Introduction to Health Policy (PDF) - Ahfad University for Women

Ahfad University for Women Introduc on to Health Policy Dr Sumaia Elsayed  Health Health Defined WHO (1946) defines health as “not merely the absence of disease or infirmity but a state of complete physical, mental and social well-being.” This broa...

Ahfad University for Women Introduc on to Health Policy Dr Sumaia Elsayed  Health Health Defined WHO (1946) defines health as “not merely the absence of disease or infirmity but a state of complete physical, mental and social well-being.” This broad defini on recognizes that health encompasses biological and social elements in addi on to individual and community well-being. Health may be seen as an indicator of personal and collec ve advancement. It can signal the level of an individual’s well-being as well as the degree of success achieved by a society and its government in promo ng that well-being (Shi and Stevens 2010). This defini on of health strikes a common chord among governments that allows policymakers at WHO, and others in the global health community, to build the case that issues such as poverty; lack of educa on; discrimina on; and other social, cultural, and poli cal condi ons found around the world are essen ally public health issues.  Public Health Public Health Defined Winslow (1920) defined public health as “the science and the art of preven ng disease, prolonging life, and promo ng physical health and efficiency through organized community efforts for the sanita on of the environment, the control of community infec ons, the educa on of the individual in principles of personal hygiene, the organiza on of medical and nursing service for the early diagnosis and preven ve treatment of disease, and the development of social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health.” It focuses on preven on and involves the efforts of society as a whole. public health is intended to protect lives and improve the health of popula ons around the globe. Whereas healthcare is intended to treat, influence, and care for individuals, public health operates on a larger scale.  Public Health The field is defined by the American Public Health Associa on (APHA n.d.) as (1) “the prac ce of preven ng disease and promo ng good health within groups of people” and (2) the research and surveillance conducted to be er understand the health issues facing a group and, in turn, to cra good health policy. Public health has broad implica ons for a popula on. Successful public health ac vi es and ini a ves can save money by promo ng healthy living and preven on, thus reducing healthcare costs and disease burden. these ac vi es can improve quality of life and reduce suffering caused by ill health in a popula on (APHA n.d.). The prac ce of public health leads to direct (e.g., healthier children, less chronic disease, less need for acute care) and indirect (e.g., fewer days missed from school and work; increased funding available for other ini a ves, such as educa on) benefits for a society. It is important to remember that public health, healthcare, and health policy are interconnected areas of study and of prac ce. All three have great influence on health. 30/04/2024  The Determinants Of Health What Are the Determinants of Health? Determinants of health Factors that influence one’s health status. they include one’s socioeconomic status, environment, behaviors, heredity, and access to medical care. Numerous theories related to assigning the determinants of health have been proposed over the past several decades. Blum (1974) offered a framework called Force Field and Well-Being Paradigms of Health, which suggests four major influences—the force fields— on health: environment, lifestyle, heredity, and medical care. According to Blum, the most important force field is the environment, followed by lifestyle and heredity; medical care has the least impact on health and well-being.  The Determinants Of Health More recent models focus on socioeconomic context and health behaviors. For example, the Dahlgren and Whitehead (2006) model divides factors that influence health into two categories: The first category is: "fixed factors,” are unchangeable, such as age, sex, and gene c makeup. The second category is : composed of modifiable factors, such as individual lifestyle choices; social networks and community condi ons; the environment in which one lives and works; and access to important goods and services, such as educa on, sanita on, food, and healthcare. The factors in the second category form layers around the popula on, and modifying them posi vely can improve popula on health. Ansari and colleagues (2003) propose a public health model of the determinants of health in which these factors are categorized into four major groups: social determinants, healthcare system a ributes, disease-inducing behaviors, and health outcomes.  The Determinants Of Health A conceptual framework developed by the WHO Commission on Social Determinants of Health (2008) focuses on: the socioeconomic and poli cal context; structural determinants and socioeconomic posi on; intermediary determinants, such as material circumstances, socioenvironmental circumstances, behavioral and biological factors, social cohesion, and the healthcare system; and the impact on health equity and well-being measured as health outcomes. Similarly, the US Department of Health and Human Services (HHS) publica on Healthy People 2020 embraces a holis c approach by considering the range of personal, social, economic, and environmental factors that determine the health status of individuals or popula ons (HHS 2010). The fige in the next slid provides an overview of the health determinants—environment, health status, medical care, and individual characteris cs (discussed in more detail below)—as they interact to influence health. For example, while individual characteris cs and medical care each affect health on their own, they also interact to become another type of factor influencing health Concep onal Framework of Health Determinants  Concep onal Framework of Health Determinants Environment Dimension The environment in this context is composed of the physical and social dimensions of an individual’s existence over which the individual has li le or no control. These dimensions exert influence at the family, community, and policy levels of society. Environmental determinants have a greater impact on health than the medical care system does. Physical Dimension The use of energy sources (e.g., oil, coal) by a popula on creates certain health hazards in the physical environment. Those hazards can present themselves in the form of air, noise, or water pollu on, resul ng in hearing loss, infec ous disease, gastroenteri s, cancer, emphysema, and bronchi s. To address the impact of climate change, WHO has launched the Climate and Health Country Profile Project (see the For Your Considera on box tled “WHO Climate and Health Country Profile Project”).  