Environmental Health II: Vector-Borne Diseases

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Questions and Answers

What is the primary focus of public health renewal as discussed?

Private healthcare improvements

Population-based systems for surveillance, prevention, and health promotion (correct)

Technological advancements in health care

Individual treatment strategies

Which of the following is a key challenge faced by Princess Margaret Hospital regarding radiotherapy wait lists?

Short wait times for all patients

Excessive funding from the federal government

Availability of specialists such as therapists and oncologists (correct)

High patient satisfaction rates

What ethical concern arises from sending patients to less-demanded centers?

Being away from family during treatment (correct)

Cost-effectiveness of treatments

Availability of advanced equipment

Increased wait times for patients

Which policy issue is NOT addressed in managing radiotherapy wait lists?

Reducing the number of specialists Signup and view all the answers

In queue management, what does the resource utilization ratio (𝞺) indicate?

The efficiency of healthcare providers in treating patients Signup and view all the answers

What was a primary policy response to the 2002 West Nile Virus outbreak?

Introduction of nucleic acid amplification testing (NAT) for screening Signup and view all the answers

Which of the following defines Environmental Health according to the WHO?

Assessing and controlling environmental factors affecting current and future generations Signup and view all the answers

What is the focus of the Precautionary Principle in public health?

Taking preventive action despite scientific uncertainty Signup and view all the answers

Which of the following is an example of a Vector-Borne Disease (VBD)?

Lyme disease Signup and view all the answers

What does the Risk Management Framework primarily involve?

Evaluating regulatory options and deciding on actions Signup and view all the answers

Which economic evaluation type focuses on comparing diverse health outcomes using Quality-Adjusted Life Years (QALY)?

Cost-Utility Signup and view all the answers

What was a key finding from the Naylor Report regarding public health coordination?

There were gaps in coordination during the SARS epidemic Signup and view all the answers

What role do arthropods play in relation to Vector-Borne Diseases?

They are the primary carriers of human pathogens Signup and view all the answers

Study Notes

Week 9: The Bite of Blood Safety: Environmental Health II

West Nile Virus Outbreak (2002) in Ontario and Quebec raised concerns about mosquito bites and bloodborne transmission.
Policy responses included nucleic acid amplification testing (NAT) for screening, focusing on evidence, ethics (precautionary principle), cost-effectiveness, and federal-provincial roles.
Environmental Health (WHO) is defined as assessing and controlling environmental factors affecting current and future generations. This is done through systems-based, ecological approaches focused on hazards and promoting health-supportive environments.
Emerging Infectious Diseases (Naylor Report, 2003) include examples like Ebola (1977), West Nile Virus (2002), and COVID-19, highlighting the importance of preparedness for new and spreading diseases.
Vector-Borne Diseases (VBDs) are diseases transmitted by infected arthropods (e.g., mosquitoes, ticks). Examples include West Nile Virus and Zika (mosquitoes) and Lyme disease (ticks).
The Precautionary Principle emphasizes prevention of harm despite scientific uncertainty, emphasizing proportionality, non-discrimination, and consistent measures based on evolving science.
Risk Management Framework involves:
- Risk Assessment: Identifying hazards, toxicity, and exposure levels to characterize risks.
- Risk Management: Evaluating regulatory options and deciding on actions (remediation, communication, policy changes).
Failure Modes and Effects Analysis (FMEA) involve identifying failure modes, causes, and consequences. A criticality matrix categorizes risk levels based on severity and likelihood.
Economic Evaluation in policy involves comparing the costs and consequences of interventions (comparative analysis). Types of evaluations include:
- Cost-Minimization (comparing costs when efficacy is the same).
- Cost-Effectiveness (using natural units like years of life gained or cases prevented).
- Cost-Utility (using QALYs to compare diverse health outcomes).
- Cost-Benefit (including tangible and intangible costs and benefits).

Week 10: What to Do With the Queue?

