Health Policy Week 2

What does health mean? 

• 
  

• Physical, social, and mental well-being 

• Understand health: absence of disease 

• 
  

Mortality: Life Expectancy 2018 

The United States not doing great on this 

For 2018, the U.S. had a life expectancy of about 78.7 years, and it lagged behind many other wealthy countries despite spending more on healthcare

Why was the U.S. lagging behind?

Factors include deaths from heart disease, drug overdoses, accidents, and differences in access to healthcare.

One important detail: life expectancy increased slightly from 78.6 years in 2017 to 78.7 in 2018, but remained below its 2014 peak of 78.9 yea

infant mortality rate 2018 

 

United States doing worse compared to other countries

WHO DEFINITION OF HEALTH

• “A state of complete physical, mental and social well-being

and not merely the absence of disease or infirmity

• 
  

Yes

PERSPECTIVES

• “This definition guarantees health care, professionals

unlimited opportunities for work, but is not of much

practical use.”

--American Journal of Public Health, 199

]

• Each bucket we do not have all 100% fulfilled 

• Ont this defintion works for healthcare professionals to measure health 

• f health includes complete physical, mental, and social well-being, then almost everyone could be considered unhealthy in some way. That makes it difficult to use the definition to measure health or determine who needs health care

PERSPECTIVES

• “The new goal is not to merely minimize the risks for

disease but to seek the maximum potential for living.”

--Lester Breslow, 200

• Running brings joy , body place where you can do all things love professors father 

• Health means doing tings that beings you joy 

• 
  

Lester Breslow is saying that health is more than just preventing illness.

Instead of only asking:

“How can we avoid getting sick?”

We should also ask:

“How can we help people live their healthiest, fullest lives?”

Example

• Old goal: Reduce the risk of heart disease.

• New goal: Also help people have energy, good mental health, strong relationships, and a high quality of life.

Key idea to remember:

Health ≠ just avoiding disease.
Health = reaching your maximum potential for living.

Example

Imagine a person who doesn't have diabetes, heart disease, or any major illness.

• Minimize disease risk: They exercise and eat healthy foods to avoid getting sick.

• Maximum potential for living: They also exercise to have more energy, build friendships, manage stress, sleep well, and enjoy life.

👉 The point: Being healthy isn't just “not being sick.” It's also being able to live your best and fullest life.

Yes

PERSPECTIVES

• “Health and well-being are quite distinct experiences.

Having a serious disease is likely to make you less happy,

but not having a serious disease does not amount to

Happiness” Lancer

Simple meaning

This quote means that being healthy and being happy are not the same thing.

• Having a serious illness can make someone less happy or lower their quality of life.

• But not being sick does not automatically mean you are happy.

Example

Someone might be:

• Physically healthy ✅

• No serious diseases ✅

• But stressed, lonely, or unhappy ❌

So, health ≠ happiness.

Easy way to remember:

“Not sick doesn’t mean happy.”

Yes

PERSPECTIVES

• "I learned that health was to be had at a

certain cost. Thus, I am now better than I

was, but not happier.”

—Sigmund Freud, 1930

…upon quitting smoking

Freud is saying that becoming healthier can sometimes come with a cost.

In this case, he quit smoking, which improved his physical health, but he didn't feel happier because he gave up something he enjoyed.

Example:

🚬 Before quitting:

• Less healthy ❌

• Smoking made him feel pleasure/relief ✅

🚭 After quitting:

• Healthier ✅

• Missed smoking and wasn't necessarily happier ❌

Yes

Health is abstract; what it means to you 

Yes

Example fisherman 

• Older fisherman go fishing every day at the river, enjoyed nature and fish home, oen day he's fishing and sees someone floating, and he tried to save him from drowning, pulls out, sees two people are now drowning, he tries to save all of them but he can’t, 

• He then sees a walking trail and a missing slide; the people are falling into the river of the missing 

• THINGS FOR SOLUTION  prevent dealth/drowning 

• Repair bridge - primary prevention, stop being from falling 

•  Close trail - primary prevention - can’t fall in 

• Life vest - secondary, you already fell but try to stop things from getting worse 

