Module 1- Introduction to Public Health PDF

Module 1: Introduction to Public Health, History, Health Delivery System, Economic and Political Impact Presented by: John Lesther B. Panggat, MPHA Camille Joy C. Caguicla-Mauhay, RMT Charmaine Gellieann R. Magsino, RMT Learning Objectives: Students are expected to: Define and discuss the differe...

Module 1: Introduction to Public Health, History, Health Delivery System, Economic and Political Impact Presented by: John Lesther B. Panggat, MPHA Camille Joy C. Caguicla-Mauhay, RMT Charmaine Gellieann R. Magsino, RMT Learning Objectives: Students are expected to: Define and discuss the differences of global health from public health (PH) and medical care Describe the science and purpose of PH Differentiate prevention and intervention in PH aspect Describe the role of PH in controlling caused by untoward events What is health? Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. 3 4 5  Many deaths are premature. A substantial proportion of death can be avoided. Public Health is related to preventing premature and avoidable deaths. 6 What is Public Health? Measures directed to group of people (not individuals) to promote, protect and preserve health. Public health may be conceptualized as: - Analyzing the health of a population and the threats it faces is the basis for public health. - Science of protecting the safety and improving the health of communities through education, policy making, and research for disease and injury prevention. 7  Comprehensive definition of Public health (Charles-Edward Amory Winslow, 1920 ): “The science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort for: - The sanitation of the environment - The control of communicable infections - The education of the individual in personal hygiene - The organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and - The development of the social machinery to ensure everyone a standard of living adequate for maintenance of health so, organizing these benefits as to enable every citizen to realize his birth right of health and longevity.  Public Health Specialist and Clinician In the medical field, clinicians treat diseases and injuries of one patient at a time. But in public health, we prevent disease and injury. Public health researchers, practitioners and educators work with communities and populations. They identify the causes of disease and disability, and they implement large scale solutions. 9 In public health, microbiologists work to find a vaccine for malaria, while behavioral scientists research ways to discourage populations from smoking. Environmental health scientists work to discover which foods prevent cancer, while health policy analysts evaluate health insurance programs and make recommendations. And epidemiologists identify trends in health and illness, looking for links, causes and interventions in areas such as HIV/AIDS, tuberculosis and infant mortality. 1 0 Public Health: Is population based Emphasis on collective responsibility for health, its protection and disease prevention. Recognizes the key role of the state, linked to a concern for the underlying socio-economic and wider determinants of health, as well as disease Emphasis on partnerships with all those that contribute to the health of the population 1 1  PUBLIC HEALTH APPROACH Public Health Model Medical Model versus 1 2  PUBLIC HEALTH HEALTH CARE Population focus Individual patient focus Public health ethic Personal service ethic Preventive and public health Diagnosis and treatment emphasis emphasis Joint laboratory and field Joint laboratory and patient involvement involvement Clinical sciences peripheral to Clinical sciences essential to professional training professional training Public sector basis Private sector basis  Components of PH and Its Sciences Public health is an interdisciplinary field. It includes 6 areas: - Epidemiology, - Biostatistics - Health economics, - Biomedical Sciences - Social and behavioral Science - Behavioral health, - Mental health, - Gender issues in health, and - Sexual and reproductive health. - Environmental Science - Environmental health, - Community health, - Occupational safety. - Public Policy - Management of health services 1 4  Prevention and Intervention Public health’s approach to health problems in a community has been described as a five-step process: 1. Define the health problem. 2. Identify the risk factors associated with the problem 3. Develop and test community-level intervention to control and prevent the cause of the problem. 4. Implement intervention to improve the health of the population. 5. Monitor those intervention to assess their effectiveness. Prevention - main task is to develop intervention designed to prevent specific problems that have been identified either through an assessment process initiated by a public health agency or through community raised by an unusual course of events. Public health has developed systematic way of thinking about such problems that facilitate the process of designing interventions that prevent undesirable health outcomes. 