Subject: Primary Health Care

Mid-term Assignment
Submitted By: Dr Abdul Wajid Khan

Q1: Health promotion and lifestyle

changes

Health promotion
It refers to a set of processes that can be employed to change the
conditions that effect health.
Health Promotion is the art and science of helping people discover the synergies between their core
passions and optimal health, enhancing their motivation to strive for optimal health, and supporting them
in changing their lifestyle to move toward a state of optimal health. Optimal health is a dynamic balance
of physical, emotional, social, spiritual, and intellectual health.

Health promotion begins with people who are basically healthy and seek; the development of;
community and individual measures; which can help them to develop; lifestyles that can help

them maintain and enhance the state of well being."

This is consistent with a conceptualization of health promotion as getting healthier as in a

progression of phases of health

Although definition of health promotion includes both community and individuals but it seems to
emphasize on "wellness type of attitude of individuals. But the main concern of promoting
health is to improve the health of public.

Five Approaches to Health Promotion

1.

Medical or Preventive: Focuses on activity which aims to reduce morbidity and mortality.

2.

Behaviour Change: The aim is to encourage individuals to adopt healthy behaviors

3.

Educational Approach: The purpose of this approach is to provide knowledge and information,

and to develop the necessary skills so that people can make informed choices about their health
behaviour.
4.

Empowerment: This approach helps people to identify their own concerns and gain skills and

confidence to act upon them.

5.

Social change: The focus is to change the socio-economic environment to enable people to make

healthier choices and adopt healthier behaviors

Lifestyle management program

A lifestyle management program (also referred to as a health promotion program, health
behaviour change program, lifestyle improvement program or wellness program) is an

intervention designed to promote positive lifestyle and behaviour change and is widely used in
the field of health promotion.
Based on this, a lifestyle management program, is defined as a structured, actionoriented health promotion initiative designed to help individuals improve
their health, reduce health risks and promote healthy behaviors.

Lifestyle management programs can target a range of different health concerns and areas, such as
physical activity, stress, smoking, and nutrition. They are used in a variety of different settings,
however most commonly in workplaces and community or public health initiatives.
Benefits

The effectiveness and impact of lifestyle management programs, when used as part of a wider,
multi-component health promotion programme, have found that they can:

Reduce health risks

Reduce medical and healthcare costs

Improve productivity

Reduce absenteeism

Reduce the incidence and severity of chronic health conditions

Lifestyle changes in favor of health promotion

Healthy Weight

Excess weight may lead to heart disease and diabetes. Creating and following plans for healthy
eating and physical activity may help you improve your health.
Body mass index (BMI) is one way to tell whether you are at a healthy weight, overweight, or
obese. It measures your weight in relation to your height.
A BMI of 18.5 to 24.9 is in the healthy range. A person with a BMI of 25 to 29.9 is considered
overweight, and someone with a BMI of 30 or greater is considered obese.
Healthy Eating

Paying attention to what, when, how often, and how much you eat can be the first step to helping
you eat better.
Eat more of these nutrient-rich foods
Nutrientslike vitamins, minerals, and dietary fibernourish our bodies by giving them what
they need to be healthy. The guidelines advise adults to eat the following foods because they are
rich in nutrients:

fruits and vegetables

whole grains, like oatmeal, whole-wheat bread, and brown rice
seafood, lean meats, poultry, and eggs
fat-free or low-fat milk and cheese, or substitutes (like soy or rice milk) that are high in
vitamin D and calcium
beans, nuts, and seeds

Eat less of processed foods, foods with added sugars and refined grains.
Physical Activity

Moderate intensity physical activity includes:

Brisk walking
Cycling on relatively flat terrain
Water aerobics
Hiking
Rollerblading
Using a manual lawnmower

Vigorous physical activity may include:

Jogging
Swimming lengths
Cycling either rapidly or over steep terrain
Football
Gymnastics
Skipping

Manage stress

Many people feel stress in their daily lives. Stress can cause you to overeat, feel tired, and not
want to do anything. Healthy eating and regular physical activity may help offset the effects of
stress.
Try some of these other ideas to help relieve stress and stay on track with improving your health:

Others

Get plenty of sleep.

Practice deep breathing while relaxing your muscles one at a time.
Take a break and go for a walk.
Add short stretch breaks to your day.
Try a new hobby or any activity that sparks your interest.
Surround yourself with people whose company you enjoy.
A balanced eating plan, regular physical activity, and stress relief may help you stay
healthy for life.

