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SYSTEM PERSPECTIVES ON PREVENTION Professor Andrew Wilson Menzies Centre for Health Policy School of Public Health Samantha Hobson Bushfire 2000 Lockhardt River
SYSTEM PERSPECTIVES ON PREVENTION
Professor Andrew Wilson
Menzies Centre for Health Policy
School of Public Health
Samantha Hobson Bushfire 2000 Lockhardt River
Outline
The Value of Prevention
System Perspectives
Components of projected $161 billion increase in total health system and aged care expenditure, Australia 2003 to 2033
81.3
37.8
34.4
8.8
1.0
-2.3
-10 0 10 20 30 40 50 60 70 80 90
Volume per case
Ageing
Population
Price
Treatment proportion
Declining disease rates
Expenditure (billion dollars)
Qld CHO Report 2010
10 prevention = small impact on health care costs
Costs growing even where rates falling
Big Growth, Limited ability to prevent
Annual Growth of Health Expenditure and GDP, Constant Prices 2001-02 to 2010-11
AIHW Aust Health Expenditure 2010-11
Health > GDP
Opportunities for Better Care without Higher Cost?
? Importance in cost containment
Systems Perspectives on Prevention
Systems Perspectives
What is a Prevention System?
Health Systems Perspective on Prevention
Systems Thinking about doing Prevention Modeling Action Systems
Prevention Systems (s)
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Current Prevention ‘System’
Reflects the broader health system Fragmented Loosely coordinated Multiple and discontinuous funding sources
Largely communicable disease focussed Largely health system focussed Poor Continuity of Effort
Weaknesses
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Current Prevention ‘System’
Committed Individuals Existing infrastructure Strong NGO sector Flexibility thru necessity History of Creativity
Strengths
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General Strategies
1. Shared responsibility – developing strategic partnerships
2. Act early and throughout life
3. Engage communities
4. Influence markets and develop connected and coherent policies
5. Reduce inequity through targeting disadvantage
6. Indigenous Australians – contribute to ‘Close the Gap’
7. Refocus primary healthcare towards prevention
National Preventative Health Taskforce 2010
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SUPPORTING INFRASTRUCTURE
Social marketing Data, surveillance and monitoring National research infrastructure Workforce development Future funding models for prevention
National Preventative Health Taskforce 2010
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Prevention System
New Capacities New Partnerships Different Ways of Thinking New Knowledge
Dementia Musculoskeletal Disease
What else is needed?
Health Systems Perspective on Prevention
Health System and Prevention
What can the health system do to better prevent disease and promote health?
Questions of Effectiveness and Efficiency in Health System Prevention Action
Individual, Group, Community, Population focus
How much Health $$ should be spent on Prevention?
What does Health control and regulate?
Critical Components
Short Term Longer Term
Downsteam
Up Stream
Effectiveness
Impact
Sustainability
Scalability
Systems Thinking and Prevention – Better Understanding Complex Systems
Huang TT et al, Prev Chronic Dis 2009;6(3):A82.
Butland B et al. Foresight Tackling Obesities: Future Choices –Project report 2007.
Scenario Testing
1. An individualistic, market-driven society that adopts a more long-term and sustainable view.
2. A society where social responsibilities are prioritised, and communities and Government implement plans to meet long-term challenges.
3. A society where communities take the lead and focus on tackling difficulties as they arise.
4. An individualistic, market-driven society that reacts to problems when and where they occur.
Butland B et al. Foresight Tackling Obesities: Future Choices –Project Report 2007.
Interventions for Obesity
Butland B et al. Foresight Tackling Obesities: Future Choices –Project report 2007.
Butland B et al. Foresight Tackling Obesities: Future Choices –Project report 2007.
Systems Thinking about doing Prevention
Complex Systems and Wicked Problems
No easy fix, no one strategy. Likely to be lots of “failures”, need to learn from failures as
well successes. Need systematic and systemic approaches. Need persistence – how do we institutionalise ongoing
action? Need to assess and minimise the potential for harm along
the way.
The Ways of a Systems Thinker
Sees the whole picture Changes perspectives to see new
leverage points in complex systems Looks for interdependencies Considers how mental models create
our futures Pays attention and gives voice to the
long-term “Goes wide” (uses peripheral vision) to
see complex cause and effect relationships
Finds where unanticipated consequences emerge
Sees oneself as part of, not outside, the system
Source: “Systems Thinking Playbook” by Linda Booth Sweeney and Dennis Meadows
What does this mean?
Understand the Problem and Context (Diagnostic) Identify Intervention Points and Options Identify Potential Impact
(Effectiveness, Risks, Equity, Benefit-Cost) Identify Potential Achievability under Different Settings
(Political, Investment Level, Scaling, Dose) Understand the Players and Interactions Implement, Learn, Change
(understanding, action, outcomes)
Research Opportunities
The Value of Prevention How do we value prevention rather then health care
avoidance? How do we communicate that value to the
community and decision makers? System Perspectives
How can we better implement what we know works in prevention? Learning from Doing.
Why doesn’t it work they way we think it should in real life?
Research Opportunities
The Prevention System What are the elements of successful prevention
system(s)? What are the options for prevention – individual,
community, population – programs, regulation, legislation?
Driving Change How do we become more effective influencers? Consumerism, choice and the prevention paradox?
Questions
Thank-you
Lena Nyadbi 2013 “Dayiwul Lirlmim” (Barramundi Scales). Musee du quai Branly, Paris.
