Health Promotion and chronic disease surveillance

Question 1

what do you understand by passive prevention?

Answer 1

• Measures that operate without the person’s active involvement (e.g. airbags in cars)
• are more effective than active prevention, measures that a person must do on their own (e.g. wearing a seatbelt)

Question 2

What do you understand by sentinel surveillance?

Answer 2

• selective reporting of disease data from a limited network of carefully selected reporting sites with a high probability of seeing cases in question,
• well-designed system can be used to signal trends, identify outbreaks, and monitor the burden of disease in a community in a timely and cost-effective manner compared to other kinds of surveillance,
• may be not as effective in identifying rare diseases, or diseases that occur outside the catchment area of sentinel sites

Question 3

What are the levels of Disease Prevention and give an example of each?

Answer 3

Primordial

• Preventing the development of risk factors Education that begins in childhood about behaviour that can harm health
• Programs that encourage physical activity

Primary

• Protect health and prevent disease onset
• Reducing exposure to risk factors
• Immunization programs (e.g. measles, diphtheria, pertussis, tetanus, polio etc)
• Smoking cessation
• Seatbelt use

Secondary

• Early detection of (subclinical) disease to
• minimize morbidity and mortality
• Mammography
• Routine Pap smears

Tertiary

• Treatment and rehabilitation of disease to prevent progression, permanent disability, and future disease
• DM monitoring with HbA1c, eye exams, foot exams
• Medication

Question 4

What are differences and similarities between screening and case finding?

Answer 4

• screening tests are not diagnostic tests
• the primary purpose of screening tests is to detect early disease or risk factors for disease in large numbers of apparently healthy individuals.
• Thee purpose of a diagnostic test is to establish the presence (or absence) of disease as a basis for treatment decisions in symptomatic or screen positive individuals (conrmatory test).
• Both screening and case finding seek to risk stratify for further investigation to minimize biases and harms, and maximize benefits,
• screening is best done at the population level, not the individual clinical level, as part of a screening program (e.g. Provincial breast cancer screening program vs. screening by primary care/family physicians)

Question 5

List 5 recommendations from the New Canada Food Guide to make healthy food choices.

Answer 5

1. Eat plenty of vegetables and fruits, whole grain foods and protein foods; Choose protein that come from plants more often.
2. Choose foods with healthy fats instead of saturated fats, and with little to no added sodium and sugars.
3. Limit highly processed foods. If you choose these foods, eat them less often and in small amounts.
4. Make water your drink of choice and replace sugary drinks with water
5. Use food labels; and choose healthier menu options when eating out.
6. Be aware that food marketing can influence your choices
   https: //food-guide.canada.ca/en/healthy-food-choices/

Question 6

List 5 recommendations from the New Canada Food Guide to make health food habits.

Answer 6

1. Be mindful of your eating habits (Take time to eat and notice when you are hungry and when you are full)
2. Cook more often (Plan what you eat and involve others in planning and preparing meals)
3. Enjoy your food (Culture and food traditions can be a part of healthy eating)
4. Eat meals with others
   https: //food-guide.canada.ca/en/healthy-eating-habits/

Question 7

What are determinants of healths? List 12 of them

Answer 7

Determinants of health are the broad range of personal, social, economic and environmental factors that determine individual and population health. 10 Determinants of health according to PHAC:

Income & Social Status; Employment & working conditions; Education & literacy; Access to health services;

Phyical environment; Social support & coping skills; Childhood experience; Personal health behaviours

Biology & genetic Endowment; Race/Racism; Gender; Culture

Income and social status: As income and social status increase, individual health status increases; as income and social inequality decrease, population health status increases (evidence: Whitehall study)

Social support Increased social contact and emotional support reduces mortality; social networks influence risk factor exposure (e.g., physical activity, obesity)

Education and literacy: Education level predicts SES, improves job security, and increases job satisfaction; literacy allows individuals to access knowledge required for problem-solving

Employment/working conditions: Unemployment, stressful work environments, and unsafe work environments are associated with poorer health outcomes

Physical environment: Air, water, soil, and food contaminants can adversely affect health; the built environment can influence both physical and psychological well-being

Personal health behaviours: The actions individuals perform to self-care, problem-solve, and cope can enhance or detract from health (e.g., smoking, alcohol use, drug use, unsafe sex, dietary choices)

Childhood experiences; Health outcomes are affected by birth weight, parental attachment, childhood housing, family income, parental education, access to nutritious foods and physical recreation, and access to dental and medical care

Gender: Culturally-determined values and roles ascribed to the sexes

Culture: Marginalization, stigmatization, and devaluation of language of minority cultures by the majority culture can lead to additional health risks (e.g., through lack of culturally-appropriate health care services, through socio-economic exclusion)

Question 8

Define Social marketing.

