Foundations to Public Health
Foundations to Public Health
Week 1:
ASSIGNMENT:
Critically discuss a public health intervention you would recommend for addressing a public health problem in your country.
This assignment asks you to recommend a feasible, evidence- and theory-based intervention for a current public health problem in your own country.
You will decide on and analyse the target problem.
Use peer reviewed evidence of best practice from elsewhere to address current barriers, gaps, and opportunities to improve your target groups health.
show how this works in theory using a logic model, and consider how feasible your intervention is.
Formative Assignment: Submit by week 7 (Due date: Thursday 10th November 2022 at 1pm UK time).
Do as much as you can the module will not have covered all aspects yet. Feedback from lecturers by end of Week 9
Summative assignment: Submit by Week 12 (Due date: Thursday 15th December 2022 at 1pm UK time). Word count: 3500 including tables and figures, excluding references.
Use the following links as part of the references
https://www.who.int/publications/almaata_declaration_en.pdfThe art and science of preventing disease, prolonging life, and promoting health through the organised efforts of society Acheson (1988)
The overall vision is to promote greater health and wellbeing in a sustainable way, while strengthening integrated public health services and reducing inequalities. In order to achieve this vision, the public health approach involves working with other sectors to address the wider determinants of health, and with health professionals: primary health care professionals can play a key role in preventing illness and promoting health, as outlined in the Alma Ata declaration.
A timeline of important events affecting the development of health promotion in the United Kingdom - Hubley, Copeman, and Woodall (2021, p.18) Practical Health Promotion. Polity
For the assignment, identify What key reports & policies have affected Public Health in your country overtime?
Identify the relevance of the 5 action areas of health promotion ( Ottawa Charter, 1986) to the selected intervention https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference.
Fair Society Healthy Lives (The Marmot Review) - IHE 2010
Health Equity in England: The Marmot Review 10 Years On 2020
Six top-level classes: 'Functions'; 'Health Issues'; 'Determinants of Health'; 'Settings'; 'Methods' of intervention; and 'Resources and Infrastructure'. A multidimensional classification of public health activity in Australia
The typology of public health interventions is an innovative tool that can be used to better inform the public and decision-makers. Making sense of what exactly public health does: a typology of public health interventions (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046854/). Read this paper, think about how your country takes direct and indirect action.
In the chosen country,
What are the Reports & Policies up until now?
What are your countrys current public health problems?
What is your country currently doing to improve public health?
How does this fit to the typology? Planning, implementation, evaluation, and continuous quality improvement?
Which United Nations goals are most important to public health in your country? https://www.un.org/sustainabledevelopment/development-agenda/The confluence of crises, dominated by COVID-19, climate change, and conflicts, are creating spin-off impacts on food and nutrition, health, education, the environment, and peace and security, and affecting all the Sustainable Development Goals (SDGs). The Report details the reversal of years of progress in eradicating poverty and hunger, improving health and education, providing basic services, and much more.
10 global health issues to track in 2021 - WHO | World Healthhttps://www.who.int/news-room/spotlight/10-global-health-issues-to-track-in-2021
Build global solidarity for worldwide health security
Speed up access to COVID-19 tests, medicines and vaccines
Advance health for all
Tackling health inequities
Provide global leadership on science and data
Revitalise efforts to tackle communicable diseases
Combat drug resistance
Prevent and treat non-communicable diseases and mental health conditions
Build back better.
Act in solidarity
Top 10 causes of Death
https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-deathWHOs Top 10 global causes of disability-adjusted life years (DALYs) in 2019https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates
Neonatal conditions
Ischaemic heart disease
Stroke
Lower respiratory infections
Diarrhoeal diseases
Road injury
Chronic obstructive pulmonary disease
Diabetes mellitus
Tuberculosis
Congenital anomalies.
What causes the most deaths?
https://www.healthdata.org/nigeria
https://doi.org/10.1016/S0140-6736(20)30925-9
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
What risk factors drive the most death and disability combined?
https://doi.org/10.1016/S0140-6736(20)30752-2Metabolic risks
Environmental/occupational risks
Behavioral risks
Dahlgren and Whiteheads 1991 Rainbow Model of health determinants for individuals.
