Podcast
Questions and Answers
What defines emerging infectious diseases?
What defines emerging infectious diseases?
Which arthropods are commonly known to transmit vector-borne diseases?
Which arthropods are commonly known to transmit vector-borne diseases?
Which of the following viruses is NOT associated with mosquitoes?
Which of the following viruses is NOT associated with mosquitoes?
When was West Nile Virus first detected in North America?
When was West Nile Virus first detected in North America?
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Severe cases of West Nile Virus can lead to which of the following symptoms?
Severe cases of West Nile Virus can lead to which of the following symptoms?
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Which statement correctly describes bridge vectors in the context of West Nile Virus?
Which statement correctly describes bridge vectors in the context of West Nile Virus?
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Which of the following is not an example of an emerging infectious disease since 1973?
Which of the following is not an example of an emerging infectious disease since 1973?
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What principle suggests that actions should be taken to prevent serious potential harm despite scientific uncertainty?
What principle suggests that actions should be taken to prevent serious potential harm despite scientific uncertainty?
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Which is a flu-like symptom of viruses such as West Nile Virus and Zika?
Which is a flu-like symptom of viruses such as West Nile Virus and Zika?
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What is the primary mode of infection for vector-borne diseases?
What is the primary mode of infection for vector-borne diseases?
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Which of the following represents a potential area of concern regarding vector-borne diseases?
Which of the following represents a potential area of concern regarding vector-borne diseases?
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In which year did West Nile Virus first become a public health concern in Ontario?
In which year did West Nile Virus first become a public health concern in Ontario?
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The Rio Declaration's Principle 15 emphasizes what aspect in the context of environmental protection?
The Rio Declaration's Principle 15 emphasizes what aspect in the context of environmental protection?
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What is the primary role of the ecological approach in health assessment?
What is the primary role of the ecological approach in health assessment?
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What is a common symptom that indicates severe cases of diseases caused by viruses like West Nile Virus?
What is a common symptom that indicates severe cases of diseases caused by viruses like West Nile Virus?
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In the context of vector-borne diseases, what does the term 'pandemic planning' refer to?
In the context of vector-borne diseases, what does the term 'pandemic planning' refer to?
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What does the precautionary principle emphasize when facing threats of serious environmental damage?
What does the precautionary principle emphasize when facing threats of serious environmental damage?
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Which principle ensures that comparable situations are treated similarly under the precautionary principle?
Which principle ensures that comparable situations are treated similarly under the precautionary principle?
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What should be examined according to the precautionary principle when considering actions to mitigate risks?
What should be examined according to the precautionary principle when considering actions to mitigate risks?
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When might precautionary regulatory policies become controversial?
When might precautionary regulatory policies become controversial?
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What does the precautionary principle allow humanity to do?
What does the precautionary principle allow humanity to do?
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What should happen to the chosen level of protection if new scientific data emerges?
What should happen to the chosen level of protection if new scientific data emerges?
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Which of the following is NOT a principle associated with the precautionary approach?
Which of the following is NOT a principle associated with the precautionary approach?
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How does the precautionary principle view scientific uncertainty?
How does the precautionary principle view scientific uncertainty?
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What is the primary goal of risk management science?
What is the primary goal of risk management science?
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What is the first step in the Failure Modes & Effects Analysis process?
What is the first step in the Failure Modes & Effects Analysis process?
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Which of the following was considered a significant public health catastrophe in Canadian history?
Which of the following was considered a significant public health catastrophe in Canadian history?
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What aspect did the Krever Commission emphasize for improving the blood system?
What aspect did the Krever Commission emphasize for improving the blood system?
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According to the Naylor Report, what challenge hinders public health policies in Canada?
According to the Naylor Report, what challenge hinders public health policies in Canada?
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In the context of risk management, what does 'un-‐priced, unintentional and uncompensated side effect' refer to?
In the context of risk management, what does 'un-‐priced, unintentional and uncompensated side effect' refer to?
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Which disease's response from the Canadian Blood Services was highlighted post-Krever Commission?
Which disease's response from the Canadian Blood Services was highlighted post-Krever Commission?
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What does the term 'infection respect jurisdictional boundaries' imply regarding infectious diseases?
