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How can we make Health Care a more effective determinant of health? Michael M. Rachlis MD York University November 29, 2002
Outline: ,[object Object],[object Object],[object Object]
Health care historically has not been a major determinant of population health ,[object Object],[object Object]
 
 
Relative risk of CHD death in the British civil service and the explanatory power of risk factors. From Marmot M. J Epi Comm H. 1978;32:244-249.
 
Determinants of Health 1. Income and social status 2. Social support networks 3. Education 4. Employment and working conditions 5. Social Environments 6. Physical Environments 7. Personal health practices 8. Healthy child development 9. Biology and genetic endowment 10. Health services 11. Gender 12. Culture
But Health care could be a more important determinant of health if services were re-designed.
Tertiary prevention: Preventing deterioration in function ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Secondary prevention: Screening and early detection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Criteria for Screening Tests ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Primary prevention: Preventing disease in the first place ,[object Object],[object Object],[object Object],[object Object],[object Object]
“ Medicine (Health) is a social science and politics is nothing but medicine writ large!” Dr. Rudolf Virchow 1848
 
 
If politics is health writ large... ,[object Object],[object Object],[object Object]
The prevention policy paradox The higher the level of preventive action, the more effective it is at promoting health but the more political barriers it faces.
Dr.Trevor Hancock notes that it is easier to start action locally: ,[object Object],[object Object],[object Object]
Population Health works best when: ,[object Object],[object Object],[object Object],[object Object]
Successful Intersectoral Action ,[object Object],[object Object],[object Object]
How to get it going ,[object Object],[object Object],[object Object],[object Object]
How to make it grow ,[object Object],[object Object],[object Object],[object Object]
What to watch out for ,[object Object],[object Object],[object Object]
How to light a bonfire: The virtuous circle for health ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What Mr. Romanow said yesterday and where are we headed tomorrow. ,[object Object],[object Object],[object Object],[object Object],[object Object]
Therefore I’m suggesting that when you’re fighting this battle, as I hope you will to maintain Medicare, you’ll not forget that the ultimate goal of Medicare must be the task of keeping people well rather than just patching them up when they’re sick. Tommy Douglas
Summary: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Courage my friends, ‘tis not too late to make a better world! Tommy Douglas

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Rachlis En

  • 1. How can we make Health Care a more effective determinant of health? Michael M. Rachlis MD York University November 29, 2002
  • 2.
  • 3.
  • 4.  
  • 5.  
  • 6. Relative risk of CHD death in the British civil service and the explanatory power of risk factors. From Marmot M. J Epi Comm H. 1978;32:244-249.
  • 7.  
  • 8. Determinants of Health 1. Income and social status 2. Social support networks 3. Education 4. Employment and working conditions 5. Social Environments 6. Physical Environments 7. Personal health practices 8. Healthy child development 9. Biology and genetic endowment 10. Health services 11. Gender 12. Culture
  • 9. But Health care could be a more important determinant of health if services were re-designed.
  • 10.
  • 11.  
  • 12.
  • 13.
  • 14.
  • 15. “ Medicine (Health) is a social science and politics is nothing but medicine writ large!” Dr. Rudolf Virchow 1848
  • 16.  
  • 17.  
  • 18.
  • 19. The prevention policy paradox The higher the level of preventive action, the more effective it is at promoting health but the more political barriers it faces.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28. Therefore I’m suggesting that when you’re fighting this battle, as I hope you will to maintain Medicare, you’ll not forget that the ultimate goal of Medicare must be the task of keeping people well rather than just patching them up when they’re sick. Tommy Douglas
  • 29.
  • 30. Courage my friends, ‘tis not too late to make a better world! Tommy Douglas