Health Inequalities PDF

Health Inequalities Health inequalities are systematic, avoidable and unjust difference in health and well being between group of people. Around each individual are various layers of influences on health (determinants), such as lifestyle, community networks, living and working conditions- including...

Health Inequalities Health inequalities are systematic, avoidable and unjust difference in health and well being between group of people. Around each individual are various layers of influences on health (determinants), such as lifestyle, community networks, living and working conditions- including access to services-and socio-economic conditions. Health inequalities are the result of inequalities enthuse determinants of health. General Socioeconomic, cultural and environmental conditions: i) Social and community networks: Agricultural and food production, Education, Work Environment, Living and working conditions, Unemployment, Water and Sanitation , Health care Services and Housing.  Health Inequalities ii) Individual Life style factors: Age, Sex and hereditary factors. Why intervene to reduce health inequalities: Wide inequalities in life expectancy exit between the most and list deprived areas of England, with a difference of 9.2 years for men and 7.0 years for women. -People living in the least deprived areas live around 20 years longer in good health than those in the most deprived areas Health inequalities account for productivity losses , and lost taxes and higher welfare payments in the range of £20-32 billion per year. -NHS healthcare costs associated with inequality are in excess of £5.5 billion per year  Why intervene to reduce health inequalities The SOS, NHS England and CCGs have legal duty to have regard to need to reduce health inequalities in access to and outcomes from health services (Health and Social Care Act 2012) -Reducing the health and wellbeing gap is a key aim of the NHS Five Year Forward View; it warns that if prevention is not taken seriously, the burden of ill health will increase and health inequalities will widen Objective 1 of the Government mandate to the NHS is, through better commissioning, to improve local and national health outcomes, and reduce health inequalities  Interventions to reduce health inequalities We can think about interventions to reduce health inequalities in a number of ways. For examples Intervening at different levels of risk Intervening for impact over time Intervening across the life course However, to have real impact, interventions need to be at scale in order to reach large sections of the population  Interventions at different level of risk Physiological Risks: High blood pressure and High Cholesterol Behavioral Risks: Smoking, Poor diet, lack of exercise, excess alcohol Psycho-social Risk: Isolation, low self esteem, poor social networks Risk Conditions (Wider determinants): Poverty, unemployment, poor educational attainment. It is important that health inequalities strategies contain population level actions at each level of risk, to impact at sufficient and sustainable scale.  Interventions for impact over time Different types of intervention will have different impacts over different time periods Substantial impact in 3-5 years: Manage hypertension, CHD, Diabetes and Cancer Substantial impact in 8-10 years: Tobacco, Alcohol harm, Obesity management Substantial impact in12-15 years: Work and skills, Reduce poverty and Housing  Interventions across the life course A life course approach means that action to reduce health inequalities starts before birth and continue through old age Sustainable communities and places: Healthy Standard of Living Early years: Prenatal and Preschool Skill Development: Preschool and School Employment and Work: Training and Employment Prevention (Accumulation of positive and negative effects on health and wellbeing): Retirement  Interventions Should be Evidence based:– concentrate on interventions where research evidence and professional consensus are strongest Outcomes orientated – with locally owned and relevant measurements Systematically applied – not depending on exceptional circumstances or exceptional champions Scaled-up appropriately – ‘industrial-scale’ processes require different thinking to small ‘bench experiments’ Appropriately resourced – refocused on core budgets and services rather than short bursts of project funding Sustainable – continue for the long haul, capitalizing on changing  Population Intervention Triangle Civic-level interventions—> Community based—> Service Based Interventions Civic-level interventions: Public policy drives the social determinants of health and wellbeing e.g., transport, education, employment and the built environment Acting to mitigate the structural obstacles to good health through civic action is a vital method of reducing health inequalities. This includes use of legislation, regulation, taxation and licensing within devolved local powers. Action on improving this level of intervention needs to be targeted appropriately, in