HS 3400: Week 2, Danger at the Gates

HS health policy, UWO

Naylor Report

2003

• creation of public health agency of Canada PHAC (2004)

• improved screening

• Pan Canadian public health network

What was the TB situation?

• in spring 1999, 200 Tibetans crossed into Canada and 5 had TB, MDR

• media hyped up story

Public Health

• health of populations

• prevention and promotion

population health

an approach to health that aims to improve the health of the entire population and to reduce health inequalities among population groups

Communicable disease transmission

direct, indirect (vehicle and vector), airborne

What is TB?

• direct transmission

• affects alveolar sacks, cant spread if you dont have symptoms

• infectious when the granuloma breaks open

Latent TB

non infectious, most cases, prophylaxis for at risk people

Active TB

infectious and deadly if not treated, adherence is important

MDR TB

multidrug resistant, VERY expensive

Framing

mental structures that people use to provide categories and a structure to their thoughts

• determines what stakeholders can participate

• determines processing of info 

The Tibetan TB problem can be frame din different ways

immigration problem, disease problem, public health problem, cost problem

Risk identification / perception

• decisions involve risk

• media alters perceived risk

prevalance

how much of a disease exists in a population at a time (total people with it)

Incidence

Measures rate of new cases (change)

TB in canada 2017

-2.6% increase

• foreign born were most cases

• highest in indigenous poeple

• 15-44 years of age

• 80% were treated

TB 2021

• most cases are foreign born and indigenous

• canada has lowest rate in the world

Policy is like lego, it involves…

ethical principles, stakeholders, levers, policies, institutional arrangements

Ethical decision making and the Precautionary Principle

• what is the morally right thing to do 

• autonomy, justice, beneficence, non-maleficence

• risk, intervention effectiveness, economic costs, burden, fairness

Types of screening

mass screening, selective screening, multiphasic screening, surveillance, case finding, population survey

Institutional arrangements

the policies, systems, and processes that organizations use to legislate, plan, and manage their activities

• choices, priorities, benefits, monetary costs, opportunity costs

British North America Act

• federal - responsible for quarantine and marine hospitals

• provinces - hospitals, asylums, charities, other institutions

What year is the Canada Health Act?

1984

What is the Canada Health Act?

• publicly funded health insurance

• protect, promote, and restore physical and mental wellbeing

• UPPAC

Canada Health Act 5 criteria and 2 conditions

• UPPAC - universality, public admin, portability, accessible, comprehensive

• information, recognition

Constitution Act 1982

• charter of rights and freedoms

• 7 parts - 1-4 is the charter of rights and freedoms, 6-7 amend the BNA Act

3 constitutional powers

• the spending power

• the power to pass laws for peace

• order and good government and criminal law power

Interim Federal Health Program (IFHP)

provides temprary coverage of health benefits to people in these groups

• protected persons, refugee claimants, and other

role of provincial government

public hospiptals and clinics, drug benefit plans, training of physicians, LTC

Role of Municipality

HPPA, vaccinations, disease tracking and treatment, sexual health

what year was the amalgamation of Metropolitan Toronto into one admin unit

1998

3 levels of government

it is a problem in a TB outbreak because of overlapping jurisdiction.

Additional Stakeholders

TB specialists, the media

The media controls…

timing, relevance, fame, human interest

Policy changes that resulted

• TB diagnosis and treatment services for uninsured

• cancelled funding for refugees in 2013 but brought it back in 2016

Canadian TB Screening Policy

Canada used two main mechanisms:

1. Pre-arrival screening (for active disease)

2. Post-landing “medical surveillance” (for those at risk of reactivation)

Ideological views differ:

1. Libertarian: minimal role (market-based solutions, individual freedom).

2. Social democratic: strong role (redistribution, universal programs).

3. Conservative: strong role in moral/social issues, limited economic interference.

Rights:

1. Negative rights: freedom from interference (e.g., liberty, speech).

2. Positive rights: entitlement to something (e.g., health care, housing).

Welfare-state models

1. Liberal – means-tested, modest benefits (U.S.).

2. Corporatist – linked to employment/social contributions (Germany).

3. Social-democratic – universal, equality-based (Scandinavia).

Accountability for reasonableness

Decisions must be transparent, relevant, appealable, and enforced.

Criteria for Screening

important health problem, recognizable early stage, reliable test for detection, Effective treatment exists, Facilities for diagnosis and treatment, Cost-effective and benefits outweigh risks, Ongoing program, Ethical acceptability

sensitivity

correctly identifies those with disease.

specificity

correctly excludes those without disease.

Positive Predictive Value (PPV):

likelihood that a positive result = true case.

Negative Predictive Value (NPV)

likelihood that a negative result = true non-case.