Environmental Health II: Blood Safety Quiz

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Questions and Answers

What is the true cost of something, according to economists?

The true cost of something is what you give up to get it

The precautionary principle suggests that action should only be taken if there is scientific certainty about the likelihood and magnitude of the harm.

False

What is the primary focus of structural functionalism in ethical decision-making?

The focus of structural functionalism is on the functions and structures of society and how they contribute to overall social stability.

What does the acronym ICER stand for?

The acronym ICER stands for Incremental Cost-Effectiveness Ratio. Signup and view all the answers

Cost-utility analysis is typically used for comparing interventions that have completely different health outcomes.

True Signup and view all the answers

What is the main difference between a Cost Analysis and a Cost-Effectiveness Analysis?

A Cost Analysis focuses on minimizing the cost of interventions with similar efficacy, while a Cost-Effectiveness Analysis compares the effectiveness of interventions in terms of natural units like life years gained or disease cases avoided. Signup and view all the answers

What is the term used to describe an infectious disease that is spread through the bite of an infected insect or tick?

Vector-borne disease or VBD Signup and view all the answers

Which of the following are considered bridge vectors in the transmission of West Nile Virus in Ontario?

Culex pipiens Signup and view all the answers

What is the name of the commission that addressed the blood supply catastrophe in Canada in the 1970s and 1980s?

The Krever Commission Signup and view all the answers

What is the major report that examined the reactions to SARS in Canada?

The Naylor Report Signup and view all the answers

In Canada, public health is primarily a federal concern.

False Signup and view all the answers

Which of the following statements accurately describes the Precautionary Principle?

Action should be taken to prevent potential harm even if the scientific evidence is uncertain. Signup and view all the answers

What are the four components of the ethical framework 'principilism'?

Beneficence, non-maleficence, autonomy, justice. Signup and view all the answers

The Precautionary Principle is an example of Utilitarianism.

False Signup and view all the answers

Economic Evaluations always involve which of the following?

All of the above Signup and view all the answers

What is the concept behind 'opportunity cost' in economic evaluation?

The value of the next best alternative that is forgone when making a decision. Signup and view all the answers

Which type of economic evaluation focuses on measuring consequences in natural units, such as life years gained or cases avoided, without assigning monetary values to them?

Cost-effectiveness analysis Signup and view all the answers

What does the acronym ICER stand for in the context of cost-effectiveness analysis?

Incremental Cost-Effectiveness Ratio Signup and view all the answers

Which type of economic evaluation measures both costs and consequences in monetary units?

Cost-benefit analysis Signup and view all the answers

What is the abbreviation for the concept of health outcome measure used in cost-utility analysis, often representing a year of life in perfect health?

QALY (Quality-Adjusted Life Year) Signup and view all the answers

Study Notes

Bite of Blood Safety: Environmental Health II

Ontario and Quebec experienced an epidemic of West Nile virus in 2002, causing public concern about possible blood-borne transmission.
Public health officials were concerned about a recurrence of blood-borne illnesses like HIV and hepatitis C, leading to the implementation of a nucleic acid amplification test (NAT) program to screen potential blood donors.
This case involves several policy issues, spanning evidence, framework creation, screening processes, trade-offs, cost-effectiveness, ethics (especially the precautionary principle), and intergovernmental roles/responsibilities.

Agenda

Environmental Health (Vector-borne diseases, blood safety)
Krever Commission (1997): Blood safety matters
Naylor Report (2003): Emerging infectious diseases, globalization, and bioterrorism.
Precautionary Principle: Background & practical applications.
Risk management science, Failure mode and effects analysis (FMEA)
Cost-effectiveness analysis
Cost-utility analysis
Ethical decision-making in policy

Related/Support Readings in Chapter 1

Federal vs. Unitary models
Federalism in Canada: The Constitution Act, 1867
Framing
Precautionary Principle
Public Health
Canada Health Act
Economic Analysis (cost-effectiveness)
Screening

Learning Objectives

Understand the importance of vector-borne diseases (VBD) and blood safety.
Summarize the key findings of the Krever Commission and Naylor Report regarding blood safety and beyond.
Identify how framing processes influence policy instrument selection.
Describe the origin and application of the precautionary principle in policymaking.
Summarize the role of risk management science in public health policy.
Differentiate between cost-effectiveness and cost-utility analysis methods.
Define the Incremental Cost-Effectiveness Ratio (ICER).

