Posted: August 2nd, 2022

PHWK3-Putting Theory Into Practice

DUE 7/29/22 AT 10AM

TOPIC: Putting Theory Into Practice

Chapter 5 BELOW discussed the public health pyramid (Figure 1-2). At each level of this pyramid, health problems, relevant theories, and targeted interventions are delivered.

For this ASSIGNMENT, do the following:

1. Refer to a specific level of the public health pyramid. This should be clearly named in your post.

2. Utilizing the health need you identified in this unit’s Goals and Outcomes in Context discussion, conduct a brief literature search of evidence-based interventions regarding the chosen health need. Identify and briefly describe the intervention. Remember, alignment is key here—if you identify “direct healthcare services” in the public health pyramid, the evidence-based intervention should in fact be one-to-one (at the individual level).

3. Cite and explain how the chosen evidence-based intervention has been utilized to impact a specific health outcome. (This does not have to be the outcome you identified in the Goals and Outcomes in Context discussion.)

4. Include THREE academic references above 2017




8. Due 7/29/22 at 10am


The Public Health Pyramid

Pyramids tend to be easy to understand and work well to capture tiered concepts. For these reasons, pyramids have been used to depict the tiered nature of primary healthcare, secondary healthcare, and tertiary healthcare services (U.S. Public Health Service, 1994), the inverse relationship of effort needed and health impact of different interventions (Frieden, 2010), and nutrition recommendations (Gil, Ruiz-Lopez, Fernandez-Gonzalez, & de Victoria, 2014).

The public health pyramid is divided into four sections (FIGURE 1-2). The top, or the first, section of the pyramid contains direct healthcare services, such as medical care, psychological counseling, hospital care, and pharmacy services. At this level of the pyramid, programs are delivered to individuals, whether patients, clients, or even students. Generally, programs at the direct services level have a direct, and often relatively immediate, effect on individual participants in the health program. Direct services of these types appear at the tip of the pyramid to reflect that, overall, the smallest proportion of a population receives them. These interventions, according to the Health Impact Pyramid (Frieden, 2010), require considerable effort, with minimal population effects.

FIGURE 1-2 The Public Health Pyramid

At the second level of the pyramid are enabling services, which are those health and social services that support or enhance the health of aggregates. Aggregates are used to distinguish between individuals and populations; they are groups of individuals who share a defining characteristic, such as mental illness or a terminal disease. Examples of enabling services include mental health drop-in centers, hospice programs, financial assistance programs that provide transportation to medical care, community-based case management for patients with acquired immune deficiency syndrome (AIDS), low-income housing, nutrition education programs provided by schools, and workplace child care centers. As this list of programs demonstrates, the services at this level may directly or indirectly contribute to the health of individuals, families, and communities and are provided to aggregates. Enabling services can also be thought of as addressing some of the consequences of social determinants of health.

The next, more encompassing level of the public health pyramid is population-based services. At the population level of the pyramid, services are delivered to an entire population, such as all persons residing in a city, state, or country. Examples of population services include immunization programs for all children in a county, newborn screening for all infants born in a state, food safety inspections carried out under the auspices of state regulations, workplace safety programs, nutrition labeling on food, and the Medicaid program for pregnant women whose incomes fall below the federal poverty guidelines. As this list reflects, the distinction between an aggregate and a population can be blurry. Programs at this level typically are intended to reach an entire population, sometimes without the conscious involvement of individuals. In this sense, individuals receive a population-based health program, such as water fluoridation, rather than participating in the program, as they would in a smoking-cessation class. Interventions and programs aimed at changing the socioeconomic context within which populations live would be included at this population level of the pyramid. Such programs are directed at changing one or more social determinants of health. Population-level programs contribute to the health of individuals and, cumulatively, to the health status of the population.

