Public Health Test 1 and Test 2 Material

The United States gives more money in development assistance for health than any other single country. True False

True

The system of global health governance was originally set-up with the World Health Organization (WHO) at the center of decision-making. True False

True

No data exists to show that having health as a human right matters for health in a country. True False

False

Public health ethicists often define utility as producing benefits. True False

False

State sovereignty is not in tension with the interdependence of global governance problems. True False

False

The IHR (2005) only applies to a limited set of named diseases. True False

False

The Universal Declaration of Human Rights has the effect of binding law on signatory states. True False

False

The World Health Organization primarily relies on binding instruments such as treaties, regulations and conventions to accomplish its global health goals. True False

False

The majority of member states have established the core capacities required under the IHR (2005). True False

False

In global health, priorities are most often set by those with the most financial power. True False

True

Most of the United States' development assistance for health goes toward HIV/AIDS. True False

True

Match the accountability challenge to the correct type of accountability (top-down or bottom-up) using the case of Ebola. A. Bottom-up B. Top-down 1. Information from experienced Ebola responders in Uganda changing the response of the World Health Organization 2. Healthcare workers in Ebola Treatment Units report shortages of essential supplies to the Ministry of Health and pressure them to provide more of these supplies. 3. The World Health Organization shames the government of Sierra Leone for not reporting cases according to the timeline specified in the IHRs. 4. The governments of affected countries shame the global community for not having mobilized sufficient resources to aid in the management of the outbreak. 5. The World Health Organization headquarters in Geneva decides to fire the employees of the WHO Africa Regional Office for failure to follow the IHRs.

1: A. Bottom-Up 2: A. Bottom-Up 3: B. Top-Down 4: A. Bottom-Up 5: B. Top-Down

Match the requirement under a Right to Health (as defined under the International Covenant on Economic, Social & Cultural Rights) to its designation as a core entitlement or an inclusive underlying determinant. A. Core entitlement B. Underlying determinant 1. System of health protection providing equality of opportunity for everyone to enjoy the highest attainable level of health 2. Safe drinking water 3. Adequate supply of safe food 4. Access to essential medicines 5. Equal and timely access to basic health services 6. Maternal, child and reproductive health 7. Gender equality 8. Healthy occupational condition

1: A. Core Entitlement 2: B. Underlying Determinant 3. B. Underlying Determinant 4. A. Core Entitlement 5: A. Core Entitlement 6: A. Core Entitlement 7: B. Underlying Determinant 8: B. Underlying Determinant

Rank the following sectors in order of greenhouse gas emissions (1=most polluting to 5=least polluting). A. Electricity Production B. Transportation C. Industry D. Commercial and Residential Buildings E. Agricultural Production

1: A. Electricity Production 2: B. Transportation 3: C. Industry 4: D. Commercial and Residential Buildings 5: E. Agricultural Production

Match the type of disease-related stigma to the correct definition or underlying factor. A. Instrumental stigma B. Symbolic stigma 1. Fear-based 2. Based in harsh moral judgement 3. Diseases that transmit quickly/easily are more likely to have this type of stigma. 4. Diseases that are caused by risk behaviors deemed inappropriate are more likely to have this type of stigma. 5. The more severe the disease, the more likely it is to have this type of stigma.

1: A. Instrumental Stigma 2: B. Symbolic Stigma 3: A. Instrumental Stigma 4: B. Symbolic Stigma 5: A. Instrumental Stigma

Match the definition of health to the field of practice. A. Medicine B. Public health 1. The absence of disease or symptoms. 2. A state of complete physical, mental, and social wellbeing.

1: A. Medicine 2: B. Public Health

Match the definition to the term. A. Private goods. B. Public goods. C. Merit goods. 1. Commodities distributed through economic markets. 2. Non-rival and non-exclusionary goods requiring government provision to prevent an undersupply or negative externalities. 3. Rival and exclusionary goods requiring government provision as they are considered priceless and crucial to societal welfare.

1: A. Private goods 2: B. Public goods 3: C. Merit goods

Match the global health governance reform proposal to the author. A. Smith and Lee 2017 B. Jamison et. al 1998 C. Ooms and Hammond 2016 1. To make the World Health Organization responsible for functions related to the promotion of global public goods and interventions to deal with international externalities. 2. To move beyond the outdated model of slow, bureaucratic organizations such as the World Health Organization into systems of network governance. 3. To make the World Health Organization the legislative organization of global health governance. 4. To make the World Bank responsible for assisting countries with greater need for development. 5. To make the Global Fund for AIDS, TB, and Malaria into a general Global Fund for health with mandatory financial contributions.

1: B. Jamison et. al 1998 2: A. Smith and Lee 2017 3: C. Ooms and Hammond 2016 4: B. Jamison et. al 1998 5: C. Ooms and Hammond 2016

Match the human right established under the Universal Declaration of Human Rights to the nature of the right. A. Negative Right B. Positive Right 1. Safe food and adequate nutrition and housing 2. Freedom from torture 3. Access to essential medicines 4. Freedom from non-consensual medical treatment 5. Prevention, treatment and control of diseases

1: B. Positive Right 2: A. Negative Right 3: B. Positive Right 4: A. Negative Right 5: B. Positive Right

Match the accountability challenge to the correct type of accountability (top-down or bottom-up) using the case of MDR-TB. A. Bottom-up B. Top-Down 1. Clinicians ensuring patients take their medicines. 2. Patients advocating for better treatment options at the World Health Assembly. 3. Donors withdrawing funding from an MDR-TB program that is not saving people's lives. 4. Civil society organizations naming and shaming specific clinics for running out of necessary medications using Twitter. 5. The World Health Organization requiring the timely reporting of surveillance data on MDR-TB cases from member states.

