1. 1 Reducing Health Inequalities: How to Effect Systems Change and What is the Evidence Which Policies Work? ______________________________________ Jordan Panayotov, M Ec, MPH (Health Economics) Independent Centre for Analysis and Research of Economies Melbourne, Australia Public Health in Canada: Reducing Health Inequalities Through Evidence & Action Halifax, Nova Scotia, 1 - 4 June 2008

2. 2 The Foundations: ______________________________________ People have the right to highest attainable health. WHO Constitution, 1948 New public health is a social and political concept aiming at improving health, prolonging life and improving the quality of life among whole populations through health promotion, disease prevention and other forms of health intervention. Nutbeam, 1998

3. J.Panayotov. All rights reserved. CPHA 2008 Conference, Halifax 3 PREVENTION PRIMARY CARE CHRONIC DISEASES I C U

4. J.Panayotov. All rights reserved. CPHA 2008 Conference, Halifax 4 Conflict of Interests When Allocating Resources OA B B1B1 B2B2 A1A1 A2A2 S1S1 S2S2 AB – Possible efficient allocations of given resources OAi – Benefit for person A OBi – Benefit for person B Si – Allocation of resources providing benefit OAi + OBi

5. 5 Public Spending for Health Dominates

6. J.Panayotov. All rights reserved. CPHA 2008 Conference, Halifax 6 System Change / Health Reform _______________________________________ Why? People want a change when they are not happy with the outcome. Why do people finance health expenditure collectively ? Is it to keep hospitals busy, or to make providers (doctors and/or insurers) happier, or to improve health and quality of life among whole populations! How? When decisions for allocating limited resources are made, i.e. choices for policies, programs or interventions are made, on what basis these decisions are made?

7. 7 The Role of Ethics and Human Rights ______________________________________ Ethics defines the values. “there is no such thing as “value-free” welfare economics.” Hurley J., 2000 What is the Declared Ethics? All people are of equal value irrespective of their age, gender, race, income or functions in the society. Human rights play important role as an instrument for assuring the declared ethics.

8. 8 Implications for Public Health __________________________________________________ There is nothing so practical as a good theory Kurt Lewin

9. J.Panayotov. All rights reserved. CPHA 2008 Conference, Halifax 9 Average Health Status - Health Inequalities Matrix _____________________________________________ AHS – Average Health Status HInEq – Health Inequalities DPP – Dead Performance Point Panayotov Matrix

10. 10 RESOURCES, RESULTS, EFFICIENCY OECD26/06/2006 Rising health costs put pressure on public finances, Health expenditure per capita

11. 11 U.S. Newborn Survival Rate Ranks Low ___________________________________________________ “Our health care system focuses on providing high-tech services for complicated cases. What we don’t do is provide basic primary and preventive health care services.” Kenneth Thorpe, Emory University health policy expert With the permission of The Associated Press Copyright 2006, All rights reserved.

12. 12 Thank you for your attention! For more information visit www.icare.biz or contact me on jp@icare.biz