Introduction: Recent political and economic developments and associated changes in the practice and delivery of health and social care have led managers and professionals to recognise the importance and links between problem solving and decision-making skills. In particular, assessing the impact of political, economic, socio-cultural, environmental and other external influences upon health care policy, proposals and organisational programmes is becoming a recognisable stage of health service strategic development and planning mechanisms. Undertaking this form of strategic analysis therefore is to diagnose the key issues that the organisation needs to address. This form of analysis can be undertaken by reviewing the organisational (external) environment using the PEST-analysis (sometimes known as STEP-analysis), extended to the PESTELI checklist described below. PESTELI Analysis is a useful tool for understanding the “big picture” of the environment in which you are operating, and the opportunities and threats that lie within it. By understanding your environment, you can take advantage of the opportunities and minimise the threats. What is PEST(ELI)?
The term PEST has been used regularly in the last 20 years and its true history is difficult to establish. The earliest known reference to tools and techniques for ‘scanning the business environment’ is by Francis J. Aguilar who discusses ‘ETPS’ - a mnemonic for the four sectors of his taxonomy of the environment: Economic, Technical, Political, and Social. Over the years this has become known as PEST with the additional letters are: Ecological factors, Legislative requirements, and Industry analysis (Aguilar, 1967). PESTELI is known as a ‘trends analysis’. The external environment of an organisation, partnership, community etc.
Can be assessed by breaking it down into what is happening at Political, Economic, Social, Technological, Environmental, Legal and Industry levels. The same checklist can also be applied inside an organisation. Now go to the Grid: Table 2: PEST (ELI) Analysis Grid (Adapted from ) PEST(ELI) Analysis Grid Subject Area: Date: PEST (ELI) Analysis Factors Potential Impact Implication and Importance Use the lists in Table 2 to get you started. Consider changes to treatment and public attitudes as well as government changes H- High M- medium L – Low U- Undetermined Time Frame: 0- 6 month 6-12 months 12-24 months 24+ months Type: Positive + Negative – Unknown Impact: Increasing >Unchanged = Decreasing. Analysis checklist: • Analyse the findings • Identify the most important issues • Identify strategic options • Write a report • Disseminate the findings • Decide which trends should be monitored on an ongoing basis. In reviewing the data drawn from undertaking a PESTELI analysis it will be important to assess whether there are any disproportionate impacts on particular groups of people, especially those who are vulnerable.
Proposals, organisational missions and policy development should not widen inequalities, but actively seek to reduce them. Part of the decision-making that follows the analysis will be to consider what could be done to counterbalance the negative impacts for groups which may get less health benefit from positive proposals or may be adversely affected by proposals with a negative impact on health.
For more on PEST(ELI) and other change management tools within the health sector see Iles and Sutherland (2001) and Iles and Cranfield (2001). • Aguilar, F J (1967). Scanning the Business Environment. • Iles, V and Sutherland, S (2001) Managing Change in the NHS: Organisational Change • Iles, V and Cranfield, S (2001). Developing Change Management Skills: A resource for health care professionals and managers. SDO London © S Markwell 2009, N Leigh-Hunt 2016.
Main article: The social determinants of health in poverty describe the factors that affect impoverished populations' and. In health stem from the conditions of people's lives, including, work environment,, and other social factors, and how these affect people's ability to respond to. These conditions are also shaped by political, social, and economic structures. The majority of people around the globe do not meet their potential best health because of a 'toxic combination of bad policies, economics, and politics'. Daily living conditions work together with these structural drivers to result in the social determinants of health. And poor health are inseparably linked. Poverty has many dimensions – material deprivation (of food,,, and safe drinking water),, lack of education,, and low income – that all work together to reduce opportunities, limit choices, undermine hope, and, as a result, threaten health.
Contributing factors such as changes in health and social care policy, demographic changes, increased patient dependency, changes in healthcare delivery. Social care information, advances in health technology, increased media coverage of healthcare and rising numbers of complaints going to litigation have influenced. Health sector reform. There is widespread evidence of significant gaps. Implementation of a health care policy: An analysis of barriers and facilitators to. Implementing health and social care policy: England and Scotland compared.
