HTW 403 Exam 2 study guide
HTW 403 Exam 2 study guide HTW 402
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This 7 page Study Guide was uploaded by Alyson Forman on Monday November 16, 2015. The Study Guide belongs to HTW 402 at Syracuse University taught by L. Narine in Summer 2015. Since its upload, it has received 38 views. For similar materials see Implem & Eval of Health Programs in Public Health at Syracuse University.
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Date Created: 11/16/15
1. What is the hierarchy of research evidence and can you distinguish among the studies that comprise the hierarchy, how was the hierarchy applied in the context of studying the effects of the red bull drink? • Association between Red Bull consumption and improved academic performance among medical students • Hierarchy of Research Evidence: the lower the number the higher the study quality. Type II studies are better than type IV, etc. • II. Well designed experimental study • III. Well designed quasi-experimental type study • IV. Well designed non-experimental study • V. Clinical examples and expert opinion Whats missing?- strengthening evidence for a causal link between Red Bull and academic • performance • Use results from previous studies to apply for funding for a prospective cohort study 2. What do we mean by critical evidence of research evidence and how is the strength of evidence graded? • Critical Appraisal of Evidence: ensures relevance and transferability of evidence from the search to the speciﬁc population for whom the care will be provided or the policy will be applied • 1. Assessing the strength of the scientiﬁc evidence • Strength of evidence graded on quality, quantity, and consistency 2. Evaluating the research for its quality and applicability to health care decision making • 3. What are the types of communities that organize to change health policies, can you identify what are the typical and good practices used by communities to organize, can you distinguish between the different sources from which lessons have come about community change and the lessons unique to the various sources? • communities, neighborhoods, union workers, farmers, ethnic groups, religious groups, elderly, disables • Good community Practices: social planning, social action, local development, community coalition • Lessons Learned About Community Organization and Change: Understanding Community Context: high proﬁle commissions and reports create conditions • for experimentation and optimism about public problem solving. you may need to use more than 1 model of community organization practice to ﬁt the variety of contexts in which community work is done. crosscutting issues are good contexts for practice. Community organization cant always be separated from politics or controversy. Poor people can make substantial gain or losses during periods of tumultuous change, and related realignment of political parties. Social planning can engage experts in helping address societal problems. • Community Planning: Action and Mobilization. Each individual has the capacity for self- determination, self-help, and improvement. You cant do it by yourself. Strong leaders are present in even the most economically deprived communities. Community practitioners should never get used to the terrible conditions they see in community work. People’s beliefs and values enable them to stay committed. Work of community org. is like that of a secular church. • Understanding Opposition & Resistance: Societal problems sometimes serve the interests of those in power. Racial and ethnic tension and controversies have disrupted and destroyed many community org. efforts. School action tactics, such s disruptive protest, have many detractors. Less in your face social action approaches can produce a strong political base from which to make change. Opposition to change may be like an onion • Intervention and Upkeep of Efforts: The strategy of community org. should ﬁt the situation. using multiple strategies usually has an advantage over any single strategy. Being in 2 cultures promotes creativity. The work of community org. takes time and follow-through. External support may be both a necessity and a trap for community orgs. Community orgs. often fade away. Orgs. need small wins. • Promoting Community Change: The central ideal of community org. practice is service. Community org. must go beyond the process of bringing people together. Primary need is not for individuals to adjust to their word, but for environments to change so people can attain their goals. Community-based orgs. can function as catalysts for change. Inﬂuencing Broader Change: The levels of intervention should reﬂect the multiple levels that • contribute to the problem. Systems change does not occur simply by reporting felt needs to appointed or elected ofﬁcials. The great power of social movements is in communicating a different vision of the world. Community orgs/ should seek changes within their power to manage. Community and broader systems change can be brought about through collaboration. • Achieving Community-Level Improvement: Societal problems often reoccur. Most community effort chip away at the problem. Real change is rare. Development of community leadership may be a positive byproduct of even a failed community effort. Optimal health and development for all