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AOHS Global Health

Lesson 11Community and Policy Health

Interventions

Teacher Resources

Resource Description

Teacher Resource 11.1 Scenarios: Public Health Interventions (separate Word file)

Teacher Resource 11.2 Presentation and Notes: Types and Levels of Global Health Interventions (includes separate PowerPoint file)

Teacher Resource 11.3 Vignettes: Community and Policy Interventions

Teacher Resource 11.4 Quiz: Community and Policy Health Interventions

Teacher Resource 11.5 Answer Key: Community and Policy Health Interventions Quiz

Teacher Resource 11.6 Key Vocabulary: Community and Policy Health Interventions

Teacher Resource 11.7 Bibliography: Community and Policy Health Interventions

Copyright © 2012–2016 NAF. All rights reserved.

AOHS Global HealthLesson 11 Community and Policy Health Interventions

Teacher Resource 11.2

Presentation Notes: Types and Levels of Global Health Interventions

Before you show this presentation, use the text accompanying each slide to develop presentation notes. Writing the notes yourself enables you to approach the subject matter in a way that is comfortable to you and engaging for your students. Make this presentation as interactive as possible by stopping frequently to ask questions and encourage class discussion.

In this presentation, you will learn about the different types and levels of global health interventions.

Presentation notes



The purpose of global health interventions is to bring about change. You’ve learned about various interventions so far in this course. For example, you learned about policy changes in Rwanda to make the roads safer. These policy changes were interventions.

An intervention is an organized effort made by health professionals to address a health-related problem. Interventions are often programs, such as a cancer-screening program or a program that teaches mothers about the benefits of breast-feeding.

Presentation notes



This graphic shows one way of understanding the scope of public health interventions.

There are three categories of public health interventions:

• Systems-focused interventions, which use government agencies, organizational structures, policies, and laws to bring about change.

• Community-focused interventions, which change the way communities think and act.

• Individual-focused interventions, which change the way individuals think and act. These interventions focus on changing unhealthy behaviors into healthier ones.

The right-hand column in the graphic gives examples of specific types of interventions. For example, school-based health education focuses on a community of students.

Presentation notes



Interventions focus on entire populations. A population is a collection of individuals who have at least one characteristic in common. For example, you are part of a population of American high school students. While there are many things that set you apart from a high school student in another state, or even from the student sitting next to you, what you have in common is that you go to high school in the same country. That makes you part of the same population.

Another characteristic of interventions is that they consider the health determinants, such as education and health services, that are linked to a health problem. For example, an intervention addressing obesity would consider a population’s ability to access healthy foods.

Interventions also focus on different levels of prevention. This means that some interventions focus on keeping problems from occurring (primary prevention). Other interventions might focus on detecting and treating problems early (secondary prevention), or they might try to keep problems from getting worse once they have occurred (tertiary prevention).

Presentation notes



A systems-focused practice does not focus directly on individuals and communities. Rather, it looks at the systems that affect health. These interventions change organizations, policies, laws, and power structures. For example, an intervention that implemented traffic laws, such as a speed limit or a requirement about motorcycle helmets, would be a systems-focused intervention.

A community-focused intervention is directed at an entire population in a community. For example, there might be a community-focused intervention in your community that aims to vaccinate children for whooping cough. These interventions change community attitudes, awareness, practice, norms, and behaviors. It is important to note that this community-focused intervention supports the individual-level intervention in which any given person receives his or her vaccination.

Individual-focused interventions are directed at individuals and families. These interventions change the knowledge, attitudes, beliefs, practices, and behaviors of individuals. For example, a nurse advising an individual with a family history of high blood pressure on diet and lifestyle changes is an example of an individual-focused intervention.

Presentation notes



There are many specific types of interventions. In this presentation, we are going to focus on four types and look at examples of each. The types are screening, health education, social marketing, and policy development.

Presentation notes



Screening is a type of intervention in which members of a population are tested for a specific disease known to be a major health issue. Members of a population who are showing symptoms of the disease will be screened. The screening is also meant to identify individuals who may have the disease but are not experiencing symptoms. With many diseases, early detection of a disease is key to effectively treating and managing it.

Public health screening is an intervention that is used in Australia and other countries to address breast cancer. Breast cancer is the second most common cause of cancer-related death in Australian women. Government officials and other health workers believed that well-organized mammograms would substantially reduce the number of deaths from breast cancer, so in 1990 a new intervention program called BreastScreen Australia began. The program targeted a specific population: well women without symptoms between the ages of 50 and 69. Since the program began, there has been a reduction in breast cancer mortality of about 25%.