order to reach all relevant parts of the population Adopting a Health in All Policies approach can support local public sector agencies to embed action on health inequalities across their wide ranging  Population Intervention Triangle Community based: The quality of community life, social support and social networks are major influences on individual and population health. Local action on inequalities can be supported by: strengthening local communities and social networks; building capacity for people to be involved in community champion, peer support or similar roles; developing strong collaborative / partnership relationships; providing access to community resources Civic structures and processes need to reach out to support and promote all communities and excluded groups, not just those with existing leadership, infrastructures and resources Involving communities may also improve service reach and uptake by breaking down barriers to using services  Population Intervention Triangle Service Based Interventions: Quality services producing good outcomes at individual level - delivered with sufficient system and scale - can add up to population level change -Variability in the delivery and uptake of services can exacerbate health inequalities. Ensuring equitable access to (and outcomes from) service-based interventions is key. Effective service based interventions work better with the combined input of civic and community interventions, e.g. a tobacco control strategy will include civic regulation on smoking in public spaces, and contraband sales; support to community campaigns and smoking policies in workplaces; smoking cessation services  Place-based system Place-based system are well positioned to achieve optimal population level changes where: Strong partnerships – involving public, private and voluntary sectors – support integrated structures, governance and funding Vision and strategy draws on shared intelligence and a bottom-up understanding of community needs and assets Plans, programmes and services are co-produced, enhancing possibilities for multifaceted approaches to reducing health inequalities Realistic but challenging goals are set, establishing the means, dimensions and timescales for change.  Tools to support local action A range of tools, data and resources are available to support a systematic approach to reducing inequalities in life expectancy and healthy life expectancy: a. assessing health inequalities – e.g. Public Health Outcomes Framework, Segment Tool, Local Health Tool b. effectiveness of actions and interventions – e.g. PHE local action on health inequalities resources, Health in All Policies c. cost effectiveness – e.g. CVD Prevention Opportunities Tool, Return on Investment Tool: Colorectal Cancer, Spend and Outcomes Tool  Summary We can intervene to reduce health inequalities in a number of ways, however, to have a real impact, interventions need to be at scale in order to reach large groups of the population Population level interventions that are multifaceted and complementary are more likely to be successful in reducing inequalities An engaged leadership that considers reducing health inequalities as key to delivery of first level priorities is critical, as it needs to be built into local vision and strategy, and integrated with other key policy areas Place-based systems are well positioned to achieve the population level change required to reduce inequalities. A range of online tools and resources have been developed by PHE to support local action on health inequalities. 19 Reducing health inequalities: System, scale and sustainability  National Public health Policies and Regulation National Health Agencies are organization has its own administrative body or committee that raises funds through its members or from private sources. It has paid or voluntary staff. Works for health promotion, health education and health legislation, etc. DEFINITION Health agency may be defined as an organization that is administered by an autonomous board which holds meetings, collects funds & expend money for providing care, health education, & research works. PURPOSES OF HEALTH CARE AGENCIES: Provision for promotive and preventive care , Rendering curative services , Reduction in population growth rate , Improvement in nutritional status , Improvement in sanitation facilities. Development of manpower resources ,Provision for safe water and food supply ,Increasing the literacy rate and Reducing the levels of poverty  National Public health Policies and Regulation National is used to describe something that belongs to or is typical of a particular country and nation. Health is state of complete physical, mental and social well-being and not merely the absence of disease or infirmity Policy course or principle of action adopted or proposed by an organization or individual.  National Public health Policies and Regulation Steps for implementation of policy: -Policy evaluation. -Policy implementation. -Policy formulation. -Identification and issue recognition.  