This article posits that if occupational therapy in Aotearoa New Zealand is to have a significant presence in the health care of older people, practitioners need to provide primary health promotion in the community. In its most simple definition health promotion is the process of facilitating individuals, groups and/or communities control of their own health. This change in focus is deemed to be desirable given Aotearoa New Zealand's ageing population. The latest statistics project that 25% of the total population will be made up of people over 65 by 2040 and unless the current system of health provision for people over 65 changes, it will face increased pressure in the coming years (Statistics New Zealand, 2009). According to Reitz (1993), one method of servicing the ageing population is to encourage occupational therapy involvement in health promotion.
The compatibility between health promotion and occupational therapy is well documented (Wilcock, 2007). Indeed, health promotion ought to be a familiar concept in the world of occupational therapy since the earliest discussion around its potential in the profession was published in the 1960s (Scriven & Atwal, 2004). The idea of health promotion to prevent illness was highlighted internationally in 1978 at an international Conference on Primary Health Care in what is now Kazakhstan. The Declaration of Alma-Ata expressed the need for immediate action by all governments, health care workers and developers, as well as the world community, to promote and protect the health of people worldwide (World Health Organisation, [WHO] 1978). Then in 1986, the WHO released the Ottawa Charter which is perhaps, the most important document in the field of health promotion. It provides five principles to guide health promotion activities; building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and re-orientating health care services toward prevention of illness and promotion of health. These principles provide a vision to which occupational therapy health promotion service should be aligned (Scriven & Atwal, 2004).
Current and future involvement in health promotion
The current scope of practice published by the Occupational Therapy Board of New Zealand (2004) gives occupational therapists a mandate to work with a health promotion focus. Currently, occupational therapists engage in both secondary and tertiary health promotion. In tertiary health promotion, this includes, but is not limited to, the provision of assistive devices and rehabilitation programmes with people experiencing degenerating chronic conditions (Scriven & Atwal, 2004). Secondary health promotion involves interventions such as falls prevention programmes and rehabilitation programmes that include aspects of lifestyle management. However, the most effective aspect of health promotion in the prevention of ill health is primary health promotion which is rarely reported. Primary health promotion targets the well population by preventing ill health through interventions such as health education, early intervention and legislative changes (Scriven & Atwal, 2004).
Conversely, there are some theories that could militate against effective health promotion for over 65s. It is reported that people in this age range will present within Laslett's third or fourth stages of ageing (Cole, 2007). The assumption within this theory is that qualitative changes occur for people in the fourth age, including a pattern of voluntary withdrawal from aspects of life such as social and leisure activities, with reduced social contacts leading to emotional detachment (Cole, 2007). Moreover, it is argued that people in this stage of life are less likely to attempt activities (Katz, 2000 as cited in Cole, 2007). These changes make effective participation in health promotion challenging and warrant professional assistance from occupational therapists. …