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Patient and Public Involvement (PPI)

17 Apr

Previously I had always overlooked PPI in favour of other more exciting things in healthcare, like the social determinants of disease and the importance of defining quality and measuring quality. Nevertheless, I can now see why patient public involvement is increasing in popularity and prominence in the world of public health and beyond.

There are the obvious things that you’d expect PPI to improve like patient empowerment and satisfaction, accountability of healthcare providers and appropriate treatment and care. In addition, PPI has been shown to improve quality of care which in turn can lead to increased compliance and better health outcomes. Nevertheless, with the above attributes, PPI remains a tool to improve the patient’s outlook on life with apparently very little benefit for the health professional or indeed, the health system itself.

Currently however, extensive patient public involvement is becoming a widely realised necessity to the health systems of the future. Okay that sounds grand but hear me out: we are seeing a massive epidemiological transition in the burden of disease globally, with increasing prominence in long term diseases such as diabetes, cardiovascular disease and mental health problems. Alongside this, ever-tightening budget restraints and a history of unsustainable spending is forcing many health systems along with the NHS to reconsider its action plan. We all know primary health care is the crux of a cost effective healthcare system but with PPI, it can be improved and enhanced even further.

Increasing PPI offers the opportunity to shift the focus from a reactive healthcare system dependent on specialised care in hospitals to a proactive healthcare system represented by extensive localised networks of community services. In doing so, PPI can help shape a much needed reform to fit the needs of the population. PPI can allow systems to be adapted to a population’s cultural or otherwise non-medical needs.

The Health Foundation’s scoping paper written by Angela Coulter (2009) gives many local examples in the UK that show the impact of various PPI projects. Of what I read (exam time dictates selective reading), it was really useful seeing how PPI was improving not only the patient experience but was also increasing efficiency of the health system.

The growth of ideas such as the Third Way and co-production is perhaps a reflection of the populist appeal they hold. PPI is a great way in which we can humanise the often bureaucratic and heartless health system, transforming its image for the public. Additionally, PPI holds great potential in accelerating the drive for efficiency within the healthcare sector without the need for introducing market principles or competition directly. PPI is a necessary companion to primary health care and it holds promise of salvaging the UK’s healthcare sector from its predicted trajectory.

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The Beattie Model applied: Smoking

7 Jan

Recap of the Beattie model of health promotion

There are two scales that form four quadrants in the Beattie model. The horizontal spectrum is Individual to Collective, and the vertical spectrum is Authoritative to Negotiated (fig 1).

The Beattie model of Health Promotion

Figure 1: The Beattie model of Health Promotion

This time I’m going to try applying the model to an intervention on smoking:

Legislative Action

Policies to increase taxation on cigarettes

Also subsidising the availability of smoking cessation products

Policies to minimise the number of cigarette vending machines in the area

Community Development

Developing locally designated “non-smoking areas” such as near certain landmarks within the local area such as fountains, squares, parks

Promoting the formation of community support groups

Developing a mentor system between ex-smokers and current smokers looking to quit

Designing a competition at the workplace to encourage employees to quit smoking collectively

Health Persuasion

Advertising campaigns encouraging quitting

Increasing availability of self-help/advice resources at GP practices, pharmacists, workplaces

Developing a smartphone app to be used alongside gradual smoking cessation programmes

Health Counselling

Personal advice on smoking cessation from a counsellor or GP

Individual smoking cessation schedules/programmes to encourage quitting

I can’t think of any more unfortunately. Probability of doing well in the exam = not looking so good.

The Beattie Model applied: Obesity

7 Jan

Recap of the Beattie model of health promotion

There are two scales that form four quadrants in the Beattie model. The horizontal spectrum is Individual to Collective, and the vertical spectrum is Authoritative to Negotiated (fig 1).

The Beattie model of Health Promotion

Figure 1: The Beattie model of Health Promotion

Obesity is an increasing problem in many HICs as well as LMICs, and it is of particular concern in the UK with the surge of obesity in children. The Beattie model can be applied when designing a public health policy. Here I’m going to try applying it to a public health promotion intervention that tackles this issue of obesity by improving the diet of children in deprived areas.

Authoritative Collective

Legislation to enforce fast food outlets to reduce salt/fat levels of their products to recommended levels

Developing  local policies to specify the contents of school meals

Developing local policies to ban younger years in secondary schools from going out of school for lunch

Developing partnerships with food suppliers to increase availability of fresh fruit and vegetable in the community

Subsidised packed lunches for single parent households/most vulnerable

Community Development

Increasing awareness of the consequences of choosing unhealthy food for children

Encouraging parents to speak out when they face limited choices in availability of fresh fruit and vegetables

Encourage the design of healthier school meals that appeal to children

Health Persuasion

Sessions in school on healthy foods and unhealthy foods at primary school level to increase awareness

Encouraging children to try different vegetables and fruit through tasting sessions

Health Counselling

Offering cooking sessions for parents to learn how to cook healthier on a budget

Cooking sessions for parents to learn how to make healthier packed lunches

Equality and Equity

14 Oct

So we came across this concept of equity vs equality in a lecture on health impact assessments (HIAs). I thought I understood it at the time of the lecture but am now struggling… The great interweb doesn’t seem to be particularly helpful on this topic either.

Google’s combined dictionary states:

Equality:

1. The state of being equal, especially in status, rights and opportunities

2. The condition of being equal in number or amount

Equity:

1. The quality of being fair and impartial: “equity of treatment”.

A quick search for “equity and equality” isn’t greatly helpful either, the following is from http://www.wcpsss.org/e-d-task-force/12-2-10/Equity%20vs%20Equality.pdf:

EQUALITY: The quality or condition of being exactly the same as something else.
EQUITY: The state, action, or principle of treating people in accordance with differential needs (fairness).

I found a blog post which uses a nice example to explain the difference between equity and equality:

” Equality means everyone gets exactly the same outcome… without regard to individual differences… Equity means everyone gets the same quality of outcome…that fit their individual needs.” http://laradavid.blogspot.co.uk/2008/07/difference-between-equity-and-equality.html

The lecturer explained the two confusing concepts by giving examples of inequality and inequity:

An individual who has a poor diet due to lack of fresh fruit and vegetables in their area is an example of inequity

An individual who suffers injuries due to skiing in the Alps on holiday is an example of inequality

So equity is being fair and equality is being equal? Is that it? But by addressing individual needs and trying to be equitable, wouldn’t there be great opportunities for inequality to arise? All I can seem to think of when I compare the two is Orwell’s Animal Farm. The animals were being treated equitably in the opinion of the dictators (all individuals receiving appropriate treatment), but this treatment was clearly an example of inequality (as the animals were not being treated equally).

It is clear that the two concepts are very distinct, but I suspect it must be difficult to separate them in reality, as in most cases of inequity, inequality is likely to exist also.

One of the principles of a HIA is the focus on equity and social justice. I understand this to mean that HIAs are one of the ways in which health inequality can be reduced or minimised. But by doing this, HIAs are surely also contributing to the advocacy of equality in health status? Maybe there’s no need to separate the two completely. But then I feel that distinguishing the two is perhaps a little redundant in the context of HIAs. If anyone could clarify or send me in the right direction re websites or relevant reading, that’d be awesome as I am still clearly confused!!!