Public Health Management week 1-2.pptx

Public Health Management PMH 3117 (PREMED) L E C T U R E R : D R R O N A L D R O B E RT S O N M D , M M E D - F M , M PA Your best quote that reflects your approach… “It’s one small step for man, one giant leap for mankind.” - NEIL ARMSTRONG Course Description Public health is the science of ide...

Public Health Management PMH 3117 (PREMED) L E C T U R E R : D R R O N A L D R O B E RT S O N M D , M M E D - F M , M PA Your best quote that reflects your approach… “It’s one small step for man, one giant leap for mankind.” - NEIL ARMSTRONG Course Description Public health is the science of identifying conditions ,factors and mechanisms for good and bad health. Identifying and implementing effective interventions to promote and prevent public health. This course will provide a basic introduction to public health with emphasis on health promotion and disease prevention in all phases of life. Specific objectives At the end of this course the student will have in-depth knowledge of different understandings of the concepts of health and diseases Will be able to argue for individual, population and environment- oriented perspectives in health promotion and preventive public health work.  Will Have thorough knowledge of public health and health determinants related to society, culture, environment and individual and see this in a past, present, and future perspective. Specific objectives continued Will have an overview of the different scientific theoretical perspectives and methods in public health work. Will have a critical attitude to theories and models, which requires knowledge of different perspectives on health promotion, prevention, and social change. Will have thorough knowledge of key political, economic, and legal guidelines that are relevant to public health work in public, work, and civil society. Course Content  The duration of the course is 16 weeks.  Classes are two (2) hours per session twice weekly.  There will be three (3) in class quizzes and one assignment.  Quizzes are worth 10 % each of the final course work.  Assignments are worth 10 %. Of final course work.  Final exams are worth 60 % of final grade. Week 1- 2: Introduction to Public Health Principles and Practice Concepts of physical, social, and mental health and an understanding of preventive and promotional efforts applicable to community health care Identify eras in the historical development of public health and ways that public health affects literature and the arts, current events, and everyone’s daily life. Week 3-4: Core Functions of Public Health Individual vs population health Primary, secondary, tertiary prevention Social class, culture, racism, discrimination, religious bias, and privilege in public health systems Week 4-5: Public Health in a Global Context Problems posed by increasing cost/wastage of human and material resources; be knowledgeable about economic aspects of health care and the uneven distribution of health manpower and their role in affecting change. Health problems, apply epidemiological methods in responding to public health issues. Interaction of environmental factors social, biological, physical and their effect on health and disease Quality and coverage (Health and Social Service) Week 6-7: Environmental Health and Safety Determinants and implications of population measures, including family planning and family life education, available for dealing with ensuing problems. Identify the roles of public health in addressing the needs of vulnerable populations and health disparities. Week 8-9: Law And Ethics in Public Health Practice Public health Act and related legislations Public health law enforcers mentagencies and authorization Ethical issues in public health: What should we be doing? For whom should we be doing it; and at? what cost to others? And Who should decide and how? Principle so ethical debate and behavior: Autonomy; Beneficence; Non- maleficence; and Justice Using framework of ethics in making difficult choices: Evidence of effectiveness; Equity; and Patient choice Week 10-11: Population Health: Past, Present and Future Trends in morbidity and mortality History of public health and impact of globalization Pragmatic challenges Inter-professional teamwork Diversity, equity, and inclusion Week 12 -13: Integrating Medicine and Public Health Healthcare organization and financing Measuring the performance of health systems by understanding the Theory and Process of Strategy Development Public health institutions systems and structure Understanding Individuals, Teams, and their Development Management and Change Week 14: Revision Week 15 & 16: Final Examination Definition of Public Health Public health is “the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.” — CEA Winslow(Winslow CEA. The untilled field of public health. Mod Med 1920;2:183–91.) Definition of Health According to the WHO “Health is a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity.” It was adopted in 1946 and has not been amended since 1948 (WHO,1946) Determinants of Health Health is influenced by many factors, which may generally be organized into five broad categories known as determinants of health:  Genetics  Behavior  Environmental and physical influences.  