The Assessment of Public Health Needs - Term Paper Example

Introduction The aim of public health is to improve health as well as wellbeing in the entire population, prolong the value of life, reduction of health inequalities, prevention of diseases and minimising the consequences of the disease. In order to achieve this, there is a need to take into account the perspective of the population, mobilise organised efforts within the society as well as advocating for the health of the public. In addition, the communities and people must be enhanced to elevate the levels of control over their own health and wellbeing. One will also be required to work on economic, social, biological and environmental determinants of wellbeing and health, minimisation and protection from the impacts related to health risks in relation to the population. Finally, there is a need to ensure that there is best value, evidence based and high quality treatment, care and preventive services (Wilson 2009). In broad speaking, it is evident that public health generally involves collective actions aimed at improvement of the health of the population. One of tools for improvement of the health of the public is epidemiology. The goal of epidemiology is basically to improve the health of populations and more specifically the health of the disadvantaged within the populations. It is worth noting that in order to ensure effective use of resources to improve the population health, there is a need to assess the health needs. Thus, health needs assessment refers to a systematic approach that ensures efficient use of resources to improve population’s health. Distinguishing between the wider community needs and individual needs is very essential in provision and planning of local health services. If in any case these needs are ignored, then it will be difficult to provide health services as in such a situation, the health services will depend on the perception of few people rather than the actual perception of population’s needs (Wright, Williams & Wilkinson, 1998). This article discusses the understanding of assessment of public health needs, the essence of epidemiology to the health of public with consideration of public health principle and values. It also discusses the importance of collaborative working and partnerships in improvement of public health as well as challenges for its effectiveness. Assessment of health needs Health is referred to as the state of complete psychological, social and physical wellbeing and not necessarily the absence of infirmity or disease. Stevens (1991) describes healthcare needs as those benefiting from health care such as disease diagnosis, treatment, prevention, rehabilitation, health education and terminal care. On the other hand he points out that patients have different perceptions of what can make them healthier such as a health centre, a job or a decent housing. In addition, health needs consists of wider environmental and social determinants of health which include education, deprivation, diet, housing, and employment. It is worth noting that the population’s health needs constantly varies and most of them are not open to medical intervention. Kirkup & Forster (1990) classifies the influences on health into four; environment such as socioeconomic status, education, housing and pollution; behaviour such as smoking, exercise and diet; genes such as inherited health potential; and health care which include tertiary, secondary and primary prevention. Wright, Williams & Wilkinson (1998) states that health needs assessment is simply not a process of relying on personal experience or listening to patients but is a systematic technique of identification of unmet healthcare and health needs of a population as well as making the necessary changes to ensure that the unmet needs are met. The assessment of public health needs involves a qualitative and epidemiological approach in order to determine the priorities that incorporate perspectives of the patients, clinical as well as cost effectiveness. They stress that this approach must put in mind the balancing of ethical, economic and clinical considerations of the need. That is, what can and should be done as well as what can be afforded (Donaldson & Mooney, 1991). For health professionals and individual practices, the assessment of health needs offers an opportunity to describe the disease patterns in local population and the differences from national or regional patterns, learning more about the priorities and needs of the local population and patients. It also assists in highlighting of the areas with unmet needs and provision of precise and clear objectives on meeting these needs, making rational decisions on use of resources to improve the health of local populations in an efficient and effective way as well as influencing interagency collaboration priorities. In addition, assessment of health needs provides a technique for promoting and monitoring equity in the use and provision of health services as well as addressing health inequalities (Womersley & McCauley, 1987). Importance of assessment of health needs Health care costs are rising. Over a long period, health expenditure has been rising rapidly as compared to the costs in other sectors of the economy making healthcare largest sector in most developed countries. In addition, medical services as well as changes in demography will continue to impact an upward pressure in the costs of health care. The available resources of health care at the same time are limited. In turn, a lot of people’s access to health care becomes inadequate as many governments fail to provide universal care. There is also creation of large variation in terms of availability and health care use by point of provision and geographical area. It is worth noting that at this point, the availability of health care becomes inversely proportional to the needs of the served population. Change of consumerism has also impacted pressure on health costs. The public expectation has significantly increased the concern on the quality of services received in terms of appropriateness and effectiveness on access and equity on health services (Jordan & Wright 1997). Such factors facilitated the health services reforms in developing and developed