HS4091 Chapter 4 - Judgment in Public Health

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Health Sciences
Health Sciences 2711A/B
Aleksandra Zecevic

Judgment in Public Health - Chapter 4 March-06-14 8:35 AM Doctor-Patient Relationship in Clinical Practice (last Class) 1. Technical Judgement • Judgement about the patient's medical good, based on generalized knowledge individualized through clinical skills, and involving consent by shared-decision making. • Situated within the formal requirements, rights, responsabilities. 2. Humane judgement • Judgement that recognized a patient's "medical good" is only part of their "total good". Public Health • Public health is an effort of prevent disease and promote health through the organized effort of society. • It has its own evidence base (epidemiology) • It envovles ethical and political judgement about colletive good. Epidemiology - the study of the distribuition and risk factors associated with disease in different groups of people. In modern epidemiology risk factors and benefits are quantified in terms of probabilites. For instance... "Relative risk" - Is the probability of an event in target group divided by the probability of the event in a comparison group. "number of persons needing to treat" - Is the avereage number of patients who need to treated for one to benefit. Epidemiology aims to provide scientific evidence of what is "best" for persons at large. According to Downie and Macnaughton, public health involves different sorts of judgments than clinical practice • experimental research focuses on systematic knowledge and it requires practiotioners judgement to individualize it to a specific patient • Epidemiology research esfocuses on issues in a cummunity and requires ethical and political judgement by community leaders. - A decision to compile data in one area (region, group, historical period) and compare it with data compiled in other areas is an ethical judgment. - Public health initiatives are aso political judgments Downie anf Macnaughton distinguish between "inequality" and "inequity"... • Some inaqualities cannot be avoided, while other can be avoided. • They argue that only avoidable inequalities are inequitable ("unfair") Some inequalities.. • older men have a higher risk of heart diesease than younger men. (it is unfair bcs it is biological) • smokers have a higher risk of noncancer than non-smokers (this is not unfair bcs it person's own choice) • exposure to environmental pollution increases the risk of disease such as asthma. ( unequal and unfair bcs we could do something about the air quality) An epidemiology finding that becomes a public health issues involves an (ethical) judgement that it is unfair (and avoidable) Clinical Relationship • A clinician has a one-to-one relationshio with a patient • The patient has initiated a consulatation because of felt problem • Involves judgmente about "medical good" Public health Relationship • Public healh initiatives involve communities rather than individuals • Public health initiatives are initiated in the public interest rather than at request of an individual • That is, such initiates involve judgement about "collective good" Public Health - Recap • It has its own evidence base (epidemiology) • It envolves ethical and political judgement about collective good Goals of public health Public health is the effort to prevent disease and promote health through the organized effort of society Downie and Macnaughton draw a distinction "prevention", "protection", and "avoidance" • Prevention - reduces the incidence of disease in a community through • Protection - reduces the risk of disease in a person through intervention • Avoidance - reduces the risk of disease in a person through withdrawal. Example - West Nile virus is an infectious disease trasnmitted by mosquitoes • Prevet
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