Compare and contrast social marketing and commercial marketing in terms of type of product, audience, primary aim, and competition

Answer 8

Definition: Social marketing is the application of commercial marketing techniques to the analysis, planning,executive and evaluation of programs designed to influence the voluntary behaviour of target audiences for health benefits. It uses the four P of marketing mix to heightens benefits, reduces barriers, and offers better chocie (Product, Place, Price, Promotion)

Social Marketing vs Commercial marketing

Type of Product: Selling desired behaviour vs selling goods and service

Audience: Participants; greatest amount of beavhioral change vs consumers; greatest profit or volume opportunity

Primary aim: Financial gains vs Social good

Cost: Time, effort, reduced pleasure; social alienation vs money and time

Competition: Audience’s current/prefereed personal behviours & associated benefits and organizations selling or promoting competing behaviours (e.g. tobacco industry) vs Other organizations offering similar goods & services

Question 9

List 5 components of the ecological framework for health promotion

Answer 9

1. Individual
2. Interpersonal
3. Organisational
4. Community
5. Public policy/societal

Question 10

List 4 components of the health beliefs model and describe each with the context of texting and driving

Answer 10

1. Perceived susceptibility - beliefs about the chances of getting in a motor vehicle accident while texting
2. Perceived severity - beliefs about the seriousness of getting into an MVA and its consequences
3. Perceived benefits - beliefs about the effectivness of taking measures to stop texting while driving
4. Perceived barriers - beliefs about the material and psychological costs of taking action to stop texting

Question 11

List the 5 actions of the Ottawa Charter

Answer 11

• build healthy public policy - create supportive environments - develop personal skills - reorient health services - strengthen community actions

Question 12

List 5 determinants of health (as per PHAC)

Answer 12

• income and social status - social support networks - education and literacy - employment / working conditions - social environment - physical environment - personal health practices and coping skills - healthy child development - biology and genetic endowment - health services - gender - culture

Question 13

Define the ‘low income cut-off’ (LICO) measure of poverty

Answer 13

income threshold below which a family is expected to spend 20% more of their income on necessities than the average Canadian family

Question 14

Define the ‘low-income measure’ (LIM) measure of poverty

Answer 14

half the median income

Question 15

Define the ‘market basket measure’

Answer 15

threshold = amount required to buy a ‘basket’ of goods and services representing a modest standard of living

Question 16

What does 0 and 100 represent in the Gini coefficient?

Answer 16

0 = absolute equality 100 = absolute inequality -> lower the better!

Question 17

List and briefly describe the OCAP principles of research involving First Nations.

Answer 17

Ownership - community owns information collectively (need to have consent of community, not just individuals) Control - control all aspects of research and information management processes Access - right to manage and make decisions of use of collective information Possession - physical holding of data

Question 18

What is the difference between: impairment, disability, and handicap?

Answer 18

Impairment: loss or abnormality in physiologic, anatomic or psychological function (due to disease). Disability: reduction in capacity to function in society (as a result of impairment). Handicap: reduction in the capacity to fulfill a social role as a result of disability or impairment.

Question 19

What are 4 key components of the Health Belief Model of behaviour change?

Answer 19

SSBB -Perceived susceptibility -Perceived severity -Perceived benefits of action -Perceived barriers to action

Question 20

What are 4 actions Public Health can take to improve health equity?

Answer 20

1. Assess and report on: -the existence and impact of inequities; and -strategies to reduce inequities 2. Modify and orient interventions -to meet the unique needs of marginalized populations 3. Partner with other sectors -to improve health outcomes for marginalized populations 4. Participate in policy development -advocate for improvements in SDOH and equity

Question 21

List 3 Protective Factors against suicide

Answer 21

• Socio-economic situation › Loving parent-child relationship › Having reasons for living › Social connectedness › Sense of belonging › Religion

Question 22

Define Health Inequity

Answer 22

Systemic, unjust, avoidable systematic differences in health status between groups that are unjust, unfair AND unnecessary and potentially avoidable.

Question 23

What are two purpose of a health equity impact assessment

Answer 23

• Identify potential unintended consequences for different populations groups - Maximize positive impacts and minimize positive impacts

Question 24

List the steps that you would take to conduct a health equity impact assessment

Answer 24

1) Scoping (what population will be impacted by policy or program, what determinants of health will be impacted) 2) Impacts (positive and negative) 3) Mitigation (how can you reduce negative amplify positives) 4) Monitoring (how can you measure success for each mitigation measure) 5) Dissemination (how will results be shared)

Question 25

Define Health Inequality

Answer 25

measurable difference in health status between individuals or groups

Question 26

Define a population health approach

Answer 26

focuses on improving the health of an entire population and improving equity between subpopulations.

Question 27

List 2 youth substance misuse prevention intervention (from CPHO report)

Answer 27

Create more equitable social and economic conditions

o Promote positive social norms and communicate risk

o Reduce access, availability, and exposure

o Develop skills and resilience for youth and their families

o Intervene early for youth that need support

Question 28

List six preventable risk factors for dementia.