• Warning sign/ranger - primary prevention, 

• Build another bridge - primary prevention 

• Lifeguards - tertiary prevention 

• Net - tertiary 

• Build another bridge 

• Requiring swim training before the trail - secondary prevention 

• Less pretty scenery - primary prevention 

• Hiking with someone - all of them 1st, 2nd, 3rd (life guard friend) 

• Drain river - 2nd 

• Blocking River - 2nd 

Yes

PRIMARY PREVENTION

•

Prevention methods used to avoid the occurrence of disease

• Most health promotion programs fall into this prevention category

•

Primary prevention example

Examples

– Immunizations

– Health education about diet and exercise

– Legislation and education about seatbelt and helmet use

– Exams and screening tests to monitor risk factors for illness

• Blood pressure and cholesterol screening

– Maintaining a safe home and workplace

• Baby-proofing one’s home

• Ergonomic workstation

PREVENT DISEASE OR NEGATIVE HEALTH OUTCOME BEFORE IT EXISTS 

Example - seatbelt, vaccines, helmet, health education, sex education, environmental changes (no smoking areas and water stations) 

Yes

SECONDARY PREVENTION

• Prevention methods that focus on early detection of disease to

prevent it from progressing and causing further harm

Secondary Prevention Example

Examples

– Breast and prostate cancer screening at age milestones

– Treating hypertension to prevent stroke or heart attack

– Taking aspirin daily to prevent a second heart attack

– Providing modified work duties for injured workers

– HIV testing

ALREADY OCCURED AND PREVENT FURTHER WORSE OUTCOMES 

• Examples - screenigs, annual visit, hiv testin g

Yes

TERTIARY PREVENTION

• Preventive methods that focus on managing existing health conditions

to prevent them from worsening and to improve the quality of life for

those affected

•

Tertiary Prevention Example

Examples

– Chronic disease management programs

– Rehabilitation

– Patient support group

BLENDING OF PREVENTION

LEVELS

•

Sometimes it is difficult to classify a prevention method as primary,

secondary, or tertiary

• Example: chronic back pain

– Symptoms come and go

– Stretching viewed as primary prevention when free of pain, but tertiary

during an episode of back pain

PREVENTABLE DEATHS

• United States last among 16 high-income, industrialized nations in deaths

that could have been prevented (2026 Commonwealth Fund Report)

• Smoking, hypertension, and overweight leading causes of preventable

death – unintentional injury, cardiovascular disease, cancer, respiratory

disease, and diabetes (Garcia 2024)

• Cigarette smoking costs more than $600 billion a year(i.e., $320 billion in

lost productivity plus $240 billion in health care expenditures) (Shrestha

2022)

• Secondhand smoke costs more than $7 billion (i.e., health care

expenditures, morbidity, and mortality) (CDC 2024)

• Obesity costs $173 billion in annual medical costs (CDC 2024

• USA worse with disease and preventing deaths, with preventable deaths

• Hypertension and overweight 

• EX. overdose, smoking, overweight - preventable deaths 

• Expensive preventable programs 

•  Major strain in our healthcare system 

• The United States lags other countries: mortality amenable to health care 

• Things have gotten a bit better but are still worse compared to other countries 

• 
  

• REASONS WHY USA WORSE

• Economic demands of the United States (documentary says doctors focus on making money and limited time with patients) 

• Gun violence is one thing that sets us apart from other countrie

US PREVENTIVE SERVICES

TASK FORCE

• The USPSTF is an independent panel of non-Federal experts in

prevention and evidence-based medicine and is composed of primary

care providers.

• The USPSTF conducts scientific evidence reviews of a broad range of

clinical preventive health care services (such as screening, counseling,

and preventive medications) and develops recommendations for

primary care clinicians and health systems.

– These recommendations are published in the form of "Recommendation Statements."

