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BL9412 Public Health : Systematic Review of Health Promotion

Consider the role of public health administration within the context of the problem:
 
What purpose does it have? E.g. what are the aims of the initiative? How have they been determined (statistics / epidemiological data)
 
Why does it have this purpose? E.g. Size of problem, impact it has in specific population
 
How is it operationalised?  E.g. what is the response? – is it driven at individual, community, population level. How was response determined? Public Health England, WHO, other??  Who is making key decisions? Central government / local government / Clinical Commissioning Group (CCG) – what is the evidence base?  Is there consultation with key stakeholders e.g. patient population – is their voice heard? Should it be?
 
Evaluate the outcomes: if the implementation of X is meant to affect Y is it working effectively? If not, why not? How might things have been done differently?  

Answer:

Introduction:

The portfolio focuses on the care of aging people. In this context, the paper provides the critical review of the Public health administration or PHA. The paper evaluates the factors necessary for effective PHA. There is an increasing number of aged population and is a marked a rising trend. According to WHO report, the number of people aged 60 and over is estimated to increase from 600 million in 2000 to 2 billion in 2050. The increase in aged population is mostly found in developing countries. In less developed countries, the number of older people will rise from 400 million in 2000 to 1.7 billion by 2050 (World Health Organization, 2011). In UK, the number of people aged 90 and above was over half a million of total population in 2015. The total number of people  aged 100 and over was found to be approximately 1500 in the year 2015 (Heslop et al., 2014). This increase may be considered as successful outcome of effective public health policies and socio-economic development. The condition is related to decline in fertility rate and increase in life expectancy. According to Boneham et al. (2006), in UK, more number of older women than men has poor general health status. The growth of the aged population is challenge to a society. Aged people suffering from dementia are the prime focus of the paper. Dementia is the neurodegenerative disorder that impairs the ability to think, reason, remember and other cognitive abilities (van der Steen et al., 2014). Dementia effects older people and the common forms of dementia include mixed dementia, vascular dementia (stroke-like symptoms, paralysis or muscle weakness), Parkinson dementia, dementia with lewy bodies (visual hallucinations, fluctuating levels of confusion), and frontotemporal dementia (change in personality, behaviour and emotions). It is difficult to diagnose exact type of dementia because of overlapping symptoms of different types of this disorder. The disorder is diagnosed by careful physical examination, medical history, set of laboratory tests, and any changed in pattern of thinking, and behaviour (Giebel et al., 2015).  Older people with dementia impose serious challenges on family, society and health workers in terms of difficult caregiving due to multiple comorbidities, economic burden, and clinical consequences. According to WHO, in 2010 there were more than 35 million people estimated to be living with dementia (Prince et al., 2013). The aim of the paper is to present the role of PHA in this public health issue. The choice of the subject is guided by personal ambition to excel as professional of PHA.

Critical review of PHA

This section deals with the role of PHA in aged people suffering from dementia. The positive implications of rise in number of aged population are many. Older people play critical role in society, they participate in labour force and assist their families, and they provide informal care to their family, share experiences and knowledge and volunteer to assist others. However, the negative implications of growth in aging population include social isolation in later life, and increase in loneliness according to Prince et al. (2015). In older people, depression is the major indicator of lone


liness (Cattan et al., 2005). The rationale for critical review of PHA is recognition of dementia as a public health priority by WHO. It is vital for public health administration to understand the psychiatric disorder among older adults as this disorder leads to impaired social and occupational functioning and increases economic burden (Dewing & Dijk, 2016).  There is no cure for the disease developed yet and hence the size of the problem is big. There is advancement in non-pharmacological approaches. Older people with dementia live many years after diagnosis and it challenges the health system with huge cost. It is overwhelming for the caregivers (Prince et al., 2013).

The field of health administration is related to management, leadership and administration of hospitals, public health system, and hospital networks. The PHA are setup with the aim of “ultimate law of public welfare”. The prime focus of public health is to improve and protect “community health and well being” (Francis et al., 2015). The role of the health care professionals who hold degree on public health administration is to keep people healthy and safe by preventing disease and injury. Public health integrates interdisciplinary approaches of health services, biostatistics, epidemiology (Rosen & Imperato, 2015). The other subfields that it encompasses are environmental health, behavioural health, community health, mental health and occupational safety and health.   Overall, there is a growing movement in UK and around the world to ensure safe community services. The goal of PHA is to make intentional changes to allow accessible of services to older dementia people and empower them to enjoy high quality of life with independence as much possible. The community services include accessibility to quality health care services keeping in view the geographical, cultural, and financial aspects  (Tulchinsky & Varavikova, 2014).