Answer 28

Low levels of early life education (up to 12 years of age)

Midlife hypertension (45-65 years of age)

Obesity

Hearing loss

Smoking in later life (over age 65)

Depression

Physical inactivity

Diabetes

Social isolation

Question 29

List six components of a multifactorial intervention for falls prevention at the individual-level.

Answer 29

Assistive devices and other protective equipment

Clinical disease management, including chronic and acute illness

E.g., visual problems, CVD, hypotension

Education

Environmental modifications

E.g., Home assessment w/ OT

Medication review and modification

E.g., reduce polypharmacy, high-risk meds for seniors

Vision referral and correction

Exercise – systematic review identified following components

Nutrition and supplements

Protein to maintain adequate muscle strength

Adequate hydration, particularly in summer

Question 30

Describe two epidemiological trends for seniors.

Answer 30

Senior’s compose 17% of Canada’s population (2016 Census) and population now exceeds the percentage of Canadians younger than 15 years of age

Expected by 2031, nearly 1 in 4 Canadians will be over 65 years

Seniors are disproportionately female:

For every man aged 85 years and older, there are 2 women

For every man aged 100 years, there are 5 women

Question 31

What are four pillars in the National Senior’s Strategy? List one policy issue within each pillar.

Answer 31

Independent, Productive, and Engaged Citizens: Enables older Canadians to remain independent, productive, and engaged members of our communities

Making addressing ageism, elder abuse, and social isolation a national priority

Ensuring older Canadians do not live in poverty by improving their income security

Ensuring older Canadians have access to affordable housing

Ensure older Canadians have access to inclusive transportation

Enabling the creation of age-friendly communities, physical environments and spaces

Healthy and Active Lives: Supports Canadians to lead healthy and active lives for as long as possible

Ensure Canadians are supported to engage in wellness and prevention activities that enable healthy ageing

Improve access to medically necessary and appropriate medications and vaccines

Ensuring older Canadians and their caregivers are enabled to participate in informed health decision-making and advance-care planning

Care Closer to Home: Provides person-centered, high quality, integrated care as close to home as possible by care providers who have the knowledge and skills to care for them

Ensure older Canadians have access to appropriate, high quality, long-term care, palliative, and end-of-life services

Ensure older Canadians have access to care providers that are trained specifically to provide the care they need

Develop standardized metrics and accountability standards to enable a national seniors strategy

Ensure the needs of older adults are recognized and supported in emergency and disaster preparedness, planning, response, and recovery efforts

Support for Unpaid Caregivers: Acknowledges and supports the family and friends of older Canadians who provide unpaid care for their loved ones.

Ensuring unpaid caregivers and older adults are supported in the workplace

Ensuring unpaid caregivers are not unnecessarily penalized financially for taking on caregiving roles

Question 32

List five health outcomes associated with homelessness

Answer 32

• MORTALITY = probability of surviving to age 75 years is only 32%

Homeless youth die at rates 11 to 40 times higher than general adolescent population, largely due to drug overdose and suicide

Mental illness and substance use

1/3 have a serious mental illness (e.g. bipolar disorder, schizophrenia)

1/2 suffer from substance misuse

Complex relationship, as homelessness is a RF for poor mental health and poor mental health is a RF for homelessness

Chronic Disease

Cardiovascular disease, hypertension, lung disease

Injuries

Traumatic brain injury (unintentional, intentional, and self-harm)

Hypothermia / frostbite

Extreme-heat effects

Higher rates of communicable diseases

Tuberculosis

Hepatitis B and C

HIV

Scabies

Body lice

Bartonella quintana (“urban trench fever”; documented in US and France)

Question 33

List five public health interventions for homelessness

Answer 33

Monitoring and surveillance of health outcomes of individuals experiencing homelessness

Case management (for psychiatric patients, assertive community treatment)

Housing first

Strategy for addressing homelessness that provides housing without requiring individuals to engage with services or find a job first

Note: In Canada’s Homelessness Strategy, all Housing First targets have been removed to give communities more flexibility to address local needs and priorities

Poverty reduction / income support

Affordable housing

Eviction prevention

Institutional transition support (housing on discharge)

Employment opportunities for low-skilled workers

Primary prevention: Anti-violence interventions, early childhood interventions

Question 34

Define the following: culture awareness, cultural sensitivity, cultural safety.

Answer 34

Cultural awareness: “Being conscious of similarities and contrasts between cultural groups; understand the way in which culture may affect different people’s approach to health, illness, and healing”; me-centred

Cultural sensitivity: being aware of how one’s own experiences and values may impact other; other-centered

Cultural competence: “Attitudes, knowledge, and skills of practitioners necessary to become effective health care providers for patients from diverse backgrounds”; other-centred

Cultural safety: Providing responsive services in a way that shows respect for culture and identity, incorporates a person’s needs and rights, free of discrimination, goal of creating equitable health and social outcomes

Encompasses all of above

Question 35

Why is racism a public health issue?

