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Flashcards in Exam 2 Deck (69):

List social determinants (10)






physical environment/living conditions

working conditions

family and social network




Health factors include: (4)

Health behaviors (30%)

Clinical care (20%)

Social and economic factors (40%)

Physical Environment (10%)


Health outcomes include: (2)

Length of life (50%)

Quality of life (50%)


Physical environment percentage and factors (2-AH)


Air and water quality

housing and transit


Social and economic percentage and factors (5- EEIFC)





family and social support

community safety


clinical care percentage and factors (2-AQ)


access to care

quality of care


health behaviors percentage and factors (4-TDAS)


tobacco use

diet and exercise

alcohol and drug use

sexual activity


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)


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


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


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


Mechanism of public health law:

Public health law coerces, influences individual behavior producing population health


Legislative branch function:

creates laws


Executive branch function

enforces laws


Judicial branch function

interprets law


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


Concurrent powers of National and State government

Maintain law and order

levy taxes

borrow money

take land for public use

provide for public welfare


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


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"


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


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


State (Police) Health Laws (10)



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


licensure of physicians/health professionals


Local Powers includes

counties, cities, special districts, municipalities

local governments act as delegates of the state, subsidiary of their states


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


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


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


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


Health policy-WHO

Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society


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


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


Solutions to the tragedy of commons (2)

privatization/private ownership

public or government ownership


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



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.


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.


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


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


Macro Systems levels (6)

Inputs from existing policy

policy formulation, modification

policy outputs, laws


outcomes and social impact

feedback and modification


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)


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)


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


"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


In the context of public health practice, what is "surveillance"?

The continuous and systematic collection



dissemination of descriptive information monitoring health problems


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


What is surveillance?

the primary mechanism through which public health agencies generate and process information for use in management, policy and practice


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


Surveillance cycle

formulate objectives

design interventions

implement interventions

evaluate effectiveness

continue, expand, modify or terminate


What is monitored via surveillance? (7)

Infectious/chronic disease


occ health/safety

environmental exposures

maternal/child health

health awareness/behavior

use of healthcare services


Forms of surveillance systems (6)

Notifiable disease reporting

sentinel surveillance

syndromic surveillance


health surveys



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)


Notifiable diseases include (5- CBACP)


birth defects

animal bites





report requires collaboration at many levels

all states report notifiable diseases to National Notifiable Disease Surveillance

CDC disseminates to states and territories


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


Sentinel health event:

disease or condition for which one occurrence requires improvements in preventative efforts

(measles outbreak in disneyland)


Syndromic surveillance

Early outbreak detection

Allows for early intervention

-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


Syndromic surveillance has

detected naturally occurring outbreaks

provided assurance that outbreaks are not occurring

help monitor outbreaks



all cases of disease are ascertained for a defined population (usually geographic)

allows investigation and monitoring of disease over time
-follow stages
- see outcomes


Health surveys:

California Health Interview Survey (CHIS)

Behavioral Risk Factor Surveillance System (BRFSS)


Combined surveillance:

combination of methods

WNV emerged in 1999

Monitored various domains to inform spread of disease
-trapped mosquitos
-avian disease
-equine disease


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


Examples of establishing system objectives (2nd 4- DPPI)

direct development, implementation, evaluation of interventions

prioritize resources

project funding needs

identify research needs


Defining which events to be monitored? (3-MMR)





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



to pursue the HIGHEST POSSIBLE level of physical and mental health in the population, consistent with the values of social justice


Collective goods include (6- EHCUSC)

-environmental protection

-hygiene and sanitation

-clean air/water

-uncontaminated food

-safe roads and products

-control of infectious disease


Surveillance allows organizations to

-measure prevalence of risk factors/behaviors

-monitor effectiveness of interventions

-assess trends in disease/other outcomes


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


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


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.


Institutional racism

refers to the policies and practices within and across institutions that, intentionally or not, produce outcomes that chronically favor, or put a racial group at a disadvantage

examples of institutional racism can be found in school disciplinary policies in which students of color are punished at much higher rates that their white counterparts, in the criminal justice system, and within many employment sectors in which day-to-day operations, as well as hiring and firing practices can significantly disadvantage workers of color.