people may be beyond the capacity of what communities may be beyond the capacity of what communities can achieve, but not beyond what they should seek. 4. What is the Belmont report and its major ethical principles that have shaped the ethics of research in the U.S, what are the differences between ethics, morals and ethical codes, what do most ethical codes include, what are the considerations when reporting research results, and what should you ask yourself when faced with ethical challenges? • Belmont Report- the major ethical statement guiding human research in the U.S • Belmont report major ethical principles: respect for persons, beneﬁcence, justice • Ethics: process of examining moral standards and looking at how we should interpret and apply such standards in real world situations • Morals: rules that deﬁne what is right and wrong Ethical Codes: AMA, APA, CRC. Help or beneﬁt others, do no harm, act fairly, respect others • • When Reporting Research Results: should be reported in an honest, accurate manner, cant massage data to ﬁt hypotheses, cant make up or report false results, must report what is found, should ensure data is being collected consistently, should give proper credit to those who have earned it 5. What are the roles and functions of federal, state and local governments in health policy and the basis for their involvement, how can the levels of care in our health system be categorized and what is their relationship to health policy, and what are the major policy goals of our health system? • Roles of Federal: regulation of commerce, funding of public health programs, provision of care for special populations, research, coordination of federal agencies • Roles of State: Community health assessment, public health policy development, assurance of public health service provision to communities, continuity between federal public and local public health Roles of Local Gov: may be city and/or county-based, provide mandated public health • services, enact and enforce public health codes as mandated by state and federal ofﬁcers, two models • Levels of care: preventive (family planning), primary (physician ofﬁce), secondary (hospital inpatient care), tertiary/quaternary (speciality hospital), restorative (rehabilitation), continuing (skilled nursing facilities, assisted living) • Goals of health care system: access, quality, efﬁciency (often competing) 6. Do you know the major federal health care regulatory agencies and for what they are responsible, what kinds of global organizations are involved in health policy and in what ways are they involved? Federal Health Care Regulatory Agencies: Dept. of Health and Human Services- major federal • actor in healthcare regulation, Other agencies: CMS, NIH, HRS, IHS, FDA, CDC, AHRQ, SAMHSA, USDA, EPA, Homeland Security, Dept. of Energy, OHSA • Global Agencies: WHO, UNICEF, UNAIDS, World Food Program, World Bank, Inter American Development Band, Asian Development Bank, USAID • WHO: policy development, coordination • UNICEF, UNAIDS, World Food Program: vaccinations, availability of HIV/AIDS drugs, food assistance • World Bank, IADB, Asian Development Bank: funding for human capital projects, health reform, technical assistance • USAID: maternal and child health, HIV/AIDS, Food 7. How are laws related to health policies, what are the various forms of health policies, can you distinguish between laws, policies, rules/regulations, judicial decisions, operational decisions and macro policies, what are the two main categories of health policies and their subtypes, can you give examples of these categories and subtypes of health policies? • Forms of Health Policies: laws, rules/regulations, operational decisions, judicial decisions, macro policies • Health policies: public policies or authoritative decisions that pertain to health or inﬂuence the pursuit of health. Affect or inﬂuence groups or classes of individuals or orgs. Public or private • Public Health Policy Categories: allocative & regulatory • Allocative: designed to provide net beneﬁts to some distinct group of class or individuals or orgs. at the expense of others, in order to ensure that public objectives are met. Come in the form of subsidies • Regulatory: policies designed to inﬂuence the actions, behaviors, and decisions of others to ensure that public objectives are met. 5 categories: social regulations, quality controls, market-entry decisions, rate or price-setting controls, market-preserving controls • Social Regulations: established in order to achieve socially desirable outcomes and to reduce socially undesirable outcomes. Targeted or broad ex. environmental protection, childhood immunization, mental health parity laws. • Quality Controls: intended to ensure that health services providers adhere to acceptable levels of quality in the services they provide and that producers of health-related products meet safety and efﬁcacy standards. Ex. FDA regulation of pharmaceuticals, P4P regulations Market-Entry Restrictions: focus on licensing of practitioners and orgs. Ex. Health professional • licensing, physician credentialing • Rate or Price Setting Controls: designed to control growth of prices. Ex. federal gov. control of rates of reimbursement to hospitals that participate in Medicare Market-Preserving Controls: establish and enforce rules of conduct for market participant. Ex. • antitrust