Answer 35

It is a social determinant of health: racialized health disparities are a consequence of racism, not race

Directly and indirectly, racism harms health and causes premature death through:

state-sanctioned violence and disruption of relationships with traditional lands

racism-induced psychosocial trauma

economic and social deprivation and inequality such as reduced access to employment, housing and education

increased exposure to toxic social, physical and environmental environments

inadequate or unsuitable care in social and health systems

racially motivated individual and structural violence; and

harmful physiological changes resulting from exposure to chronic stress

Public health agencies can advocate to dismantle, and dismantle their own, policies that bolster systemic racism

Public health research is required to understand the health impact of racism

Question 36

Public Health Roles for Racial Health Equity:

Answer 36

Capacity: anti-racism action is not integrated into public health practice in a regular and consistent manner. Consequently, as a field, public health has minimal understanding of racism as a structural determinant of health, or how public health institutions contribute to ongoing racism. As such, public health systems and organizations need to build capacity to analyze and act on the structural forces that drive racial inequities.

Knowledge: There is limited and inconsistent data and research on racial health inequities in Canada. As such, public health organizations and their partners need to assess and report on the impact of racialization and racism. This involves collecting race-based data, analyzing health status data through a critical anti-racism lens and measuring racial discrimination at the individual and structural levels.

Interventions: modify and orient public health and social interventions to ensure that they are designed to reduce and eliminate racialized health inequities.

Policy: participate in policy development that explicitly seeks to address racism (e.g., supports anti-discrimination policies; apply critical, decolonizing and anti-racist methodologies and theories to policy development and analysis; implement racial equity assessments).

Partnerships: Partner with other sectors and communities that work on racial equity to shift cultural and societal values and norms and create substantive change in the lives of racialized peoples. This includes applying allyship skills and principles, public education and awareness, and engaging with broad social movements.

Question 37

List six health concerns impacting people who are incarcerated.

Answer 37

Lower life expectancy:

Average age at death for a male in federal custody is ~60 years

Higher rates of HIV:

1-2% of men and 1-9% of women are infected with HIV (5-20x higher in gen pop)

Racialized persons disproportionally represented

Higher rates of Hep C:

18-24% of persons in federal custody are anti-HCV positive (compared to ~1.5% in gen pop)

Now receiving some treatment

Higher rates of TB

22.4 active cases per 100,000 incarcerated (vs ~5/100,000 in general pop)

Excess burden of cancer and virtually all chronic disease in people who experience incarcerations

Less likely to be screened than general population

SDOH lower levels of education

>60% of overall prison population has formal education of grade 8 or less

Higher proportion of ACES (Adverse Childhood Events)

Roughly 50% report hx of childhood physical, sexual, or emotional abuse

MH very high burden

Antisocial personality disorder – 44%

Psychotropic meds commonly prescribed prison (>60% women in fed custody)

Suicide ideation rates higher than population (completion rates lower)

Substance Misuse in Corrections much, much higher

80% feds have a serious substance use problem

2/3 use tobacco, 50% use cannabis, 25% use IVDU in community and 15% use IN PRISON (where no harm reduction in place)

Question 38

What is the Gladue Report? List 2 key considerations included in the report.

Gladue Report (1999)

Answer 38

Correctional decision-makers must take into account Indigenous social history considerations when liberty interests of an Indigenous person are at stake. Gladue factors include:

Effects of residential school system

Experience in child welfare or adoption system

Effects of dislocation and dispossession of Indigenous peoples

Family of community history of suicide, substance abuse and/or victimization

Loss of, or struggle with, cultural/spiritual identity

Level or lack of formal education

Poverty and poor living conditions

Exposure to/membership in Aboriginal street gang

Question 39

Using a social determinants of health model, explain why prevalence rates of T2DM are significantly higher in Indigenous persons than in other Canadian populations. Give 3 examples of why this may be.

SDOH

Example

Answer 39

Using a social determinants of health model, explain why prevalence rates of T2DM are significantly higher in Indigenous persons than in other Canadian populations. Give 3 examples of why this may be.

SDOH

Example

proximal

Food insecurity: more access to prepackaged, processed foods than fresh fruits, veg.

intermediate

Healthcare infrastructure: less access to preventive healthcare, diagnosing T2DM early and effective treatments; appropriate follow-up for complications of T2DM (e.g. ophtho for diabetic retinopathy screening)

distal

Colonialism: cut off from traditional lands, traditional methods of gathering food (hunting), traditional lands being taken away and reservations relegated to remote regions.

Question 40

List the 4 components of the IDEA ethical framework for decision-making in health care settings

Answer 40

Component

Question to answer

Considerations

Identify the facts

What is the ethical issue?

• Clinical/Medical Indications
• Individual Preferences
• Evidence
• Contextual Features

Determine the relevant ethical principles

Have perspectives of relevant individuals been sought?

• Nature & Scope
• Relative Weights

Explore the options

What is the most ethically justifiable option?

