Term 1 Flashcards
Consensus
Involves policymakers working to balance cost and benefits and resolve common problems (ie. Day to day problems). nuts and bolts!
Critical
this approach sees policy as a reflection of power struggles: looks at societal and political dimensions, people are different and see policy differently, power is not equal.
Policy debates are influenced by social class politics and inequalities in influence and power including gender, race, class, disability, etc.
Positivism
Only authentic knowledge is scientific
Strict adherence to the scientific method
Hypothesis is testing and identifying relationships
Structural Functionalism (social theory)
Views society as an organism, a system of parts whose function together creates overall societal effectiveness
Shared norms and values; cooperation
Herd immunity
Interpretevism
understanding the meaning of social phenomena from the perspective of those experiencing it
This theory contrasts with positivism, which seeks to uncover universal laws through objective data and emphasizes empirical evidence.
this is SUBJECTIVE
Critique of positivism
Hermeneutics: how individuals understand themselves through shared systems of meaning
All views considered equally valid
Episteme means…
Knowledge or understanding
Logos
account or argument or reason
Ontology
the study of existence - what exists, what kinds of things exist, and what it means for something to exist
World View
Comprehensive - collection of deeply held beliefs about how we interpret and experience the world
Identification of your worldview indirectly identifies your greatest weakness
A worldview is a set of assumptions about physical and social reality that may have powerful effects on cognition and behavior
Schiff, 1968: cognitive, affective, behavioural
Decision Theory
On any given occasion, a person is guided by beliefs and desires and values
A theory of beliefs, desires and other relevant attitudes and a theory of choice: what matters is how these various attitudes (call them ‘preference attitudes’) meld together
Bias
All people are inherently biased
The concept of implicit bias, also termed unconscious bias, and the related implicit association test rests on the belief that people act on the basis of internalized schemas of which they are unaware and thus can, and often do, engage in discriminatory behaviour without conscious intent.
Ideology
(ex. liberal vs conservative) “A set of beliefs or principles, especially one on which a political system, party or organization is based”
Ideology is an admixture of political and socio-economic beliefs, values and symbolism that provides explanatory coherence
Define Buse’s Version of Policy
Broad statement of the goals, objectives, and means that create the framework for activity. Often takes the form of explicit written documents, but may also be implicit or unwritten
least well of people find it ___x harder to get the healthcare they need
3x
What are the policy goals
Security, Liberty, Equity, Efficiency
Policy Analysis Triangle
(what) Content: Policy objectives, operational policies, legislation, regulations, guidelines etc.
(why) Context: systematic factors such as social, economic, political, cultural and other environmental conditions
(how) Process: The way in which policies are initiated, developed, or formulated, negotiated, communicated, implemented and evaluated.
(who) stakeholders
what is “rethink your drink”, Canada’s first SSBT?
In 2022, Newfoundland launched a tax on sugar sweetened beverage types with the goal to encourage healthier lifestyles. Revenues will fund the Physical Activity Tax Credit, prenatal infant nutrition supplement, and lunch programs
(container size/L) x tax rate
Where does the SSBT tax NOT apply
Exports
Retailers on an Indian Reserve
Anything containing alcohol
yogurts, milks, choc milk, RTDB under 75 mL, medical or Thera drinks like nutritional supplements
Canadian Public Health Ethics Framework
1) identify the issue and gather the relevant facts in order to clearly understand the problem
2) identify and analyze ethical considerations
3) identify and assess options in light of the Values and principles
4) select best course of action and implement
5) Evaluate
Normative Ethics
what is right and wrong, what is a good decision and a bad decision
(consequentialism, deontology, virtue ethics)
Ethical Principles
Prescriptive: offer recommendations for moral action
They are NOT values- “permanent, universal,and unchanging”.
