health impact pyramid and health system.pdf

The Health Impact Pyramid is a framework that illustrates the various levels of impact on public health interventions
The health system refers to all the organizations, institutions, resources, and people involved in providing healthcare services to populations.

1. Health Impact Pyramid
& Health system
Prepared by: Associate Prf. Dr Khushhal Farooqi
2023

2. •Dr. Thomas Frieden, the former director of the Centers for Disease
Control and Prevention, presented this pyramid in a 2010.
•The pyramid presents a framework (visual representation ) for organizing and
explaining public health interventions from high population impact/ low
individual effort needed (at the bottom of the pyramid), to a
relatively small population affected and high individual effort
needed (at the top of the pyramid).
•As you move up the pyramid, the interventions become
more targeted and individualized.
Introduction
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3. •the 5-tier pyramid is a tool that helps identify and prioritize public health
interventions based on their potential impact and effectiveness.
•Implementing interventions at each of the levels can achieve the maximum possible
sustained public health benefit.
1.At the base of this pyramid, indicating interventions with the greatest
potential impact, are efforts to address socioeconomic determinants of
health.
دنډیرف ونوروتکف يداصتقا زینلوټ هپ ېچ ېڅه هغه ،انیو هپزکرمت هکل يوک ېبليزو ،یلعتم ،تروپسنارت ای ،
يداصتقاهنوتصرف" هوقلاب ییولیزیغا " د وا يرلدیماریپيو هب ېک یاپ هپ.
د
ې
چ
ې
لخادم هغه دیماریپ وچک وټیټ هپ زکرمت يوکیریډ
ز
نم
ز
ریغا
ې
ز
نلوټ د یود
ې
چ هکځ يو هت وخرب وخارپ
يږ ریسريرل ایتړا هت وڅه يدارفنا ږل وا.
Introduction…
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4. Structural Approaches to Health Promotion
(for Communicable Disease, Noncommunicable Disease, and Injury Prevention)
Approaches to
Prevention
Communicable DiseaseNoncommunicable
Disease
Injuries
Socioeconomic
factors
Reduced poverty to
improve immunity,
Decreased crowding and
environmental exposure to
communicable microbes,
and
improved nutrition,
sanitation, and housing
Reduced poverty,
increased education
levels, and
more nutritional
options to reduce
cardiovascular
disease, some cancers,
and diabetes
Reduced poverty levels
to reduce drug use
and violence, improved
housing options,
and lowered
vulnerability to extreme
weather conditions
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5. Potential barriers to implementing interventions
1. Changing Socioeconomic Factors:
- Limited funding for programs that address socioeconomic factors
- Resistance from individuals or communities to change
- Political opposition to policies that address socioeconomic factors
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In ascending order are interventions that
2.change the context to make
individuals’ default decisions healthy.
Moving up the pyramid, the second layer, are changes to
the environment, such as:
•Buildingcommunities to encourage walking rather than
driving a car,
•Increasing air or water quality, and
•Passingsmoke-free laws.
•Tobacco tax
•Fluoridation

7. Structural Approaches to Health Promotion
(for Communicable Disease, Noncommunicable Disease, and Injury Prevention)
Approaches to
Prevention
Communicable
Disease
Noncommunicable Disease Injuries
Changing the context•Clean water
•Reduced indoor smoke
pollution from biomass
cooking
•Omnipresent condom
availability
Trans fat elimination in processed food to
reduce cardiovascular disease
Sodium reduction in packaged foods and food
served in restaurants to reduce cardiovascular
disease
Fluoridation of water to prevent dental cavities
Elimination of lead paint and asbestos
exposures
Increased unit price for tobacco, alcohol,
and sugar-sweetened beverages
Smoke-free workplaces
Community and transits design to promote
greater physical activity
Road and vehicle design
requirements to reduce
crashes and protect pedestrians
and bicyclists
Laws prohibiting the sale of
alcohol to minors
and increased alcohol price
Laws prohibiting driving at even
low blood alcohol levels
Effectively implementing laws to
mandate helmet
use by motorcyclists and
motorcycle passengers
Occupational safety requirements
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8. Potential barriers to implementing interventions
2.Changing the Context to Make Individuals' Default Decisions
Healthy:
- Lack of awareness or understanding of healthy choices
- Limited access to healthy options or resources e.g., Look for farmers' markets in your
community
-Cultural or social norms that support unhealthy behaviors
-1. Drinking alcohol
2. Eating junk food
3. Smoking tobacco
4. Lack of physical activity
5. Stigma around mental health
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9. 6/5/2023 Kandahar University, faculty of Medicine, 3rd class 9
3.Clinical interventions that require limited
contact but confer long-term protection.
The third level of the pyramid, long-lasting protective
interventions, are interventions that are effective but do not
require ongoing clinical contact.
Frieden’s examples include:
•Immunizations ,
•Colonoscopies , and
•Smoking cessation programs.

