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PRIMARY CARE MODEL MODELS OF HEALTH PROMOTION Models of health promotion Models of health promotion TANNAHILL’S DESCRIPTIVE MODEL v HEALTH EDUCATION- communication to enhance well- being and prevent illness through influencing knowledge and attitudes v PREVENTION...

PRIMARY CARE MODEL MODELS OF HEALTH PROMOTION Models of health promotion Models of health promotion TANNAHILL’S DESCRIPTIVE MODEL v HEALTH EDUCATION- communication to enhance well- being and prevent illness through influencing knowledge and attitudes v PREVENTION- reducing or avoiding the risk of diseases and illness primarily through medical interventions v HEALTH PROTECTION- safeguarding population health through legislative, fiscal or social measures. Models of health promotion TANNAHILL’S DESCRIPTIVE MODEL 1. Preventive Services 2. Preventive Health Education 3. Preventive Health Protection 4. Health Education for Preventive Health Protection 5. Positive Health Education 6. Positive Health Protection 7. Health Education Aimed at Positive Health Protection MODELS OF HEALTH PROMOTION TONES’S (TONES AND TILFORD, 2001) EMPOWERMENT MODEL  BEHAVIORAL FACTORS IN HEALTH PROMOTION qThe most common theories for health behavior counseling: A. Health belief model B. Transtheoretical model (stages of change) C. Theory of planned behavior D. Precaution adoption process model E. Social cognitive/social learning theory  A. HEALTH BELIEF MODEL The health belief model holds that, before seeking preventive measures, people generally must believe the following: o The disease at issue is serious, if acquired o They or their children are personally at risk for the disease o The preventive measure is effective in preventing the disease o There are no serious risks or barriers involved in obtaining the preventive measure B. TRANSTHEORETICAL MODEL C. THEORY OF PLANNED BEHAVIOR D. PRECAUTION ADOPTION PROCESS MODEL  E. SOCIAL LEARNING AND SOCIAL COGNITIVE THEORY 1.OBSERVATIONAL LEARNING 2. OUTCOME EXPECTIONS 3. SELF-EFFICACY E. SOCIAL LEARNING AND SOCIAL COGNITIVE THEORY Sample Footer Text 1/11/23 1  POLITICAL DETERMINANTS OF HEALTH 1. POLITICS The term “politics” comes from the Greek word “polis”, meaning city/state. To Aristotle is attributed the famous quote “Man is by nature a political animal”. By this he means that the essence of social existence is politics and that two or more people interacting with one another are invariably involved in political relationship.  POLITICS Ø Webster defines politics as “the science and art of political government”. ØTheodorson and Theodorson (Modern Dictionary of Sociology, 1969) defines it as “The process of creating public policy through influencing or controlling the source of power and authority”.  POLITICS POLITICS is viewed as “The human activity concerned with making and implementing decision vested with the authority of the society for which the decisions are made”. POLITICAL DETERMINANTS OF HEALTH 2. INFLUENCE It has been defined as the “capacity of a political actor to affect the behavior of others in a manner favored by the actor.”  POLITICAL DETERMINANTS OF HEALTH 3. AUTHORITY It may be defined as the ”influence derived from willing acceptance by others of one’s right to make rules or issue commands and expect compliance”. POLITICAL DETERMINANTS OF HEALTH 4. POWER It has been defined as “the capacity to affect behavior of other in some desired way”.  POWER üPERSUASION - influence without promise of reward or threat of punishment by the power wielder üMILD PRESSURE OR BARGAINING – promise of reward, threat of punishment üEXTREME PRESSURE of force, or coercion – threat or severe punishment of deprivation POLITICS HAS MANY FACES qDecision-making qValue-allocating qSocial steering qPower seeking qInterest-competing qInfluence-exerting activities  IMPORTANCE OF POLITICS IN HEALTH (Easton’s model of peoples’ participation)  ECONOMIC DETERMINANTS OF HEALTH 1. ECONOMICS Defined in its generic term “the process of provisioning a society with the goods and services it requires to meet the needs of members of society”. -by Susser, Watson and Hopper  ”how men and society utilize scarce or limited productive resources, ECONOMICS to produce various commodities and distribute them to various