Discussion paper assignment 3 DV4

Health is defined as the “state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity" (World Health Organisation (WHO), 1948). It is
widely evinced that taking a holistic approach is a promising avenue to achieve effective
health outcomes at the individual, community and societal levels (American Occupational
Therapy Association, 2024, ADD REFERENCES). The Optimal Health Program (OHP) is an
example of a program employing a holistic approach to well-being based on individual
strengths. It emphasises on hope, growth, and meaningful connections (REF). Individuals are
supported in defining their goals, boosting their autonomy and promoting their self-
reliance. The program also encourages partnerships with family, caregivers and nominated
individuals which reflects a recovery-oriented scope of enhancing individual well-being
through social interactions (Framework for recovery-oriented practice, 2011). (Frameworks
for Health, 2018). (Neami National, 2018). Furthermore, the program will enable the
individuals to eliminate and control the social determinants that would impact their health,
and therefore can lead to a significant reduction in the burden of disease (Muennig et al.,
2020).
Appreciating a holistic view of health, the social health model was proposed to bring
together the biophysical, mental, social and economic contexts of individual’s health. The
model speculates inextricable connections between biophysical and social components of
wellbeing and illness. It recognises health as combined function of one’s biology, physical
and social environments, lifestyles choices, and health behaviours which per se can be
influenced by cultural, societal and political determinants.
This discussion paper describes the social model of health and the social determinants of
health, explains how social determinants affect health outcomes in primary care. It outlines
the key barriers and facilitators in maintaining a healthy lifestyle and presents key strategies
to address two public health issues Maintaining healthy weight and diet, smoking cessation.

Social model of health and social determinants

The social model of health evolved from a social model of disability, which was initially
developed by disability activists in UK in 1970s (Community Development and Health
Network, 2014). It challenged the traditional medical model by appreciating the influence of
social, cultural, political, and environmental factors on one’s health (Stuart, 2015). The
model offers significant recognition of the social determinants of health (SDH), incorporating
a multitude of non-medical factors that can shape and impact individual’s life and wellbeing
(WHO,2024). They are largely described as the circumstances under which people are born,
work, grow, age, and live, and the wider set of societal forces and dynamics . Examples of
SDH include social and income status, gender, culture, community support, working
conditions, housing and transportation, education, literacy, social exclusion, coping skills,
early childhood development, and health care. (Stuart, 2015).

Mental wellbeing is an integral component in the social health model, largely due to its
mediating effect and interaction with physical health and overall wellbeing (Ayano, 2017).
The is a wealth of evidence showing the interplay between mental health on SDH (Thomas,
2016). For instance, poor mental health can undermine one’s access to health and lead to
poor quality care and compromised social life (Thomas, 2016). Among the most prevalent
social determinants affecting mental health are inadequate housing, social isolation,

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inadequate medical care, socioeconomic status, childhood trauma, family relationships, and
insufficient social support systems. From the social health model perspective, a good mental
health is essential to enhance quality of life and a significant resource for social, economic,
and personal development.

Social determinants application in primary care

The primary care system is one of the fundamentals of health care in developed nations,
and it has been widely regarded as an excellent place to coordinate clinical care, public
health, and community-based services to promote health and prevent illness (Katz et al.,
2018). SDHs are increasingly recognised in primary care as the prime influencers on patient's
health status. when their immediate health concerns are addressed, and a patient's
immediate health concerns can have a detrimental effect on their overall health (Katz et al.,
2018). The social determinants of health, such as food insecurity and housing insecurity, are
often associated with poor health outcomes.
Patients, communities, and public health professionals have been involved for many years in
addressing social determinants of health in primary care setting such as (DeVoe et al., 2016).
However, several barriers have prevented meaningful, systematic solutions to improve SDH
in medical care settings. Some of the key barriers include the fee-for-service payment
structure, a cultural bias toward treating disease and limited technological capabilities
(DeVoe et al., 2016). Additionally, social risk factors may not always reflect the priorities or
perceived needs of the patient (Australian Institute of Health and Welfare, 2024). Social needs
refer to the preferences and priorities of patients in terms of interventions selected to
reduce social vulnerability (Australian Institute of Health and Welfare, 2024 &Davidson et al.,
2020). Nonetheless, the consistent message from experts is that to achieve good overall
health, it is necessary to address the social determinants of health within a primary care
setting. (REF)

Facilitators and barriers to maintaining a healthy lifestyle

WHO (1999) defines a healthy lifestyle as “a way of living that lowers the risk of being
seriously ill or dying early”? According to Pender's health promotion model, barriers to a
healthy lifestyle directly interfere with implementing a health-promoting behaviour or
mediate by reducing the commitment to the action plan for changing behaviour (Pender et
al., 2006). Some of the dominant barriers include personal factors (e.g., lack of self-
discipline, knowledge, and willpower), interpersonal factors (e.g., negative attitudes and
negative influences of family and friends towards a healthy lifestyle), environmental factors
(e.g., situational factors, cultural factors, customs and festivals and language barriers) and
policy-related factors (e.g., inability to pay government taxes) (Subramaniam et al., 2022.

On the contrary, there are facilitators that contribute to enhance or facilitate the uptake
and maintenance of a healthy lifestyle (Subramaniam et al., 2022). Likewise, these can also
be tiered as: personal factors (e.g., knowledge of healthy lifestyles), interpersonal factors
(e.g., supportive family and friends), environmental factors (e.g., technology as a facilitator),
and organization factors (e.g., promoting health and promoting health professionals) and
policy factors (e.g., building space and providing health education) (Subramaniam et al.,
2022). An evidence-based behavioural change intervention can be designed and
implemented if the facilitators and barriers are identified in such a manner that the

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interventions can leverage these facilitators and target the barriers on multiple levels to
achieve a healthier lifestyle (Subramaniam et al., 2022).

