A part of course work

1. Prioritizing exiting public health
problem of Bangladesh
Presented By
Dr. Fardina Rahman Omi

4. Introduction
 Public health is the science of protecting and improving the health of
people
 It is important to prioritize health issues and population groups as
this ensures the most productive use of resources
 The resources can make a difference, reduce costs to individuals and
the community, reduce the prevalence by reducing the incidence of
disease, and help particular population groups as well as the whole
nation.
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5. Top ten existing public health problem and causes of death in
Bangladesh
5
According to GBD compare, 2010-top ten existing public health problems according to their prevalence
of mortality is listed bellow
Serial Name of problems Mortality prevalence
1 Cancer 13%
2 Lower Respiratory Infection 7%
3 Chronic Obstructive Pulmonary Disease 7%
4 Ischemic Heart Disease 6%
5 Stroke 5%
6 Preterm Birth Complications 4%
7 Tuberculosis 3%
8 Neonatal Encephalopathy 3%
9 Diabetes 3%
10 Cirrhosis 3%

6. Why prioritization???
 Resources are limited
 Impossible to provide everyone with every
effective intervention
 Limited resources and unlimited demands
 Justice and efficiency
 Lack of Consensus
 Little interaction about priority setting among
decision makers

7.  Size of problem
 Seriousness of problem
 Availability of current interventions Economic or social impact
 Public health concern
 Political will to address issue
 Availability of resources
 Disease of international interest
 Equity
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Criteria of prioritization

8. Important factors of prioritization
CDC gave emphasizes on 4 things when prioritization
 Size of Problem : Number or percentage of people affected by a
health ccondition in a particular area .
Source to learn number affected: prevalence data
 Seriousness of Problem :Potential of a health problem to result in
severe disability or death
Source of information on seriousness:
• Cause-specific mortality tables
• DALYs (disabilityadjusted life years
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9.  Availability of Current interventions:
-Are there evidence-based interventions or
promising practices to prevent or control this
health problem?
-Can these interventions or practices be
implemented easily?
9
 Economic and Social Impact
Monetary costs
Societal costs
Continued………..

10. Net result of health problems existing in Bangladesh
10
Heath problem Size Seriousness Effective interventions Impact Result
Cancer
4
(as Large number
affected in
particular
subgroups)
5
(as there is high
likelihood of death
or disability)
4
(Evidence-based
interventions available
and can be implemented
with moderate effort)
5
(There are great economic
and societal cost )
400
Lower respiratory tract
infections
2
(Moderate
number affected
in particular
subgroups)
3
(Moderately life
threatening and
disabling)
5
(Evidence-based
interventions available
and can be implemented
easily)
3
(There is likely to be
moderate costs)
90
COPD
2
(Moderate
number affected
in particular
subgroups)
3
(Moderately life
threatening and
disabling)
4
( Evidence-based
interventions available
and can be implemented
with moderate effort)
5
(There are great economic
and societal cost )
120

11. 11
Continued………..
IHD 4
(as Large
number
affected in
particular
subgroups
5
(as there is high
likelihood of
death or
disability
3
(Evidence-based
interventions
available but difficult
to implement)
4(
There is likely to be
substantial costs)
240
Stroke 5
L
s
5 3 5 375
Pre term birth
complications
1 4 4 5 80
Tuberculosis 3 3 5 4 180
Neonatal
encephalopathy
2 5 4 5 200
Diabetes 5 4 4 4 320
Cirrhosis 2 5 5 5 250

12. Effective interventions for existing problems
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Different frameworks can help to decide on asking an
appropriate intervention. These are
 Causal Pathway
 CDC Health Impact Pyramid
 Behavioral Theories and Models
 Evidence-based interventions can help to select
effective interventions

13. Causal Model of intervention
13
 With in-depth study of a disease and its risk factors, we can often
identify the causal factors
 Many factors can be associated with a disease but are not causal

14. Using the Health Impact Pyramid
14

15. Applying Behavioral Models and Theories to
Interventions
Behavioral models and theories give planners tools to design health
behavior and health promotion interventions at 3 levels:
 Individual
 Interpersonal
 Community
To use these models and theories effectively, health practitioners must
understand the target population (e.g., gender, age, geographic location)
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16. Effective interventions for existing health problems
16
Health Problem Effective interventions Best intervention
Cancer  Causal model
 Health impact pyramid model
 Behavioral models and theories
Health impact pyramid model can be best
suited there, Cause peoples knowledge and
attitudes can prevent him or her from causing
cancer.
Lower respiratory tract infections  Health impact pyramid model
 Behavioral models and theories
Health impact pyramid model
COPD  Causal model
 Health impact pyramid model
 Behavioral models and theories
Causal model will be best because it will help
to identify the risk factors ,best treatment
procedures and outcome of the disease
condition.
IHD  Causal model
 Health impact pyramid model
 Behavioral models and theories
Behavioral models and theories

17. 17
Continued……….
Stroke  Causal model
 Health impact pyramid model
 Behavioral models and theories
Behavioral models and theories
Pre term birth complications  Health impact pyramid model
 Causal model
Health impact pyramid model
Tuberculosis  Health impact pyramid model
 Behavioral models and theories
Health impact pyramid model
Neonatal encephalopathy  Health impact pyramid model
 Causal model Health impact pyramid model
Diabetes  Causal model
 Health impact pyramid mode
 Behavioral models and theories
Behavioral models and theories
Cirrhosis  Causal model
 Behavioral models and theories:
Causal model
Health Problem Effective interventions Best intervention

18. Budget planning for existing health problems
18
Health Problem Estimated cost according to
prevalence
Estimated social cost Realistic cost should be
Cancer 24.07 million 12 million 18
Lower respiratory tract infections 12.96 million 5 million 9.25
COPD 12.96 million 7 million 9.98
IHD 11.11 million 15 million 13.05
Stroke 9.25 million 14 million 11.63
Pre term birth complications 7.40 million 7 million 7.2
Tuberculosis 5.56 million 5 million 5.28
Neonatal encephalopathy 5.56 million 5 million 5.28
Diabetes 5.56 million 25 million 5.28,it should be 4 fold more
Cirrhosis 5.56 million 5 million 5.28
Total 99.99 million 100 million

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