Baum Fran, Freeman Toby, Jolley Gwyn, Lawless Angela, Bentley Michael, Värttö Kaisu, Boffa John, Labonte Ronald, Sanders David
Southgate Institute for Health, Society, and Equity and SA Community Health Research Unit, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
Southgate Institute for Health, Society, and Equity and SA Community Health Research Unit, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.
Health Promot Int. 2014 Dec;29(4):705-19. doi: 10.1093/heapro/dat029. Epub 2013 May 8.
This paper reports on the health promotion and disease prevention conducted at Australian multi-disciplinary primary health care (PHC) services and considers the ways in which the organizational environment affects the extent and type of health promotion and disease prevention activity. The study involves five PHC services in Adelaide and one in Alice Springs. Four are managed by a state health department and two by boards of governance. The study is based on an audit of activities and on 68 interviews conducted with staff. All the sites undertake health promotion and recognize its importance but all report that this activity is under constant pressure resulting from the need to provide services to people who have health problems. We also found an increased focus on chronic disease management and prevention which prioritized individuals and behavioural change strategies rather than addressing social determinants affecting whole communities. There was little health promotion work that reflected a salutogenic approach to the creation of health. Most activity falls under three types: parenting and child development, chronic disease prevention and mental health. Only the non-government organizations reported advocacy on broader policy issues. Health reform and consequent reorganizations were seen to reduce the ability of some services to undertake health promotion. The paper concludes that PHC in Australia plays an important role in disease prevention, but that there is considerable scope to increase the amount of community-based health promotion which focuses on a salutogenic view of health and which engages in community partnerships.
本文报告了澳大利亚多学科初级卫生保健（PHC）服务机构开展的健康促进和疾病预防工作，并探讨了组织环境影响健康促进和疾病预防活动的范围及类型的方式。该研究涉及阿德莱德的五家初级卫生保健服务机构和爱丽丝泉的一家。其中四家由州卫生部门管理，两家由管理委员会管理。该研究基于对活动的审计以及对工作人员进行的68次访谈。所有机构都开展健康促进工作并认识到其重要性，但均表示由于需要为有健康问题的人提供服务，这项活动面临持续压力。我们还发现对慢性病管理和预防的关注度增加，其优先考虑个人和行为改变策略，而非解决影响整个社区的社会决定因素。几乎没有健康促进工作体现出以健康生成法来创造健康。大多数活动分为三类：育儿与儿童发展、慢性病预防和心理健康。只有非政府组织报告了就更广泛政策问题开展的宣传活动。卫生改革及随之而来的重组被认为削弱了一些服务机构开展健康促进工作的能力。本文得出结论，澳大利亚的初级卫生保健在疾病预防中发挥着重要作用，但在增加以健康生成视角看待健康并建立社区伙伴关系的社区健康促进工作方面仍有很大空间。
