Dr. Paul Halverson - Evidence-Based Policy Development in Public Health
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Transcript of Dr. Paul Halverson - Evidence-Based Policy Development in Public Health
Public HealthPolicy Development
“Bridging the Gap Between Animal Health and Human Health”
NIAA Symposium, Kansas City, MONovember 12, 2013
Paul K. Halverson, DrPH, FACHEFounding Dean and Professor
www.pbhealth.iupui.edu
Core Functions of Public Health
• Assessment• Policy Development• Assurance
IOM, Future of Public Health, 1988
Impact of Public Health
• In 1999, the Centers for Disease Control and Prevention named the ten greatest public health achievements of the 20th century. These advances have been largely responsible for increasing the lifespan of populations; over twenty-five of the 30 years can be accredited to public health initiatives, while medical advances account for less than 4 years. Furthermore, since 1900, the average life expectancy for Americans has increased by about 30 years.
Turnock, BJ. Public Health: What it is and How it Works, 3rd Edition. Sudbury, MA: Jones and Bartlett Publishers, 2004
Increase in Life Expectancy
Determinants of Population Health
SOURCE: The Future of the Public’s Health (IOM, 2003)NOTES: Adapted from Dahlgren and Whitehead, 1991.
The dotted lines denote interaction effects between and among the various levels of health determinants (Worthman, 1999).
Over the life span
Living and working conditions may include:
• Psychosocial factors• Employment status and
occupational factors • Socioeconomic status (income,
education, occupation)• The natural and builtc
environments• Public health services• Health care services
The Social-Ecological Model
IndividualSociety Community Relationships
Biology Environment BehaviorAdapted from Violence-a global public health problem by Dahlberg, L.L., Krug, E.G. (2002). In Krug, E., Dahlberg, L.L., Mercy, J.A., Zwi, A.B., Lozano, R., (Eds.). World Report on Violence and Health. Geneva, Switzerland: World Health Organization; 2002:1-56. Retrieved from: http://www.cdc.gov/ncipc/dvp/Social-Ecological-Model_DVP.htm6
Policy Mechanisms
• Internal Policies/ Procedures (public and private organizations)
• Rules and Regulations (Agency)• Statutes & Ordinances
Typical State Regulatory Process
• Enabling legislation provides context (general or specific guidance or requirements may exist for regulatory language).
• Internal or external case is made for regulatory change or initiation
• Agency creates first draft• Vetting process may include informal or formal
consultation
Process (Continued)
• Initial approval by Board for issuance of draft regulation
• Public hearing(s)• Review of public hearing comments• Re-draft or issuance for Board approval• Legislative review (depending on jurisdiction)• Governor approval (some jurisdictions)• Filing with Secretary of State• Enactment within 10-30 days (unless emergency)
Framework for Evidenced Based Public Health
Ross Brownson, et al.
Political Theory 101
Potential Solutions
Window of Opportunity
Policy ChangeKingdon J.W. Agendas, Alternatives, and Public Policies (1984, 2003)
Perceived Problems
Political Dynamics
Tobacco Reduction Policy
• Price (increase taxes)• Environmental Control (place, access)• Education
Lives Saved by Seat Belt Use Between 1975-2008
NHTSA (2008)14
Prevention of Dental Caries: Community Water Fluoridation
• “Community water fluoridation has been ranked one of 10 great public health achievements in the 20th century”
• Fluoride occurs naturally in all drinking water in varying concentrations, according to geological features
• In 1931, Dr. Frederick S. McKay, proved that naturally occurring fluoride in the water supply could inhibit dental caries
Centers for Disease Control and Prevention (n.d.) Preventing Chronic Diseases Invetsing Wisely in Health - Preventing Dental Caries. Retrieved 8/26/2008 from http://www.dental.ufl.edu/Patients/Files/PreventingDentalCaries.pdf
Pfizer Inc. (2006). Chapter 9: Oral health: Case study. In Milestones in public health : Accomplishments in public health over the last 100 year. (pp.176-178). New York, NY: Pfizer Inc.
Flouridation
Prevention of Dental Caries: Community Water Fluoridation (Cont.)
• 66% of individuals on public water systems — more than 162 million people — receive community water fluoridation
• “Community water fluoridation effectively prevents dental caries in communities with varying disease prevalence– Children in communities with water fluoridation
experienced 29% fewer cavities”
Centers for Disease Control and Prevention. (n.d.). Preventing Chronic Diseases Invetsing Wisely in Health - Preventing Dental Caries. Retrieved August 26, 2008 from http://www.dental.ufl.edu/Patients/Files/PreventingDentalCaries.pdf
Fluoridation
Not everyone agrees
K2, Spice, Bath Salts
Synthetic Drugs
Raw Milk Dangers
Raw Milk Press
Strong Feelings
Thank You!
Public HealthPolicy Development
“Bridging the Gap Between Animal Health and Human Health”
NIAA Symposium, Kansas City, MONovember 12, 2013
Paul K. Halverson, DrPH, FACHEFounding Dean and Professor
Richard M. Fairbanks School of Public Health
Syndemics
Definition: two or more afflictions, interacting synergistically, contributing to excess burden of disease in a population
Related concepts include: linked epidemics, interacting epidemics, connected epidemics, co-occurring epidemics, co-morbidities, and clusters of health-related crises
Centers for Disease Control and Prevention. (2008). Syndemics prevention network: spotlight on syndemics. Retrieved from: http://www.cdc.gov/syndemics/
Syndemic
Centers for Disease Control and Prevention. (2008). Syndemics prevention network: Syndemics overview - history: What is a syndemic? Retrieved from: http://www.cdc.gov/syndemics/overview-history.htm
SubstanceAbuse
Violence HIV/AIDS