PUBH203 Revision

Kingdon's Model for Policy Making

Politics Stream + Policy Stream + Problem Stream all have to align together in order for the policy window to open.

Relative Poverty

Poverty dependant on the society in which you live, so varies over time. Standard figures for relative poverty are 50-60% below the median income.

Most effective strategies for alcohol risk reduction

Pricing and taxation, regulation of availability, regulation of promotion and marketing, drink-driving interventions, treatment and early intervention of dependance

USA Health system

Private insurance

Medicaid, Medicare, CHIP, Tricare, Veterans Association

Providers of care for the vulnerable. Medicaid = Poor and disabled, Medicare = elderly, CHIP = children's health insurance programme, tricare = retirees and families of active duty, provided for by the Veteran's association

2000-2003 Health Reform NZ

Public Health and Disabilities Act 2000 - creation of 21 DHB's, PHO's since 2003

Centralised Policy

Ran/decided at a government/national level

Decentralised policy

Ran/decided at a local level - usually through DHB's and local councils

Types of Public Policy

Regulatory (bills, acts and laws), Distributory (allocation of resources), redistrubutive

Resettlement of refugees strategy goals

Self-sufficiency, housing, education, health and wellbeing, participation

Three models of doctor-patient relationships

Active-passivity (paternalistic, doctor centred), Guidance-cooperation (paternalistic, doctor centred), Mutual Participation (patient centred, relationship model)

The Policy Cycle

Agenda Setting, Formulation, Adoption, Implementation, Evaluation, Support/Maintenance .....

Food Industry Policy instruments

product reformulation, potion sizes, packaging, promotion, price etc.

Absolute Poverty

severe deprivation in which you don't have the basics of life. Not normally seen in NZ

Refugee

someone who is unable to or unwilling to return to their home country due to a fear of some sort. Usually the fear is that they are going to be killed or persecuted because of race, religion etc.

Livewell Principles

1. Eat more plants 2. Eat a variety of foods 3. Waste less foods 4. Moderate Meat consumption 5. Credible certified standard of foods 6. eat less foods high in sugar, salt and fat

Health consequences of poverty

1.4x as likely to experience premature death, conformed by dunedin study, even if you're not poor anymore.

Proportion of children with low household income and material hardship

8%

NZ Health expenditure

9.5% GDP - 80% funded, 20% Out of pocket expenditure

Mutual Participation model for doctor-patient relationships

Bio-Psycho-Social Model, looks at the patient as a person, and the doctor as a drug. This is the most valued relationship by people.

Top down model of policy implementation

Clear division between policy formulation and policy execution. Needs a chain of command, available resources and clear understanding of goals

Policy triangle

Context, Content, Process, Actors (centre)

Ottawa Chapter for Health Promotion 1986 Action areas

Developing healthy Public Policy, Creating supportive environments, Strengthening Community Action, Developing Personal Skills, Re-Orientating Health Services

Medical Model for diability

Disability is a problem unique to that individual, and does not concern anyone else

Health Promotion

Encouragement of activities that improve health at a population level. Uses the Social Determinants of Health

Issues with the USA Health system

Expensive, not providing reflective health outcomes. Doctors tend to over use services because they get paid more. Patients might not be covered. Depends on complex policies that insurance companies will try to get out of paying (Deny, Delay, Defend)

Primary Care

First contact, accessible, continued, comprehensive and coordinated care. Subset of Primary Health Care.

FCTC

Framework Convention on Tobacco Control by WHO - legally binding treaty, the first of it's kind. 181 Countries have signed and Ratified

1993-96 Health Reform NZ

Health and Disabilities Services Act, creation of 4 RHA's and Pharmac

1996-2000 Health Reform NZ

Health and Disabilities Services Amendment Act 1998 - 4 RHA's merged into one health funding authority

Health system building blocks

Health services, Health workforce/HR, Health Information systems, Essential medical medical products, vaccines and technologies, Health financing system, leadership and governance

Bismarckian-style system

Health system funded by national health insurance schemes, general taxation and personal input, insurance schemes are generally occupation based. Examples - Australia, France, Germany, Japan, Netherlands

Opportunity cost

In order to put resources into one thing, they have to be taken away from another. Making the choice into resource allocation

Material Hardship

Inability to afford basic things such as clothes for special occasions, doctor or dentist visits, fresh fruit and veges etc. Not necessarily linked with low income.

