This is the product of compilation from various sources. I would like to acknowledge all direct and indirect sources although they have not been mentioned explicitly within the document.
This is the product of compilation from various sources. I would like to acknowledge all direct and indirect sources although they have not been mentioned explicitly within the document.
Universal Health Coverage (UHC) Day 12.12.14, NepalDeepak Karki
This presentation is made on the first ever Universal Health Coverage (UHC) Day 12.12.14 celebration in Nepal by Nepal Health Economics Association (NHEA).
The course offers an opportunity to develop a holistic understanding of Primary Health Care, its functions, and scope. The course attendants will learn the principles of Primary Health Care, the course is expected to help the students to understand and internalize international health and public health transition facilitating the integration of health sector with other sectors.
Universal Health Coverage (UHC) Day 12.12.14, NepalDeepak Karki
This presentation is made on the first ever Universal Health Coverage (UHC) Day 12.12.14 celebration in Nepal by Nepal Health Economics Association (NHEA).
The course offers an opportunity to develop a holistic understanding of Primary Health Care, its functions, and scope. The course attendants will learn the principles of Primary Health Care, the course is expected to help the students to understand and internalize international health and public health transition facilitating the integration of health sector with other sectors.
Oral health promotion is a comprehensive approach to enhancing the oral health of
families, communities and populations which both
complements and challenges the approach on which formal
health care systems are based.
A health system, also sometimes referred to as health care system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.
Health systems are responsible for delivering services that improve, maintain or restore the health of individuals and their communities.
Common elements in virtually all health systems are primary healthcare and public health measures.
Decentralization
Tools of Policy making
Financing Health care
Public-Private Partnership
Health Research
International Organizations
Equity
Health Reforms in Developing Countries
Stake Holders
The assessment and identification of health need is a process that helps:
Inform planning of health care for individuals and their families, communities and the wider population.
It can be a powerful learning tool for local service providers, presenting them with the rationale for re-designing services to better target assessed needs of the local population.
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Claire Cordeaux SIMUL8 Executive Director for Health & Social Care were invited by Centers for Medicare & Medicaid Services to discuss how NHS England work in chronic disease.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
How to Give Better Lectures: Some Tips for Doctors
Health policy and planning
1. Health Policy – Theory and Basic Concepts
Dr. Rizwan S A, M.D.,
2. Health Policy - Definition
• A set of decisions or commitments to pursue courses of action
aimed at achieving defined goals for improving health.
• Policies usually state or infer the values that underpin the
policy position.
• They may also specify the source of funding that can be
applied to the action, the planning and management
arrangements to be adopted for implementation of the policy,
and the relevant institutions to be involved.
-WHO Glossary of terms used in the Health for All Series, nos.1-8. Geneva: WHO, 1984;
-Barr, N. Economic theory and the welfare state: A survey and interpretation, Journal of Economic Literature.
XXX: 741-803, 1992;
-WHO Health for All targets. The health policy for Europe, Copenhagen: WHO Regional Office for Europe, 1993.