3 levels of approaches: Primary prevention - prevents illness or injury from occurring at all. Secondary prevention - seeks to minimize the severity of the illness or the damage due to an injury-causing event once the event has occurred. Tertiary prevention – seeks to minimize disability by providing medical care and rehabilitation. Levels of Prevention 21 A health intervention is an act performed for, with or on behalf of a person or population whose purpose is to assess, improve, maintain, promote or modify health, functioning or health conditions. https://www.who.int/standards/classifications/international-classification-of-health-interventions The International Classification of Health Interventions (ICHI) is being developed to provide a common tool for reporting and analyzing health interventions for statistical purposes. ICHI covers interventions carried out by a broad range of providers across the full scope of health systems and includes interventions on diagnostic, medical, surgical, mental health, primary care, allied health, functioning support, rehabilitation, traditional medicine and public health.  Public Health and Terrorism Many events globally disturbed the sense of complacency many people felt about the health and safety of their living conditions. Groups of individuals who not only wanted to cause harm to people at home but who has the resources and the will to succeed in that goal forced us to think about how to prevent similar events in the future.  Role of Public Health in controlling Prevention of violent attack is primarily a responsibility of law enforcement, but public health plays a big role in controlling the damage caused by such an events. Primary prevention may be out of the domain of PH, but secondary and tertiary prevention are very much a part of public health’s mission. Success at these services depend on having well-designed plans in place before a disaster occurs.  Public Health and Terrorism PH was concerned not only with coordinating emergency medical care, but also ensuring the safety of clean up workers. Natural disaster must be dealt with (polluted water and air, contaminated food, infestation of vermin etc.) Example of Anthrax mailings - damage done were relatively minor but the potential disaster that would result if more infectious microorganism were used in bioterror attack forces many sectors of society to pay attention to public health.  Summary: Public Health Activities Prevents epidemics Protects the environment, workplaces, housing, food, and water Monitors health status of population Mobilizes community action Responds to disasters Assures quality, accessibility, and accountability of medical care Reaches out to link high-risk and hard-to-reach people to needed services Researches to develop new insights and innovative solutions Leads the development of sound health policy and planning 2 5 2 6  Unit 1.2 History, determinants, core functions, essentials, UHC, and health delivery systems in public health  Learning objectives: To identify prominent events and developments of modern public health. To list and categorize determinants of health and discuss how these can be translated into health strategies. To describe the different core functions and essentials of public health.  Rise of Public Health: The Nineteenth Century: The Great Sanitary Awakening In the era of unplanned industrialization in nineteenth century, “ The great 19th Century awakening” – the identification of filth as both a cause of disease and a vehicle of transmission and ensuing embrace of cleanliness – was a central component of 19th century social reforms and advancement in public health. 2 9  Illness came to seen as an indicator of poor social environmental conditions as well as poor moral and spiritual conditions; Cleanliness was embraced as a path both to physical and moral health. Disease control shifted from reacting to intermittent outbreaks to continuing measures for prevention. With sanitation, public health became a societal goal and protecting health became a public activity. 3 0  The Development of Public Activities in Health Edwin Chadwick, a London lawyer (1838), is one of the most recognized names in the sanitary reform movement. ▪ Under his authority, a commission conducted studies of the life and health of the London working class in 1838 and that of the entire country in 1842. ▪ The report of these studies, ‘General Report on the Sanitary Conditions’, was a document of the appalling conditions in which masses of the working people were compelled to live, and die, in the industrial towns and rural areas of UK. ▪ Chadwick documented that the average age at death for the gentry was 36 years; for the tradesmen, 22 years; and for the laborers, only 16 years. 3 1 40 The changing concept of Public Health 3 3 Disease Control Phase 1880-1920 Sanitary legislation and sanitary reforms Less available technical knowledge Aimed at the control of man’s physical environment (water supply sewage disposal) & not at the control of any specific disease Improvement in the health of people due to disease and death and control 3 4 Health Promotion Phase 1920-1960 In addition to disease control activities one more goal was added to public health (i.e. health promotion of the individuals) It was initiated as personal health services such as: Introduction of mother & child health services Industrial health services Mental health services Rehabilitation services 3 5 Health Promotional Phase Two great movement were initiated for human development: a) Provision of Basic Health Services – PHCs and sub-centers for rural and urban areas b) Community development program – to promote village development through active participation of whole community. 