Public health advocacy activity help

For this portfolio sub-assignment/activity, you will find an example of a public health advocacy activity. The example must be an activity sponsored by a legitimate public health-related organization (see the Lecture 11 slides for examples).To receive credit for the assignment, you will need to answer ALL of the following questions in the submission box (please number the questions for clarity).1. Identify your chosen public health advocacy example. Provide a 1-2 sentence description of the example, including the name of the organization and the public health problem it addresses. Include a URL to the example, if available. (1/3 pt)2. Briefly describe how your example meets the definition of advocacy (see Lecture 11 slides for the definition). (1/3 pt)3. Assess whether or not you think the advocacy example was appropriate for the problem it addresses. If so, provide a specific reason why it was successful. If not, provide a specific reason why it was not, or how it could be improved. (1/3 pt)
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Policy and Priority Setting
HLTH 3101
The Problem Solving
Paradigm
Define the Problem
Measure its Magnitude
Understand Key Determinants
Develop Prevention/Intervention Strategies
Set Policy/Priorities
Implement and Evaluate
?
?
?
?
?
?
Session Objectives
?
?
?
?
?
?
Outline issues relevant to program/policy implementation
Describe/depict the policy formulation process
Discuss alternate bases for decision-making
Describe structure/use of an evidence table
Describe goal and challenge of linking policy to evidence
Examine policy in relation to tobacco
1
Session Objectives/ Policy & Priority
Setting
Discuss several activities that advocates can engage in to
help promote their cause
Differentiate between lobbying and advocating
Examine advocacy efforts of an anti-tobacco organization
Outline the general transition of AIDS activism
List/describe at least 2 activities related to obesity in the
Patient Protection and Affordable Care Act (ACA)
?
?
?
?
?
4
Reading Objectives
?
Summarize the STOP Obesity Alliance efforts
?
?
?
?
Describe its strengths and weaknesses
List/describe at least 4 chronic diseases that are sequellae
(consequences) of obesity
List/describe at least 2 barriers to achieving healthy weight
the program identified
Visit the STOP Obesity Alliance Website at
http://www.stopobesityalliance.org/
?
Visit the federal government website on health at
http://www.healthcare.gov/
Politics
“Medicine is a social science, and
politics nothing but medicine at a
larger scale.”
Rudolf Virchow
(German physician, dubbed the
‘father of pathology’ and credited
with founding social medicine)
2
Definition of Terms
Instruments of Policy
1. Information, education and communication
2. Taxes and subsidies
3. Regulation and legislation
4. Direct expenditures
5. Research
Policy Formulation Process
?
?
The problem solving process is similar to that of a
policy decision memo
The process is iterative and cyclical…
?
?
You can use it to determine which problems to
direct resources to
You can use it to determine which strategy to select
for a given problem
Policy Formulation
6. Monitor the
implemented
policy
5. Display and
distinguish
among alternate
policies
1. Verify, define, and
detail the problem
2. Establish
evaluation criteria
3. Identify
alternative policies
4. Evaluate
alternative policies
3
Criteria for Choosing Problems
Rational (objective)
Magnitude of the health problem
Nature/Modifiability of the Risk factors
Availability and effectiveness of interventions
1.
2.
3.
Political (subjective?)
Public outcry (not substantiated by facts)
Direction by higher authority
Pandering
1.
2.
3.
Rational Criteria for Choosing
Interventions (within a problem)
Cost of interventions
Cost-effectiveness of the interventions
1.
2.
1.
A measure of cost-effectiveness of interventions:
1.
Dollars Per Discounted Healthy Life-Years
(DHLY) Gained
Political Will
Technical Feasibility
3.
4.
Rational Criteria Continued
5.
6.
7.
8.
Logistic Feasibility
Resources
Stakeholder support
Minimal indirect/unintended consequences
(evidence table)
4
Political Criteria for Choosing
Interventions (within a problem)
Public visibility
Short-term impact
Secondary impact (e.g., economic impact among
constituency)
Minimal negative reactions
•
•
•
•
Politician versus a Statesman
A politician’s concern is for the next
election….
A statesman’s concern is for the next
generation
Patient Protection and Affordable Care Act
(ACA)
?
Main Principles
?
Stronger consumer rights and protections
?
More affordable coverage
?
Better access to care
?
Stronger Medicare
5
Patient Protection and Affordable Care Act
(ACA)
?
Basic provisions
?