Supporting the pyramid at its base is the infrastructure of the healthcare system and the public health system. The health services at the other pyramid levels would not be possible unless there were skilled, knowledgeable health professionals; laws and regulations pertinent to the health of the people; quality assurance and improvement programs; leadership and managerial oversight; health planning and program evaluation; information systems; and technological resources. The planning and evaluation of health programs at the direct, enabling, and population services levels is itself a component of the infrastructure; these are infrastructure activities. In addition, planning programs to address problems of the infrastructure, as well as to evaluate the infrastructure itself, are needed to keep the health and public health system infrastructure strong, stable, and supportive of the myriad of health programs.

Use of the Public Health Pyramid in Program Planning and Evaluation

Health programs exist across the pyramid levels, and evaluations of these programs are needed. However, at each level of the pyramid, certain issues unique to that level must be addressed in developing health programs. Accordingly, the types of health professionals and the types of expertise needed vary by pyramid level, reinforcing the need to match program, participants, and providers appropriately. Similarly, each level of the pyramid is characterized by unique challenges for evaluating programs. For this reason, the public health pyramid, as a framework, helps illuminate those differences, issues, and challenges, as well as to reinforces that health programs are needed across the pyramid levels if the Healthy People 2020 goals and objectives are to be achieved.

In a more general sense, the public health pyramid provides reminders that various aggregates of potential audiences exist for any health problem and program and that health programs are needed across the pyramid. Depending on the health discipline and the environment in which the planning is being done, direct service programs may be the natural or only inclination. The public health pyramid, however, provides a framework for balancing the level of the program with meeting the needs of the broadest number of people with a given need. Reaching the same number of persons with a direct services program as with a population services program poses additional expense and logistic challenges.

The pyramid also serves as a reminder that stakeholder alignments and allegiances may be specific to a level of the pyramid. For example, a school health program (an enabling-level program) has a different set of constituents and concerned stakeholders than a highway safety program (a population-level program). The savvy program planner considers not only the potential program participants at each level of the pyramid but also the stakeholders who are likely to make themselves known during the planning process.

The public health pyramid has particular relevance for public health agencies concerned with addressing the three core functions of public health (Institute of Medicine, 1988): assessment, assurance, and policy. These core functions are evident, in varying forms, at each level of the pyramid. Similarly, the pyramid can be applied to the strategic plans of organizations in the private healthcare sector. For optimal health program planning, each health program being developed or implemented ought to be considered in terms of its relationship to services, programs, and health needs at other levels of the pyramid. For all these reasons, the public health pyramid is used throughout this text as a framework for summarizing specific issues and applications of chapter content to each level of the pyramid and to identify and discuss potential or real issues related to the topic of the chapter.

The Public Health Pyramid as an Ecological Model

Individual behavior and health are now understood to be influenced by the social and physical environment of individuals. This recognition is reflected in the growing use of the ecological approach to health services and public health programs. The ecological approach, which stems from systems theory applied to individuals and families (Bronfenbrenner, 1970, 1989), postulates that individuals can be influenced by factors in their immediate social and physical environment. This perspective has been expanded into the social determinants perspective in public health, which has wide acceptance (Frieden, 2010). The individual is viewed as a member of an intimate social network, usually a family, which is a member of a larger social network, such as a neighborhood or community. The way in which individuals are nested within these social networks has consequences for the health of the individual.

Because it distinguishes and recognizes the importance of enabling and population services, the public health pyramid can be integrated with an ecological view of health and health problems. If one were to look down on the pyramid from above, the levels would appear as concentric circles (FIGURE 1-3)—direct services for individuals nested within enabling services for families, aggregates, and neighborhoods, which are in turn nested within population services for all residents of cities, states, or countries. This is similar to individuals being nested within the enabling environment of their family, workplace setting, or neighborhood, all of which are nested within the population environment of factors such as social norms and economic and political environments. The infrastructure of the healthcare system and public health system is the foundation and supporting environment for promoting health and preventing illnesses and diseases.

FIGURE 1-3 The Pyramid as an Ecological Model

The end of the chapter presents a summary of challenges or issues related to applying the chapter content to each level of the pyramid. This feature reinforces the message that each level of the pyramid has value and importance to health program planning and evaluation. In addition, certain unique challenges are specific to each level of the pyramid. The chapter summary by levels offers an opportunity to acknowledge and address the issues related to the levels.

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