health policy Flashcards
health policy:
-Decisions taken by governments (Departments/Ministries of Health) about — for the — and the — for achieving these goals
-A framework for actions undertaken by – and — who finance and deliver health services (who together with government form the health system), that aims to — and — population health
- Health policy expressed in — , — , – and — that aim to – and – the health of the population
strategic goals
health sectors and means
institutions and organisation
maintain and improve
norms practices regulations and laws
Health Policy = the process whereby our understanding of how to keep the population healthy gets translated into—
-If doctors want to have an impact on the health of the population, they need to understand:
How — is (or should be) made and implemented
AND
How some— in society can promote ill health and disease
effective action
health policy and interest groups
factors influence health policy:
1- — in health policy uses the sciences of:
—: – what is the population health need?
—: - what interventions are effective and efficient?
2- — in which health policy occurs:
— factors - economic, demography, technology
— factors - societal values, gender roles, religious beliefs
3- —
Health policy is political. How power is distributed is important (e.g. pluralist vs elitist). Interest groups (commercial organisations, pressure groups and individuals) can use their influence or resources to determine what health policies get made and implemented – and can block new health policies.
evidence
epidemiology
economics
context
structural
sociocultural
power
—- (activities aimed at changing behaviour)
— (actions on the part of responsible authorities that enable or support interventions)
Example: intervention incentivising primary care organisations to prioritise public health interventions could be implemented through different policies such as fiscal measures/ producing guidelines / legislation.
An example of such an intervention is the HSE Chronic Disease Management Programme
interventions
policies
policy tools and definitions;
1- —- as communication/marketing : Using print, electronic, telephonic or broadcast media
2- — : Creating documents that recommend or mandate practice. This includes all changes to service provision
3- — : Using the tax system to reduce or increase the financial cost
4- — : Establishing rules or principles of behaviour or practice
5- — : Making or changing laws
6- — : Designing and/or controlling the physical or social environment
7- — ; Delivering a service
information
guildnines
fiscal
regulation
legislation
environmental/social planning
service provision
- —-: is a process of identifying health objectives and choosing among alternative means of achieving them
steps:
Steps:
1. — the burden of a disease or health problem
2. — the causes that can be addressed
3. — the effectiveness of proposed interventions (policy — )
4. determine their —
5. implement — (policy — )
6. – and –
7. measure — in controlling or reducing disease
health service planning
assess
identify
effectivness
choices
efficiency
intervention
actions
monitor and evaluate
progress
- Most planning models assume a — , – set of steps – a — process that assumes that good evidence (on effectiveness and efficiency – epidemiology and economics) will determine health policy and practice – as illustrated in the Planning Cycle.
- . the reality is that public health action is incremental, opportunistic, and reversals or changes of direction occur constantly. The interventions and programmes that get implemented are partly a result of the broader —
rational
sequential
rational prcess
political climate
Ireland health policy process:
Slaintecare 2017: a ten year plan to radically transform Irish healthcare
Cross party consensus
Ten year strategy for health care and health policy in Ireland
Vision of universal single tier health and social care system; equitable access to services based on need.
Strategy includes plan for:
Comprehensive range of primary, acute and social care services at no or low cost
Majority of care in primary or community settings
Regional Health Areas
A – disease is a long-term health condition that needs ongoing treatment and management. Account for the majority of GP visits and hospitals bed days in Ireland.
Involve — and — health need which require ongoing, coordinated care delivered in different settings at different times.
Slaintecare proposed a new approach:
Over 5.1m population in 2022 (3.6m in 1996)
High life expectancy & healthy life expectancy
Increasingly diverse and older population
Overall health outcomes compare favourably BUT inequalities in access and health outcomes persist
Increasing levels of chronic disease & recent COVID-19 challenge
Leading causes of death include heart disease, stroke, lung cancer and COPD.
Leading causes of death and disability include heart disease, back pain, respiratory disease, depression and anxiety.
Significant improvements reducing tobacco/alcohol/high cholesterol/drug use
Continued focus needed on tobacco/alcohol/obesity/physical inactivity etc.
chronic
complex and multi-faceted
COPD : ireland prevelance
“a common — and – disease that is characterised by persistent — symptoms and — limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases”.
<6% told they have COPD; >70 years: prevalence ~20% men, ~15% women
Many may be undiagnosed or diagnosed at a late stage when interventions less effective and more expensive
Global Burden of Lung Disease prevalence of moderate to severe COPD in Europe of 10%.
Given mortality and high hospitalisations rate (highest among OECD) in Ireland, prevalence may well be as high as 10%
Prevalence increases as deprivation increases
consequences - burden of disease:
Considerable impact on quality of life
Premature death
Impact on carer and family/friends/health services/society
Global Burden of Disease ranked COPD 3rd for leading causes of death (in 2019)
COPD the 4th highest cause of Disability Adjusted Life Years in Ireland (in 2010)
Frequent hospitalisations for those with severe disease; 90%+ of those hospitalised have comorbidities
preventable and treatable
respiratory
airflow
risk factors:
1- — factors:
age
genes
gender
growth , development of lung
oxidative stress
respiratory airway hypersenitity
comobr ides
2— factors
inhalation particles
outdoor/indoor air pollution
occupational expsoyres
tobacco smole
social and economic level
respiratory infection
- —- is a risk factor in 85%
host fcators
environmental factors
smoking tobacco
COPD - public policy at population level :
— Prevention
Elimination or reduction of underlying economic, social, and environmental conditions leading to causation. Targets whole population/ people at high risk e.g. multicomponent tobacco use prevention interventions, focusing on young(prevention of development of risk factors)
— Prevention
Elimination or reduction of modifiable risk factors in those who do not yet have COPD. Targets whole population/ people at high risk e.g. immunisations
—- Prevention
Early detection and intervention e.g. policies to support smokers & those with chronic disease to quit (information; service delivery etc.)
—- Prevention
Effective management of COPD to maximize quality of life and reduce morbidity and mortality e.g. policies for: flu & COVID-19 vaccination; education & self-management
primordial
primary
secondary
tertiary
what works in health policy:
Health Policy should be informed by — :
What is effective (— )
What is best use of money ( — )
Health is — and Health Policy is about — and the ‘art of the feasible’
What tools does Government have for promoting healthy behaviour and how effective are they?:
Legislation and Regulation +++
Taxes and Financial incentives ++
Education
evidence
epidemiology
economics
political
power
commercial determinant of health and tactics of commercial interest groups:
1- Emphasise personal responsibility — >
2- Pay scientists who deliver ‘research’ that instils doubt
—>
3- Criticise the evidence as ‘junk science’ + Make self-regulatory pledges –>
lobbing
safer products
denial
roles of doctors in influencing policy:
Providing — on health issues
Harnessing— opinion – trusted authority
— politicians for legislative support
— and —
Day-to-day — (e.g. implementation of policies)
evidence
public
lobbying
leadership and advocacy
practice