Dahlgren, G. and Whitehead, M. (1991). What can be done about inequalities in health?
Determinants of wellbeing and health in our cities.
Barton, H. and Grant, M. (2006) A health map for the local human habitat. The Journal for the Royal Society for the Promotion of Health, 126 (6). pp. 252-253. ISSN 1466-4240 developed from the model by Dahlgren and Whitehead, 1991. Dahlgren G, Whitehead M (1991). "The main determinants of health" model, version accessible in: Dahlgren G, and Whitehead M. (2007) European strategies for tackling social inequities in health: Levelling up Part 2 http://www.euro.who.int/__data/assets/pdf_file/0018/103824/E89384.pdf
What are your countrys current public health problems?
Reliable sources and Critical insight into Public Health problems (Academic studies published in peer-reviewed journals)
Evidence for:
How many
Trends over time
Vulnerable population groups
Determinants of health
Interventions - development, feasibility, assessing their impact
Theories and models
Authors systematically search for the most rigorous studies, synthesise the different findings, to identify the overall evidence on a particular topic
What is your country currently doing to improve public health?
Which United Nations goals are most important to public health in your country?
Find and read the 1991 Dahlgren and Whitehead article in Brookes electronic Library. Identify how the factors in the Rainbow Model affect your own health
Week 2
Intervention Studies
Sources: Peer reviewed studies, and reliable reports.
Sample size, rigour, strength of evidence; effect sizes matter
Feasibility studies
Evaluate whether a new programme / intervention is acceptable: qualitative work, participant involvement.
Behaviour change: Intervention development stage: Affordable, Practical, Effective/cost effective, Acceptable, Safe/side effects, Equitable (APEASE)
Searchable libraries of systematic reviews
Library workshops on database searching in Applied Research Methods
Cochrane Library: Cochrane ReviewsHealth Evidence.
Current problems - use current studies!
Health care: RE-AIM Reach, Effectiveness, Adoption, Implementation, Maintenance Dr. Russ Glasgow describing the RE-AIM FrameworkRandomised controlled studies
The impact of a programme / intervention, compared to a matched control group, with random allocation into intervention & control
Cohort studies
The impact of a programme / intervention
Policy Evaluation
Trend over time https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815378/Surveillance Data https://www.healthdata.org/
Reliable sources of UK & global public health surveillance data (check for your country)
Task:
What is the most reliable source of health surveillance data in your country?
How are the data collected?
Is it representative of your countrys population?
Does it tell you about specific groups of people?
Does the source tell you about trends / patterns in prevalence and incidence over time? (visual representations, e.g. graphs, images)
Contents
TOC h u z Assignment title:1Critically discuss a public health intervention you would recommend for addressing a public health problem in your country (3500 words)1Two stages:21. Formative assignment submit Week 722. Summative assignment submit Week 122Word count:2Figures / tables2Layout21.Introduction32.Critical analysis of the target problem33.Current Interventions3a. PAGEREF _26in1rg h Current interventions in your country3
b. PAGEREF _lnxbz9 h Effective interventions from elsewhere3
4. Recommended intervention45.Critical Discussion46. Conclusion5How this assignment contributes to your learning on your programme6Mark Scheme8
Assignment title:
Critically discuss a public health intervention you would recommend for addressing a public health problem in your country (3500 words)
This assignment asks you to recommend a feasible, evidence- and theory-based intervention for a current public health problem in your own country.
You will decide on and analyse the target problem, and use peer reviewed evidence of best practice from elsewhere to address current barriers, gaps, and opportunities to improve your target groups health, show how this works in theory using a logic model, and consider how feasible your intervention is.
Two stages:
1. Formative assignment submit Week 7
Due date: Thursday 10th November 2022 at 1pm UK time.
Do as much as you can the module will not have covered all aspects yet.
