Exam 2

Question 1

List social determinants (10)

Answer 1

Political

legal

institutional

cultural

socioeconomic

physical environment/living conditions

working conditions

family and social network

lifestyle/behavior

demographics

Question 2

Health factors include: (4)

Answer 2

Health behaviors (30%)

Clinical care (20%)

Social and economic factors (40%)

Physical Environment (10%)

Question 3

Health outcomes include: (2)

Answer 3

Length of life (50%)

Quality of life (50%)

Question 4

Physical environment percentage and factors (2-AH)

Answer 4

10%

Air and water quality

housing and transit

Question 5

Social and economic percentage and factors (5- EEIFC)

Answer 5

40%

education

employment

income

family and social support

community safety

Question 6

clinical care percentage and factors (2-AQ)

Answer 6

20%

access to care

quality of care

Question 7

health behaviors percentage and factors (4-TDAS)

Answer 7

30%

tobacco use

diet and exercise

alcohol and drug use

sexual activity

Question 8

Discrimination/racism 3 levels (IIS)

Answer 8

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)

Question 9

Definition of public health law

Answer 9

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

Question 10

Purpose of public health law

Answer 10

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

Question 11

Rationale for public health law

Answer 11

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

Question 12

Mechanism of public health law:

Answer 12

Public health law coerces, influences individual behavior producing population health

Question 13

Legislative branch function:

Answer 13

creates laws

Question 14

Executive branch function

Answer 14

enforces laws

Question 15

Judicial branch function

Answer 15

interprets law

Question 16

Powers of National Government (Delegated-7)

Answer 16

Levy tariffs and taxes

regulate trade (interstate and foreign)

coin money

maintain armed forces

declare war

establish post offices

establish courts

Question 17

Concurrent powers of National and State government

Answer 17

Maintain law and order

levy taxes

borrow money

take land for public use

provide for public welfare

Question 18

Powers of state government (reserved-7)

Answer 18

Tax citizens

control public education

punish criminals

protect public health/safety

conduct elections

establish local governments

make marriage laws

Question 19

conflict usually arises with the different levels but…

Answer 19

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”

Question 20

Federal powers (TSR)

Answer 20

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

Question 21

State powers (3)

Answer 21

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

Question 22

State (Police) Health Laws (10)

Answer 22

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

Question 23

Local Powers includes

Answer 23

counties, cities, special districts, municipalities

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

Question 24

Key issues with public health law reform: (AMI)

Answer 24

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

Question 25

State police powers: (3 characteristics)

Answer 25

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

Question 26

Federalism represents

Answer 26

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

Question 27

Government's essential role in public health law

Answer 27

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

Question 28

Health policy-WHO

Answer 28

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

Question 29

Public policy..

Answer 29

refers not only to the result of policies, but also to the decision making and analysis of governmental decisions academic discipline- field of study

Question 30

What is the tragedy of commons?

Answer 30

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

Question 31

Solutions to the tragedy of commons (2)

Answer 31

privatization/private ownership public or government ownership

Question 32

How is the health of the public a "common"?

Answer 32

Vaccines and "herd immunity" dietary habits of individuals wages of healthcare workers vigilance against infectious disease costs of medications smoking

Question 33

basic example of "tragedy of commons"

Answer 33

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.

Question 34

Tragedy of commons and public health

Answer 34

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.

Question 35

Market Place Model (Micro)

Answer 35

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

Question 36

The systems model is (CICN)

Answer 36

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

Question 37

Macro Systems levels (6)

Answer 37

Inputs from existing policy policy formulation, modification policy outputs, laws implementation outcomes and social impact feedback and modification

Question 38

Understanding government structure and the impact on policy making

Answer 38

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)

Question 39

US government structure and results

Answer 39

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)

Question 40

US system of government design

Answer 40

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

Question 41

"Good" health reform is

Answer 41

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

Question 42

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

Answer 42

The continuous and systematic collection analysis interpretation dissemination of descriptive information monitoring health problems

Question 43

What is the significance of surveillance to the field of public health

Answer 43

surveillance is a primary mechanism through which health agencies - generate and process info - use in management - use in policy - use in practice

Question 44

What is surveillance?

Answer 44

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

Question 45

Purpose of surveillance:

Answer 45

Select targets for intervention identify populations at higher risk monitor changes in practice and policy establish priorities measure program impacts trigger more extensive surveillance

Question 46

Surveillance cycle

Answer 46

formulate objectives design interventions implement interventions evaluate effectiveness continue, expand, modify or terminate

Question 47

What is monitored via surveillance? (7)

Answer 47

Infectious/chronic disease injury/disability occ health/safety environmental exposures maternal/child health health awareness/behavior use of healthcare services

Question 48

Forms of surveillance systems (6)

Answer 48

Notifiable disease reporting sentinel surveillance syndromic surveillance registries health surveys combined

Question 49

Notifiable disease reporting:

Answer 49

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)

Question 50

Notifiable diseases include (5- CBACP)

Answer 50

Communicable birth defects animal bites cancer poisonings

Question 51

NNDSS:

Answer 51

report requires collaboration at many levels all states report notifiable diseases to National Notifiable Disease Surveillance CDC disseminates to states and territories

Question 52

Sentinel Surveillance

Answer 52

"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

Question 53

Sentinel health event:

Answer 53

disease or condition for which one occurrence requires improvements in preventative efforts (measles outbreak in disneyland)

Question 54

Syndromic surveillance

Answer 54

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

Question 55

Syndromic surveillance has

Answer 55

detected naturally occurring outbreaks provided assurance that outbreaks are not occurring help monitor outbreaks

Question 56

Registries:

Answer 56

all cases of disease are ascertained for a defined population (usually geographic) allows investigation and monitoring of disease over time - follow stages - see outcomes

Question 57

Health surveys:

Answer 57

California Health Interview Survey (CHIS) Behavioral Risk Factor Surveillance System (BRFSS)

Question 58

Combined surveillance:

Answer 58

combination of methods WNV emerged in 1999 Monitored various domains to inform spread of disease - trapped mosquitos - avian disease - equine disease

Question 59

Examples of establishing system objectives (1st 5- MDEAA)

Answer 59

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

Question 60

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

Answer 60

direct development, implementation, evaluation of interventions prioritize resources project funding needs identify research needs

Question 61

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

Answer 61

Morbidity Mortality Risk

Question 62

Steps in designing a surveillance system (7)

Answer 62

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

Question 63

PRIME OBJECTIVE OF PUBLIC HEALTH LAW is

Answer 63

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

Question 64

Collective goods include (6- EHCUSC)

Answer 64

- environmental protection - hygiene and sanitation - clean air/water - uncontaminated food - safe roads and products - control of infectious disease

Question 65

Surveillance allows organizations to

Answer 65

- measure prevalence of risk factors/behaviors - monitor effectiveness of interventions - assess trends in disease/other outcomes

Question 66

US relationship between public health and policy

Answer 66

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

Question 67

Other developed nations relationship with public health and public policy

Answer 67

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

Question 68

Example of structured racism

Answer 68

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.

Question 69

Institutional racism

Answer 69

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.