3. Aim of health policies
• The prime aim - maintenance and
improvement of the health status of
populations
• The risk factors which influence health differ
between countries
• Thus policies for health will be influenced by
different factors in each country and region
5. Health status
• Increase in non-communicable diseases in the
developing world together with the
abatement of the mortality from infectious
diseases
• In developed world the problems are mainly
concerned with the elderly, rather than
children
• This has important implications for health
policies
6. Health services
Problems faced
• Inequalities between different geographic areas and
social groups
• variations in the utilization of services for similar
conditions
• difficulties in the apportionment of limited resources
• lifestyle behaviour and political/economic issues
Health services have an essential role in improving quality
of life and can produce specific valuable improvements in
other aspects of health status
7. Organization and financing
The state is involved in all health systems in varying degrees:
• as legal regulator of the arrangements for patients to receive
medical care and doctors to receive remuneration
• as a contributor to health-care financing, taxes or compulsory
social insurance
• as a guardian to ensure that the correct balance of resources
is used to achieve optimum population health
Health care may be conceived in an economic framework as an
exchange of goods. Patients seeking medical care are making
demands while doctors are supplying services
8. Health commissioning (administration)
Health commissioning needs to take into account the following
factors:
• improvement in health status
• risk reduction
• services and protection
• data needs for monitoring the achievement of the tasks
identified
9. • The best model for this is that developed in
The Netherlands
• 'the possibility for every member of society to
function normally and to participate in social
life'
• Thus the need for health care is ‘to enable an
individual to share, maintain and if possible
improve his or her life together with other
members of the community’
10. • This societal perspective is a little different
from the individual perspective and
professional approach
11. Role of public health
• Chief responsibilities are
– the surveillance of the health of the population,
– the identification of its health needs,
– the fostering of policies which promote health
– the evaluation of health services
• Study of the nature and extent of disease and
disability in the population and how this varies
with age, sex, economic and social
circumstances, occupation, and environment
12. • Thus the problems for which public health action is
required include:
•
•
•
•
outbreaks of disease
problems arising from social and environmental issues
behavioural concerns such as smoking
health service issues - assessment of health-care needs
and outcomes, and the effectiveness and efficiency of
particular services
• Public health, as a discipline, should not become
involved in the direct management of clinical services
in the community or within institutions—it lacks the
expertise essential for these tasks
13. Assurance of appropriateness
• As the Dutch Report on Choices in Health Care
emphasizes, responsibility for others, the ideal of
equality, and the social benefits of good public health
have encouraged the belief that people are responsible
for their own health, and are free to choose how to use
health care and which risks they are willing to take
• There are three points of departure:
– the fundamental equality of people,
– the fundamental need for the protection of human life,
– the principle of solidarity.
14. Criteria, access, and utilization
• The first criterion that needs to be established
is whether care is necessary or not
• The second criterion is the effectiveness of the
services provided, the efficiency with which
they are provided, and whether the individual
could take responsibility for providing them
15. International trends in health care
• Every citizen in a country has the same rights to health
care
• There has not been much of a decline in public
financing of health care quantitatively, whether by
compulsory insurance contribution or taxation.
• There is some trend towards consumers making a
contribution in the forms of co-payments, for example
prescription charges
• Some countries are encouraging people to take out
private insurance or even to contract out of the public
system.
16. Provider–purchaser model
• For both public health and personal health services
• The separation of commissioning and providing services
theoretically enables better decisions to be made over
which services to provide within a limited budget
• Theoretically, it should also be possible to balance
preventive, curative, and rehabilitative services
• Managed care, now so popular in the United States, is an
example of this type of separation
17. The role of public health in the
determination of priorities
• It has the necessary tools to describe the
problems and to devise appropriate mechanisms
for their solution
• In all the systems, however, the ability for public
health to influence health policy is limited
• Decisions on priorities have become more explicit
and democratic. Most countries have begun to
debate how and what should be done
18. • Most have developed mechanisms for beginning
to address the problem of inequalities and
deprivation, with one notable exception (the
United States)
• Most are facing the problem of increasing costs
of medical care by rational deliberations
• Increased investment in public health research, in
order to be able to introduce appropriate and
effective preventive strategies
19. Health Policy in Developing Countries
• Central issue - making the best use of limited
resources in environments in which there is a
wide gap between needs and resources,
expectations and performance.