Medical care Social factors. Genetics Inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses such as sickle-cell anemia, hemophilia, and cystic fibrosis. Carrying the BRCA1 or BRCA2 gene, which increases risk for breast and ovarian cancer. Individuals with a particular set of genes may be either more or less likely, if exposed, to be at risk of developing a particular disease Behavior (health behavior) The term health behavior can refer to behaviors that are beneficial to health. However, the term is generally used in the negative to refer to behaviors that harm health such as : Smoking. Abusing alcohol or other substances.  Failing to use seat belts or practicing other unsafe behaviors.  Making unhealthy food choices. Not engaging in adequate physical activity. Environmental and physical influences Physical environment includes both the natural and built environments.  natural environment: Is defined by the features of an area that include its topography, weather, soil, water, animal life, and other such attributes Built environment: is defined by the structures that people have created for housing, commerce, transportation, government, recreation, and so forth. Common health threats related to the natural environment include weather- related disasters (tornados, hurricanes, and earthquakes) as well as exposure to infectious disease agents. Environmental and physical influences Health threats related to the built environment include : Exposure to toxins and unsafe conditions, particularly in occupational and residential settings. Where people spend most of their time. Many occupations expose workers to disease-causing substances, high risk of injury, and other physical risks. Medical care  Promoting and maintaining health. Preventing and managing disease.  Reducing unnecessary disability and premature death. Achieving health equity.  Social Factors The social environment is defined by the major organizing concepts of human life: Society.  Community. Religion. Social network.  Family. Occupation. . Physical Health Physical health is defined as the condition of your body, taking into consideration everything from the absence of disease to fitness level. and can be affected by: Lifestyle: diet, level of physical activity, and behavior (for instance, smoking); Genetics: a person’s genetics and physiology may make it easier or harder to achieve good physical health. Environment: our surroundings and exposure to factors such as sunlight or toxic substances; Healthcare service: good healthcare can help prevent illness, as well as detect and treat illness. Social health (well being) Social wellness is achieved when we are able to create and maintain healthy, reciprocal relationships with the people around us. Positive social relationships can provide us with comfort and support in difficult times, increasing our resilience and ability to cope with life’s challenges. Social well being is supported not only by our relationships with others – but also by how we choose to interact, express ourselves and form our own personal habits around these. Benefits of social well being Building healthy relationships with others  Improved conversational Increased self-esteem skills  The ability to set and Reduced depression and anxiety maintain boundaries A feeling of belonging and  Improved physical health security and well being Support during difficult times  Increased longevity Development of life skills such  social-wellness as assertiveness Mental health Mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being.  Mental health is a basic human right. it is crucial to personal, community and socio- economic development. Determinants of Mental Health Individual psychological and biological factors such as emotional skills, substance use and genetics can make people more vulnerable to mental health problems. Exposure to unfavorable social, economic, geopolitical and environmental circumstances – including poverty, violence, inequality and environmental deprivation – also increases people’s risk of experiencing mental health conditions. Risks can manifest themselves at all stages of life, but those that occur during developmentally sensitive periods, especially early childhood, are particularly detrimental.  For example, harsh parenting and physical punishment is known to undermine child health and bullying is a leading risk factor for mental health conditions. Health promotion Health promotion is the process of encouraging people to make healthy choices and motivating them to be consistent with their intentions based on theories related to human behavior. Health promotion is generally implemented through strategies like patient education and counseling. Approaches to Health Promotion Pender’s Health Promotion Model Health Belief Model (HBM) Transtheoretical Model (TTM) Theory of Reasoned Action (TRA) Diffusion of Innovation Theory (DOI) Pender’s Health Promotion Model Pender’s Health Promotion Model is based on the idea that people’s experiences affect their health outcomes. Health promotion models are focused on exploring people’s attitudes about health and individual experiences related to it.  