Hypertension Treatment Strategies for Adults Over the Age of 25

Introduction

Health is considered one of the fundamental human rights by the World Health Organization (WHO), and health promotion is defined as “the process of enabling people to increase control over and improve their health (WHO, 1987).” Health Promotion Strategies and Policies acknowledges that health promotion is not limited to a specific set of behaviors or to a specific health problem.

The principles and strategies for health promotion apply to a variety of population groups, risk factors, and diseases and can be used in a variety of settings. Health promotion, when applied in concert with other strategies including education, policy, legislation and regulation, and community development, is more effective in preventing Communicable and Non-Communicable Diseases (NCDs) such as hypertension.

Hypertension also known as high blood pressure is a condition mainly common amongst individuals aged 25 years and over and is estimated to be affecting more than 1 billion people and responsible for more than 9.4 million deaths annually, accounting for almost 50% coronary heart diseases and half strokes (De, et al., 2013). In sub-Sharan Africa, hypertension is estimated to range from 5% to 50% compared to developed countries where it varies from 19% to 29% (Ntuli, Maimela, Alberts, Choma, & Dikotope, 2015).

However, the prevalence of high blood pressure is estimated to be 21% in South Africa with females accounting for 14% and males accounting for 11% (Ntuli, Maimela, Alberts, Choma, & Dikotope, 2015). Since high blood pressure is a manageable disease that has been linked with several social determinants of health including; income and status, education and literacy, physical environment, health, and gender: poor management can lead to severe complications such as atherosclerosis, disability, and mortality. Due to these factors, multiple strategies have been implemented in South Africa to address social determinant factors in hopes to reduce hypertension.

Health promotion strategies are methods used to obtain the objectives of a health program. There are several strategies that can be used ranging from individual focus, population focus and community focus to bring about change in the lifestyle and environment that can improve health. Whilst health promotion strategies may differ according to their methodologies, targeted audience, evaluation criteria and goals, they all aim to prevent illness and promote health (Duplaga, Grysztar, Rodzinka, & Kopec, 2016).

As a result, effective health promotion activities in facilitating lifestyle change by combining strategies that create and enhance awareness, build skills, increase motivation, and make opportunities that open access to an environment that promote the choice of positive health practice. This paper focuses on three health strategies obtained both from the health promotion strategies and the Ottawa Charter Action Areas in hopes of addressing the social determinant of health related to hypertension such as education and literacy, physical environmental, economic and social status, gender and lastly, health behavior.

Community Development

Community development acts as an interface between behavioral change and the environment to health promotion. This strategy focuses on the way in which communities can intervene to actively change their social and physical environment through recognition of socioeconomic and environmental causes of disease with the community (Fink, Keyes, & Cerdá, 2017). By addressing the relationship between health and socioeconomic factors, community development aims to eliminate the cause of ill-health via the collective organization of the members of the community. It also aims to empower and facilitate communities to improve their physical and social environment, involving communities in decision-making together with problem-solving skills to influence structural change to the environment to improve social justice and equity in health.

In terms of high blood pressure, community development and mobilization interventions look at activities that increase the strength and effectiveness of the community by enabling the population to part-take in public decision-making, improve local conditions and accomplishing long-term control over circumstances. An example of community development intervention on hypertension would be health education sessions for the community and the use of community members in creating awareness about hypertension. In a study conducted by Halladay at al., 2017, whereby they assessed the relationship between health literacy and blood pressure reduction among American patients.

The study findings indicate that multi-level interventions designed using health literacy can effectively reduce hypertension. Their study correlates with DeWalt at al., 2012 study where multisession and single session intervention impact were evaluated on how they help reduce hypertension. Although health education was not 100% effective in changing an individual's health behaviors, it helped and reduce health illiteracy and improve education on hypertension. A study conducted by Wadler at al., 2011, indicate that the use of community health workers in cancer control in South African has resulted in improved knowledge about cancer, screening, and patient navigation improvement, henceforth one could assume that the use of community workers could also be applied in hypertension knowledge among individuals. Another example of community development would be the workplace wellness programs of blood pressure control which focuses on the physical environment under the social determinant of health. The WHO has recognized that workplace health activities are one of the most effective measures in controlling and preventing non-communicable diseases including hypertension.

The problem with community development strategy is that it is vulnerable to lack of funding's, obscures the diversity of lifestyles that exist within the community and fails to address the multiple needs of the people living in that community. Lastly, most of the time, the people who drive as agents for change are not the individuals of the community but outsiders, which can result to ethnocentrism by the drivers of change thus violating health promotion value of respect.

Developing Personal Skills

As one of the Ottawa Charter action areas, developing personal skills as a strategy focuses on how knowledge can be used in the understanding of ill-health causes and come up with health advice that enables people to manage their own health. In other words, this strategy aims to change people's behavior by targeting their cognition. This is achievable by increasing individual ability to reach health information, which results in an individual capacity to make informed choices about their health-related behavior. Since this strategy is evidence-based, it heavily depends on the provision of information about health consequences and risks through mass media, posters, leaflets to increase people knowledge about illness and disease risk factors.