legislation & rules about insurance coverage • Constitution: establish government and delineate fundamental rights and obligations of individuals and governments • Statues: created by legislatures at all levels of gov., state legislatures have greater scope to use statutes than federal legislatures • Regulations: created by gov. agencies to implement statues and clarify their ambiguities • Common Law: court opinions interpreting and applying law to speciﬁc cases • Laws: a rule of conduct or action prescribed or formally recognized as binding or enforced by a controlling authority. Enacted by any level of gov. Can also be referred to as a program • Rules/Regulations: designed to guide the implementation of laws, can be made in the executive branch by the org’s, agencies responsible for implementing laws • Operations Decisions: made by the executive brand of the gov. as a part of the implementation of a law. Normally decisions consist of protocols and procedures that follow the implementation of a new law. These decisions tend to be less permanent than rules/regs. • Judicial Decisions: policies that are created as a result of a decision made in the court system. Constitutional, civil, criminal • Macro Policies: broad and expansive and help shape a society’s pursuit of health in fundamental ways. Almost all have some basis in law ex. anti-tobacco laws 8. Can you ﬁll in the boxes in the table described in the lecture on “how health laws relate to health policies” i.e. how are various health organizations and agencies involved with the various forms, categories, and subtypes of health care policies; can you identify potential policies to address the obesity program and how would they be characterized in terms of forms, categories, and subtypes of policies? • Schools- Legislation: nutritional standards for school lunch programs. Admin. Regulations: school district policy banning sugar-sweetened beverages from vending machines. Judicial Decisions/Litigation: Suits against school boards that permit schools to accept money from soft drink companies in exchange for exclusive vending rights • Community. Legislation: taxation of non-nutritious foods. Subsidies for producers or buyers of nutritious foods. Admin. Regulations: restrictions on use of food stamps to purchase non- nutritious foods. requirements for nutrition labels on foods. Judicial Decisions/Litigation: claims against manufacturers of non-nutritious foods for product defects and unfair business practices. • Schools. Legislation: physical education requirements in public schools. Admin. Regulations: school district policy that implements a program to increase after school physical activity. Judicial Decisions/Litigation: suits against education ofﬁcials who cut physical education from public school curriculum 9. What are the major debates/tensions about health policies and what are speciﬁc concerns about the information revolution in health care, genetic and brain technologies, demographic changes, and public private arrangements in health care? • 10. How are ethics, morality, values and health policies related, what are the major ethical typologies, their focus and approaches, what are the ethical distinctions around personal responsibility, moral hazard and the free rider problem and how are they related to ethical approaches, what role does law play in ethical concerns around policymaking, how do ethical approaches relate to health policies and programs such as the Veterans and Indian Health Services, Medicare and Medicaid, mandatory immunization, obesity and so on? Ethics, Morality, Values and Health Policies: the moral values of our society are the basis of • many of our laws and policies. Community standards are also inﬂuenced by social values. health related social values • Ethics: distinction between right and wrong. moral values. rights, duties, and obligations. societal norms • Typologies: Teleological Ethics, Deontological Ethics • Teleological Ethics (utilitarianism): the rightness or wrongness of an action or policy is assess by its consequences, speciﬁcally by looking at the comparative balance of positive vs. negative. • Deotonological Ethics (Duty Based): there is an inherent rightness or wrongness to an action or choice, regardless of the outcome or consequence. Certain obligations are considered an ethical duty, and should not be subject to utilitarian reasoning. The Rights Approach, The Fairness or Justice Approach, The Common Good Approach, The Virtue Approach • The Free Rider Problem: those who beneﬁt from goods or services don't ay for them • Moral Hazard: when one person takes more risks because someone else bears the burden of those risks • Right to Due Process: “Fairness” • Right to Equal Protection: no state shall deny to any person within its jurisdiction the equal protection of the laws. prohibits race-based and other forms of discrimination • Cruel and Unusual Punishment: governs treatment of incarcerated individuals • Habeas Corpus: the privilege of the writ of habeas corpus shall not be suspended, unless when in cases of rebellion or invasion the public safety may require it. directed to person detaining another to bring the prisoner before a court judge • 11. How does resource allocation relate to the healthcare market, how is the health care market diff. from other markets, what are the necessary conditions