The PHA has many roles to play. They recruit and supervise personnel who offer services to aged population with dementia. They understand the political, economic and legal climate in which they evaluate the existing programs, develop new programs or services and administer a budget to pay for these services and efforts. PHA gives tools to the public health managers and leaders with which they can translate their knowledge into daily activities (Tanner & Harpham, 2014). In the context of dementia care, the PHA must ensure that the recruited staffs have adequate knowledge about dementia and Alzheimer’s, ability to offer family caregiver supports, cognitive assessments, provide information and services available in the community for the effected individuals and their families. It is the role of the public health to involve in surveillance, education and prevention related to dementia. Intense research is conducted to develop evidence-based policies to eliminate future risks (Prince et al., 2013).

The PHA is in unique position to build dementia capable system. It is the role of PHA to strengthen partnerships within the community. The partnership ensures that the required services for older patients of dementia are available (Tulchinsky & Varavikova, 2014). For instance, the existence of aging and disability resource centres in a community can collaborate with the local public health departments to develop programs and supports, assess the community needs and offer the referral services. In various countries non-profit organisations have been established for instance, Alzheimer’s association. These organisations are set up with professionals who provide educational materials to support individuals. Other faith-based organisations and civic groups partner together to co-sponsor awareness campaigns, educational events, and distribute information. Residential care facilities on the other hand residential care facilities partner with other business groups in the community to promote support programs, awareness and development of the dementia friendly policies. It also includes taking opinions of public (Williamson, 2015).

Different countries have different approaches in terms of dementia policies and plans. The strategy of England is “Living well with dementia: A National Dementia Strategy”. It has 17 recommendations in response to dementia care irrespective of the stage of illness. However, some other countries such as China, USA, Japan Germany, and Belgium are developing national plans for dementia care, which are yet to be implemented and finalised. Based on the recommendations set by the WHO after it declared dementia a public health priority the international federation of Alzheimer’s association around the world released “Kyoto Declaration in 2004” (Wilson & D'Ath, 2017).

PHA also plays key role in training its workforce- health care professionals to better identify and respond to individuals with dementia and Alzheimer’s as well as their caregivers (Hoang et al., 2015). It includes training of health care workers such as primary care physicians, nurses, psychologists, community health workers and pharmacists. It also involves the training of direct care professionals who offer paid services such as home health aides, personal care aides and similar others. The paid services include bathing, housekeeping, dressing, food preparation for aged people with disability. The training sessions involves education on recognising the early warning signs of dementia, benefits of early diagnosis, strategies to address the cognitive dysfunctional symptoms, management off comorbidities such as asthma, diabetes, arthritis etc. and lastly assistance to caregivers to deal with the emotional aspects of their responsibility (Tulchinsky & Varavikova, 2014).  Training is also provided to first responders such as law enforcement, emergency medical technicians. The training and education priorities also include tracking the surveillance data on caregiving and on cognitive decline. Further, addressing the issues associated with dementia patients such as stigma, discrimination, potential for abuse and the need of advance planning. Ensuring safety and independence of dementia patients includes concepts such as public transportation, walkability, considerations for mobility such as safe pedestrian crossings (Tanner & Harpham, 2014).

The outcomes of the various dementia friendly communities in England, national dementia strategy and dementia challenge there has been positive implications. England has reached to the diagnosis target of 51% although it is still lower than Scotland. With the help of the “Dementia Directed Enhanced Service” UK was able to increase uptake of patients by GPs (80%). In 2015, a quarter of hospital beds are occupied with aged people with dementia. The significant changes have been the outcome of allocating £400 million funds by Care Act 2014. UK has increased the public health professionals in the training team. In the period from 2010-2015, the total number of staff that have received the foundational level dementia training was 377,886 and those who have received the awareness training on the disease were 100,000 (Mukadam et al., 2014). When evaluating the outcomes of the national policies and plans, it was found that the  scenario was not same in every country.