1: B. Top-Down 2: A. Bottom-Up 3: B. Top-Down 4: A. Bottom-Up 5: B. Top-Down

Match the standard for assessing achievement of right to health to its description. A. Health facilities, goods and services are respectful of medical ethics and culturally sensitive B. Services are scientifically and medically appropriate C. There are enough public health and health care facilities, goods, services and programs in a country D. Health facilities, services and goods must be within safe physical reach, be affordable and impart information and ideas concerning health issues 1. Availability 2. Accessibility 3. Quality 4. Acceptability

1: C. There are enough public health and health care facilities, goods, services and programs in a country 2: D. Health facilities, services and goods must be within safe physical reach, be affordable and impart information and ideas concerning health issues 3: B. Services are scientifically and medically appropriate 4: A. Health facilities, goods and services are respectful of medical ethics and culturally sensitive

Rank the following organizations from 1 (the least) to 4 (the most) in terms of how much money they spend on global health annually. A. The Global Fund for AIDS, TB, and Malaria B. The Gates Foundation C. The World Bank D. The World Health Organization (regular budget only)

1: D. The World Health Organization 2: A. The Global Fund for AIDS, TB, and Malaria 3: B. The Gates Foundation 4: C. The World Bank

An outbreak of a novel influenza virus has progressed to the point that the World Health Organization has declared a pandemic. Despite a vaccination campaign and other measures, rates of morbidity and mortality have increased such that the number of patients needing hospital beds has overwhelmed capacity. To meet the challenge, a teleconference has been scheduled between several members of local hospitals' administration, the critical care unit directors from each hospital, and public health officials leading the pandemic response. As a public health official who played a central role in developing the pandemic plan for your jurisdiction, you have been included on the call to provide guidance for the pandemic response. You expect several of the hospital administrators who will be joining the conference call to have a utilitarian perspective on the ethical issue. Which of these statements might you expect them to make? A. "So long as our triage scheme saves the most lives, it is ethically justifiable" B. "The community's perspective on allocation of our resources should be our guidepost" C. "We should not just aim to save lives, but rather save lives fairly" D. "The plan should be revised to allow that the most seriously ill patients with the lowest probability of being saved might be left untreated because their care would require too many resources with too little prospect of recovery"

A. "So long as our triage scheme saves the most lives, it is ethically justifiable" D. "The plan should be revised to allow that the most seriously ill patients with the lowest probability of being saved might be left untreated because their care would require too many resources with too little prospect of recovery"

An outbreak of a novel influenza virus has progressed to the point that the World Health Organization has declared a pandemic. Despite a vaccination campaign and other measures, rates of morbidity and mortality have increased such that the number of patients needing hospital beds has overwhelmed capacity. To meet the challenge, a teleconference has been scheduled between several members of local hospitals' administration, the critical care unit directors from each hospital, and public health officials leading the pandemic response. As a public health official who played a central role in developing the pandemic plan for your jurisdiction, you have been included on the call to provide guidance for the pandemic response. Assume that one participant in the conference call is a social worker from a local hospital who you know to have an egalitarian perspective. Which of the following statements might you expect them to make: A. "We should not just aim to save lives, but rather save lives fairly" B. "During a public health emergency, the goal of saving lives sometimes requires sacrifices of equity" C. "Quantifying and judging the value of one life over another could disproportionately impact particular population groups" D. "A disproportionate impact on certain population groups might be acceptable so long as affected parties had fair input into the decision-making process during the planning stage"

A. "We should not just aim to save lives, but rather save lives fairly" C. "Quantifying and judging the value of one life over another could disproportionately impact particular population groups" D. "A disproportionate impact on certain population groups might be acceptable so long as affected parties had fair input into the decision-making process during the planning stage"

Which of the following are effects of a country undergoing an epidemiological transition: A. As a result of access to healthcare and medicine, infant mortality rates and deaths from infectious disease drop B. Issues of equitable access to healthcare services are resolved C. Risk of exposure to infectious disease disappears D. Developing countries often face a dual burden of communicable and non-communicable disease E. None of the above

A. As a result of access to healthcare and medicine, infant mortality rates and deaths from infectious disease drop D. Developing countries often face a dual burden of communicable and non-communicable disease

In Ochieng v. Attorney General of Kenya, what did Ochieng (and the other petitioners) argue? A. As persons living with HIV-AIDS, their right to health under Kenya's Constitution was violated because they were denied access to essential medicine B. As persons living with HIV-AIDS, their right to health under Kenya's Constitution was violated because they were denied equitable distribution of health goods and services C. As persons living with HIV-AIDS, their right to health under Kenya's Constitution was violated because they were denied the right of access to health facilities, goods and services on a non-discriminatory basis, considering they are members of a marginalized group D. As persons living with HIV-AIDS, they are entitled to the newest, patent-protected drugs at reduced costs E. As persons living with HIV-AIDS, they are a special class for which Kenya has positive obligations to ensure they do not face uncertainty about access to generic drugs

A. As persons living with HIV-AIDS, their right to health under Kenya's Constitution was violated because they were denied access to essential medicine E. As persons living with HIV-AIDS, they are a special class for which Kenya has positive obligations to ensure they do not face uncertainty about access to generic drugs

Which of the following are components of essential public health services (select all that apply): A. Assessment B. Policy Development C. Assurance D. Accessibility E. None of the above

A. Assessment B. Policy Development C. Assurance

Which of the following are key components of climate change adaptation? A. Better infectious disease surveillance and control. B. Installation of air conditioning. C. Relocation of vulnerable people. D. Swimming lessons for all coastal communities. E. Construction of sea walls.

A. Better infectious disease C. Relocation of vulnerable people. E. Construction of sea walls.

Which of the following are steps the world needs to take for rapid decarbonization? A. Bring emissions from agriculture and deforestation to zero. B. Electrify all forms of transportation (except for airplanes). C. Remove gigantic amounts of carbon dioxide from the atmosphere. D. Lift restrictions on the production of oil, natural gas, and coal. E. Cut greenhouse gas emissions from industry and energy production in half each decade.

A. Bring emissions from agriculture and deforestation to zero. B. Electrify all forms of transportation (except for airplanes). C. Remove gigantic amounts of carbon dioxide from the atmosphere. E. Cut greenhouse gas emissions from industry and energy production in half each decade.

How are priorities set at the World Health Organization? A. Bureaucrats and technical experts within WHO can decide what to prioritize within their respective programs. B. Each member state gets one vote on policies and resolutions in the World Health Assembly. C. Civil society can use international law to hold WHO accountable for meeting their health priorities. D. Donors can establish other priorities for the WHO using earmarked, extra budgetary funds. E. Donors can withdraw funding if they do not like the priorities of the organization.

A. Bureaucrats and technical experts within WHO can decide what to prioritize within their respective programs. B. Each member state gets one vote on policies and resolutions in the World Health Assembly. D. Donors can establish other priorities for the WHO using earmarked, extra budgetary funds. E. Donors can withdraw funding if they do not like the priorities of the organization.

