Intro to Public Health Final
According to the documentary "Fed Up" which of the following is primarily responsible for America's rising obesity rate? fat sugar carbohydrate protein
sugar
T or F: A premium is the amount that an individual or family is responsible for paying before being eligible for insurance coverage.
False
T or F: According to the CDC, organizational health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
False
T or F: Persons with limited health literacy skills are less likely to have chronic conditions and are able to manage them effectively.
False
T or F: Regarding health care systems, the United States relies most heavily on social justice, whereas the United Kingdom places more emphasis on market justice.
False
Medicare
Federal government program primarily funded by payroll tax that provides for ages 65 or older, disabled ppl eligible for social security disability benefits, and those with stage renal disease -50 mill Americans are eligible
Medicaid
Federal plus state program designed to pay for health services for specific categories of poor ppl and other groups -Disabled, kids, pregnant women, etc. In the basic program, the gov't pays available amount of the cost, ranging from 50-83% depending on per capita income of the state (meant to match funds provided by state) To receive matching funding, states must provide basic services such as inpatient and outpatient services
What mechanism is available to obtain insurance for those not otherwise eligible for health insurance?
Health Insurance Exchanges -Provide a competitive marketplace to help increase access and control the costs of health insurance
Essential Public Health Services (Assessment)
1. Monitor health status to identify community health problems 2. Diagnose and investigate health problems and health hazards in the community
According to the Ted Talk "Are You Confused about Health Information? You're not Alone" by Dr. Lisa Fitzpatrick, for every $1 we spend on health literacy, we can save ______. $5 $15 $25 $30
$25
How can public health agencies work together?
*Collaboration needs to be an everyday effort* -not just a requirement for emergencies or epidemics *Must coordinate local, state, federal, and global public health agencies into one unified effort*
State Child Health Insurance Program (SCHIP)
-Administered thru Medicaid -Additional funds the states may use to enhance the healthcare of kids -Participating states may raise the income level for medicaid eligibility, start eligibility more rapidly and ensure longer periods of eligibility
Factors That Increase Healthcare Costs
-Aging of the population -Technological innovations that expand treatment options -Success of medical care has raised patient expectations
Roles Non-Government Organizations Play
-American Red Cross (collects blood donations, mobilizes volunteers, and publicizes need for disaster assistance) -Doctors W/O Borders and Physicians for Social Responsibility (physician groups that advocate, seek funding, and address ethical implementation of programs) -Advocacy Groups (advocate for public health interventions and aim to influence policy decisions) -Private Organizations (provide public health education, support research, and develop evidence-based recommendations) -CARE and Oxfam International (provide services and advocate for health-related crises) -Priv. Foundations (fund public health effort and stimulate gov't funding)
Key Federal Agencies of the DHHS
-CDC and ADSTR -NIH -FDA -HRSA -AHRQ -SAMHSA
How can Public Health take lead in mobilizing community partnerships?
-Community Based Participatory Research (CBPR) -Community-Oriented Public Health (COPH)
Other Products the FDA Regulate
-Cosmetics -Medical Devices -Biological Products (such as the blood supply) -Tobacco Products
Teach-Back Method
-Ensuring agreement and understanding about care plan is essential to achieving adherence -"I want to make sure I explained it correctly. Can you tell me in your words how you understand the plan?"
Other Gov't Agencies Involved w/ Health Issues
-Environmental Protection Agency (EPA) -Occupational Safety and Health Admin. (OSHA) which aims to decrease injuries and hazardous exposures in the work place -Dept. of Homeland Security which is preparation and response to disasters and terrorism -Dept. of Agriculture- protects nation's food supply -Dept. of Housing and Urban Development -Dept. of Energy which sets radiation safety standards for nuclear power plants and other sources of energy
What types of Employment-Based Health Insurance Programs are available?
-Fee-for-Service: charges paid for specific services provided. As a payment system, it encourages the provision of as many services as possible -Health Maintenance Orgs. (HMOS): charge patients a monthly fee designed to cover a comprehensive package of services. Clinicians or their orgs are paid based on the # of individuals enrolled at their practice -Preferred provide organizations (PPOs): fee for service insurance system decides to only work with a limited # of clinicians -Point of Service Plans (POSs): patients in a HMO may choose to receive care outside the system provided by the health plan, but will pay more out of pocket
Strategies to Improve Patient Understanding
-Focus on "need to know" and "need to do" -Use teach-back method -demonstrate/draw pictures -use clearly written education materials
Red Flags for Low Health Literacy
-Freq. missed appts. -Non-compliance w/ medication -Unable to name meds, explain purpose or dosing -Identifies pills by looking at them and not the label -Unable to give coherent, sequential history -Lack of follow thru on tests or referrals
Types of Insurance in the US
-Gov't Financed -Employment-Based -Health Insurance Exchanges
Describing the US Healthcare Systems
-Has higher percentage of uninsured -System is more complex for patients and providers and costs more to administer -Places greater emphasis on giving patients a wider variety of physicians -Places more emphasis on specialized physicians with more nurse practitioner and physician assistances providing primary care -Has a more complex system for ensuring quality and a unique system of malpractice law -Encourages rapid adoption of technology
Consequences of being uninsured or underinsured in the U.S.?
