Question

At each level of the public health pyramid, identify at least two factors that can affect the acquisition of informed consent from those involved in providing evaluation data about a health program

Answer 1

Ans)

The health impact pyramid, a framework for public health action, postulates that addressing socioeconomic factors has the greatest potential to improve health. Interventions that change the context for individual behavior are generally the most effective public health actions; 1-time clinical interventions such as immunizations, can be more effectively applied than those requiring ongoing care; and clinical interventions are generally, although not inevitably, more effective than counseling and education.

Although the effectiveness of interventions tends to decrease at higher levels of the pyramid, those at the top often require the least political commitment. Achieving social and economic change might require fundamental societal transformation. Contextual change is often controversial, as evidenced by disputes over smoke-free laws, restrictions on artificial trans fat, and water fluoridation. One-time interventions tend to be less controversial, although immunization programs that attempt to reach all members of a society often meet resistance arising from suspicion and disbelief.

Although the structure and financing of health care systems can be controversial, clinical care itself rarely is. While exceptions exist, health education usually requires minimal political backing. Hence the greater popularity of school-based antismoking programs than of proven tobacco control interventions such as taxation, smoke-free environments, and comprehensive marketing bans. Similarly, exhorting people to exercise more and eat less is politically popular, but taxation of soda and other sugar-sweetened beverages, bans on marketing junk food to children, and community redesign to encourage walking and bicycling, although far more effective, are also politically more difficult.

- Interventions that address social determinants of health have the greatest potential public health benefit. Action on these issues needs the support of government and civil society if it is to be successful. The biggest obstacle to making fundamental societal changes is often not shortage of funds but lack of political will; the health sector is well positioned to build the support and develop the partnerships required for change.

- To say that social and contextual changes are more effective at improving public health is not to imply that other interventions should be ignored. For different public health problems, different interventions may be the most effective or feasible in any given context. Education to encourage condom use, although of only limited effectiveness, can reduce HIV transmission and save lives. Changing the context to make condoms ubiquitously available and acceptable makes education about their use more effective. Comprehensive public health programs should generally attempt to implement measures at each level of intervention to maximize synergy and the likelihood of long-term success.