countries. Such reforms in Britain led to separation of health care financing responsibilities from its provision and in establishment of general practitioners and health authorities’ purchasing role. There were greater opportunities for health authorities to tailor to their own populations the local services. The NHS Act in 1990 required assessment of health needs by health authorities on their populations and use the assessments in setting of priorities on health improvement on the authorities’ local population. This has also been strengthened by concerns on health inequalities which suggested that the authorities must take audits on equity in order to determine if the use of resources on healthcare are proportional to the need. Increased commissioning power at primary care level has led to increased patients and politicians expectations that making of decision would reflect local as well as national priorities thus, promoting equitable and effective care based on the need. The government is also committed on ensuring that the access to treatment is based on ‘need and need alone’ and the primary health group’s key functions will always be planning, commissioning as well as monitoring local public health services in order to meet the local needs that have been identified (National Health Service Executive 1994). As some public health needs assessments may be more successful as compared to others, London Health Economics Consortium (1997) explains three reasons that may lead to project failure. Firstly, there may be lack of understanding on what is involved in public health needs assessment as well as how it is or should be undertaken. Educational strategies may be the best way improve the necessary skills and the understanding of health professionals and valuable guidance and support can be provided by local teams on public health. Secondly, lack of resources time or commitment may lead to failure. Involvement of organisations, sharing of the required time and resources has potential advantages in team building in assessment and provision of public health services. Finally, the failure may be related to lack of integration of the results with purchasing and planning operations intentions in order to ensure change. Thus, planning should always begin with public health needs assessment and the objectives defined clearly while the relevant stakeholders such as patients and health authorities among others are properly involved. Task management Pringle & Hobbs (1991) identified various challenges commonly faced in understanding of assessment of the needs of public health. First, the mosaic of required information for assessment of needs reflects its key components: effectiveness of interventions, already existing services and incidence and prevalence of client groups. They realized that it can be difficult to obtain good quality data on utilization and the structure of health services. Second challenge is based on health professionals in assessment of healthcare needs. This calls for fundamental reappraisal of the role of the doctors as well as balancing of power on the relationship between the doctor and patient (Gillam &Murray 1996). Thirdly, the assessment of public health needs becomes futile if it does not improve the services to patients. Thus, there is a need to provide a clear definitions on the objectives such as giving a description of what needs to be done, when it will be done and by who (Spiegal, Murphy & Kinmonth 1992). Finally, there is a challenge in ensuring that the assessment of needs is also cost effective in addition to being effective. As there is little knowledge on cost effectiveness of assessment of needs, evaluation of various purchasing models should assist in clarification of population sizes for which the assessment of needs for various services is undertaken most effectively (Fulop & Henscher 1997). Epidemiological issues in assessment of the needs of public health Wright, Williams & Wilkinson (1998) defined epidemiology as the study of distribution as well as determinants of health related events or states in specific populations and applying this study in control of problems related to health. In most parts, epidemiology intends to use medical model of health need, with the perception of the need in terms of occurrence of health related states as well as specific diseases instead of client groups. The authors also state that descriptive epidemiology describes the disease occurrence in terms of place, time and person. The person refers to the affected people in terms of sex, age, socioeconomic group among others, place refers to where the people were when getting the disease and geographical variation of the incidence, and time refers to when they get diseases and where the occurrence of disease is changing. This is opposed to analytical epidemiology which involves investigation of health determinants related events or states. Epidemiological as well as cost effective approaches Stevens (1994) found out that the importance of assessment of the needs of public health is to understand what is really effective and for whom. He adds that here are critical steps involved in epidemiological approach. First step involves a clear statement the group of population in which the assessment of needs is addressed. For instance, in case of misuse of substance, the population group include the potential, present and past misuses. Second step involve identification of subcategories this group of population with particular service needs. For instance, distinguishing people with diabetes that depend on insulin from those that are non-insulin dependent. Third step involves setting out the incidence and prevalence of the subcategories such a how many of each subcategories are there. Fourth step involves setting out the services that are currently available that is, all services whether secondary or primary care or elsewhere. Fifth step involves identification of cost effectiveness as well as the effectiveness of interventions and the services associated the essence of a health care which is based on evidence. Final step involves setting out a ‘care model’ which allocated the relative priorities. In another article, Stevens (1997) ascertains that the most essential step involves the establishment