• AHRQ's Prevention and Care Management Portfolio provides ongoing

administrative, research, technical, and dissemination support to the

USPST

• How we end up making decisions 

• Video notes 

• Taks reviews all on preventive services; each member is an expert in disease prevention 

• Most are practicing primary care prevention and preventive medication 

• Final recommendation is published; enough evidence needs to be prevent 

• Primary care clinics and families have the knowledge to prevent disease and take care of their health 

US PREVENTIVE SERVICES

TASK FORCE

• For the Task Force to recommend a service

– benefits outweigh the harms

– maintenance of health and quality of life

The Task Force recommendations

– highlight the opportunities for improving delivery of effective services

and have helped others provide preventive care in different populations

– have formed the basis of the clinical standards for many professional

societies, health organizations, and medical quality review groups

• PSA screenig men 55-69  video 

• Cancer moerality rate 

• Task force does not 

• Grade c recommendation - offer or prvided psa screening - change from grade d long term trail increase use of active psa survilcen 

• Black men more likely to get prostate cancer and twice as likely to die from it than white men 

Black men would benefit greatly from this screening 

Ebenits to not eigth out false positive, clincns should discuss use fo psa screening 

Benefits do not outweigh the cost of harms 

Yes

USPSTF – LETTER GRADES

A* : Recommends that all clinicians offer or provide a service because there

is high certainty of a substantial net benefit

B* : All clinicians should offer or provide a service, but there is only a high

certainty of a moderate net benefit

Insurance covers grade A and B 

C : A service should not be universally offered. Instead it should be left to

the individual patient and clinician to decide whether the net benefit is

worth the cost and potential harms.

D : A service should not be used, because there is at least a moderate

certainty of no net benefits, or that harms outweigh the benefits

*ACA dictates that A & B recommendations must be covered with no out-

of-pocket payment regardless of coverage ty

\

Insurance covers a and b

Alcohol misuse counseling - grade b 

Diabetes screening grade b 

Tobacco use counseling and intervention, non-pregnant adults grade A 

Obesity screening and counseling children grade b 

Yes

IMMUNIZATIONS

• If individuals chose not be vaccinated, they can…

– Infect other people by passing a disease along

– Put some “at-risk” groups in danger

• 3 groups at risk?

Partially vaccinated babies - babies do not all shots at once, later on in life 

• People with compromised immune systems (cancer, HIV)

• People who have received an organ transplant

Herd immunity

– Applies to contagious diseases (e.g., measles or mumps)

– The vaccinated portion of a population (or herd) protects the unvaccinated portion

from getting the disease.

– In general, the portion of the population that needs to be vaccinated is around 90%. The

Yes

CDC sets a goal to have 90% of the population vaccinated for most disease

Yes

• Now there is an antivaccination movement 

• Someone said that vaccines cause autism 

• Very small sample and should not have been published 

• Example: Jenny McCarthy, a celebrity; she is an antivaccinator and has an autistic son 

• Republicans - antivaccinators and Democrats - vaccinators 

• Higher educated people are part of anti vaccinator movenement of measles 

• Measles outbreak: measles outbreak, professor refused to take her daughter before getting vaccinated  

• Disease still in population, eradicted disease are coming back since Covid 19 

• John Oliver delivers information 

Yes

Herd immunity 

90-95% of the population is vaccinated to protect people who can’t be vaccinated (like babies) 

Babies get shots but they later get vaccines 

• Some people get vaccines , blue people are healthy and not vaccinated 

• Yellow people are vaccinated - 

• Red are not 

• More people vaccinated in right image, disease spreads less

Yes

ADVISORY COMMITTEE ON

IMMUNIZATION PRACTICES

• ACIP consists of 15 experts in fields associated with immunization

– Selected by the Secretary of the U. S. Department of Health and Human

Services to provide advice and guidance

• to the Secretary, the Assistant Secretary for Health, and the Centers for Disease

Control and Prevention (CDC)

• on the control of vaccine-preventable diseases.

– In addition to the 15 voting members, ACIP includes 8 ex officio members

who represent other federal agencies with responsibility for immunization

programs in the United States, and 30 non-voting representatives of liaison

organizations that bring related immunization expertise

The role of the ACIP is to provide advice that will lead to a reduction in

the incidence of vaccine preventable diseases in the United States, and an

increase in the safe use of vaccines

ADVISORY COMMITTEE ON

IMMUNIZATION PRACTICES

• The ACIP develops written recommendations for the routine

administration of vaccines to children and adults in the civilian

population

• Recommendations include:

– age for vaccine administration,

– number of doses and dosing interval

– precautions and contraindications

• The ACIP is the only entity in the federal government that makes such

recommendations.

Understanding the ACIP and Vaccine Recommendations in the

ACIP

ACIP RECOMMENDATIONS FOR CHILDREN 0-6 YEARS VACCINESS

Child is born 

Get other vaccines 

Get others 

Yes