Transcript 18 Population Medicine Where do we go from here?

18 Population Medicine
Where do we go from here?
Last readings report &
Dissemination exercise report due Friday
BRING IN UNNATURAL CAUSES DVD'S
What have we learned so far?
basic ideas of the course - simplified
studies of determinants of population health focused on
USA with many studies
other rich countries as well
-dissect stages of life from womb to tomb, intergenerational aspects "
As the extent of inequality increases in the United States, it is apparent
from this study that the life chances of disadvantaged individuals
diminish and are largely determined by the accident of their birth."
(Albrecht 2007)
medical care and mental health
biology underlying population health concepts
POPULATION HEALTH
other countries:
health situation
there
– India, China,
FSU,
– South Africa,
Central and
South America
Criticisms of these concepts
Major areas of skepticism-disbelief?
Major areas of skepticism-disbelief?
Inequality (what other's
have) doesn't impact my
health
Individual behaviors have
greater impact than
presented in course
Health care is a bigger
factor
Early life is not that
important
Culture's effects are limited
Major areas of skepticism-disbelief?
Inequality (what other's
have) doesn't impact my
health
Individual behaviors have
greater impact than
presented in course
Health care is a bigger
factor
Early life is not that
important
Culture's effects are limited
Organizations
(corporations, NGO's,
financial institutions) DO
GOOD because run by
well-meaning people
Charity and philanthropy a
good idea
Can't change world order
(last paragraph) "The primary determinants of disease are
mainly economic and social, and therefore its remedies
must also be economic and social. Medicine and politics
cannot and should not be kept apart."
Ideas from Research to Policy
Smith 2007
Evidence-based policy enthusiasm
Researchers & Policymakers are distinct
Politics shapes research-policy relations,
IDEAS not research evidence
Lifestyle-behavioral ideas favored for policy
"Policy should be based on values, instinct" Minister
Ideas are marketed (entrepreneurial process)
Academic career not about influencing policy
Neoliberal policy is off limits
Web of Influence
Heymann 2006
paradigm shifts: a scientific
revolution
Scientific Revolutions
– Copernicus (1473-1543)
and paradigm shift telescope
rejected by the Catholic
church.
FLAT EARTH SOCIETY still
exists
–
–
–
–
–
–
paradigm invisible
assumptions about discipline
– doing research in science is
about discovering what is
known and mopping-up of
existing paradigms
– you are strongly constrained in
how you are supposed to think
– public largely outside of process
– current state of the world
paradigms strongly influenced
by big business, powerful
political and opinion leaders
Evolution
Origins of life
Big Bang
Quantum Physics
Post-modernism
World Poverty WE LIVE AND LET THEM DIE
WHAT TO DO?
World View
Your Take on
Ideas
Free market
ideologue
Jeffersonian
democrat
Disbelief
Economic
Curtail federal
growth solves all government
Rethink ideas in a
year or two
Skeptical
Need time to
reflect
Learn more
Strong Belief
Market
Inform to limit
externalities
inequality in
must be counted society
Inform and organize
towards economic
and social justice
ideals
What about
health care?
People need to
pay for services
Specialist restraint
Focus on PHC
Universal non-profit
+ Caps on spending
Remove current
media constraint
on these ideas
Inform of limits of
health care
Socialist
WHAT TO DO?
Your Take on
Ideas
Goals
Job is primary Job is
source of life's secondary
meaning
Family is
primary
Disbelief
Economic growth Revisit in a year or
solves all
two
Skeptical
Need time to
reflect
Strong Belief
Find job using my Find
talents to work for opportunities
economic justice outside of work
striving for
economic justice
Revisit ideas and
talk with others
Create local
community &
nurture ideas
within it
"It is difficult to get a man to
understand something when his
salary depends upon him not
understanding it."
Upton Sinclair
Your perspective, what can YOU do,
what help needed, how work together?
Existentialism, why are we here?
Can you keep your day job?
it is difficult to get a man to understand something
when his salary depends on his not understanding it
jobs/work
USA agency, government, traditional public health, teaching
Other Rich countries: functionary in WHO, WB, UNICEF,
Poor Countries
– development agencies, government, NGOs
– multilateral and bilateral organizations, UN
– teaching
Dominant Values
 Self-determination/Self discipline
 Rugged individualism
 Benefits based solely on effort
 Limited obligation to collective good
 Voluntary and moral nature of behavior
 Limited government intervention
 Smallest government is best government
Adapted from Beauchamp, 1976
Dysfunctional social systems
change when
Problem begins to attract
popular and political
attention
Major players agree upon
a refined and feasible
proposal
and a transforming political
event takes place, creating
open policy window
-major electoral realignment
-natural disaster
-economic depression
-war
A healthy society
choices: paper or plastic?
health care
education
Children & women FIRST
Policies to promote
social/economic justice
Caring and Sharing Relationships
food, water, shelter, security
What needs to be done?
YOUR Perspective on what YOU CAN DO?
What needs to be done?
Educate yourself
Inform others
– plant brush
fires in other people’s minds
– Get people thinking critically, and differently
Change rules or make new ones
Maintain your livelihood
e.g. Abolitionists in US : women in late
1700s
"Let us all first wake up the
nation to lift millions of
slaves of both sexes from
the dust, and turn them
into men and then … it will
be an easy matter to take
millions of females from
their knees and set them
on their feet, or in other
words, transform them
from babies into women"
Angelina Grimké (Zinn pg118)
TOOLS
Allies for population health
United Nations Human Development Report 2006
United Nations Human Development Report 2006
Population Health Dissemination
TEACH whatever level you can
-work on primary school curricula
-high school
Population Health Dissemination
WRITE FOR VARIOUS PUBLICATIONS
draft a creative pamphlet/flyer
on population health to hand out at your
association's meetings
meetings with stakeholders to test various drafts
are necessary
Have you ever taken the
time to consider that the
actions taken by your
parents while they were
pregnant with you could
have affected the way you
live your life today?

