Evidence-Based Policy Development in Public Health - Dr. Paul Halverson, Founding Dean and Professor, Indiana University Richard M. Fairbanks School of Public Health, from the 2013 NIAA Symposium Bridging the Gap Between Animal Health and Human Health, November 12-14, 2013, Kansas City, MO, USA. More presentations at http://www.trufflemedia.com/agmedia/conference/2013-niaa-antibiotics-bridging-the-gap-animal-health-human-health

1. Public Health
Policy Development
“Bridging the Gap Between Animal Health and
Human Health”
NIAA Symposium, Kansas City, MO
November 12, 2013
Paul K. Halverson, DrPH, FACHE
Founding Dean and Professor
www.pbhealth.iupui.edu

2. Core Functions of Public Health
• Assessment
• Policy Development
• Assurance
IOM, Future of Public Health, 1988

3. 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

4. Increase in Life Expectancy

5. Determinants of Population Health
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
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).

6. The Social-Ecological Model
Society
Biology
Community
Relationships
Environment
Individual
Behavior
Adapted 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:
6
http://www.cdc.gov/ncipc/dvp/Social-Ecological-Model_DVP.htm

7. Policy Mechanisms
• Internal Policies/ Procedures (public and
private organizations)
• Rules and Regulations (Agency)
• Statutes & Ordinances

8. 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

9. 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)

10. Framework for Evidenced Based Public Health
Ross Brownson, et al.

11. Political Theory 101
Perceived
Problems
Potential
Solutions
Political
Dynamics
Window of
Opportunity
Policy Change
Kingdon J.W. Agendas, Alternatives, and Public Policies (1984, 2003)

12. Tobacco Reduction Policy
• Price (increase taxes)
• Environmental Control (place, access)
• Education

14. Lives Saved by Seat Belt Use
Between 1975-2008
NHTSA (2008)
14

15. 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.

16. Flouridation

17. 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

18. Fluoridation

19. Not everyone agrees

20. K2, Spice, Bath Salts

21. Synthetic Drugs

22. Raw Milk Dangers

23. Raw Milk Press

24. Strong Feelings

25. Thank You!
Public Health
Policy Development
“Bridging the Gap Between Animal Health and
Human Health”
NIAA Symposium, Kansas City, MO
November 12, 2013
Paul K. Halverson, DrPH, FACHE
Founding Dean and Professor
Richard M. Fairbanks School of Public Health

26. 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, comorbidities, 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/

27. Syndemic
Substance
Abuse
Violence
HIV/AIDS
Centers for Disease Control and Prevention. (2008).
Syndemics prevention
network: Syndemics overview - history: What is a syndemic?
Retrieved from: http://www.cdc.gov/syndemics/overviewhistory.htm