US tobacco litigation affected the global approach to tobacco control in which of the following ways: A. Documents released by the tobacco companies in the course of litigation were utilized by governments of other countries to regulate tobacco B. The global health community cooperatively engaged with tobacco companies to lower the prevalence of smoking C. Global perceptions about the risks of smoking changed in response to information about how tobacco companies manipulated consumers D. Members of civil society, including health care workers, researchers, trial attorneys, anti-tobacco activists, local governments and others, banded together against tobacco companies as a common enemy E. The tobacco companies agreed to support the creation of the Framework Convention on Tobacco Control

A. Documents released by the tobacco companies in the course of litigation were utilized by governments of other countries to regulate tobacco C. Global perceptions about the risks of smoking changed in response to information about how tobacco companies manipulated consumers D. Members of civil society, including health care workers, researchers, trial attorneys, anti-tobacco activists, local governments and others, banded together against tobacco companies as a common enemy

Which of the following scenarios are potential trolley problems presented while working in an Ebola Treatment Unit? A. Clinicians create a protocol mandating that health care providers begin their rounds with the healthiest patients first, starting with patients who do not have confirmed Ebola, to prevent the potential spread of the virus within the Unit. B. Clinicians create a protocol for providers to spend no more than two hours in a protective suit due to concerns over dehydration, and they have a shortage of providers. C. Clinicians have received a small quantity of ZMapp, a potential treatment for Ebola, which they are allowed to give to patients. They do not have enough to give to everyone, so they have to decide on criteria for who will or will not receive treatment. D. Clinicians create a protocol to clean all gear and equipment with bleach to prevent the potential spread of the virus within the Unit. E. Clinicians receive a shipment of faulty protective suits and they have to decide if it is worth risking their lives to treat the patients already in their care.

A. Clinicians create a protocol mandating that health care providers begin their rounds with the healthiest patients first, starting with patients who do not have confirmed Ebola, to prevent the potential spread of the virus within the Unit. B. Clinicians create a protocol for providers to spend no more than two hours in a protective suit due to concerns over dehydration, and they have a shortage of providers. C. Clinicians have received a small quantity of ZMapp, a potential treatment for Ebola, which they are allowed to give to patients. They do not have enough to give to everyone, so they have to decide on criteria for who will or will not receive treatment. E. Clinicians receive a shipment of faulty protective suits and they have to decide if it is worth risking their lives to treat the patients already in their care.

The United States has ratified which of the following global governance instruments: A. Constitution of the World Health Organization B. International Covenant on Civil & Political Rights C. Universal Declaration of Human Rights D. International Covenant on Economic, Social & Cultural Rights

A. Constitution of the World Health Organization B. International Covenant on Civil & Political Rights C. Universal Declaration of Human Rights

Which of the following are requirements and rights stipulated in TRIPS that countries are currently responsible for fulfilling? This includes the original document and the clarifications of the Doha Declaration and August 2003 Waiver. A. Countries have the right to issue a compulsory license in times of threat to the public health. B. Low and middle-income countries were given until 2016 to change their national patent laws. C. Countries are required to grant patents in all fields, including medicines and food products. D. Countries are required to offer national patent protections for a minimum of 20 years. E. Compulsory licenses can be used for both domestic generic medicines production and for importing generic drugs from other countries if domestic production is not possible.

A. Countries have the right to issue a compulsory license in times of threat to the public health. B. Low and middle-income countries were given until 2016 to change their national patent laws. C. Countries are required to grant patents in all fields, including medicines and food products. D. Countries are required to offer national patent protections for a minimum of 20 years. E. Compulsory licenses can be used for both domestic generic medicines production and for importing generic drugs from other countries if domestic production is not possible.

Which of the following statements correctly describe directly-observed treatment short-course (DOTS)? A. DOTS programs take a top-down approach to accountability in treatment adherence. B. It primarily includes first-line treatment for drug responsive TB. C. It was largely unsuccessful in terms of managing MDR-TB. D. All stakeholders at the global level agreed it was the best solution for TB. E. It was largely unsuccessful in terms of mobilizing resources from donors.

A. DOTS programs take a top-down approach to accountability in treatment adherence. B. It primarily includes first-line treatment for drug responsive TB. C. It was largely unsuccessful in terms of managing MDR-TB.

Which of the following are consequences of the period of neglect at the global level for tuberculosis? A. Diagnostic technologies are too basic to be useful in diagnosing drug resistance. B. There are no alternatives to highly toxic second-line drugs. C. Primary treatments are more than 50 years old. D. HIV/AIDS co-infection is often unrecognized. E. Donors have emphasized treatments that are cheap, not necessarily treatments that are the most effective.

A. Diagnostic technologies are too basic to be useful in diagnosing drug resistance. B. There are no alternatives to highly toxic second-line drugs. C. Primary treatments are more than 50 years old. E. Donors have emphasized treatments that are cheap, not necessarily treatments that are the most effective.

Under the International Health Regulations, which of the following individuals/groups declare a PHEIC? A. Director-General of the WHO B. World Health Assembly by majority vote C. Regional Office affected by the PHEIC D. Emergency Committee by majority vote E. The national government of the affected country

A. Director-General of the WHO

Assume that a country has ratified the International Covenant on Economic, Social and Cultural Rights (ICESCR). While this country is working to realize the full requirements of the ICESCR, its leaders should maintain which of the following core obligations to comply with the requirements of a right to health: A. Essential medicines as defined by the World Health Organization B. Equitable distribution of all health facilities, goods and services C. Access to food, basic shelter, housing, sanitation, and water D. Non-discriminatory access to health facilities, goods and services, especially for vulnerable or marginalized populations E. Achievement of highest attainable standard of physical and mental health for its population

A. Essential medicines as defined by the World Health Organization B. Equitable distribution of all health facilities, goods and services C. Access to food, basic shelter, housing, sanitation, and water D. Non-discriminatory access to health facilities, goods and services, especially for vulnerable or marginalized populations

Which of the following are reasons why policy-makers have avoided implementing outright bans on dangerous products such as cigarettes: A. Fear of creating or growing a black market B. Avoidance of excessive infringement on personal autonomous choice C. There is no data showing that a ban would reduce prevalence of smoking D. The tax revenue generated by the sale of tobacco products is substantial and would adversely affect governmental budgets E. Concern for the economic effect on people whose livelihood is growing tobacco