Feedback from lecturers by end of Week 9
2. Summative assignment submit Week 12
Due date: Thursday 15th December 2022 at 1pm UK time
Word count: 3500 including tables and figures, excluding references.
Figures / tables
You must use a logic model
You may wish to use an image to map your determinants to the Rainbow model or other suitable framework, and to illustrate your behaviour change theory.
Remember to give tables and figures titles and numbers, to refer them by Table or Figure number in the text, and describe their key aspects within the report. You must not copy and paste copyrighted images from datasets or online sources.
Layout
Use the following six headers. The suggested word counts are simply a guide and reflect the relative importanceof the sections.
Introduction (suggested word count: 300)
Critical analysis of the target problem (600 words)
Current interventions (700 words)
Current interventions in your country / area (350 words)
Effective interventions from elsewhere (350 words)
Recommended intervention (900 words)
Critical Discussion (800 words)
Conclusion (200 words)
Introduction
Critically discuss the current overall public health situation in your country:
Identify your country
Outline your countrys current overall public health problems
Assess how your country is currently intervening at policy, primary, secondary, and tertiary levels to protect and improve public health in line with:
Your countrys health goals
global health goals
Identify a current and potentially solvable public health problem that you will focus on - this is your target problem
Critical analysis of the target problem
Use peer reviewed evidence and reliable surveillance data to explain the trends in incidence and prevalence for the target problem in your country
Identify the determinants of your target problem. Match them to a model of health determinants.
Analyse how these determinants intersect to create lower and higher risks for particular groups of people. Use an appropriate model to explain how protective and risk factors combine to create increasing vulnerability in some groups.
Select and justify your target group - specify their characteristics and explain why they are vulnerable to the target problem, based on their determinants. Be specific about the disparities they experience. Depending on the target group and problem, you decide to focus on,choose a whether you will focus on the whole country or a specific place or area within the country (target setting).
You may wish to match the determinants to a behaviour change model and consider which determinants are modifiable (can be changed) and are worth targeting, and which cannot be changed (immutable).
Current interventions in your country
Identify and critically discuss the interventions your country has already implemented to try to address the target problem:
Which Policies?
Which Primary, Secondary, and / or Tertiary level interventions?
Explain why these interventions are not effective for your target group e.g. which modifiable determinants do they fail to impact, what barriers to accessing the intervention do your target group experience, etc.
Effective interventions from elsewhere
Identify and critically discuss at least one peer-reviewed public health intervention* that has been successfully used elsewhere to address your target problem. Explain:
The evidence for how effective they were in preventing / reducing the target problem
why they were effective
how they might fit to your target group to address the determinants of the target problem
* Policies, primary, secondary, and / or tertiary interventions from other countries, or from other areas within your own country.
4. Recommended intervention
Based on these effective interventions, recommend an evidence-based intervention to address your target problem for your target group(you can combine different aspects of more than one intervention, or replicate one. You can include more than one level.)
Use a logic model to illustrate how your recommended intervention will improve the target problem for your target group according to a behaviour change theory such as the Behaviour Change Wheel. Clearly show which determinants are targeted by each aspect of the intervention (inputs), the outputs and the short, medium, and long term SMART outcomes that will prevent or reduce the target problem for your target group.
Specify how the implementation and the short, medium, longer term outcomes will be evaluated using appropriate measures and / or surveillance data. Ensure this fits with the intervention level (policy, primary, secondary, tertiary) and outcomes.
Be clear about the resources required for the intervention to work: settings, key professionals, roles, collaborations, public health service provision, policy level changes, etc.
Critical Discussion
Critically assess the feasibility* of implementing your recommended intervention for your target group in your target setting to address your target public health problem. Consider:
Acknowledge the complexity of your intervention if it targets multiple determinants, has multiple levels, and / or uses multiple techniques.
How changing modifiable determinants of the problem will change your target groups outcomes
Its strengths
Its limitations, including potential barriers to implementation; key determinants that can not be changed, etc.
