Lecture 5: Week 3

Question 1

List some public health controversies

Answer 1

1) Funding: Public Health only receives <3% of the US’s total health spending
2) Other controversies include: Taking unnecessary money or jobs, increasing taxes, taking away freedoms, etc.
-US’s individualistic, market-oriented society
Individual liberty vs collective well-being
3) Political Decisions
4) Social Disparities

Question 2

slide 5

Answer 2

Contraception, substance abuse
Governmental involvement
Environmental protections
Vulnerable populations

Question 3

Define Population Health (21st Century)

Answer 3

Coordination of public health, healthcare and public policy based on shared evidence and systems thinking; “One Health”
-Key elements: Antibiotic resistance, climate change, full life cycle approach

Question 4

1) Life expectancy of Americans increased from ____yrs to _____yrs
2) Give 6 examples of interventions

Answer 4

1) 47yrs to 77yrs
2) Nutrition
Housing
Sanitation
Vaccination
Antibiotics
Occupational safety

Question 5

How is population health different from medical care?

Answer 5

1) Focus is on community/Society and illness prevention (ideal)
3) Assesses health of population and diagnoses its problems
4) Devises strategies to cure the population’s problems and provide access to care

Question 6

Public health focuses on _________________.
Traditional medical care focuses on ________________.

Answer 6

prevention; intervention

Question 7

List and define each of the 3 types of prevention. List the intervention for each.

Answer 7

1) Primary prevention: Prevents an illness or injury from occurring; prevents exposure to risk factors
-Intervention: Encourage smokers to quit
2) Secondary prevention: Seeks to minimize the severity of the illness or the damage due to an injury-causing event once the event has occurred
-Intervention: Screening programs to detect cancer early
3) Tertiary prevention: Seeks to minimize disability by providing medical care and rehab services
-Intervention: Medical treatment and rehab of cancer patients

Question 8

Approaches to public health:
1) Define health care and give examples
2) Define tradition public health and give examples
3) Define public policy interventions and give examples

Answer 8

1) One-on-one individual health services
-Clinical services, counseling, screenings
2) Group and community-based interventions
-Food and drug safety, disease control, environmental hazards
3) Interventions with another non-health-related purpose which have secondary impacts on health
-Increase education, address socioeconomic disparities, mobility of goods

Question 9

1) What are some questions you should ask when evaluating the effectiveness of a public health intervention?
2) What are some things you should assess?

Answer 9

1) How much of a problem has been eliminated by the intervention(s)?
-What is the nature of the remaining problem?​
-Before and after assessments
-Did or will the intervention reach the target population?
-Has the intervention been accepted into clinical or public health practice in the short and long term?​
2) Reach, effectiveness, adoption, implementation, and maintenance

Question 10

1) What are 3 things that can be used to quantify Socioeconomic Status (SES)?
2) How can SES affect health? (3 ways)

Answer 10

1) Education, income, occupation
2) Access to goods and services
-Poverty: housing instability
-Environmental: greater exposure to environmental pollution, natural disasters, and dangers of the “built” environment

Question 11

1) What is Health in All Policies?
2) What is the goal?

Answer 11

1) Collaboration of sectors
2) Ensure all decision-makers are informed about the health, equity, and sustainability consequences of various policy options during the policy development process

Question 12

List 3 questions to think abt regarding Scope of Health Law, Policy and Ethics

Answer 12

1) Is there a right to health care?
2) How does public health attempt to balance the rights of individuals and the needs of society?
3) What bioethical principles are used to address public health issues?

Question 13

Legal Principles; define:
1) Police power
2) Negative constitution
3) Interstate Commerce Clause

Answer 13

1) State’s power to protect sanitation, waste disposal and environmental protections
2) Government is allowed but is not required to protect public health/provide healthcare services; due process clause
3) Major source of federal authority

Question 14

Due process protected in the 14th Amendment; list and define the 2 types

Answer 14

1) Substantive Due Process: protection of “fundamental” rights
2) Procedural Due Process: Government must follow a certain procedure

Question 15

List 4 types of law

Answer 15

Constitutional Law
Legislative Statutes
Administrative Regulations
Judicial (case) Law

Question 16

What are the two models of local (county/city) health departments? Define each.
What are most health deparments?

