unit 1 part 2: introduction to public health

economic impact, government, global health

10 **Essential** Public Health Services

1. Monitor Health
2. Diagnose and Investigate
3. Inform, Educate, Empower
4. Mobilize Community Partnership
5. Develop Policies
6. Enforce Laws
7. Link to/Provide Care
8. Assure a Competent Workforce
9. Evaluate
10. Research

The Public Health System

“all public, private, and voluntary entities that **contribute to the delivery of essential public health services** within a jurisdiction.”

* **Public health agencies** at state and local levels
* Healthcare **providers**
* **Public safety** agencies
* **Human service and charity** organizations
* **Education and youth development** organizations
* **Recreation and arts-related** organizations
* **Economic and philanthropic** organizations
* **Environmental** agencies and organizations

public health system includes:

**multidisciplinary** and **interdisciplinary**

Public Health requires ___ actions

partnership

Public health does not exist in a vacuum, it involves ___.

protect health

If the primary intent of any measure is to ___, then **that is public health.**

cost jobs = price products = tax increase = cut companies’ profit

**Public Health & Economic Impact:**

Public health regulation

resist pasteurization

**Public Health & Economic Impact:**

Resisting change in more milk production

resist building codes

**Public Health & Economic Impact:**

Landlords

resist design changes to improve safet

**Public Health & Economic Impact:**

Automobile manufacturers

harmful to health = causing thousands of deaths = million of dollar healthcare cost annually

**Public Health & Economic Impact:**

Tobacco Industry

**short term** - Preserve fishing and tourism

**long term** - Stable climate

**Public Health & Economic Impact:** *Trade Off*

Restrictions on timber

**short term** - Require expensive equipment

**long term** - Add up cost to consumer

**Public Health & Economic Impact:** *Trade Off*

Safety of workers

**short term** - Competitiveness in international market

**long term** - Good environmen

**Public Health & Economic Impact:** *Trade Off*

Pollution control in the industry

**short term** - Lost market share & profits

**long term** - Less use of cars, less pollution

**Public Health & Economic Impact:** *Trade Off*

High gas price

**short term** - Expensive screening of cows

**long term** - Prevention of spread of disease

**Public Health & Economic Impact:** *Trade Off*

Mad cow disease

**short term** - Less harvest and production, increase price

**long term** - Prevention of chronic diseases (cancer)

**Public Health & Economic Impact:** *Trade Off*

Use of pesticides

**cost** of public health measures

**Public Health & Economic Impact:**

much **easier** to calculate than the benefits.

difficult

**Public Health & Economic Impact:**

It is often ___ to **quantify what the risk really is and how to balance it against the other risk.**

Sensitive issues on sexual practices and family planning, abortion

**Moral & Religious Beliefs:**

Sexual and reproductive health, unwanted pregnancy

Use of protective methods for safe sex, (condom use),sex education among minors. Promoting immoral grounds

**Moral & Religious Beliefs:**

AIDS, STDs and Blood borne STIs

Private behavior and does not directly harm others

**Moral & Religious Beliefs:**

Drugs and alcohol abuse, use of safe needles

ineffective, and self-defeating

**Moral & Religious Beliefs:**

While __regulation for the common good is valid__, **legislating morality** has often proven to be ___ because **people differ in views as moral.**

unhealthy behaviors

**Moral & Religious Beliefs:**

Moral and religious concerns may **interfere with scientists** cause many of these problems are due to ___.

Scientific Integrity in Policy Making

**Political Interference with Science:**

* Formed by the **Union of Concerned Scientists**, composed of 60 leading scientists including 20 Nobel prize winners in 2004 during the George Bush Administration.
* Documented many instances of the **misrepresentation or suppression of scientific information of stacking of scientific advisories** to __obscure__ the fact that **policy decisions were based on its political agenda**, which __favored right-wing constituents and large corporations.__

preventing teenage pregnancy versus condom use

**Political Interference with Science:** *Issues involve policy making in public health and political agenda*

* Sexual Abstinence-only program

sex education program versus abstinence

**Political Interference with Science:** *Issues involve policy making in public health and political agenda*

* Condom use on HIV/AIDS prevention program

Abortion

**Political Interference with Science:** *Issues involve policy making in public health and political agenda*

* **causes breast cancer was discredited and removed from inaccurate information** despite reported by the National Cancer Institute in US

Conflict of interest

**Political Interference with Science:** *Issues involve policy making in public health and political agenda*

* those who hold position in the committee and who have ties to the industry

suppressed information and discredited scientific evidence

**Political Interference with Science:** *Issues involve policy making in public health and political agenda*

* Global warming versus Global Climate Change

ideologues and industry representatives

**Political Interference with Science:** *Issues involve policy making in public health and political agenda*

* scientific advisory committee

Health Economics

**discipline of economics** applied to the topic of health care.

**Broadly defined**, economics

**Health Economics:**

concerns how society allocates its resources among alternative uses

**Scarcity** of these resources

**Health Economics:**

provides the **foundation** of economic theory

* **What** goods and services shall we produce?
* **How** shall we produce them?
* **Who** shall receive them?