The potential ethical issues
Demonstrate your insight into the credibility of the existing evidence base and your ability to create a persuasive, balanced, and realistic argument to support your recommended intervention.Use peer reviewed sources to support each aspect of the discussion.
*You may wish to use the BCWs APPEASE feasibility criteria (affordability, practicability, effectiveness and cost-effectiveness, acceptability, side-effects/ safety, and equity considerations), or the UK Medical Research Council (MRC) feasibility criteria for complex interventions (optimal content and delivery, acceptability, adherence, likelihood of cost effectiveness, or capacity of providers to deliver the intervention).
6. Conclusion
Identify the key messages that your reader should learn from your assignment.
Aim to give reader an integrated and succinct summary of what you have learned about drawing on good public health practice from elsewhere in the world to make recommendations for evidence and theory-based complex interventions to address public health problems in your country (the title of the assignment*) and how you have achieved all the learning outcomes from the module and assignment.
*Critically discuss a public health intervention you would recommend for addressing a public health problem in your country
It is your responsibility to check your work against the attributes and mark scheme.
How this assignment contributes to your learning on your programme
The programme specification for your programme of study outlines the learning that you are expected to have gained during the course of your studies. Each module contributes certain skills to that learning. This table shows you the types of evidence that the marker will be looking for to assess whether you have developed relevant skills during this module.
Attributes Assessed from the Programme Specification Evidence in the CMNR7007 assignment
Academic literacy
Demonstrate advanced understanding and critical analysis of epidemiological surveillance, assessment of global population health and wellbeing, and public health intelligence systems.
Demonstrate advanced understanding and critical analysis of evidence and quality frameworks for assessing and improving the effectiveness of preventive health and healthcare interventions, programmes and services.
Demonstrate advanced understanding and critical analysis of policy and strategic development, leadership and collaborative working for implementing and achieving health improvement.
Demonstrate advanced understanding and critical analysis of health protection risk assessment and management. Each section of the report is based on critically evaluated peer-reviewed evidence and surveillance data.
The explanations of the target problem, current interventions, recommendation, and discussion are theory-based.
Demonstrates advanced understanding and critical analysis of intervening in health risks to achieve and assess health improvement.
The intervention targets modifiable determinants and has potential to make a difference.
Correct choice and application of theories and assessment methods.
Correct application of the theories
Correct application of the logic model.
The presentation and product are high-quality academic standard.
Research literacy
Interpret and critically evaluate statistical findings, draw valid inferences and flexibly and creatively communicate academic Public Health findings to different audiences
Critically analyse, synthesise and articulate knowledge from a wide variety of sources and theoretical perspectives.
Utilise research skills flexibly and creatively and with initiative to promote evidence based practice in public health. The work integrates knowledge from appropriate sources to create an evidence- and theory-based rationale for the recommended intervention.
Use of appropriate critically analysed evidence and theory to support arguments.
Academic writing which is suitable for an audience of researchers.
Critical self-awareness
Demonstrate advanced, independent and innovative thinking in academic Public Health as it relates to your chosen area of interest and to complex, specialised or unpredictable contexts.
Demonstrate insight into own leadership style and preferences, and display critical self-appraisal and reflective practice that incorporates and ethical dimension. Independent and innovative development of a feasible intervention that relates to the students interests in a complex, specialised, or unpredictable context.
Demonstrates critical reflection on own role and learning in the context of public health.
Digital and information literacy
Demonstrate advanced and systematic knowledge and skills in searching and retrieving published and grey academic Public Health literature to support public health decision making.
Demonstrate advanced knowledge and skills in the use of computer software and internet technology for statistical data analysis, and the flexible and creative digital communication of public health information. Utilises good quality current literature and data to support the decisions made.
Text, tables and figures are appropriately labelled and formatted.
Referencing is presented correctly following OBU Harvard style, as set out in the Cite them Right website.
Active citizenship
Demonstrate political astuteness relating to global health issues, including translating between levels of policy, strategy and tactics in a range of complex settings and cultures. The health issues of the country are clearly identified.
National and global public health goals are identified.
