Fluent Essays

Running Head: AIR QUALITY IN THE UNITED STATES 1 Air Pollution in the United States: History, Health Impacts, and Public Policy Student Name National University AIR QUALITY IN THE UNITED STATES 2 Air Pollution in the United States: History, Health Impact, and Public Policy Introduction Clean air is vital in protecting the health of the public. The negative health effects of air pollution are numerous; particulate matter < 10 microns in diameter (PM10) are responsible for increased risk of upper respiratory tract problems and nasal irritation. The most dangerous type of pollutants, those less than 2.5 microns in diameter (PM2.5), penetrate further into the respiratory tract, greatly increasing the risk of heart attack, stroke, cancer, asthma, and many other ailments (American Heart Association, 2015). Air pollution of PM2.5 has been shown to be the leading environmental risk factor for all disease in the United States (Tessum et al., 2019, p. 6001). Other toxins, generated mainly from the burning of fuels such as wood, coal, oil, and gasoline, include black carbon, ozone gas, sulfur dioxide, and nitrogen oxides. These pollutants contribute to the development of several diseases, including bronchitis, hypertension, and chronic obstructive pulmonary disease (COPD) (Environmental Defense Fund, N.D.). Exposure to air pollutants are especially dangerous to children, as their growing lungs and elevated air intake make them especially vulnerable to asthma and other respiratory disease throughout their life (American Lung Association, 2019). Pregnant women are also at heightened risk of complications from exposure to dirty air; pollution, especially when the particulate matter is < PM2.5, is shown to correlate with low birth weight and preterm birth (Stieb, Chen, Eshoul & Judek, 2012, p. 100). History of Air Quality in the United States Several major pollution events have occurred in this country which ultimately led to government interventions through policy and legislative action. Many of these events have been AIR QUALITY IN THE UNITED STATES 3 caused by sudden temperature inversions, a meteorological phenomenon in which the normal gradient of cold and warm air is reversed, causing cool air to become trapped under a layer of warm air (Arizona Department of Environmental Quality, N.D.). This process results in heavily polluted air being trapped near the ground, where it wreaks havoc on the health of the population. One such event occurred in 1948 in Donora, PA, where emissions from a zinc smelting plant engulfed the town, killing 20 and causing more than 1,400 of the 14,000 residents to seek medical treatment. This event was the worst air pollution disaster in U.S. history at the time (Boisoneault, 2018). During the week of Thanksgiving in 1966, a similar event occurred in New York City, lasting almost the entire week, causing at least 168 deaths, with other estimates as high as 400 deaths (Holzworth, 1972, p. 445). Three years later, during the weekend after the first moon landing in 1969, sulfur dioxide released from industrial plants in Gary, IN and East Chicago caused a widespread acid rain storm which killed wildlife, destroyed lawns, and caused trees to lose their leaves. Although no deaths were reported from the storm, there may have been long-term effects on the health of the residents of the area (Delaware Department of Natural Resources and Environmental Control, N.D.). Throughout the 1960’s and 1970’s, massive smog episodes repeatedly shrouded Los Angeles, CA in dense clouds of dangerous polluted air. These episodes often lasted for weeks at a time, exposing the public to enormous amounts of dangerous toxic particulates (Masters, 2011). These events, in addition to several others, led some local and state authorities to attempt to control pollution through public policy. However, without universal federal standards, controlling pollution and industrial emissions was extremely difficult. Air quality issues, in part, led to the creation of the Environmental Protection Agency by the Richard Nixon Administration in 1970 (Rothman, 2017). The goal of this new agency was to protect the health of both the American population and the natural environment by setting AIR QUALITY IN THE UNITED STATES 4 federal standards; these standards were meant to provide a “cleaner, healthier environment for the American people” (Environmental Protection Agency, 2019a). Disparities in Air Quality Since the industrial revolution, there have been socioeconomic and racial disparities in exposure to industrial air pollution. As of today, more than 130 million Americans live in areas with air quality below the levels deemed by the EPA as acceptable (Li, Konisky & Zirogiannis, 2019, p. 2). Due to the fact that the heaviest amounts of pollutants are concentrated in industrial zones, there are ethnic and racial disparities in the levels of exposure to poor air. One national study, which attempted to assign the ‘pollution burdens’ and ‘pollution advantages’ of different national demographics, found that Black and Hispanic Americans suffer pollution burdens of 56\% and 63\% respectively, while non-Hispanic Whites enjoy a pollution advantage of at least 17\% over both groups. The study acknowledges that while overall pollution exposure has declined significantly of