Exam 2 Flashcards

(69 cards)

1
Q

List social determinants (10)

A

Political

legal

institutional

cultural

socioeconomic

physical environment/living conditions

working conditions

family and social network

lifestyle/behavior

demographics

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2
Q

Health factors include: (4)

A

Health behaviors (30%)

Clinical care (20%)

Social and economic factors (40%)

Physical Environment (10%)

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3
Q

Health outcomes include: (2)

A

Length of life (50%)

Quality of life (50%)

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4
Q

Physical environment percentage and factors (2-AH)

A

10%

Air and water quality

housing and transit

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5
Q

Social and economic percentage and factors (5- EEIFC)

A

40%

education

employment

income

family and social support

community safety

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6
Q

clinical care percentage and factors (2-AQ)

A

20%

access to care

quality of care

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7
Q

health behaviors percentage and factors (4-TDAS)

A

30%

tobacco use

diet and exercise

alcohol and drug use

sexual activity

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8
Q

Discrimination/racism 3 levels (IIS)

A

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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9
Q

Definition of public health law

A

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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10
Q

Purpose of public health law

A

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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11
Q

Rationale for public health law

A

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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12
Q

Mechanism of public health law:

A

Public health law coerces, influences individual behavior producing population health

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13
Q

Legislative branch function:

A

creates laws

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14
Q

Executive branch function

A

enforces laws

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15
Q

Judicial branch function

A

interprets law

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16
Q

Powers of National Government (Delegated-7)

A

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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17
Q

Concurrent powers of National and State government

A

Maintain law and order

levy taxes

borrow money

take land for public use

provide for public welfare

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18
Q

Powers of state government (reserved-7)

A

Tax citizens

control public education

punish criminals

protect public health/safety

conduct elections

establish local governments

make marriage laws

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19
Q

conflict usually arises with the different levels but…

A

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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20
Q

Federal powers (TSR)

A

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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21
Q

State powers (3)

A

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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22
Q

State (Police) Health Laws (10)

A

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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23
Q

Local Powers includes

A

counties, cities, special districts, municipalities

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

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24
Q

Key issues with public health law reform: (AMI)

A

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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25
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
26
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
27
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
28
Health policy-WHO
Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society
29
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
30
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
31
Solutions to the tragedy of commons (2)
privatization/private ownership public or government ownership
32
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
33
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.
34
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.
35
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
36
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
37
Macro Systems levels (6)
Inputs from existing policy policy formulation, modification policy outputs, laws implementation outcomes and social impact feedback and modification
38
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)
39
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)
40
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
41
"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
42
In the context of public health practice, what is "surveillance"?
The continuous and systematic collection analysis interpretation dissemination of descriptive information monitoring health problems
43
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
44
What is surveillance?
the primary mechanism through which public health agencies generate and process information for use in management, policy and practice
45
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
46
Surveillance cycle
formulate objectives design interventions implement interventions evaluate effectiveness continue, expand, modify or terminate
47
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
48
Forms of surveillance systems (6)
Notifiable disease reporting sentinel surveillance syndromic surveillance registries health surveys combined
49
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)
50
Notifiable diseases include (5- CBACP)
Communicable birth defects animal bites cancer poisonings
51
NNDSS:
report requires collaboration at many levels all states report notifiable diseases to National Notifiable Disease Surveillance CDC disseminates to states and territories
52
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
53
Sentinel health event:
disease or condition for which one occurrence requires improvements in preventative efforts (measles outbreak in disneyland)
54
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
55
Syndromic surveillance has
detected naturally occurring outbreaks provided assurance that outbreaks are not occurring help monitor outbreaks
56
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
57
Health surveys:
California Health Interview Survey (CHIS) Behavioral Risk Factor Surveillance System (BRFSS)
58
Combined surveillance:
combination of methods WNV emerged in 1999 Monitored various domains to inform spread of disease - trapped mosquitos - avian disease - equine disease
59
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
60
Examples of establishing system objectives (2nd 4- DPPI)
direct development, implementation, evaluation of interventions prioritize resources project funding needs identify research needs
61
Defining which events to be monitored? (3-MMR)
Morbidity Mortality Risk
62
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
63
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
64
Collective goods include (6- EHCUSC)
- environmental protection - hygiene and sanitation - clean air/water - uncontaminated food - safe roads and products - control of infectious disease
65
Surveillance allows organizations to
- measure prevalence of risk factors/behaviors - monitor effectiveness of interventions - assess trends in disease/other outcomes
66
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
67
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
68
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.
69
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.