Presentation notes



Health education is a type of intervention in which communicating facts, ideas, and skills about health helps to change health knowledge, attitudes, values, beliefs, behaviors, and practices.

The Asthma Care Training (ACT) for Kids is an example of a health education intervention. In three educational sessions in pediatric clinics across the United States, children ages 7–12 and their families learn asthma self-management skills. The program is based on the idea that children should be active participants in the prevention and control of their symptoms. This means that they should be able to recognize asthma symptoms and know what actions to take. Parents participate too, learning about things like how to control environmental pollutants and irritants. The result of the program was that the frequency and severity of asthma episodes was reduced.

Presentation notes



Social marketing is another type of intervention. In this type of intervention, commercial marketing principles and technologies are used to influence the health knowledge, attitudes, values, beliefs, and behaviors of population members.

In the United States, the CDC launched a social marketing intervention called the VERB. For four years this intervention used print, radio, and television ads to encourage increased physical activity in the tween population. Commercials were aired on stations like MTV, the Cartoon Network, and Nickelodeon, and advertisements were placed in national magazines like Teen People, Family Circle, and YM. The campaign was geared toward both parents and kids. One ad showed a basketball. It encouraged parents to be physically active with their kids, saying that kids who are physically active aren’t just healthier but feel better about themselves. On the basketball were the words “Inflate your child’s self esteem.”

Image courtesy of Centers for Disease Control; retrieved from http://www.cdc.gov/youthcampaign/ on April 23, 2012, and reproduced under fair-use guidelines of Title 17, US Code. Copyrights belong to respective owners.

Presentation notes


http://www.cdc.gov/youthcampaign/


Policy development is another type of health intervention. Policy development results in laws, rules, regulations, ordinances, and policies about issues related to health. Policy development is a type of intervention that is aimed at systems as well as individuals and communities.

South Africa is a country that has used policy development as a form of health intervention. Like many countries, South Africa has passed into law a number of measures aimed at creating smoke-free environments and reducing the number of tobacco-related health issues in the population. For example, smoking is only allowed in designated areas in work places, public places, and public transportation. Tobacco advertising is mostly banned. All tobacco products, like cigarette boxes, contain warnings.

Presentation notes



When tackling a health issue, it is often the case that more than one intervention is used. For example, while policy development is helping to change smoking behavior in South Africa, there are also programs that use health education as an intervention to educate communities and individuals about the effects of smoking.

Comprehensive interventions often use multiple techniques. They also often require global cooperation from multiple governments and health organizations and agencies, like the WHO, the Red Cross, or the Bill and Melinda Gates Foundation. Health issues that require global cooperation include diseases that spread around the globe, like avian flu, malnutrition related to changing climate patterns and global warming, and diseases linked to war and conflict. You will learn more about global cooperation later in this course.

Presentation notes



Interventions are about making change. They focus on individuals, communities, and systems. There are many types of successful interventions, including screenings, health education, social marketing, and policy development. Governments and global health organizations use interventions to tackle pressing global health concerns around the world.

Presentation notes




Vignettes: Community and Policy InterventionsPrint out the following four vignettes and post them in different parts of the classroom. You might wish to print two versions of each, depending on the size of your class. Ask students to read each vignette and then respond to the questions at the bottom of the vignette using sticky notes.



Malaria in the Democratic Republic of Congo (DRC)Almost 10,000 employees worked at a remote mining and drilling site in the DRC. About 70% of the workers were Congolese. Many of them had traveled great distances from other parts of the country to work at the site. The other workers were expatriates from other countries. They had come to work in the mines to support their families in their home countries. They came from India, Bangladesh, Pakistan, and the Philippines.

Malaria is a leading cause of death and illness in the DRC. The mining company was concerned that if they didn’t do something to stop the spread of malaria at the site, many people could get sick and die. The company teamed up with a health organization that specialized in malaria control and prevention. First, the health organization surveyed the people who worked at the company. They wanted a better understanding of the workers’ knowledge about how malaria is spread as well as their attitudes toward the disease and practices used to prevent it. The survey revealed that the separate national groups within the community had varied levels of understanding about the disease—about its severity and how to prevent it.

Based on the results of the survey, the team created educational health awareness programs for each nationality. The programs were geared specifically toward each target audience, taking into consideration cultural practices and beliefs. Along with the educational programs, they began a program to spray insecticide inside homes and facilities. They passed out durable bed nets and provided medication to those who needed it. Local health staff workers in the area were trained about how to detect and treat malaria. After two years, the team evaluated the program and found that malaria had been reduced by 60% of what it was when the program started.

What was particularly challenging about creating this intervention?

