Download What Makes a Problem a Public Health Issue?

October 28, 2015
Pallium Canada Symposium
What Makes a Problem a Public Health Issue? The Case for Palliative Care
Ross Upshur BA(Hons), MA, MD, MSc, CCFP, FRCPC
Head, Division of Clinical Public Health Professor, Department of Family and Community Medicine,
Dalla Lana School of Public Health, University of Toronto
Objectives
1. To explore the inter‐relationship between Public Health and Palliative
Care
2. To make a positive case for the public health significance of high
quality palliative care
3. To base this in both “evidence” and “ethics.”
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October 28, 2015
Pallium Canada Symposium
Format
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What is Public Health?
Four Questions
Five good reasons
Conclusions
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October 28, 2015
Pallium Canada Symposium
Definition of Public Health
• Public health is what we, as a society, do collectively to assure the conditions for people to be healthy.
Institute of Medicine
• The science and art of preventing disease, promoting and protecting health • Uses community interventions, disease control and principles of epidemiology and biometry
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Pallium Canada Symposium
Public Health Functions
• To assemble and analyze community health needs for disease prevention, health promotion and protection
• To develop health policy through scientific knowledge
• To assure the community by providing health protection services
Public Health Functions
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Health Protection
Health Promotion
Disease & Injury Prevention
Population Health Assessment
Surveillance
Emergency Preparedness
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October 28, 2015
Pallium Canada Symposium
Public Health Achievements (CDC)
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Vaccination Programs
Food Safety
Infectious Disease Control
Water Safety
Family Planning
Tobacco Control
What is a Public Health Problem?
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Prevalence of condition or exposure
Impact of condition on society
Condition is preventable
Effective interventions available
Equity considerations
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Pallium Canada Symposium
Public Health: Thick and Thin
• Thin: Narrow concepts of disease prevention, focus on morbidity and mortality
• Thick: Broader SDOH, holistic in orientation
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October 28, 2015
Pallium Canada Symposium
Four Key Questions
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What health event is to be prevented?
What practices and behaviours will be promoted?
Who is being protected from what harm?
Are we improving community health in an equitable manner (i.e. Special consideration for marginal and vulnerable populations)?
Five Good Reasons
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Demographics and Population Shift
Unmet Need
Feasibility
Accountability
Justice and Equity
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Pallium Canada Symposium
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Pallium Canada Symposium
Unmet need
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Pallium Canada Symposium
Feasibility
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October 28, 2015
Pallium Canada Symposium
WHO Public Health Strategy
1) Appropriate policies; 2) Adequate drug availability
3) Education of policy makers, health care workers, and the public
4) Implementation of palliative care services at all levels throughout the society. Accountability
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Measurement Capacity exists
Benchmarking a standard quality exercise
Target can be set , action taken
Global Good Death Index
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Pallium Canada Symposium
Ethical Considerations
• Minimize harm • Protecting vulnerable persons • Vulnerability occurs when persons or populations are unable to optimally protect themselves from hazards or advocate for their own best interests, thus requiring enhanced protections. Public Health Ethics vs. Bioethics
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Population focus vs. focus on individual
Community perspective vs. focus on the person
Social determinants vs. individual agency and responsibility
Systems of practice vs. individual decision making 12
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Pallium Canada Symposium
Public Health as Social Justice
• Gostin and Powers: “Our account of justice stresses the fair disbursement of common advantages and the sharing of common burdens. It captures the twin moral impulses that animate public health to advance human well‐being by improving health and to do so by focusing on the needs of the most disadvantaged.” Who bears the responsibility?
• “For public health strategies to be effective, they must be incorporated by governments into all levels of their health care systems and owned by the community .” (WHO PH Strategy)
• Community engagement and education required
• Leadership from Palliative Care AND Public Health Communities
• Imaginative Collaboration Needed
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October 28, 2015
Pallium Canada Symposium
Four Key Questions
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What health event is to be prevented?
What practices and behaviours will be promoted?
Who is being protected from what harm?
Are we improving community health in an equitable manner (i.e. Special consideration for marginal and vulnerable populations)?
Conclusions
• Compelling reasons for better integration of public health and population health perspectives into palliative care
• Will take champions and leaders to bring about change
• Significant moral failure not to move in this direction
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October 28, 2015
Pallium Canada Symposium
Jonathan Lear
Radical Hope
• In the face of a cultural challenge…there is ever more pressure to explain things in the traditional ways, yet there us an inchoate sense that the old ways of explaining are leaving things unsaid. And yet one does not yet have the concepts with which to say it.
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