Flashcards in Exam 2 Deck (69):
1
List social determinants (10)
Political
legal
institutional
cultural
socioeconomic
physical environment/living conditions
working conditions
family and social network
lifestyle/behavior
demographics
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Health factors include: (4)
Health behaviors (30%)
Clinical care (20%)
Social and economic factors (40%)
Physical Environment (10%)
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Health outcomes include: (2)
Length of life (50%)
Quality of life (50%)
4
Physical environment percentage and factors (2-AH)
10%
Air and water quality
housing and transit
5
Social and economic percentage and factors (5- EEIFC)
40%
education
employment
income
family and social support
community safety
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clinical care percentage and factors (2-AQ)
20%
access to care
quality of care
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health behaviors percentage and factors (4-TDAS)
30%
tobacco use
diet and exercise
alcohol and drug use
sexual activity
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Discrimination/racism 3 levels (IIS)
Individual (prejudice, bias, hate)
Institutional (Policies/practices within and across institutions that favor one or more groups over others (race, gender, sexual orientation, age, income) (SECTION 8 HOUSING?)
Structural ( a system in which public policies, institutional practices, cultural representations and other norms work in various and often reinforcing ways to perpetuate group inequity) (BANKS-interest rates)
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Definition of public health law
the study of the legal powers and duties of the state in collaboration with its parters (health care, business, community, media) to assure the conditions for people to be healthy and the limitations on the power of the state to contain the autonomy of privacy, liberty, or other legally protected interests of people for the common good
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Purpose of public health law
creates conditions for people to lead healthier/safer lives
creates a mission for public health agencies
-assigns their functions
-specifies manner in which they exercise authority
tool to
-influence healthy behavior
-identify and respond to health threats
-set/enforce health and safety standards
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Rationale for public health law
Acting alone, no individual/group can ensure own health
These can only be obtained through organized action on the behalf of a population (government)
without governmental authority, threats to public health and safety can not be reduced easily
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Mechanism of public health law:
Public health law coerces, influences individual behavior producing population health
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Legislative branch function:
creates laws
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Executive branch function
enforces laws
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Judicial branch function
interprets law
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Powers of National Government (Delegated-7)
Levy tariffs and taxes
regulate trade (interstate and foreign)
coin money
maintain armed forces
declare war
establish post offices
establish courts
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Concurrent powers of National and State government
Maintain law and order
levy taxes
borrow money
take land for public use
provide for public welfare
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Powers of state government (reserved-7)
Tax citizens
control public education
punish criminals
protect public health/safety
conduct elections
establish local governments
make marriage laws
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conflict usually arises with the different levels but...
federal laws likely preempt state or local actions because of the supremacy clause: "the constitution, and the laws of the united states...shall be the supreme law of the land"
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Federal powers (TSR)
Tax: discourage/encourage behaviors through tax burdens and penalties
Spend: in return for federal funds, states agree to comply with federally imposed conditions
Regulate interstate commerce: (most EXTENSIVE power) environmental protection, food and drug purity, occ health and safety
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State powers (3)
10th amendment: states reserve power neither given to the federal government nor prohibited by the constitution
Police powers- authority of state to enact laws, regulations to protect, preserve, promote health, safety, morals, and general welfare of the people
can restrict private interests, liberty, autonomy, privacy, association, and economic interests
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State (Police) Health Laws (10)
Vaccination
Isolation
Inspection of property
Regulation of air pollutants
Regulations of surface water contaminants
restrict public access to polluted area
standards for food and water quality
extermination of vermin
fluoridation
licensure of physicians/health professionals
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Local Powers includes
counties, cities, special districts, municipalities
local governments act as delegates of the state, subsidiary of their states
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Key issues with public health law reform: (AMI)
Antiquity (laws are OLD!!!)