members of the society for their consumption.” -by Paul Samuelson  MACRO-ECONOMIC ISSUES MACROECONOMIC POLICIES AFFECT HEALTH THROUGH: üLevel of government expenditures on health services and on other services üDistribution of national income between various groups üChange the income level of household  Level of Development Indicators Developed Economics Underdeveloped § Availability of health information § Impoverished information system § Food sufficiency § Food insufficiency § Lower birth rates § Higher birth rates § Lower IMR § Higher IMR § Causes of death unknown § Causes of death acute and § Longer life expectancy chronic § Shorter life span MICRO-ECONOMIC ISSUES AND HEALTH A. INCOME/SOCIAL CLASS a. Lower-status job are more hazardous, mentally and physically taxing a. Poor families have inferior diets due to eating habits which in turn may be traced to limited income  A. INCOME/SOCIAL CLASS c. Low-income neighborhoods are commonly plague by pollution (chemical, dust, water and noise) crime and accidents d. The urban poor who are uprooted from their provincial roots are prone to social isolation  A. INCOME/SOCIAL CLASS e. The unemployment suffer from the emotional, physiological and psychological consequences of unemployment f. The poor have inadequate access to medical care  A. INCOME/SOCIAL CLASS g. Payment for health-related expenditures may not be a priority in a poor family’s budget. h. Poor worker’s health and nutrition contribute to the slow pace of work or the level or productivity.  B. ECONOMICS IN HEALTH CARE 1. Cost-cutting schemes and competition only shift the burdens of payment on the poor because of limited resources that may no longer afford health care. 2. Adoption of corporate techniques like contracting out personal health services may lead to greater alienation among providers of health services. B. ECONOMICS IN HEALTH CARE 3. Low wages and other benefits for health workers cause demoralization and affect the quality of health and has pushed many of them to seek greener pasture. 4. Graft and corruption has drained scarce health resources for personal gains.  SOCIALIZING AGENTS § SOCIALIZATION: Is the way in which culture becomes a part of the individual. It is the process by which individual internalize many of the socially approved values, attitudes, beliefs and behavior patterns of their culture AGENTS OF SOCIALIZATION 1. Family “A socially sanctioned, relatively permanent grouping of people who are united by blood, marriage or adoption which generally live together and cooperate economically” –Hebding, 1992 2. School -Major socializing institution of any society 3. Religion/Church ”system of beliefs and practices relating to sacred things. Sacred beliefs and practices unify people in a moral community” SOCIO-CULTURAL CHANGE PROCESS “ The process by which an alteration takes place in the structure and function of the social system” – Roger and Shalmaker, 1971 ELEMENTS OF CHANGE: § INNOVATION: an idea, a set of behavior, a new technology, a project, program introduce to effect a change § TARGET OF CHANGE: a group of people, a segment of the community or the entire community itself § CHANGE AGENT: a person or group of people introducing the innovation § STRATEGIES OF CHANGE: deliberate actions, set of activities or processes designed to effect the target change BARRIERS TO CHANGE I. CULTURAL BARRIERS TO CHANGE a. Tradition b. Fatalism c. Cultural-Ethnocentrism d. Pride and Dignity e. Norms of Modesty f. Unforeseen consequences of planned change g. Relative value II. SOCIAL BARRIERS a. Mutual obligations within the framework of family, fictive kin and friendship patterns b. Small group dynamics c. Public opinion d. Factionalism e. Vested interest f. Loci of authority within the family g. Loci of authority in the political structure III. PSYCHOLOGICAL BARRIERS a. Perception of the problem b. Perception of the role of the government c. Perception of gifts d. Differential role perception e. Differing perception on purpose III. LANGUAGE DIFFICULTIES § Demonstration Danger § Motor Patterns III. LANGUAGE DIFFICULTIES § Demonstration Danger § Motor Patterns STIMULANTS TO CHANGE § A recognition of a need for change and perception that this can be achieved § Availability of information on how the need can be met § Access to affordable materials and services required for the goal to be achieved § The society must not impose excessive negative sanctions for people to adopt the change MOTIVATION TO CHANGE a. Desire for prestige b. Desire for economic gain c. Competitive situation d. Obligation of friendship e. Play motivation f. Religious Appeal MODELS/STRATEGIES OF CHANGE I. Herbert Kelman’s Three Processes of Social Influence a. Compliance b. Identification c. Internalization MODELS/STRATEGIES OF CHANGE II. Roger’s Model of Change § Awareness § Interest § Trial § Evaluation § Adoption MODELS/STRATEGIES OF CHANGE III. Chin and Benne’s General Strategies for effecting Social Change a. Empirical-rational strategies b. Normative-reeducative strategies c. Power-coercive strategies  Everything God touches turns into a miracle, so never underestimate what He can do through your life J SUSTAINABLE DEVELOPMENT GOALS PHILIPPINE HEALTH SITUATION PHILIPPINE HEALTH AGENDA HISTORY June 2012 § United Nations Conference on Sustainable Development (Rio+20) June 1992 § Rio de Janeiro, Brazil § Earth Summit § “The Future We Want” § Rio de Janeiro, Brazil § >178 countries § Agenda 21 2013 § 30-member Open Working Group § proposal on the SDGs September 2000 § Millennium Summit § UN Headquarters in New York January 2015 § Millennium Development Goals § General Assembly began the negotiation (MDG) process on the post-15 development agenda 2002 § The Johannesburg Declaration on September 2015 Sustainable Development and the Plan of § UN Sustainable Development Summit Implementation § Adoption of the 2030 Agenda for Sustainable § World Summit on Sustainable Development Development with 17 SDGs at its core § South Africa MILLENNIUM DEVELOPMENT GOALS § Are Eight (8) goals that all 191 UN member states have agreed to try to achieve by year 2015 § Some achievements: üGlobally. The HIV, TB and malaria epidemics were turned around üChild mortality decreased by 53%- a great achievement, but fell short of the 67% target üDeaths related to pregnancy and childbirth )Maternal mortality) fell more than 40% but short of the 75% target üBetween 1990 and 2015, the global prevalence of underweight among children aged less than 5 declined from 25% to 14%  SUSTAINABLE DEVELOPMENT GOALS § September 2015: more than 150 world leaders gathered at the United Nations Headquarters to formally adopt the new post-2015 development agenda- a global plan to action for the next 15 years (2030) § 17 Sustainable Development Goals (SDGs) and 169 targets § SDGs seek to build on the MDGs and complete what these did not achieve, particularly on improving equity to meet needs of women. Children and poorest, most disadvantaged people § Aim to tackle emerging challenges including growing impact of non-communicable diseases, like diabetes and heart disease, and changing social and environmental determinants that affect health, such as increasing urbanization, pollution and climate change 1 End poverty in all its forms everywhere 2 End hunger, achieve food security and improved nutrition and promote sustainable agriculture 3 Ensure healthy lives and promote well-being for all at all ages 4 Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all 5 Achieve gender equality and empower all women and girls 6 Ensure availability and sustainable management of water and sanitation for all 7 Ensure access to affordable, reliable, sustainable and modern energy for all 8 Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all 9 Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation 10 Reduce inequality within and among countries 11 Make cities and human settlements inclusive, safe, resilient and sustainable 12 Ensure sustainable consumption and production patterns 13 Take urgent action to combat climate change and its impacts 14 Conserve and sustainably use the oceans, seas and marine resources for sustainable development 15 Protect, restore and promote sustainable use of terrestrial ecosystems, sustainable manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity 16 Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels 17 Strengthen the means of implementation and revitalize the global partnership for sustainable development  PHILIPPINE HEALTH SITUATION § The health system remains fragmented. § Health