Victoria M. Rizzo, PhD - Columbia University, School of Social Work
Jessica Seidman, MSW - Columbia University, School of Social Work.
Until the 1980s, no established framework for healthy aging existed. Furthermore, Rowe and Kahn (1998) remarked that a conceptual framework for effectively guiding an approach to healthy aging was missing until the 1990s. They suggested that development of such a framework was challenged by commonly held misconceptions including, but not limited to, the beliefs that illness and an inactive lifestyle were normal parts of the aging process. These misconceptions resulted in insufficient attention to the impact of life-style and psychosocial factors on the welfare of people aged 65 and older. In this section, we provide a history of the development of a framework for health promotion models in aging. We also discuss the implementation of these frameworks within communities committed to health aging.
Several significant historical events in the second half of the 20th century helped to lay the groundwork for development of a conceptual framework for the promotion of health.
Near the end of the century, “health promotion was defined as the process of enabling people to increase control over, and to improve, their health” (Marshall & Altpeter, 2005, p. 136). Marshall and Altpeter explained that to achieve a state of overall well-being, people should be able to realize their aspirations, meet their needs, and adapt to a changing environment.
Health promotion represents the shift from an exclusive biomedical focus that places the responsibility for the care of patients on physicians to a framework that emphasizes individuals’ ongoing participation in preventive health care practices (Hooyman & Kiyak, 2005). Because poor health interferes with a person’s capacity to live as fully as possible, the focus of health promotion is the prevention of acute and chronic illnesses (Breslow, 1999).
To provide health education, many campaigns and outreach efforts that promote health have focused on the individual. However, Marshall and Altpeter (2005) suggested that health promotion strategies founded on the ecological approach to public health might be more successful, because this approach concentrates on activities and exchanges across all levels of society—micro, mezzo, and macro—and because health promotion is multidimensional in nature. In addition, the ecological approach addresses the consequences of the increase in life expectancy in the United States, which include a demand for an improved quality of life, a greater need for informal and formal caregiving, and greater financial stress on the health care system (Breslow, 1999). The following are terms developed and commonly used by health care organizations:
Throughout the second half of the 20th century, expansion of health promotion frameworks was ongoing. Each successive version of health promotion frameworks was built on earlier frameworks. Generally, however, all the terms used in these frameworks applied a life-span perspective for prevention programs and practices focused on physical, social, and mental well-being. The main goal of health promotion was to reduce the incidence of disabling chronic diseases in the older population (WHO, 2002). In addition to prolonging life and preventing disease, health promotion programs gradually expanded to include enhancing the independence and general quality of life of older adults (Hooyman & Kiyak, 2005). Health promotion strategies are now applicable to all older people, including those who are frail or disabled or in need of support.
Although many frameworks for the promotion of health exist, the focus here is the framework developed most recently—the Alberta Rose model, developed in Alberta in Canada (KPMG Consulting, 2002). The model integrates elements of earlier health promotion strategies, incorporating primary and secondary prevention as part of health promotion. It might also be termed a wellness model. The model considers four main goals toward achieving health aging and wellness: (1) promoting health and preventing disease and injury, (2) optimizing mental and physical function, (3) managing chronic conditions, and (4) engaging with life. These four components of the model result in healthy aging. Table 1 summarizes the 4 models of health promotion that are used in the literature.
The goals encompassing the four main components of wellness that contribute to the promotion of health are described in more detail below (KPMG Consulting, 2002).
This conceptual model incorporates the different levels of society and encompasses macro, mezzo, and micro perspectives. It focuses on the health of the population, the health care systems, and the availability of partnerships that are capable of developing health strategies. Furthermore, it connects with the individual by incorporating some of social work’s core values, including dignity, autonomy, participation, fairness, security, and recognizing and building on strengths and capacities (KMPG, 2002). The strategic framework for healthy aging proposed by the Alberta Rose model, which targets people 35 years of age and older and stresses the importance of their lifelong involvement in and commitment to practicing healthy aging, takes into account health determinants, health strategies, and partnerships. Several determinants of well-being relate to factors discussed earlier: a person’s income, social and educational status, social support networks, employment, work environment, gender, and culture. The model indicates that all these factors have an impact on a population’s health status. The population health strategies represent five crucial methods of promoting health: developing policy, building supportive environments, enriching community action, expanding individual skills, and enhancing awareness of the framework among health services (KPMG, 2002). Finally, to overcome the challenges resulting from the determinants of health, partnerships must be developed among all levels of the community. Because the model includes both the determinants of health and the health care system, it incorporates Marshall and Altpeter’s ecological perspective (Marshall & Altpeter, 2005).