the last several decades for all three demographics, the disparity in exposure remains significant (Tessum et al., 2019, 6005). While some of the elevated pollution exposure is due to ethnic minorities disproportionately residing in urban areas, which have higher vehicle exhaust, this does not account for all of the existing disparities. A study which examined NO2 levels throughout all 50 states found that, even in suburban and rural environments, minority populations were still exposed to pollutants at far higher rates than whites. In all settings (urban, suburban, rural), nonwhites are exposed to 38\% higher concentrations of NO2 than whites. With 87 million non-white residents in the U.S., this higher exposure results in ~7,000 more deaths from ischemic heart disease annually in minority populations (Clark, Millet & Marshall, 2014, p. 2). AIR QUALITY IN THE UNITED STATES 5 Other factors act as determinants of average exposure to pollutants as well. Those who live below the poverty line have more than 3\% higher average exposure, including higher exposure to 11 of the 14 most dangerous pollutant particulates. Those without a high school education have about a 10\% higher rate of exposure than those with college educations, including 13 of the 14 worst particulates. Those who are unemployed have about 2.3\% greater overall PM2.5 exposure than those who are employed (Bell & Ibisu, 2012, p. 1701-1702). Legislation Attempts to control pollution at the federal level began in the mid 1950’s with the first Act Pollution Control Act of 1955. While it was an important early step in the fight against pollution, the bill focused more on gathering information and researching the impacts of pollution on health. The act did not set national emissions standards, mainly because congress believed that those issues should be left to the states and local municipalities (Schnelle Jr, Dunn & Ternes, 2015, p. 164). This legislation was followed by the initial Clean Air Act of 1963 and the Air Quality Act of 1967; however, similar to the first legislation, these did not set national standards for emissions. They did set guidelines and address interstate transportation of pollutants, but it was not until the landmark Clean Air Act of 1970 that major improvements were made. This legislation finally addressed the enormous amounts of toxic pollutants being released into the air. 42 U.S.C. §7401 et seq. (1970), the Clean Air Act, set regulations for emissions for both stationary and mobile emissions that each state would be required to meet. The ultimate goal of the legislation was to achieve safe national ambient air quality standards (NAAQS) and establish implementation plans for each state to meet these standards (Environmental Protection Agency, 2019b). Small updates were made to the law in 1977, but the next major milestone in pollution control was in 1990, when several amendments were added AIR QUALITY IN THE UNITED STATES 6 to the Clean Air Act. These amendments expanded the authority of the federal government to enforce the regulations on emissions, addressed the issue of acid deposition into the atmosphere, and added nearly 200 new toxins to the list of controlled pollutive substances. These measures all but eliminated acid rain in the U.S., massively reduced ground-level ozone gasses, and are considered a pivotal moment in reducing airborne toxins and improving public health (Manufacturers of Emission Control Association, 2020). Effects of Legislation on Public Health, Exposure Disparities, and Economic Burden It is difficult to determine the exact number of lives saved by any air pollution legislation; however, EPA estimates are that since the inception of the initial Clean Air Act, millions of lives have been saved due to improvements in air quality. It is believed that in 2011, 160,000 deaths were prevented, and that by our current year, 2020, more than 230,000 lives annually will be saved by reductions in air pollution (Tucker, 2011). While these numbers could be up for debate, the actual reduction in pollution is not. Just some of the positive impacts of the legislation were: ground level ozone reduced by more than 25\%, a reduction in sulfur dioxide (the causative agent of acid rain) by more than 70\%, air mercury levels reduced by more than 45\%, and lead air pollution reduced by more than 90\% (Union of Concerned Scientists, 2012). All of these reductions have amounted to an enormous rise in productivity and value to the United States economy. The cost of establishing and enforcing the regulations of the legislation are estimated to represent about 3\% of the total economic benefits. This means that while the annual costs of enforcement has remained between $20-25 billion since 1970 (Holladay, 2011), the benefit to the national economy is estimated to be as high as $27.6 trillion during the same time period (Yang, Matus, Paltsev & Reilly, 2005, p. 22). Although there have been significant gains made in reducing gross particulate emissions, pollution continues to be a serious economic AIR QUALITY IN THE UNITED STATES 7 burden; it is estimated that in 2014, pollution accounted for a 5\% hit to the GDP, or about $790 billion (Robinson, 2019). This economic burden is mostly attributed to loss of worker productivity due to illness, medical costs, and years of