What does the term 'infection respect jurisdictional boundaries' imply regarding infectious diseases?
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What primarily governs public health in Canada?
What primarily governs public health in Canada?
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What tension exists in the Canadian public health framework?
What tension exists in the Canadian public health framework?
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Which activity is NOT typically included in public health systems?
Which activity is NOT typically included in public health systems?
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According to the content, what is an essential perspective in economic evaluations?
According to the content, what is an essential perspective in economic evaluations?
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What statement reflects Thomas Sowell's view on economics and politics?
What statement reflects Thomas Sowell's view on economics and politics?
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Which aspect is highlighted as a strength of Canada’s public health system?
Which aspect is highlighted as a strength of Canada’s public health system?
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Who assumes responsibility for public health at the municipal level in Canada?
Who assumes responsibility for public health at the municipal level in Canada?
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In considering healthcare costs, which perspective is essential to include?
In considering healthcare costs, which perspective is essential to include?
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What is the primary focus of economic evaluation in healthcare?
What is the primary focus of economic evaluation in healthcare?
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Which type of analysis considers both costs and benefits, including intangible factors?
Which type of analysis considers both costs and benefits, including intangible factors?
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What is the key characteristic of cost-effectiveness evaluation?
What is the key characteristic of cost-effectiveness evaluation?
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Which type of analysis is specifically designed to evaluate interventions with different health outcomes using QALY?
Which type of analysis is specifically designed to evaluate interventions with different health outcomes using QALY?
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What is an opportunity cost in the context of economic evaluation?
What is an opportunity cost in the context of economic evaluation?
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Which of the following statements accurately describes cost analysis or minimization?
Which of the following statements accurately describes cost analysis or minimization?
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In which scenario can one of the comparators in economic evaluation be 'no therapy'?
In which scenario can one of the comparators in economic evaluation be 'no therapy'?
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What ethical framework is mentioned as being very utilitarian in the context of cost analysis?
What ethical framework is mentioned as being very utilitarian in the context of cost analysis?
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Study Notes
Blood Safety and Environmental Health II
- Ontario and Quebec experienced an epidemic of West Nile virus in 2002.
- Public concern arose about the risk of infection and potential blood-borne transmission.
- Canadian and US blood systems implemented nucleic acid amplification testing (NAT) to screen donors for West Nile virus.
- This case highlights policy issues, including evidence-based decision-making, framing, trade-offs, cost-effectiveness, ethical considerations (precautionary principle), and federal-provincial responsibilities.
Agenda
- Environmental Health: Vector-borne disease primer, blood safety and the Krever Commission (1997), framing.
- Specific Topics: Public Health and the Naylor Report (2003), precautionary principle, risk management science (FMEA), cost-effectiveness analysis, and ethical decision-making.
Related Readings (Chapter 1)
- Federal vs. Unitary models
- Canadian Federalism (Constitution Act, 1867)
- Framing
- The Precautionary Principle
- Public Health
- Canada Health Act
- Economic Analysis (Cost-effectiveness)
- Screening
Learning Objectives
- Understanding the importance of vector-borne diseases (VBD) and blood safety.
- Summarizing the Krever Commission's and Naylor Report's significance in blood safety.
- Identifying the role of framing in policy instrument selection.
- Explaining the precautionary principle's origins and impact on policy.
- Summarizing risk management science and precautionary principle usage in public health.
- Differentiating between cost-effectiveness and cost-utility analyses.
- Defining and using the Incremental Cost-Effectiveness Ratio (ICER).
Naylor Report (2003): Emerging Infectious Diseases
- COVID-19 is highlighted as a recent example of an emerging infectious disease.
- Diseases have existed but increased in incidence or geographic spread.
- More than 30 previously unknown viral and bacterial diseases emerged since 1973.
General VBD Overview
- Vector-borne diseases (VBDs) are transmitted via infected arthropods (like mosquitoes or ticks).
- Examples: West Nile Virus, Eastern Equine Encephalitis, Zika, and Lyme Disease
West Nile Virus
- First recognized in Africa in the 1930s.
- Circulates between birds and bird-biting mosquitoes.
