The Health Improvement Card:Perspectives of a Health Care Clinician, Educator and Researcher

The Health Improvement Card:

Perspectives of a Health Care Clinician, Educator and Researcher

Elizabeth Dean, PhD, PT, Professor, Department of Physical Therapy, Faculty of Medicine,University of British Columbia, Canada

The Health Improvement Card (HIC) endorsed by the World Health Professions Alliance (WHPA) has been a major contribution to enabling health practitioners engage in health promotion practice – the singular health care priority of the 21st century - if health care is truly to be reflective of health care, vs. simply the care of impairment and illness.

The HIC needs to be in the arsenal of every contemporary health care provider if lifestyle-related conditions are to be curbed through our collective effort. Given the well-established relationship of lifestyle choices and behaviors with conditions such as ischemic heart disease, smoking-related conditions, hypertension, stroke, type 2 diabetes mellitus, obesity and cancers, there is no reason these devastating conditions associated with enormous social and economic burdens, cannot be the least causes of premature death throughout the world, rather than leading causes, through our combined efforts. As an established physical therapy clinician, educator and researcher at the University of British Columbia, Canada, I have several perspectives of the HIC.

Physical therapy is one of the largest health professions in the world and, of these professions, is the largest established non pharmacologic health profession. Physical therapy is often primarily associated with musculoskeletal and neurological conditions. The profession however has evolved to more than physical interventions and modalities related to the management of such conditions.

The World Confederation for Physical Therapy has adopted the International Classification of Functioning, Disability and Health, endorsed by the World Health Organization (WHO) which is predicated on the WHO definition of health. Contemporary 21st century physical therapists are committed to health and the exploitation of non-pharmacological interventions to prevent and reverse as well as manage lifestyle-related conditions. Most health professionals are committed to best practice based on the evidence. No drugs and no surgical interventions address the underlying patho-etiology of chronic lifestyle-related conditions as well as healthy lifestyles and lifestyle behavior change.

The health psychology literature has identified multiple evidence-based health education methods for effecting positive health behavior change in our patients and clients. These can be readily implemented in conjunction with the findings of the HIC in the context of resource constrained busy practices. Health behavior change cannot and should not be the sole responsibility of any one professional. Patients and clients need to be receiving consistent messaging about healthy living from all health providers who have the responsibility of establishing the lifestyle-behavior health risks in their adult and pediatric patients and clients, inform and initiative health behavior change depending on systematically establishing his or her readiness to change, and/or support on-going initiatives of other health professionals. A key part of this process is the responsibility of systematically following-up with the patient irrespective which professional may have initiated one or more health behavior change interventions with the patient.

The HIC is an easy convenience inexpensive tool that can be effectively used to start the conversation about health behavior change – a conversation that is often uncomfortable for many of us to initiative. The tool can facilitate this essential process. Patients are visiting health professionals today for a wide range of problems beyond acute infectious disease. And, for many of these patients, e.g., those seen by physical therapists, the underlying lifestyle-related risk factors and secondary conditions are far more serious that a presenting musculoskeletal problem which certainly warrants attention. The HIC is being revisited by the WHPA in the form of a Delphi study to establish how it may be further refined while maintaining is user friendly format. The current literature supports the inclusion of sleep quality and quantity and stress levels given their implication in lifestyle-related conditions and other problems in so-called modern life. As a health professional community, we need to share this tool and make it common across our professional domains. It needs to be introduced in our entry-level health professional education programs, and promoted as standard practice in our clinical communities.

Our researchers need to further refine clinically based effective health behavior change strategies and interventions based on the indications of the HIC, which also lends itself to being an outcome measure (that is, to assess how well a health behavior change intervention worked, and what if anything needs to be changed to produce a greater long-term effect). Lastly, we as contemporary health care professionals need to support community health initiatives, and inform, be engaged in, and support health policies at the ministry of health level, and community and urban planning.

The 21st century is calling for interprofessional communication and practice, and less silo-d individual practice where the patient falls between the cracks and is deprived of best health care in its truest sense.

Some of Our Related Work

Dean E, Al-ObaidI S, Dornelas de Andrade A, Gosselink R, Umerah G, Al-Abdelwahab S, Anthony J, Bhise A, Bruno S, Butcher S, FageviK Olsen M, Frownfelter D, Gappmeir E, Gylfaddotir S, Habibi M, Hasson S, Jones A, LaPier T, Lomi C, Mackay L, Mathur S, O’Donoghue G, Playford K, Ravindra S, Sangroula K, Scherer S, Skinner M, Wong WP. The First Physical Therapy Summit on Global Health: Implications and recommendations for the 21st century. Physiotherapy Theory and Practice 2011;May 25. [Epub ahead of print].

Dean E, Lomi C, Bruno S, Awad H, O’Donoghue G. Addressing the common pathway underlying hypertension and diabetes in people who are obese: The ultimate knowledge translation gap. International Journal of Hypertension (2011). doi:10.4061/2011/835805.

Dean E. Physical therapy in the 21st century: A paradigm shift and implications. Physiother Theory Practice. Invited Special Issue Editor. Physiother Theory Practice 2009;25:327-462.

Dean E. Physical therapy in the 21st century (Part I): Toward practice informed by epidemiology and the crisis of lifestyle conditions. Physiother Theory Practice 2009;25:330-353.

Dean E. Physical therapy in the 21st century (Part II): Evidence-based practice within the context of evidence-informed practice. Physiother Theory Practice 2009;25:354-368. Bodner M, Dean E. Brief advice as a smoking cessation strategy: A systematic review and implications for physical therapists. Physiother Theory Practice 2009;25:369-407.