**foundation** of economic theory questions

Economic evaluation

**What Do Health Economists Do?**

relating the costs and benefits of alternative ways of delivering health care

Roots of health economics

Emerged as a **sub discipline of economics** in the1960s

“Uncertainty and Welfare Economics of Medical Care”

**Roots of health economics:**

Kenneth Arrow (1963)

“The Economics of Moral Hazard: Comment”

**Roots of health economics:**

Mark Pauly (1968)

(scarce) resources are **allocated to and within** the health economy

**Health Economics:**

Health economics is the study of how ___

magnitude and importance

**Health Economics:**

Demonstrates the ___ of the health sector

different

**Health Economics:**

What makes it ___ from other markets and how our analysis may need to adjust

improve health status

**Health Economics:**

Models the determinants of health status and looks and how government policy might ___ in short and long run

1. The size of the health economy is **large and
growing**
2. **Role of government** in the health care
markets
3. Health care market is **different from other markets**
4. **Externalities**

**Health Economics Importance**

**Public** Healthcare Facilities

**The role of public and private sector in public health:**

* National Health Services (Primary)
* Regional District & Rural Health Services (Secondary)
* RHU & Barangay Health Centers (Primary care)

**Private** Healthcare Facilities

**The role of public and private sector in public health:**

* Specialty Private Hospital
* General Private Hospital
* Private Clinic

Government

**The role of public and private sector in public health:**

* bears the **major responsibility** for public health
* when **alone, cannot achieve the objectives** of public health

organized community efforts

**The role of public and private sector in public health:** *Government*

* to prevent disease and prolong life **must involve all sector of the community**, including healthcare services, local business, community organizations, the media, and general public

**Non-government** organizations

**The role of public and private sector in public health:**

* play important roles, especially in education, lobbying and research focuses on specific diseases
* American Heart Association
* American Cancer Society, Philippine
Cancer Society
* American Diabetes Association
* Philippine Coalition Against TB (PhilCAT)
* AIDS Society of the Philippines
* Association of Diabetes Nurse Educators
in the Philippines
* ASEAN Society for Pediatric Infectious
Diseases.
* Philippine Public Health Association

Rockerfeller Foundation

**The role of public and private sector in public health:** *Other Philanthropic Foundation*

focuses on **world population** issues

Robert Wood Johnson Foundation

**The role of public and private sector in public health:** *Other Philanthropic Foundation*

providing health care to the **poor as well as on AIDS, alcoholism, drug abuse.**

Kaiser Family Foundation

**The role of public and private sector in public health:** *Other Philanthropic Foundation*

health and public policy especially on **minorities, children and elderly people**

Melida Gates Foundation

**The role of public and private sector in public health:** *Other Philanthropic Foundation*

the mission is to **improve global health.**

ability to obtain the participation of other agencies

**The role of public and private sector in public health:** *Other Philanthropic Foundation:* __*Rationale*__

Public health is **dependent** on its ___ __to solve health problems__

adept

**The role of public and private sector in public health:** *Other Philanthropic Foundation:* __*Rationale*__

Public health leaders must be ___ at n**egotiation and coalition building and develop a framework** for public health planning and action that involves all sectors of the community at the local state and national levels

National Government level

**The role of public and private sector in public health:**

The DOH acts as the national lead agency in health.

18 bureaus and services

**The role of public and private sector in public health:** *The DOH*

The DOH central office consists of ___ responsible for __policy development, programme planning, standards setting and regulation, and related management support services.__

17 regional health offices

**The role of public and private sector in public health:** *The DOH*

To __provide technical assistance to LGUs and monitor field operations__, the DOH has ___, one for each of the 28 17 administrative regions of the country

Health Facilities and Services Regulatory Bureau

**The role of public and private sector in public health:** *The DOH*

MedTechs’ bureau

**Executive Order No. 366 signed 29** by President Gloria Arroyo on 4 October 2004

**The role of public and private sector in public health:**

reflects the **major organizational changes** brought about by the __strategic review and rationalization of Government agencies and functions__

the **nomenclature** of bureaus, services and regional offices

**The role of public and private sector in public health:**

Effected by the DOH in 2013 with the final approval of its rationalization plan, this organizational change standardized ___

The **enactment of the Local Government Code of 1991** (Republic Act No. **7160**)

**The role of public and private sector in public health:**

mandated the **devolution of health** **services** from the National Government to the LGUs.

a fragmented system

**The role of public and private sector in public health:**

What used to be a **highly centralized health system** run by the DOH became ___ consisting of **more than a thousand** autonomous local health systems

Dual health system

**PH Health System:**

Organization and Governance

No Balance Billing (NBB)

**PH Health System:**

this means that __if you do not have the capability to pay__, **the state will pay** for you

Universal Healthcare Bill (UHC)

**PH Health System:**

**shows equity in health**. If there will be a payment, they are provided at a cost which means that it will generate no income

**Public** Sector

**PH Health System:**

Health services are **provided by health facilities** run by the National and local governments and are largely **financed through a tax-based budgeting system**

**Private** sector

**PH Health System:**

Largely **market-oriented**, where HS are generally **paid for through user fees** at the point of service

**Public** Sector

**PH Health System:**

typically **funded through the government** and managed by national healthcare organizations

* organizations receive their funding exclusively **from government agencies**
* **Taxpayers** will put money toward salaries, equipment, facility operations, medical procedures, and prescriptions
* **limited number of services** due to funding restrictions

**Private** sector

**PH Health System:**

created for **profit** and can be **funded through self-employed practitioners** and nongovernment organizations

* An **owner or board members** will be responsible for **setting a budget** __to manage the organization__
* The business owner will draw up **contracts** with employees **to set salaries**
* the private sector may have the potential to **offer more services** to patients
* The private sector health care facility could also make **higher investments in new equipment** pieces and workspaces.

