Scandinavian Journal of Primary Health Care

ISSN: 0281-3432 (Print) 1502-7724 (Online) Journal homepage: http://www.tandfonline.com/loi/ipri20

Health PromotionThe New Role of Primary

Health Care People

Harri Vertio

To cite this article: Harri Vertio (1986) Health PromotionThe New Role of Primary
Health Care People, Scandinavian Journal of Primary Health Care, 4:3, 129-130, DOI:
10.3109/02813438609014817

To link to this article: http://dx.doi.org/10.3109/02813438609014817

1986 Informa UK Ltd All rights reserved:

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 Scand J Prim Health Care 1986; 4: 129-30
Editorials
Health Promotion-The New Role of Primary Health Care People
Health promotion is the process of enabling people
to increase control over, and to improve, their
health. Health is seen as a resource for everyday
life. The concept emphasizes social and personal
resources as well as physical capacities. The defini-
tion of health promotion also expresses explicitly
the new role of health care professionals as sup-
porters and advocates of people in their aims and
activities for health. The role of primary health care
can thus be widened from helping people in their
symptoms and diseases to using its resources for
enhancing the health of the community, in addition.
Health promotion is directed towards actions on
the determinants or causes of health. Many of the
determinants of health are beyond the health care
system. However, resembling the situation a cen-
tury ago, general practitioners are among the first
to realize the possibilities and obstacles of health
promotion, be they problems of human relations, of
coping with losses, threat of loneliness, poverty,
pollution or infectious diseases. Primary health
care can, and should act as an advocate for health:
let the decision-makers know, use the authority of
expertise to promote health in the community. This
role can take-and has already taken-different
forms. It is obvious that the knowledge and power
aggregated in the societies of health care profes-
sionals could be used accordingly.
Health promotion aims at informed self-care, mu-
tual aid and environmental change that supports
health defined by people themselves. The role of
health professionals, again, can be seen-particu-
larly in primary health care-in helping people to
take care of their health. A general practitioner
meets the people nowadays more often in their
natural environment. She is able to see the patient
as part of the family, group of people, social envi-
ronment. This gives the practitioner an exceptional
role in enabling people to use their resources for
health.
Among the subject areas of health promotion the
development of an environment conducive to
health especially in home and at work is one of the
priorities for primary health care. This includes not
only the monitoring of the technological, cultural
and economical trends but also the realization of
social networking and social support in the society.
The health of people seems to depend strongly on
the social support they perceive available.
W o r k - o r very often lack of it-is among the
subject areas of health promotion. Occupational
health care, being primary health care by nature,
already deals with problems of healthy working
conditions, healthy work design and the health of
workers. Elements of health promotion are includ-
ed in all of these.
The promotion of positive lifestyles conducive to
health has been one of the main subject areas of
health education and as such part of primary health
care. Health promotion adds to this area a consid-
eration of personal coping strategies and disposi-
tions as well as beliefs and values relevant to
health. This could mean two things in practice.
Lifestyles are together a holistic way of behaving,
having its boundaries in social learning processes
and culture. Secondly, lifestyles are often personal
solutions to cope with problems. When lifestyles
are affected, also the coping mechanisms change.
This does not mean that the efforts to decrease, for
example, the excess use of alcohol would be worth-
less, it only adds one perspective to be taken into
account in health care.
Health is not the goal of life. This is clear to all
work in the field of primary health care. One also
has to bear in mind that individuals cannot be ex-
clusively responsible for their own health. People
may not act rationally from the viewpoint of profes-
sionals or public policy makers. Still, they may
have their own rationality. Health promotion is a
process in which many professional groups have a
Scand J Prim Health Care 1986; 3
 130 Editorial
common field to work on. Primary health care
workers are a n important health professional group
whose expertise and knowledge is needed in the
development of this process.
Thinking in terms of primary health care, health
promotion is not new. It includes something new,
something old, something borrowed and something
Hypertension in the Elderly
Whereas the feasibility of antihypertensive treat-
ment in young patients with severe hypertension
was evident very soon after the advent of active
antihypertensive drugs, it has been difficult to
prove the benefit of treatment of mild hypertension,
and even more so in the elderly. The report of the
European Working Party on High Blood Pressure
in the Elderly (1) is up to now the most adequate
evidence on this important issue. In a double-blind
randomized placebo-controlled trial comprising 840
patients over 60 years old a significant reduction in
cardiovascular mortality and a non-significant re-
duction in cerebrovascular deaths could be demon-
strated. When analysed on an intention-to-treat
basis, which provides the most stringent guidance
for clinical operation, the overall mortality of the
placebo and treatment groups were next to identity.
Thus this study does not resolve the therapeutic
dilemmas. Many points of criticism have been
raised (2), primarily concerning the recruitment
maneuvres, suspected to have been biassed. Eligi-
ble for inclusion were both the biologically young
and the very old, and both patients at high risk and
patients with a blood pressure close to the popula-
tion mean. Thus the results may have been weight-
ed by exceptional effects in either of the extreme
groups.
Both components of the risk-benefit equation,
may be altered in treating the elderly hypertensives
(3). Cardiovascular and renal changes of aging will
reduce tolerance to antihypertensive medication.
The responseto diuretics alters with age. The lower
stroke volume and age-dependent decrease in sym-
pathetic responsiveness make beta-blockers theo-
retically less attractive. Impairment of baroreceptor
mediated reflexes may contribute to the liability of
Scand J Prim Health Care 1986; 3
unknown. It is a process reflecting activity and
change.
Harri Vertio
National Board of Health
- Finland
drug-induced postural hypotension, fainting and
confusion in the elderly. Concerning the benefits
the lower range of the conjectural gain of life-length
in the elderly by reducing blood pressure as a car-
diovascular risk factor must be taken into consid-
eration.
The Swedish Trial in Old Patients with Hyperten-
sion, of which the design is outlined in the present
issue, is wellcomed as a valuable supplement to
existing evidence. Whereas the European Working
Partys trial concerned all grades of elderly: the
young old, the old and the very old, the Swedish
study concentrates on the latter two categories,
patients over 70 years old. It is to be hoped that the
study will be able to answer some of the core
questions in treating hypertension in the elderly: At
what levels of blood pressure should treatment be
initiated? What should the goal blood pressure be?
What drugs should be used? What are the dosages
appropriate for elderly patients? What effect, if any
does treatment have on longevity and quality of
life?
Bent Harvald
Odense University Hospital
Denmark
REFERENCES
1. Amery et al. Mortality and morbidity results from the
European Working Party on High Blood Pressure in
the Elderly trial. Lancet 1985; 1: 1349-54.
2. Editorial. Treatment of hypertension in the over-60s.
Lancet 1985; 1: 1369-70.
3. Statement on Hypertension in the Elderly. High Blood
Pressure Information Center, National Institutes of
Health, Bethesda, Md 20205, Sept. 1985.