General VBD Overview

Vector-borne diseases (VBD) are spread through the bite of an infected arthropod (e.g., mosquito, tick).
Examples of VBD discussed include West Nile Virus, Eastern Equine Encephalitis, Zika, and Lyme disease.

West Nile Virus

First recognized in Africa in the 1930s.
Circulates between birds and mosquitoes.
Specific mosquito species (e.g., Culex pipiens and Culex restuans) act as vectors to humans.
First detected in New York in 1999, and later spread across North America.
First detected in Ontario, Canada in 2001, becoming a public health concern in 2003.

Mosquitoes

West Nile Virus, Eastern Equine Encephalitis, and Zika are all mosquito-borne viruses.
A significant portion of infections (up to 80%) are asymptomatic.
Severe symptomatic cases can include brain inflammation, muscle weakness, paralysis, and death.

Naylor Report (2003): Emerging Infectious Diseases

Emerging infectious diseases are those newly identified or showing increasing incidence.
Examples mentioned include Ebola virus (1977), Legionnaires' disease (1977), and HIV/AIDS (1983).

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 doing something vs. not doing something (ethical implications)

Understanding the Nature of the Problem

Recognizing what we know and what we don't know about emerging issues.
Identifying potential or available tests.
Developing plans to rapidly address emerging problems.
Exploring alternative policy solutions.

Precautionary Principle

Precautionary action should be taken in the face of potential harm, regardless of the certainty of the scientific evidence.
Principle 15 of Rio Declaration 1992, emphasizes precautionary approach in environmental protection.
The precautionary principle is used to justify preventive action when significant risks exist, even if risks are not fully understood.

Precautionary Principle Principles

Proportionality (Tailoring measures of protection to the risk level).
Non-discrimination (Similar risks should be treated similarly).
Consistency (Consistent preventive measures across similar situations).
Examination of costs and benefits (comparing short and long-term effects).
Review in light of new evidence (Adjusting or revising the level of protection based on new information).

Risk Management Science

The systematic identification and evaluation of risks.
Prioritization of risks according to probability and impact.
Implementation of measures to minimize or control risks.
Includes failure modes & effects analysis (FMEA).

Risk Assessment

Site-specific information.
Hazard identification.
Toxicity assessment.
Exposure assessment.

Risk Management

Evaluation of public, economic, and social consequences.
Development of risk mitigation strategies.

Cost-Economic Evaluation

Cost of interventions involve monetary and non-monetary costs.
Opportunity costs, which represent the value of the next best option forgone.

Trade-offs

The tension between infinite desires and finite resources.
The prioritization of certain benefits in relation to their costs.

Cost-Effectiveness Analysis

Comparing the cost of interventions with the resulting outcomes.
Natural units (e.g., heart attacks prevented, life years gained) are used for comparison.
Incremental Cost-effectiveness Ratio (ICER) is a metric for comparison.

Cost-Utility Analysis

A method for evaluating interventions' cost-effectiveness using QALYs.
Comparison of health outcomes in terms of QALYs, also considering various values related to a life year.

Cost-Benefit Analysis

Compares all costs and benefits in assessing intervention value.
Considers intangible costs and benefits comprehensively.

Ethical Decision Making

Ethical frameworks used in public health decisions
Structural Functionalism, Precautionary Principle
Virtue Ethics, Deontological theories, and Principilism.

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Description

This quiz covers critical aspects of environmental health related to blood safety, particularly in the context of the West Nile virus epidemic. It examines policy issues, the implications of the Krever and Naylor reports, and the precautionary principle in screening processes. Test your knowledge on risk management strategies and the ethics surrounding blood safety.