Do you realize that the
actions you are currently
taking could be affecting
YOUR children’s adult life?

Have you ever realized that
by living in a rich country,
your adult health is
affected during early life in
ways different than those
living in poor countries?
the
Heymann, J.,A. Earle, et al.
(2004). The Work, Family and
Equity Index: Where does the
United States stand globally?
Boston, Harvard School of
Public Health.
UNICEF Innocenti Research
Centre (2007). Innocenti
Report Card No. 7. February
2007. ‘An overview of child
well-bring in rich nations’.
Florence, UNICEF.
Wilkinson, Richard G. The Impact
of Inequality: How to Make
Sick Societies Healthier. New
York:The New Press, 2005.
of
Early Life on
Adult Health
Emotional development
is one of the three most
powerful psychosocial
influences on health.
Low birth weight can be seen as a
predictor of illness at the end
stages of life.
Maternal stress also can lead to
children with emotional and
behavioral problems.


In the U.S., stress during
pregnancy is the biggest factor to
low birth weight.
If children receive good care at a
time when their brain is highly
malleable, they develop physical,
mental, and social skills that allow
them to thrive later in life.

Interestingly enough, 163 countries
around the world offer guaranteed
paid leave to women in connection
with childbirth. The U.S. does not.
You might be surprised to
find out that when extreme
stress is placed on animals
during pregnancy, smaller
offspring are produced.

45 countries ensure that fathers
either receive paid paternity leave
or have a right to paid parental
leave. The U.S. guarantees fathers
neither of these.
Social problems stand
out as more important
for illness later in life
than do economic
conditions.

Children require many things from
early abiding relationships. The
parent-child relationship shapes
the development of:
a. self awareness
b. social competence
c. conscience
d. emotional growth
e. other accomplishments
produce a website on population
health ideas aimed at (high school
students)
Option for those familiar and facile with web
design.
-Need to have rehearsals with groups of
students at a high school in your town.
give a lecture to some group
near your home or place of work on
these concepts.
a talk to homeless,
a presentation at schools or clubs,
some similar audience that you have access to.
work with a community group to get them
aware and help them take some actions.
Checklist for Action to help you in
this process:
1. From whom do we want to get a
response?
2. What responses do we want to
get?
3. What action or series of actions
has the best chance of producing
that response?
4. Are the numbers of our
organization able and willing to
take these actions?
5. How do the actions we decide to
take lead to the needed
development of our organization?
examples of community
groups you might work with
include:
homeless advocates
domestic violence support
food banks
health care advocates
environmental groups
labor unions
high school clubs
senior centers
church groups
neighborhood groups
http://www.thelaststraw.ca/
Objectives:
-to promote discussion about the
social determinants of health;
-to help players build empathy
with marginalized people and
gain an awareness of players'
own social location;
-to encourage learning in a
fun and supportive environment.
Developed 2004 in
Health Promotion Class
University of Toronto
What needs to be done?
Educate yourself
Inform others
– plant brush
fires in other people’s minds
Change rules or make new ones
Maintain your livelihood
You get what you measure
Daily/Weekly/Monthly
– Chicago Futures (15
sec.)
– Dow Jones (minute)
– NASDEC (minute)
– Money supply (10
days)
– Economic growth
• (3-4 wks)
NEVER
– Social indicators of
health
– Health Olympics
– Homicide Olympics
– Incarceration
Olympics
– Child Neglect
Olympics