3 6 Social engineering phase 1960-1980 With the advances in preventive medicine and practice of public health, the pattern of disease began to change in the developed world Many of the acute illness problems have been brought under control It moved towards preventive and rehabilitative aspects of chronic disease and behavioral problems 3 7 Social engineering phase 3 8 Health for all phase 1981-2000 AD Health gap between rich and poor, within & between countries Health for all phase Include provision of health care to all by reducing the inequalities within & between the population so that individual will lead a socially and economically productive life. 4 0 Health for all phase Most people in the developed countries, and the elite of the developing countries, enjoy all the determinants of good health - adequate income, nutrition, education, sanitation, safe drinking water and comprehensive health care. In contrast, only 10 to 20% of the population in developing countries enjoy ready access to health services of any kind. 4 1 Health for all phase Most people in the developed countries, and the elite of the developing countries, enjoy all the determinants of good health - adequate income, nutrition, education, sanitation, safe drinking water and comprehensive health care. In contrast, only 10 to 20% of the population in developing countries enjoy ready access to health services of any kind. 4 2 Health for all phase Death claims 60-250 of every 1000 live births within the first year of life Life expectancy is 30% lower than in the developed countries. “Large no. of the worlds peoples, perhaps more than half, have no access to health care at all, and for many of the rest, the care they receive does not answer the problems they have”. In 1981 WHO pledged “Health For All” by 2000 to bridge the gap between developing and developed countries.  Disease Sanitary legislation & sanitary reforms Poor sanitation Disease control phase (1880 - 1920) Health promotion Health promotion phase (1920 - 1960) Social objectives Social engineering phase (1960 - 1980) WHO Gap between rich & poor within countries Health For All phase (1981 - 2000) Modern Public Health With the adoption of Health for All (1978), a new concept of Public Health became evident worldwide, which may be defined as… “the organized application of local, state, national, international resources to achieve health for all, i.e. attainment by all the people of the world by the year 2000 of a level of health that will permit them to lead a socially & economically productive life”. 50 Modern Public Health During the 20th century the dramatic increase in average span of life is credited to public health achievement such as vaccination programs, control of infectious diseases, better safety policy such as motor vehicle and worker safety, improved reproductive health, emphasis on safe drinking water. Now focus is shifting more towards chronic diseases such as cancer, AIDS, diabetes and heart diseases. 4 8 Shifting Focus of Public Health (Healthy People Report-1979) 4 9 Surveillance is the continuous, systematic collection, analysis and interpretation of health- related data needed for the planning, implementation, and evaluation of public health practice. 5 0 Cholera — A Public Health Approach Cholera, a fatal intestinal disease, was rampant during the early 1800s in London. This causing death to tens of thousands of people in the area. Cholera was commonly thought to be caused by bad air from rotting organic matter. 5 1 John Snow, Physician John Snow is best known for his work tracing the source of the cholera outbreak and is considered the father of modern epidemiology. 5 2 Epidemiology — What is the Problem? 5 4 5 5 Risk Factor Identification — What Is the Cause? Cluster of Cholera Cases around ‘Broad Street Pump’ Site Locations 5 6  Intervention Evaluation — What Works? Through continuous research, Snow understood what interventions were to: STOP EXPOSURE to the entire contaminated water supply in the area. John Snow’s research convinced the British government that the source of Cholera was water contaminated with sewage. Broad Street Pump to supply water was sealed forever 5 7 Implementation — How Do You Do It? John Snow’s research convinced the British government that the source of cholera was water contaminated with sewage. Thus Broad Street Pump to supply water was sealed for ever. 60 History of public health.. Continuous developments in modern public health - 500 BCE: Greek and Roman civilisations sanitation measures and practices - 1346 – 1352 Black Death claimed one-third of Europe’s population. It was thought to be an epidemic of bubonic plague, a bacterial disease caused by Yersinia pestis. It was used as a weapon of war during the siege of Kaffa. - Early 1700s: Inoculation of small pox brought to Britain by Lady Mary Wortley Montagu - 1798: Vaccination by Edward Jenner; a Gloucestershire doctor who advocated the inoculation of cowpox pustules - 1830s: Edwin Chadwick was convinced that the main cause of illness was the dirty conditions that the poorest members of the society were living in. - 1848: The Public Health Act of 1848 stemmed from Chadwick’s research on the health concerns in London -1854: John Snow innovated several key epidemiologic methods that remain valid and in use today. He mapped the disease pattern of cholera epidemic in London. - 1807-1883: William Farr British physician who pioneered the quantitative study of morbidity (disease incidence) and mortality (death), helping establish the field of medical statistics. - 1870s: Louis Pasteur’s experiments led to the discovery of artificial immunity: rabies, anthrax, cholera Sources: Centres for Disease Control and Prevention; Thackray Museum, Leeds; and https://www.britannica.com/biography/William-Farr  Notable Events in Public Health John Snow is an English Anaesthesiologist and the Father of Epidemiology. He made a scientific study in London on the spread of cholera. He used his map to demonstrate the link between an outbreak of cholera and the local water pump. Map of Broad Street Source: Friis, R. (2009). Epidemiology 101. 