Case Study of Princess Margaret Hospital (Toronto) radiotherapy wait list issues.
Key challenges include shortages of specialists (therapists, oncologists, physicists), and 20% of patients being treated within 4 weeks, while nearly 50% waited over 8 weeks, exceeding the CARO recommendation.
Policy issues include managing wait lists, ethics of rationing care, and payment mechanisms and human resource planning.
Distribution solutions (sending patients to less-demanded centers) raise ethical concerns about separation from family.
Human Resource (HHR) solutions address staffing shortages, improve wages, work conditions, and extend machine operation hours.
Management solutions establish oversight bodies to coordinate and manage wait times.
Key Concepts in Queue Theory include a definition of managing waiting lines (first-in, first-out, multiple lines prioritizing critical patients, etc.), and metrics like resource utilization ratio denoted by ρ.

Week 11: Shoot and Tell - Mandatory Gunshot Reporting

Mandatory reporting of gunshot wounds under the 2005 Ontario Act requires hospitals to report the name and location of individuals treated for gunshot wounds.
Policy issues include balancing public safety with patient privacy, ethical physician-patient relationships, and potentially extending reporting to other violent injuries.
Public health perspective frames gunshot wounds as a rare occurrence, highlighting low public health risk and arguing for data collection to identify violent injury causes. Violence is framed as an issue requiring public health intervention (e.g., OPHA 1997), and trade-offs are emphasized between individual privacy and collective safety, as well as public health concerns versus criminality or prevention.
Proactive vs. reactive approaches to violence prevention are discussed.
Ethical and legal considerations include confidentiality exceptions (patient consent, public safety, legal duty), fiduciary duty (physician prioritizing patient welfare), and concerns about whether breaching confidentiality will deter care seeking behavior or if laws remove provider discretion.

Week 12: MAID in 2024: A Rapidly Evolving Ethical Landscape

Key Legal Cases:
- Rodriguez v. British Columbia (1993): Sought assisted death, but was denied due to Criminal Code S241(b).
- Carter v. Canada (2015): Gloria Taylor (ALS, age 64) and Kay Carter (spinal stenosis, age 89), challenged the prohibition of assisted death (MAID), and had the law deemed unconstitutional.
Truchon v. Superior Court of Quebec (2019) case, involving plaintiffs denied MAID due to their "foreseeable death" criteria was determined unconstitutional.
Overview of the 2016 Bill C-14, establishing a legal framework for MAID.
Ethical considerations involving MAID, including the right to autonomy.
Case studies of patients facing incurable conditions, highlighting potential ethical clashes between autonomy and safeguards.
Key ethical questions about MAID availability for chronic, non-terminal conditions; need for informed consent, and safeguards against potential socioeconomic influences in MAID requests, for vulnerable populations.

Week 13: Inching Toward Reform: Health Care Transformation

Overview of primary care reform and need for transformation.
Care settings and continuum: primary care (home, clinic, or health centers), secondary care (typically hospital-based), tertiary and quaternary care (specialized advanced facilities), public health, and alternative/complementary care are discussed.
Key problem areas identified during healthcare reform include access issues, issues regarding high-quality, patient-centered care, emergency diversions, and addressing wait times.
Policy legacies related to historical institutionalism, path dependency, and critical junctures are discussed.
Transition from primary care to primary health care to build comprehensive systems is described, including data's role in reform to understand utilization, planning, and funding.
Various payment mechanisms and models are described, including, fee-for-service, enhanced fee-for-service, blended capitation, and salary.
Discussion on alternative models and tools for assessing, improving, and measuring patient care. Alternative models include patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). Activity-based funding and bundled care are also mentioned.
Ontario health teams (OHTS), quality-based procedures (QBPs), and case mix systems are presented.

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Description

Explore the implications of environmental health focusing on vector-borne diseases like the West Nile Virus and their impact on public policy. This quiz covers key aspects such as disease transmission, preventive measures, and historical outbreaks. Test your knowledge on the strategies to manage emerging infectious diseases and their environmental factors.