Community and primary health care

Introduction Primary health care (PHC) is a philosophy or approach to health care where health is acknowledged as a fundamental right, as well as an individual and collective responsibility. The PHC approach is founded on the social model of health, which recognises that a person's health is shaped by their biology, social group and family influences, community factors, economic and environmental influences, as well as broader public policy. Social justice, equity, community participation and health promotion are key principles of PHC. In a just society, everyone is supported to achieve and maintain her or his optimum level of health and well-being. Health improvement and well-being are achieved through addressing the social and environmental determinants of health, along with reduction in the burden of preventable disease and medical treatment. The social model of health Most health care systems have been developed to respond to illness, rather than to create and support wellness. Advances in science have entrenched the biomedical model of health as the pinnacle of health care for over a century. However, this view has been challenged in the face of mounting evidence, which demonstrates that health and health care are far more complex than this model allows. The social model of health takes a broader view of the complex interactions, which occur within a society, that influence individual and community health. A range of factors which can positively or negatively influence achieving and maintaining good health and well-being have been identified. These factors are collectively referred to as the social determinants of health . The social determinants of health are simply the circumstances of daily living that influence a person's health. Lists of social determinants may vary, but fundamentally they will relate to economic, social, political and environmental conditions, and are frequently interrelated (Marmot & Wilkinson, 2006). For example, economic factors refer to the level of a person's income as well as her or his opportunities for employment. People may be employed, but not necessarily at the level they would like to be – known as being ‘underemployed’ – and they may also be unemployed. Employment opportunities can be influenced by numerous factors, including level of education, geographic location and political conditions (Keleher & MacDougall, 2011). Generally the level of education a person receives influences the type of employment they obtain, which influences how much they may earn.