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UMB / Kinesiology / KNES 400 / school of public health umd

school of public health umd

school of public health umd


School: University of Maryland
Department: Kinesiology
Course: Foundations of Public Health
Professor: Shannon jette
Term: Fall 2016
Tags: Public Health, Policy, PhysicalActivity, Privatization, parks, Recreation, Facilities, US Healthcare System, Healthcare, intervention, and evaluation
Cost: 25
Name: KNES 400: Foundations of Public Health Weeks 8 and 9
Description: These notes cover the past 2 weeks of class, including: Policy and Physical Activity, Privatization of Parks and Recreation, The Healthcare System, Issues in Intervention and Evaluation, and Beauty Salons as a Site of Health Intervention (example).
Uploaded: 10/31/2016
9 Pages 141 Views 0 Unlocks

Policy and PA III: Privatization of Parks and  Recreation Monday, October 17, 2016 11:41 AM I Parks and Recreation: What is the Future? a Urban and Metro Parks: National Recreation and Parks Association and  other interested parties hosted roundtable to discuss future of parks i Laid out challenges ii Brainstormed possible solutions  II Parks and Recreation: Possible Solutions? a Varying degrees of privatization i Free vs. Fee? 1 Those with less money are discouraged to pay and receive  health benefits  ii Partnerships with other government agencies and non-profit  1 Ex. Police departments -- fight crime and encourage health 2 Possible chance to taking police from jobs ii Donations from private individuals and corporations  1 Ex. Subaru donating to parks and recreation facilities  II The Public-Private Spectrum a Privatization of public resources is a multi-dimensional process that can  exist in varying degrees  b Fully Public Completely government funded Public Parks Operate like public utilities Outsource Public sector provides money but outsource services to private  firms Private Ownership  by Non-profits Private benefit more

I Parks and Recreation: What is the Future?

∙ Model Definition Advantages Disadvantages Full Public  Model Park  management  fully  government  funded ∙ Substantial  public  involvement  ∙ Inclusive  decision  making ∙ Parks available  for use by all  with little ∙ Requires non users to pay  through taxes ∙ Large  maintenance  range

cost  ∙ Everything has  to be  transparent -- nothing can  be hidden

Public  Parks Public parks  operate like  public utilities,  where users pay some or full  amount  Similar to utility  bills ∙ Non-users do not have a tax  burden  ∙ Responsive to  user/custome r demands  ∙ Fees increase  facility  development  and  commercializ ation  ∙ Goal of  preservation ∙ Fluctuating fees  discourage  lower-income families ∙ Excludes people  that cannot  pay ∙ Dependent upon weather and  tourism -- can lead to over commercializ ation Outsourci ng Public provides  funding, but  private firms  compete for  production  rights ∙ Competition  keeps costs  low and  maintains  flexibility  ∙ Eliminates  barriers ∙ Cut corners to  make money  ∙ Short-term profit - little room  for growth  ∙ Decreases high  paying  government  jobs Private  Ownershi p ∙ Non-profit: Local  and state  groups  privately own parks ∙ No tax burden ∙ Non-profit -- goal is more than  profit making ∙ Rely on private  corporations ∙ Less  transparency

ii Other who ask: is it really that transformative?

