31505391 By Hatim Jaber MD MPH JBCM PhD 29012018 Presentation outline Time Introduction to course 31505391 0800 to 0820 Health as social and economic issue 0820 ID: 738868
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Slide1
Faculty of Medicine Health Economics and Policies (31505391)
By Hatim JaberMD MPH JBCM PhD29-01-2018Slide2Slide3
Presentation outlineTime
Introduction to course 3150539108:00 to 08:20
Health as social and economic issue.
08:20
to 08:30
Determinants of health
: Genetic factors , Socioeconomic factors , Environmental factors
08:30
to 08:40
Determinants of
(inequalities in)
health: Exogenous determinants of health
08:40
to 08:50Slide4
معلومات وقواعد عامةالالتزام والوقت ساعات العمل في المكتب :الأحد- الاثنين –الأربعاء 10-12 الحضور والغيابالامتحانات
المراجع والكتبBjörn
Ekman
,
2015,
Introduction to Health Economics: Theory, Practice, and Policy
- Course Note for the Health Economics Course organized by WHO-EMRO and the MENA Health Policy Forum (MHPF) Slide5
Introduction to course 31505391 Course
Title : Health Economics and Policies Credit Hours : 2 Credit HoursCalendar Description : 15 weeks/ Second Semester - 3
d year (
2017/2018)
Teaching Approaches :
2 Lectures (50min) per week (mon + wed—8:00 -8:50 am) for 15 weeks Slide6
Introduction to course 31505391(cont…)General Objective: Introduce the key concepts
of healthcare management and administration , health policy, health economics and economic evaluation, including how it can serve as a useful tool in prioritizing interventions or strategies for implementation in the health system.Slide7
Introduction to course 31505391 (cont…)Course Goals:
Discuss health value, health determinants, and health behaviors.Describe the health policy making process and the factors influencing itDefine and understand health insurance markets within health care management. Understand governmental health insurance programs and health reform policies.Discuss the role of profit and not-for-profit provider firms in the health care industry. To understand the specific nature of the health care service in implementing economic principles and techniquesUnderstand and Interpret and appropriately apply the key concepts of economics within the context of the health systemDescribe major types of economic evaluation and to understand their use in the decision-making process.
To describe direct, indirect, intangible and opportunity costs.To understand the effect of some economic factors on health status of society.Gain historical and current information on health related markets in Jordan and in the rest of the world and its application to health care markets.
Discuss demand and supply model of the health care industries.
Discuss the roles of both public and private sector financing of health care and the division between public and private health care goods and services.
Understand the role of professional education, training and licensing in physician and allied health professions, and their effects on quality and cost of health care.
Understand economics of bad habits including smoking and alcohol consumption.
Discuss evaluation of medical technology, regulations of health care delivery physicians.
Discuss components of health care delivery including hospitals and the pharmaceutical industry.Slide8
Introduction to course 31505391 (cont…)Method of Instruction : Lectures
2 Lectures (50min) per week (mon + wed—8:00 -9:00 am) for 15 weeks Evaluation and Grading : two exams (MCQ)Midterm - assessment = 50% Final Examination = 50% Slide9
Introduction to course 31505391(cont..) Course Content
Week 1 Introduction to Course introduction to Health: health value, health determinants. Week 2 Introduction to: Health care management Health Policy and Healthcare Delivery.Week 3 The scope of health economics :Economics And Health Economics .Week
4 Demand and Supply Demand for Medical Care. Supply of public health . Week 5 The Market for Health Insurance
Week 6
Financing health care Economic in Health Policy Cost and price
Week
7 Health systems performance analysis. Measurement and evaluation in health care
Week
8 Midterm
assessment (Exams.) 21-3-2018
Week 9
Public Goods, Market Failures, and Cost-Benefit Analysis.
Week 10
Economic evaluation . Economics and efficiency cost analysis and cost effectiveness,
Week 11
Economic effects of Bad habits including smoking and alcohol consumption
Week 12
Quality Improvements in healthcare delivery Methods to improve health care delivery
Week 13
Human resources in Healthcare delivery.
Week
14
Health Markets and Regulation and Economic regulation of health markets
Week 15
Final
assessment (Exams.)Slide10
Week 1Overview of course syllabus and time table.Health as social and economic issue.
