Week 4 Notes
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This 11 page Class Notes was uploaded by Dkrefft on Monday September 21, 2015. The Class Notes belongs to SPHU 1010 at Tulane University taught by Mark Dal Corso in Summer 2015. Since its upload, it has received 82 views. For similar materials see Intro to public health in Public Health at Tulane University.
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Date Created: 09/21/15
SPHU 1010 Notes 915 Precede and Proceed o Precede Social assessment Epidemiological assessment Behavioral and environmental assessment Educational and organization assessment Administrative and policy assessment 0 Proceed Implementation Process evaluation lmpact evaluation Outcome evaluation Public Health Law 0 Components of health care policy and ethics 0 Individual rights v public health 0 Public health in the colonies 0 Poor diseases Cholera Yellow fever 0 Urban I Small pox Tuberculosis 0 Police power power given to the states by the tenth amendment to protect public safety 0 Most public health laws at that state level 0 Police power the right of the states to protect the health of the citizens Criminal and Administrative Law 0 Public health departments are administrative agencies 0 Given broad authority to use their expertise to develop the most effective strategies for protecting the public 0 In the LA constitution the state officer can take such action necessary 0 Location of public health powers 0 States 0 Localities through state laws 0 Federal government only through fundraising and interstate commerce 0 Court hearings are not necessary before a public health action Some states mandated this to give individual more rights than under the constitutions Hearings take time and gives the judge the power to make the decision instead of the public health official 0 Federal Tort Claims Act FTCA provides a limited waiver to the federal government Sovereign immunity when its employees are negligent 0 A legislature cannot create and fund an agency which it then administrates It does not have this power 0 Statutes laws passed by the state legislatures or congress Ordinances laws passed by municipalities Regulationsrules detailed rules written by the executive branch of state or federal government such as the department of health is based on authorizing statutes 0 Limitations on power 0 Statutory limitations 0 Habeas corpus 0 Political limitations Areas of public health law 0 Environmental regulation 0 Disease and injury reporting 0 Viral statistics 0 Disease control 0 lnvoluntary testing 0 Contact tracing o Mandated treatment 0 Mandated immunization Quarantine 0 No hearing first but some states do 0 Individual rights v Public good 0 Dumping raw sewage 0 Raising and slaughtering animals for food 0 Selling food in storesrestaurants o Refusing measles vaccine 0 Refusing tb treatment 0 HIV positive person treatment nondisclosure 0 Health policy 0 Health in all policies 0 Can be made by government organization 0 Marketjustice individual responsibility for health 0 Social justice collective responsibility 0 Is there a right to health care 0 1948 Universal Declaration of Human Rights by World Health Organization 0 the right hasn t been generally established in the US 0 medicare and Medicaid can be seen as rights of individuals to medical care by legislative ac ons 0 Emergency Medical Treatment and Labor Act EMTALA 0 How does it balance Focus of responsibility differs by risk Notes 917 Public Health Ethics 0 Tuskegee study conducted by Public Health Study 0 Assessment of untreated syphilis o The participants were not informed of the purpose of the study 0 The treatments given were not true treatments 0 The Belmont Report established respect for person beneficence and justice 0 Informed consent 0 Weighing the risks and benefits to study subjects 0 Protecting the vulnerable individuals ie minors and pregnant women Ethical Decision making 0 Arrival at a morally defensible decision 0 O O Transparency lnclusiveness Reasonableness Responsiveness if the circumstances change the trials change Accountability 0 It s not always easy to know what to do 0 0 Conflict between principles Prolong life or prevent suffering Individual freedom v public good Privacy v transparency Respect for cultural differences v preventing disease Timely action v established effectiveness Public Health policy politics and practice Policies and Politics Rules Formal laws Customs Societal laws Define course of action selected from alternatives to determine decisions Criteria and contingencies Who gets what o Interplay of power and influence 0 Actions or deeds used to acquire or exert power over other people 0 Policies 0 For the basis of out Laws Written laws Guidelines 0 Adopted by Legislative bodies The government Private companies and organizations 0 Policies can address a multitude of items I Criminal law OHSA standards 0 Politics Rely