Also, the development of the personal skills approach looks at how knowledge can be used to empower people to increase control over their social, physical and internal environments. By health education (i.e. problem-solving, social skills training, educational dramas and many more) people can evaluate their own beliefs and values and explore factors that affect the choices they make. Personal skill development interventions provide a space in which people can establish self-understanding and make choice as an agent of change of their own lives at their own convenience. Examples of this strategy interventions include the self-examination program whereby people are educated on how to examine their own blood pressure at home, which is the first for hypertension diagnostic. According to a study by Agide at al., 2018, on how to increase cancer screening uptake; the study indicate that self-examination of the breast has increased from 0% to almost 93% among Indian women, which has resulted to early detection and early diagnosis of breast cancer incidence over the past years.

On the other hand, development of personal skills is associated with limitation including the inability to target the most important socioeconomic risk factors of illness, it also assumes that the is a correlation between attitude, and knowledge, it focuses exclusively on cognition and assumption that rational choices are healthy choices. Lastly, person development targets the individual rather than the population to bring about systematic change to communities.

Reorientation of health services.

The strategy of health service reorientation from the Ottawa charter has been the least systematically implemented strategy regardless of the emerging evidence of being effective. According to the World Health Organization definition of health service reorientation 'Health service reorientation is defined by a more explicit concern for achieving of population health outcomes in a way that the health system is organized and funded (WHO, 1998).' In other word health service, reorientation focuses on how the health sector can work together with other sectors towards a health system which contribute to the achievement of health for everyone. Also, how health sectors responsibility should shift toward health promotion, away from curative and clinical services. Furthermore, reorientation of health services is the only strategy that can help in the reduction of inequality by tackling the issue of economic and social status under the determinants of health

The need to reorient health services have gradually increased with evidence showing the benefits of doing so since the late 1980s. They are numerous countries that have documented a better balance in investment in health promotion together with disease prevention programs because of health service reorientation. A well-known example would be the British National Health Service led by Sir Derek Wanless in evaluating the type and level of resources required by the British population to obtain quality health services. His findings also provided Britain with a “blunt assessment of their future health system sustainability.” The Wanless report also indicated that engagement of patients is essential for future health services since patient education strategies enable the management and prevention of chronic and acute diseases. Due to a successful health care system, the South African government adopted the British health system in 2011, by introducing the National Health Insurance which focuses on how to bring quality health care and delivery to all South Africans despite their socio-economic background.

Despite all the evidence which indicates the need of health service reorientation, little progress has been made regarding this strategy including: (1) health system attention to provide care for people with chronic illness and disregarding primary prevention and health promotion activities. (2) Also, countries inability to include health promotion, maintenance and failure to allocate resources in their health sectors has led to the disappointment of this strategy. In a nutshell, it is obvious that the lack of evidence to support the effectiveness of health service reorientation is still insufficient, which is why communities and political decisions are still swaying regarding health care service reorientation.

Partner and Building Alliances

A partnership is essential in all aspects of health, be it promotion or policy-making; for a better outcome since it emphasizes almost all health promotion practices, for instance, from a joint formulation of a general policy to a shared approach to patient education. Constructing the capacity of others is an important part of health promotion practice and contributes to the transformation of health determinant. The World Health Organization Health Promotion Strategic Framework has acknowledged that a partnership approach can be undertaken under multiple areas such as policies and frameworks, training and education, program development and implementation social marketing and partnerships with other sectors. This strategy looks at how the health sector can collaborate with other sectors to influence and improve the determinants of health and equality since more than 80% of what makes health is beyond the health sector. This strategy was influenced by the Jakarta Declaration ‘Health for All’ movement recommended by the World Health in 1978.

The application of several constituents of a comprehensive high blood pressure strategy is beyond the scope of hypertension establishments. It involves civil society, governmental organizations, healthcare professions, and the corporate sector. Moreover, many areas, a small minority of people with high blood pressure are managed by hypertension specialists or even medical expertise. Consequently, hypertension organizations need solid partnerships to aid introduce and evaluate hypertension strategies. ‘Possibly the easiest and highest priority partnerships to develop are those with the healthcare professional organizations that represent the clinicians that manage most hypertension on a day-to-day basis’. Hypertension strategies are most likely to succeed when the partners share a common goal and are more involved. Hypertension organizations ensure the involvement of primary care organizations in the implementation of hypertension endorsements.

Conclusion

As discussed in this paper, South Africa is among the top countries in Africa struggling with the rise of non-communicable Disease, it also amongst the countries that have substantial evidence indicating means of combating them. Due to the determinant of health, hypertension incidences continue to increase, however, the introduction of health promotion strategies from Ottawa Charter together with intersectoral partnership from other sectors has helped improve health outcome and addressed some of the health determinants such as economic and social status, physical activity, health behavior and many more. In a nutshell, the South African health system should continue collaborating with other sectors keeping in mind the health promotion principles and values in reducing the prevalence of hypertension amongst its citizens.