Factors necessary for effective PHA

According to WHO reports low and the middle income countries face unique set of challenges when developing national level plan. WHO reports that only 71% countries have mental health plan whereas 60% of the countries have dedicated policy for mental health. The prime obstacle in delivering adequate dementia care according to WHO is poor awareness and understanding related to dementia particularly in lower income countries. In addition, lack of infrastructure and resources in these countries, have added to poor welfare system. Consequently, it is increasing the financial burden. Hence, for these countries there is a need of sustainable strategies that can reach widespread population with low cost implementation (Prince et al., 2015). Even in the developed countries dementia in older people is diagnosed only in last stage. For instance, in the 2010-2015 UK report on dementia, the effected individuals were estimated to be 800,000. The cost of the disease was found to be £23 billion per year. The cost is likely to be treble by 2040 (Luengo-Fernandez et al., 2015). Only one-half of cases in high-income countries are documented in the primary care case note records. Non-availability of the skilled health providers is also a barrier to coordination between the primary and the palliative care services (Matthews et al., 2013).

Factors related to government and management are key challenges to the PHA. Institutional framework of the health sector is an important aspect. It is in the context of the national health mission and the reforms guided by it. It is challenging the PHA to professionalise public health management and build administrative capacity required to achieve the desired health outcomes (Innes & Manthorpe, 2013). The increasing financial cost of dementia necessitates global policy action. Dementia has been recognised as the second major cause of disability for people over 70’s. Therefore, it is needed for the government and other bodies to act now to minimise the economic burden of dementia. The greatest single step for addressing dementia according to OECD is to increase efforts on its single long-term goal, which is finding preventive treatment (Wimo et al., 2013).  However, communities are not well adapted to the necessities of dementia people.

In order to maintain effective PHA it is necessary to address the policy challenges facing ageing society across the world. There is a need to rethink the current model for drug development and innovation. It includes addressing the critical gaps in the knowledge pertaining to dementia, management and its treatment. Better policy will ensure better lives (Innes & Manthorpe, 2013). Any major medical breakthrough may take many more years. However, without the prospect of effective treatment there is a high potential for million more people to develop dementia.  Taking advantage of advance technology is crucial for effective PHA. Collection and maintenance of dementia related information using the potential of “big data” is necessary. Better collection of data ensures risk reduction and effective treatment. There is a need to increase investment in the dementia research by risk sharing mechanism and public funding. With the global dementia research fund, it is possible to provide necessary resources and plan security to translate innovation into clinical setting (Heslop et al., 2014).

In order to gain credibility external validation is necessary. For instance, the work of the National Audit Office in UK as well as the enquiry performed by “the House of Commons’ Public Accounts Committee” provided external validation on the content and the nature of the national policy. While implementing any policies and plan at a national level it is vital to involve all the stakeholders. It helps in generating shared understanding and ownership of national policies. The consultation must include younger people with dementia, indigenous and minority ethnic populations and other groups with social needs in addition to the Ministry of health. Lastly, ethical decision-making must be ensured by education and support. It should be the part of capacity building in every country, which is involved in dementia care (Van der Steen et al., 2014).

Reflection

I kind of like the pattern of the portfolio. It is broken into different subsections that helped in marinating the interest in the assignment till the end. Starting from critical review to preparation of leaflet and developing personal development plan there was no room for feeling monotonous. It was interesting to learn how myriad of health professionals work together to address the negative impact of dementia in older people.  It is the convergence of myriad of public health disciplines such as nursing, biostatics, epidemiology and in short it is the combination of micro and macro. Human behaviour and health care have been two most fascinating areas for me, which gives the concept of health behaviour. The dynamic nature of this field was clearer to me after preparing the body of the portfolio.

While critically reviewing the role of PHA in dementia care, I learnt that the desired goals are too close and yet to be far to be achieved. This section of the assignment demanded good amount of research. This section was helpful in developing the researching and writing skills.  There is increasing importance of dementia care around the world after WHO declared it to be a public health priority. The lack of appropriate care delivered to dementia patients in most counties is due to lack of financial rewards, national policies or guidelines and awareness although there are dedicated public health professionals.  Despite advancement in medical technology, there is no cure yet for this disorder. There is a difference in how developed and developing countries are caring for people with dementia. UK unlike other countries has empathetic approach. With the help of “Dementia Friends”, UK is creating global awareness to include millions of dementia friends in community. US is on its mission to cure Alzheimer’s by 2025. On the other hand, some countries are only focused on prospective dementia treatment. It is evident that healthcare is becoming more affordable and there will be higher level of good health within the population. However, dealing with dementia requires to be more advanced nation.

While preparing the leaflet, I made it sure that it is compact and contains key messages for all the stakeholders. It was a slight change in track. It was interesting to prepare in colourful format with useful information presented precisely.  Lastly, preparing the personal development plan enhanced the interest in the portfolio as it was like a shift from academics to focusing on person life. It gave me some more time to brood over what is required to develop my career. It helped me to analyse the skills set required for future, based on which I could develop an action plan.

