The local healthcare system: Focusing on health

Transcription

1 The local healthcare system: Focusing on health Sian Griffiths Professor of Public Health Director of the School of Public Health Chairman, Department of Community and Family Medicine The Chinese University of Hong Kong May2007

2 How healthy is Hong Kong?

3 Life expectancy at birth ( ) Female Male (Source: Centre for Health Protection)

4 Infant mortality rate and Maternal Mortality Ratio ( ) IMR MMR (Source: Centre for Health Protection)

5 Leading Causes of Death in Hong Kong

6 Total Fertility Rate Census and Statistics Department

7 Health risk & lifestyle practices Health risk & lifestyle practices Overall (%) Male (%) Female (%) Physically Inactive Inadequate daily fruit & vegetable intake Daily smoking Daily alcohol drinking (Source: Population Health Survey, 2003/04)

8 Overweight/obesity in China (2005) The prevalence & estimated population 25% 20% 15% 303 million 23.2% : Obesity : Overweight 10% 5% 0% 2.6% 17.6% 73 million WHO classification (BMI: 25, 30 kg/m 2 ) 5.6% Chinese classification (BMI: 24, 28 kg/m 2 ) 1.3 billion in 2005 (Sources: population data from the China Statistical Abstract: 2006; prevalence data from the National Nutrition & Health Survey in 2002)

9 Suicide

10 Depression

11 Comorbidity Multiple risk factors are common For example, nearly 60%of US adults have 2 or more behavioral risk factors (Am J Preventive Medicine 2004) Among smokers 46% overweight or obese 61% inactive 34% risky drinkers Among overweight or obese 19% smoke 62% inactive 20% risky drinkers

12 Increasing burden of NCDs (2000) Risk factor %DALYs Disease or injury %DALYs Alcohol 6.2 Unipolar depressive disorders 5.9 Blood pressure 5.0 Cerebrovascular disease 4.7 Tobacco 4.0 Lower respiratory infections 4.1 Underweight 3.1 Road traffic injury 4.1 Overweight 2.7 COPD 3.8 Cholesterol 2.1 Ischaemic heart disease 3.2 Low fruit and vegetable intake Indoor smoke from solid fuels 1.9 Birth asphyxia/trauma Tuberculosis 2.4 Iron deficiency 1.8 Alcohol use disorders 2.3 Unsafe water, sanitation and hygiene 1.7 Deafness 2.2 (WHO)

13 Pressures on Health Care System Financial constraint Increasing elderly population New treatments Patient choice

14 Financial Constraint

15 Increasing Elderly Population % % % % 20% % % % % % 10% 5% % no. of elders (aged >= 65) % of total population

16 New Treatments Minimal invasive surgery Brain mapping Gene therapy Stem cell research

17 Patient Choice e.g. TCM utilization in Hong Kong Consultation of western doctor, TCM practitioner and both amongst those who seek care in the past 30 days Consultation / Year THS 2002 (n=6526) THS 2005 (n=8371) Consulted TCM + WM professionals 3.3% 4.3% WM doctor only 88.6% 87.4% TCM practitioner only 8.1% 8.4% Thematic household survey 2002, 2005

18 The Challenge The response needs to Be strategic Apply population approach Develop primary care led response

19 Strategy A strategy is a long term plan of action designed to achieve a particular goal

20 UK Wanless consultation (2002) Public/Patients want to be engaged in decisions about their health and healthcare services Ageing an important but not overwhelming factor Enhanced Primary care is an essential component of an effective response The stresses on the health system can be described but their impact is unknown Prevention, in the fully engaged scenario, will bring the greatest benefits

21 Strategic response

22 To tackle NCDs Modifiable Risk Factors Unhealthy diet Physical inactivity Tobacco use Intermediate Risk Factors Hypertension NCDs Coronary heart disease (CHD) Premature deaths Nonmodifiable Risk Factors High blood cholesterol Glucose intolerance Stroke Diabetes Cancer COPD/emphysema Disability Age Sex Obesity/ Overweight Mental disorders Genes

23 Strategy needs: Values Vision Plan to to act Identification of of areas for action // prioritisation Monitor and evaluate impact

24 Policy Challenge Population Responsibility Primary Care Systems Patient Centred Care

25 Population Approach: 5 principles Life course approach Prevention is everybody's business Pathway of Care Evidence based care Engaging the public

26 Life course approach Accumulate risk with age Factors impact along the life span i.e. interactive and cumulative impact of social and biological factors throughout life Early years need to be healthy years, including in utero

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29 Prevention is everybody s business Screening for and management of hypertension Screening for and management of raised cholesterol Screening for cancers: breast, cervix, colon Tertiary Secondary Cardiac rehabilitation Maintenance of blood sugar Primary Promoting healthier diets in patient consultations Helping patients stop smoking

30 Pathway of Care Health Promotion Healthy eating, exercise Treatment of acute myocardial infraction Care Stroke care Prevention Screening for high blood pressure Rehabilitation Cardiac rehabilitation programme

31 Using evidence

32 NICE physical activity Guidance

33 Guidance for Physical activity Four commonly used methods to increase activity: Brief interventions in primary care Exercise referral schemes Pedometers Community-based exercise programmes for walking & cycling

34 Evidence Based Advice for clinicians Health promotion Prevention Cardiovascular disorders

35 Engaging public and patients Social marketing Health literacy Active consultation Participation

36 Develop primary care led response What do we mean by primary care? What are the issues in Hong Kong?

37 International comparisons of the extent to which systems are primary care oriented suggests that those countries with a more generalist family doctors acting as gatekeepers with registered lists are more likely to have better health outcomes as well as lower costs and greater satisfaction Gilham

38 Core primary care Self care First contact care Assessment, diagnosis, treatment, care referral Continuing care chronic disease management e.g. for diabetes Public health Promote health, protect against disease Management Targets, performance,outcomes

39 WHAT: Primary care s contribution NCDs Primary Prevention : smoking cessation advice Secondary prevention : screening for hypertension/cervical cancer Tertiary prevention : effective treatment ; referral for cardiac rehab WHO: Primary care team ISSUES: Organization Finance Information

40 Hong Kong Healthcare System Primary care Secondary care Private 72% HA/NGO 82% GOPC/DH 28% Patients TCM Patients NGO Private 18%

41 Hong Kong Healthcare system Fragmented Compartmentalised primary and secondary care No formal NCD strategy No population information system to allow programme management or outcome assessment

42 Policy commitment to address NCDs

43 Chronic Diseases Model (King s fund) Community: mobilise community resources to meet needs of patients Healthcare organizations: create a culture,organisation, mechanisms that promote safe high quality care Self management support: empower and prepare patients to manage their health and healthcare Delivery system design: assure the delivery of effective, efficient clinical care and self management support Decision support: promote clinical care that is consistent with scientific evidence and patient preferences Clinical information system: organise patient and population data to facilitate efficient and effective care

44 Policy challenge Primary care development Partnership, patient centered care Professional development Approaches; attitudes; education; primary /secondary care communication; team development; remuneration and incentivisation Patient/public engagement Expectations, knowledge, responsibility Payment

45 Paid out of pocket? Provided by government? Price Role of insurance?

46 From rhetoric to reality Policy: Integrated Strategy for preventing and treating NCDS ;primary care focus Professionals: Education, attitudes, co-operation; Leadership; pay Effectively Tackling NCDs Patients: Choice, education, empowerment Price: payment system; role of insurance

47 Thank you!