ParticipatoryAction

for

Change

ParticipatoryAction

for

Change

Dim

inis

hing

retu

rn

performance

time

Paradigm shift

No

actio

n ta

lk

only

Incr

emen

tal

chan

ge

Dis

rupti

ve

chan

ge

ศ.นพ. ไพบู�ลย์ สุ�ริ ย์ะวงศไพศาล

ความรั�บผิดชอบแต่�ละบ�คคลโดยล�าพั�ง

เปล��ยนสิ่�งแวดล�อมPuska 2001

COMMUNITYLOCALITY

Agriculture/Gardens/

Local markets

Health Care

PublicSafety

PublicTransport

Manufactured/Imported

Food

Sanitation

Modified from Ritenbaugh C, Kumanyika S, Morabia A, Jeffery R, Antipatis V. IOTF website 1999: http://www.iotf.org

POPULATION

%

OBESE

AND

OVER--WEIGHT

WORK/SCHOOL/HOME

SchoolFood &Activity

Infections

Labour

Worksite Food & Activity

LeisureActivity/Facilities

Family &Home

INDIVIDUAL

EnergyExpenditure

Food intake :

Nutrient density

Societal policies and processes influencing the population prevalence of obesity

NATIONAL/ REGIONAL

Education

Food & Nutrition

Urbanization

Health

Social security

Transport

Media &Culture

Nationalperspective

INTERNATIONALFACTORS

Development

Globalizationof

markets

Media programs

& advertising

6

7

8

9

17% GDP …5/30 yr gained

NHSO 2014;Kishore S in IOM 2013

the causes of the causes

ParticipatoryAction

for

Change

Passive or active agents

“One child one book one pen can change the world”

04/13/2023 16

โลกสุมมติ

จริ งเท็�จ

เชื่��อว�าจริ ง

ย์�ดม!�นว�าจริ ง

ปกป#องความเชื่��อน!%น

โลกจริ ง

ปริากฎการิณ์ติาม

กฎธริริมชื่าติ อ!นซั!บูซั*อน

สิ่�มผิ�สิ่ทั้� ง5

ParticipatoryAction

for

Change

1.4000 medical and

surgical procedures,

2.6000 drugs

3. 40% of coronary heart disease patients receive

incomplete care, and 60% of pneumonia

patients.

4. Two million people walk into hospital and get

infection they didn’t have because someone

forgot to wash their hands.Atul Gawande at TED2012 19

80,000 catheter-related bloodstream infections

28,000 deaths 

$2.3 billion annually

1.8 to 5.2 per 1000 catheter-days

178 actions per days

http://www.newyorker.com/magazine/2007/12/10/the-checklist20

(1)wash their hands with soap,

(2)clean the patient’s skin with chlorhexidine

antiseptic,

(3) put sterile drapes over the entire patient,

(4) wear a sterile mask, hat, gown, and

gloves,

(5) put a sterile dressing over the catheter

site once the line is in. 

21

22

23

26

27

Korn Buri DM care system

73,000 inhabitants ; 19,100 households10,000 elderly; 15% disabled

Nurse case/system

manager

Well motivated patients through

group learning led to individuals’ invention fitting their contexts

ParticipatoryAction

for

Change