We also discuss several other topics like swetools

-- things can  be hidden

I Discussion: Parks and Rec a Have no money -- have acres of land for parks that need maintenance  i Created private public resources  b In-Class Videos i Fully private parks 1 Government parks transformed into privately owned parks  a Government pays above market prices for below market  work b Include commercialization i To help fund things  ii Ex. Funded wifi -- signs  2 Privatized mass transportation ii Reserving Park Space can become dangerous  Policy and PA (IV): The Healthcare System Wednesday, October 19, 2016 11:19 AM I Recent History a The past 30 years  i Increase in cost-sharing mechanisms  i Ex. Co-payments and deductibles -- moral hazard  ii Health Maintenance Organizations (HMO's) i 1981 Reagan signed legislation that ended federal support of  HMO's and instead system promoting HMO's as investment  opportunity (for-profit) ii Medicare and Medicaid move from government run to private-sector  market based management b Affordable Care Act i Workplaces with less than 50 employees must offer private employer sponsored health insurance ii Each state to have health insurance exchange to sell private health  insurance plans in regulated fashion iii Medicaid programs: individual below 133% FPL entitled to public  insurance i Means-tested : drug tests can hold negative connotation  ii Important changes to health industry practices: i End to pre-existing condition clauses, cannot revoke after one  becomes sick  ii No lifetime limits iii Under 26 eligible to be on parents' plan ii Questions on both sides of the political spectrum i Number of attempts to circumvent/dissolve by those who view it as too much government  ii Other who ask: is it really that transformative? 1 Many left uninsured or under-insured2 Leaves intact a system predicated on key neoliberal health  care benefits a Primacy of health consumerism, and the essentiality of the private health insurance industry  ii Not how Obama intended it to be 1 Key stakeholders = corporations (health insurance industry  and pharmaceutical industry)  2 Corporate interest takes away from helping ALL families  ii In-Class Video i Young women with lung disease, leaving her with only one lung ii Stuck in the gap -- not rich enough to qualify for Obamacare, but too rich to qualify for Medicaid  b Rise of Neoliberal Policy --> Health and well-being transformed from being a "public issue" to being a privatized "personal trouble"  i Commercial privatization of the health and wellness sector  i In the 70's exercise was not common and seen as "Cookey"  ii In the 80's exercise became popular --> better health, less  money spent on health care ii Exponential Growth of Health and Fitness Industry i From 1990's, # of Sports Clubs and Health Club Industry  Revenue has grown exponentially  ii Blurring of Health and Beauty i Outer body has come to symbolize one's moral worth -- health is inscribed on surface of the body ii Attractive body = Healthy body iii Ex. Downtown YMCA compete against Upscale Gyms II Expression of Neoliberalism -- Rise of "Healthism" a Healthism: a belief that health can be achieved unproblematically through individual effort and discipline, directed mainly at regulating size and  shape of body  b According to neo-liberal ideology of healthism: i Fit and healthy and morally, physically, and socially responsible ii The unfit and unhealthy are morally, physically and socially  irresponsible i Not just exercise and a good diet will help someone lose weight  b Health Outcomes/Disease Patterns Theories: c Healthism Social Determinism Individual health and well being are a direct result of  an individual's lifestyle  choices Considers that social,  economic and political  context within which  individual health behaviors  are both formed and occur Neo-Liberal  ideology=health privatized and commercialized Emphasis on social aspects of  health (poverty,  unemployment, poor housing, lack of PA spaces) and root  causes of ill health

a What do you think about PA?

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Issues in Intervention & Evaluation Monday, October 24, 2016 10:10 AM I Class Activity a What do you think about PA? What do Latinos want from PA? b Community Leader involved -- personally relates to culture  i Trust involvement ii Helps w/ education  b Dancing - fun social form of physical activity compared to jogging  c Family activity i Especially women, children  b Latino music -- salsa i Not just one style  b Take weight at beginning, middle and end of the program  i If they don’t want to, they can still participate  II 3 Common Categories of PA Intervention: used by community guide for all  program interventions  a Informational: change knowledge and attitudes about the benefits of an  opportunities for PA within community --> LEAST EFFECTIVE i Examples 1 Community-Wide Campaigns  a Include many community sectors; very visible, broadly  targeted strategies i Ex. TV ad plus community event 2 Mass Media Campaigns a Ex. Smoking -- young girl smoking in mirror and aging --  smoke cancer -- goal is to attract eyes and concern viewers  2 Classroom based health education programs a Ex. Concussion education  2 Point of Decision Prompts -- piano stairs to encourage people  taking stairs instead of escalator  b Behavioral and Social: teach behavioral management skills for success  adoption and maintenance of behavior change and/or creating social  environment to facilitate change i Example: Heart and Soul PA Program 1 Women aged 35-65 years from 4 churches in 2 rural  communities 2 A 12 week program consisting of weekly meetings and a  program booklet 3 Intervention: walking video, individual PA program, pedometers,  4 Control: pamphlet  5 Measures: baseline, weeks and 12 weeks -- time spent in PA,  energy expenditure  6 Results: not statistically significant but increased time spent in  PA, energy expenditure, and perceived support for PA in  intervention group  b Environmental and policy: directly influence organizations and physical  structures to try achieve longer term, more sustainable results --> MOST  EFFECTIVE i Example: Natural Experiment in Austin, TX 1 Inside neighborhood, total recreational walking, all recreational  activity, and outside neighborhood  II Intervention vs. Program a Intervention Program Researchers- top  down Community based- up down Test compared to  control/placebo group Assessing value of program  while making it the best it  can be Rigorously designed  (researchers) Controlled by those involved  (stakeholders) Internal validity Usefulness/feasibility Tightly controlled Holistic and flexible Specific timeframe Ongoing

