Sigillo di AteneoSigillo di Ateneo
You are here: Home » Cultural Aspects

Cultural Aspects

Community Medicine’s cultural aspects emerge from WHO documents
1948: Constitution of the WHO (Multidimensional Health)
1978: Alma-Ata Declaration (Primary Health Care)
1991: Health for All
2008: Primary Health Care: now more than ever
The Community Medicine cultural peculiarity is based on the bio-psycho-social approach (BPS), a person-families and communities-centered approach, opposed to the traditional bio-medical disease-centered approach.
The BPS approach includes welfare (health protection), clinical (health promotion and prevention, diagnosis, treatment, rehabilitation), organizational (integration, coordination) and relational (communication, psychological support, counseling) activities, and configures a complete approach model to health.
The BPS approach requires specific competences, products of specific training objectives:
1. Knowledge : physician should be able to define, describe and discuss cultural principles supported by WHO in several guidance documents. These principles are:
  • ·         Health: multidimensional health in its positive and negative aspects.
  • ·         People and communities: people-centrality, patient-family duo, patient and family involvement, community involvement.
  • ·         Range of services: accessibility, acceptability, timeliness, adequacy of professional resources and expertise , reliability and appropriateness of processes, communication, continuity of care, integration, coordination, equity, effectiveness, efficiency, globality, subsidiarity.
  • ·         Services outcomes: global care of patient.
  • ·         Health outcomes: effective for health, autonomy, quality of life, satisfaction.
2. Skills: physician must demonstrate to own skills to perform bio-psycho-social approach to patient, his family and local community, in the settings of primary care integrated with hospital care and in all sectors (health promotion and disease prevention, diagnosis and treatment, rehabilitation). These skills are:
  • ·         Multidimensional health diagnostic assessment: it’s the recognition of patient’s health needs and residual capacities. Starting from the definition of disease considered in the traditional sense, health needs (disabilities, activity limitations) and residual abilities are identified, focusing attention on the impact that disabilities and limitations can have on the subjective and familiar experience. Diagnostic assessment extends to the environment of a person's life (family, education, employment, etc.), in order to identify resources and barriers that facilitate or hinder the realization of life and health full potential.
  • ·         Individual care plan drawing up: it consists in planning care setting, operations and resources for care and assistance, in order to meet health needs of patient considered in his family and his social context. The assessment identifies profile of health and social care needs of patient to which bind a complex series of responses or actions which, while centered in the medical and health dimensions, will not run out with them, but integrate them with other characteristics of the life of every person (i.e. his family and social context). In fact, family and local communities (voluntary, self-help groups etc.) could represent an important resource to which institutions should pay attention in a perspective of therapeutic alliance.
  • ·         Individuals, families and communities involvement: it consists of the information, accountability, subsidiarity support and training of individuals and communities.
  • ·         Provision of integrated and continuous intervention: it is based on institutional, organizational, professional, family and community integration. Multiple responses coming from health, social services, families and local communities require integration and coordination, specific skills that are typical of Community Medicine.
  • ·         Analysis of local communities’ health profile and of the appropriateness effectiveness and efficiency of services.
  • ·         Attitudes: community medicine/primary health care (CM/PHC) physicians’ attitude must be individuals, families and communities-centered.CM/PHC physicians must be able to coordinate patient focused working groups and to create conditions for the development of multi-professional team. These conditions are represented by shared goals, respect for different opinions, trust in each other's skills, collaboration between different roles, aware of the limits of their work if done in isolation. CM/PHC physician must activate the welfare of the community by supporting horizontal subsidiarity responding to health needs.