common approaches: a shared need? perspectives from public health sian griffiths sept 6 2008
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Common approaches: a shared need?
Perspectives from public health
Sian Griffiths Sept 6 2008
WHY?
• Changing influences on health
• Changing ways of working
• Changing needs of our patients
The Health Map. Barton & Grant 2006Based on a public health concept by Whitehead & Dahlgren. The Lancet 1991
Waste management professionals, Farmers, Gardeners, Landscape Designers Architects, Traffic
engineers, Spatial planners, Electricians, Plumbers, Builders Restaurant owners,
Caterers, Transport planners, Teachers, Business owners/Employers, Engineers, Scientists
Employers, Businessmen, Bankers
Religious leaders, Local Leaders, School teachers
Doctors, Nurses, Pharmacists, Carers, Social Workers
Political and Global Leaders, Scientists, Business Leaders, Civil Servants
Stakeholders in promoting health
Healthcare needs
Case Study • Mrs. C is 72 years old and lives alone supported by CSSA.
She has hypertension, diabetes mellitus and history of minor stroke. Her blood pressure and glucose control are not good and her vision is deteriorating.
• She has several episodes of fall and once broke her wrist. She now seldom goes out on her own due to fear of falls, and avoids physical exercise. She does not sleep well and feels depressed. She stays alone in her apartment except when she goes shopping which she finds difficult and the increasing price of food causes her increasing anxiety.
Medication for HT & DM control
Transport assistance
Care at home
Financial support Frequent falls
Lifestyle modification & self-monitoring for HT, blood glucose control
Social & emotionalsupport
Rehabilitation & physical exercise programmes
Mrs. C, 72 yr, DM, HT, minor stroke,
frequent falls
Nurse
Physiotherapist
Doctor
Pharmacist
NGO outreach programme
Social worker
NGO day centre
Mental health services
TCM practitioner
Needs of vulnerable populations
• Greater morbidity , less access• Lifestyle issues greater• Poverty exacerbates ill health • Less empowered • More social problems , lower social
capital • Migrant needs are greater
New Directions for healthcare workforce
• Patient centred care
• Extended roles
• Developing teams
• Multidisciplinary working
• Partnerships with NGOs
• Intersectoral working
• Electronic patient record
Approach to Education: The doctor…
• Modern healthcare is provided through a complex system within a constantly-changing environment. Partnerships are created between disciplines, professions, agencies, organisations, patients and the public. Communication and co-operation are important for improving healthcare for patients. CPD opportunities should take into account the environment within which medicine is practised.
Source: GMC guidance on Continuous Professional Development, accessed http://www.gmc-uk.org/education/continuing_professional_development/cpd_guidance.asp 2 September 2008
Tomorrows Doctors
• 47. Students must have different teaching and learning opportunities that combine an appropriate balance of teaching in large groups with small groups, practical classes and opportunities for self-directed learning. Medical schools should explore and, where appropriate, provide opportunities for students to work and learn with other health and social care professionals. This will help students understand the importance of teamwork in providing care.
»GMC website
Approach to education: Pharmacy • Pharmaceutical public health
education and training should take place within a strong multidisciplinary context, should commence at undergraduate level and should feature strongly in continuing professional development. Education and training should be closely linked with the mainstream of public health professional development… p62
• The undergraduate curriculum should include an overview of the three domains of public health, strategies for preventing disease and promoting health, the wider determinants of health and the health psychology elements of behaviour change… p63
Approach to Education: Nursing
Medical Schools
• The committee strongly recommends that
– all medical students receive basic public health training in the population-based prevention approaches to healthserious efforts be undertaken by academic health centers to provide joint classes and clinical training in public health and medicine
Other Schools Recommendation
• All undergraduates should have access to education in public health.
Access to Life-Long Learning• Schools of public health should fulfill their
responsibility for assuring access to life-long learning opportunities for several disparate groups including:
– public health professionals– other members of the public health
workforce– other health professionals who
participate in public health activities.
How do we meet the challenges?
Approach to trainingin multidisciplinary public health
• Entry criteria for acceptance into training
• A structured framework which is modular and flexible
• Assessment of competence with demonstration of knowledge , skills and expertise
• Clear standard to be achieved [before being awarded specialist status]
• Registration• Appraisal of practice/continuous professional development
Competency escalator :surveillance
Design Policies
Design/Guide/plan strategies
Make decisions based on interpretations of data
Give technical inputs/confirm diagnosis/analyze data/interpret data
Facilitate Process/Plan further steps/collection of data
Collect samples/perform basic tests/supply necessary remedy
Identify & confirm the info/report Observe, Identify and report
Observation
Levels of practice in PH
Policy Makers /Strategic Public Health Leaders/senior academics
Early/Middle level academicians/ NGOs/Early/Middle Level Administrators
Technical Specialists / Public health nurses
Auxiliary Nurse Midwife/Health Inspector
Community workers
Lay Skilled/Trained Birth Attendants
Community Self Help Groups
What we are doing at CUHK in PH
• Foundations course in public health taught to :– Year I medical students – Offered to
• nursing /pharmacy students• All undergraduates: minor programme • All undergraduates :elective • All undergraduates :general education
• Introducing BSc in public health 2009– Potential for intercalated year leading to MPH– Potential for double major
• Year 4 :Integrating public health and primary care to emphasize inter relationship individual and society
• Lifelong learning opportunities
Mrs. C
Nurse
Physiotherapist
NGO day centre
Doctor
Pharmacist
NGO outreach programme
Social worker
TCM practitioner
Mental health service
Patient centred care:
team working
