Tuesday, May 31, 2011

More from Jyvaskyla

Health promotion is firmly entrenched in the Central Finland Hospital District, though the team have hinted that there have been various battles for support, visibility and acceptance in the clinical environment. The universal struggle for resources and conflict over the relevance of health in a sickness environment. (And no, the picture is not of the hospital, I believe it's a soft drink company - I just liked the building)
There are two things that are unique about hospitals here that make the hospital/HP fit a bit easier. The hospitals belong to the community or the surrounding municipalities. That's where funding comes from, it's where the hospital board comes from and there is an expectation that the hospital will provide leadership in this area. And while government makes decrees about health promotion it is up to the hospitals to develop HP strategies and to implement them. My understanding is, if hospitals weren't doing it, no one would be.
From Jyvaskyla it's about 300 ks to any edge of the Central Finland District. The hospital district is made up of three general hospitals and 3 smallish psychiatric hospitals and together they serve a population of around 280,000. HP at the hospital has an internal focus; staff and patients, as well as an external/community focus, including a community bus - or truck actually - that focuses on men's health. It travels the district and gets men in to measure their grip strength, their resting heart beat and their everything else on a funky little Finnish machine that can measure BMI, fat type , muscle density and bone . . . stuff. I went through the motions to learn that I was an average Finnish woman - which is good news apparently.
The internal mechanisms in the hospital were what interested me the most and I was particularly interested in their efforts to engage staff and have them self evaluate their HP efforts and impacts. This is an ongoing process of learning and quite cleverly they are trying to develop ways to engage staff in the process so that it's not just another onerous bureaucratic and seemingly meaningless task. They are also concerned that the evaluation is framed in a wellness mode - salutogenesis is the buzz word. It's about framing the evaluation questions so that it guides staff, in a way, to consider how they might be capturing the "wellness" resources in an otherwise sick patient. It's murky but clarity will come with time.
Health literacy is not a known concept but here I was more interested in the structural approaches to HP in a hospital context. And of course health literacy is central to the HP program as it always is whether you use the langauge of health literacy or not. For example, their wonderful nutrition program in schools provides information to families but rather than structure the information around which vitamins you need, it is stuctured around food. The nutritionist told me that her profession got very excited when the research started telling them about iron levels and folate and how much vitamin C we need etc. and they assumed that other people would get excited with them. But the affect of delivering infomation in this way is that it encourages people to buy vitamins rather than eat well.
Travel to Turku this day and will share some of my adventure with the Health Promoting Hospitals Conference.

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