Public health policies

This use of animal evidence is based, in part, upon its scientific standing, but it is also based upon a science policy decision - it is one of the defaults present in the risk assessment process. Even in the absence of specific knowledge that the response detected in a toxicology study is relevant to humans, it will be assumed to be so -unless other data arrive to demonstrate that it is not relevant to humans (see below what is meant by other data ). Regulators and public health policies generally call for action even when the evidence regarding adverse health effects does not rise to the level necessary to establish causation in humans. 

Regulatory officials nevertheless act on the basis of such hypothetical risks ( hypothetical definitely does not mean imaginary it means that the risk estimates are based on certain scientific hypotheses and that they have not been empirically tested). Such actions are in part based on legal requirements (Chapter 11) and in part on the prudence that is a traditional feature of public health policies. The scientific information, assumptions, and extrapolation models upon which risk assessments are based are considered sufficiently revealing on the question of human risk to prompt risk-control measures. To put off such actions until it is seen whether the hypothesized risks are real - to wait for a human body count - is considered to be an unacceptable course. 

The publication of the 4S study in 1994 transformed the debate. The study demonstrated unequivocally that cholesterol, lowered total as well as cardiovascular mortality with no increased risk of cancer. Cardiologists, who as a group, were previously sceptical of the value of cholesterol lowering, became strong advocates of a change in public health policy. As Professor Oliver wrote in the British Medical Journal in 1995 Lower patient s cholesterol now - trial evidence shows clear benefits from secondary prevention. As noted previously, UK physicians are remarkably conservative, and largely follow the principles of evidence-based medicine. When the evidence is presented to them... 

Trouiller P, Olliaro P, Torreele E, Orbiniski J, Laing R, Ford N. Drug development for neglected diseases a deficient market and a public health policy failure. Lancet 2002 359 2188-94. 

Establishing the value of diese different assumptions would seem to be a basic component of public health policy. The exercise involves decisions on the magnitude of a socially acceptable risk. This needs to be assessed in the light of observed toxic effect, quality of information on residue toxicity and content, benefit-risk trade-off assessment determined by the therapeutic or productive... 

Trouiller, Patricia, P. Olliaro, E. Torreele, J. Orbinski, R. Laing, and N. Ford. 2002. Drug Development For Neglected Diseases A Deficient Market and a Public-Health Policy Failure. Lancet 359 (9324) 2188-2194. 

Rigby, Neville J., Shiriki Humanykika, and Philip T. W. James. 2004. Confronting the Epidemic The Need for Global Solutions. Journal of Public Health Policy 25(3/4) 418-434. 

The ability to generate new biomonitoring data often exceeds the ability to evaluate whether and how a chemical measured in an individual or population may cause a health risk or to evaluate its sources and pathways for exposure. As CDC states in its National Reports on Human Exposure to Environmental Chemicals, the presence of a chemical in a blood or urine specimen does not mean that the chemical causes a health risk or disease. The challenge for public-health officials is to understand the health implications of the biomonitoring data, to provide the public with appropriate information, and to craft appropriate public-health policy responses. 

In several instances, biomonitoring data have confirmed health effects of environmental exposures and have validated public-health policies. For example, population data on blood lead concentrations that were associated with adverse health effects provided the impetus for the U.S. Environmental Protection Agency (EPA) regulations reducing lead in gasoline. Methylmercury concentrations in blood and hair that were correlated with neurodevelopmental effects provided the rationale for EPA s revision of the oral reference dose. In those examples, the biomonitored concentrations of chemicals could be shown to be related to adverse health effects because of the body of epidemiologic, toxicologic, and clinical... 

A Consistent Public Health Policy. The first key question in formulating dietary policy is whether the guidelines should be... 

Vaccination has prevented, in a safe and efficient way, more diseases and deaths due to infectious agents than any other public health policy except... 

Preventive medicine through vaccination continues to be the most cost-effective public health practice, even with the drastic advance in modem medicine. Mass vaccination programs have eradicated smallpox from the earth. The World Health Organization (WHO) has a major campaign underway to eradicate polio by the year 2000. The development of vaccines has saved millions of lives and prevented many more from suffering. However, there are still many diseases without effective vaccines, such as malaria. With the recent emergence of antibiotic-resistance strains and exotic viruses, an effective vaccine development program becomes a top priority of public health policy. 

Thompson K. 2003. Stigma and public health policy for schizophrenia. Psychiatr Clin North Am 26(1) 273-294. Tienari P, Wynne LC, Sorri A, Fahti I, Faksy K, et al. 2004. Genotype-environment interaction in schizophrenia-spectrum disorder. Long-term follow-up study of Finnish adoptees. Br J Psychiatry 184 216-222. 

The intake of fluoride as a constituent of substances described in FCC monographs, even at the maximum limits established for fluoride, is not expected to significantly add to the human daily fluoride intake from other sources and is well within the various limits described in the Institute of Medicine s committee report. Nonetheless, given that toxicological manifestations have been amply demonstrated for fluoride, as described in the report, the maintenance of fluoride limits in drinking water and food, and thus food additives, appears consistent with sound public health policy. Therefore, the Committee on Food Chemicals Codex considers that maintaining fluoride limits for relevant food additives and ingredients is justified. 

Ideally, the division of responsibility would be based on what makes the most sense in terms of the optimum functioning of the public health system. In practice, there are overlaps and gaps in the division of responsibility. Even more troubling for someone trying to fathom public health policy, each state is free to adopt its own regulatory scheme, making it difficult to make simple statements about what the law allows or requires nurses—or other health professionals—to do in a public health crisis. In the discussion in the second portion of this chapter, the reader is cautioned to seek professional advice on the law in his or her own state. 

Goiter is the human pathology of hyperplasia of the thyroid gland induced by the deficiency of dietary iodine. The disease is localized in those regions where soils are low in iodine or where seafood is not consumed. Fortification of fable salt with sodium iodide, where applied, has practically eradicated this disease. Unfortunately, many regions of the world do not practice this public health policy. 

Cunningham, G. C. (1995). California s public health policy in preventing neural tube defects by folate supplementation. Weif.. 162, 265-267. 

As micronutrient deficiencies more or less ceased to be a large pubhc health problem in Western countries, the attention of scientists and manufacturers turned towards the many other functions that vitamins have in human metabolism. For the last several decades, pharmacological doses of most vitamins have been claimed to be of therapeutic value in a wide variety of conditions, which have only a superficial resemblance to the classic vitamin deficiency syndromes. The literature on which many of these claims are based unfortunately often consists of poorly conducted clinical trials or anecdotal reports. Properly designed studies are relatively few in number. No authoritative body has proposed quantitative recommendations or reference values for public health policy. 

J. Tickner, Precaution and Preventive Public Health Policy, Public Health Reports, Nov/ Dec, 117, 493-497 (2002). 

Cardiovascular diseases are a major cause of death in developed countries, making prevention a priority for public health policy. Research evidence over years has shown that cardiovascular diseases can be managed and even prevented by healthful eating practices involving a resveratrol-enriched diet of whole plant foods such as offered by superfruits. For more than fifty years, research has shown that a healthful, active lifestyle combined with the dietary benefit of high fruit and vegetable intake may lower blood lipid levels, blood pressure, and risk of coronary heart disease and stroke. 

Informing clinicians about public health policies... 

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