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