MPH/HSMP 2007-2008: CC1: DHS: GI: Antwerp school of Thought in Public Health

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;

1. Social values & Patient centred approach (Family practice): Participation-autonomy, Acceptability of services, Holistic concepts of health
2. 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
3. Medical/scientific values & Patient centred approach (Specialist practice): Efficacy of care, EVM
4. Medical/scientific values & Population centred approach (Disease control, prevention, health promotion): Effectiveness, Productivity

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

1. Quality health care: patient centred care (holistic, integrated, continuous care)
2. 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

Terms

              Health is a state of physical, psychological and social well being, not just the absence of disease (WHO, 1947)

             Sickness or Health problem is social action, Disease as for cure, Illness as for care.

             Health problem is as the sum of all suffering (including social and economic, direct & indirect suffering). Well-being is as opposite of suffering.

Two basic approaches to public health

1. 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.
2. 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

-          Primary prevention & health promotion: prevent a health problem to happen

-          Secondary prevention & curative care: prevent a health problem to worsen, Early detection & treatment

-          Tertiary prevention & rehabilitative care: Control the impact of a health problem

                 Passive case finding is to detect during any contact with population.

                 Active case finding is to go out into the community to find the specific cases (screening) with these criteria;

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

                The criteria to consider the best strategies: efficiency, cost-effectiveness, marginal cost & opportunity cost.

Phichet Banyati,

November 11, 2007.

Antwerp