Contemporary Public Health Issues II

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  Based on your reading of Chapter 1 of Fleming and Parker (2015), reflect on the key characteristics of public health. How are they different to what you have studied in your undergraduate degree? What particular skills do you think that you already have and what will you specifically need to develop to work in Public Health?
Instruction:

Assessment 1a:
Based on your reading of Chapter 1 of Fleming and Parker (2015), reflect on the key characteristics of public health. How are they different to what you have studied in your undergraduate degree? What particular skills do you think that you already have and what will you specifically need to develop to work in Public Health?

500 word submission. No particular format is required but assessment must be clearly written and well presented in terms of grammar and punctuation. You are expected to cite the Fleming and Parker chapter at a minimum.

8/08/2017 1 Dr Catherine MacPhail HAS 911 / 831 Contemporary Public Health Issues Lecture Week 3 – Evidence-based practice History of EBP • Originally developed in clinical medicine ‘the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients’ – Sackett et al. 1996, p. 71 Eliminate ineffective, inappropriate and potentially dangerous practices (Hamer & Collinson 2014) Systematic and organised approach to locating the evidence Implies wise application of evidence to the specifics of an individual patient Evidence-based Public Health – ‘a decisionmaking process that public health practitioners adopt to identify and use the best intervention strategy to address the health issue of a specific individual and group within their local context.’ (Liamputtong 2016, p. 179) 8/08/2017 2 What is evidence? • Depends on worldview/perspective • Evidence is usually the proof generated by research that something (like an intervention) works (rigour) • Science has generally taken a positivist approach – absolute & objective truth • Paradigm shift – appreciation for the role of qualitative approaches to exploration of feelings, experiences and interpretations “Positivists are concerned about the frequency and distribution of an event or phenomenon, and attempt to use standardised methods and maintain objectivity, primarily through distancing themselves from the subjects under study, to reach a ‘truth’” (Fleming & Parker 2015, p. 186) Population characteristics, needs, values, & preferences Resources, including practitioner expertise Best available research evidence Environmental and organisational Decision-making context Satterfield et al. 2009 8/08/2017 3 Key concepts of EBP • Best practice based on best available evidence Not just a single study (‘research utilisation’) • If there isn’t any or sufficient evidence – professional judgement and experience • Using strategies that research suggests are the best means for achieving aims • Changing practice • Systematic appraisal of the best available evidence Evidence-based practice • Using evidence to make decisions about practice 1. Identify the problem 2. Identify evidence that relates to the problem 3. Finding the evidence 4. Using critical appraisal to determine how useful the evidence is 5. Synthesising evidence into a practical application Fleming & FitzGerald 2015 1. Identifying the problem • Is your problem qualitative or quantitative? Think about how you would determine this Do legal smoking bans have an impact on adult smoking rates? What are young people’s perceptions of anti-smoking legislation? 8/08/2017 4 Qualitative questions PS Model Patient/ population Situation How does [P] experience [S]? How do adolescents experience access to sexual health care? Quantitative questions PICO Model Patient/ population Outcome In middle-aged women suffering migraines, is Botulilium toxin type A compared to placebo effective at decreasing migraine frequency? Intervention Comparator Quantitative questions For Public Health might choose to use PISCO (S = setting) McMaster University Library Guide 2017 8/08/2017 5 We are interested whether there is evidence to show that condoms protect men who have sex with men from getting HIV P = men who have sex with men I = consistent condom use C = no/inconsistent condom use O = HIV transmission Answerable question = In men who have sex with men, does condom use reduce the risk of HIV transmission? 2. Identify evidence that relates to the problem • What type of evidence is going to answer your question? Generally look to primary research from academic/professional journals, textbooks, reports, conference papers and presentations Does the study design used in the evidence provide the right information for your question? Hierarchy of Evidence 8/08/2017 6 3. Finding the evidence • Week 5 tutorial • Be systematic in searching for evidence: Explicit – use key terms, record your search, ensure that it is transparent to that others can assess, it can be replicated Appropriate – look where the evidence is likely to be Sensitive – Collect all information that is relevant Specific– Collect only information that is relevant Comprehensive – Include all available information Fleming &FitzGerald 2015, p. 190 4. Using critical appraisal to determine how useful the evidence is • Not all published information is valuable! Understanding the study designs that your search generates Standardised checklists available — CASP Pragmatic – best use of what is available 5. Synthesising evidence into a practical application • Determining a course of action based on the evidence • Can be slow – 17 years in general – particularly if change is at a policy or country level • Michie et al. (2005)  Evidence base  Individual practitioner  Organisation Male circumcision for HIV prevention as an example 8/08/2017 7 Source: Taljaard, Auvert & Rech 2010 What about acceptability? 13 studies from 9 sub-Saharan countries Uncircumcised men for themselves 65% (29-87%) Women (for their partners) 69% (47-79%) Men for their son 71% (50-90%) Women for their son 81% (70-90%) 8/08/2017 8 Where are we now? Since 2007 the WHO and UNAIDS have recommended male circumcision in countries with high HIV prevalence and low male circumcision rates • 80% coverage in 14 priority countries by 2016 • Ethiopia, Kenya, Tanzania • Malawi, Namibia, Rwanda, Zimbabwe Source: Avert 2016