The Accident Compensation Act 2001

Introduced no fault personal injury cover, covering tourists. But it meant that we had to forgo the right to sue. Formed from the Woodhouse report as an address to his recommendations.

1983 Health Reform NZ

Introduction of 14 Area Health boards

Why measure poverty?

Keeps it on the agenda, provides a benchmark for changes over time, evaluation of interventions, comparison internationally, identifying clusters

Social Democracy

Labour Party - favours equity

Private Insurance System

Mainly work-based coverage, less regulation, emphasis on individual choice of level of healthcare cover. Example - United States.

Migrants

Move for economic reasons - not refugees

Internal DHB reforms since 2009

Movement away from public health and prevention measures and back into health as a business - better, sooner, more convenient

Strategies for reduction of harm from learning disabilities

NZ Disability Strategy, UN convention on the rights of persons with disabilities, NZ Disability action plan, NZ Health Strategy 2010

Beveridge-style system

National Health System with universal access, primarily funded by general taxation, eligibility determined by residence and citizenship, PC is independent. Examples - NZ, UK. Common problems are that they are underfunded and technically inefficient

Neoliberalism

National Party - things should be run as a business, and favours equality over equity

NZPHDA 2000

New Zealand Public Health and Disability Act 2000, outlined a set of goals and action plans for Maori Health Services using the strategy of He Korowai Oranga

Primary Health Care

Not a Healthcare Provider. An umbrella term used to describe an approach to health policy, services and provision. Holistic approach to all kinds of care.

PPACA

Obamacare - main goals were to expand Medicaid, and reduce the amount of uninsured people by making this compulsory, or pay a fine.

1984 Hui Whakaoranga

Outlined a new approach to Maori Health, and to address inequalities

The Treaty of Waitangi

Signed 6th Feb 1840, outlines responsibilities of the government to address Maori health inequalities.

4 qualities most important in a 'good doctor'

Technical competence, Integrity and trustworthiness, Good communication skills, Respect and caring

Whanau Ora

The approach Maori Health Practitioners use when delivering care - has a focus on holistic care and the social determinants of health. Fix issues such as housing, money and food before medical care will be successful

Social Model for disability

The idea that society disables people through poor accomodation in design. People have impairment, not disability.

Public Health definition

The science and art of preventing disease, prolonging life, and promoting health

Attainability determined by..

The social determinants of health, things that influence a person's health that either is within our outside of their control

NHS

Universal Healthcare system, like NZ, Hospitals and Primary care provided for, free at the point of entry, comprehensive care with equitable and universal access.

Format for comparing health systems

Use building blocks, health data on spending, access and equity, and outcomes, use inputs, outputs and resulting outcomes of the systems

Private Public Partnerships

When the government allocates roles for intervention so they don't have to deal with it themselves - Breakfast and Milk in schools, Salt reduction etc.

Define a health system

all organisations, people and actions whose primary intent is to promote, restore or maintain health

Bottom Up model of Policy implementation

depends on 'street level' actors such as managers, doctors etc. Motivations and policy preferences must be understood by all parties

Indonesian Health Care system

in 2014, Indonesia introduced a compulsory health insurance scheme that has potential, but still needs work.

Measures incorporated in the approach to measuring child poverty

income measure adjusted for family structure, measure for material hardship, duration of poverty, income after housing costs

What is a learning diability

one condition within the group of neurodevelopmental disorders, usually identified early in life, deficits in general mental abilities leading to adaptive functioning, issues in personal, social, academic and occupational functioning. 3 criteria must be met for diagnosis: 1. onset in the developmental period, 2. deficits in adaptive functioning, and 3. deficits in intellectual functioning (IQ below 70).