Role of Government and Health

Question 1

Where does the market exhibit problems in the US?

Answer 1

1) Inequities (unfairness)

2) Technical market failures

Question 2

List 10 great public health achievements for the 20th century

Answer 2

1) Immunizations
2) Motor vehicle safety
3) Workplace safety
4) Control of infectious disease
5) Declines in deaths from heart disease and stroke
6) Safer and healthier foods
7) Healthier mothers and babies
8) Family planning
9) Fluoridation of drinking water
10) Tobacco as a health hazard

Question 3

What do achievements in public health have in common?

Answer 3

Advances in science, medicine and technology. Most could not have been done without government

Question 4

What are inequities in public health?

Answer 4

1) Lack of timely and high quality health care for indigent or uninsured
2) Policies or practices that discriminate by sex, race, sexual orientation, age, etc

Question 5

What are some technical market failures

Answer 5

1) Inadequate information or knowledge
2) nonexistence of markets for some goods
3) Monopoly power
4) Externalities
5) A public good

Question 6

Inadequate information or knowledge example

Answer 6

Doctors Dx and Tx

Question 7

Nonexistence of markets for some goods example

Answer 7

Fixing medicare for future generations

Question 8

Monopoly power meaning

Answer 8

Firms can charge prices higher than in competitive market

Question 9

Monopoly power examples

Answer 9

1) Sole producer of essential drugs; patents
2) Only hospital in area
3) Only EMS

Question 10

Externalities meaning

Answer 10

Cases in which consumption or production by one party imposes costs (or benefits) on other parties not involved in the consumption or production decision

Question 11

Externalities example

Answer 11

1) Vaccination against communicable disease
2) Second hand smoke exposure
3) Drunk driving or texting while driving
4) Factory dumping waste materials in river or air

Question 12

A public good meaning

Answer 12

Good or service that, if consumed by one person is consumed by all persons (in the relevant area)

Question 13

A public good examples

Answer 13

1) Fluoridated water system
2) Traffic light
3) Air pollution control
4) Missile defense system

Question 14

Legal rationale for government involvement

Answer 14

Both state and federal constitutions- the legal bases for the existence of those entities (ie the individual states and their confederation into a nation)-require the entities to take responsibility for the welfare of the public

Question 15

Health in the US constitution

Answer 15

Not mentioned in the US constitution! “The powers not delegated to the United States by the Constitution are reserved to the states

Question 16

Health in state constitutions

Answer 16

States have authority for PH, require states to protect health and welfare of the public, assign responsibility to themselves

Question 17

Conceptual hierarchy of government authority re PH in law

Answer 17

1) State governments

2) Federal governments

Question 18

Hierarchy of government authority in PH

Answer 18

1) Federal government
2) State governments
3) Local governments

Question 19

Why does actual hierarchy in PH differ from conceptual hierarchy?

Answer 19

1) Federal government has the ability to regulate commerce, taxation and spending

Question 20

Police power:

Answer 20

Power to provide for the health, safety and welfare of the citizenry

Question 21

Purposes of police power:

Answer 21

1) Prevent people from harming others
2) Defend interests of person incapable of fully informed rational decisions
3) Prevent person from harming him/herself

Question 22

Examples of use of police power for PH

Answer 22

1) Requiring immunization prior to enrollment
2) Smoke free workplace laws
3) Regulating age, time, and place of alcohol use
4) Drivers license, speed limits, seat belt laws, helmet laws, DUI, driving while texting
5) Fluoridated water
6) Gun control laws

Question 23

What are some mechanisms for implementing public health policies

Answer 23

1) Law/ordinance by legislative body
2) Regulation/rule setting by administrative agencies
3) Court mandate from review of court challenges to law or regulation

Question 24

Components of the public health system include:

Answer 24

1) Formal governmental PH system
2) Other governmental agencies with PH responsibilities
3) Non- governmental entities with formal PH responsibilities
4) Non-governmental entities with voluntary involvement (ACS, AHA, ALA, American Red Cross)

Question 25

Formal governmental PH System

Answer 25

1) Federal: Public Health Service& CDC, FDA at heart
2) State: State health departments and other departments
3) Local health departments

Question 26

What is the institutional structure of federal role in PH?

Answer 26

Department of Health and Human services (DHHS)

Question 27

What is the role of the CDC

Answer 27

1) Infectious disease control
2) Chronic disease control
3) Injury control
4) Environmental health
5) Creator and repository of national health data bases

Question 28

What are roles of major PH agencies

Answer 28

1) Safety of manufactured foods
2) Safety and efficacy of pharmaceuticals
3) Safety of medical devices
4) Safety of cosmetics
5) Safety of vaccines, diagnostic tests, food additives and colorings
6) Newest: Tobacco product regulations

Question 29

What is the role of the NIH

Answer 29

1) Biomedical research
a) Intramural, including at own clinical center
b) Extramural main source of research universities research funding
c) National Library of Medicine
2) Disease specific institutes (with lots of associated politics)

Question 30

What is the role of the CMS

Answer 30

1) Administrative arm of Medicare and Medicaid: Health insurance for the elderly(Medicare)
2) Health insurance and nursing home care of the poor (Medicaid)

Question 31

How much of the federal budget does social security take up?

Answer 31

48% AKA 3.9 trillion dollars

Question 32

What does the EPA do?

Answer 32

1) Water and air pollution, toxic substances control, environmental contamination
2) Very controversial

Question 33

What does USDA do?

Answer 33

1) Safety of meat supply
2) Food and nutrition programs
3) Occasional example of regulatory capture

Question 34

What are LDHs?

Answer 34

Local health departments

Question 35

What are some major problems of LDHs?

Answer 35

1) Inadequate budges
2) Inadequate personnel (numbers, aging, and training)
3) Enormous burden of medical care clinical needs

Question 36

What are some weird parts about the American healthcare system?

Answer 36

1) no national health insurance or system
2) No system of hospitals
3) No ministry devoted exclusively to health
4) No participation in international health treaties