2021 Policy and Planning Flashcards
What are the steps in the Nuffield intervention ladder, from least to most intrusive?
Vaccine hesticacy or low vaccine uptake
- No nothing/monitor the situation
- Inform and educate (e.g. social media messaging about vaccine safety and effectiveness)
- Enable choice that allows people to change behaviour (e.g. provide vaccine to people whenever and wherever they want it through mobile phone app and online platform in a model similar to uber)
- Guide choice through changing the default (HCPs will automatically offer vaccine unless the patient explicitly refuses during each healthcare visit)
- Guide choice through incentives (e.g. Receving money for completing vaccinations)
- Guide choice through disincentives (e.g. vaccination mandatory to get publicly-funded programs and services including public schools, colleges/universities, daycare as well as to be employed by government agencies)
- Restrict choice (e.g. Mask or vaccinate)
- Eliminate choice (e.g. Mandatory to get vaccinated or else face jail time)
List the five principles of the Canada Health Act.
CUPPA!
- Comprehensiveness
- Universality
- Portability
- Public administration
- Accessibility
As an AMOH, you have been asked to recommend a policy to your Board of Health that will guide decision making about opening local vaping establishments. List the steps you would take to develop this policy.
PHO 8 steps to making Healthy Public Policies
- Identify, describe, analyze the problem (e.g Opioid overdose)
- Identify, describe, analyze different policy options (e.g. needle exchange program, supervised consumption site, advocacy for decriminalization of all drugs)
- Identify, understand important stakeholders including decision makers (e.g. your boss and upper mgmt) and influencers (Community groups on opioid harms) to gain buy-in early
- Assess readiness for this type of policy (e.g. organization facing reorganization, so not a good time to develop new programs)
- Develop an action plan including goals and objectives, resources required.
- Implement the policy
- Faciliate the adoption and implementation of the policy
- Monitor and evaluate the policy
A new virus has been discovered recently that you believe is responsible for increased morbidity and mortality in your region. You are considering the application of quarantine measures to reduce the impact of this virus. List three criteria you would use to apply the precautionary principle to this situation.
- Is there sufficient evidence to support a reasonable suspision that there is a causal relationship between the virus and increased morbidity/mortality observed?
- Is there an observed increased morbidity/mortality when exposure to virus is increased?
- Is the exposure widespread?
- Are the harms from the virus serious?
- Are the harms from the virus difficult to treat or irreversible?
- What are the costs and benefits of action or no actions?
- Are the proposed measures proportionate to the risk?
- Similar situations with a new virus treated similarly based on best practice?
- Acceptability of the proposed quarantine measures to the public.
List 4 ypes of cost outcomes in health care and give an example of each
- Direct health costs - actual costs of delivering intevention e.g. drugs, nursing staff, lab tests
- Direct non-health costs - transport, support services, pension payouts, disability benefits, unemployment benefits (EI)
- Indirect costs - e.g. days lost from work, reduced productivity
- Intangible costs - e.g. pain, psychological harm, stigma
What are 3 measures of health status that takes into account time, mortality and morbidity?
HALYs (Health-Adjusted Life Years) are a group of summary measures of population health used in estimating burden of disease. HALYs combine the effects of morbidity and mortality simultaneously and are used to compare across diseases, interventions and populations. HALYs include QALY, DALY and HALE. QALY (Quality Adjusted Life Year) - estimate the number of years lived and the quality of life during these years that can be attributed to an intervention/treatment. QALY often used to analyze clinical interventions with the goal of maximizing the “good” quality of life. QALY can give an idea of how many extra months or years of life of reasonable quality of health a person might gain with each intervention. DALY (Disability Adjusted Life Yea) - quantify the burden of disease and disability in populations. It measures the gap between the current health of a population and an ideal situation (i.e. where everyone reaches the standard life expectancy). Daly estimates the number of years of life lost due to premature mortality and years lived in disability/disease. DALYs are an absolute measure used to compare disease burden in populations with the goal of minimizing the “bad” of gaps in health. HALE (Health Adjusted Life expectancy or Healthy Life Expectancy) - estimates the number of years that a person at a given age can expect to live in good health. It summarizes mortality and morbidity in a single measure of average population health, and has been used to compare health between countries and to measure changes over time. Healthy Life Expectancy is related to HALYs but not disease-specific and calculated using the life table method, incorporating estimates of average health over each age interval. https://nccid.ca/publications/understanding-the-measurement-of-global-burden-of-disease/
What is QALY? and how do you calculate QALY?
Quality-Adjusted Life Year is a summary measure of population health used in estimating burden of disease. QALY estimate the number of years lived and the quality of life during these years that can be attributed to an intervention/treatment. QALY = number of additional year of life lived x utility values related to Health Related Quality of Life
What is DALY? and how do you calculate DALY?
DALY (Disability Adjusted Life Yea) - quantify the burden of disease and disability in populations. It measures the gap between the current health of a population and an ideal situation (i.e. where everyone reaches the standard life expectancy). Daly estimates the number of years of life lost due to premature mortality and years lived in disability/disease. DALYs are an absolute measure used to compare disease burden in populations with the goal of minimizing the “bad” of gaps in health. DALY = DALY= Years of life lost due to premature mortality (YLL) + Years lived with disability (YLD) YLL = the number of deaths multiplied by a standard life expectancy. YLD=multiplying the number of disability cases (incidence cases) by the average duration of the disease/disability and weighted representations of disability called the disability weight.