• Harms & Benefits
• Strengths & Limitations
• Laws & Policies
• Mission, Vision, Values

Act

Are we comfortable with this decision?

• Recommend
• Implement
• Evaluate

Question 41

Your PHU is developing options for an obesity reduction plan. Using the Nuffield ladder, describe six levels of intervention and provide an example for each.

Level of Intervention

Example within obesity reduction plan

Answer 41

Eliminate choice

Ban trans fats

Restrict choice

Limit fast-food restaurants around schools (minimum distance in zoning)

Guide through disincentives

Tax sugary drinks

Guide through incentives

Subsidize public transportation

Change default option

Change the default option from French fries to salad

Enable choice

Offer healthy food choices in public arenas

Inform

Mandatory nutrition labelling

Do nothing or monitor

Monitor trends in overweight and obesity

Question 42

Using the 6E mechanisms of control, list six ways to mitigate the risk from radon.

Answer 42

Environment: Radon database for monitoring/risk identification

Enforcement: Building codes to reduce radon in new construction (e.g., inclusion of passive stack)

Economic: Financial incentives for remediation and testing

Education: Awareness of risk and opportunity to mitigate risk (e.g., radon awareness campaign)

Empowerment: Smoking cession, home monitoring

Engineering: Remediation at high levels, improve ventilation –> active soil depressurization

Question 43

Paternalism: the interference of a state or an individual with another person, against their will, and defended or motivated by a claim that the person interfered with will be better off or protected from harm

Answer 43

Reasons to be attracted to paternalist PH policies:

Because they can help reduce the burden of NCDs and injuries : e.g., interventions aimed at changing people’s lifestyles in ways that protect or promote health (e.g., reduce or eliminate harmful foods like transfats)

Because they can be more effective or efficient (e.g., taxation of cigarettes vs poverty reduction)

Because they can be more equitable (e.g., voluntary programs tend to be most effective in people who have higher SES, who are already healthier at baseline, thereby increasing inequities)

Reasons to be reluctant to accept “paternalistic” public policies

Because adults should not be treated like children (e.g., avoid infantilizing competent citizens by NOT giving ability to choose what is good for themselves -> lack of respect to autonomy)

Because one should be free to do as one wishes as long as it does not harm others (e.g., legitimate for state to interfered with the freedom of competent adult citizens to prevent them from harming others - e.g., reasonable to install traffic-calming measures around school, impose quarantine for highly contagious disease, ban smoking in public places)

AKA harm principle: idea legitimate for state to protect citizens from others, but not from themselves

Because no one is in a better position than me to know what is good for me (e.g., If someone else, or worse still, the state, were to intervene to influence or constrain my choices, they would risk being wrong most of the time and harming me instead of enhancing my well-being, in addition to infringing on my freedom or autonomy)

Question 44

List and explain the 4 principles of biomedical ethics.

1) Autonomy – patients have autonomy of thought, intention, and action when making decisions regarding their health. Decision-making process must be informed, free of coercion.
2) Beneficence – promote the wellbeing of others; health care inte

Answer 44

List and explain the 4 principles of biomedical ethics.

1) Autonomy – patients have autonomy of thought, intention, and action when making decisions regarding their health. Decision-making process must be informed, free of coercion.
2) Beneficence – promote the wellbeing of others; health care interventions are done with the intent of doing good for the patient involved.
3) Non-maleficence – avoid harms or injuries that arise through acts of commission OR omission.
4) Justice – distributing benefits, risks and costs fairly (e.g., fair distribution of scarce resources, competing needs, rights and obligations, avoid potential conflicts of interest)
1) Autonomy – patients have autonomy of thought, intention, and action when making decisions regarding their health. Decision-making process must be informed, free of coercion.
2) Beneficence – promote the wellbeing of others; health care interventions are done with the intent of doing good for the patient involved.
3) Non-maleficence – avoid harms or injuries that arise through acts of commission OR omission.
4) Justice – distributing benefits, risks and costs fairly (e.g., fair distribution of scarce resources, competing needs, rights and obligations, avoid potential conflicts of interest)

Question 45

how do you respond to privacy breach

Answer 45

Respond

contain

notify

remediate

discipline

Question 46

Define collaborative negotiation as a conflict management technique

Answer 46

· Approach that treats the relationship as an important and valuable element of what’s at stake while seeking a fair and equitable agreement (as opposed to always conceding in order to sustain the relationship)

o Win-win: assumes that the pie can be enlarged by finding things of value to both parties, thus creating a win-win situation where both parties can leave the table feeling that they have gained something of value.

o Fair process: most comfortable result from a negotiation happens when our needs are met, including the need for fairness.

o Joint problem-solving: seeks to convert individual wants into a single problem and to bring both parties together to work on solving this problem.

o Transparency and trust: be open and transparent, giving information before it is requested

Question 47

List six possible steps in the collective bargaining process

Answer 47

Notice to bargain: By either union or employer to the other party, in writing within 90 days before the agreement expires

Negotiation: dialogue between the union and employer representatives to reach a new collective agreement

Conciliation: Alternative dispute process where parties use a conciliators (appointed by Ministry of Labour), who meets with union and employer separately and together in attempt to reach a collective agreement

Mediation: Process through which a netural third party assists the union and employer in reaching a collective agreement. Differs from conciliation in that often need to restore or repair a relationship.