A. Fear of creating or growing a black market B. Avoidance of excessive infringement on personal autonomous choice D. The tax revenue generated by the sale of tobacco products is substantial and would adversely affect governmental budgets E. Concern for the economic effect on people whose livelihood is growing tobacco

In 2016, over 23,000 infants died in the U.S. within their first year of life. The primary cause of infant mortality is birth defects, which can have hereditary or environmental causes such as alcohol consumption or exposure to environmental pollutants. In total, birth defects are responsible for 20% of infant mortality. The second cause is preterm birth, which is closely linked to maternal health, good nutrition during pregnancy, and regular access to prenatal care. Preterm birth is responsible for 17% of infant mortality. There are also large disparities in rates of infant mortality by race. In 2016, the infant mortality of non-Hispanic blacks was 11.4 for every 1000 births. For non-Hispanic whites it was 4.9 for every 1000 births. The primary medical explanation for this difference is due to higher rates of preterm birth among non-Hispanic blacks. Additionally, social scientists have found connections between lack of access to prenatal care, underlying health conditions among pregnant women, and racism as determinants of preterm birth among blacks. Considering this information, what would a utilitarian do to formulate a policy for reducing infant mortality? (ONE CORRECT) A. Focus on addressing birth defects. B. Focus on addressing the factors contributing to preterm birth among non-Hispanic blacks. C. Not do anything because many of the risk factors are behavioral, and individuals have the right to behave however they want. D. Solicit input from the broader community to determine what their priorities are for creating a better and healthier society. E. To address environmental pollution through governmental regulation.

A. Focus on addressing birth defects.

Why do many climate scientists now believe we will not meet the temperature rise target of the Paris Declaration (staying below 2 degree Celsius)? A. Global greenhouse gas emissions are still rising. B. High emissions countries have all the technology they need to keep the world below 2 degrees of warming, the only barrier is political will. C. The targets countries set at Paris were not sufficient to stay below 2 degrees Celsius. D. No country is currently on track to reach Paris goals. E. Feedback loops are leading to more rapid changes in global temperature.

A. Global greenhouse gas emissions are still rising. C. The targets countries set at Paris were not sufficient to stay below 2 degrees Celsius. D. No country is currently on track to reach Paris goals. E. Feedback loops are leading to more rapid changes in global temperature.

Which of the following were strengths of the Millenium Development Goals: A. Goals motivated the major actors in global governance to cooperatively undertake key initiatives addressing identified problems that affect the poorest people in the world B. The actors in global aid and key decision-makers were empowered to focus on greatest areas of need C. The surveillance and data collection systems of development countries were improved D. A horizontal approach to health highlighted a need to improve health systems E. Simple goals were easy to communicate and measure

A. Goals motivated the major actors in global governance to cooperatively undertake key initiatives addressing identified problems that affect the poorest people in the world B. The actors in global aid and key decision-makers were empowered to focus on greatest areas of need C. The surveillance and data collection systems of development countries were improved E. Simple goals were easy to communicate and measure

Which of the following are key differences between global health governance and having a global government for health? A. Governments have military powers whereas governance systems do not. B. Governance requires voluntary participation and compliance, whereas governments can often compel compliance through law and policing. C. Systems of governance often rely on "soft power" instead of "hard power." D. Governance can be conducted exclusively by nation-states. E. None of the above

A. Governments have military powers whereas governance systems do not. B. Governance requires voluntary participation and compliance, whereas governments can often compel compliance through law and policing. C. Systems of governance often rely on "soft power" instead of "hard power."

Climate change-related flooding poses what human health risks? A. Increases the spread of mosquito-borne illnesses. B. Threatens clean water supplies C. Contributes to malnutrition by diminishing crop yields. D. Leads to the temporary or permanent displacement of populations. E. Threatens human settlements in low-lying areas.

A. Increases the spread of mosquito-borne illnesses. B. Threatens clean water supplies C. Contributes to malnutrition by diminishing crop yields. D. Leads to the temporary or permanent displacement of populations. E. Threatens human settlements in low-lying areas.

Which of these countries are the world's top three growers of tobacco? A. India B. United States C. China D. Brazil E. Mexico

A. India C. China D. Brazil

The Alma Ata Declaration of 1978 was a key moment in global health governance for the following reasons: A. It advocated for a horizontal approach to improving the health of global populations B. The provision of primary health care was identified as the sole solution to health inequities C. The Conference reaffirmed that health is a fundamental human right D. The Conference acknowledged that realizing of the goal of attainment of the highest possible level of health for all requires a cross sectoral approach E. All of the above

A. It advocated for a horizontal approach to improving the health of global populations C. The Conference reaffirmed that health is a fundamental human right D. The Conference acknowledged that realizing of the goal of attainment of the highest possible level of health for all requires a cross sectoral approach

Which of the following actors tried to prevent the implementation of the Medicines Act of 1997 in South Africa? A. South African pharmaceutical companies B. The Indian Government C. The Office of the President in South Africa D. Multi-national pharmaceutical companies E. The U.S. Government

A. South African pharmaceutical companies D. Multi-national pharmaceutical companies E. The U.S. Government

When questioning whether a constitutionally enshrined right to health has the desired effect of improving the overall health of populations, the following are critiques that have been made: A. It is economics of a country that make a difference in the health of the population, and a constitutionally enshrined right to health cannot be disassociated from economic status. B. It is strength of democracy that makes a difference in the health of a population, and a constitutionally enshrined right to health cannot be disassociated from political structure. C. The overall health of the general population might suffer as resources are diverted to a smaller minority claiming entitlements under the right of health. D. The horizontal approach of the right to health creates health inequities.

A. It is economics of a country that make a difference in the health of the population, and a constitutionally enshrined right to health cannot be disassociated from economic status. B. It is strength of democracy that makes a difference in the health of a population, and a constitutionally enshrined right to health cannot be disassociated from political structure. C. The overall health of the general population might suffer as resources are diverted to a smaller minority claiming entitlements under the right of health.

