Subject: ethical challenges faced during the community development health promotional activity and measures recommended to overcome the same
Background: A health and wellbeing plan as a part of the curriculum was investigated and that was in the municipal of Galong in Victoria which is covered under the health and wellbeing plan of Victoria 2019-2023. Galong is a village suburb which is located in the New South Wales and according to the Australian Bureau of Statistics report of 2016 the total population of Galong is 224 (Australian Bureau of Statistics, 2017). For the betterment of the health of the people living in the community health promotional activity was undertaken and it was focused on the community development aspect of the health promotion (Ofanoa, Paynter & Buetow, 2020). Concept of health promotion is not a novel one and it has been used in the betterment of health. In the recent times' emphasis of health has shifted from provision of treatment to prevention of diseases and in turn promotion of good health so that the disease occurrence can reduce (Fletcher et al., 2018).
The World Health Organization has defined health promotion as the process by which the people can be enabled to give more control they have over their health such that they can take care of their health get control and take measures to improve their health (Kubzansky et al., 2018). In the year 1986, in the Ottawa charter for the health promotion, the definition of health promotion was given along with the components of health promotion which was shown in the form of the logo (Thompson, Watson & Tilford, 2018). The definition of health has been redefined to not only include the absence of disease or infirmity but to include the physical, social and mental wellbeing so that an individual can lead a socially and economically productive life (Chirico, 2016). Based on this holistic concept of health it is no longer an individual responsibility but it has become a state responsibility and the stakeholders have increased who are responsible for the health of a person as well as the health of the community.
Health promotion is in terms of social science is the behavioural nature which takes the strengths from the biological, environmental, psychological, medical and physical sciences such that there can be the promotion of health and prevention of disease (Edelman, Mandle & Kudzma, 2017).
The essence of the health promotion is that the disease can be prevented in a person and disease burden in a society can be reduced such that the expenditure of the community on the healthcare can be reduced as well. There are various aspects of a disease which can be tackled so that a disease can be prevented and they are either called determinants of health or risk factors of the disease. The preventative measures are to make sure that these factors do not come together at some point in time so that the disease does not occur. Health promotion is a cumulative effort that is expected and is put in by an individual, a group of individuals, institutional, community and systemic strategies to make sure that the health of everyone in a community as well as the community as a whole can improve knowledge of health, attitudes, skills and behaviour (Haber, 2019). For the promotion of health the three key strategies that are used in health promotion planning and program which are to enable, meditate and advocate. In the Ottawa charter, there is the provision of five main action areas which are to be included in the health promotion planning: building healthy public policy, creation of a supportive environment, to strengthen community action, development of personal skills and re-orientation of existing health services (Thompson et al., 2018).
In the healthcare and wellbeing plan of the Victoria 2019-2023, it can be seen that it is based on the comprehensive approach (Department of Health and Human Services, 2019). This is planned to achieve by the action that is taken towards the factor which is most strongly contributed towards the burden of disease and inequalities of health. It has to be made sure that all the sectors involved in the health of individual and community work together to get a singular outcome of better health. The other determinants of health need to be considered like social, economic and cultural and the health promotional planning is to be done accordingly (Department of Health and Human Services, 2019). At present, the average life expectancy of the people living in Victoria including Galong is 83.5 years. In the Galong municipality, the action areas that have been taken in the health promotion activity was community development with a focus on advocacy policy and lobbying (Australian Bureau of Statistics, 2017).
In terms of health promotion, advocacy includes the range of activities which are responsible for the influence that has an influence on the decision-makers. The activities that are included in the advocacy are litigation, lobbying, and education of the public. In terms of health promotion and community development the factors that are included are building of relationships, the formation of networks, and development of leadership (Blenner, Lang & Prelip, 2017). In the same terms, lobbying includes activities which are intended to include legislation which is specific to the piece of health promotion (Tselengidis & Östergren, 2019). Health promotion includes various stakeholders like the governments at various levels like at the national level, state and even at the level of community of the municipality of Victoria. As there are various factors which are involved in the health promotion the implication of ethical issues becomes profound and the related challenges need to be overcome by the policymakers. This is required so that the policy which is made can be such that it can help the people and the community for the betterment.