-Less preventative care, diagnosed at more advanced stages of disease, receive less treatment after being diagnosed -Less likely to have usual source of healthcare. More likely to use ER for routine care and an increased mortality rate
Problem of Limited Health Literacy is Greater Among:
-Older adults -Ppl w/ limited education -Minority populations -Ppl w/ limited English proficiency -Ppl w/ limited mental health issues
How Low Health Literacy Impacts Health
-Ppl w/ low health literacy skills are more likely to skip preventative programs -They enter the healthcare system sicker than those w/ adequate health literacy -Persons w/ limited health literacy skills are more likely to have chronic conditions and are less able to manage them -Higher use of hospitalization and emergency services, thus higher healthcare costs
goals and roles of governmental public health agencies
-Prevent epidemics and spread of disease -Protect against environmental hazards -Prevent injuries -Promote and encourage healthy behaviors -Respond to disasters and assist with recovery -Ensure quality and accessibility with health services
How to Improve the Usability of Health Forms and Instructions
-Revise forms to ensure clarity and simplicity -Test forms with intended users and revise forms as needed -Provide forms in mult. languages -Offer assistance w/ completing forms and scheduling follow-up care
Roles of Federal Public Health Agencies
-The Dept. of Health and Human Services (HHS) is the main public health agencies of the federal gov't -includes operating agencies that report directly to the cabinet and secretary level of the HHS
7 Tips for Healthcare Professionals and Clinicians for Health Literacy
-Use plain language -Limit info -Be specific and concrete -Demonstrate -Repeat/summarize -Teach-Back -Be positive, hopeful, empowering
Local Health Department Roles
-immunizations for those not covered by the private system -communicable disease surveillance and initial investigation of outbreaks -communicable disease control -inspection and licensing of restaurants -environmental health surveillance -coordinating public health screening programs -tobacco control programs -public health preparedness and response to disasters
According to the documentary "Fed Up" type 2 diabetes, once known as "adult onset diabetes" was virtually unheard of in children just a few decades ago. In 1980, there were ______ childhood cases of the condition. In 2010, there were ________. 0 and 57,000 6,780 and 90,500 1,000 and 35,000 4,000 and 76,000
0 and 57,000
Steps in Foodborne Outbreak Investigation
1. Detecting a possible outbreak 2. Defining and finding cases 3. Generating hypotheses (interviews) 4. Testing hypotheses (analytic studies (case-control), lab tests) 5. Finding point of contamination 6. Controlling outbreak (recall, remove source of contamination, revise production process) 7. Deciding whether or not outbreak is over
Essential Public Health Services (All 3 Functions)
10. Research for new insight and innovative solutions to health problems
The National Academy of Medicine estimates that nearly ________ Americans die each year as a result of adverse effects of drugs. 85,000 100,000 150,000 135,000
100,000
According to Dr. Lisa Fitzpatricks Ted Talk, the cost of low health literacy to the U.S. economy is between $___ billion to $____ billion annually. 75 to 88 90 to 105 106 to 238 240 to 298
106 to 238
Phase 3 of FDA approval
2 independently performed randomized controlled trials, unless not practical or ethical. Objectives: Establish efficacy for one indication among a homogenous group of patients compared to conventional treatment. Investigate short-term safety relative to conventional treatment. Limitations: Randomized controlled trials may be too small, too short and participants' conditions too simple to observe side effects that will be seen in clinical practice
Essential Public Health Services (Policy Development)
3. Inform, educate, and empower ppl about health issues 4. Mobilize community action to identify and solve health probs 5. Develop policies and plans that support individual and community health efforts
According to the film "Fix It: Health Care at the Tipping Point", the United States has the most bureaucratic healthcare system in the world - with _____% of every health care dollar going to paperwork, overhead and administrative costs.