As the Health Goal was being negotiated ahead of establishment of the Sustainable Development Goals of 2030, which of the following were arguments why Universal Health Coverage should be the Health Goal? A. It is relevant for both the rich and the poor B. It is measurable C. It is flexible for the unique situations of individual countries D. It is feasible E. Underlying determinants should be left to goals other than the Health Goal

A. It is relevant for both the rich and the poor B. It is measurable C. It is flexible for the unique situations of individual countries

Assume the government of Cambodia designs a health program in anticipation of the upcoming influenza season. The program is two-pronged: (1) to distribute information related to prevention of influenza and (2) to provide access to flu vaccines. Health workers will distribute flyers and posters in urban areas on flu prevention, and a mobile flu shot clinic will be established to travel throughout the country where anyone can be vaccinated at no cost. This program can most likely be criticized for violating a right to health for what reasons: A. Lack of Accessibility B. Lack of Acceptability C. Lack of Availability D. Lack of Quality

A. Lack of Accessibility C. Lack of Availability

Which of the following are justificatory conditions from a Three-Step Approach to Public Health Decision Making to support ethical decision-making in global public health? A. Least Infringement B. Necessity C. Utility D. Respect for Individual and Community Interests E. Public Justification F. Effectiveness G. Proportionality

A. Least Infringement B. Necessity E. Public Justification F. Effectiveness G. Proportionality

Which of the following statements correctly reflect major trends in the global burden of disease? A. Noncommunicable diseases are on the rise. B. Infectious diseases are on the decline. C. There are still multiple infectious diseases in the top 10 causes of death and disability. D. The top 5 causes of healthy life years lost are the main targets of the Millennium Development Goals (MDGs). E. None of the above.

A. Noncommunicable diseases are on the rise. B. Infectious diseases are on the decline. C. There are still multiple infectious diseases in the top 10 causes of death and disability.

Which of the following parties to Ochieng v. Attorney General of Kenya utilized a Constitutionally-embedded Right to Health to support their argument: A. Ochieng (and Petitioners) B. Attorney General of Kenya C. Special Rapporteur D. None of the above

A. Ochieng (and Petitioners) B. Attorney General of Kenya C. Special Rapporteur

Which of the following are key problems of using patents to incentivize research and development? A. Patents create monopolies, and monopolies prevent competition which could generate better and more research and development. B. Patents create monopolies, and monopolies tend to set prices extraordinarily high as there are no other competing products to bring prices down. C. Patents are a system designed to protect investments, but in practice they incentivize maximizing profits above and beyond initial investments. D. The profit incentive patents create drives pharmaceutical companies toward high-income, big-market drugs, not the drugs necessarily needed to address the global burden of disease. E. Patents do not create problems for research and development, they only have positive impacts.

A. Patents create monopolies, and monopolies prevent competition which could generate better and more research and development. B. Patents create monopolies, and monopolies tend to set prices extraordinarily high as there are no other competing products to bring prices down. C. Patents are a system designed to protect investments, but in practice they incentivize maximizing profits above and beyond initial investments. D. The profit incentive patents create drives pharmaceutical companies toward high-income, big-market drugs, not the drugs necessarily needed to address the global burden of disease.

Which of the following are social determinants of MDR-TB in Swaziland? A. Poor quality housing B. Smoking C. HIV/AIDS co-infection D. Stigmatization E. Overcrowded public transportation

A. Poor quality housing D. Stigmatization E. Overcrowded public transportation

Which of the following are examples of how soft power is enacted? A. Praise B. Financial reward or coercion C. Data D. Naming and shaming E. Military strength

A. Praise C. Data D. Naming and shaming

The inclusion of the entitlement to participation of the population in health-related decision-making at the national and community levels in the Right to Health draws upon which concepts of justice (select all that apply). A. Procedural justice B. Libertarian theory of justice C. Communitarian theory of justice D. Utilitarian theory of justice

A. Procedural justice C. Communitarian theory of justice

Which theory of distributive justice most closely aligns with the philosophical underpinnings of the Right to Health? (ONE CORRECT) A. Rawls' Veil of Ignorance B. John Stuart Mill's Utilitarianism C. The Harm Principle D. Kant's Axe

A. Rawls' Veil of Ignorance

Which of the following measures under the Framework Convention on Tobacco Control have the highest implementation rates: A. Smoke-free public places B. Restrictions on sales to minors C. Liability D. Protection of the environment E. Packaging/labelling of tobacco products

A. Smoke-free public places B. Restrictions on sales to minors E. Packaging/labelling of tobacco products

Which of the following are ongoing problems with the implementation of the International Health Regulations? A. State capacities for health systems and surveillance continue to be weak in most countries. B. State sovereignty concerns. C. The decision instrument for identification and notification is unclear. D. Concern over the economic consequences of having an outbreak considered to be a public health emergency of international concern. E. The decision instrument for declaring a public health emergency of international concern is missing important criteria related to national-level conditions.

A. State capacities for health systems and surveillance continue to be weak in most countries. B. State sovereignty concerns. D. Concern over the economic consequences of having an outbreak considered to be a public health emergency of international concern. E. The decision instrument for declaring a public health emergency of international concern is missing important criteria related to national-level conditions.

Which of the following global agreements on emissions reductions for climate change mitigation were NOT legally binding treaties? A. The Intergovernmental Panel on Climate Change, created in 1988. B. The Paris Declaration in 2015. C. The Framework Convention on Climate Change in 1992. D. The Kyoto Protocol in 1997. E. The Copenhagen Accord in 2009.

A. The Intergovernmental Panel on Climate Change, created in 1988. B. The Paris Declaration in 2015. C. The Framework Convention on Climate Change in 1992. E. The Copenhagen Accord in 2009.

Which of the following are powers given to the World Health Organization under the International Health Regulations? A. The WHO is authorized to make the final determination as to whether or not the outbreak in question constitutes a public health emergency of international concern. B. The WHO establishes the reporting guidelines for all countries to follow in case of possible public health emergency of international concern. C. The WHO can force countries to accept international financial and technical assistance. D. The WHO can prevent other countries from putting in place trade and travel restrictions on the outbreak country (countries). E. The WHO can enforce compliance for all State Parties to reach core public health capacities through financial penalties.

A. The WHO is authorized to make the final determination as to whether or not the outbreak in question constitutes a public health emergency of international concern. B. The WHO establishes the reporting guidelines for all countries to follow in case of possible public health emergency of international concern.

Which of the following are global health governance challenges to regulate/manage? A. The coordination of many different types of organizations and priorities. B. Infectious diseases with the potential to spread across national borders. C. Unequal distribution of knowledge, financial resources, and medical workforce across countries. D. Global problems, such as climate change, that are caused by, and affect, every country in the world. E. Harmful substances, such as tobacco, sold by domestic and multinational corporations.

