Advocacy and Policy Flashcards
Review: Incidence vs. Prevalence
• Incidence: rate of a new disease within a given period of time
• Prevalence: total number of people living with a disease
3 Core Functions of PH
Assessment
Policy Development
Assurance
What is at the center of all core functions of PH?
Equity
4/10 of the Essential Services that regard Policy Development
• Communicate effectively to inform and educate
• Strengthen, support, & mobilize communities & partnerships
• Create, champion, & implement policies, plans, & laws
• Utilize legal & regulatory action
Policy
• The authoritative decisions made in the legislative, executive, or judicial branches of government
• Enacted at all 3 levels of government (local, state, federal)
• Intended to influence the actions, behaviors or decision of citizens
• Public policy
crafted by governments
- Health Policy
- Social Policy
Health Policy
Health Policy is when the intent of public policy is to influence health or health care
Social Policy
Social policy identifies course of action to deal with social problems – typically addressing the social determinants of health
Private Policy
crafted by nongovernmental entities – health care organizations, insurers, or others
Big P
governmental policies
Little P
policies crafted by non-governmental organizations
Public Health Policy
• Directed toward influencing actions, behaviors, or decisions influencing population health
• Intrinsically connected to the health care system, values, and philosophies about the place of government
• Grounded in the health planning process
• Should be based on evidence and support determinants of health
Upstream Factors
• Broad range of issues – other than health care that influence health and wellbeing.
• Social Determinants of Health – Health is determined in a large part by the conditions where people live, work, and play
• To date …the focus on reducing disparities has been health policy addressing access, coverage, cost, & quality once the individual ENTERS the health care system
• Focus must shift to addressing upstream factors in and outside of health care systems
Two types of Public Policy
Allocative
Regulatory
Allocative Policy
Provides benefits for a distinct group of individuals or organizations (at the expense of others) to achieve a public objective (may be redistribution of wealth) What we are funding and how we are funding it
Regulatory Policy
Influence actions, behaviors, and decisions of individuals or groups to ensure that a public objective is met
_____- itself is policy!
Funding
(how we choose to lay out our dollars)
Nursing and Policy
• Health policy affects every nurse’s practice
• Health policy determines who gets what type of health care – when, how, from whom & at what cost
Why do nurses participate in policy?
• To advance a healthier society
• To promote a safer healthcare system
• To support nursing’s ability to care for people with equity & skill
The Triple Aim
Developed by the Institute for Healthcare Improvement (IHI)
• Improving population health
• Improving the patient experience of care
• Reducing per capita costs
Goal of The Triple Aim
creating a high-performing health care system
The Triple Aim requires HC providers to…
to broaden focus from individuals to populations
Triple Aim may be Quadruple aim now:
Improving the work life of clinicians and staff OR Achieving health equity
Health Care Finance
Public Health Finance
Funding and Access to Care
Public Health Finance
Complex system determines how public health infrastructure, services, etc. are financed
Public Health Funding Needs (fix 21-6 from book)
- Core funding for public health - at the federal, state, and local levels -should be increased
- First dollars of core PH funding should be used to a assure all Americans are protected by a set of foundational PH capabilities and services no matter where they live
- Funding should be considered strategically, so funds are used efficiently to maximize effectiveness and lowering disease rates and improving health
- The Prevention Fund, identified as part of the Affordable Care Act, should be implemented quickly and strategically to effectively and efficiently reduce rates of disease
- Stable, sufficient, dedicated funding should be provided to support public health emergencies and major disease outbreaks – so the country is not caught up and unprepared for threats ranging from Ebola to an act of bioterrorism – and is better equipped to reduce ongoing threats such as flu, foodborne illness, and the measles
- Accountability should be a corner stone of public health funding. Americans deserve to know how effectively their tax dollars are used, and the government’s use of funds should be transparent and clearly communicated with the public
3 branches of government
Legislative—Makes laws (Congress, comprised of the House of Representatives and Senate)
Executive—Carries out laws (president, vice president, Cabinet, most federal agencies)
Judicial—Evaluates laws (Supreme Court and other courts)
3 levels of government
Federal
State
Local
Criteria to Evaluate Public Health Policy - Effectiveness
likelihood of achieving the goals and objectives of the policy or demonstrated achievement of them
Limits to use: estimates involve uncertain projection of future events
Criteria to Evaluate Public Health Policy - Efficiency
achievement of policy goals relative to cost. Least cost for a given benefit or that largest benefit for a given cost
Limits to use: measuring all costs and benefits is not always possible.
Criteria to Evaluate Public Health Policy - Equity
fairness or justice in the distribution of a policy’s costs benefits, and risks across population subgroups
Limits to use: difficulty in finding techniques to measure equity; disagreement over whether equity means a fair process or equal outcomes
Criteria to Evaluate Public Health Policy - Liberty/Freedom
Extent to which public policy extends or restricts privacy and individual rights and choices
Limits to use: Assessment of impacts on freedom is often clouded by ideological beliefs about the role of the government
Criteria to Evaluate Public Health Policy - Political Feasibility
The extent to which elected officials accept and support a policy proposal
Limits to use: Difficult to determine. Depends on perceptions of the issues and changing economic and political conditions
Criteria to Evaluate Public Health Policy - Social Acceptability
The extent to which the public will accept and support a policy proposal
Limits to use: Difficult to determine even the public support can be measured. Depends on saliency of the issues and level of public awareness
Criteria to Evaluate Public Health Policy - Administrative Feasibility
The likelihood that a department or agency can implement the policy well
Limits to use: Involves projection of available resources and agency behavior that can be difficult to estimate
Criteria to Evaluate Public Health Policy - Technical Feasibility
The availability and reliability of technology needed to policy implementation
Limits to use: Often difficult to anticipate technological changes that would alter feasibility
