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Health System Dynamics

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... Why Place So Much Emphasis on ... Modeling Why Do We Do Public Health Work? ... Foresight and precaution The meaning of work Mutual accountability ... – PowerPoint PPT presentation

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Title: Health System Dynamics


1
Health System Dynamics
Work in Progress (June 27, 2006)
  • Mapping the Drivers of Population Health,
    Vulnerability, and Affliction

Bobby Milstein Syndemics Prevention
NetworkCenters for Disease Control and
PreventionAtlanta, Georgia bmilstein_at_cdc.gov
Jack Homer Homer Consulting Voorhees,
NJ jhomer_at_comcast.net
2
Public Health Effort Across the Chain
Upstream Prevention and Protection --------------
--------------------- Total ? 3
Downstream Care and Management ------------------
-------------- Total ? 97
3
Health Protection as a Dynamic System
Milstein B, Homer J. The dynamics of upstream and
downstream why is so hard for the health system
to work upstream, and what can be done about it?
Presented to the CDC Futures Health Systems
Workgroup Atlanta, GA December 3, 2003.
4
Why focus on affliction?
5
Focusing on Disease Prevention and Control Has
Led to Major Achievements
Actual and Expected Death Rates for Coronary
Heart Disease, 19501998
700
Rate if trend continued
600
500
Peak Rate
400
Age-adjusted Death Rate per 100,000 Population
300
200
Actual Rate
100
50
1950
1960
1970
1980
1990
1995
1955
1965
1975
1985
Year
Marks JS. The burden of chronic disease and the
future of public health. CDC Information Sharing
Meeting. Atlanta, GA National Center for Chronic
Disease Prevention and Health Promotion 2003.
6
Focusing on Disease Prevention and Control Has
Led to Major Achievements
Adult Per Capita Cigarette Consumption and Major
Smoking-and-Health Events United States, 1900-1998
1st Surgeon Generals Report
Broadcast Ad Ban
Federal Cigarette Tax Doubles
End of WW II
Nonsmokers Rights Movement Begins
1st Smoking- Cancer Concern
Great Depression
Source USDA 1986 Surgeon General's Report
7
But the Pictures Look Different When We Examine
Summary Measures of Health (or Affliction)
17 increase
Centers for Disease Control and Prevention.
Health-related quality of life prevalence data.
Available at http//apps.nccd.cdc.gov/HRQOL/inde
x.asp
8
Navigating Health FuturesQuestions Supported by
System Dynamics Modeling
Where?
What?
17 increase
How?
Why?
Who?
2005
2025
2050
Centers for Disease Control and Prevention.
Health-related quality of life prevalence data.
Accessed June 4, 2006. Available at
http//apps.nccd.cdc.gov/HRQOL/index.asp Milstein
B. Hygeia's constellation navigating health
futures in a dynamic and democratic world.
Dissertation. Cincinnati, OH Union Institute
and University April 11 draft, 2006.
9
Why Do We Do Public Health Work?What is the
System Organized to Do?
CDC Vision Mission Healthy people, in a
healthy world, through prevention To promote
health and quality of life by preventing and
controlling disease, injury, and disability
Institute of Medicine The purpose of public
health is to fulfill societys interest in
assuring the conditions in which people can be
healthy
How we reconcile these two frames of reference
will shape the possibilities for what we can
accomplish in leading health system change.A
systems approach understands that both
perspectives exist in a dynamic relationship with
each other.
10
Toward a Balanced System of Health Protection
Becoming safer
and healthier
Safer
Afflicted
Afflicted with
Vulnerable
Healthier
without
Complications
People
People
Developing
Becoming
Becoming
Complications
complications
vulnerable
afflicted
Dying from
complications
One major task that CDC is intending to address
is balancing this portfolio of our health system
so that there is much greater emphasis placed on
health protection, on making sure that we invest
the same kind of intense resources into keeping
people healthier or helping them return to a
state of health and low vulnerability as we do to
disease care and end of life care." -- Julie
Gerberding
Gerberding JL. CDC's futures initiative. Atlanta,
GA Public Health Training Network April 12,
2004. Jackson DJ, Valdesseri R, CDC Futures
Health Systems Work Group. Health systems work
group report. Atlanta, GA Centers for Disease
Control and Prevention, Office of Strategy and
Innovation January 6, 2004. Milstein B, Homer
J. The dynamics of upstream and downstream why
is so hard for the health system to work
