Lecture 18: Prioritising in public health

Question 1

Where does NZ Health budget go?

Answer 1

Question 2

When prioritizing in health what evidence is used for identifying risk and protective factors, and defining the problem, and assuring widespread adoption

Answer 2

risk & protective factors- explanatory
defining the problem- descriptive
Assuring widespread adoption- Evaluative

Question 2

When prioritizing in health what evidence is used for identifying risk and protective factors, and defining the problem, and assuring widespread adoption

Answer 2

risk & protective factors- explanatory
defining the problem- descriptive
Assuring widespread adoption- Evaluative

Question 3

What needs to be considered when establishing population Health priorities?

Answer 3

Evidence-based measures
Community expectations and values
Human rights and social justice

Question 4

Descriptive evidence

Answer 4

Problem: Who is most/least affected?
Where are we now?

Describes the problem

5 leading causes of death in NZ
(in order of decreasing prevalence)
-Cancer
-I.Heart Disease
-stroke
-Lower Respiratory disease
-Diabetes

Question 5

Explanatory evidence

Answer 5

What are the determinants? What are the risks?
Why are we getting worse/better?
Why are populations different?

Explains why + equity(why some are affected more than others)

Major risk factors of disease burden (excluding individual injury risk factors) in NZ

1. High body mass index
2. Tobacco use
3. High blood pressure
4. High blood glucose
5. Physical inactivity
6. Alcohol

Question 6

Epidemiological measures used in prioritization

Answer 6

– 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)

Question 7

Population Attributable Risk( PAR)

Answer 7

• The amount of “extra” disease attributable to a particular risk factor in a particular population
• If the association is causal – this is the amount of disease (theoretically) we could prevent if we removed that particular risk factor from the population

OCCURENCE IN TOTAL POPULATION(EG+CG) - OCCURENCE IN UNEXPOSED GROUP(CGO)= PAR

PGO-CGO=PAR

Question 7

Population Attributable Risk( PAR)

Answer 7

• The amount of “extra” disease attributable to a particular risk factor in a particular population
• If the association is causal – this is the amount of disease (theoretically) we could prevent if we removed that particular risk factor from the population

OCCURENCE IN TOTAL POPULATION(EG+CG) - OCCURENCE IN UNEXPOSED GROUP(CGO)= PAR

PGO-CGO=PAR

PAR IS DIRECTLY RELATED TO THE PREVALENCE OF THE RISK FACTOR IN THE POPULATION

Question 8

PAR VS RD

Answer 8

RD is used for high-risk groups interventions

PAR is used for population-based interventions( determine the need/potential impact of the intervention)

Question 9

Evaluative evidence

Answer 9

• What can improve health outcomes (and in whom)?
• Is the intervention improving health outcomes?

How well can the problem be solved?
– Target population
– The expected number in the population who will be reached
– Evidence of effectiveness (based on known success rates)
– Cost

Economic feasibility

Acceptability
- Will the community and/or
target population accept the
problem being addressed?

What do communities want?
– Confidence in the health
system
– Access to necessary care
– Fair treatment
– Culturally appropriate
– Good information about their
options