The setting is clearly identified.
Disparities and intersecting risks to health are appropriately discussed.
The proposed interventions ethical implications and implementation challenges are discussed in the context of the complex setting and culture.
Mark Scheme
This matrix shows how the marks are calculated. We have split the marks into the different sections of the assignment to help you check that you have given the right evidence in each part of your work.Your marker will assess your work within one of the cells of this table. They will then award you a proportion of the marks for each criterion (the rows of the matrix). For example, a piece of work which is mainly described by the pass criteria in the background, with some elements from the merit criteria, will score a mark which is at the higher end of the pass criteria. The marker may award 58% of the 15 marks, which represents a high pass. This will result in a mark of 9 for the background section. Whole and half (0.5) marks can be awarded and total scores ending in a .5 will be rounded up to the nearest whole number for the final grade.
Assignment Sections Distinction (70-100%) Merit (60-69%) Pass (50-59%) Bare Fail (40-49%) Fail (0-39%)
Introduction and critical review of the target problem
(out of 25 marks) Concisely outlines current public health problems and goals. Target problem is justified, clearly defined, and critically analysed. Target group and setting are clearly justified anddefined. Relevant models/theories are accurately applied.
Appropriate use ofcritically reviewed, high-quality peer-reviewed research and reliable surveillance data.All referencing is accurate:correct, complete, and in Harvard style. Clearly outlines current public health problems and goals. Target problem is clearly defined and analysed. Target group and setting are clearlydefined. Relevant models/theories are correctly applied.
Satisfactory use of critically reviewed,high-quality peer-reviewed research and reliable surveillance data;more citations needed / some errors in formatting in the text / list. Adequately outlines current public health problems and goals. Target problem is adequately defined and analysed. Target group and setting are defined. Relevant models/theories are applied.
Adequate use ofcritically reviewed,high-quality peer-reviewed research and reliable surveillance data, but some citations are low quality, more may be needed, and / or referencing has multiple errors in the text / list. Outlines the current public health problems and goals but is not accurate. Unclear target problem, group and / or setting. Relevant models/theories are not correctly applied.
Inadequate use ofpeer-reviewed research and surveillance data, and / or referencing has multiple errors in the text / list. Does not outline the current public health problems and goals. Does not define the target problem, group, and / or setting. Does not apply relevant models/theories.
Poor referencing: few relevant sources, in text and list referencing is incomplete / not Harvard style
Current Interventions
(out of 20 marks) Current interventions in the country are succinctly and critically discussed using high-quality peer-reviewed evidence and surveillance data. Barriers, gaps, and opportunities are clearly identified. Effective interventionsfrom elsewhere that might fit the target group are critically discussed.
Relevant theories are accurately applied. Accurate referencing. Current interventions in the country are critically discussed using high-quality peer-reviewed and surveillance data. Barriers, gaps, and opportunities are identified. Effective interventionsfrom elsewhere that might fit the target group are clearlydiscussed.
Satisfactory application of relevant theories. Satisfactory referencing. Current interventions in the country are adequately discussed using peer-reviewed and surveillance data. Adequate identification of barriers, gaps, and opportunities. Effective interventionsfrom elsewhere that might fit the target group are adequatelydiscussed.
Adequate application of relevant theories. One or more aspects missing, unclear, or incorrect. Adequate referencing.
Current interventions in the country are inadequately discussed.Limited attempt to identify barriers, gaps, and opportunities. Effective interventionsfrom elsewhere that might fit the target group are inadequatelydiscussed.
Incorrect application of relevant theories. Some aspects are missing, unclear, or incorrect. Inadequate referencing.
Current and effective interventions aremissing or poorly discussed. Incorrect / missing use of relevant theories. All / most aspects are missing, unclear, or incorrect. Poor referencing.