According to the theory, one would have to look at people’s lifestyles, psychological health, and social and cultural environment to understand most of their health-related decisions. For example, not eating fresh vegetables because one grew up not consuming produce is a way of understanding why someone may suffer from a severe condition like obesity. Health Belief Model (HBM) HBM theory suggests that a person’s belief of a diagnosed illness combined with their view of a treatment’s effectiveness predicts their likelihood of adopting a change. As a result , health practitioners might take immediate action of telling someone that they’re either susceptible or have a serious medical condition. Moreover, they might expect a person to question the medical approach if they don’t feel the symptoms and show apprehension toward medical advice. What follows this initial outcome might be an informed recommendation of the risk factors that can worsen illness. In more severe cases of non-compliance, healthcare leaders must develop strategies based on the HBM. Transtheoretical Model (TTM) The transtheoretical model of behavior change is an integrative theory of therapy that assesses an individual's readiness to act on a new healthier behavior, and provides strategies, or processes of change to guide the individual. The model is composed of constructs such as: Stages of change.  Processes of change.  Levels of change.  Self-efficacy. Decisional balance. Stages of Transtheoretical Model (TTM) 1.Pre-contemplation: the patient does not intend to act yet despite knowing about the medical condition. 2.Contemplation: the patient is planning to act with intention. 3.Preparation: the patient establishes a course of action and sets a timed objective. 4.Action: the patient takes the course of action. 5.Maintenance: the patient focuses on not relapsing and maintaining a plan within their daily routines. For some individuals, this may last a few months, while for others, it could turn into a permanent state. For example, a recovering alcoholic may struggle with relapses and might stay in the maintenance stage their entire life. 6.Termination: the patient is actively healthy and no longer interested in returning to old behaviors. Theory of Reasoned Action (TRA) The theory assumes that a person will act a certain way on a health issue depending on their willingness due to subjective norms. The norms are usually the result of social and environmental surroundings and the person’s perceived control over that behavior. For example, a healthcare professional might ask a young man if his close circle of friends thinks he should incorporate exercise into their daily routine. Diffusion of Innovation Theory (DOI) Diffusion of Innovation (DOI) is another theory that falls under community and organization participation models.  The theory investigates how a new idea or health behavior is disseminated in a social structure or community and identifies what influences how quickly the idea or behavior is adopted. The adoption of new ideas depends on the type of innovation, communication channels, time and social system.  According to the Health Communication Capacity Collaborative, the DOI model “highlights the uncertainties associated with new behaviors and helps public health program implementers consider ways to resolve these uncertainties.” Promotion Planning Tools PABCAR MODEL PRECEDE-PROCEED MODEL LOGIC MODEL PABCAR model The PABCAR model is a decision-making tool for health program planning and is useful for the needs assessment process. PABCAR is an acronym for five key questions support program development. 1. What is the Problem and is it significant? 2. Is it Amenable to change? 3. Are the intervention Benefits greater than costs? 4. Is there Acceptance for the interventions? 5. What actions are Recommended? PRECEDE-PROCEED Model PRECEDE provides the structure for planning a targeted and focused public health program. PRECEDE stands for :Predisposing Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation Functions of PRECEDE Social Assessment: Determine the social problems and needs of a given population and identify desired results. Epidemiological Assessment: Identify the health determinants of the identified problems and set priorities and goals. Educational and Ecological Assessment: Analyze behavioral and environmental determinants that predispose, reinforce, and enable the behaviors and lifestyles identified. Health Program and Policy Development: Identify and develop appropriate interventions that encourage desired and expected changes. PROCEED PROCEED provides the structure for implementing and evaluating the public health program. PROCEED stands for Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development. It involves the identification of desired outcomes and program implementation: Functions of PRECEED Process Evaluation: Determine if the program is reaching the targeted population and achieving desired goals. Short-term Evaluation: Evaluate the change in knowledge, skills, and attitudes. Intermediate Evaluation: Evaluate the change in behavior. Long-term Evaluation: Identify if there is a decrease in the incidence or prevalence of the identified negative behavior or an increase in identified positive behavior. PRECEDE-PROCEED FRAMEWORK LOGIC MODEL The logic model is used during the developmental stages of program planning to demonstrate the logical flow of program elements. It provides a visual map of the activities and outputs of a health based program. The logic model elements are: Inputs: the resources, contributions and investments that go into the program. Outputs: the activities, services, events and products that reach the target audience. Outcomes: the results or changes for individuals, groups, communities, organizations or systems. Assumptions: the beliefs we have about