10. Structural Approaches to Health Promotion
(for Communicable Disease, Noncommunicable Disease, and Injury Prevention)
Approaches to
Prevention
Communicable Disease Noncommunicable
Disease
Injuries
Long-lasting protective
interventions
Immunizations
Male circumcision in countries
with high HIV prevalence and
significant
female-to-male transmission
Mass antibiotics to prevent or
treat tropical diseases (e.g.,
onchocerciasis
Colonoscopy
Treatment of tobacco
addiction
Surgical sterilization,
intrauterine device
insertion, or other long-
acting contraception to
reduce maternal mortality
Dental sealants
Brief behavioral counseling to
reduce alcohol
consumption
Home modification, such as
installation of grab
bars and handrails, to prevent
falls among
the elderly
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11. Potential barriers to implementing interventions
3.Long-Lasting Protective Interventions:
- Limited resources or funding for long-term interventions
- Resistance from individuals or communities to change
- Difficulty in measuring the effectiveness of long-term interventions
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4.Ongoing direct clinical care, and
The fourth level of the pyramid is clinical interventions. This is
where most traditional medical interventions occur on the
pyramid

13. Structural Approaches to Health Promotion
(for Communicable Disease, Noncommunicable Disease, and Injury Prevention)
Approaches to
Prevention
Communicable
Disease
Noncommunicable
Disease
Injuries
Clinical interventionsHIV treatment to decrease
viral load and reduce
transmission
Treatment of tuberculosis,
resulting in decreased
spread of infection
Treatment of hypertension
and hyperlipidemia
Aspirin therapy for people
with coronary heart
disease
Methadone and
buprenorphine treatment
to decrease opiate
overdose
Screening and treatment
of women older than 65
years for osteoporosis to
reduce fractures
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14. Potential barriers to implementing interventions
4.Clinical Interventions:
- Limited access to healthcare or insurance coverage
- Stigma or fear associated with seeking healthcare
- Limited resources or funding for healthcare providers
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5.Health education and counseling.
Finally, the tip of the pyramid is counseling and education.
Examples include
•Counseling patients to change their diet or
•Exercise more.
Frieden TR. Framework for public health action: the health impact pyramid. Am J Public Health 2010;100:590–5.

16. Structural Approaches to Health Promotion
(for Communicable Disease, Noncommunicable Disease, and Injury Prevention)
Approaches to
Prevention
Communicable DiseaseNoncommunicable
Disease
Injuries
Counseling and
educational
interventions
Providing medical information to
reduce infections transmissions.
•Dietary counseling
•Counseling to increase
levels of physical
activity
•Public education about
avoiding lifestyle-
mediated disease
•Counseling and public
education to avoid
drinking and driving
and
•encourage compliance
with traffic laws.
•School-based
programs to prevent or
reduce violent behavior
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17. Potential barriers to implementing interventions
5.Counseling and Education:
- Limited access to education or resources
- Cultural or language barriers to understanding
- Stigma or fear associated with seeking counseling or education
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18. PRACTICAL APPLICATION OF THE HEALTH IMPACT PYRAMID
•یيايتغورتمايلعت ًلاومعمريډمکیسايسړتلام ايتړا هتیرل . هښیګليبیي هپتاکموب د یکوټيرګس هپ
یدناړوهنونياپمکید . یچ یدد هسرتيرثومیي د وخ ید مک مهوکابتم تباث وغه د یدناړو هپشويو
هکل وتامادقاtaxation, smokefree environments هپ واعيسو هپ هسر لوډټيکرام یکیرپزيدنبپ وګل رپ ه
هلتريډ ترهشیرل .
• لوډ یدج هپ هګنرادمه وکلخ دقيوشت یچ لوکیکيزف کاروخ مک وا یړک هسررت وتانيرتمیړکو دیسايس
هولپريډ ید یوش روهشم تايزنکيل هپاډوس رون وايرغیلوهکلا وتابوشرم وږوخیدنابکيټس لوړولريډ هن
وګترس هپیږيک . هپ هګنرادمهjunkfoodیدنابزيدنب یچ لوګل ًاثرکا ناموشامیولماعتساريډن لاعف هیو.
o لوډ یدمه هپ دینلوټهرابوودیسادنيازيډ یچ لوکهدايپ د وا ګتلکيسياب لماعتساشتقيو د یړک
یسايس هولپريډید تخس.
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Health Systems
&
HEALTH SERVICE PHILOSOPHIES

20. Health Systems
A health system , health care system or healthcare
system is an organization of people, institutions, and
resources that delivers health care services to meet the
health needs of target populations.
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21. There are four types of healthcare systems used in the Western world. These
systems include:
1.TheBeveridge model,
2.The Bismarck model,
3.Thenational health insurance model, and the
4.Out-of-pocket model.
What are the Types of Healthcare Systems?
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22. 1-The Beveridge Model
Feature Beveridge Model
Funding Government-funded and government-run healthcare system
Healthcare ProvidersGovernment-run healthcare system
Access Universal access to healthcare services
Choice Limited choice of healthcare providers
Regulation Healthcare providers are regulated by the government
Strengths Provides universal access to healthcare services
Weaknesses May face challenges in terms of quality and efficiency
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1.The United Kingdom
2.Spain
3.Hong-Kong
4.Cuba
5.New Zealand
This system is named after William Beveridge, a social reformer who proposed the
establishment of the National Health Service (NHS) in the United Kingdom.

