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Reducing Health Inequalities: How to Effect Systems Change
and What is the Evidence Which Policies Work?
______________________________________
Jordan Panayotov, M Ec, MPH (Health Economics) Independent Centre for Analysis and Research of Economies Melbourne, Australia
Public Health in Canada:Reducing Health Inequalities Through Evidence & ActionHalifax, Nova Scotia, 1 - 4 June 2008
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The Foundations:______________________________________
People have the right to highest attainable health.
WHO Constitution, 1948
New public health is a social and political concept aiming at improving health, prolonging life and
improving the quality of life among whole populations through health promotion, disease prevention
and other forms of health intervention. Nutbeam, 1998
J.Panayotov. All rights reserved. CPHA 2008 Conference, Halifax
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PREVENTION
PRIMARY CARE
CHRONIC DISEASES
I C U
J.Panayotov. All rights reserved. CPHA 2008 Conference, Halifax
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Conflict of Interests When Allocating Resources
O A
B
B1
B2
A1 A2
S1
S2
AB – Possible efficient allocations of given resourcesOAi – Benefit for person AOBi – Benefit for person BSi – Allocation of resources providing benefit OAi + OBi
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Public Spending for Health Dominates
J.Panayotov. All rights reserved. CPHA 2008 Conference, Halifax
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System Change / Health Reform_______________________________________
• Why? People want a change when they are not happy with the outcome.
Why do people finance health expenditure collectively ?
Is it to keep hospitals busy, or
to make providers (doctors and/or insurers) happier, or
to improve health and quality of life among whole populations!
• How? When decisions for allocating limited resources are made,
i.e. choices for policies, programs or interventions are made,
on what basis these decisions are made?
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The Role of Ethics and Human Rights______________________________________
Ethics defines the values.“there is no such thing as “value-free” welfare economics.”
Hurley J., 2000
What is the Declared Ethics? All people are of equal value irrespective of their age, gender, race, income or functions in the society.
Human rights play important role as an instrument for assuring the declared ethics.
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Implications for Public Health__________________________________________________
There is nothing so practical as a good theory
Kurt Lewin
J.Panayotov. All rights reserved. CPHA 2008 Conference, Halifax
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Average Health Status - Health Inequalities Matrix_____________________________________________
AHS
HInEq
DPP
AHS – Average Health StatusHInEq – Health InequalitiesDPP – Dead Performance Point
Panayotov Matrix
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RESOURCES, RESULTS, EFFICIENCY
0
1000
2000
3000
4000
5000
6000
7000
US $ per CAPITA0
2
4
6
8
10
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EFFICIENCY
-6-4-20
INFANTMORTALITY
USA
CzechRep.
OECD26/06/2006 Rising health costs put pressure on public finances, Health expenditure per capita
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U.S. Newborn Survival Rate Ranks Low___________________________________________________
“Our health care system focuses on providing
high-tech services for complicated cases.
What we don’t do is provide basic primary
and preventive health care services.”
Kenneth Thorpe, Emory University health policy expert
With the permission of The Associated Press Copyright 2006, All rights reserved.
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