life lost (YLL). While racial, ethnic, and socioeconomic inequalities certainly still exist in 2020 in regard to air pollution exposure, there have been major improvements in these disparities. Research released just this year has found that ambient particulate pollution PM2.5 in African American communities is now nearly on par with white communities, and that communities with majority African American residents have actually seen a greater reduction in PM2.5 pollution than in any other population since regulations were established (Currie, Voorheis & Walker, 2020). The researchers specifically credit the Clean Air Act as the biggest contributor to these disparity reductions, attributing 60\% of the pollution decline to the measures in this legislation. Satellite imagery from 2014 has also shown improvements in pollution levels across the entire country, including regions with large minority populations. While there are still large collections of particulates in some regions of the country, they are mainly over large metropolitan areas, affecting all residents, both urban and suburban (Main, 2014). Conclusion While air pollution continues to burden the United States in many ways, great strides have been made in the battle. Work still needs to be done to decrease emissions, especially of PM2.5 materials, but legislation such as the Clean Air Act have caused significant improvements in air quality throughout the country. The focus going forward must be on continuing to address the pollution exposure disparities in underserved communities, including minority communities and those stricken with high poverty/low socioeconomic challenges. It has been shown repeatedly since 1970 that every dollar invested in research, regulation, and enforcement of air AIR QUALITY IN THE UNITED STATES 8 quality standards yields far greater value to the health and prosperity of the nation, and investment into these matters must continue to be a priority at the federal level. AIR QUALITY IN THE UNITED STATES 9 References American Heart Association. (2015, July 31). Air pollution and heart disease, stroke. Retrieved from https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular- disease/air-pollution-and-heart-disease-stroke American Lung Association. (2019, April 17). Children and air pollution. Retrieved from https://www.lung.org/our-initiatives/healthy-air/outdoor/air-pollution/children-and-air- pollution.html Arizona Department of Environmental Quality (N.D.) Temperature inversions impact air quality. Retrieved from https://legacy.azdeq.gov/environ/air/ozone/Inversion\%20Info.pdf Bell, M. L., & Ebisu, K. (2012). Environmental inequality in exposures to airborne particulate matter components in the United States. Environmental health perspectives, 120(12), 1699-1704. Boisoneault, L. (2018, October 26). The deadly Donora smog of 1948 spurred environmental protection- but have we forgotten the lesson? Smithsonian Magazine. Retrieved from https://www.smithsonianmag.com/history/deadly-donora-smog-1948-spurred- environmental-protection-have-we-forgotten-lesson-180970533/ Clark, L. P., Millet, D. B., & Marshall, J. D. (2014). National patterns in environmental injustice and inequality: outdoor NO 2 air pollution in the United States. PloS one, 9(4), e94431. Currie, J., Voorheis, J., & Walker, R. (2020). What Caused Racial Disparities in Particulate Exposure to Fall? New Evidence from the Clean Air Act and Satellite-Based Measures of Air Quality (No. w26659). National Bureau of Economic Research. AIR QUALITY IN THE UNITED STATES 10 References (cont.) Delaware Department of Natural Resources and Environmental Control. (N.D.) A history of air pollution events. Retrieved from http://www.dnrec.state.de.us/DNREC2000/Divisions/ AWM/aqm/education/airqualityappx.pdf Environmental Defense Fund. (N.D.). Health impact of air pollution. Retrieved from https://www.edf.org/health/health-impacts-air-pollution Environmental Protection Agency. (2019, December 19a) EPA history. Retrieved from https://www.epa.gov/history Environmental Protection Agency (2019, August 15b). Summary of the Clean Air Act. Retrieved from https://www.epa.gov/laws-regulations/summary-clean-air-act Holladay, J. (2011, January). How do we know how much clean air is worth? NYU Institute for Policy Integrity. Retrieved from https://policyintegrity.org/files/publications/Valuing_the_Clean_Air_Act.pdf Holzworth, G. C. (1972). Vertical Temperature Structure During the 1966 Thanksgiving Week Air Pollution Episode. Monthly Weather Review, 100, 445. Li, Z., Konisky, D. M., & Zirogiannis, N. (2019). Racial, ethnic, and income disparities in air pollution: A study of excess emissions in Texas. PloS one, 14(8), 1-16. Main, D. (2014, June 27). Satellite images show massive reduction in US air pollution. Popular Science. Retrieved from https://www.popsci.com/article/science/satellite-images-show- massive-reduction-us-air-pollution/ AIR QUALITY IN THE UNITED STATES 11 References (cont.) Manufacturers of Emission Control Association. (2020). The Clean Air Act. Retrieved from http://www.meca.org/regulation/the-clean-air-act Masters, N. (2011, March 17). L.A.’s smoggy past, in photos. KCET. Retrieved from https://www.kcet.org/shows/lost-la/las-smoggy-past-in-photos Robinson, E. (2019, September 19). How much does air pollution cost in