Chapter 8: Epidemiology and the Policy Arena

T/F Involvement of epidemiologists in the policy arena is growing.

True

Epidemiologists have many forms of expertise germane to ____________________.

policy development

How can epidemiologists contribute to public health policy?

1- performing research and sharing the results with others

2- joining policy-making bodies that have expertise in public health issues

3- contributing expertise to legal proceedings

4- offering expert testimony to the various policy-making arms of government from local to national

5- advocating on behalf of specific health policy initiatives

What are some policy rules for epidemiologists?

1- Provide quantitative data regarding proposed health policies

2- Help to demonstrate the effectiveness of policies

3- Take an objective stance with respect to data collection

4- Conducting and disseminating their own research

5- Serving on expert groups that make policy recommendations

6- Serving as an expert witness in litigation

7- Testifying before a policy-making body (e.g., city council or state legislature)

8- Working as an advocate (e.g., within a health-related coalition) to achieve a specific policy objective"

What are the Core Public Health Functions Steering Committee developed a framework for essential services?

1- Three core functions of public health: Assurance, Assessment, Policy Development

2- Ten essential public health services: monitor health; diagnose and investigate; inform, educate, empower; mobilize community partnership; develop policies; enforce laws; link to/provide care; assure competent workforce; evaluate; research

Of the ten essential public health services in the Core Public Health Functions Steering Committee developed a framework for essential services what can epidemiology aid with?

1- monitoring health status to identify and solve community health problems;

2- Diagnose and investigate health problems and health hazards in the community

9- Evaluate effectiveness, accessibility and quality of personal and population-based health services

What is a policy?

A plan or course of action, as of a government, political party, or business, intended to influence and determine decisions, actions, and other matters

What is a health policy?

A policy that pertains to the health arena, for example, in provision of healthcare services, dentistry, medicine, or public health

What aspects of health do public health policies apply?

water quality, food safety, health promotion, environmental protection

T/F Health policy is the same as law.

False, it's not the same as law but they are linked with the development of laws

What health policies are linked with the development of laws?

Licensing (e.g., licensing medical practitioners)

Setting standards (e.g., specifying the allowable levels of contaminants in foods)

Controlling risk (e.g., requiring the use of child safety seats)

Monitoring (e.g., surveillance of infectious diseases)

What is the policy cycle?

Refers to the distinct phases involved in the policy-making process

What are the stages of the policy cycle?

1- Problem definition, formulation, and reformulation

2- Agenda setting

3- Policy establishment (i.e., adoption and legislation)

4- Policy implementation

5- Policy assessment

Who are policy actors?

Individuals who are involved in policy formulation Include members of the legislature, citizens, lobbyists, and representatives of advocacy groups

Who are stakeholders?

Individuals, department, families, community, law enforcement- Individuals, organizations, and members of government who are affected by policy decision

What is legitimization?

The process of making policies fair, to be acceptable to the norms of society

What is an interest group?

A group of persons working on behalf of, or strongly supporting, a particular cause, such as an item of legislation, an industry, or a special segment of society

Environmental policies may incorporate ____________________.

environmental objectives

What are statements of objectives?

Statements of an environmental policy intended to be assessed using information from a monitoring program that must be adequate in its quality and quantity of data so that the environmental objectives can be assessed

What is an example of statements of objectives?

An example of a statement of objectives can be found on the Healthy People website (healthypeople.gov)

What does evidence-based public health refer to?

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

T/F One of the most reliable forms of evidence comes from randomized controlled trials.

true

What is an excellent website for trusted information about many health issues?

cochrane.org named after Archie Cochrane, a physician, Browse the Cochrane library

How are epidemiologic studies ranked?

Ranked for validity of etiologic inference

When ranking epidemiologic studies what types of studies are ranked lowest to highest?

Lower rankings for case studies, case reports, cross-sectional studies, ecologic studies

Higher rankings for analytic studies including case-control studies and cohort studies

Highest rankings for intervention studies, especially clinical trials

quasi-experimental studies (community interventions) are often the ___________________________.

only types of intervention studies that can be conducted

What are Computes cost-effectiveness (CE) ratios?

Involves dividing the costs of an intervention by its outcomes expressed as units (often deaths averted)

What are cost-effectiveness (CE) ratios used for?

CE ratios are compared for alternative programs and interventions to identify the least costly alternatives Facilitates the optimization of resources for public health programs

What is an example of cost-effectiveness (CE) ratio?

HIV prevention programs

What is decision analysis?

Involves developing a set of possible choices and stating the likely outcomes linked with those choices- Each of the possible choices may have associated risks and benefits

When conducting a decision analysis policy makes select what ideal alternatives?

the alternatives that minimize health risk and maximize desirable health outcomes and other benefits (unlike TX right now )

_____ involves the likelihood of experiencing an adverse effect

Risk

________________refers to a process for identifying adverse consequences and their associated probability

Risk assessment

What does Risk assessment calculated?