30 -35
Essential Public Health Services (Assurance)
6. Enforce laws that protect health and ensure safety 7.Link ppl to needed health services 8.Ensure provision of competent healthcare workforce 9.Evaluate effectiveness, accessibility and quality of health services
According to Dr. Rishi Manchandra, living and working conditions account for ________ percent of preventable death. 40 50 60 70
60
Due to food-borne diseases, the Centers for Disease Control and Prevention estimates that each year One in 6 Americans get sick More than 100,000 are hospitalized Over 3,000 people die All of these are correct.
All of these are correct
According to the ____________, poor health literacy is "a stronger predictor of a person's health than age, income, employment status, education level, and race." Centers for Disease Control and Prevention (CDC) American Public Health Association (APHA) American Academy of Pediatrics (AAP) American Medical Association (AMA)
American Medical Association (AMA)
According to Dr. Rishi Manchandra, what is an upstreamist?
An upstreamist is someone who looks towards the root of an issue. Rather than plainly treating symptoms, upstreamist healthcare workers strive to find the cause of health issues. This involves regarding the patient's everyday life. Upstreamists consider a patient's diet, workplace, cleanliness, home and other factors when trying to investigate the cause of their problem.
How much does the US spend on healthcare?
Approx. $3 trillion per yr. -18% of GDP -$9,000 per person per yr.
How can public health agencies partner with healthcare to improve response to health problems?
Clinicians and public health professionals share a common commitment to: -Evidence based thinking -Cost-effective delivery services -Providing quality services to entire population and eliminating health disparities -Computerized, confidential data systems
Foodborne Illness Prevention
Collaboration among CDC, FDA, and USDA to create the Foodborne Disease Active Surveillance Network (FoodNet) -aims to identify and investigate foodborne illness from both outbreaks and routine exposure In 2010, the Food and Safety Modernization Act passed -gave FDA and USDA increased authority -Provided ability to track foods including origin, date of production, and other useful data for locating source of food if a disease outbreak occured Supplmental Nutrition Assistance Program (SNAP) -formerly called ''food stamps" -makes relatively expensive items like fresh fruits and veggies accessible to those w/ low incomes
State Health Department Roles
Collecting vital statistics Running a public health laboratory Licensing health professionals Administering nutrition program Regulating health facilities Drinking water regulation Administration of the state Medicaid program Office of the medical examiner
Are there programs for those who are disabled or injured on the job?
Complex systems of federal and state programs available, categorized as: -Workers Compensation and Federal Programs for Workers -Social Security Disability Insurance & Social Security Income *Doesn't replace health insurance but does provide some assistance
The efforts to shift costs of health care to individuals on the assumption that individuals will spend less when the costs are coming out of their pockets is: High deductible plans Regulation Cost sharing Co-payment Preauthorization
Cost sharing
Policy Development
Creating evidence-based recommendations and other analyses options to guide implementation
The amount individuals need to pay out-of-pocket before being eligible for insurance coverage is known as the:
Deductible
The _______________________ is the central public health agency of the federal government.
Department of Health and Human Services DHHS
Which of the following is responsible for the preparation and response to disasters and terrorism? Occupational Safety and Health Administration (OSHA) Department of Homeland Security Environmental Protection Agency (EPA) Department of Agriculture
Department of Homeland Security
Phase 2 & 3
Designed to establish efficacy of a drug for a particular use -needs to establish that on average, the drug improves outcomes under research conditions Phase 2 Trials: Small, sometimes uncontrolled, trials designed to determine whether there is a suggestion of efficacy -used to justify expensive, potentially harmful and time-consuming Phase 3 Phase 3 Trials: large, randomized, control trials -Gold standard for establishing efficacy for 1 particular indication -However, there are limitations for establishing safety (too small, too short, too simple)
Preclinical Research on Drugs
Drug testing begins before any humans have received the drug -FDA requires animal safety studies before a drug can be studied in humans -However, animal models may either fail to detect subsequent effects in humans or demonstrate high dose effects that are difficult to determine Animal testing is administering to 2 diff species as levels well above the equivalent dose expected to be used in ppl -Researchers look to detect cancer, teratogenicity and effects on fertility -Investigate the effects on drug sensitive organs
Communicable Foodborne Disease Effects
Due to foodborne diseases, CDC estimates that each yr: -1 in 6 Americans get sick - over 100,000 hospitalized -over 3,000 die the very young, old, and immunocompromised are most vulnerable
Global Agencies and their Role in Food Issues
FAO: UN ageny with overall responsibility for food supply WHO: establishes policy and makes recommendations regarding safety of world food supply CAC: Joint program with FAO and WHO that develops food standards, guidelines, and codes of practice
Implications of FDA Approval of a Drug
FDA approved implies: -The drug may be advertised for a particular indication, the one for which it was studied and approved -It may be prescribed by clinicals for any patient Off-Label prescribing: The clinician has the authority to use the treatment for indications or at dosages not specifically approved by FDA
Federal Agencies & Food Issues
FDA: Overall responsible for food safety regulation in US USDA: regulatory responses for meat, poultry, eggs in the US EPA: Regulation of pesticide usage and establishment of water quality standards CDC: Responsible for ongoing surveillance and acute investigations in collab w/ state and local health depts.