the U.S.? Stanford University School of Earth, Energy and Environmental Sciences. Retrieved from https://earth.stanford.edu/news/how-much-does-air-pollution-cost-us#gs.vbxjtb Rothman, L. (2017, March 22). Here’s why the Environmental Protection Agency was created. Time Magazine. Retrieved from https://time.com/4696104/environmental-protection- agency-1970-history/ Schnelle Jr, K. B., Dunn, R. F., & Ternes, M. E. (2015). Air pollution control technology handbook. CRC press. Stieb, D. M., Chen, L., Eshoul, M., & Judek, S. (2012). Ambient air pollution, birth weight and preterm birth: a systematic review and meta-analysis. Environmental research, 117, 100- 111. Tessum, C. W., Apte, J. S., Goodkind, A. L., Muller, N. Z., Mullins, K. A., Paolella, D. A., ... & Hill, J. D. (2019). Inequity in consumption of goods and services adds to racial–ethnic disparities in air pollution exposure. Proceedings of the National Academy of Sciences, 116(13), 6001-6006. AIR QUALITY IN THE UNITED STATES 12 References (cont.) Tucker, C. (2011, May). Number of lives saved by U.S. Clean Air act continues to grow: opponents trying to repeal protections. American Public Health Association. Retrieved from http://thenationshealth.aphapublications.org/content/41/4/1.3 Union of Concerned Scientists. (2012, February 1). The Clean Air Act. Retrieved from https://www.ucsusa.org/resources/clean-air-act Legislative Impact Legislative Impact on Breast Cancer in Young Women and Those Whom Are Affected Student Name National University Legislative Impact Introduction One of the most painful and long suffering thing a woman can go through is breast cancer. Breast cancer is the most common cancer found in women, no matter the race or ethnicity(CDC, 2020). In the United States alone breast cancer have reached an all time high with 245,299 new cases reported in 2016 alone(CDC, 2020). Not only are these rates high, but out of 124 cases, 20 women have died due to this cancer. 1 in 8 women worldwide have a lifetime risk of contracting and/or developing breast cancer(Sun, Zhao, et al, 2017). The statistics continue to trouble as years extend. The risk starts at the age of 40 with women, and can grow exponentially to 80 years of age. The most common age for breast cancer in women have been documented to be between 50 to 70 years of age(Statista, 2019). The problem that the legislation was intended to impact was to reach women whom had breast cancer and to give them financial and physical support in their time of need. Another way to the legislation seemed to help was to also provide preventative care with education and support to young women. In July 24, 2014 a bill was introduced to Congress to amend the public health service act but authorizing young womens breast health education and awareness program to continue and to be funded through this act. This act would allow campaigns to educate the public health division and other professionals about breast cancer awareness and to help with research for preventative care, and finally would help support women whom have been diagnosed with breast cancer(Congress.Gov, 2020). This bill would later on be passed and become a public law on December 18, 2014 by the title of H.R. 5185 – Early[Education and Awareness Requires Learning Young] Act Reauthorization of 2014(Congress.Gov, 2020). This law is and was intended to provide support the entire nation, not only in specific states, thus it went through both the House and Senate, and finally to the President of the United States for approval and signature. History Legislative Impact The original act was singed into law in 2010, thus calling itself the Young Act of 2009. It was the Department of Health and Human Services that spearheaded this notion into action in late 2009, early 2010 to better educate and assist young women whom are affected by breast cancer(Hart Health Strategies, 2011). From this beginning of this coalition, an advisory committee was formed, and federally was able to register. It wasnt until October of 2010 when the Center for Disease Control and Prevention had joined this coalition to help push its campaign(Hart Health Strategies, 2011). This was a great help for the cause and the law in itself that a large government organization such as the CDC would be involved with this campaign. The CDC would be involved to identify gaps within the program to better educate young women and better help their health care providers and to assists in other various ways(Susan G. Komen, 2014). As years continued the campaign did not get enough traction until it had reached Congress for its reauthorization. Upon passing from both the House of Representatives and the Senate, and finally making it to the President of the United States at that time, Barrack Obama had signed the document and make the law legal, passing it officially on December 18, 2014. Legislation The legislation process of the Early Act of 2014 goes a few different way, depending on where we officially look at as the starting date. The bill, S.2655 itself was introduced to the House in July of 2014. From then on it was passed/agreed upon in the House, which passed the bill into the next section of the legislation, which is the Senate. This took place on December 15, 2014 where this bill was passed/agree on by the Senate and was moved to its