upstream, and what can be done about it?
Presented to the CDC Futures Health Systems Work
Group Atlanta, GA December 3, 2003.
11
Balancing Two Major Areas of Emphasis
Milstein B. Hygeia's constellation navigating
health futures in a dynamic and democratic world.
Unpublished dissertation. Cincinnati, OH Union
Institute and University October 7, 2005
(draft).
12
Beyond Obvious Morality, Why Place So Much
Emphasis on Democracy and Social Justice?
Foege WH. Public health moving from debt to
legacy. American Journal of Public Health
198777(10)1276-8.
13
A More Detailed Dynamic HypothesisIncorporating
Public Strength
14
Health System DynamicsIncorporating Public
Strength
Milstein B. Hygeia's constellation navigating
health futures in a dynamic and democratic world.
Unpublished dissertation. Cincinnati, OH Union
Institute and University April 13, 2006 (draft).
Milstein B, Homer J. System dynamics modeling
work in progress the dynamics of upstream and
downstream. Syndemics Prevention Network,
Centers for Disease Control and Prevention.
Atlanta, GA. Available at http//www.cdc.gov/synd
emics
15
Health System DynamicsIncorporating Public
Strength
Milstein B. Hygeia's constellation navigating
health futures in a dynamic and democratic world.
Unpublished dissertation. Cincinnati, OH Union
Institute and University April 13, 2006 (draft).
Milstein B, Homer J. System dynamics modeling
work in progress the dynamics of upstream and
downstream. Syndemics Prevention Network,
Centers for Disease Control and Prevention.
Atlanta, GA. Available at http//www.cdc.gov/synd
emics
16
Health System Dynamics Incorporating Public
Strength
Milstein B. Hygeia's constellation navigating
health futures in a dynamic and democratic world.
Unpublished dissertation. Cincinnati, OH Union
Institute and University April 13, 2006 (draft).
Milstein B, Homer J. System dynamics modeling
work in progress the dynamics of upstream and
downstream. Syndemics Prevention Network,
Centers for Disease Control and Prevention.
Atlanta, GA. Available at http//www.cdc.gov/synd
emics
17
Health System Dynamics Incorporating Public
Strength
Milstein B. Hygeia's constellation navigating
health futures in a dynamic and democratic world.
Unpublished dissertation. Cincinnati, OH Union
Institute and University April 13, 2006 (draft).
Milstein B, Homer J. System dynamics modeling
work in progress the dynamics of upstream and
downstream. Syndemics Prevention Network,
Centers for Disease Control and Prevention.
Atlanta, GA. Available at http//www.cdc.gov/synd
emics
18
An Even More Detailed Dynamic HypothesisIncorpor
ating Public vs. Professional Concern
19
Health System DynamicsIncorporating Public vs.
Professional Concern
Milstein B. Hygeia's constellation navigating
health futures in a dynamic and democratic world.
Unpublished dissertation. Cincinnati, OH Union
Institute and University April 13, 2006 (draft).
Milstein B, Homer J. System dynamics modeling
work in progress the dynamics of upstream and
downstream. Syndemics Prevention Network,
Centers for Disease Control and Prevention.
Atlanta, GA. Available at http//www.cdc.gov/synd
emics
20
Health System Dynamics Incorporating Public vs.
Professional Concern
Milstein B. Hygeia's constellation navigating
health futures in a dynamic and democratic world.
Unpublished dissertation. Cincinnati, OH Union
Institute and University April 13, 2006 (draft).
Milstein B, Homer J. System dynamics modeling
work in progress the dynamics of upstream and
downstream. Syndemics Prevention Network,
Centers for Disease Control and Prevention.
Atlanta, GA. Available at http//www.cdc.gov/synd
emics
21
Health System Dynamics Incorporating Public vs.
Professional Concern
Milstein B. Hygeia's constellation navigating
health futures in a dynamic and democratic world.
Unpublished dissertation. Cincinnati, OH Union
Institute and University April 13, 2006 (draft).
Milstein B, Homer J. System dynamics modeling
work in progress the dynamics of upstream and
downstream. Syndemics Prevention Network,
Centers for Disease Control and Prevention.
Atlanta, GA. Available at http//www.cdc.gov/synd
emics
22
Health System Dynamics Incorporating Public vs.
Professional Concern
Milstein B. Hygeia's constellation navigating
health futures in a dynamic and democratic world.
Unpublished dissertation. Cincinnati, OH Union
Institute and University April 13, 2006 (draft).
Milstein B, Homer J. System dynamics modeling
work in progress the dynamics of upstream and
downstream. Syndemics Prevention Network,
