Case Study - Making Tough choices in Public Health Services

Tough choices abound in extending, improving, or administering public health services to people, often because life and death issues must be resolved. Health-related tough choices are highlighted here for this reason.

While not all societies may even be able to afford "zero-cost" public health interventions, they can at least consider what opportunities may exist to incorporate them into programs.

Top Ten "Zero-Cost" Public Health
Interventions According to Life-Cycle Stage

Type of Intervention	Specific Actions	Numbers Affected (Calculate those for your jurisdiction)
All forms of prenatal care of mothers	Counselling, incentives, screening, monitoring, smoking cessation advice	Pregnant women wanting to come to term.
Screening newborn infants	PKU (genetic disorders) and hypothyroidism screening for newborns	Live births.
Childhood immunization and vaccination programs	Pertussis, diptheria, tetanus, mumps, measles, rubella, polio	Children aged 0-4 years.
National measles eradication program for children	Measles immunization and prevention	Children aged 0-9 years.
HIV prevention measures: populations at highest risk	Needle exchange, testing, counselling	Males aged 15-24 years engaging in risky behaviours.
Improved vehicle safety, driver behaviour	Seat belts, design improvements, education for poor drivers, safety helmets	Drivers and passengers commuting to work.
Smoking cessation advice, especially for high-risk groups	Counselling, incentives, support, assistive technologies	Smokers.
Occupational assistance programs for problem drinkers	Counselling, group support, incentives, monitoring	Adult general or psychiatric hospital separations.
Annual screening for people aged 55+	Stool guaiac colon cancer test	Adults aged 55+ years.
Cancer screening every 3 years: women 65 plus	Cervical cancer test (Pap smear)	Women aged 65+ years.

As economies evolve, they develop different patterns of diseases as the main killers and sources of illness. In developing economies, for example, infectious diseases remain most important. However, other diseases are becoming more important even there, and hence the need to consider effective prevention measures.

Top Interventions According to Life-Expectancy
Gain in Months, Harvard University Study, 1998

Type of Intervention	Specific Actions	Results
Reduce cholesterol	Lovastatin therapy, diet	Up to 76 months, depending on risk group and sex.
Reduce blood pressure among people with hypertension	Therapy, smoking cessation	Up to 68 months, depending on risk group and sex
Smoking cessation, reduction	Mixture of measures	Up to 72 months, depending on risk group and sex .
HIV prevention among intravenous drug users	Distributing bottles of bleach for equipment disinfection	Up to 28 months.
Hormone replacement therapy	Taking estrogen and progestin	Up to 27 months

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