Strike: Collective action by employees to stop or curtail work during a labour dispute. Legal in Ontario if: CA has expired + strike vote held + conciliation not successful

Lock-out: Employer closes a workplace or suspects work during a labour dispute. Legal in Ontario if CA has expired + conciliation was not successful

Arbitration: Quasi-judicial process in which arbitrator/arbitration board hears from union and employer and makes binding decision. Interest arbitration is the mandatory way to achieve a CA for parties without the ability to strike or lock out.

Implementation: Once union and employer reach a new agreement, must be ratified by a sectret-ballot vote (majority in favour) and copy filed with Ministry of Labour. Requirement to ratify does not apply to agreements that are settled by interest arbitration, ordered by the Ontario Labour Relations Board, or reflect an offer accepted by a last-offer vote (e.g., a vote of employees to accept/reject employer’s last offer to union before or after a strike or lock-out begins).

Question 48

What is an essential service and why is this distinction important for collective bargaining? List three groups of federal essential services and three groups of provincial essential services.

Answer 48

An essential service is one necessary for the safety and security of the public. During collective bargaining, essential workers do not have the ability to strike or be locked out; rather interest arbitration becomes mandatory when mediation is unsuccessful in reaching consensus on a new agreement between a union and the employer.

Federal essential services include border security, correctional services, food inspection, accident safety investigations, income and social security, marine security, national security, law enforcement, and search and rescue

Provincial essential services include hospital and nursing home workers, transit workers (e.g., TTC), firefighters, and police

Question 49

A process for establishing a shared understanding about what is to be achieved and how it is to be achieved (align individual goals with organizational goals), and an approach to manage people that increases the probability of achieving success

Answer 49

Performance management cycle: PMDRR

Planning work and setting expectations

Continually monitoring performance

Developing the capacity to perform

Periodically rating performance in a summary fashion

Rewarding good performance

Question 50

List 4 steps of progressive discipline.

Escalating consequences aimed at correcting performance

Managers expected to use the min amount of discipline required to correct the behaviour

Answer 50

Verbal warning

Written warning

Suspension

Termination

Ensure support of HR, legal

Be concrete

Do at end of day

Ensure communications strategy is in place before termination occurs

Question 51

List 5 expenditures that can be found on a typical public health unit budget

Answer 51

· Salary/Wages/Benefits (~80% of budget)

· Staff training

· Travel expenses

· Office expenses, printing, postage, and other materials/supplies

· Services and Rents (e.g. janitorial, courier)

· Program materials

· Professional and purchased services

· Communication costs

· Information technology

Question 52

List 2 methods for your health unit to increase revenue and 2 methods to decrease expenditures

Answer 52

o Increase revenues

§ Increase fees and charges (e.g. increase fees for septic system inspections, travel clinics)

§ Draw from reserve funds

§ Cash out investments

o Decrease expenditures

§ Salary gapping: don’t fill available position

§ Decrease material and supplies budget

§ Restructuring- freezing, recycling,

§ Capital asset sales (e.g. buildings)

§ Professional substitution (e.g. switch from RN to LPN)

§ Technological efficiencies

Question 53

List 3 methods that can be used to procure a good or service

Answer 53

o Common service: government provides the services to government agencies (e.g., in Ontario, ITS provides network services)

o Vendor of record: agreement between a government-funded organization and a vendor, after the agreement is established, the organization purchases specific goods and services from a single or limited set of vendors; established via an request for proposal; time-limited and price-specified

o Open competition: invite all vendors to bid to provide the good or service, usually used for expensive items (less expensive items can use an invitational process, which is usually faster)

o Invitational competition: invite a pre-specified number of vendors to bid to provide the good or service (in Ontario three vendors must be invited)

o Non-competitive: usually avoided unless there is a sole source vendor (e.g., you want Windows operating system and the sole source is Microsoft)

§ Single source: Choosing one of many vendors

§ Sole source: Only one vendor supplies the product or service you want

Question 54

List 4 items to consider when discussing different options in a business case

Answer 54

Strategic alignment: describe how the option supports the organization’s current business architecture and planned program results and strategic outcomes

Alignment with desired business outcomes: prepare an option outcome analysis and present a summary of the findings for each business outcome. It may be preferable to organize the findings in a table format.

Costs: provide a complete description of the costs. Projected costing estimates should be based on total cost of ownership, which includes ongoing costs over the course of the investment’s life cycle as well as potential compliance costs for stakeholder groups

Cost-benefit analysis: based on the costs established for each option, describe how those costs are weighed against the benefits. Conduct the cost-benefit analysis for each option taking into account costs, benefits, and risks.