National Health Policies -National health policy in India was not framed and announced until 1983. - The ministry of health and family welfare evolved a National Health Policy in 1983, keeping in view the national commitment to attain the goal health for all by 2000 A.D. - The policy lays stress on the preventive, promotive, public health and rehabilitation aspects of health care. -To attain the objectives “Health for all by 2000 AD”, the Union Ministry of Health and Welfare formulated National Health Policy 1983. -Creation of greater awareness of health problems in the community and means to solve the problems by the community.  National Health Policies -Supply of safe drinking water and basic sanitation using technologies that people can afford. - Reduction of existing imbalance in health services by concentrating more on the rural health infrastructure. - Establishing of dynamic health management information system to support health planning and health program implementation. - Provision of legislative support to health protection and promotion. -Concerned actions to combat wide spread malnutrition. - Research in alternative method of health care delivery and low cost health technologies. - Greater co-ordination of different system of medicine. Factors interfering with the progress towards health for all Insufficient political commitment to the implementation on Health for All. - Failure to achieve equity in access to all primary health care elements. - The continuing low status of women. - Slow socio-economic development. -Difficulty in achieving intersectoral action for health. -Unbalanced distribution of and weak support for human resources. - Widespread inadequacy of health promotion activities. - Weak health information system and no baseline data. - Pollution, poor food, safety, and lack of water supply and sanitation. - Rapid demographic and epidemiological changes. - Inappropriate use of and allocation of resources, high-cost technology. - Natural and man-made disasters  National Health Policies Considering the kind and level of progress, the barriers and the change in health problems and the circumstances, the department of Health, Ministry of Health and Family Welfare felt it necessary to formulate a new health policy frameworks as National Health Policy 2001 (NHP 2001) -The main objective of National Health Policy 2001 is to achieve acceptable standard of good health amongst the general population of the country  Goals to be achieved by 2001-2015 -Eliminate Polio and Yaws - 2005 - Eliminate Leprosy - 2005 -Eliminate Kala- Azar - 2010 - Eliminate Lymphatic Filariasis - 2015 - Achieve zero level growth of HIV/AIDS - 2007 - Reduce mortality by 50% On account of TB,Malaria - 2010 Other vector born and water born Prevalence of blindness to 0.5% - 2010 -Reduce IMR to 30/1000 and MMR to 100/lakh - 2010 -Improve nutrition and reduce LBW Babies from 30% to 10% - 2010 - Increase the utilization of Public Health Facilities from current >20 to  National Health Policies National Health account and Health statics: - Increase health expenditure by government as a % GDP from 0.9 to 2% - 2010 - Increase share of central grants to Constitute at least 35% of total Health spending - 2005 - Increase State health spending From 5.5% to 7% of budget - 2010  National Health Care Agencies 1. Indian Red Cross Society: this society is to promotion of health, prevention of disease and mitigation of suffering among the people. 2. Hind Kusht Nivaran Sangh: To carry out research on various aspects of leprosy 3. Indian Council for Child Welfare :to secure Indian children and those opportunities and facilities which are necessary to develop them physically mentally, spiritually and socially in a healthy and normal manner. 4 Tuberculosis Association of India: basically encourages prevention, control, treatment and relief of tuberculosis 5. Bharat Sevak Samaj: Work to enlist people’s participation in National construction programs.  National Health Care Agencies 6. Central Social Welfare Board: Carry out welfare activities for promoting voluntarism, providing technical financial assistance to the voluntary organisations for general welfare family, women and children 7. The Kasturba Memorial Fund 8. Family Planning Association of India: been recognized as India’s Leading and Largest Reproduction and Sexual Health Organization 9. All India Women's Conference: It is a women’s voluntary welfare organization working for women’s development and empowment  National Health Care Agencies INDIAN RED CROSS SOCIETY (IRCS) It was established in 1920 under the Indian Red Cross Society Act and incorporated under Parliament Act XV of 1920. The National headquarters of Indian Red Cross Society (IRCS) is at Delhi. It is a national organization with more than 655 branches, which are spread throughout the state, district and sub- division of the country. The main objective of this society is to promotion of health, prevention of disease and mitigation of suffering among the people.  