The evaluation of the program looked at the reduction in malaria cases. What is another way that the program could have been evaluated?



Hepatitis B in CambodiaOne way that the disease hepatitis B can be contracted is when mothers who are infected transmit it to their babies during delivery. However, it is possible to prevent mother-to-child transmission. Infants must be given a vaccine within three days of being born. In Cambodia, 90% of infants are born at home, and this makes vaccinating infants against dangerous diseases like hepatitis B very difficult.

A nonprofit agency wanted to create an intervention that would increase the number of children who were vaccinated. They decided to first focus on one province. The agency identified local health workers in the province who could give them more information about families in the area. Then they worked together to create a specific plan for targeting infants in this province.

The local workers set up an informal system whereby people in communities in the province would communicate via word-of-mouth when a mother was about to give birth. This pass-the-word system worked. The information would soon reach the health workers, who would then prepare to make a home visit and deliver the vaccine. However, transportation to homes could be difficult. Often there weren’t direct roads, so arrangements were made for health workers to travel first by rail and then by motorbike to reach out-of-the-way homes. Only nine months after starting the program, over 1,000 newborns were vaccinated, or 40% of the children being born.

What made the community that was the focus of this intervention unique?

What were some of the challenges of executing this intervention?



Diarrhoeal Disease in EgyptOral rehydration therapy (ORT) was developed in the 1960s. ORT is a simple solution of water, sugar, and salt that was found to be effective in stopping dehydration caused by diarrhoeal disease.

In the 1970s, infant mortality was very high in Egypt. Diarrhoeal disease caused at least half of all infant deaths. When ORT first reached pharmacy shelves in Egypt, it wasn’t being used, but the government soon realized how powerful ORT could be in curbing the number of deaths due to diarrhoeal disease. It decided to target a community that could make a difference: mothers of young children.

The ORT packages were designed and branded in a way to appeal to mothers. They were created in a size Egyptian mothers would think was appropriate for a child’s drink. They were distributed in places that would be accessible to mothers, such as the private homes of community leaders. Thousands of health workers were trained to teach mothers how to use ORT, and there were educational ads about ORT on TV.

Between 1982 and 1987, infant mortality dropped 36% and child mortality dropped 42%. In addition, the cost per child treated with ORT was estimated at only $6, a small price to save a life.

What part of this intervention do you think could work in other parts of the world?

How could the program be evaluated to see if the beliefs or attitudes of the target population had changed?



Iron Deficiency in VenezuelaAfter an economic crisis, the nutritional status of the Venezuelan population deteriorated. People could not afford the food needed to provide them with valuable nutrients like iron.

For more than 50 years, countries around the world have used iron fortification to increase the iron intake of their populations. When a food is fortified, a nutrient is added to it. So, in 1993 the Venezuelan government began a mandatory iron fortification program. Precooked corn flour is a staple in the Venezuelan diet. The program required manufacturers by law to enrich precooked corn flour with iron.

Soon after the program began, surveys showed a sharp drop in iron deficiency in children.

What are the characteristics that made this intervention successful?

Why do you think a policy intervention was needed in this situation?




Quiz: Community and Policy Health Interventions

Name:___________________________________________ Date:______________________

Directions: Answer each question accurately and thoroughly in the space below the question.

1. What is a global health intervention and what is its purpose?

2. Describe the differences between community-focused, systems-focused, and individual-focused interventions.

3. Read the following description of a community-based intervention. Then identify the resources, activities, products, and outcome:

An intervention targets the parents of middle-school girls in a rural community in Kansas. The program, run by a group of public health nurses, provides health education about the physical and mental health risks of eating disorders. The nurses have developed brochures that explain warning signs parents should be aware of. They also host events at a community center where parents can ask questions and share personal stories.

Since the program was launched, health care providers in the community have tracked an increase in parents bringing their daughters in for medical attention in the early stages of an eating disorder. Since early detection and intervention is important in treating the illness, the intervention is considered to be a success.

a. Resources (what is needed to make the intervention happen):

b. Activities (what the program does with the resources to fulfill its mission):

c. Products (the goods that result from the program):



d. Outcome (the benefits):

4. A program has been launched of physical activity for overweight adult males with a family history of cardiovascular disease. Is this an example of a primary, secondary, or tertiary level of prevention? Explain your reasoning.

5. Which of these do policy interventions target? Explain your reasoning.

Individual

Communities

Systems

6. You are in charge of evaluating a new program designed to support orphaned refugee children who have been taken in by a nonprofit organization in Basel, Switzerland. Which of these methods of evaluation would you use, and why?

a. Interview the children to see how they are responding to support.

b. Interview the caregivers of the children to see if they think the children are benefiting.

c. Analyze the students’ performance on IQ tests.

d. Analyze medical data about their physical condition over the time they have been in Switzerland.




