What does working at a community and population level mean? I asked people I know and many didn't have a clue; I had to do some research to find out.
The research I did outlined to me the fact that all around us there are influences at community and population levels, mainly put out by the government, but we treat them as part of the wallpaper.
Who hasn't seen the hard hitting, clever adverts that show gruesome drink driving accidents, or friends intervening with binge drinkers and family abusers. Not to mention the oldest of them all, the quit smoking advertisements. Working at population and community levels is nothing new. It involves reaching, educating and influencing a wide audience as opposed to just one or two individuals at a time (Dyson, 2002). It would seem the New Zealand government is mastering this art.
Occupational therapy is moving towards working at these levels. In the future, it is going to become unfeasible for occupational therapists to work in the community seeing clients 1:1. In this role, they are acting as the ambulance at the bottom of the cliff, picking up the pieces. A better alternative is a fence at the top stopping people going over the edge.* This is referred to as an 'upstream approach' (Scriven & Atwal, 2004). Something has to give as the government will not keep supporting this type of intervention without measures in place to help prevent it.
A move to population based healthcare or 'health promotion' (Scriven & Atwal, 2004) is aimed at countering the strain the aging population will put on the healthcare system. To put this in perspective; Healthcare expenditure is set to rise 3.6% each year for the next fifty years (Dyson, 2002).
The government has already started. Objective 5 of the Health of Older People Strategy (2002) is aimed at promoting; ‘population-based health initiatives and programmes’, these initiatives will; ‘promote health and wellbeing in older age’ (Dyson, 2002, pg 38-45). The aims of this objective are; increasing physical activity, improving nutrition, reducing social isolation, decreasing depression and curtailing the number and frequency of falls in older people (Dyson, 2002).
Occupational therapists have a proven record of being of value in these areas. They just have to define their role within the changing face of New Zealand healthcare.
Jamie
*This analogy is used in class by one of our lecturers, it can be found in Scriven & Atwal (2004). Thanks Fiona!
The analogy Fiona used in class about the ambulance at the bottom of the cliff was a very potent one Jamie - it helped make all this learning about "working on a community level" make sense to me! It does seem to make more sense to work at the "top of the cliff, redirecting people" doesn't it - it's just hard to think up workable projects isn't it (as all us Stage Three students are well aware!)
ReplyDeleteYou have reminded me of the working upstream VS working downstream concept - I liked the explanation of that in the same article you refer to Scriven and Atwal :).
Thanks Rach, I really like that analogy, it made more sense to me than paragraphs of detailed litany! Amazing how something that paints a simple picture can explain so much.
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