insurance now covers 92% of the population § Maternal and child health services have improved: ü more children living beyond infancy ü Higher number of women delivering at health facilities ü more births being attended by professional service providers than ever before § Access to and provision of preventive, diagnostic and treatment services for communicable diseases have improved, while there are several initiatives to reduce illness and death due to non-communicable diseases (NCDs). WHO/CCU/18.02/Philippines  PHILIPPINE HEALTH SITUATION § Deep inequities persist between regions, rich and the poor, and different population groups § Many Filipinos continue to die or suffer from illnesses that have well-proven, cost- effective interventions, such as tuberculosis, HIV and dengue, or diseases affecting mothers and children. § Many people lack sufficient knowledge to make informed decisions about their own health. § Rapid economic development, urbanization, escalating climate change, and widening exposure to diseases and pathogens in an increasingly global world increase the risks associated with disasters, environmental threats, and emerging and re-emerging infections. WHO/CCU/18.02/Philippines Society and Culture  SOCIO- PHYSICAL CULTURAL DISEASE BIOLOGIC SOCIETY: § NOT synonymous with culture § “any community of individuals drawn together by a common bond of nearness and interaction, that is, a group of people who act together in general for achievement of certain common goals” –John Hanlon SOCIETY: § “a large number of people who form a relatively organized, self-sufficient, enduring body.” –Hebding & Glick § SOCIETY: Refers to the peopl § CULTURE: Patterns and ways of group life SOCIAL STRUCTURE § Pattern of interaction or networks of relationship found within the society § Key elements: ü Role: pattern of behavior; role expectancy vs role performance ü Status: position ü Institutions  CULTURE: § “the complex of material and spiritual goods created by the activity of people in the process of its social development. Material goods, in particular the forces of production, belong to the realm of material culture, e.g., tools and machinery, roads and bridges. Spiritual goods, belong to the realm of non-material culture such as societyʼs political institutions, social institutions, productions of sciences and technology, laws, art and customs, philosophy, medicine etc.”  CULTURE: § “a complex whole which includes knowledge, beliefs, art, morals, laws, custom and any other capabilities and habits acquired by man as a member of society. It is the entire social heritage an individual receives from the group.” –EB Taylor Characteristics of culture: 1. It is learned and not instinctive 2. It is universal 3. It is social 4. It is integrated 5. It is dynamic and adaptive Components of culture: § Material: tools, furniture, clothing computer system § Non-material: norms, values, beliefs and language Non-material Culture: § Norms: rules and standards of expected behavior in given situation. ü Folkways: simple, everyday customs of a group that represent the usual ways of behaving. ü Mores: moral judgement of the group as to what is right or wrong Non-material Culture: § Values: personʼs ideas about worth and desirability ü Social Values: those things, in a given society which are though to be desirable because they are believed to contribute to the good life and the general welfare Non-material Culture: § Beliefs: ideas that people hold about the universe or any part of the reality surrounding them. § Language symbols are the foundation of culture. Social Institution § An organized, complex patterns of behavior in which a number of persons participate in order to further important group interest. ü Personnel ü Equipment ü Organization Why do we study society and culture in Public Health? Socio-cultural Analysis § The study of concrete or objective conditions-events, problems, issues-within the context of the dynamic and interrelated, economic, political and cultural dimensions of society. Socio-cultural Analysis 1. Sensing or observing problem 2. Asking why 3. Constructing theory 4. Connecting theory to observations by logical steps 5. Further testing the theory by predicting logically consistent observations. The Scientific Perspectives 1. Holisms 2. Dynamism 3. Conflict Socio-Cultural Determinants of Health q It influences the way health, disease, illness are defined by society q It influences the epidemiology of diseases q Affects health and health behaviors e.g., perception and presentation of symptoms, reaction to pain, sick role, lay conferral q Social determinants like social roles, social structure, social network also influence the susceptibility of certain groups to disease. 