Determinants of health: Genetic factors , Socioeconomic factors , Environmental factors Determinants of (inequalities in) health: Exogenous determinants of healthThe social and economic environment and healthThe value of health: Health related quality of life Health vs. Welfare/Utility
Value in Health and Health CareMeasuring Value in Health Care
Definition of health behaviorsSlide11
What is health?
Nutritious foods help us stay healthy.
Doctors, hospitals & medicines help us get healthy
if we’re sick
.
Regular exercise helps keep us strong and
healthy.Slide12
Definition: ‘Health …’‘…
is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’(WHO, 1948)
‘Health is only possible where resources
are available to
meet human needs
and where the
living and working environment
is protected from life-threatening and health threatening pollutants, pathogens and physical hazards
’(
WHO, 1992)Slide13
Concepts of Health Biomedical : “ health is the absence of disease”- (Germ theory of disease).
Ecological Concept: Health is an
Dynamic Equilibrium between Man and his Environment. Imbalance results in Disease.
Psychosocial concept:
Psychological,
Social,
Cultural ,
Economic, Political
factors are included in defining and measuring health.
Holistic concept: I
nclude all the factors of the other concepts in addition to all human activities such education, communication, agriculture, industry, housing , recreation etc.Slide14
Physical , Mental & Social Health Physical health deals with the body’s ability to function.Mental heath deals with how we think, feel and cope
with daily life.Social Health deals with the way react with people within our environment. Slide15
New philosophy of HealthHealth is a Fundamental right
Health is the essence of Productive lifeHealth is IntersectorialHealth is Integral part of DevelopmentHealth is central to Quality of Life
Health Involves Individuals, Families, Communities Local, National and International responsibilities
Health and its maintenance is a Social Investment
Health is
Worldwide Social Goal
.Slide16
16Slide17
DIMENSIONS OF HEALTHHealth is multidimensional and are interrelated, each has its own nature Physical Dimension“Perfect functioning” of the body. It conceptualizes health biologically as a state in which every cell and every organ are functioning at optimum capacity and in perfect harmony with the rest of the body.
Mental DimensionAbility to respond to many varied experiences of life with flexibility and a sense of purpose.Mental health has been defined as “a state of balance between the individual and the surrounding world, a state of harmony between oneself and others17Slide18
Social DimensionHarmony and integration with the individual, between each individual and other members of society, and between individuals and the world in which they live. “quantity and quality of an individual’s interpersonal ties and the extent of involvement with the community.”
Spiritual DimensionSpiritual health refers to “something” that transcends physiology and psychology.18Slide19
Emotional DimensionRelates to “feeling.” it reflects emotional aspects of humanness.Vocational DimensionWork often plays a role in promoting both physical and mental health. Physical work is usually associated with an improvement in physical capacity, while goal achievement and self-realization in work are a source of contentment and enhanced self-esteem.
OthersA few other dimensions have also been suggested such as philosophical dimension, cultural dimension, socioeconomic dimension, environmental dimension
, educational dimension, nutritional dimension, and so on.
19Slide20
DETERMINANTS OF HEALTH
Health
Biological
Gender
Environment
Health services
Behavioral & sociocultural condition
Socioeconomic
Aging
Other factor
20Slide21
Determinants of healthSlide22
Socioeconomic Conditions● Economic status: Economic situation in a country is an important factor in morbidity, increasing life expectancy and improving quality of life, family size and pattern of disease
● Education: Illiteracy correlates with poverty, malnutrition, ill health, high infant and child mortality rates. ● Occupation: Productive work provides satisfaction, promotes health and improves quality of life.● Political system: timely decisions concerning, resource allocation, choice of technology etc
22Slide23
Health ServicesTo be effective, the health services must reach the masses, equitably distributed, accessible at a cost the country and community can afford and social acceptable.Aging of the PopulationA major concern of rapidly aging population is increased prevalence of chronic diseases and disabilities that deserve special attention.Gender
Women’s health is gaining importance in areas such as nutrition, health consequences of violence, aging, lifestyle related conditions and the occupational environment. There is an increased awareness among policy makers of women’s health issues, and encourages their inclusion in all development as a priority.23Slide24
Economic DeterminantsIntersection between social (e.g. job) and economic (income) determinants is fuzzy.Concept of “social class”
is less accepted here.Social status is more than income, though income is an important determinant.“Status Syndrome” (Marmot)24Slide25
Effects of DisparitiesComplex relationship between determinants and outcomes.Some “determinants” are likely outcomes of others.
