1 & 2 Flashcards
(31 cards)
Upstream
- Policy and Programs (corporations and other businesses, government agencies, schools)
- Social Inequities (class, race/ethnicity, gender, immigration status, sexual orientation)
- Government, schools, CBOs
Midstream
- Physical Environment (housing, land use, transportation, residential segregation)
- Behavior (smoking, nutrition, physical activities, violence)
- Parks and housing
Downstream
- Disease and Injury (infections disease, chronic disease, injury)
- Mortality (infant mortality, life expectancy)
- Hospitals and clinics
Examples of Upstream Interventions for Physical Inactivity
Healthy Public Policy
- Tax incentives for physically active people
- Change environment to facilitate activity
- Insurance coverage for athletic facility membership
Examples of Midstream Interventions for Physical Inactivity
Preventative
- Target communities to provide exercise facilities for seniors
- Training clinicians to do activity counseling
- Media campaigns to change norms re: Exercis
- Exercise training studies (almost downstream..)
Examples of Downstream Interventions for Physical Inactivity
Curative
- Clinical Exercise Interventions
- Patient Education
Liberal Paternalism
- Public institutions (i.e. gov) might nudge people in specific directions without eliminating freedom of choice to improve their lives
- possible and legitimate for private and public institutions to affect behavior while also respecting freedom of choice
- it tries to influence choices in a way that will make choosers better off, as judged by themselves
- people should be free to opt out of specified arrangements if they choose to do so
- Thaler & Sunstein, 2003
- Health systems can help nudge people toward healthier behaviors
- Default option is the healthiest but it isn’t the only option/people have the choice to opt out (Fluoride in public water)
“Choice Architecture”
Menu labeling example
- Premise: individuals will make rational decisions based on nutrition info
- Patterns of behavior that may play a role in poor nutrition choices: tendency to stay with the usual, motivated by actions with immediate benefit
- “Choice architecture” refers to the framing or presentation of choice options
- Health systems can help nudge people towards healthier behaviors
Selective Primary Health Care
Focus on single disease interventions
Comprehensive Primary Health Care
Focus on prevention, provision of basic health services and addressing the overall disease burden in low-income countries
Improving Health Systems (General)
- Eliminate multiple vertical programs to more horizontal approaches
- Small reforms > big-bang reforms
- End goal of reform = improved health outcomes
- Performance-based financing possible if monitoring is adequate
- Capacity strengthening at all levels
- Health systems are based on theory, but inputs and outputs must be testable
Behind Doing the Behavior Associated with Improved Health Outcomes
Attitudes and beliefs about the behavior, perceived social norms about the behavior, perceived self-efficacy to (avoid) the behavior -> intention toward the behavior -> doing the behavior
National Health Model
(Beveridge): Universal health care coverage of all citizens by a central government; financed through general tax revenue; providers can be private or controlled by government.
Social Insurance Model
(Bismarck): Compulsory coverage funded by employer, individual and private insurance funds; production is controlled/owned by governments or private organizations; financed through employment taxes
Private Insurance Model
Employment-based of individual purchase of private health insurance; financed by individual and employer contributions; service delivery owned/managed by private organizations
Demand Side Health Care
Health care is like any other good; customers can exercise control over what services to buy and at what price; customers and suppliers are matched and suppliers have little control to induce demand therefore set rates of charge
South Korea and Singapore
Supply Side
Health care is a good that needs to be reasonably available to all and is an entitlement; government agencies control resources rather than allowing the market to determine cost/access to care
-Drawback: cost, and even if you provide healthcare it doesn’t mean that they’ll use it, there must be incentive/demand
former Soviet Union
Major Goals of Health Reform
- Controlling health costs and improving outcomes
- Universal coverage
Issues with the WHO Health System Framework (Service delivery, health workforce, info, medical products, vaccines & tech, financing, leadership/governance)
- Missing: people receiving care, gender/class (more social, upstream things)
- Very hard to measure outcomes and variables
- Very hard to effectively implement (multisectoral)
Leadership, Management & Governance in Afghanistan Case Study
- What is capacity development? How do we measure governance?
- Control group?
- Funding must be flexible, plans must change to adapt to on the ground conditions
- Money must go to what’s needed, not necessarily what donors want to fund
MDGs vs. SDGs
- MDGs: Poverty, hunger, disease, unmet schooling, gender inequality, environment
- SDGs: Economic development, environmental sustainability, and social inclusion
- Crossroads: how do we spur econ development (Asia and Africa) but be sustainable and promote social inclusion?
- Family planning huge here
Why Do People Engage in Risky Behavior?
- Outcome expectations (instant gratification)
- structural, things in the environment, barriers (if we want people to eat healthier we should change the built environment)
- interpersonal influences (peer pressure)
- individual values and beliefs
- so how do we intervene? structural, interpersonal, community, individual
Chapter 1, Jamison, Good News and Bad News in Health
Good news:
-Life expectancy has gone up, (but measurement has changed-HIV)
-decreasing of health inequality
-Recognition that health -> economic welfare
have to have good health systems before econ dev (Sen)
Bad news:
-emerging infectious (HIV/AIDS) and non-communicable disease (heart disease)
-influenza pandemic threat
-preventable deaths due to malaria, TB, diarrhea
-new pandemic on the horizon
-need: surveillance, structural/environment changes, health edu (more of a downstream), WASH (one of the best investments), waste management,
-hand washing is a very downstream intervention, have to do it over and over again, even here where we have access to water and soap we have to post millions of posters and educate providers
Global Health Systems and Global Progress
Health: key to economic development, security, governance, and human rights (health not absence of disease)
- Increased investment in health (infectious disease to NCD)
- Focus on strengthening health systems
- governance: strong health system is a good indicator of low corruption
1. Human resources, financing, health facilities, technologies, commodities: how do they all inter- relate?
2. Demand side is essential and often overlooked, along with the supply side
3. Goal: improve health, but also the distribution of health and recognition of human rights
4. Health systems must perform