Answer Key: Community and Policy Health Interventions Quiz

1. What is a global health intervention and what is its purpose?

A global health intervention is an organized effort made by health professionals to address a health-related problem. The purpose of this type of intervention is to bring about positive change.

2. Describe the differences between community-focused, systems-focused, and individual-focused interventions.

Community-focused interventions change the way communities think and act.

Systems-focused interventions use government agencies, policies, and laws to bring about change.

Individual-focused interventions change the way individuals think and act. These interventions focus on changing unhealthy behaviors into healthier ones.

3. Read the following description of a community-based intervention. Then identify the resources, activities, products, and outcome:

An intervention targets the parents of middle-school girls in a rural community in Kansas. The program, run by a group of public health nurses, provides health education about the physical and mental health risks of eating disorders. The nurses have developed brochures that explain warning signs parents should be aware of. They also host events at a community center where parents can ask questions and share personal stories.

Since the program was launched, health care providers in the community have tracked an increase in parents bringing their daughters in for medical attention in the early stages of an eating disorder. Since early detection and intervention is important in treating the illness, the intervention is considered to be a success.

a. Resources (what is needed to make the intervention happen):

Staff—specifically, public health nurses

b. Activities (what the program does with the resources to fulfill its mission):

Events at the community center for parents

c. Products (the goods that result from the program):

Brochures for parents

d. Outcome (the benefits):

More parents bring their daughters in for medical attention when they recognize early stages of an eating disorder.

4. A program has been launched of physical activity for overweight adult males with a family history of cardiovascular disease. Is this an example of a primary, secondary, or tertiary level of prevention? Explain your reasoning.



This is a tertiary level of prevention because it focuses on preventing disease progression after a disease or a risk factor for that disease has been identified. In this case, the identified risk factor is a family history of cardiovascular disease.

5. Which of these do policy interventions target? Explain your reasoning.

Individual

Communities

Systems

Policy interventions target all three, because laws and regulations affect individuals, whole communities, and systems such as governments, education, and health.

6. You are in charge of evaluating a new program designed to support orphaned refugee children who have been taken in by a nonprofit organization in Basel, Switzerland. Which of these methods of evaluation would you use, and why?

a. Interview the children to see how they are responding to support.

b. Interview the caregivers of the children to see if they think the children are benefiting.

c. Analyze the students’ performance on IQ tests.

d. Analyze medical data about their physical condition over the time they have been in Switzerland.

A case could be made for a, b, and d; all of these would provide information about how the children’s psychological, emotional, and physical health have improved (or not) over time while the children were in the program. The IQ of the children is irrelevant to whether the program supports their healing and well-being. Option d, analyzing medical data, would be useful only in conjunction with evaluating students’ psychological and emotional states.




Key Vocabulary: Community and Policy Health Interventions

Term Definition

community-based intervention

A health intervention that aims to reduce the impact of disease and other health-related risk factors in a supportive environment; targets a specific community and takes place in a variety of settings.

comply To act in accordance with a law or rule.

evaluation An analysis of a health intervention in order to determine its effectiveness.

legislation A law or laws passed by the government.

mandate To be instructed or given the authority to do something, such as carry out a policy.

policy intervention A health intervention that aims to reduce the impact of disease and other health-related risk factors by changing organizations, laws, rules, and regulations; focuses on systems that affect health rather than individuals or communities; uses local, state, and national government agencies to bring about change.

population A collection of individuals who have at least one characteristic in common.

primary prevention A level of intervention that focuses on preventing disease before it begins.

repeal To officially end a law so that it is no longer valid.

secondary prevention A level of intervention that focuses on screening and early detection of disease and conditions.

social marketing A type of intervention that uses commercial marketing principles and technologies to increase the health knowledge, attitudes, values, beliefs, and behaviors of population members.

tertiary prevention A level of intervention that focuses on preventing disease progression after a disease or risk factor has been identified.




Bibliography: Community and Policy Health Interventions

The following sources were used in the preparation of this lesson and may be useful for your reference or as classroom resources. We check and update the URLs annually to ensure that they continue to be useful.

PrintGuttmacher, Sally. Community-Based Health Interventions. San Francisco: Jossey-Bass, 2010.

Skolnik, Richard. Global Health 101. Burlington, MA: Jones and Bartlett Learning, 2012.

Online“Asthma: Interventions.” CDC, http://www.cdc.gov/asthma/interventions.htm (accessed October 26, 2015).

