A new concept of health—implications for public health policy and practice: a qualitative analysis

Abstract

BackgroundIn many developed countries ageing populations, growing health-care costs, and the rising burden of chronic diseases pose challenges for health systems and require innovations to improve and maintain population health. “Health as the ability to adapt and to self manage, in the face of social, physical and emotional challenges” was introduced as a new concept of health at an invitational conference in 2011, in reaction to the static nature and lack of realism of the 1948 WHO definition. Since this concept is one of the pillars of the innovation of the Dutch health-care professions and educational structure, we analysed the implications of this new concept for public health policy and practice. MethodsWe conducted focus group interviews (n=28) with stakeholders (n=277) in Dutch public health and health care (eg, physicians, nurses, policy makers, and patient organisations) on the pros and cons of this new concept in the light of a changing health-care system. We developed a framework of key themes within the interviews starting from WHO's essential public health operations and used a deductive approach to qualitative data analysis (Framework method) to analyse the interviews. FindingsIn reaction to the conceptualisation of adaptation and self-management, the participants perceived health as an individual asset and did not seem aware of the collective dimension, resulting in less attention paid to primary prevention programmes. Prevention was mainly mentioned in relation to primary and secondary care; health promotion was primarily regarded as an instrument to support individuals in adapting to a healthy lifestyle. However, adaptation and self-management could be supported by assuring governance for health and wellbeing through other sectors. InterpretationThe new concept fits with the changing burden of disease and the contribution of individual behaviour to health outcomes. The main challenge of this concept for public health policy and practice will be to preserve primary prevention through the collective efforts of society. The main task will be to incorporate essential public health operations in the different sectors (health, housing, education, social policy) and to integrate public health in community care programmes. FundingThe focus group interviews were funded by the National Health Care Institute, Netherlands. There was no external funding for the present analysis.