Hi Glen,

You raise really important points about the overlap among models. Some have
useful ideas but if used exclusively also have significant limitations as
you point out. Add to that the political agendas for adopting a model such
as population health which can be seen by politicians as supporting the
reduction of illness-care or downstream services in the name of improving
health and you have a recipe for disaster. The challenge is balancing not
only upsteam-downstream approaches but also population-individual
approaches. Although it is not consistent with any of the population health
literature I have read, the dichotomizing of population health from the
individuals within that population has been a nifty tool for the divestment
of public health's individual/family focused health promotion services.

Just one word about the medical model--it is still necessary as you point
out but nursing is not part of the medical model. There is overlap between
the medical model and a nursing model when disease becomes the salient
health issue of an individual, family, community, or population and
depending on a nurse's job, that overlap might be larger or smaller. A
nurse working in the immunization program, for example, would have a much
larger overlap with the medical model than one working to promote the
health of young families or specific populations. Rather than focus
primarily on the treatment or even prevention of disease, nursing's primary
focus has always been holistic, supporting self-determination of clients in
the pursuit of health. Promoting individual health in the presence of
chronic illnesses such as AIDS is therefore quite congruent with a nursing
paradigm but I can assure you that when I used that approach working in the
AIDS program as a public health nurse it met with significant resistance
because it was not considered congruent with the medical model's construct
of primary prevention!


Adeline

_______________________________________________________________

"This is the future: to fight in favor of change or to fight in favor of
keeping the present" Freire