Governance Structure President (Hon’ble President of India): Mr Shri Ram Nath KOVIND Chairman (Hon'ble Minister of Health & Family Welfare, Government of India) : Dr. Harsh VARDHAN Vice-Chairman: Mr Avinash Rai Khanna Secretary General: Mr Shri. R.K. JAIN Joint Secretary : Dr. Veer BHUSHAN Deputy Secretary: Mr Manish CHOUDHARY Deputy Secretary: Mr Neel Kamal SINGH Director, Blood Bank: Dr Vanshree SINGH  INDIAN RED CROSS SOCIETY (IRCS) Activities of Indian red cross society -Social and relief work at time of disasters like floods, earthquakes, epidemics. -Supplies of essential items like drugs, milk, milk powder, vitamins, nutritional supplements to hospitals, maternity health centres, child care centres, schools and orphanages. -Maintenance of blood banks. -Services for maternal and child welfare. -Medical care for defense forces. -Family welfare ( Support the well beings of families and their members) -Home for disabled servicemen -Vocational Training centre (to help low-income group and women improve their skills and earning potentials.  Indian Council for Child Welfare Abbreviation: ICCW Founded: 1952 Services: Children Indian Council For Child Welfare aims to secure Indian children and those opportunities and facilities which are necessary to develop them physically mentally, spiritually and socially in a healthy and normal manner. -It is connected with the international children welfare council. It is voluntarily engaged in promoting development services for children.  Activities Day care centre These centres provide services to small children (0-3 years) by giving food, care and protection. The scheme has been found very fruitful and essential for working mothers. Pre-school These centres cater to children ageing between 3 and 6 years. Non Formal education is implemented and nutrition is also given to them. Orphanages The department provides grant-in-aid to voluntary organizations properly registered under Society Registration Act and who are engaged in the welfare of orphans.  Activites Recreational centre cum children's library Recreational centre cum children's library has been opened at different places to enable the children to spend their leisure time in a beneficial manner and to guide them in their future lives. Selected books and material have been supplied to these centers for this purpose. State council for child welfare It was constituted to provide services to the children in need of care and protection and to promote child development in line with the aims and objectives of the Indian council of child welfare.  Others Advocating children’s rights (It aim is ensure that all children can fully enjoy their rights) Providing sponsorship under privileged to pursue school education Special project on street and working children Scrutiny of adaptation cases (Provide dependable help when disasters and other crises strike to reduce risk) Rehabilitation programs for abandoned children (Parents are unable to take care of child) Special focus on girl child Conduction of national integration and adventure camps(Adventure training in NCC and Scouts ) ICMR as National Public Health Regulating Agency ICMR Overview: The ICMR, New Delhi, is among the oldest medical research organizations globally and the leading body in India. Premier National Agency: Responsible for the planning, formulation, coordination, implementation, and promotion of biomedical research in India. Historical Background: Established in 1911 as the Indian Research Fund Association (IRFA) to sponsor and coordinate medical research across the country. Post-Independence Changes: Significant organizational and activity-related changes were made to the IRFA after India's independence.  Introduction Renaming and Expansion in 1949: Redesignated as the Indian Council of Medical Research (ICMR) in 1949, with an expanded scope of functions and responsibilities. Government Funding: Funded by the Government of India through the Ministry of Health and Family Welfare. Roles and Expectations: Plans and promotes medical research and addresses emerging health problems, while building a strong national network of skilled biomedical scientists. Technological Advancements: Embraces rapid advances in science and technology to understand disease processes and develop strategies for prevention and cure.  Policies The Policies of ICMR coincide with national health policies such as Control and management of communicable disease Fertility control Maternal and child health Control of nutritional disorder Developing alternative strategies for health care delivery Safety limits of environmental and occupational health problems Non-communicable disease including cancer, cardiovascular, neurological, ophthalmic and haematological disorder  Aim and Objectives Network of Institutes: ICMR comprises 30 state-of-the-art institutes/centres, making it a leading organization in the field of biomedical sciences. Advancing Medical Science: Promotes biomedical research to enhance the health and well-being of the Indian population. Informing Policy: Provides evidence-based advice to the government on public health issues and medical research priorities. Building Capacity: Strengthens the research capabilities of medical colleges and institutions across India. Headquarters and Region Served: Headquartered in New Delhi, serving the entire region of India.  