of the effectiveness of an intervention. He adds that it would be of no point in counting the intervention’s potential beneficiaries which is of no benefit. He states that the most challenging step involves allocation of relative priority to different recipients as well as services. It is important to put into consideration the cost effectiveness of the costs. Stevens points out that employment of measures of unitary cost- utility ( that is, if they are available) and the decision making is made more explicit by use of decision matrix. However, flexibility around the particular circumstances of the patients is required often. Partnerships and collaborative working in public health improvement Collaborative partnerships for improvement of public health require engagement of all the relevant stakeholders at all levels in order to achieve the goals of public health improvement across the lifespan. It also leads to achievement of health equity as well as eliminating the disparities on health for everyone especially the health of disadvantaged within the population. Stewart & Cornish (2009) ascertained that establishment of partnerships in informal and formal levels are very essential in addressing the planning on improvement of community health and actions that affect the outcome of population health as well as a shared vision for everyone living longer and better. They stress that partnerships usually offer capacity for a healthy community, they collaboratively identify, evaluate and implement strategies that health priorities and infrastructure and local and state levels. Partnerships use interventions that are based on evidence to support and build healthy communities. The authors also identify key elements considered in collaborative elements which include engaging, working with, working in, leading teams; people, budgets, managing resources, delivery of the function of public health, programs, managing change; negotiating, facilitating, managing and influencing others; participating in, leading alliances; setting strategic direction, influencing. Scriven & Garman (2007) states that success in community health improvement requires that partnerships in the community should embrace their roles as leaders, in application of science and also evidence in order to achieve the public health’s mission. He adds that partnership are crucial in providing solutions to problems, preserving the assets of the community and also building of social capital within the communities. Sustaining and building partnerships that reach out as well as include the organizations that are based on communities in serving diversity of populations will assure that the community diversity is represented. The authors conclude that representativeness and diversity are essential factors improvement of public health. Wright, Williams & Wilkinson (1998) found out that successful collaborative working require engagement of individuals as well as organizations interests in, affected by, or having the capacity to affect the public health issue. They add that nurturing of relationships that are strong between the diverse individuals across the entire community, demonstration of balancing of power among all stakeholders, and fostering trust, understanding and mutual respect are factors evident in a successful partnership for improvement of public health. However, Himmelman (2002) pointed out the challenges or barriers for effective collaborative working. He stated that lack of staff and resources in community organizations and failure to include the diversity of partnership is a significant barrier to the success of collaborative working. He adds that lack of representative partnerships within the community leads to creation of power differential where the majority of partnerships may make decisions for fixing the problems of the minority populations and partners either intentionally or unintentionally. The existence of differential power is due to issues on trust and cultural insensitivity such as ethnicity, language, social and economic. Unless this is addressed in a straight forward way, there will be no successful partnerships focused on health equity. It is worth noting that partnerships make improvements on health through a collective action and they can take various forms of actions ranging from collaborating, to cooperating, to coordinating, to networking. Himmelman notes that effective partnerships must overcome potential barriers to collaborative working effectiveness posed by trust, time and turf. Conclusion The assessment of public health needs involves epidemiological methods among others to describe the problems on health of a certain population; identify health inequalities and access to services; and makes determination on priorities to come up with the most effective employment of resources. Successful assessment of health needs require practical understanding what’s involved, the necessary time and resources for undertaking assessments as well as sufficient integration of results into commissioning and planning of local services. Collaborative partnerships for improvement of public health require involvement of all the relevant stakeholders in order to achieve the goals of public health improvement across the lifespan. It also leads to achievement of health equity as well as eliminating the disparities on health for everyone especially the health of disadvantaged within the population. References Donaldson C, Mooney G 1991, Needs assessment, priority setting, and contracts for health care: an economic view. BMJ, vol. 303, p. 1529-1530. Fulop N, Henscher M 1997, A survey of needs assessment activity in London health authorities. London: King's Fund. Gillam S, Murray A 1996, Needs assessment in general practice. London: Royal College of General Practitioners, (Occasional paper No 73.) Himmelman A 2002, Communities Collaboration for Change; Definitions, Decision-making models, Roles, and Collaboration Process Guide. Retrieved on June 17, 2012 from http://depts.washington.edu/ccph/pdf_files/4achange.pdf Jordan J, Wright J. Making sense of health needs assessment. Br J Gen Pract 1997; 48: 695-696. Kirkup B, Forster D 1990, How will health needs be measured in districts? 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