Calculates either qualitative or quantitative estimates of probability of undesirable outcomes, given exposure to a hazard

What are the risk assessment steps?

1- hazard identification

2- dose-responce assessment

3- exposure assessment

4- risk characterization

5- risk management

What are hazards?

the inherent capability of an agent or a situation to have an adverse effect on health

What is hazard identification or hazard assessment?

the examination of evidence that relates exposure to an agent with its toxicity and produces a qualitative judgment about the strength of that evidence that is derived rom human epidemiology or extrapolated from laboratory animal data

T/F Health effects range from reductions in lower level conditions (immune status) to catastrophic (mortality).

True

What is a dose-responce assessment?

The measurement of the relationship between the amount of exposure and the occurrence of the unwanted health effects

What does a dose-responce assessment examine?

Examines the quantitative relations between the experimentally administered dose level of a toxicant and the incidence or severity of a response in test animals

What is exposure assessment?

The procedure that identifies populations exposed to the toxicant, describes their composition and size, and examines the roots, magnitudes, frequencies, and durations of such exposures

Quality of exposure assessment determines the accuracy of ________ assessments

risk

What is a limiting factor of exposure assessment?

A limiting factor in risk assessment process especially when exposures occur at low levels

What is risk characterization?

the development of estimates of the number of excess unwarranted health events expected at different time intervals at each level of exposure

T/F Risk characterization integrates hazard identification, dose-response assessment, and exposure assessment.

True

What does risk characterization inform policy makers?

Provides policy makers with a synopsis of all information that allows an informed decision about what to do and Yields a synthesis and summary of information about a hazard

What is risk management?

actions taken to control exposures to toxic chemicals in the environment oriented toward specific actions

What are the actions of risk management?

Exposure standards, pre-market testing requirements, recalls of toxic products, banning of hazardous materials

What are three examples of public health polices?

Healthy People,

National Prevention Strategy,

Health in All Policies

What is the public health policy Health in All Policies?

A collaborative approach to improving the health of all people by incorporating health considerations into decision making across sectors and policy areas

What is the public health policy National Prevention Strategy?

aims to guide our nation in the most effective and achievable means for improving health and well-being by prioritizes prevention by integrating recommendations and actions across multiple settings to improve health and save lives.

What are some public health related laws and regulations?

smoke-free bar laws, trans-fat rules, Bisphenol A (BPA) rules

Why where the worldwide smoke-free bar laws implemented?

Implemented due to information about the health hazards that secondhand cigarette exposure presented in the work setting

Why were the trans-fats laws implemented?

consumption of manufactured hydrogenated vegetable oils is associated with adverse cardiovascular effects

What organization removed trans fats from processed foods?

U.S Food and Drug Administration

Why were laws implemented against the use of Bisphenol A (BPA) as an ingredient used in the manufacture of plastics.

because more than 90% of US populations have detectable levels in their urine and there is cause for concern that BPA exposures in fetuses, infant and children causes developmental changes

What government agency is responsible to ban the use of BPA in plastics but has not done it yet because "human data is not conclusive"?

USDA

What are ethics in research?

informed consent, freedom from coercion, protection from harm, risk-benefit analysis, deception, debriefing, confidentiality

____________ are the norms for conduct that distinguish between acceptable and unacceptable behavior.

Ethics

When discussing ethics in research it refers to ___________________.

Adherence to ethical norms

Why research ethically?

ethical research:

Promotes the aims of research (knowledge, truth, and avoidance of error)

Promotes values that are essential to collaborative work (trust, accountability, mutual respect, and fairness)

Helps to ensure that researchers can be held accountable to the public

Helps build public support for research

Promotes a variety of other important moral and social values (social responsibility, human rights, animal welfare, compliance with the law, and health and safety)

What is an example of a US ethical research violation?

U.S. Public Health Service Syphilis Study at Tuskegee Syphilis investigation from 1932 to 1972 Purpose was to "record the natural history of syphilis in hopes of justifying treatment programs for blacks"

A total of 600 African American men participated 399 syphilis cases and 201 syphilis-free controls. Never gave informed consent. Despite discovery of penicillin, men were never offered treatment. Class-action suit filed in 1973 resulted in a $10 million settlement plus medical and health benefits

Today universities and many health-related facilities maintain _____________________________________________ to ensure all research proposals that involve humans or animals meet requirements for informed consent and other ethical standards.

Human Subjects Review Boards/IRBs

What are the ethical guidelines of epidemiologists?

1-minimizing risks and protecting the welfare of research subjects

2- obtaining the informed consent of participants

3- submitting proposed studies for ethical review

4- maintain public trust

5- Meeting obligations to communities