1 & 2 Flashcards
Upstream
- Policy and Programs (corporations and other businesses, government agencies, schools)
- Social Inequities (class, race/ethnicity, gender, immigration status, sexual orientation)
- Government, schools, CBOs
Midstream
- Physical Environment (housing, land use, transportation, residential segregation)
- Behavior (smoking, nutrition, physical activities, violence)
- Parks and housing
Downstream
- Disease and Injury (infections disease, chronic disease, injury)
- Mortality (infant mortality, life expectancy)
- Hospitals and clinics
Examples of Upstream Interventions for Physical Inactivity
Healthy Public Policy
- Tax incentives for physically active people
- Change environment to facilitate activity
- Insurance coverage for athletic facility membership
Examples of Midstream Interventions for Physical Inactivity
Preventative
- Target communities to provide exercise facilities for seniors
- Training clinicians to do activity counseling
- Media campaigns to change norms re: Exercis
- Exercise training studies (almost downstream..)
Examples of Downstream Interventions for Physical Inactivity
Curative
- Clinical Exercise Interventions
- Patient Education
Liberal Paternalism
- Public institutions (i.e. gov) might nudge people in specific directions without eliminating freedom of choice to improve their lives
- possible and legitimate for private and public institutions to affect behavior while also respecting freedom of choice
- it tries to influence choices in a way that will make choosers better off, as judged by themselves
- people should be free to opt out of specified arrangements if they choose to do so
- Thaler & Sunstein, 2003
- Health systems can help nudge people toward healthier behaviors
- Default option is the healthiest but it isn’t the only option/people have the choice to opt out (Fluoride in public water)
“Choice Architecture”
Menu labeling example
- Premise: individuals will make rational decisions based on nutrition info
- Patterns of behavior that may play a role in poor nutrition choices: tendency to stay with the usual, motivated by actions with immediate benefit
- “Choice architecture” refers to the framing or presentation of choice options
- Health systems can help nudge people towards healthier behaviors
Selective Primary Health Care
Focus on single disease interventions
Comprehensive Primary Health Care
Focus on prevention, provision of basic health services and addressing the overall disease burden in low-income countries
Improving Health Systems (General)
- Eliminate multiple vertical programs to more horizontal approaches
- Small reforms > big-bang reforms
- End goal of reform = improved health outcomes
- Performance-based financing possible if monitoring is adequate
- Capacity strengthening at all levels
- Health systems are based on theory, but inputs and outputs must be testable
Behind Doing the Behavior Associated with Improved Health Outcomes
Attitudes and beliefs about the behavior, perceived social norms about the behavior, perceived self-efficacy to (avoid) the behavior -> intention toward the behavior -> doing the behavior
National Health Model
(Beveridge): Universal health care coverage of all citizens by a central government; financed through general tax revenue; providers can be private or controlled by government.
Social Insurance Model
(Bismarck): Compulsory coverage funded by employer, individual and private insurance funds; production is controlled/owned by governments or private organizations; financed through employment taxes
Private Insurance Model
Employment-based of individual purchase of private health insurance; financed by individual and employer contributions; service delivery owned/managed by private organizations