A. The coordination of many different types of organizations and priorities. B. Infectious diseases with the potential to spread across national borders. C. Unequal distribution of knowledge, financial resources, and medical workforce across countries. D. Global problems, such as climate change, that are caused by, and affect, every country in the world. E. Harmful substances, such as tobacco, sold by domestic and multinational corporations.

Which of the following correctly reflect major trends in donor assistance for health. A. There has been an increase in the number of multilateral organizations, such as the Global Fund, channeling funds for health assistance. B. Over time donor assistance for health has increased. C. Most donor assistance goes to horizontal programs. D. Over time donor assistance for health has decreased. E. Most donor assistance goes to vertical programs.

A. There has been an increase in the number of multilateral organizations, such as the Global Fund, channeling funds for health assistance. B. Over time donor assistance for health has increased. E. Most donor assistance goes to vertical programs.

According to the latest data, which of the following countries are in the highest Universal Health Coverage service coverage quintile globally: A. United States B. Canada C. United Kingdom D. Australia E. Brazil

A. United States B. Canada C. United Kingdom D. Australia E. Brazil

A health promotion campaign designed without community input that uses a photograph of a man who is HIV+ without his permission could be criticized as a human rights violation on what grounds: [Assume the country has ratified the International Covenant on Economic, Social & Cultural Rights] A. Violates a right to participate B. Violates a right to education C. Violates a right to health D. Violates a right to information E. Violates a right to privacy

A. Violates a right to participate E. Violates a right to privacy

In this hypothetical scenario, there is a new, suspected outbreak of Ebola in Liberia, in several villages just outside of Monrovia, the capital city. The Ministry of Health is considering the implementation of a forced quarantine, where suspected Ebola cases and their contacts will be taken from their villages, placed in isolation units, monitored, and treated if necessary for a minimum of 21 days, or until a different diagnosis is made, or until death - whichever comes first. Which of the following are ethical concerns to consider when deciding whether or not to implement this policy? A. Whether or not the loss of individual liberty for the period of quarantine is justified. B. Whether or not the potential risk to the larger population of Liberians by not quarantining the suspect cases outweighs the potential risks of quarantine to the smaller population of cases. C. How to implement the policy so that is is uniformly applied. D. Whether or not the potential severity of an Ebola outbreak outweighs the scientific uncertainty around whether or not this outbreak is actually Ebola. E. Whether or not the benefits of quarantine outweigh the risk that the quarantine policy will drive cases of Ebola underground because people are afraid of being taken against their will.

A. Whether or not the loss of individual liberty for the period of quarantine is justified. B. Whether or not the potential risk to the larger population of Liberians by not quarantining the suspect cases outweighs the potential risks of quarantine to the smaller population of cases. C. How to implement the policy so that is is uniformly applied. D. Whether or not the potential severity of an Ebola outbreak outweighs the scientific uncertainty around whether or not this outbreak is actually Ebola. E. Whether or not the benefits of quarantine outweigh the risk that the quarantine policy will drive cases of Ebola underground because people are afraid of being taken against their will.

According to the visual depiction of the UHC Cube, what are the dimensions that need to be considered when allocating the current pooled funds for Universal Health Coverage? A. Which services are covered? B. How is access to services provided? C. Who is covered? D. What proportion of costs are covered? E. How is coverage communicated?

A. Which services are covered? C. Who is covered? D. What proportion of costs are covered?

An outbreak of a novel influenza virus has progressed to the point that the World Health Organization has declared a pandemic. Despite a vaccination campaign and other measures, rates of morbidity and mortality have increased such that the number of patients needing hospital beds has overwhelmed capacity. To meet the challenge, a teleconference has been scheduled between several members of local hospitals' administration, the critical care unit directors from each hospital, and public health officials leading the pandemic response. As a public health official who played a central role in developing the pandemic plan for your jurisdiction, you have been included on the call to provide guidance for the pandemic response. During the conference call, a number of critical care unit directors are particularly concerned with the process through which the current pandemic plan for your jurisdiction was developed, as well as which community organizations/members were involved in those discussions. From which theory (or theories) of distributive justice would these critical care unit directors most likely be drawing to ask these questions? A. Libertarian B. Communitarian C. Egalitarian D. Utilitarian

B. Communitarian C. Egalitarian

Which theory of justice places the most emphasis on fair procedures in the distribution of goods? (ONE CORRECT) A. Communitarian B. Egalitarian C. Libertarian D. Utilitarian

B. Egalitarian

In 2016, over 23,000 infants died in the U.S. within their first year of life. The primary cause of infant mortality is birth defects, which can have hereditary or environmental causes such as alcohol consumption or exposure to environmental pollutants. In total, birth defects are responsible for 20% of infant mortality. The second cause is preterm birth, which is closely linked to maternal health, good nutrition during pregnancy, and regular access to prenatal care. Preterm birth is responsible for 17% of infant mortality. There are also large disparities in rates of infant mortality by race. In 2016, the infant mortality of non-Hispanic blacks was 11.4 for every 1000 births. For non-Hispanic whites it was 4.9 for every 1000 births. The primary medical explanation for this difference is due to higher rates of preterm birth among non-Hispanic blacks. Additionally, social scientists have found connections between lack of access to prenatal care, underlying health conditions among pregnant women, and racism as determinants of preterm birth among blacks. Considering this information, what would an egalitarian do? (ONE CORRECT) A. Focus on addressing birth defects. B. Focus on addressing the factors contributing to preterm birth among non-Hispanic blacks. C. Not do anything because many of the risk factors are behavioral, and individuals have the right to behave however they want. D. Solicit input from the broader community to determine what their priorities are for creating a better and healthier society. E. To address environmental pollution through governmental regulation.

B. Focus on addressing the factors contributing to preterm birth among non-Hispanic blacks.

Which of the following statements are libertarian arguments for supporting climate change emissions reductions policy? A. Climate change is one of the most unjust issues of our time. The public health harms are disproportionately affecting the worst-off populations in the world. B. Individuals have the freedom to do what they choose up until the point that their actions harm others. Greenhouse gas emissions are harming others and should therefore be regulated. C. Market mechanisms can be used to reduce emissions, such as through cap and trade policies. These policies will restrict the amount of government interference and create desired outcomes. D. Climate change has the potential to destroy our common heritage. It is a direct threat to the maintenance of a good and fair society. E. The best solutions for addressing climate change should be targeted at emissions reductions, as tools for reducing emissions are far more cost-effective than adaptation efforts.

