title: Implications of health as 'the ability to adapt and self-manage' for public health policy: a qualitative study.
abstract: To explore the implications for public health policy of a new conceptualisation of health as 'The ability to adapt and to self-manage, in the face of social, physical and emotional challenges'.
  
  
  
  Secondary qualitative data analysis of 28 focus group interviews, with 277 participants involved in public health and healthcare, on the future of the Dutch healthcare system. WHO's essential public health operations (EPHOs) were used as a framework for analysis.
  
  
  
  Starting from the new concept of health, participants perceived health as an individual asset, requiring an active approach in the Dutch population towards health promotion and adaptation to a healthy lifestyle. Sectors outside healthcare and public health were considered as resources to support individual lifestyle improvement. Integrating prevention and health promotion in healthcare is also expected to stimulate individuals to comply with a healthy lifestyle. Attention should be paid to persons less skilled to self-manage their own health, as this group may require a healthcare safety net. The relationship between individual and population health was not addressed, resulting in little focus on collective prevention to achieve health.
  
  
  
  The new concept of health as a basis for changes in the healthcare system offers opportunities to create a health-promoting societal context. However, inequalities in health within the general population may increase when using the new concept as an operationalisation of health. For public health, the main challenge is to maintain focus on the collective socioeconomic and environmental determinants of health and disease and, thereby, preserve collective prevention.
authors.affiliation: Department of Public Health, Academic Medical Centre/University of Amsterdam, PO box 22660 1100 DD Amsterdam, The Netherlands m.jambroes@amc.nl.
authors.forename: Marielle
authors.initials: M
authors.lastname: Jambroes
authors.affiliation: Verwey-Jonker Institute, Kromme Nieuwegracht 6, 3512 HG Utrecht, The Netherlands.
authors.forename: Trudi
authors.initials: T
authors.lastname: Nederland
authors.affiliation: The Dutch Healthcare Authority, PO box 3017, 3502 GA Utrecht, the Netherlands.
authors.forename: Marian
authors.initials: M
authors.lastname: Kaljouw
authors.affiliation: National Health Care Institute, dept. Healthcare professions and Health education, PO box 320 1110 AH Diemen, The Netherlands.
authors.forename: Katja
authors.initials: K
authors.lastname: van Vliet
authors.affiliation: Department of Public Health, Academic Medical Centre/University of Amsterdam, PO box 22660 1100 DD Amsterdam, The Netherlands.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Essink-Bot
authors.affiliation: Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. box 616 6200 MD Maastricht, The Netherlands.
authors.forename: Dirk
authors.initials: D
authors.lastname: Ruwaard
mesh_terms: D000223:Adaptation, Psychological; D006291:Health Policy; D006304:Health Status; D006801:Humans; D011634:Public Health / Q000379:methods*; D036301:Qualitative Research; D000073278:Self-Management / Q000379:methods*