Health Literacy is Dependent on Demands of Healthcare and Public Health Systems
Individuals need to read, understand and complete many kinds of forms in order to receive treatment and payment reimbursement -They also need to know diff types of health professionals and services, as well as how to access care!
Phase 1 of FDA Approval Process
Initial testing of a drug on humans may include healthy volunteers or terminally ill patients not necessarily on whom drug will be used. Objectives: Designed to assess pharmacology in an effort to establish dosage, timing, and route of administration. Safety assessed, esp. on vulnerable organs Limitations: small #s and short-term studies mean effects could be missed. May not help predict side effects when patients aren't representative
Which of the following is not true of community-oriented primary care? -It builds on the strengths of communities. -It defines a community based exclusively on geography. -It defines a community using quantitative and qualitative measures. -It prioritizes interventions by considering the values of the community.
It defines a community based exclusively on geography
In the documentary "Fed Up", the _______________ suggested that Americans eat less fat, less cholesterol, less refined and processed sugars, and more complex carbohydrates and fiber. McGovern Report International Food Policy Research Institute (IFPRI) The U.S. Beef Industry Let's Move program United States Department of Agriculture (USDA)
McGovern Report
Which of the following components of Medicare provides partial coverage for professional services such as physician services? Medicare Part A Medicare Part B Medicare Part C Medicare Part D Medicare does not provide coverage for this.
Medicare Part B
Which of the following components of Medicare provides partial coverage for outpatient drugs? Medicare Part A Medicare Part B Medicare Part C Medicare Part D
Medicare Part D
All of the following populations are vulnerable to low health literacy levels except: Minority populations Immigrant populations Seniors Middle to high level income populations
Middle to high income level populations
How Can Population Health Become a Mechanism for Controlling Costs?
More efficiently connecting prevention, treatment, and rehabilitation may decrease costs and increase effectiveness of healthcare treatment
Drug Safety- 21st Century Issue
National Academy of Medicine estimates that nearly 100,000 Americans die every year as a result of adverse effects on drugs
How Can a Healthcare System be Scored?
National Scorecard on the US Healthcare System: standardized measurements to try and objectively measure performance in 19 developed countries Criteria: healthy lives, quality, access, efficiency and equity Highest score possible for each category is 100
Assessment
Obtaining data that defines population health overall and specific groups
Assurance
Oversight responsibility for ensuring key components of an effective health system
4 Different Parts of Medicare
Part A: covers hospital care, skilled nursing care and hospice care Part B: Voluntary supplemental insurance that covers diagnostic and therapeutic services Part C: Program designed to encourage Medicare beneficiaries to enroll in prepaid health plans Part D: prescription drug plan open to individuals enrolled in parts A and B
phase 4 of FDA approval
Post-market surveillance Assessment of safety in clinical practice, spontaneous report system, data bases from clinical practice increasingly used Objectives: Designed to detect rare or serious side effects; once approved, may be used for diff. dosages/patients/ other indications at discretion of physician Limitations: Spontaneous reporting may not detect side effects; interactions between drugs are common; making it difficult to establish causation
Is there a process of accreditation of health departments?
Public health accreditation board developed a voluntary accreditation process -Health depts. that serve over 75% of US pop are accredited or in the process of being renewed for it
Medicare is/does all of the following except: -Provides for persons 65 years and older, disabled persons eligible for disability benefits and those with end-stage renal disease -Regionally run government program -Primarily funded by payroll tax -Covers about 50 million people
Regionally run government program
The __________________ program makes relatively expensive items, such as fresh fruits and vegetables, accessible to those with low incomes. USDA (United States Dietary Agency) FAO (Food and Agricultural Organization) SNAP (Supplemental Nutrition Assistance Program) FRN (Food Recovery Network)
SNAP (Supplemental Nutrition Assistance Program)
FDA Process of Assessing Safety and Effectiveness of Drugs: Preclinical Testing
Safety assessment on at least 2 species at high dosages prior to initial use on humans Objectives: Access carcinogenic, teratogenic and fertility effects Limitations: High-dose effects may not correlate with effects on humans, species differences may result in missing effects that later appear in human testing or widespread clinical use
Phase 2 of FDA approval
Small-scale, controlled or uncontrolled, trial of efficacy with 2nd assessment of safety. Objectives: Establishes that there is enough evidence of efficacy to warrant phase 3 randomized controlled trials. Limitations: Primary intent is proof of concept
How Are Adverse Effects of a Drug Monitored in Phase 4 After FDA Approval?