the program, the people involved, the context and the way we think the program will work. External Factors: the environment in which the program exists that includes a variety of external factors that interact with and influence the program. LOGIC MODEL Why is health promotion important Individuals’ behavior is easier to change than physical and social environmental factors including cultural, economic, and political factors. Health promotion improves the health status of individuals, families, communities, states, and the nation. Health promotion enhances the quality of life for all people. Health promotion reduces premature deaths. By focusing on prevention, health promotion reduces the costs (both financial and human) that individuals, employers, families, insurance companies, medical facilities, communities, the state and the nation would spend on medical treatment. For the Next Class Identify eras in the historical development of public health and ways that public health affects literature and the arts, current events, and everyone’s daily life History of Public Health The history of public health is derived from many historical ideas, trial and error, the development of basic sciences, technology, and epidemiology. In the modern era: James Lind’s clinical trial of various dietary treatments of British sailors with scurvy in 1756  Edward Jenner’s1796 discovery that cowpox vaccination prevents smallpox have modern-day applications.  as the science and practices of nutrition and immunization are crucial influences on health among the populations of developing and developed countries. Why study the history of public health? It provides a perspective to develop an understanding of health problems of communities and how to cope with them. the history of public health is a story of the search for effective means of securing health and preventing disease in the population Public health evolved through trial and error and with expanding scientific medical knowledge, at times controversial, often stimulated by war and natural disasters. The evolution of public health is a continuing process; pathogens change, as do the environment and the host. In order to face the challenges ahead, it is important to have an understanding of the past Main Historical eras of public health 1. Prehistoric Societies 2. The Ancient World 3. The Early Medieval Period (Fifth to Tenth Centuries CE) 4. The Late Medieval Period (Eleventh to Fifteenth Centuries) 5. The Renaissance (1400–1600s) 6. Enlightenment, Science, and Revolution (1600s–1800s) 7. Eighteenth-Century Reforms 8. Social Reform and the Sanitary Movement (1830–1875) 9. Twentieth and twenty-first century reforms. Prehistoric Societies The Paleolithic Age is the earliest stage of human development where organized societal structures are known to have existed. These social structures consisted of people living in bands which survived by hunting and gathering food.  Mesolithic Age or transitional phase of evolution from hunter–gatherer societies into the food- raising societies  Neolithic Age of food-raising societies occurred during different periods in various parts of the world, first in the Middle East from 9000 to 8000 BCE onward, reaching Europe about 3000 BCE. Resulted in communal habitation and changes in environment which led to disease production and methods to cure said diseases (shamans and witch doctors)  life expectancy : 25–30 years, with men living longer than women, probably due to malnutrition and maternity-related causes. The Ancient World The development of agriculture: served growing populations unable to survive solely on hunting, gathering, responded to disease such as malnutrition, and stunted growth. Development of urban societies: Population growth and communal living led to improved standards of living but also created new health hazards which required community action to prevent disease and promote survival. In the first civilizations, mystical beliefs, divination, and shamanism coexisted with practical knowledge of herbal medicines, midwifery, management of wounds or broken bones, and trepanation to remove “evil spirits”. The Ancient World writing led to medical documentation. Requirements of medical conduct were spelled out as part of the general legal code of Hammurabi in Mesopotamia (c. 1700 BCE) Training of medical practitioners, regulation of their practice, and ethical standards evolved in a number of ancient societies. Some cultures equated cleanliness with godliness and associated hygiene with religious beliefs and practices. The Hebrew Mosaic law of the five Books of Moses (c. 1000 BCE) stressed prevention of disease through regulation of personal and community hygiene, reproductive and maternal health, isolation of lepers and other “unclean conditions”, and family and personal sexual conduct as part of religious practice. The Early Medieval Period (Fifth to Tenth Centuries CE) The Roman Empire disappeared as an organized entity following the sacking of Rome in the fifth century CE. The eastern empire survived in Constantinople, with a highly centralized government.  Later conquered by the Muslims, it provided continuity for Greek and Roman teachings in health. The western empire integrated Christian and pagan cultures, which viewed disease as punishment for sin.