Implementation and capacity considerations: demonstrate the ability of the sponsoring organization to both deliver and manage the investment throughout its life span.

Contracting and procurement: provide information concerning the procurement vehicle, and precisely how it will be utilized.

Schedule and approach: identify the core work streams and associated milestones

Impact: conduct an impact assessment from both internal and external perspectives

Capacity: describe the sponsoring organization’s capability to successfully manage the investment

Risk: identify the risks and conduct a risk assessment for each option, along with the development of a risk response Provide an option risk summary, which should include risk, probability, impact, mitigation and contingency, outcome, tolerance, and a risk assessment summary rating. It may be preferable to present the option risk summary for each option in a table format

Benchmark: compare each option against industry-standard benchmarks

Policy and standard considerations: describe the option’s impact, if any, on the existing policies and standards of the sponsoring organization and relevant stakeholder environments. Also describe any limitations imposed by the policies and standards and the known effect on the option

Advantages and disadvantages: determine whether the option’s measure against the aforementioned criteria is found to be either an advantage or a disadvantage (financial and non-financial). It may be preferable to summarize the findings in a table format

Question 55

List 5 things that comprise a strategic plan.

Answer 55

Vision: image of the desired future; “what we want to be”

Mission: statement of the purpose of the organization; “why we exist”; “what we do, for whom and why”

Values how an organization will carry out its mission; “how we behave”

Strategic directions: broad strategies or objectives that will contribute to achieving the vision and mission

Goals: concrete, medium-term outcome statements(~5 yrs) that fit within the strategic directions; specifically tied to objectives that are SMART

Question 56

How do we go about health promotion program delivery?

Answer 56

Assess- Population health assessment, Health needs situational assessment, Health impact assessment
* Plan HP strategy:
Community engagement HP strategy:
Social marketing HP strategy: Harm reduction
* Implement
* Evaluate

Question 57

What are some health status and health system indicators?

Answer 57

Health Status: Hospitalizations Entirely Caused by Alcohol, Injury Hospitalization; Hospitalized Stroke Event; Hospitalized Acute Myocardial Infarction (AMI) EventHealth System Performance:; Ambulatory Care Sensitive Conditions; 30-Day Acute Myocardial Infarction In-Hospital Mortality; 30-Day Stroke In-Hospital Mortality; Readmission(s); Hospitalized Hip Fracture Event; Hip Fracture Surgery Within 48 HoursCommunity and Health System Characteristics: Inflow/Outflow Ratio(s); Coronary Artery Bypass Graft; Percutaneous Coronary Intervention; Cardiac Revascularization; Hip Replacement; Knee Replacement; Hysterectomy; Doctors Rate

Question 58

What are the steps for Health status assessment?

Answer 58

Identify the necessary resources to complete the assessment * Identify community partners and their engagement * Collecting, analyzing and presenting data * Preparing a written report.

Question 59

What are the steps in stake holder analysis

Answer 59

Identify stakeholder roles and expectations* Determine their overall degree of involvement (peripheral, supportive, involved, or core, as per the stakeholder wheel)* Determine the specific roles for each stakeholder in the planning process, engaging them in a meaningful way* Ensure you understand why each stakeholder is interested or involved with the program and/or planning processgovernment sector, private sector,non-health sector, health sector, community grassroot, classify according to - core, involved, supportive, perepheral

Question 60

What are some health status and health system indicators?

Answer 60

Health Status: Hospitalizations Entirely Caused by Alcohol, Injury Hospitalization; Hospitalized Stroke Event; Hospitalized Acute Myocardial Infarction (AMI) Event

Health System Performance:; Ambulatory Care Sensitive Conditions; 30-Day Acute Myocardial Infarction In-Hospital Mortality; 30-Day Stroke In-Hospital Mortality; Readmission(s); Hospitalized Hip Fracture Event; Hip Fracture Surgery Within 48 Hours

Community and Health System Characteristics: Inflow/Outflow Ratio(s); Coronary Artery Bypass Graft; Percutaneous Coronary Intervention; Cardiac Revascularization; Hip Replacement; Knee Replacement; Hysterectomy; Doctors Rate

Question 61

What are the steps for Health status assessment?

Answer 61

Identify the necessary
resources to complete
the assessment
* Identify community
partners and their
engagement
* Collecting, analyzing
and presenting data
* Preparing a written
report.

