2021 Health Promotion COPY Flashcards
what do you understand by passive prevention?
- 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)
What do you understand by sentinel surveillance?
- 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
What are the levels of Disease Prevention and give an example of each?
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
What are differences and similarities between screening and case finding?
- 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)
List 5 recommendations from the New Canada Food Guide to make healthy food choices.
- Eat plenty of vegetables and fruits, whole grain foods and protein foods; Choose protein that come from plants more often.
- Choose foods with healthy fats instead of saturated fats, and with little to no added sodium and sugars.
- Limit highly processed foods. If you choose these foods, eat them less often and in small amounts.
- Make water your drink of choice and replace sugary drinks with water
- Use food labels; and choose healthier menu options when eating out.
- Be aware that food marketing can influence your choices
https: //food-guide.canada.ca/en/healthy-food-choices/
List 5 recommendations from the New Canada Food Guide to make health food habits.
- Be mindful of your eating habits (Take time to eat and notice when you are hungry and when you are full)
- Cook more often (Plan what you eat and involve others in planning and preparing meals)
- Enjoy your food (Culture and food traditions can be a part of healthy eating)
- Eat meals with others
https: //food-guide.canada.ca/en/healthy-eating-habits/
What are determinants of healths? List 12 of them
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)
Define Social marketing.
Compare and contrast social marketing and commercial marketing in terms of type of product, audience, primary aim, and competition
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
List 5 components of the ecological framework for health promotion
- Individual
- Interpersonal
- Organisational
- Community
- Public policy/societal
List 4 components of the health beliefs model and describe each with the context of texting and driving
- Perceived susceptibility - beliefs about the chances of getting in a motor vehicle accident while texting
- Perceived severity - beliefs about the seriousness of getting into an MVA and its consequences
- Perceived benefits - beliefs about the effectivness of taking measures to stop texting while driving
- Perceived barriers - beliefs about the material and psychological costs of taking action to stop texting
List the 5 actions of the Ottawa Charter
- build healthy public policy - create supportive environments - develop personal skills - reorient health services - strengthen community actions
List 5 determinants of health (as per PHAC)
- 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
Define the ‘low income cut-off’ (LICO) measure of poverty
income threshold below which a family is expected to spend 20% more of their income on necessities than the average Canadian family
Define the ‘low-income measure’ (LIM) measure of poverty
half the median income
Define the ‘market basket measure’
threshold = amount required to buy a ‘basket’ of goods and services representing a modest standard of living
What does 0 and 100 represent in the Gini coefficient?
0 = absolute equality 100 = absolute inequality -> lower the better!
List and briefly describe the OCAP principles of research involving First Nations.
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
What is the difference between: impairment, disability, and handicap?
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.
What are 4 key components of the Health Belief Model of behaviour change?
SSBB -Perceived susceptibility -Perceived severity -Perceived benefits of action -Perceived barriers to action
What are 4 actions Public Health can take to improve health equity?
- 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
List 3 Protective Factors against suicide
- Socio-economic situation › Loving parent-child relationship › Having reasons for living › Social connectedness › Sense of belonging › Religion
Define Health Inequity
Systemic, unjust, avoidable systematic differences in health status between groups that are unjust, unfair AND unnecessary and potentially avoidable.
What are two purpose of a health equity impact assessment
- Identify potential unintended consequences for different populations groups - Maximize positive impacts and minimize positive impacts
List the steps that you would take to conduct a health equity impact assessment
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)
Define Health Inequality
measurable difference in health status between individuals or groups
Define a population health approach
focuses on improving the health of an entire population and improving equity between subpopulations.
List 2 youth substance misuse prevention intervention (from CPHO report)
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
List six preventable risk factors for dementia.
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
List six components of a multifactorial intervention for falls prevention at the individual-level.
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
Describe two epidemiological trends for seniors.
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
What are four pillars in the National Senior’s Strategy? List one policy issue within each pillar.
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
List five health outcomes associated with homelessness
- 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)
List five public health interventions for homelessness
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
Define the following: culture awareness, cultural sensitivity, cultural safety.
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
Why is racism a public health issue?
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
Public Health Roles for Racial Health Equity:
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.
List six health concerns impacting people who are incarcerated.
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)
What is the Gladue Report? List 2 key considerations included in the report.
Gladue Report (1999)
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
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
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.
List the 4 components of the IDEA ethical framework for decision-making in health care settings
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
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
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
Using the 6E mechanisms of control, list six ways to mitigate the risk from radon.
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
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
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)
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
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)
how do you respond to privacy breach
Respond
contain
notify
remediate
discipline
Define collaborative negotiation as a conflict management technique
· 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
List six possible steps in the collective bargaining process
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).
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.
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
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
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
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
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
List 5 expenditures that can be found on a typical public health unit budget
· 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
List 2 methods for your health unit to increase revenue and 2 methods to decrease expenditures
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
List 3 methods that can be used to procure a good or service
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
List 4 items to consider when discussing different options in a business case
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
List 5 things that comprise a strategic plan.
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
