WHO and member nations to address through crianges in health poUcies to focus on health promotion and prevention all over the world.

As an example of how health promotion has been used as a focus for change in a program of nursing education is the University of Haifa. Moshe-Eilon and Shemy (2003) reported that the healthcare systems are complex anci are interdisciplinary nature, which requires that each team in the system should re-evaluate its framework as an independent discipline. All health care professions should know their contribution and must take into account the cost-effectiveness in order to prevent the overlap of functions that can cause extra burden on the financial resources of the health system. Moshe et al. (2003) also stated that there are rapid changes going on in the healthcare system, in general, as a result nursing should contribute in improving new and clear plans to fulfiU a vision that incorporates the importance of health promotion and cost-effectiveness. A good example is the nursing department at the Umversity of Haifa which developed a professional paradigm that was considered as the building blocks for health promotion, management, and research in nursing. Integration of the building blocks into the four-year baccalaureate degree program includes focus on the following: How to practice health promotion with students in the community setting; teach managerial nursing skuls at the baccalaureate level with appreciation of leveling; and nursing research, including both didactic teaching of basic research skiUs and implementation of a community project. The authors concluded that the current healthcare system is characterized by complexity and interdisciplinary teamwork. Each component of this system must demonstrate its unique contribution as mentioned earUer, and through their new curriculum plan they have demonstrated the potential contributions that nurses can meet. Discussion Question Health Promotions

This kind of health promotion education program is an excellent example for nursing education curricula. In addition, schools of nursing need to identify clear strategies for measuring their programs outcomes.

In the health system of Saudi Arabia the Ministry of Health (2009) reported that the history of health