Poverty has been linked to higher prevalence of many health conditions, including increased risk of, injury, deprived infant development, stress, anxiety, depression, and. According to Loppie and Wien, these health afflictions of poverty most burden outlying groups such as women, children, ethnic minorities, and the disabled. – like,, living and, and - are of special importance to the impoverished. According to Moss, socioeconomic factors that affect impoverished populations such as education,, and, represent the strongest and most consistent predictors of health and mortality. The inequalities in the apparent circumstances of individual's lives, like individuals' access to health care,, their conditions of work and,, communities, towns, or cities, affect people's ability to lead a flourishing life and maintain health, according to the WHO.
The inequitable distribution of health-harmful living conditions, experiences, and structures, is not by any means natural, 'but is the result of a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics'. Therefore, the conditions of individual's daily life are responsible for the social determinants of health and a major part of health inequities between and within countries. Along with these social conditions, 'Gender, education, occupation, income,, and place of residence are all closely linked to people's access to, experiences of, and benefits from health care.' Social determinants of disease can be attributed to broad social forces such as,, poverty, violence, and war. This is important because health quality, health distribution, and social protection of health in a population affect the development status of a nation. Since health has been considered a fundamental human right, one author suggests the social determinants of health determine the distribution of human dignity. Impoverished people depend on healthcare and other social services to be provided in the, therefore availability greatly determines health outcomes.
Since low living standards greatly influence health inequity, generous social protection systems result in greater population health, with lower mortality rates, especially in disadvantaged populations. Nations that have more generous social protection systems have better population health (Lundberg et al., 2007). More generous family policies correlate with lower infant mortality. Nations that offered higher coverage and reimbursement for pensions and sickness, unemployment, and employment accident insurance have a higher LEB (Lundberg et al., 2007), as well as countries with more liberal pensions have less senior mortality. (Lundberg et al., 2007) Healthcare [ ] The health care system represents a social determinant of health as well as it influences other determining factors.
People's access to health care, their experiences there, and the benefits they gain are closely related to other social determinants of health like income, gender, education, ethnicity, occupation, and more. For poor people, systematic barriers in the social structure are formidable, especially financing. Medicaid and maternity coverage structures have complex and time-consuming registration processes, along with long waits and unsure eligibility. Inequalities in health are also determined by these socioeconomic and cultural factors. Health care is inequitably distributed globally, with pronounced inequality for the poor in low- and middle-income countries. One study demonstrated that doctors treat poor populations differently, showing that disadvantaged patients are less likely to receive the recommended diabetic treatments and are more likely to undergo hospitalization due to the complications of diabetes (Agency for Health Care Research and Quality, 2003).
According to the WHO, healthcare systems can most improve health equality when institutions are organized to provide universal coverage, where everyone receives the same quality healthcare regardless of ability to pay, as well as a Primary Healthcare system rather than emergency center assistance. These structural problems result in worse healthcare and therefore worse health outcomes for impoverished populations. Steamboy Full Movie English Dub Download.
Health care costs can pose absolutely serious threats to impoverished populations, especially in countries without proper social provisions. According to US HHS, 'In 2009, children 6–17 years of age were more likely to be uninsured than younger children, and children with a family income below 200% of the poverty level were more likely to be uninsured than children in higher-income families.' In elderly populations, individuals below 400% of the poverty line were between 3 and 5 times more likely to lack insurance. Children below 200% of the poverty line were also less likely to have insurance than wealthier families.
Also, in 2009 in the US, 20% of adults (ages 18–64) below 200% of the poverty line did not receive their necessary drugs because of cost, compared to only 4% of those above 400% of the poverty line. This can be seen in other nations, where in Asia, payments for healthcare pushed almost 3% of the population of 11 countries below 1 US$ per day.
