Health Equity: 08/24/12

Friday, August 24, 2012

[EQ] The Cost-Effectiveness of Environmental Approaches to Disease Prevention

The Cost-Effectiveness of Environmental Approaches to Disease Prevention

Dave A. Chokshi,and Thomas A. Farley

From Brigham and Women’s Hospital and Harvard Medical School
— both in Boston (D.A.C.), and the New York City Department of Health and Mental Hygiene, New York (T.A.F.).

N Engl J Med 2012; 367:295-297July 26, 2012

Website: http://bit.ly/QzPJCd

“…..How can society prevent the most disease and deaths per dollar spent? This question arose throughout the debate on U.S. health care reform and will continue to drive decision making as health care funding becomes increasingly constrained. In an atmosphere of austerity, demonstrating the cost-effectiveness of preventive health interventions becomes particularly important.

Although preventive approaches to disease are intuitively appealing — and frequently presented as a way to reduce costs — analyses have suggested that, as a whole, they're no more cost-effective than therapeutic interventions.1 But are some preventive approaches more cost-effective than others?

The National Commission on Prevention Priorities attempted to address this question, ranking clinical preventive services in terms of cost-effectiveness and “clinically preventable burden” of disease.2 Yet some preventive services, such as tobacco taxes or water fluoridation, are not delivered in health care settings. Understanding whether certain approaches are more cost-effective than others requires a framework for categorizing preventive interventions.

Medicine traditionally classifies preventive interventions on the basis of disease course: primary prevention aims to prevent new cases of disease; secondary prevention and tertiary prevention mitigate the effects of existing disease. We propose two overlapping dimensions to further characterize primary preventive interventions: environmental versus person-directed, indicating whether the proximate target is an element of the environment or an individual, and clinical versus nonclinical, indicating where an intervention takes place…..”

KMC/2012/SDE
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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ KMC Area]
Washington DC USA

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Health Organization PAHO/WHO or its country members”.
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[EQ] Why corporate power is a public health priority

Why corporate power is a public health priority

Gerard Hastings
Institute for Social Marketing, University of Stirling and the Open University, UK

BMJ - 2012; 345 doi: 10.1136/bmj.e5124 - Published 21 August 2012

“….The marketing campaigns of multinational corporations are harming our physical, mental, and collective wellbeing. Gerard Hastings urges the public health movement to take action..

Website: http://bit.ly/PD49po

“…..The work of Professor Richard Doll* provides two key lessons for public health.
The first, that we must do all we can to eradicate the use of tobacco, has been well learnt and is being energetically acted upon.
The second, more subtle learning—that our economic system has deep flaws—remains largely ignored. And yet, lethal though tobacco is, the harm being done to public health by our economic system is far greater…..”

** Professor Sir Richard Doll, epidemiologist and Regius Professor of Medicine at Oxford University, was one of the first two scientists to link smoking with lung cancer

Thank you.

[EQ] Global oral public health - the current situation and recent developments

Global oral public health – the current situation and recent developments

Kenneth A Eaton

President, European Association of Dental Public Health

Journal of Public Health Policy (2012) 33, 382–386. doi:10.1057/jphp.2012.22

Website: http://bit.ly/RJJIdf

“……In many countries, oral health has a relatively low priority. This is perhaps unsurprising because, with the exception of oro-pharyngeal cancer, very few people die as a direct result of oral diseases.

Painful or unsightly teeth and periodontal tissues (gums) and oral infection can, however, have a variety of consequences leading to a reduced quality of life and considerable expense. In 2000, some 50 billion Euros was spent directly on oral health in the then 15 Member States of the European Union.1 Indirect costs, because of such factors as time off work and poor performance at school, add substantially to this cost.

In addition, isolation of dentists from the mainstream of health care has led to relatively little interest in oral health by health planners.

Why? One reason is that in North America and North West Europe, for over a century, dentists have been educated separately from medical doctors and undergo an Odontological education, which, although it includes perhaps 50 per cent of a medical course, has historically put an emphasis on the treatment of teeth and more recently the prevention of oral diseases. In Southern and Eastern Europe, until relatively recently, dentists underwent a Stomatological education in which they were trained as medical doctors before further education in dental procedures.

A second reason is that dentists generally practice in isolation from other health care workers, in what are effectively small businesses. From a public health point of view, dental public health is under-developed, and in Europe is recognised as a specialty in only three countries (Bulgaria, Finland, and the United Kingdom).2

This article explains why oral health should be fully integrated into health planning and public health, considering, in particular, the increasing emphasis placed on non-communicable diseases (NCDs) and oral manifestations of infectious disease. It discusses current trends in oral diseases, and developments to raise the profile of oral health and integrate it into the mainstream of health planning and public health…..”

KMC/2012/HSS
Twitter http://twitter.com/eqpaho

* * *
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ KMC Area]
Washington DC USA

Thank you.

[EQ] Ecological public health: the 21st century's big idea?

Ecological public health: the 21st century’s big idea?

……….Public health thinking requires an overhaul. Authors outline five models and traditions, and argue that ecological public health—which integrates the material, biological, social, and cultural aspects of public health—is the way forward for the 21st century ………

Tim Lang, professor of food policy, Geof Rayner, honorary research fellow
Centre for Food Policy, City University London, UK

BMJ 2012; 345 doi: 10.1136/bmj.e5466 - Published 21 August 2012

Website: http://bit.ly/PCvQi7

“……It seems to be the fate of public health as concept, movement, and reality to veer between political sensitivity and the obscure margins. Only occasionally does it gain what policy analysts often refer to as traction. Partly this is because public health tends to be about the big picture of society, and thus threatens vested interests. Also, public health proponents have allowed themselves to be corralled into the narrow policy language of individualism and choice.

These notions have extensively framed public discussion about health, as though they are not tempered by other values in the real world. As a result, the public health field suffers from poor articulation, image, and understanding. The connection between evidence, policy, and practice is often hesitant, not helped by the fact that public health can often be a matter of political action—a willingness to risk societal change to create a better fit between human bodies and the conditions in which they live.

We have reviewed how public health theory and practice have evolved over the last two or three centuries, and looked at the challenges present and ahead, and we conclude a rethink is in order. In difficult economic times, public health too easily falls down the political agenda. It is judged worthy but not a political priority. Yet there is strong evidence that health is societally determined, that public health is high in the public’s notion of what a good society is, and that health underpins economics.

“….Today, as financial crises continue—banking failures, debt bubbles, slowing economic growth, nervous but contradictory consumerism—there is an opportunity to review what is meant by public health for the 21st century….”

KMC/2012/HSD
Twitter http://twitter.com/eqpaho

Thank you.