2nd ed. Sudbury, MA: Jones & Bartlett Learning, p. 11-15  Notable Events in Public Health The Forerunner of the Modern Epidemiology Snow’s notable contributions - Powers of observation and written expression - Application of epidemiologic methods - Mapping (spot maps)* - Use of data tables to describe infectious disease outbreaks - Participation in a natural experiment - Recommendation of a public health measure to prevent disease Map of Broad Street Source: Friis, R. (2009). Epidemiology 101. 2nd ed. Sudbury, MA: Jones & Bartlett Learning, p. 11-15  Notable Events in Public Health William Farr is considered as a major figure in the history of epidemiology. He used data such as census reports to study occupational mortality in England. Sources: Tapia Granados, J. (2020). William Farr | British physician. [online] Encyclopedia Britannica. Available at: https://www.britannica.com/biography/William-Farr [Accessed 10 Jan. 2020]. Friis, R. (2009). Epidemiology 101. 2nd ed. Sudbury, MA: Jones & Bartlett Learning, p.15.  Notable Events in Public Health - He explored the possible linkage between mortality rates and population density. - In 1837, with an extensive knowledge of statistics, he was recommended for the post of “Compiler of Abstracts” at the General Register Office of England and Wales, which registered births, marriages, and deaths. - Over the next four decades, he compiled statistics on death and disease across the regions. Sources: Tapia Granados, J. (2020). William Farr | British physician. [online] Encyclopedia Britannica. Available at: https://www.britannica.com/biography/William-Farr [Accessed 10 Jan. 2020]. Friis, R. (2009). Epidemiology 101. 2nd ed. Sudbury, MA: Jones & Bartlett Learning, p.15. Notable Events in Public Health Robert Koch (1843 – 1910) - A German physician who had verified that the human disease was caused by a specific living disease. First to isolate Bacillus anthracis and Vibrio cholerae. Most notable contribution: the discovery of Mycobacterium tuberculosis; described in 1882 Die Aetiologie der Tuberkulose Source: Friis, R. (2009). Epidemiology 101. 2nd ed. Sudbury, MA: Jones & Bartlett Learning, p. 15 Notable Events in Public Health Koch’s 4 Postulates to Demonstrate the association of Disease and a Microorganism 1. The organism must be observed in every case of disease. 2. It must be isolated and grown in pure culture. 3. The pure culture must, when inoculated into a susceptible animal, reproduce the disease. 4. The organism must be observed in, and recovered from, the experimental animal Source: Friis, R. (2009). Epidemiology 101. 2nd ed. Sudbury, MA: Jones & Bartlett Learning, p. 15  Notable Events in Public Health Early 20th Century (1900-1940) 1918: Pandemic Influenza or Spanish Influenza was known to cause 50 to 100 million fatalities worldwide 1928: Alexander Fleming discovery of the antimicrobial properties of the mould Penicillium notatum (now Penicillium chrysogenum), a breakthrough to the development of the first antibiotic penicillin. Thackray Museum, Leeds Sources: Centres for Disease Control and Prevention; and Friis, R. (2009). Epidemiology 101. 2nd ed. Sudbury, MA: Jones & Bartlett Learning, p. 15  Notable Events in Public Health The Contemporary Era (1940 to the present) The first polio vaccine (1950s) known as inactivated poliovirus vaccine (IPV) or Salk Vaccine, was developed by Jonas Salk. 1960s: The second type of polio vaccine was developed by Albert Sabin. It was known as oral poliovirus vaccine (OPV) or Sabin Vaccine. OPV and IPV discoveries led to the launching of eradication initiatives in 1988. 1960s Highly Effective Surveillance and Vaccination programmes against smallpox 1977: The last known naturally acquired case of smallpox was reported in Somalia Sources: Friis, R. (2009). Epidemiology 101. 2nd ed. Sudbury, MA: Jones & Bartlett Learning, p. 15  Notable Events in Public Health 1949: Epidemic Intelligence Service 1964: U.S. Surgeon General Food labelling Alexander Langmuir was released Smoking and Health and promotion of hired by the Centres for which stated the linkages of physical activity. Disease Control and smoking to disabling and fatal Prevention as the first diseases Epidemiologist. Sources: Centres for Disease Control and Prevention; and Friis, R. (2009). Epidemiology 101. 