Answer 16

1) Home rule (local autonomy model): authority delegated from the states to the local health dept
2) Branch office model: “branch office” of the state agency with little or no independent authority or funding
-*MOST local health departments lie somewhere in between the two models

Question 17

List some local health department responsibilities

Answer 17

Immunizations for those not covered by the private system
Communicable disease surveillance and initial investigation Communicable disease control (TB, syphilis)
Inspection and licensing of restaurants
Environmental health surveillance
Coordinating public health screening programs
Tobacco control programs
Public health preparedness and response to disasters

Question 18

List some state health department roles

Answer 18

Collecting vital statistics
Running a public health laboratory
Licensing health professionals
Administering nutrition program
Regulating health facilities
Drinking water regulation
Administration of the state Medicaid program
Office of the medical examiner

Question 19

1) Define social justice
2) Define market justice

Answer 19

Social Justice: views the equitable distribution of health services as a social responsibility
Market Justice: emphasizes individual, rather than collective responsibility for health

Question 20

What provided the framework defining the goals and services of governmental public health agencies with the Public Health in America statement?

Answer 20

United States Public Health Service (1994)

Question 21

List some goals of the Public Health in America statement from United States Public Health Service (1994)

Answer 21

Prevent epidemics and the spread of disease
Protect against environmental hazards
Prevent injuries
Promote and encourage healthy behaviors
Respond to disasters and assist communities in recovery
Ensure the quality and accessibility of health services

Question 22

3 core public health functions:
1) Who are they performed by?
2) What do they provide?
3) Can they be delegated?

Answer 22

1) Performed by governmental public health agencies
Provide a delineation of responsibilities and framework for govt health agencies

Cannot be delegated to other agencies or to nongovernmental organizations

Question 23

List and define the 3 core functions of governmental public health agencies

Answer 23

1) Assessment: Collecting and analyzing information about health problems.
2) Policy development: developing evidence-based recommendations and other analyses of options
3) Assurance: governmental public health agency’s oversight responsibility

Question 24

Defined in the Public Health in America statement, the 10 essential public health services do what?

Answer 24

1) Guide day-to-day responsibilities
2) Evaluate whether the core functions are fulfilled.
3) Define the responsibilities of the combined local, state, and federal governmental health system.

Question 25

What are the 2 steps of the core function of assessment? Give examples

Answer 25

1) Monitor health status to identify and solve community health problems
-Health surveys, health surveillance
2) Diagnose and investigate health problems and health hazards in the community
-Epidemic investigations, state public health laboratories

Question 26

What are the first 2 steps of the core function of policy development? Give examples

Answer 26

1) Inform, educate, and empower people about health issues
-Health education campaigns
2) Mobilize community partnerships and action to identify and solve health problems
-Lead control programs

Question 27

What are the second 2 steps of the core function of policy development? Give examples

Answer 27

1) Develop policies and plans that support individual and community health efforts
-Examples: newborn screening and follow-up programs for phenylketonuria (PKU) and other genetic and congenital diseases
2) Enforce laws and regulations that protect health and ensure safety
-Examples:
-local: fluoridation and chlorination of water;
-state: regulation of nursing homes;
-federal: FDA drug approval and food safety

Question 28

What are the second 2 steps of the core function of assurance? Give examples

Answer 28

1) Link people to needed personal health services and ensure the provision of health care when otherwise unavailable
-Community health centers
2) Ensure a competent public and personal healthcare workforce
-Licensure of physicians, PAs, nurses and other health professionals

Question 29

1) What are Foundational Public Health Services?
2) What are foundational areas?
3) What are foundational capabilities?

