Management Principles and Social Determinants in Public Health Study Notes

Management Principles in Public Health: Concepts and Historical Functions

• Learning Objectives:

  • Define the functional and institutional concepts of management.

  • Explain the differences between management terms.

  • Identify and explain the specific competences required by managers.

  • Differentiate between various management roles.

• Management Concepts (Schreyögg & Koch, 2020):

  • Functional Concept: Refers to a complex of tasks that must be fulfilled to steer a(n) (healthcare) organisation.

  • Institutional Concept: Refers to a group of persons within a(n) (healthcare) organisation who are entrusted with authorising powers.

• Functional-Orientated Definition of Management:

  • According to Schreyögg & Koch ($2020$, p. $7$), management is defined as a "complex of control tasks that are performed in the creation and assurance of performance in organisations."

• Historical Evolution of Management Functions:

  • Henri Fayol ($1929$): Identified five core functions: Prévoir (Planning), Organiser (Organizing), Commander (Commanding), Coordoner (Coordinating), and Contrôler (Controlling).

  • Gulick ($1937$) - POSDCORB-Concept: Expanded the functions to Planning, Organising, Staffing, Directing, COordinating, Reporting, and Budgeting.

  • Koontz & O’Donnell ($1955$): Established the modern standard of management functions, which include:

    • Planning.

    • Organising.

    • Staffing.

    • Leadership (Directing).

    • Controlling.

• The Management Process (Classic Feedback Loop):

  • The process involves a directional framework of action (Schaffung eines zielgerichteten Handlungsgerüsts) through activities like defining, communicating, analyzing, and comparing targets vs. actual results (Soll-Ist-Vergleich).

  • Elements involved: People (Menschen), things (Dinge), and ideas (Ideen).

Management Competences, Roles, and Realities

• Management Skills (Schreyögg & Koch, 2020):

  • Technical Competence: The ability to apply theoretical knowledge, techniques, and specific methods to individual cases.

  • Conceptual Competence: The ability to structure complex problem areas and transform them into manageable concepts for action.

  • Social Competence: The ability to work effectively with and through other people.

• Mintzberg’s Critique of Management Functions:

  • Henry Mintzberg ($1975$) observed that if you ask managers what they do, they cite planning and organizing, but their actual behavior often does not relate to those specific words.

• Mintzberg’s Managerial Roles ($1980$):

  • Interpersonal Roles: Figurehead, Leader, Liaison.

  • Informational Roles: Monitor, Disseminator, Spokesperson.

  • Decisional Roles: Entrepreneur, Disturbance Handler, Resource Allocator, Negotiator.

Fundamentals of Public Health: Society and Systems

• Learning Objectives:

  • Distinguish between and illustrate the complementary nature of medicine and public health.

  • Illustrate multiple determinants of health.

  • Define health through theoretical and practical lenses.

  • Explain core theoretical models of Public Health.

• Society as a System:

  • Society is a complex system that reduces complexity through differentiation into subsystems (e.g., education, political, health).

  • Subsystems use specific binary codings (e.g., in education: knowing vs. not-knowing) and are represented by formal organisations (e.g., parliaments in politics).

• The German Public Health System:

  • Characterized as decentralized rather than centralized.

  • Operates on local, regional (16 federal states), and national levels with various departments and federal institutes.

• Case Study: The American Public Health Association (APHA):

  • A formal organization in the Public Health System that has held an annual congress for over $150$ years.

  • Differentiated into sections (e.g., Community Health Workers, Aging, Food and Nutrition) and caucuses (e.g., Homelessness, LGBTQ Health, Refugee and Immigrant Health).

The Mission and Perspective of Public Health

• The Core Mission:

  • According to the Institute of Medicine (IOM, $1988$), the mission of public health is to "fulfil society’s interest in assuring conditions in which people can be healthy."

• Main Assumptions of Public Health (Goldstein et al., 2014):

  1. Assuring health for all people.

  2. Society benefits from a healthy populace.

  3. Health is not guaranteed.

  4. Public Health services are not limited to clinical services.

• Shift from "Old" to "New" Public Health (Hurrelmann & Laaser, 2003):

  • Old Public Health: Dominated by infectious diseases; target groups were underserved and sick populations.

  • New Public Health: Dominated by chronic diseases; target groups include all populations, including the healthy.

Prevention: The Cornerstone of Public Health

• The Holistic Approach:

  • Public health is complementary to clinical professions but distinct in its strategies. It addresses the conditions (social and environmental) in which people live.

• Three Types of Prevention (Fos & Fine, $2000$):

  • Primary Prevention: Concerned with eliminating risk factors for a disease to reduce incidence. Examples include seat belts, condom use, and skin protection.

  • Secondary Prevention: Focuses on early detection and treatment of subclinical or clinical disease to prevent permanent adverse consequences. Target group: Patients. Examples: Exercise for diabetics, rest during a cold.