Multiple layers
inconsistency (Key issue- health threats don't neatly fit into jurisdictional boundaries [ air travel, water flow, disease control]
-Politics & science don't mix well
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State police powers: (3 characteristics)
The government's purpose is to promote the public good
the state authority to act permits the restriction of private interests
the scope of state powers is pervasive
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Federalism represents
a partition in the fountain that separates federal and state powers.
preserves the balance of power among national and state authorities
functions as a sorting device for determining which government (federal, state, or local) may respond to a public health threat
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Government's essential role in public health law
ensures the conditions for the population's health is demonstrated by its constitutional powers and its role in a democracy
constitutional design has intent to vest power in government at every level to protect community health and safety
allows people to gather and advocate in numbers- meaningful protection requires communal effort
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Health policy-WHO
Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society
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Public policy..
refers not only to the result of policies, but also to the decision making and analysis of governmental decisions
academic discipline- field of study
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What is the tragedy of commons?
economic theory
individuals acting rationally will act in their own best interest/individual incentive
Open access resources!
they will then deplete common resources to the detriment of the group or society as a whole
Commons include: oceans, atmosphere, fish, office fridge
Basically people doing things for themselves with the assumption that if they don't, someone else will
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Solutions to the tragedy of commons (2)
privatization/private ownership
public or government ownership
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How is the health of the public a "common"?
Vaccines and "herd immunity"
dietary habits of individuals
wages of healthcare workers
vigilance against infectious disease
costs of medications
smoking
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basic example of "tragedy of commons"
Each individual farmer will graze his cattle/sheep on the communally owned pastures ("the commons") to boost his own profit, since the commons are "free".
This exploitation of what the market has determined is "free" leads to overgrazing and the destruction of the commons--a huge loss to the entire community as well as to the farmers who were grazing their animals in the commons.
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Tragedy of commons and public health
When the system is set up to encourage maximizing self-interest, accountability for the whole is lost. And once accountability for the effectiveness and health of the whole system is lost, the system will degrade and eventually collapse, for the same reason that unrestricted grazing by individuals eventually destroys the commons.
Put another way: if I concern myself with the health of the commons (or the overall health of the populace), I earn nothing for this work. Even worse, while I devoted myself to the common good, someone else increased his herd grazing the commons. I will eventually be forced to either join in the exploitation or go broke.
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Market Place Model (Micro)
Individuals and groups in a constant state of exchange
-suppliers (politicians supply favorable policies in exchange for public support)
-demanders (residents demand government services in exchange for political support)
Disparities in power- certain groups attain more power and disproportionally use this to deteriorate the commons
groups attempt to gain control over the marketplace to their advantage
- forge alliances with others (gov agencies) that can help them attain their goals
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The systems model is (CICN)
complex- multiple interactions to attain same level of equilibrium
interrelatedness- all actions impact the overall system in some way
cyclical- no beginning or end- continues as long as society continues
no permanent policy success or failures
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Macro Systems levels (6)
Inputs from existing policy
policy formulation, modification
policy outputs, laws
implementation
outcomes and social impact
feedback and modification
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Understanding government structure and the impact on policy making
Minimize the threat of government tyranny, US government was divided
result: major policy changes could NOT be enacted without a strong national consensus (mere majority support)
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US government structure and results
historically been a force against major social change
construed as "power grab" by the national government against its citizens
us political system is designed to slow or stop most major policy initiatives (including those in healthcare)
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US system of government design
design of system does not promote "systems" thinking
1st rule of politics- "get elected"
2nd rule of politics- "get re-elected"
no politician will get elected or re-elected telling their constituency that they should limit their share of commons
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"Good" health reform is
a reform that helps others but does not have an adverse impact on my own situation
those with disproportion power fight to maintain the status quo
those with little power become the "have nots" and usually include
-lower educated
-limited economic resources
-minorities over-represented in these groups
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In the context of public health practice, what is "surveillance"?