Concep onal Framework of Health Determinants Social Dimension The social environment is reflected in a na on’s poli cal, economic, and cultural preferences, which exert significant influence on the health of the popula on. Characteris cs of an environment’s social dimension include behavioral health factors and demographic trends. In the United States, for example, rates of psychological stress, homicide, suicide, and other behavioral health indicators can be a ributed in part to crowding, isola on, and other social environmental factors. In terms of popula on trends, the increase in the number of elderly(those aged 65 years or older)as a propor on of the total popula on will place increasing pressure on healthcare systems around the world.  Individual Characteris cs Related to Health Demographic, behavioral, and socioeconomic condi ons shape individual characteris cs, which explain much of the varia on in health status within popula ons. According to WHO (2018), the Climate and Health Country Profile project “aims to raise awareness of the health impacts of climate change, support evidence-based decision making to strengthen the climate resilience of health systems, and promote ac ons that improve health while reducing carbon emissions. The profiles provide country-specific es mates of current and future climate hazards and the expected burden of climate change on human health, iden fy opportuni es for health co-benefits from climate mi ga on ac ons, and track current policy responses at na onal level.” The project has been expected to track na onal progress on climate ac on in the health sector through a WHO climate and health country survey conducted every two years and designed to provide updated informa on on such aspects as adapta on and resilience measures, climate and health finance, disease surveillance, emergency preparedness, leadership and governance, mi ga on ac on in the health sector, and na onal vulnerability and adapta on assessments (WHO 2018).  Individual Characteris cs Related to Health Demographics Age, gender, race, and ethnicity are strongly associated with health. Advancing age, For example, contributes to arthri s, diabetes, atherosclerosis, and cancer. Gender health is influenced in part by the social construct of gender characteris cs, such as the associa on between masculine iden ty and risk-taking. People also experience significant differences in health status depending on their race or ethnic origin. Explana ons for these differences include socioeconomic status, behaviors, social circumstances, level of access to healthcare services (CDC 2005a; Filice and Joynt 2017; Gupta et al. 2018; James et al. 2017; Shi 1999; Shi, Lee, Chung, et al. 2017; Shi, Lee, Haile, et al. 2017; Shi and Stevens 2010), and factors that are associated with par cular ethnic or racial groups (CDC 2012b). Behaviors The leading causes of death in the United States have shi ed since the beginning of the twen eth century. In 1900, infec ous diseases, such as diphtheria, tuberculosis, measles and pneumonia, caused 797 per 100,000 deaths in the United States, but by the end of the twen eth century, infec ous diseases caused fewer than 100 per 100,000 deaths, and instead chronic diseases, such as heart disease and cancer, caused significantly higher mortality (Armstrong, Conn, and Pinner 1999). This “epidemiologic transi on” supports the idea that the presence of behavioral risk factors— including poor dietary habits, cigare e smoking, alcohol abuse, lack of exercise, and unsafe driving— tend to predict higher risk for certain chronic diseases and mortality. What is health policy? What is health policy?  What is health policy? Therefore, health policy define as policy that pertains to or influences the attainment of health. In terms of the determinants-of-health framework, health policy refers to legislation that may influence, directly or indirectly, social and physical environments, behaviors, socioeconomic status, and availability of and accessibility to medical care services. Health policies affect groups or classes of individuals, such as physicians, the poor, the elderly, and children. They can also affect types of organizations, such as medical schools, HMOs, nursing homes, medical technology producers, and employers. On the basis of this broad definition, health consequences may result from virtually all major policies, such as Social Security mandates, national defense–related guidelines, labor policy, and immigration policy.  What is health policy? Health policies can also be made through the private sector. Examples of private-sector health policies are the decisions made by insurance companies regarding their product lines, pricing, and marketing and by employers regarding health benefits, such as leave policies, worksite health promotion, and insurance coverage.  What is health policy? Health policy must be distinguished from healthcare policy, which refers to that part of health policy pertaining to the financing, organization, and delivery of care. Whereas the predominant goal of health policy is to improve population health, the goals of healthcare policy are typically to provide equitable and efficient access to and quality of needed healthcare services. Healthcare policy Part of health policy but with a focus on healthcare. Specifically, it is related to the financing, delivery, and governance of health services for the populations or sub-populations within a jurisdiction. Regulatory policies Regulations or rules that impose restrictions and are intended to control the behavior of a target group by monitoring the group and imposing sanctions if it fails to comply. FOR YOUR CONSIDERATION  Types of Health Policy Regulatory policies Regulations or rules that impose restrictions and are intended to control the behavior of a target group by monitoring the group and imposing sanctions if it fails to comply. Allocative Health Policies Allocative health policies involve the direct provision of income, services, or goods to certain groups of individuals or institutions. They can be distributive or redistributive: Distributive policy Regulations that provide benefits or services to targeted populations or sub-populations, typically as entitlements. Redistributive policy Deliberate efforts to alter the distribution of benefits by taking money or property from one group and giving it to another.  Determinants ofHealthPolicy the framework for health determinants include four major categories: environment, health status, medical care, and individual characteristics. The framework for health policy determinants: Broad determinants include the nature of the health problem, the sociocultural norms that influence the perception of the problem, and the political system within which policy is formulated. The inner circle of the framework shows the narrower determinants: Potential solutions to the identified health problem Views and efforts of the stakeholders Demonstrated leadership of the policymakers Available resources needed to implement the policy This general framework may be applied to health policies at the national, state, or local level, to public and private policies.. A Conceptual Framework of Health Policy Determinant