Societal psychological influences [ ] In impoverished communities, different and stressors exist than in other populations, which can greatly affect health outcomes in disadvantaged populations. According to the National Institutes of Health, 'low socioeconomic status may result in poor physical and/or mental health.
Through various psychosocial mechanisms such as poor or 'risky' health-related behaviors, social exclusion, prolonged and/ or heightened stress, loss of sense of control, and low self-esteem as well as through differential access to proper nutrition and to health and social services (National Institutes of Health 1998).' These stressors can cause physiological alterations including increased cortisol, changed blood-pressure, and reduced immunity which increases their risks for poor health. Structural violence [ ] Underlying social structures that propagate and perpetuate poverty and suffering- - majorly determine health outcomes of impoverished populations. Poor and unequal living conditions result from deeper structural conditions, including 'poor social policies and programs, unfair economic arrangements, and bad politics,' that determine the way societies are organized.
The structure of the global system causes inequality and systematic suffering of higher death rates, which is caused by inequity in distribution of opportunities and resources, which is termed. Definition [ ] is a term devised by and during the 1960s to describe economic, political, legal, religious, and cultural social structures that harm and inhibit individuals, groups, and societies from reaching their full potential. Structural violence is structural because the causes of misery are 'embedded in the political and economic organization of our social world; they are violent because they cause injury to people.' Structural violence is different from personal or behavioral violence because it exclusively refers to preventable harm done to people by no one clear individual, but arises from unequal distribution of power and resources, pre-built into social structure.
Structural violence broadly includes all kinds of violations of human dignity: absolute and relative poverty, social inequalities like gender inequality and racism, and outright displays of human rights violations. The idea of structural violence is as old as the study of and, and so it can also be understood as related to and. Effects [ ] Structural violence is often embedded in longstanding social structures, ubiquitous throughout the globe, that are regularized by persistent institutions and regular experience with them. These social structures seem so normal in our understanding of the world that they are almost invisible, but inequality in resource access,,,, and legal standing are all possible perpetrators of structural violence. Structural violence occurs 'whenever persons are harmed, maimed, or killed by poverty and unjust social, political, and economic institutions, systems, or structures' Structural violence can contribute to worse health outcomes through either harming or killing victims, just like armed violence can have these effects. This type of unintended harm perpetuated by structural violence progressively promotes misery and that eventually results in death, among other effects.
Ehrlich and Ehrlich reported in 1970 that between 10 and 20 million of the 60 million annual deaths across the globe result from starvation and malnutrition. Their report also estimated that structural violence was responsible for the end of one billion lives between 1948 and 1967 in the third world. Structural violence connection to health [ ] Inequality in daily living conditions stem from unseen social structures and practices, according to the WHO. This systematic inequality is produced by social norms, policies, and practices that promote the unfair distribution of power, wealth, and other social resources, such as healthcare. 'The poor health of the poor, the social gradient in health within countries, and the marked health inequities between countries are caused by the unequal distribution of power,,, and, globally and nationally.'
First, structural violence is often a major determinant of the distribution and outcome of disease. It has been known for decades that epidemic disease is caused by structural forces. Structural violence can affect disease progression, such as in, where harmful social structures profoundly affect,, and of HIV and associated illnesses. The determinants of disease and their outcome are set by the social factors, usually rampant with structural violence, that determine risk to be infected with the disease. Understanding how structural violence is embodied at the community, individual, and microbial levels is vital to understanding the dynamics of disease. The consequences of structural violence is post pronounced in the world's poorest countries and greatly affects the provision of clinical services in these countries. Elements of structural violence such as 'social upheaval, poverty, and decrease the effectiveness of distal services and of efforts' presents barriers to medical care in countries like Rwanda and Haiti Due to structural violence, there exists a growing outcome gap where some countries have access to interventions and treatment, and countries in poverty who are neglected.
With the power of improved distal interventions, the only way to close this outcome gap between countries who do and do not have access to effective treatment, lies on proximal interventions to reduce the factors contributing to health problems that arise from structural violence. See also [ ] • References [ ].