public health programmes succeed and survive if organisations address 6 areas
1) INNOVATION to develop the evidence base for action
2) A techincal packge of a limited number of high-priority, evidenc-based interventions that together have a MAJOR IMPACT
3) EFFECTIVE PERFORMANCE MANAGEMENT, through real time monitoring, evaluation and programme improvement
4) PARTNERSHIPS & COALITIONS with public and private sector organisations
5) COMMUNICATION of accurate & timely info to health care community & public to effect behaviour change and engage civil society
6) POLITICAL COMMITMENT to obtain resources & support for effective action
Programs inlcuding small pox eradication, TB control, tobacco control have made progress by addressing these 6 areas
- INNOVATION
- Essential to all aspects of public health strategy & program development
- Critical to developing the evidence base needed to establish and refine successful program intervention
- A new diagnostic technique/treatment can make a previously unobtainable goal possible.
- Innovations dont have to be scientific or medicine - can be innovations in information systems, data colelction, communication techniques which can increase political commitment and be essential for progress
- Innovation can contribute to sustainence of high-impact interventions
e. g. smallpox was eradicated through continuous introduction and implementation of innovations including new types of needles and new ways to vaccinate different groups of people
- TECHNICAL PACKAGE
- a technical package of proven interventions sharpens and focuses what otherwise might be a vague commitment to action - comit to implementation of specific interventions known to be effective
-Avoids scattershot approach of using a large numbe of interventions with small impact
E.g. smoking ban - lots of effective interventions like plain packaging, limiting displays, stopping sale of 10 packs etc.
E.g. DOTS for TB control (directly observed treatment, short course)
>consisted of 5 components incl good lab diagnosis, standardised treatment, good supply of high-quality anti-TB drugs & rigorous monitoring > lead to successful treatment of 56million people and saving of 22 million lives since widespread implementation of DOTS ~20 years ago
WHOS MPOWER package for tobacco control
consists of 6 key policy measures:
monitoring tobacco use & prevention policies, protecting people from tobacco smoke, offering help to wuit, warning about dangers of tobacco, enforcing bans on tobacco advertising/promotion/sponsorship and raising tobacco proces = Steady long term declines in smoking prevalence in California & NY, similar stats seen in european countries
- MANAGING PERFORMANCE
-hard to measure public health activities unlike private secor when metrics e/g/ product sales provide prompt performance feedback
Often no automatic, accurate and affordable way to track public health programme performance in real time
Also, impact of public health programs may not be evident for months/years, further complicating measuring performance
- PARTNERSHIPS
- getting many organisations to collaborate can be slow and frustrating but is often crucial to create advocacy needed to support change and implement new/improved programs
- government programs are more likely to succeed and be sustained when orgaisations outside of government advocate for them. e.g. fruit at mcdonalds?
- can be ethical issues in developing public-private partnerships in public health. partnerships between government and the food/beverage/other industries addressing health issues are expanding..sugar tax? coca cola?
- COMMUNICATION
- effective communication can lead to behaviour change and increased political commitment & programme effectiveness
- advent of internet, social media & other technologies more info is available from more sources than ever (although some is incorrect & potentially harmful)
- An effective programme needs to effectively communicate its success & benefits as well as threats to health.
- use anecdotes & case studies to illustrate points
- Presenting a human face to demonstrate impact of abstract data can show decision makers that health & lives are at stake.
-by providing accurate, timely and convincing info including outcome data, public health entities can incr credibility with decision makers/health care providers, public and private program funders
- POLITICAL COMMITMENT
- political commitment built on and supported by the components described in stages 1-5
- effective political commitment leads to the resources and support needed to coordinate, implement & sustain public health interventions, incl policy change if needed
- public health often underfunded, in US budget cuts have led to loss of more than 46,000 state & local public health jobs since 2008
- big companies with lots of money sometimes oppose public health interventions e.e. tobacco companies in smoking ban
