Lecture 23: Prioritising In Public Health Flashcards
Why do we need prioritising in health ?
Not enough money to fund all the health problems (although low in NZ, it’s not necessarily bad- about 9.2% of GDP is spent on health)
Where does health funding come from?
Taxpayers
How much of NZ health dollar is spent on public health?
6%
What is most of the NZ health dollar spent on?
- inpatient curative and rehab (26%)
- outpatient/home curative and rehab (26%)
What are the three evidence based processes when establishing public health priorities?
- Descriptive
- Explanatory
- Evaluative
What are questions explaining descriptive processes?
Where are we now?
Where have we come from?
Where are we going?
Who is the most/least affected?
What are questions regarding explanatory processes?
Why are we getting worse/better?
Why are populations different?
(Ie determinants)
What are questions explaining evaluative processes?
What can improve health outcomes (and in whom)?
What are two ways to measures descriptive processes?
- Age-standardised mortality rates (with ethnicity/age groups etc identified)
- Trends over time (ie increasing/decreasing)
What are two examples of the explanatory process?
- Identification of risk factors
2. Epidemiological measures (e.g Population Attributable Risk)
What process does an understanding of equity, human rights and the treaty of waitangi come under?
The explanatory process
What is the attributable risk definition?
The amount of extra disease attributable to a particular risk factor in the exposed group (incidence in the EGO)
What is the attributable risk calculation?
The risk difference
Aka
EGO-CGO
What is the population attributable risk (PAR) definition?
The amount of extra disease attributable to a particular risk factor in a particular population
What does it mean if the PAR association is causal?
This is the amount of disease (theoretically) we could prevent if we removed this particular risk factor from the population
Is relative risk a good indicator of association?
No
What are the two equations for PAR?
- PGO-CGO
- RD x (EG/population)
(You get same outcome and can identify who is more at risk)
What are for aspects of evaluative processes to consider?
- Target population
- Expected number in population who will be reached
- Evidence of effectiveness (based on known success rates in literature)
- Cost
What is economic feasibility?
“Does it make economic sense to address the problem?”
“Are there economic consequences if not carried out?”
What is opportunity cost?
The health benefits that could have been achieved had the money been spent on the next best alternative intervention or healthcare programme
What three other aspects must be considered alongside evidence-based processes?
- Community expectations and values
- Public attitudes
- Human rights and social justice
How does acceptability relate to prioritisation?
- ” will the community or/and target population accept the problem being addressed
- competing interests
Prioritisation: what do patients want?
- Access to necessary care
- Confidence in the health system
- Fair treatment
- Culturally appropriate
- Good information about their options
What types of risks are identified in the explanatory process?
Modifiable ones eg obesity (make sure to look at disparities between ethnic groups)
Why is it important to look at research papers for proposed interventions at the evaluative stage?
Because you need to ensure that the proposed intervention will work for the specific group
What was the total health budget for 2013/14?
14.7 billion
Why do we measure PAR?
To compare the extra risk in an exposure between two different exposures (eg heroin or smoking) so you can decide which has higher disease risk, and which to prioritise