Name the 5 Stages in policy cycle?
Agenda Setting
Policy formulation
Decision-making
Policy implementation
Policy evaluation
According to the ACF, how does polic change occur?
- Policy-oriented learning: “enduring alterations in thought or behavioural intentions that result from experience and which are concerned with the attainment or revision of the precepts of the belief system of individuals or of collectives”; generally takes place in public fora
- Policy brokers: Similar to the MSF’s policy entrepreneur
- External shock: “events outside the control of subsystem participants”; might include economic or regime changes, disasters, or changes in other subsystems (often necessary, but not sufficient, for policy change)
- Internal shock:Events directly related to the policy subsystem that “confirm the policy core beliefs of minority coalitions, increase doubts abou the core beliefs of the dominant coalition, and bring into question the effectiveness of their policies”
- Negotiated agreement:Agreement between two or more parties that disagreed over a policy choice; requires a hurting stalemate, in which the status quo hurts all parties
List 5 mechanisms for implementing policy instruments
- Legislation and regulation
- Constitution
- Court ruling
- Institutional rules
- Arbitration
- Inaction: Non-decision becomes policy “when it is pursued over time in a fairly consistent way against pressures to the contrary”
How do governments decide which policy instrument to use?
- Effectiveness: “Degree of goal-realization”
- Efficiency: “Input-output/outcome ratio”
- Legality: “degree of correspondence…with the relevant formal rules as well as with principles of proper (administrative) process)
- Democracy: “accepted norms as to government-citizen relationships in a democratic political order”
- Legitimacy: Degree to which policy instrument choice is viewed as just
Name 5 types of policy analysis
- Descriptive: What happened? (e.g., description of the development and implementation of the IHR 2005)
- Explanatory: Why did it happen? (e.g., why was the IHR 2005 developed and implemented?)
- Evaluative: Did it work? (e.g., did the implementation of the IHR 2005 reduce the risk of the international spread of disease?)
- Predictive: What will happen? (e.g., will the IHR 2005 continue to be effective in an increasingly globalized world?)
- Prescriptive: What should happen? (e.g., how can the IHR 2005 be amended to better address inequities in surveillance?)
You are tasked with developing policy instruments to reduce childhood obesity. List the 4 types of policy instruments and give an example of each as applicable to reducing childhood obesity.
- Incentive - government subsidies to reduce price of fresh produce and fruits to affordable level
- Disincentive - taxing sugar heavily e.g. 100% per kg of sugar
- Governmental delivering service - running a bike-sharing programs nation-wide for free
- Legislation/Regulation - Ban markerting of junk food towards children and teenagers
You have been asked to plan for a process, short-term, and long-term outcome evaluation of an intensive 12-week group intervention program designed to increase physical activity among men aged 40-64 in your region who are at high risk of progression to T2DM and developing IHD.
A) Apart from reduced risk of T2DM and IHD, list 4 health benefits of physical activity
B) List 4 potential process indicators
C) List 4 potential short-term outcome indicators
D) List 4 potential medium-to-long-term outcome indicators
A) Health benefits
- Decreased risk of certain cancers
- Decresed blood pressure/risk of hypertension
- Decreased risk of adverse blood lipid profile
- Decreased risk of dementia
B) Process indicators
- Number of participants who took part in group sessions
- Number of group sessions delivered
- Proportion of target population in region that participated
- Number of individuals referred to the program
C) Short-term outcome indicators
- Proportion of participants meeting 150 minutes of moderate-vigorous physical activity upon completion of program
- Mean % change in weekly minutes of physical activity reported by participants before and after program
- Mean % change in weight of participants before and after program
- Mean % change in HDL, LDL and triglycerides before and after program
D) Medium-Long-term outcome indicators
- Proportion of participants meeting 150 minutes of moderate-vigorous physical activity 1 year after completion of program
- Proportion of participants who develop T2DM in 1-5 years
- Proportion of participants who are diagnosed with an MI in 1-5 years
- Mean % change in weight 1 year after program
You are performing an HIA related to the proposed construction of a new sports complex in your area. You have identified that there is likely to be a significant impact related to noise on residents in neighbouring areas during the construction phase.
A) List 4 adverse health impacts associated with noise
B) List 4 potential mitigating measures you could recommend to reduce the adverse health impacts of noise on the residents.
C) List 4 potential indicators you could use to assess the impact of noise on residents once construction has commenced
A)
- Noise induced hearing loss
- Impaired speech comprehension
- Increased sleep disturbance
- Increased stress & annoyance
B)
- Erect a sound barrier around construction site
- Alter routes of construction vehicles into area to reduce need for reversing alarms
- Use machinery with improved technological effiiciency to reduce noise production
- Alter orientation and design of construction site to maximize physical distance between construction and residents
- Reduce the maximum blast noise produced in exchange for increased number of blasts (evidence-based)
C)
- Noise complaints made by residents to local council about construction noise
- % of residents reporting sleep disturbance pre and post construction commencement
- % of residents reporting extreme annoyance pre and post construction commencement
- % change in background noise levels in decibals before and after construction commencement
Regarding economic analysis, list 3 types, and an advantage and a disadvantage for each.
