Global Trends and Innovations in Public Health

Paula Lantz

University of Michigan

Global Trends• Globalization:

– Increased migration and travel– Increased rapid communication– Convergence of:

• Markets; Technology; Policy

• Population:– Exponential growth– Population aging– Some declines in life expectancy– Urbanization

Global Trends

Epidemiologic Transition:

• Shift from population dynamic of high fertility and high mortality primarily from infectious disease to lower fertility and lower mortality, primarily from chronic disease and injury/violence

• Different countries experience transition in different ways

Serious Challenges

• Escalating costs of health care

• Health system infrastructure

• Health system financing

• Health services workforce shortages

• Leadership

Serious Challenges

• Social disparities in health status

• Social disparities in access to services

• Political threats to health

• Environmental threats to health

• Food security threats to health

• HIV/AIDS

• Pandemic influenza

Public Health Innovations—Focus on Prevention

• Primary Prevention– Prevention of incidence of disease or injury– Examples: Immunizations; smoking prevention

• Secondary Prevention– Identify or control disease processes in their

early stages, before signs/symptoms are apparent

– Examples: Mammography screening; smoking cessation

Public Health Innovations—Focus on Prevention

• Tertiary Prevention– Prevent disability by restoration to optimal level

of functioning or prevent further progression of disease

– Examples: Rehabilitation after stroke; diabetes management; antiretroviral therapy for HIV

Public Health Innovations

Tobacco Control– Primary prevention– Secondary prevention

HPV Vaccination

Public Health Innovations

Chronic Disease Management– Diabetes– Asthma

Economic Incentives:– Pay for Performance (Providers)– Value-Based Insurance Design– Incentives for Patients:

• Positive• Negative

Public Health Innovations

Focus on essential medicines

• Barriers to existing medicines – Inadequate national commitment– Inadequate human resources– Inadequate finance from international

community– Lack of coordination of aid– TRIPS agreement– Disincentives for R & D

Public Health Innovations

Focus on essential medicines

(Millennium Project, 2005)

• Improving availability – Improving rate/relevance of innovation– Developing more reliable procurement

and supply procedures– Promoting safety of medicines

Public Health Innovations

Focus on essential medicines

• Improving affordability– Adequate and fair financing– Promoting safety of medicines

• Promoting appropriate use– Better prescribing and dispensing– Better use of medicines in the home

Public Health Innovations

Workforce interventions• Workforce structure and distribution• Centralized versus decentralized policy• Workforce capacity and motivation• Reforms

– Training of non-physicians for surgery– Other examples

Public Health Innovations

Information Technology– Syndromic Surveillance– Telemedicine

Nanotechnology– Consumer products—Benefits and Risks– Medical/therapeutic applications– Environmental concerns

Older Simple Technology Still Critical

• Childhood vaccinations

• Oral re-hydration therapy

• Bed nets

• Condoms

• Potable water

• Sanitation

• Basic health education

Investments Needed in Social Determinants of Health• Education

• Housing

• Income Security– Microfinance– Social Enterprise

• Prevention of ethnic and religious conflict