Personal development plan

Ever since I have passed high school, I was interested in pursuing career in health care management. I have been planning career in this field since a long time. Currently, I am working hard to accomplish good scholastic record in graduate programs. Unlike the traditional route of pursuing master degree, I would like to pursue other courses concentrating in health service management. I would like to investigate other options including degree in business and public administration with specialisation on health care management. Based on my research and knowledge there are various domains of PHA. There is a dearth of education related to PHA programs. However, the one that I would like to embrace academically and professionally is the role of health educator.  The role is related to counselling people on various types of diseases and preventive strategies. I would like to start my career as health educator and later engage in management of contracted network of health care providers. It is an interesting role which  will develop my experience in provide analytics. In this area, the prime role will be to manage the health care data. The purpose of provider analytics is to manage the “financial and utilisation performance” of the health care providers (Tulchinsky & Varavikova, 2014). The rationale is to develop skills that would enhance my portfolio. The interest in this area is also the outcome of increasing rate of chronic illnesses which are on top of the list in terms of contributing to disability, particularly dementia.  

PHA is a dynamic field and one interested in this field, require several skills to adapt along with economic, scientific, and political landscapes (Rosen & Imperato, 2015). Keeping my career in view, I have developed set of academic, personal and professional goals which is given below.

Below given is the plan for the my future career.

Academic Goals

Personal goals

Professional goals

· Investigate different education programs, postgraduate administrative fellowships  and access tools to increase my network to develop my career  

· Find alternatives to traditional mode of PHA professionals

· Participate in internship program

 

· To increase vivid reading skills

· Read more about healthcare from trade publications such as journal of health care management

· Enhance knowledge on healthcare providers- participate in volunteer programs

· Practice being more flexible and patient- to adapt relocation to different cities

· Practice skills to get along with people  as professionals of PHA need to deal with people from diverse backgrounds

· Develop skills to self- motivate, motivate others, manage and negotiate

·  Development of oral and written communication skills

· Develop skills of self dependability

· Ability to make rationalised decisions while maintaining honesty and ethical norms  

· Develop accounting skills and financial strategies as health care executives need to know how to interpret data

· Update knowledge on health care trends-opportunities due to  change in demographics and new health care policies

· Strengthen communication skills- being a professional of PHA it is necessary to develop people’s skills. Learn to present proposals and reports

· Develop leadership, competency and collaborative skills  

The action plan involves implementing and achieving the target goals to excel in career. I would evaluate the outcomes frequently by taking feedback from my colleagues and professors. I would take guidance from my seniors to develop my career.

Conclusion:

Public health professionals can properly propagate the importance of the public health. These personals and the organisations are efficient in performing the analysis and assessments of public health concerns. PHA plays key role in evaluating the evidence and research. They thus channel the evolving health promotion programs and policies by collaborating with different government and non-government agencies. They address population health concerns by working with range of partners. The immediate actions for PHA in response to dementia include taking early action to anticipate and prevent future needs of dementia patients and families. It refers to active ageing and timely diagnosis.  It is necessary for PHA to prioritise improvement in quality of life of dementia people by helping communities to adjust and accommodate their needs. According to WHO there is a need of improving access to high quality “person centred care”. Based on the critical review it can be concluded that across the world, there is increasing mortality and morbidity due to dementia.  The older people with dementia  have poor quality of life. In developed countries like UK, there are adequate residential care for older people but the same cannot be generalised globally. The impact of poor care provision involves increase in economic burden, depletion of resources and more number of people being susceptible to ageing with disability.  Based on the critical review it can be concluded that the there is need of more efforts from the community and the health care system to support dementia patients and their families. Further, there is a need of reforming the regulatory and the incentive frameworks to aid progress of dementia care and research. As per OECD data, public health administrators require to effectively collect and use data on dementia care and treatment. Every country must have clear policy on reimbursement for pharmaceutical and technological development. The developers must have facility of return on investment. It guarantees safety and cost-effectiveness. There is a need of greater collaboration between the private and public sectors. Overall, the portfolio has been helpful in developing wider knowledge on the current status of dementia and the challenges faced by the patients, caregivers, health care professionals in addressing the care needs of the patients. It helped gain knowledge on how PHA collaborates, coordinates and partnerships to achieve its outcomes. Preparing the portfolio has helped in improving both academic and intellectual skills.

References:

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