HCMG LATEST QUESTIONS AND ANSWERS UPDATE: A
MASTERING A+ MATERIAL!
Public health
i) the science and art of preventing disease, prolonging life, and promoting health through the
organized efforts and informed choices of society, organizations, public and private
communities and individuals
ii) public health aims to provide the maximum benefit for the largest number of people (health
of populations vs individuals, societal focus
- values related to the distribution and allocation of resources and notions of justice, economic
efficiency view
- social externalities --> role for govt/public policy)
US Public Health Service
HHS Agencies in PHS, overs NIH, FDA, etc.
US Public Health System
Public health system = all public, private and voluntary entities that contribute to the delivery of
essential public health services within a jurisdiction (public health agencies, HC providers, public
safety orgs, charity orgs, educational orgs, etc)
Domains of public health services
- sanitation and environmental health
- pandemics / epidemics
- disaster response preparedness
- disease prevention policy (food labeling, smoking ban)
Ten Essential Public Health Services
1. Monitor Health
2. Diagnose and Investigate
3. Inform, Educate, Empower
4. Mobilize Community Partnership
5. Develop Policies
6. Enforce Laws
7. Link to/Provide Care
8. Assure a Competent Workforce
9. Evaluate
10. Research
,Example:
Federal Assessment = National tobacco public health surveillance
Policy Development = smoking ban on commercial flights
Assurance = Federal grants for anti-smoking research
Federalism and Public Health
Federalism = system of government in which national government given powers enumerated in
the Constitution and state governments given powers not explicitly trusted to national
government
Federalism can be a constraint during a public health crisis!
Commerce Clause: Congress allowed to regulate commerce among several states (but that is
the limit, has to be commercial)
States granted police powers through the 10th Amendment and common law to make and
enforce laws related to public health - includes disease mitigation strategies like mandatory
mask-wearing, school and business closures, bans on gatherings ,stay at home orders,
vaccinations
COVID-19 and Public Health System
States granted police powers through the 10th Amendment and common law to make and
enforce laws related to public health - includes disease mitigation strategies like mandatory
mask-wearing, school and business closures, bans on gatherings ,stay at home orders,
vaccinations
Formal responsibility for public health services lies with states and cities/counties.
CDC is primarily a public health surveillance and investigative entity (issues guidelines, has
enforcement powers related to isolation and quarantine with respect to travelers from foreign
countries and into the US and between states)
Scope of federal action:
- cooperative federalism = federally supported, state managed, locally executed (cannot force
state cooperation)
- public health interest vs precaution against excessive concentration of power
Formal responsibility for public health services lies with the states and (by delegation)
cities/counties
States not cooperating, competing with each other for PPE and other needs.
, CDC
CDC is primarily a public health surveillance and investigative entity (issues guidelines, has
enforcement powers related to isolation and quarantine with respect to travelers from foreign
countries and into the US and between states).
For the most part, CDC is an information gathering entity.
Social Determinants of Health
Social determinants of health are economic and social conditions that influence the health of
people and communities
- 40% individual behavior
- 30% genetics
- 20% social and environmental factors
- 10% healthcare
Categories:
- Economic Stability (Employment, Income, Expenses, Debt, Medical bills, etc)
- Neighborhood/Physical Environment (Housing, Transportation, Safety, Parks, Plagrounds, etc)
- Education (Literacy, Language, etc)
- Food (Hunger, access to healthy options)
- Community/Social Context (social integration, support systems, community engagement,
discrimination, stress)
- HC System (health coverage, provider availability, quality of care, etc)
Examples of Social Policy Interventions
Early Childhood Education - Perry Preschool Project (basis for Head Start)
- led to lower rates of risky health behaviors like smoking
Housing - Moving to Opportunity (involved randomized group, given some support related to
housing, could move where they wanted to move)
- lower risk of high BMI, better self rated mental health, etc. for those who were able to move
where they wanted
Income Supports - Earned Income Tax Credit (tax credit for families depending on # of kids, if
below a certain income level, get some income tax back)
- decrease in low birthweight births, reduction in maternal smoking
How do we integrate SDHs into health policy?