Improves and emphasizes primary care service
delivery
?
Eliminates pre-existing conditions
?
Extends coverage of young adults on their parents’
health insurance until age 26
?
Extends Medicaid eligibility for low-income families
Patient Protection and Affordable Care Act
(ACA)
?
Provisions related to obesity
?
?
?
?
?
Calorie counts on chain restaurant menus in 2014
No copay/cost for some services (obesity screening and
intensive counseling will be covered for adults; obesity
screening and moderate to intensive counseling
will be covered for children
Providers can bill for obesity conversations
People cannot be denied coverage for obesity related
preexisting conditions or b/c they’ve had a procedure for
obesity (for example, bariatric surgery)
Investment in prevention (The Prevention and Public Health
Fund)–community level funding for obesity activities
Patient Protection and Affordable Care Act
(ACA)
?
Provisions related to obesity
?
?
?
?
?
Employers will now be allowed to financially penalize (30-50%
of insurance policy cost) employees who do not meet health
goals (for example, target BMIs) AND are not enrolled in
wellness programs
States will design a media campaign to make Medicaid patients
aware of obesity related services
Reporting of obesity efforts to Congress, including incidence
Evidence reviews of obesity programs
“Essential benefits packages” put together by states may or may
not include obesity related procedures and drugs
6
Funding issues
•
•
A component in understanding the political process
is understanding funding mechanisms.
Funding in the health sector is often categorized as
either vertical or horizontal funding
•
•
Vertical (or categorical) funding means funds are limited to
a specific issue (e.g., HIV/AIDS)
• Special interests are often able to influence vertical
funding (“earmarking”) but this may have (unintentional
or not) negative impacts for effective/ comprehensive
solutions
Horizontal (or block) funding means funds can be used for
a variety of related purposes (e.g., primary care)
Example: CHD
Let’s look at an evidence table to evaluate different
possible interventions for addressing coronary heart
disease.
First, a logic model of the causes of CHD
Non-Modifiable
Risk Factors
Physiological Risk Factors
Age
Male Sex
Family History
Hypertension
Hypertensive
Heart Disease
Behavioral
Risk Factors
Hemorrhagic
Stroke
Sedentarianism
Diet
– % saturated fat
– salt
– cholesterol
– total energy
content
Heavy alcohol
consumption
Smoking
Obesity
Elevated LDL
Cholesterol
Decreased HDL
Cholesterol
Diabetes
Endpoints
Coronary Heart
Disease
Atherothrombotic
Stroke
Peripheral
Vascular Disease
Figure 4: Scheme of Relations among Risk Factors for Cardiovascular
Disease (source: Pearson, Jamison, Trejo-Gutierrez, forthcoming.
7
Efficacy and Cost of Elements of Preventive Strategy for
Major Cardiovascular Diseases
Effectiveness
Preventive Strategy
Costs
Compliance
Clinical
Efficacy
Manpower
Technology
Drugs
Smoking Cessation
+
+++
+/-
0
0/+
Low Salt Diet
+
?
+/-
0
0
Modified Fat Diet
+
++
+/-
0
0
Exercise
+
++
+/-
0
0
Diabetic Diet
+
0
++
0
0
Obesity Control
0
?
+/-
0
0
1.CORONARY ARTERY DISEASE
Community-Based
0=NA; +/- both positive & negative
Continued from the previous slide:
Effectiveness
Preventive Strategy
Compliance
Clinical
Efficacy
Costs
Manpower
Technology
Drugs
1.CORONARY ARTERY DISEASE
Clinic-Based
Antihypertensive Drugs
Lipid-Lowering Drugs
Diabetic Drugs
Antiplatelet Drugs
+
++
++
+
++
+/-
+++
++
++
++
+
0
+++
++
+++
++
++
+
+
+
0=NA; +/- both positive & negative
Continued from the previous slide:
Preventive Strategy
Effectiveness
Costs
Compliance
Clinical
Efficacy
Manpower
Technology
Drugs
Smoking Cessation
+
++
+/-
0
0
Low Salt Diet
+
+
+/-
0
0
Obesity Control
0
+
+/-
0
0
+
+++
++
+
++
++
+++
+
+
+
2. STROKE
Community-Based
Clinic-Based
Antihypertensive Drugs
Antiplatelet Drugs
0=NA; +/- both positive & negative
8
Continued from the previous slide:
Effectiveness
Preventive Strategy
Costs
Compliance
Clinical
Efficacy
Manpower
Technology
Drugs
Low Salt Diet
+
+
+/-
0
0
Exercise
+
+
+
0
0
Obesity Control
0
++
+/-
0
0
Alcohol Restriction
?
+
0
0
0
+
+++
++
+
++
2. HYPERTENSION
Community-Based
Clinic-Based
Antihypertensive Drugs
Efficacy and Cost of Elements of Case Management
Strategy
Case Management Strategy
Efficacy
Costs
Manpower
Technology
Drugs
1.CORONARY HEART DISEASE
Acute MI/Unstable Angina
Cardiopulmonary
Resuscitation
+/-
+++
+++
+++
Coronary Care Units
+
++++
++++
+++
Antiarrhythmic Drugs
0
++
++
+++
Thrombolysis
++
++++
++++
++++
Nitrates
++
+/+++
+
+/+++
Antiplatelet/ Anticoagulant
Drugs
++
+
+
+
26
Continued from the previous slide:
Case Management Strategy
Efficacy
Costs
Manpower
Technology
Drugs
Chronic Angina / Stable Post-MI