  • Tertiary Prevention: Focuses on optimum treatment of clinically apparent disease to reduce complications and disability. Target group: Rehabilitands. Examples: Lifestyle adaptations after cancer or heart attacks.

• Clinical vs. Health Professional Perspectives:

  • Clinical professions primarily impact secondary and tertiary prevention.

  • The Hippocratic Oath (Lasagna, $1962$ version) emphasizes preventing disease whenever possible, acknowledging the patient's economic/family stability, and avoiding overtreatment.

Defining Health and its Determinants

• WHO Definition ($1946$):

  • "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

• Association of Teachers of Preventive Medicine Definition (Stokes et al., $1982$):

  • Health is characterized by anatomical, physiological, and psychological integrity; the ability to perform family, work, and community roles; and ability to deal with stress.

• Determinants of Health (Evans & Stoddart, $1994$):

  • Physical Environment.

  • Social Environment.

  • Genetic Inheritance.

  • Health Behaviour.

  • Health Care.

Theoretical Models in Public Health

• Primary Category Objectives (Goldstein et al., $2014$):

  1. Ecological Models: Focus on context and collectives.

  2. Behavioural Models: Focus on individuals and lifestyles.

• The Shift of the $1960$s and $1970$s:

  • Ecological models focused on infectious diseases lost usability as chronic/lifestyle diseases rose (e.g., lack of exercise, smoking).

  • In $1974$, health promotion became a pivotal part of public health policy.

• The Epidemiological Triangle:

  • Used to understand infectious disease outbreaks involving the relationship between the Agent (microbial organism), the Host (organism harboring the agent), and the Environment.

• The PRECEDE-PROCEED Model (Green & Kreuter, $1999$):

  • PRECEDE: Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation.

  • PROCEED: Policy, Regulatory, and Organisational Constructs in Educational and Environmental Development.

  • This model emphasizes educating people to change behavior over changing environmental conditions.

• Health Impact Pyramid (Frieden, $2010$):

  • Level $1$ (Bottom): Socioeconomic factors (greatest population impact).

  • Level $2$: Changing context to make individual default decisions healthy.

  • Level $3$: Long-lasting protective interventions.

  • Level $4$: Clinical interventions.

  • Level $5$ (Top): Counseling and education (requires most individual effort).

Origins and Historical Milestones of Public Health

• Classification of Health Problems:

  • Diseases: Infectious vs. Noninfectious.

  • Injuries: Intentional vs. Unintentional.

• Industrial Revolution (Modern Public Health Starting Point):

  • Characterized by infectious diseases and injuries due to poor living/working conditions, lack of sanitation, and toxic exposure.

  • Factory Act $1833$ (Example Response): Established child labor regulations (no worker under age $9$; limited hours for those $9$ to $18$).

• Mortality Statistics (United States):

  • $1900$: Leading causes were infectious (Pneumonia/Flu at $11.76\%$, TB at $11.31\%$, Diarrhea/Enteritis at $8.30\%$). Combined with Diphtheria ($2.35\%$), these accounted for $34\%$ of deaths.

  • $2006$: Leading causes shifted to chronic diseases (Heart disease at $26.03\%$, Malignant Neoplasm at $23.08\%$, Cerebrovascular diseases at $5.65\%$).

• Life Expectancy Changes:

  • In the US in $1900$, average life expectancy at birth was $49.24$ years. By $2006$, it rose to $77.7$ years.

  • Only about $28\%$ of this increase occurred prior to $1951$.

• $10$ Greatest Public Health Achievements ($1900$ – $1999$):

  1. Vaccination.

  2. Motor vehicle safety.

  3. Safer workplaces.

  4. Control of infectious diseases.

  5. Decline in deaths from heart disease and stroke.

  6. Safer and healthier foods.

  7. Healthier mothers and babies.

  8. Family planning.

  9. Fluoridation of drinking water.

  10. Recognition of tobacco as a health hazard.

Social Determinants of Health and Health Equity

• Equity vs. Equality:

  • Health Equality: An empirical measure; assuming everyone benefits from the same supports.

  • Health Equity: A value-based concept defined by everyone having a fair opportunity to attain their full health potential. It addresses systematic modifiable inequalities in resource distribution.

  • Justice: Removal of systemic barriers so supports are no longer needed.

• Economic Principles in Public Health:

  • Decision-making involves a trade-off between efficiency (focusing on population averages like life expectancy or mortality rates) and equity (allocating resources based on individual needs to improve well-being).

• Social Determinants of Health (SDOH):

  • Defined by the WHO as non-medical factors influencing health outcomes: conditions where people are born, grow, work, live, and age.

  • Major Domains: Education Access/Quality, Economic Stability, Healthcare Access, Neighborhood/Built Environment, and Social Context.

  • Example: Mortality from breast cancer is significantly higher for Black women ($27.1$ per $100,000$ in $2020$) than for White women ($19.1$ per $100,000$).