The main ethical issues that were faced in the health promotion of healthcare and wellbeing of the people in the Municipality of Galong are two. First, it cannot be gauged that the intervention that is planned can have the efficacy that is required for the promotion of health by the enablement of the community (Gardner, 2014). In public health instead of individual person community as a whole is taken as the focus and measures are taken for the betterment of health. Community development is one of the key action areas of the health promotion and in the basic terms, it means giving the power to the individuals about their health and by extension to the community. There are various aspects to this which are the cause of ethical issues.
Second, the ethical issue that was seen was that the intervention of health promotion was that level of free will that is given to the people as a part of the intervention (Gardner, 2014). For the promotion of good health, habits have seen to be effective in some cases where the free will of the people as a part of community development has been reduced and the disease burden have been reduced. This is a part of the top-down approach which has been effective in such cases where the community and people living in the community have no choice but to agree (Gardner, 2014). For example, the mandatory use of helmets and seatbelts to reduce the number of accidents and in turn disease burden. On the other hand, doing this for other things might not be feasible for example like removal of all carbohydrate-rich snacks and beverages from a community to reduce the incidence of diabetes and obesity (Tselengidis & Östergren, 2019). It is a fact that reduction of carbohydrate intake reduces the incidence of diseases but the autonomy of the community is to be considered before enabling the community with such a policy (Banna & Bersamin, 2018). It is the choice of people to eat things which they like and not to give then that choice hinders their autonomy which is was one of the ethical issues that were faced in the promotion of health.
These ethical issues not only affect the people for whom the health promotion activity is being formulated but also other stakeholders of health who are responsible. The stakeholders, in this case, are the government of the state, councils, stakeholder and public and private partners. When the first ethical issue is considered that is the effectiveness of the health promotion plan. The implication of this can have a trickle-down effect on the system. This is because the state government is responsible for the allocation of all kinds of resources for the program or successful running of the policy. These resources ultimately have to reach the grass-root level for the proper working or implementation. In case the effectiveness of the program is questionable the continuation as the effectiveness is measured in terms of cost-effectiveness and the government would want its money’s worth (Pearson, 2018). The councils are responsible for the allocation of staff or healthcare professionals required for the program and this ethical issue of effectiveness can affect the working capacity. The implementation of any health promotion activity requires public and private partners. In case of community development, the public and private partners are the ones working with the community and people and if effectiveness is the ethical issue that present it can affect the working of the partners in terms of support (Warner & Sullivan, 2017).
The next ethical issue that was faced was the autonomy and there are various ways in which the health promotion can be done like provision of education, persuasion, new policy implementation, manipulation of preferences or even coercion (Gardner, 2014). Depending on the intervention the level of involvement can be established and measures that are required for the community development. Advocacy and lobbying are the activities that were used in community development activities for the promotion of health. In the course of enabling the community it is possible that autonomy is not considered. This can cause unacceptance of the measures that are being taken for enabling the community. The implication of this at the level of government can be comparatively less as the work or implementation of this happens at the level of community (Warner & Sullivan, 2017). The other stakeholders like municipality council can have an implication of this in terms of protests from the community because of reduced autonomy. Due to the activities of lobbying which could be taken for the betterment of health can bring impact from the industry that might be affected like sugar or tobacco industries.
The key challenges that have been seen in the case of community development are the complete involvement of all the stakeholders and engagement of the community to take the activities that are required. Also, there can be a challenge which can be caused by the healthcare systems because there can be less revenue generation which can be a potential challenge. These challenges can have implications on the stakeholders for one the government of the state might not be able to get the task force for the implementation of the health promotion activity (Campos & Reich, 2019). The other stakeholders like the healthcare system might not be completely on board with the planning and can affect the outcome. At the level of the municipality, it might be difficult to mobilize the community so that it can be enabled and in turn, it can affect the public and private partners.
Municipality of Galong is one which consists of very less population and the health promotional activity can be deemed easy but that is not the case as from the healthcare and wellbeing plan that was evaluated. The activity that was undertaken for the promotion of health was community development under which advocacy and lobbying was the main focus. The key ethical issues that have implications on the stakeholders are the effectiveness of the promotional activity and autonomy of the community. The key challenges that could have an implication on the implementation of the program are the opposition faced from the industry that might be involved like tobacco and sugar. Also, the mobilization of the community can be potentially challenging along with the healthcare system might pose a challenge.
These are the key ethical considerations and potential challenges which were observed as a part of community development health promotion activity. It is required that these factors are considered and the other stakeholder who might not have included should be considered before making any policy change. Community and local partners are the main strengths for the success and it is required that they are appropriately addressed in the promotion of health.
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