9/08/2017 1 Public Health Issues – Challenges II – Public Policy Heather Yeatman Head, School of Health and Society Vice President, Public Health Assoc. of Australia Public Health Policy: The main aim of healthy public policy is to create a supportive environments to enable people to lead healthy lives.  healthy choices possible or easier for citizens.  social and physical environments health-enhancing.  government sectors need to take into account health as an essential factor when formulating policy. Sectors should be accountable for the health consequences of their policy decisions. They should pay as much attention to health as to economic considerations. http://www.who.int/healthpromotion/conferences/previous/adelaide/en/index1.html Contemporary Public Health Issues What is Policy? (Milio 2001) A guide to action to change what would otherwise occur, a decision about amounts and allocations of resources. The overall amount is a statement of commitment to certain areas of concern; the distribution of the amount shows the priorities of decision makers Policy set priorities and guides resource allocation. IMPORTANT NOTE: Not acting – is an action – contributing to status quo Contemporary Public Health Issues 9/08/2017 2 Contemporary Public Health Issues Global legal and regulatory instruments 1. International human rights treaties 2. Trade treaties 3. Environmental agreements (such as those affecting climate change, UNFCCC) 4. Framework Convention on Tobacco Control 5. International health regulations Trans Pacific Partnership puts member countries’ health at risk https://theconversation.com/trans-pacific-partnership-puts-member-countries-health-atrisk-13711 Negotiating Healthy Trade in Australia http://hiaconnect.edu.au/wp-content/uploads/2015/03/TPP_HIA.pdf 9/08/2017 3 International trade agreements: health implications Areas of concern: • Access to medicines (changes to intellectual property rules >> prolong monopolies >> decreased access to generic medicines >> higher costs for patients • Changes to decision-making: giving pharma and food companies more say in policy processes • Enshrining rights of private companies to compete: privatisation of parts of the health system, which would not be possible to reverse even if evidence indicated detrimental effects Challenges in Public Health Issues Negotiating Healthy Trade in Australia http://hiaconnect.edu.au/wp-content/uploads/2015/03/TPP_HIA.pdf Policy: “The most persuasive misunderstanding that affects a Commission such as ours is the belief that crucial policy questions can be resolved by carefully weighing up the scientific, medical and statistical evidence” (Sackville – South Australian Royal Commission into the Non-Medical Use of Drugs 1979) Contemporary Public Health Issues 9/08/2017 4 Contemporary Public Health Issues What policies influence students at University? Contemporary Public Health Issues What policies influence students at University? Structures? Processes? Environment? Financial? Health & Well-being? Students & Staff? Wider environment? Personal? Contemporary Public Health Issues What factors influences policies and their potential to influence students at University? Historical factors? Financial factors? Wider Social factors? Political factors? Media & Advocacy? Personal factors? Wider environment? 9/08/2017 5 Contemporary Public Health Issues What Public Health Principles should influence policies and their potential to influence students at University? Conclusion: • Policy shapes how we live, our opportunities and our societies • Policy is fundamental to public health practice & improving public health outcomes • Public health principles should underpin policy decision making and critique of policy relevance & quality • Policy action is the responsibility of all public health professionals

