The World Health Organization (WHO)'s (2006) definition of health as ‘complete physical, mental and social wellbeing rather than merely the absence of disease or infirmity’ is included in all healthcare professional curricula. Despite this, healthcare practice is almost entirely focused on curative activities. To an extent, this reflects that much healthcare practice occurs within hospital settings. However, demographic changes and the burgeoning population with long-term conditions necessitate that the neglect of health creation is addressed urgently to avert the inevitable consequences for both the individual and society as a whole. Further, the deficit approach to health—the identification of problems and needs, such as deprivation, ill-health and damaging health behaviours—has resulted in services being designed to deliver curative and supportive care rather than nurture creation and maintenance of health.
In contrast, the asset approach focuses upon health protection at different levels for individuals and communities that are likely to lead to improved overall health and wellbeing. Individual assets include self-esteem, sense of purpose and resilience, while community assets include support networks, such as the family and other relationships, inter-generational and community cohesion, religious tolerance and social harmony (Hopkins and Rippon, 2015). Community activities that exist tend to focus on health maintenance, rather than health creation and environments that are conducive to health, despite Antonovsky (1996) proposing the theory of salutogenesis to guide public health and health-promotion activities.
In Van Bortel et al's (2019) systematic review of 478 studies across 40 countries, 148 studies were UK-based and 100 were US-based. Health asset-based interventions included education and training, relationship interventions and physical activity, and were interdisciplinary and inclusive of all stakeholders, that is, they were co-creations rather than offering a ‘fix’. Indeed, the WHO European Office (2019) proposed a model for health and development that encourages individuals and communities to take greater control of their own health and their relationships with health services, although the balance of power among various interests was not addressed.
It is easy to say that district nursing has no part to play in health creation, with its focus on those requiring nursing care in the home, but this notion ignores the role of district nurses in the wider healthcare economy and the fact that, inevitably, all district nurses will engage with the carers of their clients, whose health and wellbeing should be promoted. One way of maximising finite healthcare resources is to enable everyone to live happy and healthy lives for as long as possible with the need for supportive services limited to a compressed end-of-life dependency, in line with the ‘healthy ageing’ advocated by the WHO (2015). Many district nurses may feel that requesting their involvement in health creation is one ‘ask’ too many while they are working at full stretch delivering increasingly complex care to housebound clients. Nonetheless, it is important that all health professionals engage with health creation if population health is to improve.
‘Demographic changes and the burgeoning population with long-term conditions necessitate that the neglect of health creation is addressed urgently to avert the inevitable consequences for both the individual and society as a whole.’