**Public** Sector

**PH Health System:**

* Typically offer **higher base pay** guaranteed by the state
* **Plantilla** positions are **limited**
* Hiring based on **exigency** depending on **available public funds**
* Salaries determined by **established salary grades**

**Private** sector

**PH Health System:**

* Typically offer __**less competitive**__ **base pay**
* Job positions **based on services offered and available funds**
* May offer **more** **lucrative salaries** for __higher managerial positions__

**Public** Sector

**PH Health System:**

* Typically **longer** waiting time
* **Lower** personnel to patient ratio
* Targets **population segments** with limited capacity for out-of-pocket payments
* **Affordable** rates

**Private** sector

**PH Health System:**

* Has **shorter** waiting time
* **Higher** personnel to patient ratio
* Targets **affluent patients** with **higher** capacity **to pay**
* More **expensive** rates

private providers

**PH Health System:**

relies heavily on ___

**30%** of the Philippine population

**PH Health System:**

uses the private healthcare system as their **main source of care**

60%

**PH Health System:**

are also **privately owned**

Medical tourism

**PH Health System:**

important part of the **economy**, which explains why there are so many private hospitals and specialty clinics

**Public** Health

* focus on the health of the **population of a specific country or community**

**International** Health

* focuses on the **health issues**, especially __infectious diseases, and maternal and child health__ in **low-income countries**

**Global** Health

* an area for study, research, and practice that places a **priority on improving health and achieving health equity** for all people **worldwide**
* health issues that **transcend national boundaries** and governments and call for actions on the global forces that determine the health of people
* collaborative trans-national research and action for promoting **health for all**

* Immunization


* Malaria and Parasitic Diseases

**CDC Global Health Issues:**

* Global Health **Security**

* Traveler’s Health
* Other Disease and Threats

**CDC Global Health Issues:**

* Global Health **Protection**

* HIV and Tuberculosis
* Food & Water

**CDC Global Health Issues:**

* Global Health **Equity**

* **environmental** health
* **human** health
* **animal** health

**WHO One Health Approach:**

what makes one health

interdependence

**WHO One Health Approach:** *We Need to:*

Recognize the ___ of human, animal and environmental health

systems thinking

**WHO One Health Approach:** *We Need to:*

Approach **health issues and opportunities** holistically using ___

**interdisciplinary/transdisciplinary** teams

**WHO One Health Approach:** *We Need to:*

Form ___ across human, animal and environmental health practitioners

communication and collaboration

**WHO One Health Approach:** *We Need to:*

Promote ___ among representatives of diverse constituencies across human, animal, environmental health and other relevant disciplines

human health is **inextricably linked** with animal and environmental health.

concept of one health

* Increasing global population pressures
* Deforestation and environmental destruction
* Intensive agriculture
* Global trade and travel
* Climate change

Why are these infectious diseases emerging in the 20th century?

* food safety
* control of zoonotic diseases
* laboratory services
* neglected tropical diseases
* environmental health
* antimicrobial resistance

areas of work in One Health approach

Roemer 1991

**Health Delivery Systems: WHO Framework:** *Health System*

**combination** of resources, organization, financing and management that **culminate in the delivery of health services** to the population.

World Health Organization (2000)

**Health Delivery Systems: WHO Framework:** *Health System*

* all the activities whose **primary purpose** is to **promote, restore, and maintain** health.
* includes efforts to **influence determinants of health** as well as more direct health improving activities

* To **improve health** of the population
* To **improve responsiveness of health system** to people’s health expectations
* Providing **financial risk protection**

**Main Goals** of Health Systems

Health Service **Provision**

**4 main health system functions:**

* Direct **provision of services** to patients
* **Public and private** health services
* the approaches can either be **preventive, curative or diagnostic**

Health Service **Inputs**

**4 main health system functions:**

* health **products and supply** chain
* manufacturing, sales, and distribution of key assets, including facilities, drugs, and devices
* **resource generation**: investing in people, facilities, and equipment

Stewardship

**4 main health system functions:**

* **process of setting the strategic goals** of a health system
* sets the **context and policy framework** for the overall health system
* **overall stewards** of the resources, powers and expectations
* HS function in **generating appropriate data for policy making**
* dependent on **financing**

priorities

**4 main health system functions:** *Stewardship*

* What are the health ___ to which public resources should be targeted?

* institutional framework

**4 main health system functions:** *Stewardship*

* What is the ___ in which the system and its many actors should function?