Health care professions operate on a set of ethical principles that are morally established
Virtue Ethics - Aristotle
- Cultivation of virtuous habits: person-based rather than action- based
- Character is determining factor in deciding if someone is a good person
- Good people create good societies and good decisions
In health care: compassion, honesty, morally correct actions
Consequentialism or Teleology
Wrong things could be right if there is a morally good reason
e.g. Utilitarianism
Moral (correct) decisions are identified based on extent to which they promote more happiness than unhappiness for the greatest number of people
Ratio of happy: unhappy is not consistent
Options initially accepted as moral may be rejected in specific circumstances
Health care: professionals make decisions based on best interest of a particular collective of patients (e.g. quarantine)
Often lead to further moral issues/conflict
DEONTOLOGY OR DUTY-BASED
it is always wrong to lie, no matter the circumstances
* * Every person has an inherent dignity and value
* What is right or wrong vs. the consequences of the action
* Do the right thing - universal and applicable in all circumstances – even if it produces a bad result (certainty)
* First step is to identify the ‘morally correct’ choice and proceed from there
* The Hippocratic Oath and the Universal Declaration of Human rights are examples of deontology (Kant)
Casuistry
Essentially the case law of ethics
Precedent-setting situations
Need for similarly salient characteristics and moral issues
Previous cases are a social construct in terms of being reflective of prevailing ideology, popular culture, or societal bias
Feminism Approach
Skeptical towards traditional ethical concepts like autonomy * Social, political suppression of women
Often care focused and power focused
Compassion, freedom, equality
Distributive justice
In health care – Belmont Report, 1978
Ethical Principle: Personalism
Emphasis on human dignity and subjectivity cannot be reduced to material objects and natural instincts (Phenomenology)
Everyone should have access to wide possibilities of choice in treatment – therefore, need access to information to promote decision making
Dr Charlotte Blease… purpose of her talk
Not acknowledging how we think is equally problematic - this is a really critical idea
Genetics loads the gun, environment pulls the trigger. Are there bullets we have not really considered?
Implicit bias sinks into our behaviours
TB 1999
1999, 200 Tibetans came to the border into canada and asked for refugee status, 5 has active pulmonary tuberculosis.
Policy issues related: screening for communicable diseases, immigration policy, risk perception and federal-provincial relations
Media hyped it up to emphasize the public health risk which worked up anxieties
Latent TB
is not infectious
Active TB
infectious and deadly if left untreated
MDR-TB
a multi drug resistant TBH that costs 250,000 annual to treat
TB 2016
There were 1796 cases of active TB in 2017, increasing 2.6% from 2016
Incidence rate went from 4.8 to 4.9%
Foreign born individuals made up the majority of the cases
Incidence rate remained highest among indigenous people
IR was higher among males
Majority of cases were between 15 and 44 yrs old
IR was highest among adults over 75 years of age
Of the 2016 cases, 80.4% were treated successfully
2021 TB
1829 cases of active TB
Foreign and indigenous = most of the cases
One of the lowest TB rates in the world
What changes were made after the TB outbreak?
Toronto public health: instead of waiting 60 days for immigrants to present, the were identified at the border and sent to immigration officials, TB xray supplemented with TB skin test
Ontario Ministry of health: TB diagnosis and treatment services for uninsured persons (TB-UP)
Federal Gov: canceled health insurance services for refugees - but TB care would have been exempt as it is a risk to PH
Nov. 14 - the federal court of canada determined this was unconstitutional
Dec 2015 - IFHP
April 2016 - program fully reinstated
Types of screening
Mass Screening
Selective Screening
Multiphasic screening
Surveillance
Case finding
Population Surveys
Most cost effective way to handle the TB immigration concern
Most cost-effective way to deal with this screening
(not testing) - looks for possible symptoms but doesn’t test and diagnose
Screening
More likely to screen AT RISK populations than the general population (selective screening - homeless, FN, inuit people)
Multiphasic screening
might screen for multiple diseases, taking pockets of the population and multiple different points in time
Mass Screening
Costs of doing something can help save money in the long term (mass screening - pricking childrens feet to see if they have diabetes)
Surveillance
looking at data to suggest a condition is active in our environment or not (monitoring individuals OR populations)
Case Finding
actively go out and find them. You find one person who has TB and you connect who they’ve been around to specifically find the people that could have been exposed (food poisoning - find the source through case finding)
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
Canada Health Act 1984
Legislation: publicly funded health insurance
Protect, promote and restore wellbeing of Canadian residents, facilitate reasonable access to health care
Risk
Hazard + Exposure
Hazard
something that can potentially cause harm
Prevalence
measure of HOW MUCH of a particular disease exists in a population at a particular point
Incidence
measures the rate of occurrence of NEW CASES
Before a policy decision is made.. What should we do:
- inform a decision maker/stakeholder about the relevance of adopting a particular public policy; bias-free,
- advocate: aim is to promote the adoption of a public policy; you are an provide information advocate
- compare public policies to inform the DM process
MAIN PROBLEM WITH TB
Solving TB isn’t the issue, but multi-jurisdictional boundaries and restrictions complicated it!
Had to use expensive drugs
Constitution Act of 1982
is the Charter of Rights and Freedoms, includes the “Notwithstanding Clause”, recognizes the rights of Aboriginal peoples; recognizes the equalization payments process