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b Intervention translation i Efficiency Testing: 1 Standardized  2 Random design 3 Implemented by research staff following strict protocol ii Effectiveness Testing 1 Adapted to setting 2 Randomized, time series 3 Quasi-experimental 4 Implemented by variety of different staff ii Community Implementation  1 Widespread implementation in community setting  b Found that dissemination did not lead to community implementation i Dissemination: targeted distribution of info and intervention  materials to specific PH or clinical practic audience ii Implementation: use of  II Working with Vulnerable Populations a Well-known, extreme abuses i Tuskegee Syphilis Study: 1 Conducted by US Public Health Services  2 Recruited people and informed them only of free medical care,  food, and burial services during study  3 When cure was found, they did not provide it to subjects  because they wanted to see long-term effects ii Fight over DNA of the Havasupai Indians 1 Misuse DNA by Arizona State  2 Using science to disprove science within tribe  b Unethical history creates relationships in the future  i Distrust remains1 Suspicion due to past medical/research abuses, as well as  history of marginalization  a HIV prevention in blacks 2 Distrust due to more subtle form of disrespect a Rise of research focusing on chronic diseases means  researchers often looking at specific communities that are  more at risk of chronic illness i Lifestyle interventions ii Screening b Helicopter remains  2 Continuum of Community Partnership Models a Top-down/Least: community is just a setting for research i Program identified by top structure (government) in  the system down to the community ii Focus on lifestyle and behavior compliance iii Ex. Health education b Bottom-Up/Most: community based participatory research  i Community identifies itws own problems and  communicates these to the top structures ii Outside agent = support factors, work as a team,  transforms their power over to a power with  relationship where the community shares and  increasingly takes control of the program  iii Empowerment of individuals and communities  2 Categories = goals  3 Top-down Bottom-up = intervention  Beauty Salons as a Site of Health Intervention  (used as example for Assignment 2) Wednesday, October 26, 2016 11:09 AM I Historical and Social Context of Beauty Salons  a African American beauty salons: women-centered basis makes it seem as  if there is no significance -- advocating voting  i Could function as an institution in a political way, worked best if: 1 Women are connected to civil rights movements 2 Women w/ salons attached the their houses  ii Spaces are still being used to benefit health 1 HIV/AIDS intervention 2 Domestic violence  II BEAUTY Project: Bring Education And Understanding To You  a Settings Intervention: addressing health disparities by reaching people  where they live  b Disparity: Black women are dying more from all cancers compared to  other races  i WHY? Class Discussion 1 Quality of healthcare/treatment - regular practitioner vs. general care  2 Transportation and access to receive healthcare 3 Women typically carry "caretaker" role and tend to not focus on  themselves  4 Living conditions 5 Nutrition  6 Chronic stress --> weathering effect along with social decisions  7 Also a gendered issue  ii WHY? Statistics show 1 Later stage of diagnosis: differences in access to and utilization  of early detection  2 Quality of care more generally: disparities in quality of treatment -- access to surgery and rehabilitative services 3 History still influences the stigma in healthcare for African  Americans  b North Carolina BEAUTY and Health Project i "Applied a community-based participatory research process and a  Political Economy of Health theoretical perspective with an aim  toward addressing disparities in health among African American  women" 1 Political economy of health: general viewpoint that emphasizes  history, economics, politics, and society shape and influence  health and health outcomes  ii Complemented by Micro-level theories  1 Cognitive behavioral theories: knowledge, beliefs, self-efficacy  II The Intervention Process: Concurrent and Continuous  a Effective = Change  i Need baseline measurements at beginning  b Steps i Assessment: community analysis, formative evaluation ii Planning: goal/objectives, select activities, adequate resources iii Implementation: process evaluation  iv Evaluation: results = change 1 Impact Evaluation: immediate outcomes 2 Outcome Evaluation: long-term outcomes b The Process leading up to the RCT i Created an advisory board to explore possibility of partnering w/  beauty salons  ii Survey of salon owners and stylists to assess interest  1 80% response rate 2 Felt more comfortable talking about diet and nutrition ii Observational study w/ 10 beauty salons  1 Need to understand the flow of the salon -- don’t intervene ii Pilot Intervention: 2 Salons 1 Goal: promote PA and veggie/fruit consumption 2 Strategies: a Educational displays b Stylist training workshops ii Focus Groups: used to hone intervention strategies  b Study Design i Groups 1 10 of salons got only educational displays2 10 got tailored magazines 3 10 got trained cosmetologists 4 10 got both  5 All got the educational displays  II Hierarchical Axis a Above Water factors: i Social support: stylist-customer interactions  ii Access to health promoting environment: salon b Underwater Factors: i Beliefs, attitudes ii Knowledge
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