next position, which it was presented to the President of the United States, Barrack Obama on December 17, 2014. From then on, The POTUS Legislative Impact signed the bill, ensuring that this will pass and move forward in being an official law on December 18, 2014, giving it a title of H.R.5185, the Early Act of Reauthorization of 2014(Congress.gov, 2020). Now taking a look back at its originality in 2009. The first advisory group was formed, established and federally registered in mid-2010. From then on, CDC had their involvement in this bill to push the campaign to its present time. Though the bill allowed this campaign to be formed, created various coalitions with CDC, WHO as well as the Department of Health and Services, it did not officially taken into legislation until 2014, whereby the bill was presented to the House to be passed. There were not enough information to really dig deep into why the large delay for this bill had been done, but one can assume the trails of lobbying and trying to push this bill into the legislation “realm” had to take its price and time. Impact The impact of the Early Act carried by CDC have made great leaps towards success. To speak of advocating along, over 200 binders were distributed to young women in the 2018 campaign, over 3 webinars had taken place to educate young women, over 70 website videos have been published and mobile Apps have been created to help patients to continue with progress. This is all from CDC and John Hopkins Medicals joint coalition to back this campaign along(CDC, 2018). In regards to patients, over 10,000 survivors were supported, 3,627 co-survivors were supported, 1,900 educational navigators were performed, and 100s of volunteers helped campaign and progress this cause along. All this from 2018 alone proving that this cause and impact of this Act have helped and continue to help young women and those whom have been affected by breast cancer(CDC, 2018). With CDCs launch of social media outlet program of “Bring Your Brave,” which helps connect and reach young women nationwide has also seen a great deal of impact. It had reached over 14,000 Legislative Impact learners, over 7,000 whom came in and took a test of self-diagnosis, and over 10,000 CME credits have been distributed to those whom desired to learn and volunteer with the program(CDC, 2018). The impact is needlessness to say is fairly large compared to what had been estimated. The CDC has also launched a multimedia national campaign when stems off this act to encourage and educate women on the risk factors for breast cancer before age 45, which also stems into ovarian cancer, and others that young women are prone to(Ekwueme, Tragdon, 2016). The first critical step in management or even knowing of potential risk of breast cancer is a pathological examination, which is a diagnosis of self- evaluation(WHO, 2020). Financial Burden of EARLY Act Reauthorization of 2014 To the individual patient, the average cost of breast cancer after diagnosis is $60,000 - $135,000 per total care. This is broken down relatively per the stage of the cancer itself. Some have received a bill of over $185,000 per their specific case of related disease. The cost is based on their current diagnosis, which includes chemotherapy, and even non-cancerous treatment. But overall, this is roughly the estimate of treatment(Blumen, Fitch, et al, 2016). The burden of cost related to this Act is pretty hefty. The authorizations of appropriations in dealing with this Act is capped at $9,000,000 for each of its fiscal years starting in 2014, going all the way until 2014. From 2015 on, the cost of the Act drops significantly down to $4,900,000 every fiscal year(Govtrack, 2020). There is no documentation of the cost prior to, since the law was not established before. Since the law had been passed officially, the cost for each fiscal year is at $9,000.000, which includes services for both parties CDC and the Department of Health and Services. The cost of this program was estimated to be nearly $25,000,000 for each year, but the cost savings trickled down to more than half of what was estimated. Even from 2015 onwards, it was reduced to nearly half again Legislative Impact due to funding arrangements and the significant low cost to maintain this program nationwide. Though there is a cost associated with the program, the patients are able to be taken care of and be provided with other programs such as the Affordable Care Act, along with the EARLY Act which has been joined together by the CDC(CDC, 2020). Conclusion The impact of this law, Early Act Reauthorization of 2014 has really changed the course of young women, and women who have been impacted by breast cancer. It has opened a pathway to be encouraged, gain knowledge and wisdom, and even get financial and physical support through the trail of cancer. The current efforts of this campaign has shown promising achievements of getting young women involved with CDCs projects such as “bring the brave,” along with coalition collaborations with various hospitals and government agencies to continue to progress this act(CDC, 2019). The goal of this law is to help women whom are in need, and to continue to press against all odds to defeat breast cancer. Legislative Impact References Blumen, H., Fitch, K., & Polkus, V. (2016). Comparison