Other changes in lifestyle that can have a positice impact on health include

Avoid Alcohol and Substance Abuse

Stop Smoking
Maintain Blood Cholesterol Level
Regular Annual Medical checkup
Maintain Blood Pressure and Sugar Level

Q2: Mental health in Pakistan

Mental health:
A state of well-being in which every individual realizes his or her own potential, can cope with
the normal stresses of life, can work productively and fruitfully, and is able to make a
contribution to her or his community
Introduction
Mental health is very important just like our physical health. For a healthy body a healthy mind
is very important. Mental health provides us resilience i.e. ability to cope up with the stress of
daily life, it provides inner strength, emotional well-being and enables us to adapt to the changes
of daily life. Despite the above mentioned importance of mental health, it is notable that mental
health is neglected in third world countries more specifically in Pakistan.
Common mental health problems

Common mental disorders faced by people in Pakistan are depression, anxiety, obsessivecompulsive disorder (OCD), phobias, eating problems, bipolar disorder, schizophrenia,
personality disorders and drug addictions.
Causes for mental illnesses in Pakistan and their effects

Mental health issues have been on the rise in Pakistan. Various factors contributing to this
increase are low income, poverty, redundancy, illiteracy, malnutrition, gender biasness, break-up
of social relationship, terrorism, corruption and increased stress levels. Psychiatric patients are
stigmatized that they are mad and people consider that these patients cannot be cured.
Additionally, it is culturally considered that mental illnesses are due to supernatural causes e.g.
sorcerer, witchcraft and evil eye which is a myth and becomes a barrier in availing the mental
health services

An important factor is the physical health which plays a vital role in mental health. The patient
with physical illness usually has low self-esteem and suffers from depression and anxiety which
impair the mental health of that patient. Major factors of suicides in Pakistan are psychiatric
disorders mainly depression, conflict related to marital status, joblessness and distressing life
Another important factor is social life. There is a lack of rehabilitation centers and support for
psychiatric patients from the society. Bad social habits like drinking alcohol and smoking etc.
cause: depression, anxiety and psychological dependency. In addition to above factors another
deep-rooted factor is culture which is comprised of social norms and religious values of any
society.
Mental health statistics

Literature reveals that prevalence of mental disorders in the rural areas of Pakistan is reported as
15% in men and 46% in women. The magnitude of the mental illness in Pakistan has increased.
The rate of depression is 6%, schizophrenia 1.5%, 1% Alzheimers disease, 1-2% epilepsy and
other disorders. In addition, the magnitude of mental illness in Sindh is, depression: urban/rural
5%/7%, seizure disorder: urban/rural 1%/2%, substance abuse disorder: urban/rural 7%/6.5%,
obsessive-compulsive disorder: urban/rural 2%/1%. Moreover, depression and anxiety disorder
prevalence in the Pakistani community was 34% (range is 29%66% for women and 10%33%
for men) and the factors associated with these disorders were female sex, middle age, low level
of education, financial difficulty, being a housewife, and relationship problems depicts that the
cultural and societal factors play a major role in the cause of anxiety and depression among
Pakistan population
Mental health care facilities

According to press release of Pakistan Association for Mental Health (PAMH) in Pakistan, there
are four mental health hospitals in Hyderabad, Lahore, Peshawar and Mansehra with a total
capacity of 3,000 beds, while small psychiatric units were attached to teaching hospitals and
private psychiatric hospitals had a capacity of about 4,000 beds for patients reporting with
mental disorders. There were only 419 psychiatrists in the country, concentrated mostly in urban
areas, while there were no trained psychiatric nurses and community mental health workers.
NGOs working for mental health

Pakistan Association for Mental Health working for the mental health of community, KarawanE- Hayat working for the rehabilitation of psychiatric patients, Edhi Destitute Home and Habitat
for Mentally ill provides shelter for the psychiatric who cannot afford service charges at other
institutions, Rozan provides counseling for psychiatric patients and Children Youth and Families
Foundation is working on the developmental issues of children and youth. There are community
based organizations working for the mental health of their own communities which are not
registered with the government
Mental Health in Primary Health Care

Twenty seven percent of the training for medical doctors is devoted to mental health, in

comparison to 3% nurses and 11% non-doctor/non-nurse primary health care workers

Only physician-based primary health care clinics are present in the country. In terms of
physician-based primary health care clinics, some (between 21 - 50%) has assessment
and treatment protocols for key mental health conditions available. 21 - 50% of
physician-based primary health care doctors make on average at least one referral per
month to a mental health professional. None of the non-physician based primary health
care clinics make a referral to a higher level of care
Nurses and non-doctor/non-nurse primary health care workers are not allowed to
prescribe psychotropic medications, in any circumstance. Whereas, primary health care
doctors are allowed to prescribe psychotropic medications without restrictions. As for
availability of psychotropic medicines, a few of the clinics (1-20%) of physician-based
PHC clinics have at least one psychotropic medicine of each therapeutic category (antipsychotic, antidepressant, mood stabilizer, anxiolytic, and antiepileptic) available in the
facility or at a nearby pharmacy all year long in comparison to a majority of clinics (5180%) in non-physician based primary health care
Conclusion

There is great need for specific mental health care policy at government level. Also, a movement
of awareness about psychiatric and behavioral disturbance should be started at national level.
There should be proper psychiatric support facilities available in primary care level which will
help to treat mental health problems at early stage. International NGOs and donor agencies
should come forward in order to help the Pakistani government to improve mental health care
conditions. Foreign investors should be encouraged to invest in Pakistan which will support the
weak economy of the country and will create new employment opportunities. New training
institutes for psychiatry and psychology fields should be opened to meet the high demand of
professional staff in psychiatry and psychology field. Psychiatric training should be given at both
undergraduate and postgraduate level in medical education curriculum. Electronic media in
Pakistan can play a very active role for creating awareness about mental health care in the
Pakistani population