1. A well-defined concept of health can be best promoted by activities other than medical care; 2. Knowledge of health can further the knowledge of man and the role of health among other aspects of man; 3. A concept oh health can identify the professional focus of activity for various health related disciplines; and 4. It can provide a basis for comparative cost benefit studies of disease care versus health promotion.  HEALTH “A state of complete physical, mental, social well-being and is not merely the absence of disease or infirmity” –by World Health Organization (WHO)  HEALTH 1. WELL-WORKINGNESS – identifies the physical ability of components of the body to function 2. WHOLENESS – identifies the simultaneous functioning of the different components of the ability to self-heal. -by Kass  HEALTH Ability of the person to adapt to continuing physical, social and personal change as the primary element of a concept of health. -by Dubos, Candus and Thrall  HEALTH A state in which the organism is “functioning effectively, fulfilling needs, successfully responding to the requirements or demands of the environment, whether external or internal and pursuing its biological destiny, including growth and reproduction.” -by Engel  DISEASE Western medical paradigm defines diseases as “that which is malfunctioning or maladapatation of biologic and psychophysiologic process in the individual.”  ILLNESS § “the threat of incapacity of the person to fulfill personal expectations or perform social role tasks” § Culturally, illness is defined as “personal, interpersonal and cultural responses to disease or discomfort.”  Three (3) Structural Domains of Health Care 1. Professional – utilizes biomedicine and which is primarily interested in the recognition and treatment of disease (curing), and generating technological interventions 2. Popular – family and social networks 3. Folk (non-professional healers) or the traditional  Cultural Definition of Disease Causation q Personalistic medical system: Sickness is a result of the “active purposeful intervention of an agent, who may be human ( a witch or sorcerer), non-human (a ghost, an ancestor and evil spirit) or superhuman (a deity or other powerful being)”  Cultural Definition of Disease Causation q Naturalistic Medical System Sickness as a result of “natural forces or condition such as cold, heat, winds, dampness and above all, from upset in balance of the basic body elements.”  Influence of Culture on Perception of Symptoms § Cultural diversity results to different perception of symptoms in societies. ü The prevalence of the sign, and ü Congruence of the sign with dominant or major value orientations.  Lay Conferral System An informal community-based network of individuals, most of whom are not medical professionals whose function is to provide medically relevant information in the form of diagnoses, treatment, and professional referral.  Reason for Extensive practice of Lay Referral: 1. When an objective basis for defining reality is not available, people will rely on social definition of reality produced by mutually shared opinion. 2. High cost of relying on expert information 3. A desire to avoid or minimize responsibility for important decisions 4. A sense of helplessness and passivity imposed by physical impairment. Cultural Influence on Presentation of Symptoms In most social situations, people would want to present themselves in a favorable light, that is a way that is defined to be “acceptable and good” by society “SOCIAL DESIRABILITY” Cultural Influence on Reaction to Pain Pain behavior or reaction may be categorized in two: 1. Private pain 2. Public pain  Cultural Influence on the Epidemiology of Diseases 1. DIETARY PATTERNS Culture dictates how food is prepared, stored, and preserved. 