of Treatment Costs for Breast Cancer, by Tumor Stage and Type of Service. American health & drug benefits, 9(1), 23–32. Center for Disease Control and Prevention. Bring Your Brave. Web. 2019. Retrieved from: https://www.cdc.gov/cancer/breast/pdf/ACBCYW-BYB-Updates-EarlyOnset-TFairley-082019- 508.pdf Center for Disease Control and Prevention. Breast Cancer. Web. 2020. Retrieved from: https://www.cdc.gov/cancer/breast/what_cdc_is_doing/young_women.htm Congress. H.R.5185 – Early Act Reauthorization of 2014. Web. 2020. Retrieved from: https://www.congress.gov/bill/113th-congress/house- bill/5185/actions?r=15&s=3&KWICView=false Congress. Advanced Search. Web. 2020. Retrieved from: https://www.congress.gov/search?q=\%7B\%22source\%22\%3A\%22legislation\%22\%2C\%22con gress\%22\%3A\%22113\%22\%2C\%22bill-status\%22\%3A\%22law\%22\%7D Ekwueme, D. U., & Trogdon, J. G. (2016). The Economics of Breast Cancer in Younger Women in the U.S.: The Present and Future. American journal of preventive medicine, 50(2), 249–254. doi:10.1016/j.amepre.2015.11.011 https://www.cdc.gov/cancer/breast/pdf/ACBCYW-BYB-Updates-EarlyOnset-TFairley-082019-508.pdf https://www.cdc.gov/cancer/breast/pdf/ACBCYW-BYB-Updates-EarlyOnset-TFairley-082019-508.pdf https://www.cdc.gov/cancer/breast/what_cdc_is_doing/young_women.htm https://www.congress.gov/bill/113th-congress/house-bill/5185/actions?r=15&s=3&KWICView=false https://www.congress.gov/bill/113th-congress/house-bill/5185/actions?r=15&s=3&KWICView=false https://www.congress.gov/search?q=\%7B\%22source\%22\%3A\%22legislation\%22\%2C\%22congress\%22\%3A\%22113\%22\%2C\%22bill-status\%22\%3A\%22law\%22\%7D https://www.congress.gov/search?q=\%7B\%22source\%22\%3A\%22legislation\%22\%2C\%22congress\%22\%3A\%22113\%22\%2C\%22bill-status\%22\%3A\%22law\%22\%7D Legislative Impact GovTrack. H.R. 5185(113th): Early Act Reauthorization of 2014. Web. 2020. Retrieved from: https://www.govtrack.us/congress/bills/113/hr5185/text Hart Health Strategies. PPACA: A Closer Look. Web. 2011. Retrieved from: https://primaryimmune.org/wp-content/uploads/2011/10/X24- EARLYActUPDATED092911.pdf Statista. Number of female deaths due to breast cancer in the U.S. As of 2019, by age. Web. 2019. Retrieved from: https://www.statista.com/statistics/778095/breast-cancer-female-deaths- number-us/ Susan G. Komen. SUSAN G. KOMEN® APPLAUDS REAUTHORIZATION OF THE BREAST HEALTH EDUCATION AND AWARENESS REQUIRES LEARNING YOUNG ACT (EARLY). Web. 2014. Retrieved from: https://ww5.komen.org/News/Susan-G--Komen-today- applauds-the-reauthorization-of-the-Breast-Health-Education-and-Awareness-Requires- Learning-Young-Act,-or-EARLY-Act-.html Sun, Y. S., Zhao, Z., Yang, Z. N., Xu, F., Lu, H. J., Zhu, Z. Y., … Zhu, H. P. (2017). Risk Factors and Preventions of Breast Cancer. International journal of biological sciences, 13(11), 1387–1397. doi:10.7150/ijbs.21635 World Health Organization. Cancer: Diagnosis and Treatment. Web. 2020. Retrieved from: https://www.who.int/cancer/treatment/en/ https://www.govtrack.us/congress/bills/113/hr5185/text https://primaryimmune.org/wp-content/uploads/2011/10/X24-EARLYActUPDATED092911.pdf https://primaryimmune.org/wp-content/uploads/2011/10/X24-EARLYActUPDATED092911.pdf https://www.statista.com/statistics/778095/breast-cancer-female-deaths-number-us/ https://www.statista.com/statistics/778095/breast-cancer-female-deaths-number-us/ https://ww5.komen.org/News/Susan-G--Komen-today-applauds-the-reauthorization-of-the-Breast-Health-Education-and-Awareness-Requires-Learning-Young-Act,-or-EARLY-Act-.html https://ww5.komen.org/News/Susan-G--Komen-today-applauds-the-reauthorization-of-the-Breast-Health-Education-and-Awareness-Requires-Learning-Young-Act,-or-EARLY-Act-.html https://ww5.komen.org/News/Susan-G--Komen-today-applauds-the-reauthorization-of-the-Breast-Health-Education-and-Awareness-Requires-Learning-Young-Act,-or-EARLY-Act-.html https://www.who.int/cancer/treatment/en/ COH 435 Public Health Legislation Paper – Signature Assignment Public Health Legislation Paper- Signature Assignment Description For the final paper, students are required to write a minimum five-page paper (not including title, references, or abstract) that reflect knowledge and understanding gained in your coursework. Identify a legislation (passed in the United States) that has had a significant impact on the burden and distribution of disease, injury, and affects health disparities. Students are advised to only look at policies that have been in effect for more than three years so that data may be collected and reported, enabling you to compare the policy impact, even preliminarily. For example, this course is taking place in mid-2020, therefore, only policy implemented in 2016 or prior. The selected legislation could impact behavior, social determinants of health, or the environment in the context of where people live, play, or work. Your text is a wealth of information that includes many different policies and associated references. When choosing the policy to write your paper on, consider the significance of a piece of legislation in terms of impact. In general, the broader or deeper the impact on a population, a health issue, an important health disparity, or social or economic aspects, the more significant it is. For example, legislation that has resulted in setting legal