• There are three main issues
– diversity
– Complexity
– change
20. Diversity
• Ecological and geographical factors account
for some of the variation in the pattern of
distribution of health and disease but
economic, social, and cultural determinants
also contribute to the diversity
21. Complexity
• The explosion of new knowledge and innovative
health technologies have markedly increased the
complexity of health care
• it is necessary to mobilize inter-sectoral action
because of the important influence of nonmedical factors on health, such as:
•
•
•
•
Agriculture
Education
Waterworks and sanitation
Labour and industry
22. Change
• Policy-making in developing countries has to
be fluid and dynamic to adapt strategies and
programmes to the many changes that are
occurring in the environment
– Epidemiological transition
– Epidemics and other emergencies
– Socio-economic variables
23. Epidemiological transition
• Traditional health problems, such as childhood
diseases and communicable diseases, are
declining, whilst chronic diseases, such as
cancers, cardiovascular diseases, diabetes, are
becoming increasingly prominent
24. Epidemics and other emergencies
• Epidemics and other acute problems, for
example natural disasters
25. Socio-economic variables
• Changes in the economic and social situation in
the country may have a profound effect on the
health sector
• Health policies have had to be modified in the
light of rapid development in some countries and
economic recession in others
• In recent decades, national policies are
increasingly favouring free-market economy in
place of welfare programmes and central control
26. Major challenges and issues
• health reform with special emphasis on structural
reform and decentralization
• tools for policy-making—assessment of burden of
disease, cost-effectiveness, and health accounts
• financing health care—cost recovery schemes,
user fees, and private insurance
• public–private partnerships
• health research
• donor agencies
• equity in health
27. Health Reform
• Health reform has been defined as 'sustained
purposeful change to improve efficiency,
equity and effectiveness of the health sector'
(Berman 1995)
• The decentralization of planning and
management
• Delegate responsibility of management to
peripheral authorities — provincial, state,
municipal, and local governments
28. Models of decentralization
• Primary health care through community level
services and local referral hospitals
• Provincial or state level co-ordinating services in
defined geographical parts of the country
• Setting up a ministry of health at central
government level
• Decentralization involves allocating functions to
provincial and local governments as well as
defining their relationships with each other and
with the central government
29. Primary Health Care - Functions
•
•
•
•
•
•
•
immunization
education on prevailing health conditions
food supply and proper nutrition
safe water and basic sanitation
MCH including family planning
treatment of common diseases and injuries
prevention and control of locally endemic
diseases
• essential drugs
30. Provincial or state level provision
• intermediate role between the central
government and the local health authorities
• they
develop
regional
policies
and
programmes in the context of the overall
national policy and plans
31. Central government provision
•
•
•
•
•
•
•
setting national goals and targets
establishment of standards
accreditation of training programmes
registration of drugs
national disease surveillance
highly specialized services including research
emergency response to natural disasters and
major epidemics
• international relations.
32. Making decentralization work
Certain important issues need to be addressed
as follows
• autonomy
• financial resources
• professional and technical capacity
• information system
• health-related sectors
• relationship with other health-care providers
33. Tools for policy-making
• measurement of burden of disease
• assessment
of
cost-effectiveness
interventions
• analysis of national health accounts
of
34. Burden of disease
The DALY is used to
• Rank diseases and conditions by the burden of
disease
• Estimate
the
cost-effectiveness
of
interventions by comparing the cost of
averting a DALY
35. National health accounts
• These analyses attempt to obtain an overview of
health spending from all sources — public and
private, corporate and personal — into
comprehensive health accounts.
• The basic analysis consists of a matrix of
elements as follows:
• the columns of the matrix list all sources of health spending
• the rows of the matrix show the distribution of expenditure
for personal health care, public health and environmental
sanitation services, and administration
36. Financing health care
• The wide margin between the public
resources for health and the demands and
expectations - common challenge
• Macroeconomic policies advocated by the
International Monetary Fund and other
funding agencies have forced many
governments to trim public spending on
health and to reassess the allocation of their
limited resources
37. • policy-makers are exploring approaches to
increase the resources available for health
• develop income-generating schemes
• promote supplementary sources of finance
38. Income generation
• In the least developed countries, it is critically
important to increase the financial resources if the
health sector is to provide basic essential services
• In the more advanced middle-income countries, the
main issue is how to organize and manage a prepay
system that is efficient and fair
• In the high-income developing countries - using
resources in the most cost-effective manner and
promoting equity.