23. The Bismarck modelis named after Otto von Bismarck (universal healthcare system in Germany in 1883).
•Funding : Social insurance, financed jointly by employers and employees through payroll taxes
•Healthcare Providers: Private providers
•Access: Universal access to healthcare services
•Choice: Freedom to choose healthcare providers
•Regulation: Healthcare providers are regulated to ensure quality and cost-effectiveness
•Strengths: Can provide universal access to healthcare services while preserving choice and
competition
•Weaknesses: Can be complex to administer and may face challenges in terms of affordability and
equity
1.Japan
2.Germany
3.Switzerland
4.The Czech Republic
5.Belgium
2- The Bismarck model
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24. Healthcare System Model: The National Health Insurance (NHI) Model
Provider Type: Government-funded and government-run healthcare services
Cost Control: The government acts as the single payer for healthcare services, which allows for centralized
cost control and negotiation with healthcare providers.
Access: The NHI model provides universal coverage to all citizens, regardless of income or employment
status.
Funding: The NHI model is typically financed through taxes.
Examples:
-Canada
-South Korea
-Taiwan
3- The National Health Insurance (NHI) Model
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25. Out-of-pocket model.
The reality is that the wealthy get professional medical care and the poor don't,
•& Uninsured or underinsured populations in the U.S.
Healthcare System
Model
Provider TypeCost ControlAccess Funding Examples
Out-of-Pocket
Model
Private providersNone Limited Personal funds
Many
developing
countries &
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1.The United Kingdom
2.Spain
3.Hong-Kong
4.Cuba
5.New Zealand
1.Japan
2.Germany
3.Switzerland
4.The Czech Republic
5.Belgium
Examples:
-Canada
-South Korea
-Taiwan

27. Health care
It is defined as a "multitude of services condensed to
individuals, families or communities by the agents of the health
services or professions, for the purpose of PROMOTING,
MAINTAINING, MONITORING or RESTORING health" .
•In many countries, health care is completely or largely a government function.
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Health care includes "medical care".

28. Threetier health care
The health system that most of the nations have set up after 1980 consists of
three tiers, as recommended by “health for all” policy
1.Primary care
•This is the bare necessity—Essential health care every citizen needs.
•It is the first level of contact between public and the health system.
•Most of common health problems should be served at this very level.
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29. 2.Secondarycare
•Diseases beyond the primary level are referred to secondary level which providesmainly
curative service.
•Thelevel is called the ‘1st referral level’ because ideally, it should receive only thosepatients
who have been referred from primary level.
3.Tertiary care
It is super specialty care. It includes medical colleges, regional hospitals and medicalinstitutes (i.e.,
school of tropical medicine). This tire is also concerned withtraining, administration, planning
and management of the whole system.
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31. •Thespectrum of diseaserefers to the range of manifestations and severities of illness associated
with a given diseases, illnesses, or injury. For example, HIV infection has broad clinical spectrum,
from inapparent to severe and fulminating.
•Theiceberg phenomenondescribe a situation in which a large percentage of a problem is
subclinical, unreported, or otherwise hidden from view. Thus, only the "tip of the iceberg" is
apparent to the epidemiologist.
•Uncovering disease that might otherwise be below "sea-level" by screening and early detection often
allows for better disease control.
The Spectrum of Disease and The Iceberg Phenomenon
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32. Consider:
• For every successful suicide attempt there are many more unsuccessful attempts and a still larger
number of people with depressive illness that might be severe enough to have them wish to end their
lives. With appropriate treatment, depressives with suicidal tendencies would be less likely to have
suicidal ideation and be less likely to attempt suicide.
• Reported cases of AIDS represents only the tip of HIV infections. With proper anti-retroviral
therapy, clinical illness may delayed and transmission averted.
• Serious dog bite injuries often go undetected. For each fatal dog bite there are about 670 dog bite
hospitalizations, 16,000 emergency department visits, 21,000 medical visits to other clinics, and 187,000
non-treated bites (Weiss et al., 1998; Figure 2.7). With effective recognition, animal control programs
can be put into place to prevent dog bite injuries.
The Spectrum of Disease and The Iceberg Phenomenon…
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33. Iceberg of disease
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34. 1-Reducing The Burden Of Excess Morbidity And Mortality Among
The Poor;
2-Counter Reacting The Threats Of Economic Crisis,
3-Unhealthy Environment and Lifestyle;
4-Developing More Effective Health System And
5-Investing In Expanding Knowledge Base.
Public healthchallenge in the twenty
firstcenturyare:
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35. 1. http://www.enotes.com/public-health-ncyclopedia/
history-public-health
REFERENCES
5. http://www.cdc.gov/about/history/tengpha.html
2. Gupta MC, Mahajan BK. Textbook of Preventive and
Social Medicine, 5
th
edition, Chp 1, p1-3.
3. http://en.wikipedia.org/wiki/public_health
4. Park K. Textbook of Preventive & Social Medicine,
22
nd
edition, chp1, p1-10.
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