of competitive markets, why do health care markets fail and what are some important aspects of market failures in healthcare? • Resource Allocation and The Market: demand, supply and the market. sources of failure in the market for healthcare. the insurance system of funding health care. resource allocation in the absence of the free market • Necessary Conditions for Competitive Market: • 1. no barriers to entry to exit (large numbers of independent buyers and sellers) 2. Consumer bears costs and receives beneﬁt • • 3. Consumer has perfect information on cost and beneﬁts • Why Healthcare Markets Fail: uncertainty, imperfect information and knowledge imbalance, monopoly & oligopoly, externalities, equity • How healthcare market differs: Health care transaction with an insured patient involves three parties. Typical market transaction involves 2 parties • How medical market is different: presence of uncertainty, prominence of insurance, large role of not-for-proﬁt providers, role of equity and need 12. How does the health insurance market affect supply and demand in health care and what are some of the determinants of health insurance? Demand: consumers purchase those commodities which, subject to their income constraint, • maximize their utility. willingness and ability to pay for a commodity at each and every price, over a given period of time, subject to all else being constant • Determinants of Demand: full price of the commodity, prices of other commodities, consumer income/weather, consumer tastes/needs, quality • 13. Do you understand what the concepts of supply, demand, determinants of supply and demand, moral hazard, adverse selection, supplier induced demand, co-payments and health risk pooling mean and their relation to health policies? • Supply: ﬁrms produce those commodities which, subject to capacity, maximize their proﬁt. Willingness and ability to sell a commodity at each and every price, over a given period of time, subject to all else being constant • Determinants of Supply: price of the commodity, prices of factors of production, state of technology, other goals of ﬁrm, number of sellers • Adverse Selection: insurance may cover more high risk than low risk individuals. If too many high risk cases are covered, there will be excessive payouts, the insurance company will lose money, premiums will have to rise further, and the insurance company will eventually close • Supplier-Induced Demand: provider version of moral hazard. Providers create a demand beyond the amount the well-informed consumer would have chosen. It is debated whether supplier-induced demand actually occurs. • Moral Hazard: because a consumer doesn't pay the full cost of a good, the consumer may purchase more than goods than he would otherwise purchase without insurance. Full insurance means money cost facing consumer=zero. Leads to excess demand. Once insured against x, x more likely to occur • Importance of Adverse Selection in Pooling Health Risk: variation in individual cost extremely wide, signiﬁcant proportion of variance in individual cost is predictable, high cost of insurers acquiring knowledge 14. What were the important features of the 2 international CBPR studies discussed at the end of the course including the actions resulting from the research, and what are the similarities and differences in how CBPR is done internationally vs. being done in the U.S? • You Cant Clap With One Hand: learnings to promote culturally grounded participatory action research with migrant and former refugee communities. Ethnographic study with young Assyrian women who experienced tension with bottom-up, participant-centered and social change-oriented ideals of PAR. Women wanted adults in community to understand desire to adapt Assyrian cultural norms so they could ﬁt in between in New Zealand society. Conduct research with rather than on people. Participant centered. Participants as co-researchers. Social change. Focus groups and semi-strutted interviews. Proposed photo voice project • Bride Price in Uganda: high prevalence of HIV/AIDS. Purpose: explore inter-relations between bride-price, domestic violence, and poverty. Develop local action plan. Participatory research led by local partners. Random contact of interviewees. Joint reﬂection meetings. Two round tables. Collaborated on design of sensitization model. Solutions: action plan: petition to make practice of bride price unconstitutional, Torero Bridal Gifts Ordinance, training and capacity building, community sensitization • 15. What are the differences between concepts such as relational collectivism, egalitarianism, hierarchical stratiﬁcation, acculturation, cultural adaptation, and cultural maintenance? • Hierarchical Stratiﬁcation: high power distance, ways societies ensure members behave responsibly and co-exist well with each other • Relational Collectivism: network of interpersonal relationships • Egalitarianism: belief in human equality • Acculturation: cultural modiﬁcation of an individual, group, or people by adapting to or borrowing traits from another culture Cultural Adaptation: the process and time it takes a person to assimilate to a new culture. • ensuring your message is presented using cultural references and role models that your intended audience will identify with • Cultural Maintenance :
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