Individual Responsibility For Health Research Articles

A critical analysis of Neuman's systems model in relation to public health nursing.

The public health movement is an old discipline being given new life and meaning based on a recognition of continuing health problems associated with social inequalities. The 'new public health' movement has goals which are closely aligned to those of the World Health Organization in their Health for All by 2000 initiative which represent a collective approach to health in contrast to the current political emphasis on individual responsibility for health. Public health nursing is a relatively new concept in Britain but posts are beginning to be established in many areas where nurses are working in partnership with communities in a public health capacity. At a time when this area of nursing is in its relative infancy it is appropriate to develop a clear philosophy and framework and to examine potential strategies. This paper sets out to contribute to the development of this discipline by critically analysing the work of Betty Neuman to determine its utility for public health nursing.

Role of the emergency medical services system in regionwide health monitoring and referral

The emergency medical services (EMS) system of the future has the opportunity to serve as a regional community health monitoring and referral system. Such a system would shift attention from care of the individual to cost-effective community health efforts using community resource integration, while emphasizing individual responsibility for health. This health care system model requires the establishment of a centralized monitoring agency, the "regional center." The regional center would coordinate the monitoring of regional EMS use and linkage of patients with essential health promotion and behavior change organizations. Many of these supporting organizations are in place but are functioning without the benefit of communitywide health monitoring or effective referral and follow-up links with other resources. Coordination through the EMS system and a regional center would permit these resources to be used in an efficient and accountable fashion. We propose a model in which the EMS system could contribute to coordinated regional health monitoring and maintenance, timely and appropriate health care legislation and regulation, and high-impact health care education and intervention in the setting of self-destructive individual behavior.

Self-care myth reconsidered

Self-care ideology and theory can do much to shape the development of health policy and the organization and delivery of health care. From a critical social perspective, self-care theory can be seen as an attempt to sustain the illusion of individual choice in contemporary health care delivery. Understanding the dominance of individual responsibility for health that permeates the essence of self-care theory provides a way of understanding a vision of thought and practice that currently exists within the discipline of nursing. This article attempts to elucidate the social and political construction of nursing knowledge with a view to self-care.

Lay self-care in health: The views and perspectives of Israeli laypeople

A random sample of 407 Israel laypeople was interviewed about several dimensions of their attitudes toward lay self-care in health. The dimensions studied were perceptions of laypeople's motives in undertaking self-care, views regarding the division of responsibility for individual health between laypeople and professionals, and opinions regarding the effects of lay autonomy and initiatives in health care and seven specific self-care behaviors. These attitudes were analyzed in relation to sociodemographic and health-related variables. The findings suggest that Israeli laypeople take a medically-dependent view of health care, and indicate that self-care in health is not a particularly salient or widely advocated behavior. This research compliments previous studies on Israeli physicians and allied health professionals' attitudes towards self-care.

Primary prevention: A new look at basic concepts

Personal health and well-being are gaining priority on the American agenda. A renewed interest in health promotion has been facilitated by the need to contain health care costs, realization of the limits of medicine in preventing illness, and a deeply rooted societal ethic of personal responsibility for individual health. Although the health status of Americans has changed significantly for the better during this century, further improvements are necessary, especially among high risk subgroups within the population who have not been effectively reached by traditional health promotion strategies. Past efforts, aimed at individuals modifying their risk factors, have neglected to address environmental factors that contribute to disease risk. This points to the need for an integrated approach where problems are addressed as properties of the systems in which individuals behave. This paper reviews selected health trends in the United States, discusses limitations of the current approach to health promotion, presents a comprehensive definition of prevention, and provides principles for planning that may facilitate improved health status in this country.

Economic crisis and health policy in the Netherlands.

Beginning with a brief historical overview of health policy in the Netherlands from 1945-1960 (a period of restoration of the capitalist economy after World War II) until 1960-1970 (a period of capitalist expansion), this paper discusses the health policy of the Dutch state under the present conditions of economic crisis. The main characteristics of this policy are growing state intervention, reorganization of the decision-making process, deinstitutionalization of health care, a laissez-faire policy with regard to services in the so-called first echelon of the health sector, reprivatization of health costs, and an ideological emphasis on individual responsibility for health and self-care. The paper concludes with a discussion of the various strategies proposed for the health sector by the Left and the connection between prevention and social struggle.

Concepts of illness causation and responsibility: Some preliminary data from a sample of working class mothers

In recent years official policy in the U.K. has been marked by a shift in emphasis from curative to preventive medicine, with increasing stress being laid on the role of the individual in maintaining his/her health. However, we lack empirical data on the extent to which the concept of individual responsibility for health is accepted by various groups in our society and such data is essential before effective strategies for health education can be implemented. It is argued that readiness to accept responsibility for one's health depends partly on the views held about the aetiology of illness, and this proposition is explored using material on causation and the circumstances where blame is attributed, derived from semi-structured interviews with a sample of 41 working class mothers (Socio-economic Group 9). Roughly half the sample held fatalistic views on the aetiology of illness and thought they were only morally accountable in very restricted circumstances. These women tended to be less well-educated than the rest of the group and they were less likely to be buying their own homes. The results are discussed in relation to current health education policies, consultation behaviours in primary medical care and consumer attitudes to the services provided by their doctors.

The holistic health movement: a survey and critique.

This article discusses the nature and significance of the holistic health movement in four ways. First, a general characterization of the movement is proposed, based on shared commitment to five assumptions: (1) a positive view of health as well-being, (2) individual responsibility for health, (3) the importance of health education, (4) control of social and environmental determinants of health, and (5) low technology of "natural" therapeutic techniques. Second, a basic difference among advocates of holistic health/medicine is proposed in terms of the presence or absence of commitment to scientific method. Third, holistic health/medicine is briefly compared with concepts of holism in biology and in the social sciences. Finally, criticisms of each of the basic tenets of the holistic health movement are offered.

Implications of changing social policy for the medicalization of deviance

Since medicalization of deviance is ade facto rather than explicit social policy, it is affected by policy changes in the medical and criminal justice systems. I have pointed to some of the implications of changing social policy on medicalizing deviance. In summary, it appears likely that social policies such as decriminalization, decarceration, the production of more physicians and the enactment of national health insurance may encourage more medicalization. On the other hand, increased individual responsibility for health, the fiscal crisis in medical costs, and the punitive backlash may discourage medicalization and promote some demedicalization. What seems clear from this vantage point, however, is that medicalization of deviance, with few exceptions, remains a residual product of other social policies and its consequences are usually overlooked in policy deliberations. Since medicalization has important social consequences [32], it should be afforded consideration in policy discussions.