- Mosquitoes that transmit the virus are called "bridge vectors".
- First detected in New York in 1999 then spread.
- First human cases in Ontario were in 2002, becoming a significant public health issue in that year.
Mosquitoes and VBDs
- VBDs (West Nile, Eastern Equine Encephalitis, and Zika) are viral.
- 80% of individuals are asymptomatic.
- Severe cases include brain inflammation, muscle weakness, paralysis, and death.
- Flu-like symptoms are common, including fever, headache, body aches, and fatigue.
Framing (Problem Identification)
- Nature of the condition (potential or available tests).
- Alternative policy options.
- Risk to blood supply (Krever Commission).
- Zero tolerance (Precautionary Principle).
- Costs of action versus inaction (economic implications).
Understanding the Nature of the Problem
- Important to understand the known information about emerging issues.
- How to keep on top of emerging issues.
- Having available tests when issues arise.
- Action plans for emergencies (pandemic planning).
- Policy options should be considered.
Precautionary Principle
- Action should be taken to prevent potential harm, regardless of scientific uncertainties.
- This should be considered given possible threats that could cause irreversible damage.
- The Rio Declaration (1992) emphasized this principle in environmental protection.
- Application in public health often involves controversial policies when scientific understanding is incomplete.
- Precautionary principle gives humanity a mechanism to help with regulation based on human and environmental health.
Risk Management Science
- This approach systematically identifies, evaluates, and prioritizes potential risks of adverse health effects from exposure to hazardous agents.
- Aims at minimizing, monitoring, and controlling adverse events through resource applications.
Risk Assessment and Management
- Step-by-step process of assessing risks to public health.
- Assessing site-specific information, hazard identification, toxicity assessment, exposure assessment leads to risk characterization.
- Risk characterization feeds into options, balancing public health against social and economic factors.
Failure Modes and Effects Analysis (FMEA)
- A structured approach for identifying potential failures in a process or system.
- Steps in the process, failure modes (what could go wrong), failure causes (why would the failure happen), and failure effects (what would be the consequences).
Economic Evaluation
- Consideration of both costs vs. consequences in alternative policies.
- Methods for evaluating economic implications of health programs/measures.
- Costs encompass direct (e.g., lost wages) indirect costs (lost wages, lost opportunities), and intangible costs.
- Evaluating consequences (natural units or health indexes) for evaluating public health measures.
Cost-Effective Evaluation
- Comparing the costs and effectiveness of different interventions.
- "Natural Units" are used to measure health outcomes: heart attacks, kilos lost, life years gained.
Cost-Consequence Analysis
- Separate consideration of costs and consequences.
- No comparison ratio, instead specific outcomes are measured.
- Outcomes are often consequences like "number of patients treated".
Cost-Utility Analysis
- Compares interventions that have different health outcomes, using a quality-adjusted life year (QALY) or similar measure.
Cost-Benefit Analysis
- Compares all costs and all benefits to assess overall value.
- A comprehensive assessment that often includes ethical considerations.
Ethical Decision-Making
- Various ethical frameworks are used in public health policy, including structural functionalism, virtue ethics, principles and utilitarianism (cost analysis).
Krever Commission and Naylor Report
- Public health policy in Canada is heavily affected by intergovernmental relations, which sometimes results in confusion and overlaps.
Public Health Renewal in Canada (2003)
- Public health in Canada is often viewed as a provincial concern, but federal involvement is sometimes necessary.
- Canadian public health systems, especially, have demonstrated the capability to address public health challenges and outbreaks.
Trade-offs
- The principle that "infinite desires chase a finite number of resources" is relevant in public policy planning.
- Tradeoffs are generally recognized and must be considered in any analysis.
Types of Economic Evaluations
- Key metrics for various evaluation types (e.g Cost Analysis, Cost-Effectiveness, Cost-Utility, Cost-Benefit), their measurements (both of costs and consequences).
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Description
Explore the intersection of blood safety and environmental health in the context of the West Nile virus outbreak in Ontario and Quebec. This quiz covers important topics such as evidence-based decision-making, risk management, and ethical considerations related to public health policies. Test your knowledge of the frameworks that govern health and safety regulations.