Jurisdiction is mostly at the state level, especially as it relates to both education and taxation
MASTERING A+ MATERIAL!
Public health
i) the science and art of preventing disease, prolonging life, and promoting health through the
organized efforts and informed choices of society, organizations, public and private
communities and individuals
ii) public health aims to provide the maximum benefit for the largest number of people (health
of populations vs individuals, societal focus
- values related to the distribution and allocation of resources and notions of justice, economic
efficiency view
- social externalities --> role for govt/public policy)
US Public Health Service
HHS Agencies in PHS, overs NIH, FDA, etc.
US Public Health System
Public health system = all public, private and voluntary entities that contribute to the delivery of
essential public health services within a jurisdiction (public health agencies, HC providers, public
safety orgs, charity orgs, educational orgs, etc)
Domains of public health services
- sanitation and environmental health
- pandemics / epidemics
- disaster response preparedness
- disease prevention policy (food labeling, smoking ban)
Ten Essential Public Health Services
1. Monitor Health
2. Diagnose and Investigate
3. Inform, Educate, Empower
4. Mobilize Community Partnership
5. Develop Policies
6. Enforce Laws
7. Link to/Provide Care
8. Assure a Competent Workforce
9. Evaluate
10. Research
,Example:
Federal Assessment = National tobacco public health surveillance
Policy Development = smoking ban on commercial flights
Assurance = Federal grants for anti-smoking research
Federalism and Public Health
Federalism = system of government in which national government given powers enumerated in
the Constitution and state governments given powers not explicitly trusted to national
government
Federalism can be a constraint during a public health crisis!
Commerce Clause: Congress allowed to regulate commerce among several states (but that is
the limit, has to be commercial)
States granted police powers through the 10th Amendment and common law to make and
enforce laws related to public health - includes disease mitigation strategies like mandatory
mask-wearing, school and business closures, bans on gatherings ,stay at home orders,
vaccinations
COVID-19 and Public Health System
States granted police powers through the 10th Amendment and common law to make and
enforce laws related to public health - includes disease mitigation strategies like mandatory
mask-wearing, school and business closures, bans on gatherings ,stay at home orders,
vaccinations
Formal responsibility for public health services lies with states and cities/counties.
CDC is primarily a public health surveillance and investigative entity (issues guidelines, has
enforcement powers related to isolation and quarantine with respect to travelers from foreign
countries and into the US and between states)
Scope of federal action:
- cooperative federalism = federally supported, state managed, locally executed (cannot force
state cooperation)
- public health interest vs precaution against excessive concentration of power
Formal responsibility for public health services lies with the states and (by delegation)
cities/counties
States not cooperating, competing with each other for PPE and other needs.
, CDC
CDC is primarily a public health surveillance and investigative entity (issues guidelines, has
enforcement powers related to isolation and quarantine with respect to travelers from foreign
countries and into the US and between states).
For the most part, CDC is an information gathering entity.
Social Determinants of Health
Social determinants of health are economic and social conditions that influence the health of
people and communities
- 40% individual behavior
- 30% genetics
- 20% social and environmental factors
- 10% healthcare
Categories:
- Economic Stability (Employment, Income, Expenses, Debt, Medical bills, etc)
- Neighborhood/Physical Environment (Housing, Transportation, Safety, Parks, Plagrounds, etc)
- Education (Literacy, Language, etc)
- Food (Hunger, access to healthy options)
- Community/Social Context (social integration, support systems, community engagement,
discrimination, stress)
- HC System (health coverage, provider availability, quality of care, etc)
Examples of Social Policy Interventions
Early Childhood Education - Perry Preschool Project (basis for Head Start)
- led to lower rates of risky health behaviors like smoking
Housing - Moving to Opportunity (involved randomized group, given some support related to
housing, could move where they wanted to move)
- lower risk of high BMI, better self rated mental health, etc. for those who were able to move
where they wanted
Income Supports - Earned Income Tax Credit (tax credit for families depending on # of kids, if
below a certain income level, get some income tax back)
- decrease in low birthweight births, reduction in maternal smoking
How do we integrate SDHs into health policy?
Jurisdiction is mostly at the state level, especially as it relates to both education and taxation
