Friday, Week 3. Future of Public Health Intervention: Three Cold Hard Numbers

I’ve been in a lot of meetings lately. I’m getting grumpy about discussions that are ‘hand wavy’ and never go anywhere. People are full of ideas, but how do we harness discussions about population health interventions and move them rapidly into real-world thinking and planning? Thinking through complex problems is hard, so we often defer this necessary activity until it is too late to even attempt it before a decision needs making!

I have been considering how I and my Public Health Intelligence colleagues might usefully influence the “Future of Public Health Interventions” when this future has never looked so uncertain. System complexity clouds our ability to see clearly how to intervene, declining intervention resources limit our flexibility, while demand for health services increases the pressure for immediate prevention results  — we live in a mad world.

What can we do to help colleagues with their increasingly tough and demanding decision making?

Let’s start with the basics, and have a better conversation.

Three Cold Hard Numbers: Reach, Compliance and Efficacy.

I wonder if we can begin to develop a better shared-understanding of the challenge of prevention with the use of a very simple, but incredibly scary equation — it’s maybe the most frightening maths in public health!

Number of successful interventions = population@risk * reach * compliance * efficacy

population@risk = the target group within the overall population that could benefit from our intervention

reach = % of the population@risk that we can reach each year in an STP area. This is really down to the design and implementation of the intervention programme. And funding of course!

compliance = % of the population we were able to reach who then took up our offer of an intervention. This seems to vary from locality to locality, the effectiveness of the intervention programme and intrinsic nature of what we are asking people to do.

efficacy = % of the population who complied with the intervention AND for whom the intervention worked as intended. You’d have to look this number up for most interventions — maybe NICE or somewhere in the peer reviewed literature, where researchers have studied this under controlled conditions.

What if you could sit down with colleagues and model your intervention at the project planning stage and could visualise the intervention’s impact over its planned life and threw in some basic financial information?

Three cold hard numbers. Not the entire future of public health interventions. But an important place to start.

Here’s the beginnings of a useful model, let me know what you think — just have a play. I’ve noticed it works well using the Chrome browser, but not so well with the Microsoft Explorer/Edge browsers. I have no idea why. I’ve used InsightMaker.com. It is a System Modelling tool, you can set up an account for free to build and share your own thinking — and if this is useful, you can just make your own copy and modify.

This futures blog

This blog is about how we create ‘healthy places’ and what our possible ‘futures’ could be given current trends and momentum within society, the economic and political systems, and the environment. I use the plural ‘futures’ intentionally, because our future is not pre-determined (I hope), we can and should work towards the future we want. This blog aims to generate discussion (maybe even some debate) around ‘Healthy places futures’ in the hope that if we all put our minds to it, a collective vision may emerge, which would inform any strategy we might put in place to get us to our preferred future. We’ll be leaning on heavily on futuring tools found on our Shaping Tomorrow hosted website: phd.shapingtomorrow.com.

The future is already here — it’s just not very evenly distributed (William Gibson 1993).

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