Spontaneous reporting system -Those who prescribe the drug and patients are encouraged to report side effects of FDA (but not required) Patients who receive a new treatment over the first few months to few years after the initial marketing approval need to be regarded as part of the experiment
Other Agencies
State/local: These health depts. conduct restaurant inspections and outbreak investigations Consumer: consumer protection agencies provide education in safe food purchasing, preparation and storage
All of the following are true of the US health care systems except: -The US health care system encourages rapid adoption of technology, especially for diagnosis and treatment when covered by insurance. -The US health care systems spends considerably more per person and as a percentage of the GDP (gross domestic product). -The US health care system places greater emphasis on providing giving patients a wider choice of clinicians. -The US health care system is less complex for patients and providers of care and costs far less to administer
The US health care system is less complex for patients and providers of care and costs far less to administer
Which of the following represents the status of a right to health care in the United States? -The United States, like most countries, has accepted a right to health care. -The United States Supreme Court has found a right to health care in the United States Constitution. -The United States Congress, through legislation, has established a right to health care under specific circumstances, such as access to emergency care. -The right to health care is accepted in the United States as a result of participation in the World Health Organization.
The United States Congress, through legislation, has established a right to health care under specific circumstances, such as access to emergency care.
Health Literacy
The capacity to obtain, process, and understand basic health information and services needed to make appropriate health-care decisions.
FDA approval of a drug has all of the following implications, except: the drug may be prescribed for other indications the drug is free of life-threatening side effects the drug may be prescribed for the approved indication on populations other than the one on which it was investigated. the drug may be advertised and marketed for the approved indication
The drug is free of life-threatening side effects
All of the following are part of the goals and roles of governmental public health agencies except: To promote and encourage healthy behaviors To ensure the quality and accessibility of health services To protect against environmental hazards To regulate the use of cannabis in communities. To respond to disasters and assist communities in recovery
To regulate the use of cannabis in communities
T of F: According to Dr. Rishi Manchandra, in healthcare, providers often treat symptoms without addressing the conditions that make people sick in the first place.
True
T or F: According to the article by O'Rourke "Lost in the Health Care Reform Discussion: Health Care as a Right or a Privilege" we already have a national health insurance program for part of our population which is Medicare.
True
T or F: According to the documentary "Fed Up," sugar has many different names including high fructose corn syrup and maltodextrin.
True
T or F: According to the documentary "Fix It: Healthcare At the Tipping Point," the largest percentage of bankruptcies for individuals in the US is due to medical bills
True
T or F: Persons with limited health literacy skills are more likely to skip important preventive measures such as mammograms, Pap smears, and flu shots
True
Conclusions from looking at the US, UK, and Canada Healthcare Systems
US: relies heavily on market justice UK: relies heavily on social justice Canada: somewhere in between
Which of the following does the FDA not regulate: Medical devices Vaccines for animal diseases Cosmetics Tobacco products
Vaccines for animal diseases
Do All FDA Regulated Products Receive the Same Effectiveness and Safety Assessment as Prescription & Non-Prescription Drugs?
Vaccines undergo many of the same phases of testing and monitoring Dietary supplements fall under diff regulations than "conventional" drug products (can't be promoted as treatment for or prevention of disease, and the manufacturer is responsible for determining safety)
How Can Healthcare Costs be Controlled in the US?
Variety of efforts have and are continued to be made through: -Cost control through reimbursement incentives -cost sharing -restrictions on malpractice -regulation
Focus on "need to know" and "need to do"
What patients need to do... -When they leave exam room -When they check out What patients need to know.. -Taking meds -Referrals and follow ups -Self care -Filling out forms
Core Public Health Functions
assessment, policy development, assurance
___________________ is a fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services. deductible capitation skimming fee-for-service medigap
capitation
Phase 1
initial administration of a drug to humans -focuses on pharmacology of drug (absorption, excretion, metabolism) aims to establish the dosage range and rate of administration to be used in subsequent studies examines safety issues capable of identifying common and serious side effects small # of participants