The continuous and systematic collection
analysis
interpretation
dissemination of descriptive information monitoring health problems
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What is the significance of surveillance to the field of public health
surveillance is a primary mechanism through which health agencies
-generate and process info
- use in management
- use in policy
- use in practice
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What is surveillance?
the primary mechanism through which public health agencies generate and process information for use in management, policy and practice
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Purpose of surveillance:
Select targets for intervention
identify populations at higher risk
monitor changes in practice and policy
establish priorities
measure program impacts
trigger more extensive surveillance
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Surveillance cycle
formulate objectives
design interventions
implement interventions
evaluate effectiveness
continue, expand, modify or terminate
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What is monitored via surveillance? (7)
Infectious/chronic disease
injury/disability
occ health/safety
environmental exposures
maternal/child health
health awareness/behavior
use of healthcare services
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Forms of surveillance systems (6)
Notifiable disease reporting
sentinel surveillance
syndromic surveillance
registries
health surveys
combined
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Notifiable disease reporting:
monitor diseases, conditions, events of importance by designating as notifiable
state police powers mandate reporting
requires persons with knowledge of their occurrence to report (clinicians, labs, infection, control professionals)
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Notifiable diseases include (5- CBACP)
Communicable
birth defects
animal bites
cancer
poisonings
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NNDSS:
report requires collaboration at many levels
all states report notifiable diseases to National Notifiable Disease Surveillance
CDC disseminates to states and territories
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Sentinel Surveillance
"a solider or guard whose job is to stand and keep watch"
Convenience sampling
- designated to characterize magnitude of a larger health problem
Use 122 cities morality reporting system
-US influenza sentinel providers surveillance network
Use reporting data to monitor mortality patterns and assess severity
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Sentinel health event:
disease or condition for which one occurrence requires improvements in preventative efforts
(measles outbreak in disneyland)
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Syndromic surveillance
Early outbreak detection
Allows for early intervention
Tracks
-behavioral data (absenteeism, over the counter medication purchases)
- pre-diagnostic (lab results)
-clinical data (primary diagnosis)
Clusters symptoms into categories or define syndromes (gastrointestinal, respiratory, etc)
At a certain point, an "alarm" sounds that triggers a public health investigation
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Syndromic surveillance has
detected naturally occurring outbreaks
provided assurance that outbreaks are not occurring
help monitor outbreaks
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Registries:
all cases of disease are ascertained for a defined population (usually geographic)
allows investigation and monitoring of disease over time
-follow stages
- see outcomes
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Health surveys:
California Health Interview Survey (CHIS)
Behavioral Risk Factor Surveillance System (BRFSS)
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Combined surveillance:
combination of methods
WNV emerged in 1999
Monitored various domains to inform spread of disease
-trapped mosquitos
-avian disease
-equine disease
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Examples of establishing system objectives (1st 5- MDEAA)
Monitoring frequency and distribution of a health problem in a community
describe the features of a disease
examine sources of morbidity and mortality
assess healthcare delivery, quality and safety
assess changes in healthcare practice
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Examples of establishing system objectives (2nd 4- DPPI)
direct development, implementation, evaluation of interventions
prioritize resources
project funding needs
identify research needs
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Defining which events to be monitored? (3-MMR)
Morbidity
Mortality
Risk
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Steps in designing a surveillance system (7)
Establish system objectives
select and define health events to be monitored
establish population under surveillance
establish reporting procedures
analyze and interpret surveillance data
disseminate and apply surveillance findings
maintain and evaluate operations
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PRIME OBJECTIVE OF PUBLIC HEALTH LAW is
to pursue the HIGHEST POSSIBLE level of physical and mental health in the population, consistent with the values of social justice
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Collective goods include (6- EHCUSC)
-environmental protection
-hygiene and sanitation
-clean air/water
-uncontaminated food
-safe roads and products
-control of infectious disease
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Surveillance allows organizations to
-measure prevalence of risk factors/behaviors
-monitor effectiveness of interventions
-assess trends in disease/other outcomes
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US relationship between public health and policy
Lack of clear and consistent vision by the federal government
health is seen as the absence of disease
health is the individual's responsibility
resource allocation treatment oriented
private (FOR PROFIT) health insurance
public sector assumes secondary role in health
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Other developed nations relationship with public health and public policy
Federal government provides consistent and clear support
health is more holistic
health is the collective responsibility
resource allocation prevention oriented
public (NON PROFIT) health insurance
public sector plays a PRIMARY ROLE
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Example of structured racism
When the practice is based on race alone, it is considered structured racism.
Low income populations have more difficulty acquiring loans to purchase homes; pay higher interest rates (decreasing their disposable income, making them poorer), and less likely to build generational wealth through homeownership (affording their children a similar disadvantage.
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