Engaging in Primary Health Care - Physiotherapy New Zealand

Primary Health Care as a Concept: An IntroductionHealthcarehas changeddramatically overthe last 30 years,and physiotherapymust seek to movewith these changesHealth care has changed dramatically in industrialized countries since the middleof the 19th century to the present time.From the middle of the 19th century to early 20th century infectious diseaseswere responsible for a high death rate, and a shorter life expectancy, comparedto today’s statistics. The greatest impact on the control of infectious diseaseswas the improvement in poor living conditions and overcrowding. Improvedwater supplies, sanitation and housing, and education about nutrition andpersonal hygiene rather than medical interventions, brought about significantimprovements in the health of the population.From the 1930s onwards non communicable diseases and injuries emergedas the major health problems. Subsequently rapid diagnosis and “treatmentinterventions” were the primary method of controlling these problems.Since the 1970s technological advances have provided more and more expensivetreatments for previously fatal illnesses. This combined with the increasing lifeexpectancy of the population in the developed world, resulting in the consequenthealth problems of an aging population, has led to a rapidly escalating healthbudget. The continually increasing health budget is unsustainable.However alongside this there is an epidemic of non communicable diseases such astype II diabetes, cardio vascular disease and cancer, which increases the likelihoodof premature death. These diseases can be attributed to a range of changes insociety associated with the determinants of health that have disproportionatelyaffected lower socioeconomic groups.In 1978 a World Health Organization (WHO) forum met in the USSR to examine theinequalities in health within societies, with the aim of achieving population healthgains. The outcome was the Alma Ata Declaration, which was the first internationaldeclaration to recognize the importance of primary health care.The Alma Ata Declaration recognised that the population’s health could not betreated by medical intervention alone. It required inter-sectoral collaboration andcommunity involvement in addressing the determinants of health, with a focuson reducing health inequalities.4Primary Health Care