2nd ed. Sudbury, MA: Jones & Bartlett Learning, p. 15 Determinants of Health: Influencing the public’s health  Determining and influencing the public’s health Observe the illustration: Public health challenge: to achieve _____________ in health  Determining and influencing the public’s health Equity in Health Everyone should attain their full health potential and no one should be disadvantaged from this potential because of their social position or other socially determined factors. Source: University of Leeds Nuffield Centre for International Health and Development 7 4  Determining and influencing the public’s health The 1992 Rio Declaration on Environment and Development defines rights Rio Declaration of the people to be involved in the development of their economies, and the responsibilities of human beings to safeguard the common environment. (2011) World Conference on Social Determinants “.. To convene a global event, with the assistance of Member States, before the 65 th World Health Assembly in order to discuss renewed plans for addressing the alarming trends of health inequities through addressing social determinants of health..” Sources: World Health Organization; and University of Leeds Nuffield Centre for International Health and Development  Determining and influencing the public’s health (2011) World Conference on Social Determinants - Adopt improved governance for health and development - Promote participation in policy-making and implementation - Further reorient the health sector towards promoting health and reducing health inequities - Strengthen global governance, partnerships/collaboration - Monitor progress and increase accountability Endorsed by WHO Members in 2012 Source: University of Leeds Nuffield Centre for International Health and Development  Determining and influencing the public’s health Determinants of Health Circumstances and environmental factors that affect health, whether healthy or not. The determinants of health include: The social and economic environment; The physical environment; and The person’s individual characteristics and behaviours.  Determining and influencing the public’s health Framework 1 Developed by Göran Dahlgren and Margaret Whitehead in 1991 Source: WHO (2010). A Conceptual Framework for Action on the Social Determinants of Health Determining and influencing the public’s health This framework maps the relationship between the individual, their environment and health. Individuals are placed at the centre, and surrounding them are the various layers of influences on health. What influence health? - Individual lifestyle factors - Social and Community influences - Living and working conditions - General social conditions Source: WHO (2010). A Conceptual Framework for Action on the Social Determinants of Health  Determining and influencing the public’s health Framework 2 Source: WHO (2010). A Conceptual Framework for Action on the Social Determinant of Health  Determining and influencing the public’s health Determinants of Health Examples based from the WHO: Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Income and social status - higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health. Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions Education – low education levels are linked with poor health, more stress and lower self- confidence. Health services - access and use of services that prevent and treat disease influences health Source: World Health Organization  Determining and influencing the public’s health Determinants of Health Examples based from the WHO: Social support networks – greater support from families, friends and communities is linked to better health. Culture - customs and traditions, and the beliefs of the family and community all affect health. Personal behaviour and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health. Gender - Men and women suffer from different types of diseases at different ages. Genetics - inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Source: World Health Organization Core Functions and Essential Services of Public Health  Core functions and essential services of public health 1. 2. 3. 4. Activity 4 Refer to the video about John Snow Identify how he used the public health approach in solving cholera outbreak in London,1854. Cholera Epidemics Investigation in London - 1854  Core functions and essential services of public health Modern Approach Assess Health Needs Review Health Services and Programmes Evaluate Choose the Best Interventions List Activities and Draft an Action Plan Implement and Monitor Adapted from: Walley J., WrightJ. And Hubley J. (2004). Public Health and action guide to improving health in developing countries. Oxford University Press; and University of Leeds Nuffield Centre for International Health and Development  Core functions and essential services of public health 3 Core Functions of Public Health Assessment A systematic collection, analysis, and distribution of data/information on healthy communities Promotes use of evidence-based scientific information in Policy Development creating policies and decision making Assurance Ensure provision of services to those in need Source: Centres for Disease Control and Prevention  Three Core Functions of Public Health Systematically collect, analyze, and Assessment make available information on population at risk to identify health problems and priorities. Promote the use of a scientific Policy knowledge base in policy and Development decision making to solve problems. Assurance Ensure provision of services to those in need Core functions and essential services of public health 10 Essential Public Health Services 1. Monitor Health 2. Diagnose and Investigate 3. Inform, Educate, Empower 4. Mobilize Community Partnership 5. Develop Policies 6. Enforce Laws 7. Link to/Provide Care 8. Assure a Competent Workforce 9. Evaluate 10. Research The Core Public Health Functions Steering Committee developed the framework for the Essential Services in 1994. The committee included representatives from US Public Health Service agencies and other major public health organizations. Source: Centres for Disease Control and Prevention  Core functions