39. Mobilizing additional resources
• User fees generate resources that can be used to expand the
quantity and improve the quality of health services
• Redistribution of resources
• Community financing
• Risk sharing through privately financed health insurance
In summary, the policy direction for financing health care in
many developing countries is to ensure that those who can
afford to pay cover health costs from their own resources
This enables the public sector to focus resources on top priority
health issues and to target selectively the needs of the poor
40. Public–private partnerships
• The WHO now strongly supports the
promotion of public – private partnerships
with the caveat that such partnerships should
be mutually beneficial and must always
benefit health
– non-profit private sector—non-governmental
organizations and religious-based medical
missions
– employment-related health schemes
– for-profit private services
41. Health research
• There is now increasing pressure to make
decisions on the basis of sound scientific
knowledge
• Evidence-based decision-making requires that
relevant information be collected and
analysed, and that essential research be
conducted to elucidate issues
42. • Each country should adopt the principles of
Essential National Health Research as a strategy
for planning, prioritizing, and managing national
health research
• The goal of Essential National Health Research is
health development on the basis of social justice
and equity; its content is the full range of
biomedical and clinical research, as well as
epidemiological, social, and economic studies
43. Equity
• Equity in health is intuitively understood to
reflect a sense of fairness and justice
• But the term is used to refer to
– health status of families, communities, and
population groups
– allocation of resources
– access to and utilization of services
44. Optimization of equity
Optimization of equity requires conscious attention
to a number of important issues
• political commitment
• policy formulation
• allocation of resources
• inter-sectoral action
• community involvement
• information system
• monitoring of equity
• political commitment
45. Public health sciences and policy in
developing countries
• Developing countries are those countries with
a low average income as well as a low gross
national product compared with the
‘developed countries’
• Problems
• A shortage of resources - budget and
infrastructure
• poverty, political instability, social unrest, and
security problems
46. • The major concern to alleviate suffering from
the major diseases prevalent in the locality
• Thus, priorities are for hospitals to serve the
immediate needs of sick patients instead of
preventive services
• Limited knowledge and technologies to
ascertain health problems often leads to
inappropriate health decisions by leaders
47. Application of public health sciences
and policy
• 1.Policies developed in response to immediate
health problems - malaria, yaws, and rabies
• 2. Policies developed from existing knowledge,
which are recommended by international
organizations - poliomyelitis eradication
programmes, EPI, ADD and ARI programmes
• 3. Policies for the control of specific diseases
derived from national scientific research
48. • It is important for public health researchers
and decision-makers to co-operate in the
formulation of health policy
• To achieve this goal it is important to provide
training for public health professionals,
preferably in national schools of public health
as well as abroad
49. Conclusion
• Not only must policy-making be knowledge based it must
also be result oriented
• Careful planning and skilled management can achieve good
results even where financial resources are limited
• Policy-makers must give high priority to strategies that will
eliminate the major items of the unfinished agenda that
still plague many developing countries
• Many lives can be saved and much disability prevented by
simple measures like boosting immunization programmes,
ensuring access to adequate supplies of safe water and
good sanitation, providing effective treatment for common
childhood ailments, and ensuring skilled care during
childbirth including emergency obstetric care
50. Health policy in the developed world
• It is paradoxical that the greatest interest in public health
policy now exists in developed countries where the benefits
of public health activity may seem least apparent
• Three major impediments to relating overall mortality
levels in rich countries to their public health endeavours
– there are no readily available measures of the amount of
'organised effort'
– adult mortality levels is strongly influenced two major
overlapping epidemics: (a) tobacco smoking, and (b) vascular
diseases
– lagged effects of changes in disease determinants over
preceding decades and these temporal relationships are not
easy to specify or quantify
51. Examples of policies to improve health
1. Administrative means: fluoridation
• Fluoridation introduces several themes pertinent to the
consideration of public health policy in rich countries
– One is the power of research using quantitative methods,
including experiments on whole communities, to expand the
repertoire of effective means for controlling disease and injury.
– Another is the possibility of massive disjunctions between the
cost-effectiveness of a preventive measure and the political
feasibility of its implementation.