on popular support 0 0 Rally behind a cause Figurehead or advocate O o Allows for experts on a topic to provide information 0 Steering of structures and institutions How Policies Improve Health 0 Shape the physical built and social environment 0 Bike lanes o Junk food ads Change things that impact health 0 Immunization 0 Drinking age Direct effect on behavior 0 Seat belts 0 Dietary guidelines Bringing issues to the limelight 0 Michelle Obama s Let s Move campaign 0 Drew Brees and Healthy Living Provide funding for projects Expert opinions put forth academics Provide direction for public and private organizations Generation Policy in America Multiple levels of policy Complex web of stakeholders 0 Government 0 Private sector 0 Interest groups 0 Citizen advocates o Academics and researchers Linear model doesn t always work Authority can be vague confusing overlapping widely distributed Stakeholders come and go Policy Approaches in Public Health 0 Advantages May cost little or nothing 0 O Impacts large numbers with small effort Long tasting O 0 Transparent and often times the most inclusive method 0 Disadvantages o Impacted large numbers which means one size fits all 0 Enforcement problems 0 Resistors to change ie backlash o Unintentional consequences ie needle restrictions 0 Time delay 0 Changes require politics 0 Policy entrepreneur 0 Anyone with a position of authority 0 Identify and define the problem Creates a problem if necessary 0 Sources of power 0 Formal authority 0 Resource control 0 Network position nubnexus 0 Expert knowledge 0 Communication 0 Representation 0 Personal characteristics 0 Advocacy 0 Any effort to influence decision making on a specific issue ie lobbyists interest groups 0 lnsider advocacy 0 Existing relationships 0 Very collegial Lobbyist Small group meetings One to one 0 Outsider advocacy o Confrontational o Emotional o Nontraditional 0 Meetings mailings demonstrations 0 Media advocacy o Expansive power and the central challenge 0 Paid media advertising you can control content 0 Earned media PR Chapter 6 Reading Notes Asymptomatic implies that they do not have symptoms related to the disease being investigated Screening implies the use of tests on individuals who do not have symptoms of a specific disease Epidemiologicalpublic health transition describes the changing patterns of disease that has been seen in many countries as they have experienced social and economic development Criteria for the ideal screening program 0 The disease produces substantial death andor disability 0 Early detection is possible and improves outcome 0 There is a feasible testing strategy for screening 0 Screening is acceptable in terms of harms costs and patient acceptance Lead time bias the early detection without an improved outcome False positives individuals who have positive results on a screening test but do not turn out to have the disease False negatives those who have negative results but turn out to have the disease True positives individuals who have a positive test and also have the disease Sequential testingconsecutive testing implies that an initial screening test is followed by one or more definitive diagnostic tests Simultaneousparallel testing two tests are used initially if one test can be expected to detect one type of the disease Baye s theorem is a mathematical formula that has very practical applications to interpreting the meaning of diagnostic and screening tests It provides the connection between the probability of the disease before the test is conducted and the probability of the disease after knowing whether the test result is positive or negative Pretest probability of a disease the probability of a disease before a test is conducted Posttest probability of a disease the probability of disease after knowing whether the test result is negative or positive These elements should be taken into consideration with Baye s theorem 0 The meaning of the pretest probability of a disease 0 The measures used to summarize the info provided by the results of a test 0 The meaning of the posttest probability of the disease when the test is positive and when negative Sensitivity the probability that the test will be positive in the presence of the disease positive in the disease Specificity the probability that the test will be negative in absence of disease negative in health lf positive the posttest probability of the disease becomes the predictive value of a positive lf negative the posttest probability that the disease is a absent is the predictive value of a negative Incremental cost effectiveness ratio this ratio represents the additional cost relative to the additional net effectiveness Current and developing applications of genetics 0 Genetic prevention 0 Genetic detection prior to disease 0 Geneenvironmental protection 0 Genotypic based screening for early disease
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