Lecture 23: Prioritising In Public Health

Question 1

Why do we need prioritising in health ?

Answer 1

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)

Question 2

Where does health funding come from?

Answer 2

Taxpayers

Question 3

How much of NZ health dollar is spent on public health?

Answer 3

6%

Question 4

What is most of the NZ health dollar spent on?

Answer 4

• inpatient curative and rehab (26%)

- outpatient/home curative and rehab (26%)

Question 5

What are the three evidence based processes when establishing public health priorities?

Answer 5

1. Descriptive
2. Explanatory
3. Evaluative

Question 6

What are questions explaining descriptive processes?

Answer 6

Where are we now?
Where have we come from?
Where are we going?
Who is the most/least affected?

Question 7

What are questions regarding explanatory processes?

Answer 7

Why are we getting worse/better?
Why are populations different?
(Ie determinants)

Question 8

What are questions explaining evaluative processes?

Answer 8

What can improve health outcomes (and in whom)?

Question 9

What are two ways to measures descriptive processes?

Answer 9

1. Age-standardised mortality rates (with ethnicity/age groups etc identified)
2. Trends over time (ie increasing/decreasing)

Question 10

What are two examples of the explanatory process?

Answer 10

1. Identification of risk factors

2. Epidemiological measures (e.g Population Attributable Risk)

Question 11

What process does an understanding of equity, human rights and the treaty of waitangi come under?

Answer 11

The explanatory process

Question 12

What is the attributable risk definition?

Answer 12

The amount of extra disease attributable to a particular risk factor in the exposed group (incidence in the EGO)

Question 13

What is the attributable risk calculation?

Answer 13

The risk difference
Aka
EGO-CGO

Question 14

What is the population attributable risk (PAR) definition?

Answer 14

The amount of extra disease attributable to a particular risk factor in a particular population

Question 15

What does it mean if the PAR association is causal?

Answer 15

This is the amount of disease (theoretically) we could prevent if we removed this particular risk factor from the population

Question 16

Is relative risk a good indicator of association?

Answer 16

No

Question 17

What are the two equations for PAR?

Answer 17

1. PGO-CGO
2. RD x (EG/population)

(You get same outcome and can identify who is more at risk)

Question 18

What are for aspects of evaluative processes to consider?

Answer 18

1. Target population
2. Expected number in population who will be reached
3. Evidence of effectiveness (based on known success rates in literature)
4. Cost

Question 19

What is economic feasibility?

Answer 19

“Does it make economic sense to address the problem?”

“Are there economic consequences if not carried out?”

Question 20

What is opportunity cost?

Answer 20

The health benefits that could have been achieved had the money been spent on the next best alternative intervention or healthcare programme

Question 21

What three other aspects must be considered alongside evidence-based processes?

Answer 21

1. Community expectations and values
2. Public attitudes
3. Human rights and social justice

Question 22

How does acceptability relate to prioritisation?

Answer 22

• ” will the community or/and target population accept the problem being addressed
• competing interests

Question 23

Prioritisation: what do patients want?

Answer 23

1. Access to necessary care
2. Confidence in the health system
3. Fair treatment
4. Culturally appropriate
5. Good information about their options

Question 24

What types of risks are identified in the explanatory process?

Answer 24

Modifiable ones eg obesity (make sure to look at disparities between ethnic groups)

Question 25

Why is it important to look at research papers for proposed interventions at the evaluative stage?

Answer 25

Because you need to ensure that the proposed intervention will work for the specific group

Question 26

What was the total health budget for 2013/14?

Answer 26

14.7 billion

Question 27

Why do we measure PAR?

Answer 27

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