8/08/2017 1 Dr Catherine MacPhail HAS 911 / 831 Contemporary Public Health Issues Lecture Week 3 – Evidence-based practice History of EBP • Originally developed in clinical medicine ‘the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients’ – Sackett et al. 1996, p. 71 Eliminate ineffective, inappropriate and potentially dangerous practices (Hamer & Collinson 2014) Systematic and organised approach to locating the evidence Implies wise application of evidence to the specifics of an individual patient Evidence-based Public Health – ‘a decisionmaking process that public health practitioners adopt to identify and use the best intervention strategy to address the health issue of a specific individual and group within their local context.’ (Liamputtong 2016, p. 179) 8/08/2017 2 What is evidence? • Depends on worldview/perspective • Evidence is usually the proof generated by research that something (like an intervention) works (rigour) • Science has generally taken a positivist approach – absolute & objective truth • Paradigm shift – appreciation for the role of qualitative approaches to exploration of feelings, experiences and interpretations “Positivists are concerned about the frequency and distribution of an event or phenomenon, and attempt to use standardised methods and maintain objectivity, primarily through distancing themselves from the subjects under study, to reach a ‘truth’” (Fleming & Parker 2015, p. 186) Population characteristics, needs, values, & preferences Resources, including practitioner expertise Best available research evidence Environmental and organisational Decision-making context Satterfield et al. 2009 8/08/2017 3 Key concepts of EBP • Best practice based on best available evidence Not just a single study (‘research utilisation’) • If there isn’t any or sufficient evidence – professional judgement and experience • Using strategies that research suggests are the best means for achieving aims • Changing practice • Systematic appraisal of the best available evidence Evidence-based practice • Using evidence to make decisions about practice 1. Identify the problem 2. Identify evidence that relates to the problem 3. Finding the evidence 4. Using critical appraisal to determine how useful the evidence is 5. Synthesising evidence into a practical application Fleming & FitzGerald 2015 1. Identifying the problem • Is your problem qualitative or quantitative? Think about how you would determine this Do legal smoking bans have an impact on adult smoking rates? What are young people’s perceptions of anti-smoking legislation? 8/08/2017 4 Qualitative questions PS Model Patient/ population Situation How does [P] experience [S]? How do adolescents experience access to sexual health care? Quantitative questions PICO Model Patient/ population Outcome In middle-aged women suffering migraines, is Botulilium toxin type A compared to placebo effective at decreasing migraine frequency? Intervention Comparator Quantitative questions For Public Health might choose to use PISCO (S = setting) McMaster University Library Guide 2017 8/08/2017 5 We are interested whether there is evidence to show that condoms protect men who have sex with men from getting HIV P = men who have sex with men I = consistent condom use C = no/inconsistent condom use O = HIV transmission Answerable question = In men who have sex with men, does condom use reduce the risk of HIV transmission? 2. Identify evidence that relates to the problem • What type of evidence is going to answer your question? Generally look to primary research from academic/professional journals, textbooks, reports, conference papers and presentations Does the study design used in the evidence provide the right information for your question? Hierarchy of Evidence 8/08/2017 6 3. Finding the evidence • Week 5 tutorial • Be systematic in searching for evidence: Explicit – use key terms, record your search, ensure that it is transparent to that others can assess, it can be replicated Appropriate – look where the evidence is likely to be Sensitive – Collect all information that is relevant Specific– Collect only information that is relevant Comprehensive – Include all available information Fleming &FitzGerald 2015, p. 190 4. Using critical appraisal to determine how useful the evidence is • Not all published information is valuable! Understanding the study designs that your search generates Standardised checklists available — CASP Pragmatic – best use of what is available 5. Synthesising evidence into a practical application • Determining a course of action based on the evidence • Can be slow – 17 years in general – particularly if change is at a policy or country level • Michie et al. (2005)  Evidence base  Individual practitioner  Organisation Male circumcision for HIV prevention as an example 8/08/2017 7 Source: Taljaard, Auvert & Rech 2010 What about acceptability? 13 studies from 9 sub-Saharan countries Uncircumcised men for themselves 65% (29-87%) Women (for their partners) 69% (47-79%) Men for their son 71% (50-90%) Women for their son 81% (70-90%) 8/08/2017 8 Where are we now? Since 2007 the WHO and UNAIDS have recommended male circumcision in countries with high HIV prevalence and low male circumcision rates • 80% coverage in 14 priority countries by 2016 • Ethiopia, Kenya, Tanzania • Malawi, Namibia, Rwanda, Zimbabwe Source: Avert 2016