The application of health promotion to the older population is a relatively recent endeavor. The latest attempt to apply this framework at the national level in the United States was through the Healthy People 2010 initiative (U.S. Department of Health and Human Services [USDHHS], 2000), a successor of the Healthy People 2000 initiative (National Center on Health Statistics, 2001). That initiative implemented the health promotion model by targeting healthy behaviors, such as the following, for the American population:
Once health promotion programs are developed, implemented, and tested for efficacy and efficiency in rigorous scientific studies, targeting the areas outlined in the healthy promotion framework discussed above, the next task is to translate these programs into formats appropriate for various communities. The Re-Aim framework can be used to consider the strengths and weaknesses of health promotion programs to guide their implementation in specific communities (Glasgow, Vogt, & Boles, 1999). This framework includes the following dimensions:
The Re-Aim framework is a powerful tool for program planners and macro-level social workers to utilize when identifying health promotion programs for their communities to adopt for implementation. The framework allows for evaluation of the multiple dimensions that can influence the success of health promotion programs for aging individuals (Glasgow, Vogt, & Boles, 1999).
Breslow, L. (1999). From disease prevention to health promotion. Journal of the American Medical Association 281, 1030-1033. Retrieved on March 18, 2008, from www.jama.com
Centers for Disease Control (CDC). (2008). Healthy aging: Preserving function & improving quality of life among older adults. Atlanta, GA: Author. Retrieved on December 17, 2008, from http://www.cdc.gov?nccdphp/publications/aag/pdf/healthy_aging.pdf
CDC & The Merck Company Foundation. (2007). The state of aging and health in America. Whitehouse Station, NJ: The Merck Company Foundation. Retrieved February 8, 2008, from http://www.cdc.gov/aging
Glasgow, R., Vogt, T., & Boles, S. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327.
Hooyman, N. R., & Kiyak, H. A. (2005). Social gerontology: A multi-disciplinary perspective (7th ed.). New York: Pearson Education, Inc.
KPMG Consulting. (2002). Alberta’s health aging & seniors wellness strategic framework 2002-2012. Edmonton, AB: Alberta Health and Wellness. Retrieved March 18, 2008, from http://www.gov.ab.ca/acn/images/2002/702/12861.pdf
Marshall, V. W., & Altpeter, M. (2005). Cultivating social work leadership in health promotion and aging: Strategies for active aging interventions. Health & Social Work, 30(2), 135-144.
National Center on Health Statistics, U.S. Public Health Service. (2001). Healthy People 2000 Final Review. Hyattsville, MD: Author. Retrieved January 5, 2009, fromwww.cdc.gov/nchs/data/hp2000/hp2k01.pdf
Rowe, J. W., & Kahn, R. L. (1998). Successful aging. New York: Pantheon Books.
U.S. Department of Health and Human Services. (2000). Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 volumes. Washington D.C.: U.S. Government Printing Office Retrieved January 5, 2009, from http://www.healthypeople.gov/Document/tableof contents.htm#volume1 and http://www.healthypeople.gov/document/tableofcontents.htm#Volume2
World Health organization (WHO). (2002). Active ageing: A policy framework. Geneva, Switzerland: Author. Retrieved February 5, 2008, from http://whqlibdoc.who.int/hq/2002/WHO_NMH_NPH_02.8.pdf
WHO. (2008). The Ottawa Charter for Health Promotion. Geneva, Switzerland: Author. Retrieved February 20, 2008, from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
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