ABSTRACT: The US health care deliverv svstem has undergone dramatic change in recent years. Multiple societal factors are seen as responsible for this evolution. Quite apparent is a shift from an individual to a community.16cus on health care delivery. As a result, health education/promotion strategies with a communitv focus have become more important to today @ health care practitioners, including physical therapy professionals. Adopting a community health education approach will expand the roles of physical therapy professionals, improve the effectiveness 0/physical therapy services, and positively influence patient outcomes. Physical therapy professionals, however appear ill equipped to serve as community health educators. The purposes of this article are to describe contemporary community health education, to relate contemporary community health education to physical therapy, practice, and to propose strategies to prepare physical therapy professionals as community health educators.
CONTEMPORARY HEALTH CARE
A shift in the focus of the health care delivery system has occurred as a result of our rapidly evolving society. Changes in population characteristics, lifestyle, environmental factors, and health disorders have altered the leading causes of death and illness.1 These changes, combined with increasing health care costs, earlier discharge of patients from hospitals, and the introduction of capitated managed care, have led health care professionals to focus more attention on community- and population-focused approaches to health promotion and disease prevention.
Conditions such as obesity; type II diabetes, coronary heart disease; appendicitis; cancer of the breast, lung, colon, and prostate; and numerous other common diseases are direct consequences of the Western lifestyle. These diseases account for the bulk of noninfective disease in modern society. Temple and Burkitt2 described changes in attitudes, experienced in the last three decades, with regard to medicine and disease. These changes include: (1) the realization that the bulk of the chronic noninfective diseases (Western diseases) are preventable, (2) the perceived failure of medicine to significantly influence incidence rates for these diseases, and (3) frustration about the inability to discover effective cures despite the rapid pace of technological advances in medicine.2 The current approach to disease management has been called "illogical." Over the past three decades, rarely has conventional medical progress led to a significant improvement in the cure rate for Western diseases (eg, a focus on curing disease after it has appeared).
More contemporary approaches to health care have emphasized educating health care recipients to adopt healthier lifestyles to prevent disease and/or reduce further negative effects in the presence of existing health crises. The basic concepts of health promotion are not new. Health and well being have long been associated with and affected by social interactions between individuals, and between individuals and their community.3 The role of education in preventing and treating health problems is widely accepted.
Despite the fact that a small percentage of the total health care expenditure in the United States is spent on health promotion and disease prevention, their role in medical management has been given greater attention in recent years. Considering the current economics of health care and the ever-increasing ethno-cultural mix of the population, it is imperative that health care professionals make their skills available to communities. Like the roles of other health care professionals, the role of the physical therapist has expanded to include that of community health educator. The community sector holds many opportunities for physical therapy professionals to exert their influence. Through such skills as networking, consulting, collaborating, planning, and reflecting, the physical therapy professional can incorporate health promotion and community interventions into physical therapy practice. …