Answer 29

1) Skills, programs, activities that must be available in state and local health depts
2) Areas of expertise or program-specific activities in all state and local health depts also essential to protect the community’s health
3) Cross-cutting skills that must present in state and local health depts everywhere for the health system to work anywhere

Question 30

1) Interstate Commerce Clause provide? What does it primarily justify?
2) Federal public health authority rests on the states’ ___________________ of funding provided by the federal government.

Answer 30

1) Provides federal government authority to regulate commerce between the states
Primarily justifies the federal government’s role in public health.
2) voluntary acceptance

Question 31

What is The Department of Health and Human Services (HHS)?

Answer 31

Central public health agency of the federal government

Question 32

The Department of Health and Human Services (HHS); describe each of the following:
1) CDC and ATDSR
2) NIH
3) FDA
4) HRSA
5) AHRQ

Answer 32

1) CDC and ATDSR (Agency for Toxic Substances and Disease Registry)
2) NIH – largest, budget > $30 billion, lead research agency
3) FDA – consumer protection agency- drugs, medical devices, vaccines, food safety
4) HRSA (Health Resources and Services Administration) – funds community health centers
5) AHRQ (Agency for Health Research and Quality)- supports

Question 33

The Department of Health and Human Services (HHS); describe each of the following:
1) USPSTF
2) SAMHSA
3) IHS (Indian Health Service)
4) CMS

Answer 33

1) USPSTF, research
2) SAMHSA (Substance Abuse and Mental Health Services Administration)
3) IHS (Indian Health Service) – responsible for public health AND healthcare services
4) CMS - Centers for Medicare and Medicaid Services

Question 34

What does the CDC do?

Answer 34

Conducts research and epidemiological investigations
Works closely with states to monitor and prevent disease
Provides national leadership and coordinates the efforts of local/state and federal public health agencies

Question 35

Less than ___% of all health-related expenditures in the US go to governmental public health agencies

Answer 35

5%

Question 36

ATDSR works with the ____ for guidance on health hazards of toxic exposures

Answer 36

EPA

Question 37

Public health is global; what are some global organizations?

Answer 37

1) UN (United Nations)
2) WHO (World Health Organization) (under UN)
3) World Bank & other multilateral financial institutions fund global health efforts

Question 38

True or false: Collaboration needs to be an everyday effort at every level

Answer 38

True

Question 39

Must coordinate local, state, federal, and global public health agencies into one unified effort through what 3 things?

Answer 39

1. parallel play
2. true collaboration
3. integration of efforts

Question 40

List what each does relating to health:
1) Environmental Protection Agency (EPA)
2) Occupational Safety and Health Administration (OSHA)
3) Dept. of Homeland Security

Answer 40

1) Environmental health
2) Reducing injury and hazards in the workplace (Dept of Labor)
3) Preparation and response to disasters and terrorism-

Question 41

List what each does relating to health:
1) Food and Drug Administration (FDA) and Dept. of Agriculture
2) Dept. of Housing and Urban Development
3) Dept. of Energy

Answer 41

1) Protect the nation’s food supply
2) The effects of the built environment
3) Radiation safety standards

Question 42

NGOs: What does The American Red Cross do?

Answer 42

Obtains donations, mobilizes volunteers, and publicizes the need for disaster assistance

Question 43

NGOs:
Public organizations such as American Cancer Association, the American Heart Association, the Alzheimer’s Association, the American Lung Association, the March of Dimes, Mothers Against Drunk Driving do what?

Answer 43

1) Provide public health education, support research, develop evidence-based recommendations
2) Advocate for public health policies

Question 44

NGOs; What do the following do?:
1) Physicians for Social Responsibility and Doctors without Borders.
2) CARE & Oxfam International.
3) Privatephilanthropic foundations such as the Bill and Melinda Gates Foundation and Robert Wood Johnson Foundation.

Answer 44

1) Advocate for public health efforts, seek funding for public health needs, and address the ethical implementation of public health programs.
2) Provide services and advocate for global health-related crises.
3) Fund public health efforts and stimulate government funding.