and essential services of public health The public health system includes Public health agencies at state and local levels The Public Health System Healthcare providers Public safety agencies Human service and charity organizations “all public, private, and voluntary Education and youth development entities that contribute to the delivery organizations of essential public health services within Recreation and arts-related organizations a jurisdiction.” Economic and philanthropic organizations Environmental agencies and organizations Source: Centres for Disease Control and Prevention Core functions and essential services of public health Public Health requires multidisciplinary and interdisciplinary actions Source: Centres for Disease Control and Prevention If the primary intent of any measure is to protect health, then that is public health. Health Delivery Systems: WHO Framework Introduction to Health System What is a Health System? Roemer 1991 It is the combination of resources, organization, financing and management that culminate in the delivery of health services to the population.” World Health Organization (2000) ”all the activities whose primary purpose is to promote, restore, and maintain health..” A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. It includes efforts to influence determinants of health as well as more direct health improving activities. Main Goals of Health Systems To improve health of the population To improve responsiveness of health system to people’s health expectations Providing financial risk protection Villaverde (2019) Health System Functions The 4 main health system functions 1. Health service provision 2. Health service inputs 3. Stewardship 4. Health financing Health System Functions The 4 main health system functions 1 Health service provision - Direct provision of services to patients - Public and private health services Preventive Curative Diagnostic Health System Functions The 4 main health system functions 2 Health service inputs - Health products and supply chain - Manufacturing, sales and distribution of key assets, including facilities, drugs and devices - Resource generation: investing in people, facilities and equipment Health System Functions The 4 main health system functions 3 Stewardship - The process of setting the strategic goals of a health system - Sets the context and policy framework for the overall health system - Acting as overall stewards of the resources, powers and expectations - HS function in generating appropriate data for policymaking Health System Functions The 4 main health system functions 3 Stewardship Core questions of stewardship functions: - What are the health priorities to which public resources should be targeted? - What is the institutional framework in which the system and its many actors should function? - Which activities should be coordinated with other systems outside the realm of health care, and how - What are the trends in health priorities and resource generation and their implications for the next 10, 20, or 30 years? Health System Functions The 4 main health system functions 4 Health Financing - Generating, pooling, and purchasing/allocating resources towards healthcare. - a) Revenue collection: entails collection of money to pay for health care services - Mechanisms: general taxation, donor financing, mandatory payroll contributions, mandatory or voluntary risk-rated contributions (premiums), direct household out-of-pocket expenditures, and other forms of personal savings. Health System Functions - b) Risk pooling: refers to the collection and management of financial resources in a way that spreads financial risks from an individual to all pool members 2 Main Models Bismarck model Beveridge model Utilizes an insurance system funded mainly from salaried Funding is based on taxation employees. These social health insurances are termed as A dominant model focusing on universal, free coverage the sickness/health funds and are collected through payroll materialized only in few equitably wealth and well-managed deduction – wage-dependent premiums health sectors The Bismarck Model is based on the principles of plurality, The core principles of Beveridge systems: universality and liberty, and solidarity. equity. Advantages: Care is provided by non-profit hospitals and Advantages: Utilizes universal coverage; and administers individual practitioners; and general taxation – large scope to raise resources Subsidizes the poor and vulnerable Disadvantages: Difficulty on cost control; Disadvantages: High risk of under-funding or unstable funding; Over-utilization of health car; and delivery systems requires decisive political actions; and overspending Health System Functions The 4 main health system functions 4 Health Financing - Generating, pooling, and allocating resources towards healthcare. - c) Purchasing and allocation of resources - Strategic collection and pooling of financial resources to finance or buy health care services for their members. What to buy? – Which health services will respond to the needs of the target population, how will they be defined? From whom to buy? – Which providers, public and/or private, will be able to deliver effectively those health services? How to buy? – How will providers be paid, at what rates, what are contracting terms and how will compliance be monitored?  