Lecture 25

Question 1

Epidemiological measures

Answer 1

1. PAR
2. Age at death and premature mortality (YLL)
3. Time lived with disability (YLD)

Question 2

Calculate PAR

Answer 2

Occurrence in total population - occurrence in unexposed pop

PAR = PGO - CGO

PAR = (a+b/p) - (b/p)

Question 3

Why do we need to prioritise in health?
Requirement for prioritisation

Answer 3

We don’t have enough money to fund all the health problems we would like

We need to decide which ones are going to give us the best possible returns in terms of reducing disease outcomes

Question 4

Evidence-based measures

Answer 4

1. Descriptive
2. Explanatory
3. Evaluative

Question 5

Community expectations and values

Answer 5

Te tiriti
Human rights
Social justice
Medical ethics

Question 6

Descriptive

Answer 6

Define the problem

Who is most/least affected now?
What are the trends over time? Are causes increasing or decreasing over time?

Question 7

Explanatory

Answer 7

Identify risk and protective factors

WHY are population health issues getting worse/better?
WHY are populations different?
What are the determinants or risk factors?

Use equity lens

Question 8

Evaluative

Answer 8

Develop and test prevention strategies –> Assure widespread adoption –> Monitor and evaluate

Effectiveness of an intervention is important to consider when prioritsing funding

How do we choose the best possible health intervention?

Is the intervention improving health problems?

Question 9

Risk difference (RD) = Attributable Risk

Answer 9

The amount of “extra” disease attributable to a particular risk factor in the EXPOSED GROUP

Occurrence in exposed population (EGO)

RD = Attributable Risk (AR) = ECO - CGO

Question 10

Population Attributable Risk

Answer 10

The amount of “extra” disease attributable to a risk factor in a particular POPULATION

If the association is casual - this is the amount of disease (theoretically) we could prevent if we removed the risk factor from the particular POPULATION

PAR is high if the prevalence of a risk factor is high in the population

Question 11

How well can the problem be solved?

Answer 11

1. Target population
2. Expected number in population who will be reached
3. Evidence of effectiveness (based on known success rates)
4. Cost

Question 12

Community expectation

Answer 12

1. Ability to set their own priorities
2. Confidence in the health system
3. Access to necessary care
4. Fair treatment
5. Culturally appropriate
6. Good information about their options

Question 13

Prioritisation

Answer 13

Provides an opportunity to allocate funding to services that are more effective in improving population health