1. DIETARY PATTERNS q The men of Karamajong tribe of East Africa includes a daily pint of blood drawn from the jugular vein of their cattle in their diet. q Laryngeal cancer in Shanghai, China, it was established thar high intake of garlic, fruits (particularly oranges and tangerines) and certain dark green/yellow vegetables protected the Chinese (both sexes) against getting laryngeal cancer.  Cultural Influence on the Epidemiology of Diseases 2. PREGNANCY AND CHILDBIRTH PRACTICES Predisposes or protects a group to certain diseases include changes in diet, dress or behavior during pregnancy; the techniques used in childbirth and the nature of birth attendants; the position of the mother during the labour; care of the umbilical cord, etc.  Cultural Influence on the Epidemiology of Diseases 3. CONTRACEPTIVE PATTERN The spread of sexually transmitted diseases may also be influenced by society’s attitude towards the use of condoms. Societal’s acceptance of condom use can help reduce of STDs, HIV, as well as Hepatitis B. Cultural Influence on the Epidemiology of Diseases 4. HOUSING ARRANGEMENT This cultural variable includes construction, internal division of living space, the number of occupants per room/house or hut, and how the living is being heated or cooled during the different seasons of the year.  Cultural Influence on the Epidemiology of Diseases 5. MARRIAGE AND KINSHIP PATTERNS § Polygamy vs monogamy § Enogamous vs exogamous § Levirate vs sororate  Cultural Influence on the Epidemiology of Diseases 6. CHILD-REARING PRACTICES § Certain child rearing practices which in interaction with heredity affect the growth and development of children of certain societies. § Feeding of infants also have widespread differences a cross cultures. § Different cultures have different emotional climate of child rearing e.i. some may be permissive while others may be authoritative.  Cultural Influence on the Epidemiology of Diseases 7. BODY IMAGE ALTERATION Certain culture approve body mutilations or alterations, such as male and female circumcision, tattooing, ear and lip piercing, foot binding, different forms of cosmetic surgery.  Cultural Influence on the Epidemiology of Diseases 8. ACCULTURATION Assimilation to a different culture may impact both social and psychological well-being.  SOCIAL DETERMINANTS OF HEALTH 1. SOCIAL STRUCTURE OF HEALTH § lower classes have higher mortality, morbidity, and disability rates. § Race is strongly correlated with social class. § Antonovsky established that those in the lower classes have lower life expectancy and higher death rates from all causes of death, and that this higher rate has been observed since the 12th century.  SOCIAL DETERMINANTS OF HEALTH 1.1 ADVERSE ENVIRONMENTAL CONDITIONS § Lower social groups always encounter adverse environmental conditions both at home and at the workplace § Lower status jobs tends be more hazardous, mental and physically taxing. § Poor neighborhood § Substandard housing  SOCIAL DETERMINANTS OF HEALTH 1.2. PSYCHOLOGICAL STRESS AND SOCIAL ISOLATION § Stigmatization § Humiliation § Generalized susceptibility to disease may be influenced not only by the impact of various forms of life changes and life stress, but also by the differences in the way people cope with such stress.  SOCIAL DETERMINANTS OF HEALTH 1.3 INADEQUATE MEDICAL CARE § considered as an important characteristic of the disadvantage that make them more susceptible to diseases § The poor tend to receive less preventive services like dental care, pap smear, prenatal care etc SOCIAL DETERMINANTS OF HEALTH 2. SOCIAL NETWORK “As a specific set linkages among a defined set of persons with the additional property that the characteristics of these linkages as a whole be used to interpret the social behavior of the person involved.”  