B. Individuals have the freedom to do what they choose up until the point that their actions harm others. Greenhouse gas emissions are harming others and should therefore be regulated. C. Market mechanisms can be used to reduce emissions, such as through cap and trade policies. These policies will restrict the amount of government interference and create desired outcomes.

Which of the following can be said of the right to health, as described in the International Covenant on Economic, Social & Cultural Rights: A. By providing health-care to its citizens, a state satisfies its obligations under a right to health B. It is understood as a right to enjoy a variety of facilities, goods, services and conditions to achieve the highest attainable standard of health C. Even though it takes into account a state's available resources, that state must make every possible effort to use those resources to realize the right to health D. The right to health is built exclusively on a positive rights scheme E. It takes into account an individual's biological and socioeconomic preconditions

B. It is understood as a right to enjoy a variety of facilities, goods, services and conditions to achieve the highest attainable standard of health C. Even though it takes into account a state's available resources, that state must make every possible effort to use those resources to realize the right to health E. It takes into account an individual's biological and socioeconomic preconditions

Which of the following are reasons why low and middle-income countries agreed to TRIPS (trade-related aspects of intellectual property rights)? A. They wanted to join the World Trade Organization (WTO) and voluntarily opted into TRIPS. B. Most of these countries disagreed with TRIPS but believed access to markets for other goods and services was more important. C. Many of these countries were strong-armed by the United States into accepting TRIPS. D. Most of these countries believed TRIPS was important. E. They wanted to join the WTO and therefore were required to implement TRIPS.

B. Most of these countries disagreed with TRIPS but believed access to markets for other goods and services was more important. C. Many of these countries were strong-armed by the United States into accepting TRIPS. E. They wanted to join the WTO and therefore were required to implement TRIPS.

Which of the following are factors contributing to the success of activism for access to HIV/AIDS treatment? A. A non-controversial condition. B. Strong leadership and participation of affected groups in activism. C. A large and diverse global coalition. D. Activism coincided with, and helped to create, a favorable economic environment. E. A non-controversial solution.

B. Strong leadership and participation of affected groups in activism. C. A large and diverse global coalition. D. Activism coincided with, and helped to create, a favorable economic environment. E. A non-controversial solution.

Which of the following problems did the re-negotiation of the International Health Regulations in 2005 seek to address? A. The top-down structure of IHR implementation. B. The narrow focus of the original IHRs on only three infectious diseases. C. Problems in core public health capacities within low and middle income countries. D. The emphasis on border control instead of action within a country. E. Countries failing to report through the notification system

B. The narrow focus of the original IHRs on only three infectious diseases. C. Problems in core public health capacities within low and middle income countries. D. The emphasis on border control instead of action within a country. E. Countries failing to report through the notification system

An adult male patient presents in the emergency department of a Medicaid-participating hospital with a gunshot wound. No more is known about the financial status of the patient. The following best describes whether this patient has a right to health care in the United States for this injury: (ONE CORRECT) A. The patient has a right to health care under Medicaid B. The patient has a right to screening and stabilization under the Emergency Medical Treatment and Active Labor Act C. The patient has a right to health care under Medicare D. The patient has no right to heath care or treatment

B. The patient has a right to screening and stabilization under the Emergency Medical Treatment and Active Labor Act

Which of the following could be considered to be deontological statements? A. In the event of a public health emergency, it is always acceptable to prioritize the health of those who require the fewest resources to heal. B. There is no such thing as a "white lie." C. During an outbreak of a highly infectious disease, infringement of the rights of individuals by issuing a quarantine order is justified to maximize net benefits. D. The toxic side effects of current treatment for MDR-TB cannot be overlooked despite any data showing effectiveness in reducing prevalence in the overall population.

B. There is no such thing as a "white lie." D. The toxic side effects of current treatment for MDR-TB cannot be overlooked despite any data showing effectiveness in reducing prevalence in the overall population.

Which of the following are critiques that have been made of the focus on Universal Health Coverage (UHC): A. By focusing on UHC, the global health community might address several risk factors for priority diseases by providing greater access to primary care B. There is too little guidance as to which services to provide under UHC in order to ensure equity and efficiency in providing services C. UHC is too expensive for most low- and middle-income countries to implement D. UHC addresses economic accessibility but often ignores other components of accessibility such as physical and information accessibility E. Other horizontal approaches to health have failed to gain traction, so it's not a worthwhile focus of global resources

B. There is too little guidance as to which services to provide under UHC in order to ensure equity and efficiency in providing services D. UHC addresses economic accessibility but often ignores other components of accessibility such as physical and information accessibility

Which of the following arguments are made in the reform proposal of authors Ooms & Hammond in "Global constitutionalism applied to global health governance"? A. To establish a global government through a global constitution. B. To give WHO primary legislative power in global health governance. C. To identify problems in global health governance through the application of constitutionalist principles to the major organizations involved in governance. D. To convert the Global Fund for AIDS, TB, and Malaria into a general Global Fund for health that possesses executive powers with mandatory contributions. E. To give the International Court of Justice judiciary power to enforce compliance.

B. To give WHO primary legislative power in global health governance. C. To identify problems in global health governance through the application of constitutionalist principles to the major organizations involved in governance. D. To convert the Global Fund for AIDS, TB, and Malaria into a general Global Fund for health that possesses executive powers with mandatory contributions. E. To give the International Court of Justice judiciary power to enforce compliance.

Which of the following are critiques made of the Framework Convention on Tobacco Control (FCTC): A. FCTC's top-down approach lacks input from key members of civil society B. Which measures to implement is largely at the discretion of individual states C. States may not have capacity for implementation D. FCTC excessively relies on hard law to punish growers of tobacco E. FCTC's provisions lack a multisectoral approach

B. Which measures to implement is largely at the discretion of individual states C. States may not have capacity for implementation

Which of the following are bottom-up approaches to tobacco control seen in the implementation of the Framework Convention on Tobacco Control: A. Prohibiting tobacco advertisements B. The imposition of a sales tax on cigarettes C. Connecting FCTC 2030 Parties to global networks like the South-South Cooperative to facilitate sharing of resources among similar countries D. The formation of a social hub where civil society and governments could convene for support, information exchange, and advocacy E. Bans on smoking in public places

C. Connecting FCTC 2030 Parties to global networks like the South-South Cooperative to facilitate sharing of resources among similar countries D. The formation of a social hub where civil society and governments could convene for support, information exchange, and advocacy

Which statement most accurately describes the current role of the World Health Organization in global health governance? (ONE CORRECT) A. It is the only organization responsible for global health governance. B. It is the legislative institution creating global health policies. C. It is one of numerous organizations engaged in global health governance. D. It has no role in global health governance.

