Milo's Framework Modern Healthcare Is so Complex,

Milo's Framework Modern healthcare is so complex, so rife with new technologies, new procedures, and new expectations from stakeholders, that the contemporary nurse and physician need all the tools possible to pull for varied situations. Milo's framework is a set of propositions that help frame strategies to improve health inducing behaviors by enhancing personal choice-making while still in the context of societal and cultural expectations. Milo posits that the health status of populations at any given time is essentially the result of individual choice.

However, the choices that individuals have tend to be limited by what the individual perceives to be options, depending on their personal and cultural/societal background, not necessarily the choices that are really available. In fact, Milo says, "Most people, most of the time will make the easiest choices, i.e., will do the things, develop the patterns or life-styles, which seem to cost them less and/or from which they will gain more of what they value in tangible and/or intangible terms" (Milo, 1976, p. 435).

And how is it that the individual learns about options? Simple, they are set by public and private organizations, both formal and informal. The more powerful the organization, the more the individual believes it establishes the options available. This also means that many health professionals tend to expect more out of the consumer in terms of educational level, previous knowledge, and even the ability to understand what can be a complex set of variables dealing with personal health choices.

Milo gives a superior example on the difference in the health care world of "knowing" (e.g. clinical knowledge) and "doing" -- what actually happens in the real world. If knowing was the key to both change and actuality, then the healthcare world would be non-smoking, slim, exercisers, temperate eaters, low consumers of alcohol, a low-sucrose diet with only smart carbs, and a lean and agile system (Milo, p. 435).

Since this is not the case, the proposed model may help increase the understanding of the paradigms of choice available to the average consumer. Change can occur at many levels of society -- from the micro to the macro. Some change happens because it is mandated; some happens based on a unique idea that then becomes disseminated outward and upward.

Milo's model is important because it gives nurses the opportunity to move the bar upward by teaching about available health choices and assisting patients to become at least partially responsible for their own health functions. This is a local example in which the nurse can partner with public health officials, the schools, and the local media to call attention to problems like obesity, type-II diabetes, and the effects of smoking on health. Preventative measures are often difficult because of socioeconomic realities, but some intervention is better than none.

At the State or National level, though, National level policy is probably the most effective in terms of changing health belief and patters for most Americans. At the national level, for instance, the socioeconomic realities of the nation's poor and underinsured must be considered when helping make health decisions. For example, in some neighborhoods, there are no grocery stores that carry fresh fruit and vegetables based on the presumption that there is no market.