Reflections on Public Health : principles for a person-centred promotion of mental and physical health

Abstract

Recent public health data, especially those generated in countries in dramatic societal transition and collected in the WHO European “Health for all” database, show clearly that physical and mental health are indivisibly linked and exist in continuous interaction. The parallelism of societal stress and figures of premature mortality show that individual health is interrelated to public health. Therefore, health promotion has to address healthcare at both the individual as well as at the aggregate level. Public health development over years and clarified by health surveys in especially eastern European countries in dramatic societal transition and the collected research evidence on the psychosocial determinants of health presented by the World Health Organisation have identified the determinants of health as including a sense of existential cohesion, social connectedness and significance, self governance and the absence of helplessness, as well as individual dignity and integrity. In order to promote culturally and individually these determinants of health, a person-centred approach is demanded, both on an individual level as well as aggregated on a societal level with a focus on at-risk populations. Concrete strategies have to be developed in order to address these identified health determinants differently in different stressful and potentially pathogenic individual or societal environments. Even at-risk populations have to be supported differently, e.g. immigrants, elderly, males in one type of society, females in another, adolescents, mentally vulnerable or unemployed persons. Thus, a person-centred way of salutogenic and health promoting action is of incontrovertible significance. A person-centred and societally-engaged psychiatry has here an important role to play – as a pool of expertise and a knowledge base for impact awareness and consequence analysis provided to and needed by political and other decision makers in a society. A person-centred individual psychiatry and an aggregated societal and community focused mental health approach to health promotion appears here to be a human right.