Parental income associated with educational attainment and health of child. Low education associated with high tobacco use. Tobacco use associated with…..25Slide26
Social effects of DisparitiesDiscrimination?Stress?Low self-esteem?High-risk behaviors
??26Slide27
Behavioral DeterminantsTobaccoNutrition and Physical ActivityAlcoholViolence What is the origin or cause of behavior?
27Slide28
The dependent variables: health and social problemsIn other words, these are the variables which may be affected by income inequality.Based on this social gradient principle, Wilkinson and Pickett (2009a: 18) produced a list of variables for which reliable data could be found. These were: level of trust; • mental illness (including drug and alcohol addiction); • life expectancy and infant mortality; • obesity; • children’s educational performance; • teenage births; • homicides; • imprisonment rates; and • social mobility (not available for US statesSlide29
Health inequalities Slide30
Social inequalities and health
Social structureInequalities in social position
Inequalities in access to determinants
Inequalities in healthSlide31
PerceptionWhat comes to mind when I say
“health inequalities”?Difference or unfairness?
Differences, e.g. between numbers of men and women who smoke
Unfairness
,
e.g.
higher cost of fresh fruit in poorer areasSlide32
E.g. Height Being
short as an adult could be due to genetics, ante-natal difficulties such as blood vessel malformation, physical illness or condition as a child, such as polio or cystic fibrosis
Or,
poor maternal nutrition
, lack of access to food as an infant, poor nurturing relationship etc,
i.e
.
as a result of poverty and disadvantage
Being short could disadvantage social progress, or not
For any factor where there are differences or a social hierarchy, there could also be unfairness
Slide33
Theories for health inequalityRelative povertyAbsolute povertyCulture and behaviorBiological responses to stressLife course effects starting from early years
Social stratification and discriminationSlide34
Health policies say that health inequalities are related to:
Environment
Poverty
Geography
Individual differences
Combined social circumstances
Deprived areas
Social inclusion
Lifestyles
Ethnicity
Gender
Disability
Opportunities
Discrimination
Personal choices
Age Slide35
A questionFrom what you’ve heard (and what you know), what do you think should be the two main priorities to address in order to
reduce the inequalities gap in children’s health and well-being?Slide36
Two prioritiesReduce povertyImprove educational attainmentSlide37
37Inequalities in Health
It is now generally recognised that there are many reasons for health inequalities. People can suffer health inequalities for many reasons, due in the main to:The
geographical area they live in.
The
racial group
they belong to
.
Their
gender
And, perhaps most importantly, their
social class.
The common denominator of all these factors is that they all link to
POVERTYSlide38
38Approaches to Solving Health Inequalities (1)
There are two major approaches to tackling inequalities in health:
THE COLLECTIVIST APPROACH
THE INDIVIDUALIST APPROACHSlide39
39Approaches to Solving Health Inequalities (2)>THE COLLECTIVIST APPROACH<
This approach to solving inequalities is based on the view that differences in health are beyond the ability of the
individual to change
The view is that differences in health are due to major
economic
and
social problems
in society - eg. poor housing stock, unemployment, inflation
These problems impact on different people in different ways - but
poorer social classes suffer most.
Idea first found favour in the
Black Report
(1980) and
Acheson Report
(1998)
Subscribers to this view feel that improvements will only come by
concerted government action
centering on anti-poverty strategiesSlide40
40Approaches to Solving Health Inequalities (3)>THE INDIVIDUALIST APPROACH<
This approach is based on the belief that health inequalities are the result of how INDIVIDUALS choose to lead their lives
There seems to be differences in health habits
between different social classes
People of
lower social class
seem to; smoke and drink alcohol more often, exercise less and have less healthy diets
Idea is that people should be largely responsible for
monitoring own health
Government action should centre on high-profile health
advertising campaigns
etc. Approach favoured by
Tory Government
in early mid 1990s.Slide41
Thank You