Lecture 26: Prioritising in Public Health

Question 1

why should we prioritise in health?

Answer 1

not enough money in the kitty to fund all
**health expenditure is not proportional to life expectancy

Question 2

establishing population health priorities

Answer 2

1. evidence based measures
   - descriptive: define theprobelm
   - explanatory: risk + protective factors
   - evaluative:
2. community expectations and values (social justice)

Question 3

descriptive measures

Answer 3

who is the most/least affected + what is happening now?
- looks at population stats + smaller poulation health groups to see which disease to prioritise
- also looks at trends over time,where have we come from where are we going?

Question 4

explanatory evidence

Answer 4

what are the determinants? causes of causes, what are the risks?
why are we getting worse/better + why are populations different

major risk factors: high bmi, tobacco, high blood pressure, high blood glucose, physical inactivity, alcohol

equity: does the problem/risk factor disproportionately affect population sub groups? why?

Question 5

what are the epidemiological measures used in prioritisation?

Answer 5

yll, yld, par

Question 6

what is the attributable risk?

Answer 6

same as risk difference (ego-cgo)
amount of extra disease attributable to a particular risk factor in the exposed group

Question 7

population attributable risk (par)

Answer 7

amount of extra disease at

Question 8

population attributable risk (par)

Answer 8

amount of extra disease attributable to a particular risk factor in a particular population
**since population is bigger than exposure group, the rate is smaller.

pgo-cgo, pgo = those with disease/total population

Question 9

evaluative evidence

Answer 9

what can improve health outcomes? is the intervention improving health outcomes?

who is the target population
expected no in population who will be reached
evidence of effectiveness (based on known success rates)
cost
economic feasibility: does it make economic sense to address the problem? any consequences??

Question 10

community expectations, values, and lived realities

Answer 10

acceptability: will the target population accept the problem being addressed? competing interests

what do communites want?
- confidence in the health system
- access to necessary care
- fair treatment
- culturally appropriate
- good information about their options

Question 11

breast cancer:

Answer 11

descriptive: nz has the highest breast cancer rates
explanatory: using par, can conclude obesity is the biggest risk factor
evaluative: what can make it better? healthy lifestyle
- consuming more white meat, fish, fruit and vegetables
- lower alcohol consumption
- not smoking
- higher exercise levels
- lower body mass index
- longer cumulative duration of breastfeeding

community expectations:
- access to necessary care
- confidence in health system; using those ppl in the communities to share health msgs
culturally appropriate
- good info about their options

**10 year survival screen rates screen detected Maori is 5% higher than NZ europeans.