Role and Responsibilities Setting Standards: Develops guidelines and frameworks to ensure ethical and scientific integrity in clinical trials and medical research. Funding Research: Provides grants and resources to support innovative clinical and translational research projects. Regulatory Oversight: Oversees the regulation of new drugs, devices, and diagnostics to protect patient safety.  General Principles Principle of Essentiality: Human participants are only used in research when deemed essential after considering all alternatives with current knowledge. Principle of Voluntariness: Respect for participants' rights to agree or decline participation or withdraw at any time. Informed consent process protects participants' rights. Principle of Non-Exploitation: Equitable selection of research participants to fairly distribute the research's benefits and burdens, ensuring protection for vulnerable groups. Principle of Social Responsibility: Research is designed to avoid creating or worsening social and historical divisions, and to maintain social harmony in community relationships.  General Principles Principle of Ensuring Privacy and Confidentiality: Maintain participant privacy by keeping identity and records confidential, with access only for authorized individuals. Privacy can be breached under specific circumstances (e.g., suicidal ideation, homicidal tendency, HIV status, legal requirements) in consultation with the EC, as the right to life supersedes privacy rights. Principle of Risk Minimization: All stakeholders (researchers, ECs, sponsors, regulators) ensure risk minimization at all research stages, with appropriate care and compensation provided if harm occurs. Principle of Professional Competence: Research is planned, conducted, evaluated, and monitored by individuals with the necessary and relevant qualifications, experience, and training. Principle of Maximization of Benefit: Research is designed and conducted to maximize benefits, both directly and indirectly, for participants and society.  General Principles Principle of Institutional Arrangements: Institutions have policies for research governance and are responsible for providing infrastructure, manpower, funds, and training for research. Principle of Transparency and Accountability: Research plans and outcomes are made public through registries, reports, and publications, while protecting participants' privacy. Stakeholders must disclose conflicts of interest and manage them appropriately. Research is conducted fairly, honestly, impartially, and transparently, with records retained for possible external scrutiny or audit. Principle of Totality of Responsibility: All stakeholders are accountable for their actions and must comply with professional, social, and moral responsibilities according to ethical guidelines and regulations. Principle of Environmental Protection: Researchers must ensure environmental protection and resource conservation at all research stages, complying with existing guidelines and regulations.  Specific Principles 1.Drug trials 2. Vaccine trials 3. Surgical procedures / medical devices 4. Diagnostic agents - with special reference to use of radioactive materials and x-rays 5. Trials with herbal remedies  International Health Regulation The International Health Regulations (IHR) are the governing framework for global health security yet require textual and operational reforms to remain effective, particularly as parallel initiatives are developed. - The World Health Organization (WHO) is the agency charged with oversight of the IHR, and its leadership and efficient functioning are prerequisites for the effective implementation of the IHR. - The International Health Regulations are a formal code of conduct for public health emergencies of international concern. (PHEICs) - They are a matter of responsible citizenship and collective protection. - They involve all 194 World Health Organization member countries.  International Health Regulation The IHR requires that all countries have the ability to do the following: - Detect: Make sure surveillance systems and laboratories can detect potential threats - Assess: Work together with other countries to make decisions in public health emergencies - Report: Report specific diseases, plus any potential international public health emergencies, through participation in a network of National Focal Points - Respond: Respond to public health events  International Health Regulation Why are IHR: Assist countries to work together to save lives and livelihoods endangered by infectious diseases. - Prevent, protect against and control the spread of disease. - Avoid unnecessary interference with international trade & travel -Provide a public health response to the international spread of