Lecture 3 (Sept 17) Flashcards
Public Health
- No common definition
- Health of populations
- Prevention & promotion
- Not addressed by Canada Health Act
Like a where’s Waldo picture book
Population health PHAC 2012:
An approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups
10 Essential Public Health Services ( don’t need to memorize) Just know a few :)
- Assess and monitor population health
- Investigate, diagnose and address health hazard and not root causes
- communicate effectively to inform and educate
- Strengthen, support and mobilize communities
What happened in Toronto Spring 1999?
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
Important Disease and surveillance concepts
Ideally always evidence based
Communicable disease transmission 4 of them
Direct (person to person)
Indirect (Through a vehicle like water or food)
Indirect (vector) bridging such as zoonotic infections (malaria, Lyme disease)
Airborne
TB is spread through:
The air in tiny droplets
that live in the air for several hours
Pulmonary or Active TB
when TB bacteria escapes the granuloma
Infectious, deadly if not treated
Adherence is important; prompt treatment is necessary
13 million people in the states have
TB
Latent TB
Tb is trapped in the granuloma
Not infectious
Prophylaxis for at risk people (e.g. HIV, dialysis, incarcerated, homeless, First Nations, Transplant)
MDR-TB
Multi drug resistant TB (expensive, public health threat)
~$250,000 anual to treat
Framing
- 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
What are different ways we could frame what happened in Toronto Spring 1999?
-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
- 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
risk of getting TB in London Ontario is about the same as
getting hit by a car
Prevalence
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.
Incidence
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.
Tuberculosis in Canada 2017
- 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
Screening 6 (these could be broken into smaller cards if you have time :) )
- 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.
Institutional Arrangements
“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)
Jurisdictional Issues
Sorry You’re gonna have to go back and make this one
Constitution Act 1982
Charter of rights and freedoms
Repatriation of the constitution
has 7 parts
Canada Health Act, 1984
Legislation:
- publicly funded health insurance
Role of the Federal Government in 1982
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
Role of the provincial government
- 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
Role of municipality (Public Health
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.
Additional Stakeholder in the Toronto Immigrant TB case
TB specialists
The media
What are the factors which make TB specialists stakeholders
Drug resistance
symptoms vs. screening
Medical school curriculum
Quality of care: uneven and potentially dangerous
Social, psychological and pharmacological
What are the factors which make Media stakeholders
Timing
relevance
fame
Human interest
Effects Framework
effectiveness
unintended effects
equity
Implementation framework
Cost
Acceptability
Feasibility
Canada Health Transfer
The full cash contributions from government to provincial and territorial health insurance plans
The federal government is most involved in health in ways directly related from 3 constitutional powers
- The spending power
- The power to pass laws for peace, order
- Good government and criminal law power
IFHP
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
HPPA
The health Protection and promotion Act
