L18 Prioritising in public health Flashcards
Why is prioritisation important in health?
Limited resources - money to fund all health problems
How do we determine population health priorities?
There are multiple factors to consider:
- Evidence-based measures (descriptive, explanatory, evaluative)
- Community expectations and values
- Human rights and social justice
What are the different evidence measures and at what stage of the public health framework do they apply?
Define the problem - descriptive evidence
Identify risk and protective factors - explanatory evidence
Develop and test prevention strategies, assure widespread adoption, monitor and evaluate - evaluative evidence
How does descriptive evidence apply when determining health priorities?
Need to determine who is most and least affected - the current state of the disease
Need to determine trends in disease occurrence - increasing or decreasing?
How does explanatory evidence apply when determining health priorities?
Need to figure out what the determinants and risks of the disease are
Also with respect to descriptive evidence
Why are different populations affected differently
Why are we getting worse/better in the trend
What are the epidemiological measures used in prioritisation?
Age at death and premature mortality - years of potential life lost to death (YLL)
Time lived with disability - years lived with a disability (YLD)
Population attributable Risk (PAR)
What is attributable risk?
Same as risk difference (EGO - CGO)
It is the amount of extra disease attributable to a difference in risk factor between the exposure and comparison group
What is population attributable risk?
The amount of extra disease attributable to a particular risk factor linked to a particular population
Calculated by PGO (population group occurrence) - CGO (unexposed group occurrence)
In effect it shows the occurrence of disease that would be removed if the risk factor in the population was removed (assuming relationship between risk factor and outcome is causal)
How does evaluative evidence apply when determining health priorities?
Need to figure out what will improve health outcomes
Is the intervention improving health outcomes?
What kind of evaluative evidence exist?
Target population
Expected number in population who will be reached
Evidence of effectiveness (based on success rates)
Cost
What is economic feasibility?
The debate of whether a decision to fund a prevention makes economic sense
What do communities seek in public health policies?
Confidence in healths ystem
access to necessary care
fair treatment
culturally appropriate
