epi & policy

safety policies

• Most important safety feature - seatbelts 

• Sometimes when a policy is introduced, not everyone is on board with the idea

how can public policy impact health?

• creation/regulation of public goods

• regulation of natural resources

• requirements & mandates to protect citizens

• direct support

• creation of opportunities & incentives

epi and public health

• At the end of the process when it is implemented, we as epidemiologists determine whether is is working properly

• After a policy is implemented we continue to monitor (over years) if the policy is working 

  • Assessment and continuing assessment 

epi and policy

• At the very beginning of the policy process, we need to see if there is an issue we need to fix 

  • We present it to the policy legislators (people making the policies) 

• We try to get the message out to the public 

• When the policy is released we see if the strategy is effective 

• We look at quantitative and qualitative evidence 

• **Sometimes public policies aren’t implemented due to political pressure

the essential services of public health

1. monitor health status to identify and solve community health problems

2. diagnose and investigate health problems and health hazards in the community

3. (9). evaluate effectiveness, accessibility, and quality of personal and population-based health services

policy

a plan or course of action (government) to influence and determine decisions, actions, etc.

health policy

• laws, regulations, organizational practices, and funding priorities

• have a substantial impact on the health and pop well-being

• influence nearly every aspect of daily life

polices ≠ laws

• Laws require certain behaviors

• Policy development leads to the development of laws

  • licensing (licensing medical practitioner)

  • setting standards (levels of contaminants in food)

  • controlling risk

  • monitoring/surveillance

policy actors

• individuals involved in policy formulation

  • members of the legislative, citizens, lobbyists, representatives, or advocacy

policy cycle

epidemiologist fits in at the:

• Start: problem (definition/formulation/reformation)

• agenda setting

• policy establishment

• policy implementation

• policy assessment

stakeholders

individuals, organizations, and members of government who are affected by policy development

society

especially w/ legitimization - making polices legitimate, meaning to be acceptable to the norms of society

interest group

non-profit and usually voluntary org whose members have a common cause for which they seek to influence public policy, without seeking political control

• business groups, trade unions, religious groups, and professional associations

agenda setting

• lack of information on risks = difficult to prioritize

• lack of coordination among government agencies

implementation

• political and social contexts

• may stimulate/impede creation & implementation of public health policies

• effective campaigns to block policy initiatives

evidence-based public health

adoption of policies, laws, and programs that are supported by empirical

evidence based medicine movement (archie cochrane)

use of clinical trials for substantiating the efficacy/safety of medical practices

evidence-based policy

• empirical data varies in quality

• evaluation of most public health polices=quasi-experimental

• cost-effectiveness (cost-benefit) analysis (CEA) = dividing the costs of an intervention by its outcomes expressed as units (deaths averted)

• identifies the least costly alternatives

• optimizes resources for public health programs, esp when resources are scarce

decision analysis

• developing a set of possible choices

• stating likely outcomes linked w/ choices (risks/benefits)

• selecting alternatives that minimize health risks and maximize desirable health outcomes and other benefits

  • any activity has a risk

risk assessment

• a process for identifying adverse consequences and their associated probability

• calculates either qualitative or quantitative estimates

• can include input of various data

• identifies and alleviates potentially harmful situations that could injure individuals, communities, or ecosystems (environmental)

• risk varies greatly; in our professional context = morbidity/mortality

dread/unknown risk

• Dread risk - how much we dread the event 

• Unknown risk - how much do we know about the event

risk assessment process

hazard identification —> dose-response assessment —> exposure assessment —> risk characterization

what is hazard identification?

• Anything that has a negative impact on our health

  • Chemical, biological, behavioral, physical, social, etc

hazard process

• Examines evidence associating exposure to an agent with its toxicity

• Results in a qualitative judgment about strength of that evidence

• Using human epidemiology or laboratory animal data

• Health effects may range from dramatic outcomes (mortality or cancer) to lower-level conditions (reduced immunity)

dose response

• Measures quantitative relationship between the amount of exposure and the

occurrence and severity of the unwanted health effects

• Domain of toxicology, the science of poisons. In their research

• Start with test animals, draws inferences for humans

exposure assessment (process)

• look at the pop that are actually exposed 

  • Where is it occurring, how are they affected

• identifies populations exposed to toxicant, describes their composition and size, and examines roots, magnitudes, freqs, durations of exposures

• Quality of exposure data affects accuracy of risk assessment (it is known to be one of the weaker aspects of human risk assessment processes)

• Factors in

  • where the exposure occurs

  • how much exposure occurs

  • how substance is absorbed by body.

company personal records

occupational health research

• older records = used for retrospective cohort studies

• sources of employment records could include: personal identifiers, demographic characteristics, info about potential confounding variables

personal identifiers

to permit record linkage to social security administration files and retrieval of death certificates

demographic characteristics

length of employment, and work history with the company

information about potential confounding variables

such as the employee’s medical history, smoking habits, lifestyle, and family history of disease

biomarkers

correlated with exposure to potential carcinogens and other chemicals

• changes in genetic structure

risk characterization

• developing est. of the number of excess unwarranted health events expected at different time intervals at each level of exposure

• synthesis and summary of info about a hazard (that is iterative) to address the needs and interests of decision makers and interested/affected parties

• how to successfully communicate it to the public 

  • Present it to the public in a way that is easy to understand

  • Leads to decision/policy making

risk management

• Actions taken to control exposure to toxic chemicals in
  the environment. Examples:

  • Exposure

  • Standards requirements for premarket testing

  • Recalls of toxic products

  • Banning of very hazardous
    materials

• develop a policy to manage the issue

national prevention strategy

• healthy & safe community environments

• clinical & community preventive services

• empowered people

• elimination of health disparities

health in all policies

• health

• transport

• housing

• work

• nutrition

• water and sanitation