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What are the goals of preventative medicine?

What are the benefits?

To reduce incidence and burden of preventable disease.

Much of the burden (morbidity, mortality and financial) on disease is attributable to preventable diseases. Preventable diseases are those with known risk and contributing factors that can be modified.

Modifiable factors that can reduce incidence of preventable disease include (but are not limited to): smoking, housing, clean water and air, healthy eating, reducing alcohol intake, support from social networks, exposures to dusts and pollutants, poor hygiene, poor workplace health standards, overcrowding, poor access to health facilities

The benefit of preventative medicine is that, if the intervention is effective, it can reduce the incidence of the given disease, and thus reduce the burden associated with it.


What is a population health approach?

Population Health Approaches aim to benefit the greatest number of people.

Imagine a bell-curve distribution of disease: a population-level approach does not only aim to reduce disease in the upper portions of the bell curve. Population health approaches aim to create a left-shift in the entire bell-curve distribution: thus, the entire population receives some benefit, as a whole.

I.e. a population health approach does not only focus on high-risk groups - it focusses on decreasing risk, population-wide


How do we currently address Australia's population-level Health Problems?

Mainly through health policy. Currently, the population-level health problems of focus are:

1) National Health Priority Areas:
The NHPAs areas have been identified as significant as they contribute so much to Australia's health burden: in terms of morbidity, mortality, resources, and health dollar expenditure. These areas were identified through epidemiological research and literature reviews.

2) Health inequity between Indigenous Australians and non Indigenous Australians

3) The Social Gradient of Health

4) Rural and Remote Health Problems

5) Increasing demand and cost of health care due to increasing medical costs (ie. with new technologies, etc.) and also (and to a lesser extend, as recent research has suggested) the ageing population, and increasing incidence of chronic disease


What are the underpinning principles of a Population Health Approach?

**There needs to be strong evidence supporting the focus of the approach, and the methods that are intended to be used in the approach**

**A population-level approach must address the social determinants of health, to ensure that everyone is benefited by the approach**

**It must take into account issues surrounding inequity - e.g. there needs to be a broad approach geared towards benefit on a population-wide level, however there may be cause to invest more into enabling lower income earners to accessing the heath services**

**It must empower individuals and communities to take control of their health**

**It must take action across the entire bell curve - not just those in the highest risk groups**


What is prevention? What are its components?

Primary prevention = reducing incidence of disease

Secondary Prevention = early detection of disease, and reduction of disease progression

Tertiary Prevention = Reduction of the negative impact of the disease, and reducing incidence of further complications


Example of prevention:

Primary prevention = advocating healthy lifestyle, healthy eating, low cholesterol, not smoking, healthy BMI, physical activity, blood pressure

Secondary Prevention = early detection of disease - e.g. high cholesterol, HTN, obesity

Reduction of disease progression: attempts at lifestyle modification, pharmacological treatments to help reduce risk of worsening of condition - e.g. hydrochlorothiazide and ramipril to manage HTN, Statin therapy to reduce cholesterol

Tertiary Prevention: If atherosclerosis found, add aspirin to equation to reduce risk of thrombosis and MI / PE / Stroke; or treat angina symptoms - GTN, etc.


Role of Prevention in Population Health Approaches:

Because a population health approach focus on 'the whole bell-curve', a population health approach must include aspects of primary, secondary and tertiary prevention, in order to improve outcomes at all levels along the bell-curve (i.e. not just reducing incidence in well individuals, and non just optimising treatment amongst the afflicted)

In 'well' populations, the approach needs to include Primary prevention strategies, and secondary strategies

Amongst those with the disease, the approach needs to deal with some secondary elements, but chiefly tertiary elements


Requisites of a Population Health Approach Framework

The framework must have a logical structure, which is both comprehensive and systematic


What are the Steps to creating a Population Health Approach (broadly speaking)

1) Must understand the problem at hand: the context, the population you are dealing with, etc.

2) Must Identify the burden of the disease

3) Must Identify the public health benefits involved in implementing a population health approach focused on this particular area

4) Once the problem is understood, the burden has been identified, and potential benefits (of the proposed intervention) have been established, you need to engage stakeholders

5) Then, along with stakeholders, need to develop intervention options and steps, and assess each one using an explicit critera

6) Implement the Strategy

7) Evaluate the Strategy


What is involved in understanding the disease?

The disease must be understood - you cannot implement an interventional approach to prevent a disease with an unknown aetiology, pathogenesis, etc.

The disease must be understood, its distribution, the populations it affects, the risk factors associated with it, the co-morbidities associated with it, there must be a known way to diagnose for it, there must be the potential to be able to screen for it, and there must be known treatements for how to best treat the disease (secondary and teriary approaches)

How do we know these things?

Interaction with epidemiological research, with literature reviews, with experts


What is involved in identifying the burden of disease

To show that the area you want to focus on is an important one for a population-level approach, you must be able to show that there is a significant population-wide burden of the disease - thus, that the burden of this disease would benefit from a population-level appraoch


What is involved in identifying the benefits of intervention?

Once you understand the disease, and understand the burden of the disease, you can then deduce the expected benefits from addressing the disease - this involves planning out how you plan to address the disease, and what benefits your particular strategy should be able to offer


What is involved in engaging stakeholders?

Need to demonstrate understanding of the disease, the burden of the disease, and how you intend to reduce that burden to engage stakeholders.

Who do you need to engage with?

Potential consumers
Local groups, committees, and organisations concerned with the area of your focus
Local Governments
Medicare Locals
Other health professionals
Local businesses


What is involved with developing the Specific Intervention Process?

A clear, comprehensive and logical step-by-step framework must be devised, along with stakeholders*

Each step then needs to be critically assessed with regards to:
The size of impact it will have on health
Whether the intervention is adaptable
Is it cost effective?
Is it acceptible to consumers?
Is it accessible to consumers?
Is it relevant to the community/population at hand?


Implement Stratergy and Evaluate the Stratergy

For implementation, we need finance (from stakeholders) and people to exact the actions.

Once the strategy has been implemented, it must be evaluated