Primary care is the most important place to be to prevent disease, nurse practitioner (NP) Lesley Salem told delegates at the recent Australian Primary Health Care Nurses Association (APNA) conference held in Brisbane.

“It lies with us in primary care. Everything you get in primary health is fixable. Doing a urinalysis is like a window to the world. We do not see it as mundane.”

Ms Salem, a NP of 16 years, has worked for the past eight years in primary healthcare in a number of community clinics across Australia. Her current role is in

Doomadgee Lower Gulf, far north Queensland where the life expectancy is 55 years.

Health promotion is key to improving health outcomes, but there are several take home messages to get it right, argues Ms Salem.

Language and medium are particularly important, she says. “Simple messages. Hyperbolic messages are useless. They are future oriented.”

Hyperbolic messages include that eating too much sugar will lead to heart disease.

“Aboriginal communities live in the past and present. Those who live in lower socioeconomic areas live in the now. Future oriented messages are not a priority. The rewards need to be for now,” says Ms Salem.

Rewards in health promotion may include a free cooking class that promotes health eating.

It’s also important to take care not to take the moral high ground or use a ‘subservient tone’, says Ms Salem. “It’s often seen as ‘stuffing messages’ down their throats. Don’t overkill your message. It’s for us to inform. Patients are architects of their own future.”

We live in a culture that discourages empathy, says Ms Salem. “We have to look at it differently. Have a social justice view. Patients have chosen this and empathy belongs to everyone.”

A bottom up approach to health promotion leads to better outcomes, argues Ms Salem. This includes planned, organised, structured activities over time to a targeted population.

“What are your goals? Is it that there are no school absences due to skin sores? Is it malnourishment? Is it that all children will be immunised? Your data drives what you need.”

“Offer school screening. What time do we need to open? Do we need to promote a policy on immunisation?”

To optimise success also be aware of possible pitfalls, says Ms Salem. This includes that more public health funding does not necessarily always result in improved health outcomes. Some interventions may have unanticipated or even untoward effects.

“There may even be some harm out of some health activities. Posters to promote access to treatment for sexual health caused shame in an Aboriginal community. Be very careful of the fallout and perceived effects.”

Health promotion is both education and environmental action, says Ms Salem. “It has to be sustainable and organised.”

“Know your own prejudices and assumptions. Make sure the message is clear.

Patients forget words but they remember how you make them feel.”