Centers for Disease Control and Prevention.
Atlanta, GA. Available at http//www.cdc.gov/synd
emics
23
Health System Dynamics Incorporating Public vs.
Professional Concern
Milstein B. Hygeia's constellation navigating
health futures in a dynamic and democratic world.
Unpublished dissertation. Cincinnati, OH Union
Institute and University April 13, 2006 (draft).
Milstein B, Homer J. System dynamics modeling
work in progress the dynamics of upstream and
downstream. Syndemics Prevention Network,
Centers for Disease Control and Prevention.
Atlanta, GA. Available at http//www.cdc.gov/synd
emics
24
Health System Dynamics Incorporating Public vs.
Professional Concern
Milstein B. Hygeia's constellation navigating
health futures in a dynamic and democratic world.
Unpublished dissertation. Cincinnati, OH Union
Institute and University April 13, 2006 (draft).
Milstein B, Homer J. System dynamics modeling
work in progress the dynamics of upstream and
downstream. Syndemics Prevention Network,
Centers for Disease Control and Prevention.
Atlanta, GA. Available at http//www.cdc.gov/synd
emics
25
Health System Dynamics Incorporating Public vs.
Professional Concern
Milstein B. Hygeia's constellation navigating
health futures in a dynamic and democratic world.
Unpublished dissertation. Cincinnati, OH Union
Institute and University April 13, 2006 (draft).
Milstein B, Homer J. System dynamics modeling
work in progress the dynamics of upstream and
downstream. Syndemics Prevention Network,
Centers for Disease Control and Prevention.
Atlanta, GA. Available at http//www.cdc.gov/synd
emics
26
Health System Dynamics Incorporating Public vs.
Professional Concern
Milstein B. Hygeia's constellation navigating
health futures in a dynamic and democratic world.
Unpublished dissertation. Cincinnati, OH Union
Institute and University April 13, 2006 (draft).
Milstein B, Homer J. System dynamics modeling
work in progress the dynamics of upstream and
downstream. Syndemics Prevention Network,
Centers for Disease Control and Prevention.
Atlanta, GA. Available at http//www.cdc.gov/synd
emics
27
Health System Dynamics Incorporating Public vs.
Professional Concern
Milstein B. Hygeia's constellation navigating
health futures in a dynamic and democratic world.
Unpublished dissertation. Cincinnati, OH Union
Institute and University April 13, 2006 (draft).
Milstein B, Homer J. System dynamics modeling
work in progress the dynamics of upstream and
downstream. Syndemics Prevention Network,
Centers for Disease Control and Prevention.
Atlanta, GA. Available at http//www.cdc.gov/synd
emics
28
Health System Dynamics Incorporating Public vs.
Professional Concern
Milstein B. Hygeia's constellation navigating
health futures in a dynamic and democratic world.
Unpublished dissertation. Cincinnati, OH Union
Institute and University April 13, 2006 (draft).
Milstein B, Homer J. System dynamics modeling
work in progress the dynamics of upstream and
downstream. Syndemics Prevention Network,
Centers for Disease Control and Prevention.
Atlanta, GA. Available at http//www.cdc.gov/synd
emics
29
SummaryWhy is it So Hard to Work Across the
Whole System?
  • Initial Observations
  • Upstream work requires more public concern, which
    is less a reaction to the prevalence of disease
    as to the spread of vulnerability and affliction
    that over many years threaten everybody (think of
    economic decline, inadequate education, unsafe
    housing, sprawl, racism, environmental decay,
    etc.)
  • Long before upstream threats become widely
    apparent, money and other resources have focused
    downstream (where professional expertise and the
    weight of scientific evidence lie)
  • Because of their role as providers of downstream
    services, health professionals do not respond to
    vulnerability and social disparity FOR ITS OWN
    SAKE, in the WAY that ordinary citizens often do
  • Upstream health action involves broad-based
    organizing it is politicalbut non-partisanand
    cannot be done by professionals alone.

30
Putting the System in MotionPrototype of a
Simulation Game
31
Neighborhood Assistance Gamehttp//broadcast.fori
o.com/sims/syndemic2003/
Homer J, Milstein B. Syndemic simulation. Forio
Business Simulations, 2003. Available at
lthttp//broadcast.forio.com/sims/syndemic2003/gt.
32
Neighborhood Assistance Game
See also Homer J, Milstein B. Syndemic
simulation. Forio Business Simulations, 2003.
Available at lthttp//broadcast.forio.com/sims/syn
demic2003/gt.
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