Beta Blocking Agents
+++
+++
+
++++
Calcium Channel Blockers
0
+++
+
++++
Angioplasty
?
++++
++++
++
Coronary Artery Bypass
Surgery
+
++++
++++
++
0
+++
++
++++
+++
+++
+
0
Antiarrhythmic Drugs
Cardiac Rehab (incl. Smoking
cessation)
Antiplatelet Agents
++
+
0
+
Cholesterol Lowering Drugs
++
++
+++
++++
9
Continued from the previous slide:
Case Management Strategy
Efficacy
Costs
Manpower
Technology
Drugs
Congestive Heart Failure
Drug Therapy
Heart Transplantation
2. STROKE
+
++++
+++
++++
++
++++
+
++++
?
++++
++++
++++
?
+++
++
0
Acute Stroke
General Support
Stable Post Stroke/TIA
Antiplatelet Agents
Antihypertensive Drugs
Carotid Surgery
++
+
0
+
+++
++
+
+++
?
+++
++++
+
Continued from the previous slide:
Case Management Strategy
Efficacy
Costs
Manpower
Technology
Drugs
++
+++
++++
++
3. PERIPHERAL VASCULAR DISEASE
Acute: Surgery
Chronic
Surgery/Angioplasty
Smoking Cessation
++
++++
++++
++
+++
+
0
0
+/-
++++
+++
++++
++
++++
++++
++
4. HYPERTENSIVE DISEASE
Congestive Heart Failure
Drug Therapy
Hypertensive Renal Disease
Dialysis
Getting to Implementation
?
?
?
The analysis supported by the evidence table will lead you
to the objectively ‘correct’ answer/approach
Adding in an assessment of social forces (political will,
etc), will suggest more ‘realistic’ or ‘attainable’
goals/objectives.
Is half a loaf better than none?
30
10
Getting to Implementation
?
Sometimes achieving a larger goal first requires
generating support/political will… This is where
ADVOCACY comes into play.
31
Advocacy
Advocacy
?
“the process of turning passive support into educated
action by stakeholders” (American Library
Association, 2004).
?
“a planned, deliberate, sustained effort to raise
awareness of an issue. It’s an ongoing process in
which support and understanding are built
incrementally over an extended period of time and
using a wide variety of marketing and public relations
tools”. (Canadian Library Association)
33
11
Advocacy
Organized activism related to a particular set
of issues.
? Expected to be non-deceptive and in good
faith, though it is sometimes tainted by use of
propaganda.
? It is almost always organized into or by an
advocacy group or special interests.
? Typically of “grassroots” origins
?
34
Advocacy
Under-utilized
Often avoided by academics (who feel advocating
might cloud their perception as objective purveyors
of the truth)
Needed to generate political will, esp for unpopular
or difficult courses of action
Use community standing to your advantage (this is why
?
?
?
?
your personal and professional integrity is so important)
35
Advocacy vs Lobbying
?
Lobbying involves activities aimed at influencing
public officials regarding specific legislation.
?
Advocacy involves activities aimed at advancing
a cause or principle (usually evidence or morallybased)
36
12
Brief History of AIDS Activism
?
?
?
?
June 5, 1981 – MMWR report
“Pneumocytis pneumonia – Los Angeles”
? 5 young homosexual men in 3
hospitals with biopsy-confirmed
disease
End of 1981 – 150 individuals die of “new” virus
Michael Callan and Dan Turner begin to realize that they, as
PWAs need to become more involved and speak up for
themselves
May 1983 – Self-empowerment movement; impromptu
meeting of PWAs at Lesbian and Gay Health Conference
37
Brief History of AIDS Activism
?
?
Produced “The Denver Principles”
? Challenged healthcare professionals to deal with their attitudes
about AIDS and to acknowledge both mental/physical issues
? Implores all people to not stigmatize or blame PWAs
? States that PWAs have many rights, including the rights to have
sex, obtain quality healthcare, have access to available,
affordable treatments and have privacy
? Urge PWAs to disclose their status to partners and to
advocate for themselves
People returned home and began efforts to establish local PWAs
Coalitions
38
Brief History of AIDS Activism
?
?
?
GLAAD emerges but again, many feel the agenda is too
conservative
Lavender Hill
Mob forms
1987 – AIDS
Coalition to
Unleash Power
(ACT UP) is
established
39
13
40
Brief History of AIDS Activism
?
Many other “radical” displays
of advocacy/activism by ACT
UP:
?
?
?
?
Protests at CDC/NIH
Scattering remains of PWAs
on White House lawn
Shutting down of the NYSE
after people were found
chained to the balcony
protesting AIDS drug pricing
Delivering of coffins to
government officials
41
Brief History of AIDS Activism
?
Key accomplishments of ACT UP include:
?
?
?
?
Securing the use of the CD4 clinical marker
Change in the AIDS definition to include low CD4
marker levels and other indicator diseases
Publication pressure; especially related to
treatments
Influenced drug trials, speed which drugs are
approved; cost of AIDS drugs
42
14
“Socialized Medicine” Advocacy Video
?