– Perceptions of risks and benefits held by vocal minorities may
depart substantially from those of experts, and governments
may be more sensitive to their reputations in the eyes of the
press and other powerful bodies than they are to public opinion.
52. 2.Enhanced coverage with clinical procedures:
control of high blood pressure
• Rose coined the term 'prevention paradox' to
describe how, when risk is related monotonically
to a quantitative attribute such as blood pressure,
the interventions which offer most to the
individuals at high risk contribute less to reducing
the population burden of the disease than do
small downward shifts in the whole distribution
(Rose 1985).
53. 3. Behaviour change: HIV and sudden infant
death
• In circumstances such as those surrounding
the early HIV epidemic, the ability of formal
public health programmes to contribute to
health improvement may be limited by the
need to await the building of a supporting
political consensus
54. • The main point to emerge from these
examples is that the 'organised efforts' that
have contributed most to reducing the burden
of these diseases have been the research
efforts.
• Thus, in developed countries, investment in
the development of public health science is
the most fundamental component of public
health policy
55. • medicine and public health should not be
understood just as domains of professional
practice; they are, more fundamentally,
cultural resources appropriated by all
members of society — lay as well as
professional
56. • Behaviour change: road traffic injuries - lessons
– large secular declines in traffic injury deaths are likely
to have occurred with a substantial degree of
independence from the specific policies and
programmes
– But important degree of variation seems attributable
to the intensity and nature of the control measures
taken
– It was possible to build support for the escalation of
control measures notwithstanding a political culture
that valued personal independence
57. • Behaviour change: smoking
– cigarette smoking remains the leading public
health problem in developed countries. It is
without rival in the disease burden it generates.
– If the course of the epidemic of nicotine addiction
is to be curtailed, intergenerational transmission
must also be minimized
58. Unsolved issues
• physical inactivity and obesity
• sustainability
• Global warming
• Use of materials and absorption of wastes
• Effects on ecosystems
59. Four interim conclusions
• Governments may be more concerned to
protect their reputations in the eyes of the
press than to implement measures with high
public support and dramatically favourable
cost–benefit ratios
• Enhanced coverage with preventive measures
applied to individuals appeals to doctors but
may, in many circumstances, offer only
modest gains in health
60. • Formal programmes to promote change to
healthier ways of life may have small effects
compared with the informal processes
promoting such changes
• Combinations of regulatory measures and
persuasion are likely to be more effective in
changing behaviour but these are only likely to
be politically feasible where there is
widespread public appreciation
61. 'Social capital'
• Tangible substances in the daily lives of people, namely,
goodwill, fellowship, mutual sympathy and social
intercourse among a group of individuals and families who
make up a social unit
• If he may come into contact with his neighbour, and they
with other neighbours, there will be an accumulation of
social capital, which may immediately satisfy his social
needs and which may bear a social potentiality sufficient to
the substantial improvement of living conditions in the
whole community.
• The community as a whole will benefit by the cooperation
of all its parts, while the individual will find in his
associations the advantages of the help, the sympathy, and
the fellowship of his neighbours
62. • Inherited stocks of social capital are important
determinants of the good government and
economic well being of today's citizens
• Eg. government in Italy – north and south
Strong 'civic community‘ was responsible for the
success of the south: the empirical measures
used were voting behaviour (including turnout,
not preferences), newspaper readership, and
density of sports and cultural associations
63. The search for equality
• Recent favourable trends in overall adult
mortality have been accompanied by growing
inequalities in states such as the United
Kingdom, because mortality declines have
been much greater in more favoured strata
• 'materialist' interpretation of the cause marked increase in income inequalities
64. Making progress safe
• Material progress both favours and harms
health
• It has been one of the main responsibilities of
public health institutions to help resolve this
ambivalence
• This has enabled the net effect closely
towards its beneficial effect
65. • Public health endeavour will continue to be an
important determinant of what we are able to
mean by 'progress' and of whether we shall be
able to make it safe