Recommended Intervention
(out of 25 marks) The intervention accurately reflects good practice: based on effective intervention(s)from elsewhere, precise fit to all / some of the determinants of the problem, and accurately mapped to a clearly specified and appropriatebehaviour change theory in the logic model. The evaluationmethods are appropriate and clearly defined. Each section is described in sufficient detail to allow replication of the intervention. Accurate referencing. The intervention is a satisfactory reflection of good practice:based on effective intervention(s)from elsewhere,satisfactory fit to most of the determinants of the problem, and clearly mapped to an appropriatebehaviour change theory in the logic model. The evaluation methods are correctly identified. Nearly all sections are described in sufficient detail to allow replication. Satisfactory referencing. The intervention is an adequate reflection of good practice:based on effective intervention(s)from elsewhere,an adequate fit to some of the determinants of the problem, and is mapped to an appropriatebehaviour change theory in the logic model. The evaluation methods are adequately identified. One or more aspects are missing, unclear, or incorrect.Adequate referencing. The intervention does not reflect good practice: it is not adequately based on effective intervention(s)from elsewhere /it is not anadequate fit to the determinants of the problem. An attempt has been made to map it to behaviourchange theory and / or a logic model. The evaluation assessment methods are not adequately explained. Some aspects are missing, unclear, or incorrect.Inadequate referencing. The intervention is not relevant, incomplete, or missing. The theory is missing or poorly chosen. Thelogic model ismissing or substantially incorrect.The evaluation methods are irrelevant, incomplete, or missing. The intervention could not be replicated. All / most aspects are missing, unclear, or incorrect. Poor referencing.
Critical discussion
(out of 25 marks) The feasibility of the recommended intervention is critically discussed using appropriatepeer- reviewed evidence and relevant guidelines and theories. Accurate referencing. The feasibility of the recommended intervention is critically discussed using appropriate peer-reviewed evidence and relevant guidelines and theories. Satisfactory referencing.
The feasibility of the recommended intervention is adequately discussed using appropriate peer reviewed evidence and relevant theories and / or guidelines. Adequate referencing The feasibility of the recommended intervention is not adequately discussed in comparison to appropriate peer- reviewed evidence and relevant theories / guidelines. Inadequate referencing.
The feasibility of the recommended intervention is not adequately discussed. Poor referencing.
Conclusion and Referencing
(out of 5 marks) The conclusion concisely integrates the assignment and clearly reflects on the acquired learning. Accurate referencing. The conclusion integrates the assignment well and reflects on the acquired learning.Satisfactory referencing.
The conclusion adequately integrates the assignment and reflects on the acquired learning. Adequate referencing
The conclusion does not adequately integrate the assignment or reflect on the acquired learning.Inadequate referencing. The conclusion is missing or fails to reflect the assignment and the learning.Poor referencing.
Introduction
(300 words) Identify your country
Outline the overall health problems
Assess current interventions at primary/secondary/tertiary levels to protect and improve public health in line with local and global health goals
Identify a current and potentially solvable health problem Proposed Intervention
(800 words) Recommend an evidence based intervention
Use a logic model to illustrate how it will improve the problem for your target group according to a behaviour change theory.
Show which determinants are targeted by each aspect of the intervention.
Specify how implementation and outcomes will be evaluated. Ensure fit with intervention level. Specify resources required for successful intervention
Critical Analysis of Problem (600 words) Explain the trends in incidence and prevalence using peer reviewed evidence and surveillance data
Identify the determinants and match them to a model of health determinants
Analyse how determinants intersect to create triskSelect and justify a target group
Consider matching determinants to a behaviour change model and decide which are modifiable and worth targeting Critical Discussion
(800 words) Critically assess the feasibility of implementing the intervention. Acknowledge the complexity. Identify strengths, limitations, barriers, and outline ethical issues.
Demonstrate insight into credibility of evidence base and create a persuasive balanced and realistic argument to support intervention
Current Interventions (700 words)) Identify and critically discuss current interventions in your country
Explain why (justify) the interventions are not effective for your target groups
Identify and critically discuss a successful intervention elsewhere and propose a fit with your target group Conclusion
(200 words) Identify key messages, provide a succinct summary of what has been learned about drawing on good public health practice from elsewhere to make recommendations
