this topic is the part of CC1: Vocabulary & terms by Tom Huree

                  Antwerp school has Public health profession: balancing conflicting values and approaches (an attempt for a synthesis): 2 values (Social values, Medical/scientific values), 2 approaches (Patient centred care, Population centred care) that considering in 4 dimensions for Public health professionalism and ethics, balancing competing values, approaches and interests as following; <ol>

  • Social values & Patient centred approach (Family practice): Participation-autonomy, Acceptability of services, Holistic concepts of health
  • Social values & Population centred approach (Health problem management): 1) Equity, Solidarity, Basic needs, 2) Accessibility of services, 3) Efficiency, Cost effectiveness, Marginal costs and opportunity costs
  • Medical/scientific values & Patient centred approach (Specialist practice): Efficacy of care, EVM
  • Medical/scientific values & Population centred approach (Disease control, prevention, health promotion): Effectiveness, Productivity

    • </ol>                 The techniques to balance all these conflicting values and approaches in coordinated and integrated health care provision organization are as following; <ol>

  • Quality health care: patient centred care (holistic, integrated, continuous care)
  • Integrated local health system: complementary health care services with: First line health services (FLHS): Decentralized, polyvalent and permanent; and Referral services: Centralized, specialized & periodically organized

    • </ol><p style="margin: 0cm 0cm 0pt" class="MsoNoSpacing">Terms</p><p style="margin: 0cm 0cm 0pt" class="MsoNoSpacing">              Health is a state of physical, psychological and social well being, not just the absence of disease (WHO, 1947)</p><p style="margin: 0cm 0cm 0pt" class="MsoNoSpacing">             Sickness or Health problem is social action, Disease as for cure, Illness as for care.</p><p style="margin: 0cm 0cm 0pt" class="MsoNoSpacing">             Health problem is as the sum of all suffering (including social and economic, direct & indirect suffering). Well-being is as opposite of suffering.</p>Two basic approaches to public health <ol>

  • Horizontal approach (Health needs-oriented approach): organizing services responding to the felt needs of a population. Health care services should offer care as a negotiation between the demand of the patient/population and their needs as identified by professionals (demand, need, offer) with the model of the integrated local health system.
  • Vertical approach (Health problem or disease-oriented approach): organizing services based on the identified needs of a population. Health interventions strategies to contribution of PH care services to well-being by

    • </ol><p style="margin: 0cm 0cm 0pt" class="MsoNoSpacing">-          Primary prevention & health promotion: prevent a health problem to happen</p><p style="margin: 0cm 0cm 0pt" class="MsoNoSpacing">-          Secondary prevention & curative care: prevent a health problem to worsen, Early detection & treatment</p><p style="margin: 0cm 0cm 0pt" class="MsoNoSpacing">-          Tertiary prevention & rehabilitative care: Control the impact of a health problem</p><p style="margin: 0cm 0cm 0pt" class="MsoNoSpacing">                 Passive case finding is to detect during any contact with population.</p>                 Active case finding is to go out into the community to find the specific cases (screening) with these criteria; <ol>

  • Health problem occurs frequently (incidence/prevalence), is serious (mortality rate/sequelae) has an import social cost.
  • The disease is curable, the health problem is vulnerable.
  • Prognosis after active detection is better than after passive detection.

    • </ol><p style="margin: 0cm 0cm 0pt" class="MsoNoSpacing">                The criteria to consider the best strategies: efficiency, cost-effectiveness, marginal cost & opportunity cost.</p><p style="margin: 0cm 0cm 0pt" class="MsoNoSpacing"></p><p style="margin: 0cm 0cm 0pt" class="MsoNoSpacing">Phichet Banyati,</p><p style="margin: 0cm 0cm 0pt" class="MsoNoSpacing">November 11, 2007.</p><p style="margin: 0cm 0cm 0pt" class="MsoNoSpacing">Antwerp</p>