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• W2619944107 abstract "Despite the contemporary, misplaced, and ill-informed resistance to vaccinations (e.g. Dube et al. 2013; Jacobson et al. 2007), the authentic scientific record overwhelmingly speaks to their well-documented efficacy (see for instance Jefferson et al. 2005; Rambout et al. 2007). Dr. Edward Jenner, pioneer of the world's first vaccine, is often referred to as ‘the father of immunology’ and his pioneering work is credited with having saved more lives than any other person in human history. While the exact number remains a matter of debate, conservative figures of over 500 million human lives saved has been advanced (Riedel 2005). At the risk of sounding tautological, seminal works of a recognized vintage have long identified the ecological approach as being central to public health concepts and methods (e.g. Greene et al. 2002). Concomitantly, the relevant theoretical and empirical literature appears to be consistent in recognizing vaccinations as a valid and credible example of a public health (health promotion) intervention (e.g. Kumar et al. 2012; Lang & Rayner 2012). Moreover, multilevel, ecological vaccination models appear to be even more advantageous and effective as a public health intervention (Nyambe et al. 2016). On a related matter, some mistakenly attribute the significant decline in death rates from communicable diseases (e.g. cholera, dysentery, tuberculosis, typhoid fever, influenza, yellow fever, and malaria) around the turn of the 20th century through to the 1940s, to advances in medicine and medical care (Jayachandran et al. 2008; World Health Organization: Global Health Observatory (2016)). While there is some evidence to indicate that the introduction of Sulfa drugs contributed somewhat to this decline in the 1940s, the gains are attributed to significantly-improved ecological, public health measures (e.g. clean water supplies, sanitation systems, household hygiene, and rising living standards/access to better nutrition) (Cutler & Miller 2005; Jayachandran et al. 2008; Centers for Disease Control and Prevention (2016b). While exact figures might not be available regarding the number of lives saved as a result of these interventions, the CDC data indicate that these measures contributed to 70% of all life expectancy increases during the 20th century, resulting in a 29.2 year increase in life expectancy and a corresponding sharp drop in infant mortality. Closer scrutiny of the CDC data, as represented in Figure 1, shows that these significant health gains cannot be attributable to advances or developments in medicine or medical practice. For example, the first antibiotics only became widely available in the late 1940s, as mortality rates were nearing their lowest level. Hyperbole aside, the empirical evidence pertaining to these public health interventions clearly indicates that they have had the most significant impact on increasing life expectancy, and have saved many more lives than reactionary, disease, or illness-response health-care interventions. When the evidence is aggregated, the impact and effectiveness of ecological, public health interventions is compelling, persuasive, and very difficult to refute. However, despite this evidence, by far, the majority of so-called ‘health care’ all around the world is predicated on and organized around a reactionary model; one commonly identified as an ‘illness’ or ‘disease-care’ system (Greene et al. 2002; Woolf & Aron 2013). In the USA, for example, reports indicate that 95 cents of every health-care dollar was spent in treating or responding to disease after it had already occurred. The same counterintuitive situation is very much evident when it comes to mental health funding, only it is more pronounced. Mental health-care expenditure accounts for a small percentage of total health-care funding (Canada: 7%, UK: 13%, USA: 5.6%, Australia: 8%). By far, the ‘lion's share’ of funding, as stated earlier, is spent on reacting to clients who present with mental health problems, not on preventative, public health interventions and programmes. While a number of countries have made noticeable progress towards embracing a genuine public health, preventative care system (e.g. Canada and Australia), the disease-responsive system remains dominant in most parts of the world and absorbs the significant majority of the costs. The illogical, uneconomic, and counterintuitive nature of this problem is further illustrated by drawing on the example of suicide prevention. The global epidemiological data, limitations notwithstanding, indicate that suicide remains as a major public health problem (World Health Organization 2010, 2014). The same data show that there has been a slight upward trend in global suicide rates from the 1950s until the present day; this trend is more distinct in males than females (Fig. 2). Given that the formal study of suicide began in earnest in the 1950s, and that the resultant body of knowledge produced by this effort ‘spoke’ directly and indirectly to suicide prevention, we can assert with a high degree of empirical confidence that our suicide-prevention efforts have not yet resulted in widespread or significant reductions in the global suicide rates. During the corresponding time period (1950s to the present day), the principal efforts to attempt to reduce the suicide rate have not focussed on public health approaches. During this time, suicide has been viewed (predominantly) as a mental health issue, responded to through clinical, individual-focussed interventions, most commonly interventions associated with ‘treating depression’ (Canadian Mental Health Association, 2016; Centers for Disease Control and Prevention 2016a,b, Knox et al. 2004). As a result, suicide prevention has, in the main, focussed narrowly on identifying proximate, individual-level risk factors, rather than focussing on population mental health (Eskin et al. 2007; Goldsmith et al. 2002). Lewis et al. (1997) calculated that such strategies have a modest effect on a population's suicide rate, even when an effective intervention has been developed. While individual-level risk factors should not be ignored, focussing on psychiatric morbidity alone in suicide prevention is unhelpful (Knox et al. 2004). To draw these salient threads together: (i) there is an overwhelming body of evidence that speaks to both the efficacy and cost-effectiveness of ecological public health interventions; (ii) there is strong evidence that shows how the vast majority of our health-care funding is spent on reacting and responding to health challenges, after the challenge has already occurred; (iii) public health-care spending on mental health care, in many parts of the world, is disproportionately low when compared to scope and severity of the problem; (iv) the proportion of health-care dollars spent on preventative care, including within the domain of mental health, is very small (approximately 5%); (v) so-called suicide-prevention efforts have, in the main, been clinical, individual-focussed interventions, most commonly interventions associated with ‘treating depression’, and these efforts have not brought about a reduction in the trend of global rates of suicide; and (vi) yet there is persuasive evidence that shows how 70% of all increases to life expectancy during the 20th century are attributed to improved ecological, public health measures (e.g. clean water supplies, sanitation systems, household hygiene, and rising living standards/access to better nutrition). The work that already exists in this area, for example, the recently-published Mental Health Strategy for Canada (Mental Health Commission of Canada 2012), includes theoretically-sound principles, such as (i) increase awareness about how to promote mental health; (ii) increase the capacity of families, caregivers, schools, post-secondary institutions, and community organizations; (iii) create workplaces that are mentally healthy; and (iv) increase the capacity of older adults, families, care settings, and communities to promote mental health later in life. Yet as laudable as these principles are, what remains unidentified are the programmes, the interventions, the specific efforts to help operationalize these principles. It therefore behooves P/MH nurses, especially those who embrace ecological mental health promotion, to explore and operationalize 21st century mental health analogues for ‘vaccines’ and ‘clean water supplies’. In so doing, the P/MH stand to have a far greater positive impact on the mental health of their communities." @default.
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• W2619944107 title "Ecological mental health promotion - The case of suicide prevention: 21st century mental health analogues for ‘clean water’, ‘improved sanitation’, and ‘vaccines’" @default.
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