Vincent A. Campbell, Ph.D.
Various pyramidal models have been
proposed to demonstrate the likely population impact of health interventions
and health care (e.g., United States Public Health Service, 1994; Hamilton
& Bhatti, 1996; Grizzell, 2007; Frieden, 2010). Generally, these models suggest that broad
population-oriented public health activities cover the largest proportion of
the public, and form the lower levels of the pyramid, and that
individually-oriented clinical activities cover the smallest proportion, which
form the upper portion of the pyramid. Interventions
toward the lower levels in these models have been proposed as more effective as
they have broader reach through contextual changes that alter social, economic,
and psychological factors that bear on health and depend less on individual
effort (Frieden, 2010).
Many of the interventions and
health promotions that have been developed for people with disabilities are
clinical in nature or involve counseling and education, which are toward the
upper portion of the Frieden pyramid. As
a result, they are subject to individual access, adherence, and lack of
availability. These services are paid
for out of pocket, a service provider, or third party payer. Payment by third party payers is dependent on
demonstration of a threshold of effectiveness.
This presentation will discuss
prevention activities and health promotions targeted at people with disabilities
and consider the impact of these interventions with regard to reach (number of
people enrolled on an annual basis), immediate and long-term health outcomes,
and costs. The presentation will include
a discussion of evidence-based interventions under a CDC cooperative
agreement. Consideration will be given
to difficulties involved in taking promising interventions to population scale
in a manner that results in cost effective health outcomes. Consideration will also be given to promoting
a policy of inclusion of people with disabilities into mainstream public health
promotion and prevention services.
Frieden TR. A
framework for public health action: The health impact pyramid. Am. J. Public Health. 100(4):590-595, 2010
Grizzell J. High reach/low cost
health agenda programming. Pomona CA: California State Polytechnic
University,2007. Available at: http://www.csupomona.edu/~jvgrizzell/healthagenda/
Accessed August 16, 2010.
Hamilton N, Bhatti T.
Population health promotion: An integrated model of population health
and health promotion. Ottawa: Health Canada, Health Promotion Development
United States Public Health Service. For a healthy nation: Return on investments in public health. Hyattsville MD: US Public Health Service, 1994.