Some observations on health care by health services or health industries


First published in 1986: Henderson V. (1986) Some observations on health care by health services or health industries. Journal of Advanced Nursing11, 1–2

For nursing this is ‘the best of tim'es and the worst of times’. It is the best of times because the World Health Organization (WHO) and other influential bodies have given global recognition to nurses as providers of primary health care. This presupposes that nurses have an independent as well as an interdependent function.

The WHO goal of ‘health care for all by 2000’ can only be reached if nurses – the largest body of health care providers – are allowed to realize their full potential. This supposition leads, in turn, to the conclusion that nurses, like other ‘professional’ health workers, should be prepared in national, provincial or state systems of higher education – now a well-established trend worldwide.

Ours is ‘the worst of times’ for nurses because it is a period of accelerated, technological change in health care and nurses (who are with the sick, the handicapped and the dying more hours of the day than any other category of health worker), bear the brunt of helping to make these changes constructive rather than destructive. Nurses everywhere are frustrated because within existing systems they are so often unable to give the supportive care that they believe would enable people to recover from disease, cope with a handicap or die peacefully when death is inevitable. Most especially, for various reasons, nurses are unable to make health prevention a priority in their practice. If the goal of ‘health care for all by 2000’ is to be realized, the following are some of the important objectives involved:

  • 1health education to make citizens aware of the conditions that promote well-being and/or those that increase morbidity;
  • 2acceptance by individuals and organized society of the obligation to adopt a healthful lifestyle; and
  • 3allocation of adequate funds and the equitable distribution of monies and other resources to promote health and combat disease.

It is generally conceded that the human desire to help others dominates the social services (as for instance education) and that the profit motive dominates industry. ‘Professionals’ are said to be effective when their clients learn enough from them to make their help unnecessary. Industrialists are successful to the extent that they promote dependence of the public on their products and create escalating needs or desires for more and more possessions.

Health care systems in some countries are unabashedly industries, directed by industrialists rather than by experts in the service they offer. They use the depersonalized methods of ‘scientific management’ (as for example, job rather than patient assignment) and tend to compete rather than cooperate. Conferences of health workers may be developed around the concepts of pricing, marketing and power (as opposed to influence).

With more and more health agencies and institutions coming under the dominion of corporate industrialized management it is increasingly difficult to preserve the humane values in health care. Citizens, but especially healthcare workers, should judge, and, when possible, measure the effect of such management on the welfare of clients and workers. Assessments will be most effective if healthcare professionals cooperate with other informed persons in society in making them.

Nothing seems more important to me in this era than the provision of universal health education through the curricula of grade schools, high schools, colleges and universities; and through the channels of communication – radio and television – that reach all ages. An effective programme of health education also implies opening health science libraries to the public. But most particularly, I believe universal ability to deal effectively with health problems is promoted by giving all citizens copies of their health (medical) records.

There is legislation in some countries, provinces or states making health records (like education records) available to adults, parents or guardians. However, health, or medical, records are unintelligible to many who would like to be informed by them. Realizing this, some health agencies provide even their professional workers with glossaries or guides so that they can understand and use the abbreviations and jargon in the particular agency.

I believe that nothing could be more timely than a study by international health organizations of the essentials of an effective health record. This might result in the publication of a universal model that identifies the essential content, the terminology, and the conditions controlling its usefulness to the individual who is the subject of the record and also the usefulness of the record to the public at large – as for instance in litigation, health education, control and treatment of disease.

Nursing, fortunately, has an increasing number of journals, such as the Journal of Advanced Nursing, with editorial policies permitting the presentation of controversial ideas and practices. Giving citizens copies of their health records has been, and still is controversial. In the 1978 edition of the text Principles and Practice of Nursing (Henderson & Nile 1978) the authors quote Dr Lawrence Weed (1975) addressing the public on health management as follows.

There are those who fear the patient will panic if he owns and understands his own record. But what of the confusion, bad medicine and suffering that results directly from the present practice of keeping source oriented records unavailable to patients and families just when they need them most... It [making the record accessible] may be the most effective weapon we have against over-utilization of medical care... If you [the public] want to develop a mature and helpful philosophy about maintaining your health, you need to understand the means by which physicians’ clinical judgements are made and tested.

Individual health records are the ultimate source of information for patients and their families but they also provide data for evaluation of health care, the incidence of disease, methods of treatment, and any number of questions related to social welfare. Appropriate use by health workers and concerned citizens is almost essential to the improvement of what some critics call our ‘ailing healthcare systems’ whether they be health services or health industries.