Person-centered public health promotion: an overview and a plea

Main Article Content

Wolfgang Rutz

Abstract

The Definition of Health of the World Health Organisation (WHO) has traditionally focused on individual health as a human right, defined not only by the absence of symptoms, disorder and disease, but also including a state of continuous and balanced mental- and physical wellbeing [1]. Today, increasingly holistic approaches in medicine are concerned to integrate physical, mental, psychosocial and existential factors and to focus additionally on salutogenesis and resilience, even on happiness [2]. Over the last few decades, the WHO has summarized the global research evidence on mental health and mental wellbeing and has identified the following determinants of health as necessary for the maintenance of health and the avoidance of illness [3]: (i) a state of control: not to be helpless, to be in charge of and execute mastery in one’s own life; (ii) a sense of existential cohesion and meaning:  to experience an individual context of meaning and sense and to find individual and feasible ways to live according to this experience; (iii) a feeling of social connectedness: to feel socially connected and related, to experience the feeling of being needed and to be supported by others when needing help, to have someone to care for and  to be cared for by and (iv) a feeling of “caseness” - being a person and identity of one’s own:  this involves feelings of integrity, identity, dignity, being respected and the absence of alienation. It is here that person-centred public health and community approaches, focussing on regions or populations at risk, have to investigate and elucidate these four dimensions for each person or population at risk.In this article, the often complex patterns of specific vulnerabilities will be described, specific assets and strengths as well as specific etiological causalities analyzed and some different individual salutogenic or pathogenic health causalities and consequences  in different populations discussed, in order to elucidate an underlying basis for actions and interventions on a demographic level.

Article Details

Section
Regular Articles
Author Biography

Wolfgang Rutz, University for Applied Sciences of Coburg (Germany); Public and International Mental Health, Karolinska Institutet, Stockholm

Dr Rutz is Professor of Social Psychiatry at the University for Applied Sciences of Coburg (Germany) as well as Senior Advisor for Public and International Mental Health, based in Stockholm. He is chairman of the International Advisory Committee of the German network on Suicide Prevention and Vice Chairman of the World Psychiatric Organisations (WPA) Section for Psychiatry and Policy. Dr Rutz is Member of the Board of the Swedish Social Psychiatric Forum and head of its international secretariat as well as member of the board of the Swedish Family Association of Suicide Prevention (SPES) and its scientific advisor. 1976 to 1998 Director of the Mental Health and Psychiatric Services in the County of Gotland, Sweden. During this time Dr Rutz headed the professional and structural development of the mental health services on Gotland towards deinstitutionalisation, professionalisation and community based mental health to become one of the model organisations both in Sweden and internationally. He acquired his Doctorate of Philosophy at the University of Linköping, Sweden, with a dissertation about the “Gotland Study”on suicide prevention by the involvement and education of General Practitioners.During the 90s he became Vice Chairman of the Swedish Psychiatric Assocoation and President of the Swedish Society for Biological Psychiatry.From 1998 to 2005 Dr Rutz was recruited as WHO European Regional Advisor for Mental Health and Director of WHO's European Program for Mental Health at its European office in Copenhagen.After his retirement from WHO and United Nations he was Head of the Department for Psychiatry and Health Promotion at the Academic University Clinic of Uppsala from 2005 to 2009. 

References

World Health Organisation. (1946). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19 June - 22 July 1946.

Cloninger, R.C. et al. Promotion of Well-Being in Person-Centered Mental Health Care. Focus 8,165-179.

World Health Organisation. (2001). Mental Health. New Understanding, new Hope. The World Health Report. Geneva.

Rutz,W. (2011). Reflections on Public Health: principles for a person-centred promotion of mental and physical Health. International Journal of Person Centered Medicine 1 (3) 435-439.

Mezzich, J.E., Salloum, I., Cloninger,C.R., Salvador-Carulla, L., Kirmayer, L.J., Banzato, C.E., Wallcraft, J. & Botbol, M. (2010). Person-centered Integrative Diagnosis:Conceptual Bases and Structural Model. Canadian Journal of Psychiatry 55, 701-708,

Rutz, W. (2009). Positive Health and Health Promotion: The WPA Institutional Programme of Psychiatry for the Person in a European Public Health Perspective. In: Psychiatric Diagnosis. Challenges and Prospects. (Salloum, I. & Mezzich, J.E. eds.). London: Wiley and Sons.

Rutz, W. (2001). Mental health in Europe: Diversities, possibilities, shortcomings, challenges. The WHO perspective. European Archives of Psychiatry and Clinical Neuroscience 251 (Supplement 2) II 3-5.

Rutz, W. (2003). The European WHO mental health programme and the World Health Report 2001: input and implications. British Journal of Psychiatry 183, 73-74.

Muijen, M. (2006). Challenges for psychiatry: delivering the Mental Health Declaration for Europe. World Psychiatry 5 (2) 113–117.

Mezzich, J.E. (2007). Psychiatry for the Person: articulating medicine's science and humanism. World Psychiatry 6 (2) 65–67.

Rutz, W. (2007). A need to rethink social psychiatry. International Journal of Public Health 52, 137-139

Rutz, W. (2006). Social psychiatry and public mental health: Present situation and future objectives. Time for rethinking and renaissance. Acta Psychiatrica Scandinavica 113 (Supplement 429) 95-100.

Wilkinson, R. & Pickett, K. (2010). The Spirit Level: Why More Equal Societies Almost Always Do Better. London: Penguin group.

Gunnell, D., Platt, S. & Hawton, K. (2009). The economic crisis and suicide. British Medical Journal 338, b1891.

De Marinis. V. (2012). Pastoral care – existential health and existential epidemiology. A swedish postmodern case study. Verbum online.

Magnusson Hansson, L & Theorell, T. (2008). Demand, control and social climate as predictors of emotionel exhaustion symptoms in working Swedish men and women. Scandinavian Journal of Public Health 36 (7) 737-743.

Warr, P. (1994). A conceptual framework for the study of work and mental health. Work & Stress 8 (2) 84-97.

Tsankova, N., Renthal, W., Kumar, A. & Nestler, E.J. (2007). Epigenetic regulation in psychiatric disorders. Nature Reviews Neuroscience 8, 355-367.

Ljungberg, T. (1991). Människan, kulturen och evolutionen ett alternativt perspektiv (in Swedish). Stockholm: Exiris Förlag.

Antonovsky, A. (1996). The salutogenic model as a theory to guide health promotion. Health Promotion International 11 (1) 11-18.

Wong, P.T.P. (2011). Positive psychology 2.0. Canadian Psychology 52 (2) 69-81.

Kickbusch, I. (2003). The Contribution of the World Health Organization to a New Public Health and Health Promotion. American Journal of Public Health 93 (3) 383-388.

Rutz,W. (2004). A need to rethink social psychiatry in Europe. Lancet 363 (9424) 1652.

Levav, I. (2006). Terrorism and its effects on mental health. World Psychiatry 5 (1) 35–36.

Ezechieli, E. (2003). Beyond Sustainable Development: Education for Gross National Happiness in Bhutan. Monograph. International Comparative Education. School of Education. Stanford University.

Paz,O. (1963). Life is plurality, death is uniformity. Quoted in www.Thinkexist.com.

Russell, B. & Einstein, A. (1955). The Russell-Einstein Manifesto. Issued in London, 9 July 1955. Quoted in www.google.com