The Australian Institute of Health and Welfare suggests several key barriers and facilitator of
maintaining a healthy way of life among Australians (Australian Institute of Health and
Welfare, 2024). The barriers include lack of social support, stress, depression, a lack of
transportation, and a long commute time to health services. Facilitators include enjoyment
and a sense of well-being associated with physical activity, health benefits such as healthy
aging, social support, clear messages, and website accessibility (Subramaniam et al., 2022).

In the following section, key health strategies in response to addressing two ongoing public
health issues are discussed in the light of the social health model.

Maintaining healthy weight and diet

Losing weight more efficiently can be achieved by knowing an individual's healthy weight
range, and a realistic plan tailored to one's body type and lifestyle can also be beneficial.
Several tools are available to determine a healthy weight range, including online charts,
calculators and healthcare professional advices. Each individual's weight range can vary
depending on sexuality, age and body composition. Hence, the range should only be
considered as a guide (Ramage et al., 2014). An individual's healthy weight can be
determined by their body mass index (BMI) and waist circumference. BMIs between 18 and
24 are considered healthy weight (Health Direct, 2019). Healthy diets can prevent
malnutrition in all its forms and non-communicable diseases such as diabetes, cancer, stroke
and heart disease (WHO,2020). Drinking water and consuming a variety of nutritious foods
from the five food groups every day are important for staying healthy. The five food groups
include vegetables, legumes and beans, grains (cereals), fruits, lean meats, poultry, fish,
eggs, tofu, nuts, seeds, legumes, beans, dairy, and alternatives (Department of Health and
Aged Care, 2021). The most critical component of effective weight loss is to prevent
unwanted weight gain due to excess body fat. A healthy diet and physical activity, which
should be at least 150 minutes per week, control calorie intake by limiting portion size, plan
realistic goals, keep hydrated and avoid sugary drinks, can help maintain a healthy weight,
increase energy, and reduce the risk of developing health problems (Chen et al., 2015 and
Sheer & Lo, 2023). The goal of a multidisciplinary team is to provide a holistic and
integrative approach to achieving the best clinical outcome, including referrals to a health
coach, dietician, physical therapist, bariatric endocrinologist, integrative cardiology,
gastroenterology proceduralists, and bariatric surgeon. To reduce weight and improve
health, it is each of their responsibility to collaborate with the patient (Sheer & Lo, 2023).

Smoking cessation
Despite the written warnings on cigarette packs stating that “smoking is injury to health”
and “smoking causes cancer” (Balakrishnan, 2019), people still choose to smoke cigarettes
to satisfy their nicotine addictions or to enjoy the pleasure of smoking. The use of tobacco
results in approximately 8 million deaths every year, including an estimated 1.3 million non-
smokers who are exposed to passive smoke as a result of exposure to tobacco smoke
(WHO,2023). Smoker patients who come to a health professional for treatment should be
provided with a brief motivational message, set expectations, and be left with an open door

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Discussion paper assignment 3 DV4

for future discussions (WHO,20214). Primary care providers can help patients quit smoking
in three to five minutes as part of their routine practice (WHO,20214). As part of their brief
tobacco interventions to patients in primary care, 5A's (Ask, Advise, Assess, Assist, and
Arrange) and 5R's (Relevance, Risks, Rewards, Roadblocks, and Repetition) are commonly
used strategies to motivate them to stop smoking (Agency for Healthcare Research and
Quality, 2012 and WHO,20214). However, lapses (defined as at least one puff) and relapses
(return to regular smoking after quitting) are common after quitting, which emphasises the
need for support during this time (Tobacco in Australia, 2016). The majority of lapses result
in relapses, and partial relapses usually precede full relapses. Young people report a higher
relapse rate (Tobacco in Australia, 2016). Evidence-based treatment, such as behavioural
counselling and medications, increases the chances of successful cessation. Behavioural
counselling combined with medication is particularly effective (Zwar, 2020). Nicotine
replacement therapy (NRT) and pharmacotherapy (Varenicline and Bupropion) are common
treatments for nicotine addiction. Evidence suggest that one form of NRT is not always
effective, and it is usually necessary to use a combination of NRT to alleviate nicotine
addiction (Zwar, 2020). In recent years, E-cigarettes, also known as vapes, are introduced to
replace smoking cigarettes as a method of quitting smoking (Hartmann-Boyce et al., 2016).
Although these have fewer harmful effects than actual smoking, they are still considered
unsafe (Blaha, 2022). Quitline is an effective telephone counselling system designed to assist
smokers intending to quit smoking (Quit Victoria2024).

To conclude, social determinants play an important role in individuals' health, and a primary
care setting plays a vital role in addressing those barriers to maintaining a healthy lifestyle.
The most prevalent social determinants associated with diseases include housing
inadequacies, isolation, limited medical assistance, rural and regional locations, minimal
financial resources, low-income family relationships, and a lack of community support. To
assist in healthcare delivery, primary healthcare providers must be capable of evaluating,
assessing needs, and implementing appropriate and relevant models of care. Advocacy,
empowerment and mediation strategies core components in delivering a robust healthcare
model that accounts for individuals' health needs and the SDH. Health literacy,
understanding the disease process, and supporting self-management are crucial to the
optimal management of diseases. In delivering person-centred care, the holistic model of
care acknowledges biological, social, psychological, and spiritual aspects of patient care.
Taking a multidisciplinary approach while adopting a social health model enables healthcare
providers to identify therapeutic potentials and maintain an effective approach to address
public health issues such as obesity and tobacco smoking.

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