disease  CDC As International Health Regulating Agency CDC the leading national public health institute of the United States. It is a federal agency under the Department of Health and Human Services and is headquartered in Atlanta, Georgia. Center for Disease Control and Prevention The Center for Disease Control and Prevention (CDC) is a federal agency that conducts and supports health promotion, prevention and preparedness activities in the US with the goal of improving overall public health. Established in 1946 and based in Atlanta, the CDC is managed by the Department of Health and Human Services (HHS). The CDC works with partners at the local, state and national level to: monitor and prevent disease outbreaks , implement disease prevention strategies and maintain national health statistics.  Goals and Aims Its main goal is to protect public health and safety through the control and prevention of disease, injury, and disability. It especially focuses on: i) infectious disease ii) food borne pathogens iii) environmental health iv) occupational safety and health v) health promotion vi) injury prevention vii) educational activities to improve the health of citizens. In addition, the CDC researches and provides information on non- infectious diseases such as obesity and diabetes  Organization The CDC is organized into "Centers, Institutes, and Offices" (CIOs) which allow it to be responsive and effective in public health concerns. Each organizational unit implements the agency's response in a particular area of expertise. Within "Offices" are Centers, Divisions, and Branches. Some examples of CIOs are i) CDC Washington Office ii) Center for Global Health iii) National Institute for Occupational Safety and Health iv) Office for State, Tribal, Local and Territorial Support v) Office of Equal Employment Opportunity vii) Office of Infectious Diseases  Diseases in which CDC is involved 1.Influenza: The CDC has launched campaigns targeting the transmission of influenza, including the H1N1 swine flu. The CDC has launched websites including [flu.gov] to educate people in proper hygiene. 2.Other infectious diseases: The CDC's website has information on other infectious diseases, including smallpox, measles, and others. The CDC runs a program that protects the public from rare and dangerous substances such as anthrax and the Ebola virus. The program, called the Select Agents Program, calls for inspections of labs in the U.S. that work with dangerous pathogens.  Diseases in which CDC is involved 3. Non- infectious diseases: The CDC also works on non-infectious diseases, including chronic diseases caused by obesity, physical inactivity and tobacco-use 4Antibiotic resistance: The CDC implemented their National Action Plan for Combating Antibiotic Resistant Bacteria as a measure against the spread of antibiotic resistance in the United States.  Global Health The CDC partners with many international organizations such as the World Health Organization (WHO) and global divisions include: Division of Global HIV & TB (DGHT), Division of Parasitic Diseases and Malaria (DPDM), Division of Global Health Protection (DGHP), and Global Immunization Division (GID). The CDC is integral in working with WHO in establishing the International Health Regulations (IHR), that is binding on 194 member countries, through the Global Disease Detection Program (GDD) and the WHO and CDC Global Surveillance Systems.  Malnutrition and Lifestyle disorder Malnutrition Definition: A condition resulting from an unbalanced diet, either deficient or excessive in nutrients, causing health problems. Affected Nutrients: Can involve an imbalance of calories, proteins, carbohydrates, vitamins, or minerals. Example Case: A 1-year-old girl in Chittagong, Bangladesh, is severely malnourished. WHO Definition: According to WHO, malnutrition is "The cellular imbalance between supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions."  Malnutrition Malnutrition Types: Under Nutrition: Protein-energy malnutrition and micronutrient deficiency. Over Nutrition: Obesity. WHO Classification: BMI: A simple index of weight-for-height used to classify underweight, overweight, and obesity in adults. Definition: Weight in kilograms divided by the square of height in meters (kg/m²).  Classification of Malnutrition Gomez Classification : The degrees were based on weight below a specified percentage of median weight for age. The risk of death increases with increasing degree of malnutrition Degree of PEM % of desired bodyweight for Age and Sex Normal 90-100% Mild: Grade I 75-89% Moderate: Grade II 60-74% Severe: Grade III < 60%  Classification of Malnutrition Water low classification: The classification established by waterlow combines weight- for-height (indicating acute episodes of malnutrition) with height-for-age to show the stunting that results from chronic malnutrition. Degree of PEM Stunting (%) Height for Age Wasting (%) Weight for height Normal > 95% >90% Mild: Grade I 87.5-95% 80-90% Moderate: Grade II 80-87.5% 70-80% Severe: Grade III