Fifth Annual Maureen Dixon Lecture A Health Policy that Promotes Health Jo Ivey Boufford, M.D. May 15, 2003
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Fifth Annual Maureen Dixon Lecture
A Health Policy that Promotes Health
Jo Ivey Boufford, M.D.May 15, 2003
Key Determinants of Health
Source: Toward a Common Understanding: Clarifying the Core Concepts of Population Health; A Discussion Paper; The Conceptual Framework Subgroup on Population Health; Health Canada, December 1996
• Income and Social Status• Social Support networks• Education• Employment/
Working Conditions• Social Environments• Physical Environments• Personal Health Practices
• Healthy Child Development
• Biology and Genetic Endowment
• Health Services• Gender• Culture
SOCIETY AND INSTITUTIONS
COMMUNITY
INDIVIDUALS INDIVIDUAL ILLNESS
TARGET OF INTERVENTION
TYPE OF INTERVENTION
Clinical Care Intersectoral Working: Jobs/Housing/Education
Public Advocacy
Health Promotion/Prevention
POPULATION HEALTH
Health Service Utilization
1000 750 250
White, et al, 1963
9 Community Hospitals
5 Specialists
1 Teaching Hospital
SOCIETY AND INSTITUTIONS
COMMUNITY
INDIVIDUALS INDIVIDUAL ILLNESS
TARGET OF INTERVENTION
TYPE OF INTERVENTION
Clinical Care Intersectoral Working: Jobs/Housing/Education
Public Advocacy
Health Promotion/Prevention
POPULATION HEALTH
Community Health Improvement Strategy
• Identify a defined population (“community”) and develop links
• Assess health status and need and adjust volume and types of services
• Develop effective primary care systems• Develop effective intervention programs in
partnership with the community
Community Health Improvement Strategy (Continued)
• Address the health status of the workforce• Develop staff as force for community health• Serve as advocate in the community to
increase healthy choices available to the population
• Use economic leverage for health related changes:– Jobs – Channeling purchasing power– Housing development
Behavioral Factors
50%
Inadequate Access to
Medical Care10%
Genetic Factors20%
Environmental Factors
20%
Causes of Premature Mortality
The Core Function Project: U.S. Public Health Service, 1993
Public Health Expenditures As a Percentage of Health Expenditures
Tot al Healt h Expend it ures
9 9 %
Pub lic Healt h Expend it ures
1 %
The Core Function Project: U.S. Public Health Service, 1993
Actual Causes of Premature Death in the United States - 1990
DeathsCause
Estimated % of Total
Tobacco 400,000 38%Diet/activity patterns 300,000 28%Alcohol 100,000 10%Microbial agents 90,000 8%Toxic agents 60,000 6%Firearms 35,000 4%Sexual behavior 30,000 2%Motor vehicles 25,000 2%Illicit use of drugs 20,000 1%
Source: McGinnis & Foege, JAMA 1993
Key Determinants of Health
Source: Toward a Common Understanding: Clarifying the Core Concepts of Population Health; A Discussion Paper; The Conceptual Framework Subgroup on Population Health; Health Canada, December 1996
• Income and Social Status• Social Support networks• Education• Employment/
Working Conditions• Social Environments• Physical Environments• Personal Health Practices
• Healthy Child Development
• Biology and Genetic Endowment
• Health Services• Gender• Culture
Principles of Epidemiology, Ian Taylor and John Knowelden, London, 1957
01020304050607080
Mor
talit
y R
ates
: Inf
ants
und
er 1
year
I II III IV VSocial Classes
1930 - 321950
Infant Mortality Rates and Social Classes: England and Wales
0
200
400
600
800
1000
1200
1400
1600D
eath
s pe
r 100
,000
I IIIN IV SingleParents
Social Class
England and WalesSweden
Redrawn from Wilkinson, Richard G., Unhealthy Societies. Taken from Leon et. Al. 1992
Social Class Difference in Infant Mortality
Source: David Kindig, University of Wisconsin
Death Rates for White Males
050
100150200250300350400
Dea
ths
per 1
00,0
00
HeartDisease
CarAccident
LungCancer
GICancer
Stroke Suicide
Cause of Death
MarriedSingleWidowedDivorced
“The Effects of Relationships on Well-Being,” by M. Argyle, in Building a Relational Society; ed. Nicola Baker. Hampshire, England, 1999
The Public Health System
Community Health caredelivery system
Employers & Business
Governmental Public Health Infrastructure
Academics The Media
Assuring the Conditions for Population Health
INSTITUTE OF MEDICINE
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