Question 62

What are the steps in stake holder analysis

Answer 62

Identify stakeholder roles and
expectations
* Determine their overall degree
of involvement (peripheral,
supportive, involved, or core,
as per the stakeholder wheel)
* Determine the specific roles
for each stakeholder in the
planning process, engaging
them in a meaningful way
* Ensure you understand why
each stakeholder is interested
or involved with the program
and/or planning process

government sector, private sector,non-health sector, health sector, community grassroot,

classify according to - core, involved, supportive, perepheral

Question 63

What are the steps in situational assessment

Answer 63

Identify key
questions
– Develop a data
gathering plan
– Gather the data
– Organize,
synthesize,
summarize the
data
– Communicate
the information
– Consider how to
proceed with
planning

What is the situation?
What influences are making the situation better
and worse?
What possible actions can you take to address
the situation?
⮚ ask your stakeholders what they want and
need to know to plan the program;
⮚ ​review documents that outline your mandate,
planning requirements, and
community/organization expectations.
⮚ ​select one or more health promotion or
behaviour change theories that apply to your
situation

Question 64

How do we go about health promotion program delivery?

Answer 64

Assess
– Population health assessment
– Health needs situational assessment
– Health impact assessment
* Plan
– HP strategy: Community engagement
– HP strategy: Social marketing
– HP strategy: Harm reduction
* Implement
– NIRN model
* Evaluate

Question 65

Health Impact Assessment

Answer 65

Done to assess health impacts of programs and policies

1.Screening- establish health relevance
2.Scoping- identify key issues
3.Appraisal-Indepth or rapid assessment of health impacts
4.Reporting-conclusions and recommendations
5. Monitoring- actions to mitigate negative health impacts during implementation of program and policy

Question 66

Health Equity Impact Assessment

Answer 66

Step 1: Scoping
* Step 2: Impacts
* Step 3: Mitigation
* Step 4: Monitoring
* Step 5: Dissemination

Question 67

health promotion plans

Answer 67

Choose strategies and activities:
– Education- social Marketing
– Environment
– Empowerment- community engagement/development
– Engineering
– Economic- bylaws development
– Enforcement

Question 68

PROCEDE PRECEDE

Answer 68

PRECEDE stands for Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation. As its name implies, it represents the process that precedes, or leads up to, an intervention.

PROCEED spells out Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development, and, true to its name as well, describes how to proceed with the intervention itself.

Phase 1: Identifying the ultimate desired result.
Phase 2: Identifying and setting priorities among health or community issues and their behavioral and environmental determinants that stand in the way of achieving that result, or conditions that have to be attained to achieve that result; and identifying the behaviors, lifestyles, and/or environmental factors that affect those issues or conditions.
Phase 3: Identifying the predisposing, enabling, and reinforcing factors that can affect the behaviors, attitudes, and environmental factors given priority in Phase 2.
Phase 4: Identifying the administrative and policy factors that influence what can be implemented.
Phase 5: Implementation – the design and actual conducting of the intervention.
Phase 6: Process evaluation. Are you actually doing the things you planned to do?
Phase 7: Impact evaluation. Is the intervention having the desired impact on the target population?
Phase 8: Outcome evaluation. Is the intervention leading to the outcome (the desired result) that was envisioned in Phase 1?

Question 69

What is social marketing?

Answer 69

“the application of
commercial marketing
technologies to the analysis,
planning, execution, and
evaluation of programs
designed to influence
voluntary behavior of target
audiences in order to
improve their personal
welfare and that of society.

product, people, place, price, promotion

Question 70

How do you approach community engagement?

Answer 70

Inform- inform stakeholders
consult-for stakeholder feedback
involve- work directly with stakeholders
collaborate-partner with community
Empower-shared leadership

Question 71

benefits of centralization and local public health unit

Answer 71

Benefits of local of Public health units
Flexibility to adapt to local context
Relationships with organizations within jurisdictions
Better understanding of local context
Higher creativity
Faster decision making
Self-sufficient leaders
Happier managers/team members

Benefits of centralization of Public Health
Powerful data sharing
Coordinated response/ more standardization
More resources to respond
Less expensive (decreased admin costs, more efficient use of money/less wasting/duplication of efforts)
Improved collaboration across jurisdiction

Question 72

How would you reduce risk of COVID-19 in outdoor spaces

Answer 72

7 risk reduction options for transmission of COVID and outdoor spaces
-Maximize distance and minimize interactions
-Close or remove features that cause visitors to gather
-Close features on which the virus may have settled
-Sanitizing surfaces
-Discourage activities that involve physical contact
-Washrooms- additional sanitation
-Provide opportunities for hand hygiene
-Ensure trash containers are available for discarding PPE

Question 73

Effects of lock downs

Answer 73

3 risks associated with less access to outdoor spaces
-Mental health impacts and the benefits of green space
- Reduced physical activity
-Creating drivers for risky behaviors
-Equity impacts of park closures

Question 74

Public Health Roles for reducing Inequities.

Answer 74

• Assess and report. – may include surveillance, epidemiological analysis, literature review or primary research
• Modify and orient interventions – Various tools, resources and approaches can be used to modify interventions to meet the unique needs of populations and reduce inequities.eg HEIA tool
• Partner with other sectors – mobilize partnerships with govt, community or other organizations to improve health inequity
• Participate in policy development- support the development of legislation, regulations or policies that consider the determinants of health and reduce inequities.