blood alcohol concentration levels has positively impacted health outcomes and decreased economic costs. It is not recommended to select legislation that is disjointed, or does not have a large amount of readily available information for you to review (this should tell you that the impact of the legislation is not necessarily significant). It is suggested that different topic should be chosen. Impact. Definition: have a strong effect on someone or something (Merriam-Webster, 2019). In policy, we measure impact as what do health outcomes look like BEFORE and what do health outcomes look like AFTER the policy was enacted. This tells us the impact of the policy on the population. See the Policy Impact Resource in week 4. Components that need to be addressed and included: • Describe the health problem that the legislation was intended to impact and provide descriptive statistics (incidence, prevalence) related to the health issue in the jurisdiction (State, county, nation, zip code, etc..) of the law before legislation was enacted. • The statistics you provide should be appropriate to the level of government that the policy was intended to address. For example, if it is a statewide policy, include statistics that are relative to that state. • Describe public health legislation (law, policy, ordinance) in the United States. Through description of the specific legislation (policy) and the level of government (federal, state, local jurisdiction) that enacted the legislation. COH 435 Public Health Legislation Paper – Signature Assignment • Describe the group(s) (adults, children, elderly, gender, etc.), communities (ethnic, socio-economic status, urban, rural, etc.) and municipalities, state or governments it is hoping to impact (what is the goal of the legislation?). • Compare the burden and distribution of the disease distribution (across age groups, ethnicities, SES, gender), injury, or health problem using statistics that clearly illustrate the impact (before and after) of the legislation. How did/has it changed? • Identify and describe health disparities among populations (differences across groups) that exist before the policy was enacted and after policy implementation. Did the implementation have a positive or negative impact? • Explain the financial impact of the disease and the impact the legislation has had. Include research that shows the burden of cost before the legislation was enacted (health care costs, productivity, etc.) and show the difference or make a comparison on the cost savings after the law was adopted. Economic impact can be inferred from other economic data related to the problem, population or policy. • Correctly identify and use primary and secondary data to support the impact assessment of the burden of disease and financial costs. • Integrate course concepts into your analysis. Students are expected to use concepts learned in this course, such as, policy description/understanding; advocacy, etc… • Conclusion: Your critical analysis (backed by facts) is key to this paper. (For example, when you are comparing impacts, think about what did it impact, to what degree, what factors might have played a complementary role, why did this occur.) You might also pose what might have improved this legislation or what some of the problems and recommendations you might make. • You should have at least 4 scholarly sources cited and referenced in your paper. • Print should be 12-point font (Times New Roman or Arial), with margins of one (1) inch on all four sides. All papers submitted must have APA formatting. The written assignments must reflect college-level writing and thinking. Please view this link for an example APA formatted paper: http://www.apastyle.org/manual/related/sample-experiment-paper-1.pdf. No abstract is required. Papers not following proper APA format will be deducted appropriately. Research Resources: • Your course text, Prevention, Policy and Public Health (Eyler, Eds.) has a wealth of resources on specific policies you may use to identify Scholarly http://www.apastyle.org/manual/related/sample-experiment-paper-1.pdf COH 435 Public Health Legislation Paper – Signature Assignment sources are from peer-reviewed journal articles, or data analysis from public health departments, at the state, national, or local levels. • Scholarly sources can be searched using the National Library database and the COH 435 Library Guide. • See the resources placed in the assignment link in week 4 Writing resources: • The National University writing center can support you with consultations to improve your writing. Successful students will make an appointment for a consultation if they want to improve their writing skills. A link to the NU writing center can be found in the course resources. So… How do I write this Paper? See below for: • What are good policies to research vs those that are not • Sources that can assist you in locating a topic and policy outcomes • Sample outline of the paper Good Public Health Policy Issues – Federal, state, or local (ordinances) • Increasing safe workplace practices • Alcohol – Blood Alcohol Concentration (BAC); tax; minimum drinking age; drunk driving checkpoints • Speed Limits • Tobacco- tax; second-hand smoke; minimum smoking age; marketing/packaging • Immunization (not recent, but older policies) • School