Lecture 3 (Sept 17)

Question 1

Public Health

Answer 1

• No common definition
• Health of populations
• Prevention & promotion
• Not addressed by Canada Health Act
  Like a where’s Waldo picture book

Question 2

Population health PHAC 2012:

Answer 2

An approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups

Question 3

10 Essential Public Health Services ( don’t need to memorize) Just know a few :)

Answer 3

1. Assess and monitor population health
2. Investigate, diagnose and address health hazard and not root causes
3. communicate effectively to inform and educate
4. Strengthen, support and mobilize communities

Question 4

What happened in Toronto Spring 1999?

Answer 4

200 Tibetan refugees crossed from buffalo
* Sent to shelter in Toronto awaiting processing
5 were found to have active, contagious MDR TB strain
* Media hyped up the story to emphasize public health risk to Canadians; worked up previous anxieties related to Kosovar and Chinese refugees

Question 5

Important Disease and surveillance concepts

Answer 5

Ideally always evidence based

Question 6

Communicable disease transmission 4 of them

Answer 6

Direct (person to person)
Indirect (Through a vehicle like water or food)
Indirect (vector) bridging such as zoonotic infections (malaria, Lyme disease)
Airborne

Question 7

TB is spread through:

Answer 7

The air in tiny droplets
that live in the air for several hours

Question 8

Pulmonary or Active TB

Answer 8

when TB bacteria escapes the granuloma
Infectious, deadly if not treated
Adherence is important; prompt treatment is necessary

Question 9

13 million people in the states have

Answer 9

TB

Question 10

Latent TB

Answer 10

Tb is trapped in the granuloma
Not infectious
Prophylaxis for at risk people (e.g. HIV, dialysis, incarcerated, homeless, First Nations, Transplant)

Question 11

MDR-TB

Answer 11

Multi drug resistant TB (expensive, public health threat)
~$250,000 anual to treat

Question 12

Framing

Answer 12

• Mental structures that people use to provide categories and a structure to their thoughts
• How potential hazard is processed? How policy is perceived? How policy is evaluated?
• Demonstrated how the same set of facts can be used to present different messages
• How to best influence an outcome
• Helps determine what stakeholder can participate

Question 13

What are different ways we could frame what happened in Toronto Spring 1999?

Answer 13

-Illegal immigration
-Infectious Disease transmission and natural progression of disease
Public Health & Risk to public
-Cost, cost benefit, opportunity costs
-“Old disease”: many physicians have not been trained to recognize it or have little experience

Answer 14

• decisions involve risk
• not doing anything involves risk
• Uncertainty
• How well risk is understood
• extent to which it evokes dread
• How many people exposed
• Less acceptable if classified as involuntary, dread, or catastrophic (vs. common)
• Media attention alters perceived risk
• Risks with identifiable victims are more severe than statistical

Question 15

risk of getting TB in London Ontario is about the same as

Answer 15

getting hit by a car

Question 16

Prevalence

Answer 16

Is an epidemiological measure of how often a disease or condition occurs in a population. It measures how much of a particular disease or condition exists in a population at a particular point in time.

Question 17

Incidence

Answer 17

measures the rate of occurrence of new cases of disease or condition. Incidence is a relative measure which considers the number of new cases in a specific time period (e.g. annually) in relationship to the population which is initially disease free.

Question 18

Tuberculosis in Canada 2017

Answer 18

• 2.6% increase from 2016-2017
• Increase from 4.8-4.9 per 100 000 people
• Foreign born individual continue to make the majority of cases (71.8%)
• Canadian born indigenous people (21.5 per 100 000 population)
• higher among males
• 45.6% were between 15 and 44 years
• The incidence rat was highest among adults over 75
• 80.4 % were treated successfully in 2016

Question 19

Screening 6 (these could be broken into smaller cards if you have time :) )

Answer 19

• Mass screening (screen everybody)
• Selective screening (only screening populations at risk)
• Multiphase screening ( do it now, do it 2 months from now)
• Surveillance (looking for data which suggests the virus is active in our environment) ex. testing ticks mosquitos etc.
• Case finding ( Go looking in a specific area ex. food poisoning, or in a specific factory)
• Population surveys a research method that involves collecting data from a specific group of individuals to measure attitudes, behaviors, or characteristics of a larger population.

Question 20

Institutional Arrangements

Answer 20

“Institutional arrangements are the policies, systems, and processes that organizations use to legislate, plan and manage their activities efficiently and to effectively coordinate with others in order to fulfill their mandate.“ (UNDP 2016)

Question 21

Jurisdictional Issues

Answer 21

Sorry You’re gonna have to go back and make this one

Question 22

Constitution Act 1982

Answer 22

Charter of rights and freedoms
Repatriation of the constitution
has 7 parts

Question 23

Canada Health Act, 1984

Answer 23

Legislation:
- publicly funded health insurance

Question 24

Role of the Federal Government in 1982

Answer 24

The Supreme Court of Canada stated
The federal government pays the provinces back for the immigrant health costs
Duty to First Nations and Inuit, Veterans and active military, prisoners in federal penitentiaries

Question 25

Role of the provincial government

Answer 25

• Public hospitals and clinics
• Drug benefit plans ( and deciding what is in/out)
• Training and regulation of physicians and the health professionals
• Long term care

Question 26

Role of municipality (Public Health

Answer 26

The health Protection and promotion Act (HPPA) 1983
1998 - amalgamation of metropolitan Toronto into one administrative unit, reducing number of PHUs from 5 to 1 (Toronto Public Health)
Typical responsibilities included vaccinations, communicable disease tracking/tracing/treatment, vector borne disease surveillance, sexual health, etc.

Question 27

Additional Stakeholder in the Toronto Immigrant TB case

Answer 27

TB specialists
The media

Question 28

What are the factors which make TB specialists stakeholders

Answer 28

Drug resistance
symptoms vs. screening
Medical school curriculum
Quality of care: uneven and potentially dangerous
Social, psychological and pharmacological

Question 29

What are the factors which make Media stakeholders

Answer 29

Timing
relevance
fame
Human interest

Question 30

Effects Framework

Answer 30

effectiveness
unintended effects
equity

Question 31

Implementation framework

Answer 31

Cost
Acceptability
Feasibility

Question 32

Canada Health Transfer

Answer 32

The full cash contributions from government to provincial and territorial health insurance plans

Question 33

The federal government is most involved in health in ways directly related from 3 constitutional powers

Answer 33

• The spending power
• The power to pass laws for peace, order
• Good government and criminal law power

Question 34

IFHP

Answer 34

Interim Federal Health Program
provides limited, temporary coverage of health-care benefits to people in the following groups who aren’t eligible for provincial or territorial health insurance

resettled refugees
refugee claimants
certain other groups

When Stephen Harper was in power he took this away for 4 years

Question 35

HPPA

Answer 35

The health Protection and promotion Act