43
*Side note on leadership
?
Bases for leadership
?
?
?
?
?
?
Technical competence
Voted
Appointed
Assignment
Charismatic
Leadership is a SERVICE position
44
Service is the rent we
pay for the privilege of
living on this earth.
Shirley Chisholm*
(also attributed to Marian Wright Edelman**)
*First black female elected to US Congress and first to run for the US
Presidency
** Founder & President, Children’s Defense Fund
15
Application to Tobacco
•
What have they done?
?
?
?
?
Federal
Healthcare reform: new
coverage under Medicaid for
cessation programs; multiple
other prevention efforts
Increased federal tobacco tax to $1.01 in 2009
FDA authority over regulation, marketing, sale of tobacco
Images on tobacco products – Sept 2012
?
Ruling overturned by courts
46
Application to Tobacco
•
What have they done?
State
?
?
?
Increased state tobacco taxes ($0.17 to $4.35)
29 states now have smoke-free restaurants and bars (some
countries are smoke-free too!)
Worked to keep state level prevention monies focused on tobacco
? Money from 1998 Settlement funds are being used for nontobacco related activities!
? See this website for more info.
?
http://www.tobaccofreekids.org/what_we_do/state_local/tobacco_settlement/north_carolina
47
Application to Tobacco
?
What activities have they engaged in to advocate for tobacco
prevention/cessation?
? Health fairs
? Kick Butts Day
? PSA contests
? Memorial walls
? Cigarette butt cleanups
? Tobacco control compliance campaigns
? Email House representatives
? Tobacco Unfiltered blog
? Youth advocates
48
16
Example advocacy messages…
?
?
?
Youth Advocates

Costs of smoking

?
Yul Brenner http://www.youtube.com/watch?v=JNjunlWUJJI
…and closer to home
?
?
Norm the 9er – SGA policy

Teen smoking – UNC student PSA

49
Questions?
17

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