(Possession by the devil and witchcraft were accepted as causes of disease) The Early Medieval Period (Fifth to Tenth Centuries CE) Most physicians were monks guided by Church doctrine and ethics. The largely rural population of the European medieval world lived with poor nutrition, education, housing, sanitary, and hygienic conditions  Endemic and epidemic diseases resulted in high infant, child, and adult mortality. Commonly, 75 percent of newborns died before the age of five. Maternal mortality was high. Leprosy, malaria, measles, and smallpox were established endemic diseases, along with many other less well-documented infectious diseases. The idea of prevention was seen as interfering with the will of God. The Late Medieval Period (Eleventh to Fifteenth Centuries) Feudal period: ancient Hebraic and Greco-Roman concepts of health were preserved and flourished in the Muslim Empire Monastery hospitals were established between the eighth and twelfth centuries to provide charity and care to ease the suffering of the sick and dying The monastery hospitals (described in eleventh-century Russia) were gradually supplanted by municipal, voluntary, and guild hospitals developed in the twelfth to sixteenth centuries. By the fifteenth century, Britain had 750 hospitals. Medical care insurance was provided by guilds to its members and their families. Hospitals employed doctors, and the wealthy had access to private doctors. The Late Medieval Period (Eleventh to Fifteenth Centuries) Leprosy became a widespread disease in Europe measures were developed to control same. Crowding, poor nutrition and sanitation, lack of adequate water sources and drainage, unpaved streets, keeping of animals in towns, and lack of organized waste disposal created conditions for widespread infectious diseases. Medical care was still largely oriented towards symptom relief. The Black Death, mainly pneumonic and bubonic plague ravished Europe and China. The Renaissance (1400–1600s) During this period, mines, foundries, and industrial plants flourished, creating new goods and wealth. vast epidemics of malaria, syphilis, typhus, smallpox, measles, and the plague continued to spread across Europe Rickets, scarlet fever, and scurvy, particularly among sailors, were rampant Control measures to combat syphilis tried in various cities, included examination and registration of prostitutes, closure of communal bath houses, isolation in special hospitals, reporting of disease, and expulsion of sick prostitutes or strangers. The Renaissance (1400–1600s) In England in 1662, John Graunt published Natural and Political Observations Upon the Bills of Mortality. He showed statistical relationships between mortality and living conditions. it was the first instance of statistical analysis of mortality data, providing a foundation for the use of health statistics in the planning of health services. He also established the sciences of demography and vital statistics and methods of analysis, providing basic measurements for health status evaluation with mortality rates by age, sex, and location Enlightenment, Science, and Revolution (1600s–1800s) The Enlightenment, a dynamic period of social, economic, and political thought, provided great impetus for political and social emancipation and rapid advances in science and agriculture, technology, and industrial power. the development of microscopy, invented in 1676, as a tool that provided a method for the study of microorganisms In the seventeenth century, the great medical centers were located in Leyden, Paris, and Montpelier. Health situation 17th and 18th century Improvements in agriculture created greater productivity and better nutrition. These were associated with higher birth rates and falling death rates, leading to rapid population growth. The agricultural revolution during the sixteenth and seventeenth centuries, based on mechanization and larger land units of production with less labor, was associated with rural depopulation and provided excess workers to staff the factories, mines, ships, home construction, and shops of the industrial revolution. Urban areas suffered from crowding, poor housing, sanitation, poor nutrition, and harsh working conditions, which together produced appalling health conditions. Advances made in the 17 and th 18th centaury In 1700, Bernardino Ramazzini (1633–1714) published a monumental piece on occupational diseases (Diseases of Workers),  applying epidemiological principles and highlighting specific health hazards. These occupational risks included exposure to chemicals, dust, and metals, as well as musculoskeletal injury from unnatural postures and repetitive or violent motions Considered to be the “father of occupational medicine” Applied epidemiology Samuel Purchas (1577–1626) in 1601 and John Woodall (a British naval doctor, 1570–1643) in 1617 recommended the use of lemons and oranges in the treatment of scurvy, but this was not widely practiced. During the seventeenth to eighteenth centuries, Russian military practice included antiscorbutic preparations, and the use of sauerkraut for this purpose became common in European armies Edward Jenner (1749–1823) was the first to use vaccination with cowpox to prevent smallpox in 1796 Historic implications today Sanitation Occupational health Epidemiology Health promotion (vacination, balanced diet, disease control ) https://siren.org.au/program-planning-tools-and-templates/ https://www.floridatechonline.com/blog/healthcare-management/5-health- promotion-models-and-how-to-apply-them/