SOCIAL DETERMINANTS OF HEALTH 2. SOCIAL NETWORK Affective support – provision of moral support, caring and love Instrumental support – the provision of tangible aid and services Cognitive support– provision of access to information, new knowledge, advice and feedback Maintenance of social identity – validation of a shared world view Social outreach – access to social contacts and social roles  SOCIAL DETERMINANTS OF HEALTH 2. SOCIAL NETWORK Prevention of stressful situation Alteration of the stressful situation Changing the meaning of the situation Management of the symptoms of stress  SOCIAL DETERMINANTS OF HEALTH 3. SOCIAL ROLES A role is a pattern of behavior that is expected of the person who occupies a specific status in one’s society. It provides a way for the integration of members and society  SOCIAL DETERMINANTS OF HEALTH a. Sick role – a kind of role assumed by a person when that person defines himself /herself to be ”sick”. b. Sick-role behavior – any activity undertaken by those who consider themselves ill, for the purpose of getting well, like patient compliance.  SOCIAL DETERMINANTS OF HEALTH 3.1 SOCIAL CONTROL Is a mechanism by which social relationships affects health behaviors that affect health outcomes.  SOCIAL DETERMINANTS OF HEALTH 3.1 SOCIAL CONTROL 2 PRIMARY WAYS a. Via Internal Influence – through the internalization of norms for conventional behaviors b. Via External Influence – usually in the form of sanctions for behavior defined as unconventional or deviant.  SOCIAL DETERMINANTS OF HEALTH 4. GENDER ROLE Physiologic differences between the sexes together with associated social roles distinctions create a lot of differences in illness and response to illness between males and females The 5-Star Physician § Healer § Counselor § Researcher/Life Long Learner § Teacher/Educator § Manager/Social Advocate  AS A HEALER: 1. Re c o g n i z e a n d d i a g n o s e c l i n i c a l c a s e s a c c u ra t e l y a n d e f f i c i e n t l y. 2. C l a s s i fy a n d p r i o r i t i z e c l i n i c a l c a s e s. 3. C h o o s e a p p ro p r i a t e a n d c o s t e f f e c t i v e l a b o ra t o r y / a n c i l l a r y p ro c e d u re s. 4.Competently manage all primary cases, 85% of secondary cases and given initial management to all tertiary c a re c a s e s. 5. P ro v i d e c o m p re h e n s i v e c a re : p ro m o t i v e , p re v e n t i v e , c u ra t i v e a n d re h a b i l i t a t i v e c a re t o p a t i e n t a n d h i s fa m i l y. 6. P ro v i d e c o n t i n u i n g c a re – f ro m w o m b t o t o m b. 7. Re f e r p ro m p t l y a n d p ro p e r l y a n d c o o rd i n a t e s w i t h o t h e r s p e c i a l i s t a n d a l l i e d m e d i c a l p ro f e s s i o n s. 8.Can effectively work in a health team. 9. C a n m a n a g e a n d m a i n t a i n a g o o d c l i n i c a l p ra c t i c e.  AS A COUNSELOR: 1.Recognize that the illness is both a biomedical and a psychosocial phenomenon and therefore its management must reflect a synthesis of the two. 2.Diagnose the degree of impact of this illness to the patient and his family. 3.Respond with compassion and empathy to the patient and his family. 4.Do primary care counseling in clinical problems especially so if the illness deals with psycho- emotional problems, manifesting in physical form. 5.Conduct family meeting to deal with impact of illness to the family. 6.Do formal counseling for Category I psychiatric conditions. 7.Do referral counseling to other mental health professionals. 8.Be guided by bioethical principles in all his interventions.  AS A RESEARCHER AND LIFELONG LEARNER: 1.Apply the principles of EBM in his clinical practice. 2.Critically appraise medical journals and literature. 3.Conduct an actual research. 4.Apply quality assurance in his everyday clinical practice.  AS A TEACHER/EDUCATOR: 1.As s es and interpret th e tra in ee’s n eeds. 2.O rien t th e tra in ees ’ n eeds for th e learning experience. 3.Pla n appropriate learnin g experiences for th e learner. 4.Conduct tea ch in g rou n ds in th e h os pita l and clin ic. 5.B e a good role m odel to th e tra in ees. 6.Conduct h ea lth education activ ities to patients and th eir fa m ilies 7.Conduct h ea lth education to th e com m u n ity. 8.Prov ide effective educational m eth od to give th e audience a work in g k nowledge about h is illnes s. 9.U tilize every opportu n ity to tea ch th e patient and h is fa m ily about th e dis eas e s y ndrom e. 1 0.Apply th e principles of h ea lth education to ta rget groups in th e fa m ily and com m u n ity s etting  AS MANAGER: 1.Demonstrate leadership qualities. 2.Manage his clinic or hospital. 3.Prioritize health issues identified. 4.Implement solutions to health issues identified. 5.Plan, organize, implement, monitor and evaluate health programs in the community.