“Ban on Texting While Driving in Arkansas Starts Oct. 1.” Insurance Journal, September 29, 2009, http://www.insurancejournal.com/news/southcentral/2009/09/29/104151.htm (accessed October 26, 2015).

“The California’s Motorcycle Helmet Law Has NOT Caused Lower Fatality and Injury Rates, But It HAS Resulted in Drastically Lower Motorcycle Ridership, Ownership and Usage.” Bikers Rights, http://www.bikersrights.com/statistics/hlfaq.html (accessed October 26, 2015).

“Cambodia Achieves Significant Boost in Immunization.” PATH,http://www.path.org/news/press-room/586/ (accessed October 26, 2015).

“Case 14: Curbing Tobacco Use in Poland.” Center for Global Development, http://www.cgdev.org/section/initiatives/_archive/millionssaved/studies/case_14/ (accessed October 26, 2015).

“Case Studies: Leading a Successful Malaria Programme.” International SOS, https://www.internationalsos.com/case-studies/case-study-folder/leading-a-successful-malaria-programme (accessed October 26, 2015).

“Country Details for South Africa.” Tobacco Control Laws, http://www.tobaccocontrollaws.org/legislation/country/south-africa (accessed October 26, 2015).

“Distracted Driving.” Governors Highway Safety Association, http://www.ghsa.org/html/issues/distraction/index.html (accessed October 26, 2015).

“Distracted Driving Laws.” Governors Highway Safety Association, http://www.ghsa.org/html/stateinfo/laws/cellphone_laws.html (accessed October 26, 2015).

“It Can Wait.” AT&T, http://www.att.com/gen/press-room?pid=2964 (accessed October 26, 2015).

Mannar, Venkatesh, and Erick Boy Gallego. “Iron Fortification: Country Level Experiences and Lessons Learned.” The Journal of Nutrition, April 1, 2002, http://jn.nutrition.org/content/132/4/856S.full (accessed October 26, 2015).

“Nepal: A Whiff of Sobriety.” Economist, July 28, 2012, http://www.economist.com/node/21559665 (accessed October 26, 2015).


http://www.economist.com/node/21559665

http://jn.nutrition.org/content/132/4/856S.full

http://www.att.com/gen/press-room?pid=2964

http://www.ghsa.org/html/stateinfo/laws/cellphone_laws.html

http://www.ghsa.org/html/issues/distraction/index.html

http://www.tobaccocontrollaws.org/legislation/country/south-africa

https://www.internationalsos.com/case-studies/case-study-folder/leading-a-successful-malaria-programme

https://www.internationalsos.com/case-studies/case-study-folder/leading-a-successful-malaria-programme

http://www.cgdev.org/section/initiatives/_archive/millionssaved/studies/case_14/

http://www.path.org/news/press-room/586/

http://www.bikersrights.com/statistics/hlfaq.html

http://www.insurancejournal.com/news/southcentral/2009/09/29/104151.htm

http://www.cdc.gov/asthma/interventions.htm


Parker, Elisbeth. “Campaign to Discourage Texting While Driving Visits Tampa Prep.” Tampa Bay Times, May 16, 2012, http://www.tampabay.com/news/education/k12/campaign-to-discourage-texting-while-driving-visits-tampa-prep/1230444 (accessed October 26, 2015).

“Public Health Interventions.” Minnesota Department of Health, http://www.health.state.mn.us/divs/opi/cd/phn/docs/0301wheel_manual.pdf (accessed October 26, 2015).

“Q & A: Motorcycles—Helmets.” Insurance Institute for Highway Safety, http://www.iihs.org/iihs/topics/t/motorcycles/qanda#motorcycles--helmets (accessed October 26, 2015).

Stoto, Michael A., and Leon E. Cosler. “Chapter 18: Evaluation of Public Health Interventions.” Jones & Bartlett Learning, http://www.jblearning.com/samples/0763738425/38425_CH18_495_544.pdf (accessed October 26, 2015).

“Youth Media Campaign.” CDC, http://www.cdc.gov/youthcampaign/ (accessed October 26, 2015).


http://www.cdc.gov/youthcampaign/

http://www.jblearning.com/samples/0763738425/38425_CH18_495_544.pdf

http://www.iihs.org/iihs/topics/t/motorcycles/qanda#motorcycles--helmets

http://www.health.state.mn.us/divs/opi/cd/phn/docs/0301wheel_manual.pdf%20

http://www.tampabay.com/news/education/k12/campaign-to-discourage-texting-while-driving-visits-tampa-prep/1230444

http://www.tampabay.com/news/education/k12/campaign-to-discourage-texting-while-driving-visits-tampa-prep/1230444

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