Relationship between functions and objectives of a health system Responsiveness Stewardship (to people’s (oversight) expectations) Creating Resources Delivering Services Health (investing & training) (provision) Financing Fair Contribution (collection, pooling and (financial protection) purchasing) Villaverde (2019)  WHO Health Systems Framework System Building Blocks Overall Goals/Outcomes Service Delivery Improved Health Health Workforce Access Coverage Responsiveness Information Medical products and technologies Financial Risk Protection Health Financing Quality Safety Leadership/ Governance Improved Efficiency  WHO Health Systems Framework System Building Blocks Good health services are those which deliver effective, safe, quality Service Delivery personal and non-personal health interventions to those who need them, when and where needed, with minimum waste of resources. Health Workforce A well-performing health workforce is one which works in ways that are responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances. (i.e. there are sufficient numbers and mix of staff, fairly distributed; they are competent, responsive and productive) A well-functioning health information system is one that ensures the Information production, analysis, dissemination and use of reliable and timely information on health determinants, health systems performance and health status.  WHO Health Systems Framework System Building Blocks Medical products and A well-functioning health system ensures equitable access to essential technologies medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost- effective use. A good health financing system raises adequate funds for health, in ways Health Financing that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them. Leadership and governance involves ensuring strategic policy frameworks Leadership/ Governance exist and are combined with effective oversight, coalition- building, the provision of appropriate regulations and incentives, attention to system- design, and accountability. Public Health and Economic Impact Public Health Measures have a negative impacts of some kind on some segment of the population or on some industry: Examples: 1. Public health regulation = cost jobs = price products = tax increase = cut companies’ profit 2. Resisting change in more milk production = resist pasteurization 3. Landlords resist building codes 4. Automobile manufacturers resist design change to improve safety. 5. Tobacco Industry = harmful to health = causing thousands of death = million of dollar healthcare cost annually (but mild restrictions were instituted). - only until recently that many were injured due to SHS and lawsuits begun and this issue were taken seriously.  The trade off in public health and the economy Short Term Long term Restrictions on timber Preserve fishing and Stable climate tourism Safety of workers Require expensive Add up cost to consumer equipment Pollution control in the Competitiveness in Good environment industry international market High gas price Lost market share & Less use of cars, less profits pollution Mad cow disease Expensive screening of Prevention of spread of cows disease Use of pesticides Less harvest and Prevention of chronic production, increase diseases (cancer) price  The cost of public health measures are usually much easier to calculate than the benefits. It is often difficult to quantify what the risk really is and how to balance it against the other risk. Moral and Religious Belief Public Health arouses controversy on moral grounds on the following: Public Health Issues Moral grounds Sexual and reproductive Sensitive issues on sexual practices health, unwanted and family planning, abortion pregnancy AIDS, STDs and Blood Use of protective methods for safe borne STIs sex, (condom use),sex education among minors. Promoting immoral grounds Drugs and alcohol abuse, Private behavior and does not use of safe needles, directly harm others.  While regulation for the common good is valid, legislating morality has often proven to be ineffective, and self defeating because of people differ in views as moral. Moral and religious concerns may interfere with scientists cause many of these problems are due to unhealthy behaviors. Research on change behavior were highly controversial and still encourages more funding as there are many important public health problems despite traditional values coalition often reluctant to support. Political interference with Science Scientific Integrity in Policy Making - Formed by the Union of Concerned Scientists, composed of 60 leading scientists including 20 Nobel prize winners in 2004 during the George Bush Administration. - Documented many instances of the misrepresentation or suppression of scientific information of stacking of scientific advisories to obscure the fact that policy decisions were based on its political agenda, which favored right-wing constituents and large corporations. Issues involve policy making in public health and political agenda: Sexual Abstinence – only program for preventing teenage pregnancy versus condom use. Condom use on HIV/AIDS prevention program with 5 sex education program versus abstinence. Abortion causes breast cancer was discredited and remove from inaccurate information despite reported by the National Cancer Institute in US. Conflict of interest of those who hold position in the committee and who have ties to the industry. Global warming versus Global Climate Change suppressed information and discredited scientific evidence. Packing scientific advisory committee with ideologues and industry representatives.