C. It is one of numerous organizations engaged in global

Which theory of distributive justice sometimes distills its philosophy into the following statement: "Your right to swing your fist ends where my face begins." (ONE CORRECT) A. Egalitarian B. Communitarian C. Libertarian D. Utilitarian E. All of the above

C. Libertarian

In 2016, over 23,000 infants died in the U.S. within their first year of life. The primary cause of infant mortality is birth defects, which can have hereditary or environmental causes such as alcohol consumption or exposure to environmental pollutants. In total, birth defects are responsible for 20% of infant mortality. The second cause is preterm birth, which is closely linked to maternal health, good nutrition during pregnancy, and regular access to prenatal care. Preterm birth is responsible for 17% of infant mortality. There are also large disparities in rates of infant mortality by race. In 2016, the infant mortality of non-Hispanic blacks was 11.4 for every 1000 births. For non-Hispanic whites it was 4.9 for every 1000 births. The primary medical explanation for this difference is due to higher rates of preterm birth among non-Hispanic blacks. Additionally, social scientists have found connections between lack of access to prenatal care, underlying health conditions among pregnant women, and racism as determinants of preterm birth among blacks. Considering this information, what would a libertarian do to formulate a policy for reducing infant mortality? (ONE CORRECT) A. Focus on addressing birth defects B. Focus on addressing the factors contributing to preterm birth among non-Hispanic blacks C. Not do anything because many of the risk factors are behavioral, and individuals have the right to behave however they want D. Solicit input from the broader community to determine what the priorities are for creating a better and healthier society E. To address environmental pollution through governmental regulation

C. Not do anything because many of the risk factors are behavioral, and individuals have the right to behave however they want

Which of the following are examples of vertical programs? A. Primary healthcare (PHC) B. Clean water and sanitation initiatives C. Polio vaccination D. DOTS for tuberculosis E. Smallpox eradication

C. Polio vaccination D. DOTS for tuberculosis E. Smallpox eradication

The World Bank is the largest non-disease specific funder of the following: A. Tobacco control B. Alcohol control C. Universal Health Coverage/Health Systems Strengthening D. Health impacts of climate change E. HIV-AIDS

C. Universal Health Coverage/Health Systems Strengthening

Considering the four main theories of distributive justice, which most closely represents the viewpoint of the Global Burden of Disease Project at the Institute for Health Metrics and Evaluation? (ONE CORRECT) A. Egalitarian B. Communitarian C. Utilitarian D. Libertarian

C. Utilitarian

The WHO was formed in the aftermath of the following event: (ONE CORRECT) A. Typhoid epidemic in the early 20th century B. World War I C. World War II

C. World War II

Which of the following countries have NOT ratified the Framework Convention on Tobacco Control: A. Turkey B. China C. Mozambique D. Indonesia E. United States

D. Indonesia E. United States

Which countries have been the biggest roadblocks to creating a binding global treaty on greenhouse gas emission reductions? A. Germany B. The UK C. France D. The United States E. China

D. The United States E. China

Which of the following is NOT a normative statement about global health priorities? (ONE CORRECT) A. Due to the rise of noncommunicable diseases, donors should shift funding from infectious to noninfectious diseases. B. All countries should protect the right to health. C. Governments should target smoking due to its contribution to the burden of disease. D. The primary cause of death and disability globally is heart disease.

D. The primary cause of death and disability globally is heart disease.

Most development assistance for health from all sources goes to noncommunicable diseases. True False

False

Which statement most accurately summarizes the Millennium Development Goals? (ONE CORRECT) A. The process of deciding what to target was open and inclusive, and most of the targets have been met. B. The process of deciding what to target was open and inclusive, and most of the targets have not been met. C. The process of deciding what to target was closed to only a small number of people within the UN, and most of the targets have been met. D. The process of deciding what to target was closed to only a small number of people within the UN, and most of the targets have not been met.

D. The process of deciding what to target was closed to only a small number of people within the UN, and most of the targets have not been met.

In 2016, over 23,000 infants died in the U.S. within their first year of life. The primary cause of infant mortality is birth defects, which can have hereditary or environmental causes such as alcohol consumption or exposure to environmental pollutants. In total, birth defects are responsible for 20% of infant mortality. The second cause is preterm birth, which is closely linked to maternal health, good nutrition during pregnancy, and regular access to prenatal care. Preterm birth is responsible for 17% of infant mortality. There are also large disparities in rates of infant mortality by race. In 2016, the infant mortality of non-Hispanic blacks was 11.4 for every 1000 births. For non-Hispanic whites it was 4.9 for every 1000 births. The primary medical explanation for this difference is due to higher rates of preterm birth among non-Hispanic blacks. Additionally, social scientists have found connections between lack of access to prenatal care, underlying health conditions among pregnant women, and racism as determinants of preterm birth among blacks. Considering this information, what would be a global public goods approach to formulating a policy for reducing infant mortality? (ONE CORRECT) A. Focus on addressing birth defects B. Focus on addressing the factors contributing to preterm birth among non-Hispanic blacks C. Not do anything because many of the risk factors are behavioral, and individuals have the right to behave however they want D. Solicit input from the broader community to determine what their priorities are for creating a better and healthier society E. To address environmental pollution through governmental regulation

E. To address environmental pollution through governmental regulation

A country's failure to adequately address an influenza outbreak by neglecting to design and conduct a health promotion campaign on flu prevention and by failing to provide a sufficient supply of flu vaccine could be criticized as a human rights violation on the following grounds: [Assume the country has ratified the International Covenant on Economic, Social & Cultural Rights] A. Violates a right to information B. Violates a right to participate C. Violates a right to education D. Violates a right to privacy E. Violates a right to health

E. Violates a right to health

In the United States, there are no rights to health care. True False

False

In Ochieng v. Attorney General of Kenya, the Court found that Kenya's right to health establishes both positive and negative duties. True False

True

Before TRIPS (Trade Related Aspects of Intellectual Property Rights), many countries did not grant patents or had more limited patent protections. True False

True

Deforestation is an important contributor to greenhouse gas emissions. True False

True