8/08/2017 1 Dr Catherine MacPhail HAS 911 / 831 Contemporary Public Health Issues Lecture Week 3 – Evidence-based practice History of EBP • Originally developed in clinical medicine ‘the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients’ – Sackett et al. 1996, p. 71 Eliminate ineffective, inappropriate and potentially dangerous practices (Hamer & Collinson 2014) Systematic and organised approach to locating the evidence Implies wise application of evidence to the specifics of an individual patient Evidence-based Public Health – ‘a decisionmaking process that public health practitioners adopt to identify and use the best intervention strategy to address the health issue of a specific individual and group within their local context.’ (Liamputtong 2016, p. 179) 8/08/2017 2 What is evidence? • Depends on worldview/perspective • Evidence is usually the proof generated by research that something (like an intervention) works (rigour) • Science has generally taken a positivist approach – absolute & objective truth • Paradigm shift – appreciation for the role of qualitative approaches to exploration of feelings, experiences and interpretations “Positivists are concerned about the frequency and distribution of an event or phenomenon, and attempt to use standardised methods and maintain objectivity, primarily through distancing themselves from the subjects under study, to reach a ‘truth’” (Fleming & Parker 2015, p. 186) Population characteristics, needs, values, & preferences Resources, including practitioner expertise Best available research evidence Environmental and organisational Decision-making context Satterfield et al. 2009 8/08/2017 3 Key concepts of EBP • Best practice based on best available evidence Not just a single study (‘research utilisation’) • If there isn’t any or sufficient evidence – professional judgement and experience • Using strategies that research suggests are the best means for achieving aims • Changing practice • Systematic appraisal of the best available evidence Evidence-based practice • Using evidence to make decisions about practice 1. Identify the problem 2. Identify evidence that relates to the problem 3. Finding the evidence 4. Using critical appraisal to determine how useful the evidence is 5. Synthesising evidence into a practical application Fleming & FitzGerald 2015 1. Identifying the problem • Is your problem qualitative or quantitative? Think about how you would determine this Do legal smoking bans have an impact on adult smoking rates? What are young people’s perceptions of anti-smoking legislation? 8/08/2017 4 Qualitative questions PS Model Patient/ population Situation How does [P] experience [S]? How do adolescents experience access to sexual health care? Quantitative questions PICO Model Patient/ population Outcome In middle-aged women suffering migraines, is Botulilium toxin type A compared to placebo effective at decreasing migraine frequency? Intervention Comparator Quantitative questions For Public Health might choose to use PISCO (S = setting) McMaster University Library Guide 2017 8/08/2017 5 We are interested whether there is evidence to show that condoms protect men who have sex with men from getting HIV P = men who have sex with men I = consistent condom use C = no/inconsistent condom use O = HIV transmission Answerable question = In men who have sex with men, does condom use reduce the risk of HIV transmission? 2. Identify evidence that relates to the problem • What type of evidence is going to answer your question? Generally look to primary research from academic/professional journals, textbooks, reports, conference papers and presentations Does the study design used in the evidence provide the right information for your question? Hierarchy of Evidence 8/08/2017 6 3. Finding the evidence • Week 5 tutorial • Be systematic in searching for evidence: Explicit – use key terms, record your search, ensure that it is transparent to that others can assess, it can be replicated Appropriate – look where the evidence is likely to be Sensitive – Collect all information that is relevant Specific– Collect only information that is relevant Comprehensive – Include all available information Fleming &FitzGerald 2015, p. 190 4. Using critical appraisal to determine how useful the evidence is • Not all published information is valuable! Understanding the study designs that your search generates Standardised checklists available — CASP Pragmatic – best use of what is available 5. Synthesising evidence into a practical application • Determining a course of action based on the evidence • Can be slow – 17 years in general – particularly if change is at a policy or country level • Michie et al. (2005)  Evidence base  Individual practitioner  Organisation Male circumcision for HIV prevention as an example 8/08/2017 7 Source: Taljaard, Auvert & Rech 2010 What about acceptability? 13 studies from 9 sub-Saharan countries Uncircumcised men for themselves 65% (29-87%) Women (for their partners) 69% (47-79%) Men for their son 71% (50-90%) Women for their son 81% (70-90%) 8/08/2017 8 Where are we now? Since 2007 the WHO and UNAIDS have recommended male circumcision in countries with high HIV prevalence and low male circumcision rates • 80% coverage in 14 priority countries by 2016 • Ethiopia, Kenya, Tanzania • Malawi, Namibia, Rwanda, Zimbabwe Source: Avert 2016



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