lunch policy/Nutritional standards (but not focusing on the change/impact on obesity rates) • Infectious disease – healthcare associated infections; HIV • Seat belt laws • Laws allotting funding for specific health programs – Condom Program • Family Planning – long acting reversible contraceptives (e.g. I.U.D.) • Affordable Care Act COH 435 Public Health Legislation Paper – Signature Assignment • Prescription drug laws • Illicit drug use- public health harm reduction, such as, needle exchange programs • Emergency preparedness laws • Zoonotic transmission reduction laws Policy that is Difficult to Evaluate (a.k.a. may be too difficult for this paper): • Injury prevention – helmet policy • Violence prevention policy • Illicit drug use – decriminalization, such as medical marijuana laws. Too early to determine impact (effect of) Use these CDC Policy Impact Briefs: https://www.cdc.gov/policy/hst/hi5/index.html • To help select a topic • Review epidemiology about the public health issue • Review “impact” statements – these statements show the effects of the policy implementation • Assist in guiding your research Seat belts: https://www.cdc.gov/motorvehiclesafety/seatbeltbrief/index.html Alcohol Impaired Driving: https://www.cdc.gov/motorvehiclesafety/pdf/PolicyImpact- Alcohol-a.pdf Clean Needle Exchange Programs: https://www.cdc.gov/policy/hst/hi5/cleansyringes/index.html Alcohol Pricing: https://www.cdc.gov/policy/hst/hi5/alcoholpricing/index.html Prescription Drug Monitoring Programs & Pain Clinic: https://www.cdc.gov/drugoverdose/policy/successes.html Graduated Driver Licensing (teen driving safety) https://www.cdc.gov/motorvehiclesafety/pdf/PolicyImpact-TeenDriverSafety-a.pdf https://www.cdc.gov/policy/hst/hi5/index.html https://www.cdc.gov/motorvehiclesafety/seatbeltbrief/index.html https://www.cdc.gov/motorvehiclesafety/pdf/PolicyImpact-Alcohol-a.pdf https://www.cdc.gov/motorvehiclesafety/pdf/PolicyImpact-Alcohol-a.pdf https://www.cdc.gov/policy/hst/hi5/cleansyringes/index.html https://www.cdc.gov/policy/hst/hi5/alcoholpricing/index.html https://www.cdc.gov/drugoverdose/policy/successes.html https://www.cdc.gov/motorvehiclesafety/pdf/PolicyImpact-TeenDriverSafety-a.pdf COH 435 Public Health Legislation Paper – Signature Assignment Paper Outline (Suggested) • Introduction • Describe the health problem that the legislation was designed • Provide a minimum of 5 descriptive statistics (incidence, prevalence) related to the health issue • The statistics you provide should be appropriate to the level of government that the policy was intended to address. For example, if it is a statewide policy, include statistics that are relative to that state. • Legislation • Thoroughly describe the United States public health legislation (law, policy, ordinance) • Include the level of government (federal, state, local jurisdiction) that enacted the legislation. • Describe the group(s) communities, and state or governments it is hoping to impact (what is the goal of the legislation?). • Impact on Disease (or Injury) Outcomes • Compare the burden and distribution of the disease distribution, injury, or using statistics that clearly illustrate the impact (before and after) of the legislation. • Disease distribution means describe the pattern of the disease outcomes • How has the outcome of disease changed since the policy was implemented? • Impact on Disparities • Identify and describe health disparities among populations (differences across groups) that exist before the policy was enacted and after policy implementation. • Did the implementation have a positive or negative impact? • Economic Impact • Explain the financial impact of the disease and the impact the legislation has had. Include research that shows the burden of cost before the legislation was enacted (health care costs, productivity, etc.) and show the difference or make a comparison on the cost savings after the law was adopted. COH 435 Public Health Legislation Paper – Signature Assignment • Advocacy About the Issue • Is there an organization that supports(ed) this policy? How so? • Is there a health campaign about this program? Describe it. • Conclusion: • Final thoughts about the legislation and impact • You might also pose what might have improved this legislation or what some of the problems and recommendations you might make. COH 435 Public Health Legislation Paper – Signature Assignment Rubric Levels of Achievement Criteria Proficient Competent Novice Needs Improvement Public Health Problem Weight 15.00\% 91.00 to 100.00 \% In-depth explanation of the health problem. Includes comprehensive descriptive statistics (incidence, prevalence) related to the health issue in the jurisdiction (state, county, zip code) of the law before legislation was enacted. 80.00 to 90.00 \% Clear explanation of the health problem. Provides adequate descriptive statistics (incidence, prevalence) related to the health issue in the jurisdiction of the law before legislation was enacted 65.00 to 79.00 \% Provides some descriptive statistics (incidence, prevalence) related to the health issue in the jurisdiction of the law before legislation was enacted. 0.00 to 65.00 \% Description of problem and/or descriptive statistics missing. Public Health Legislation Weight 12.00\% 91.00 to 100.00 \% Thorough description of the public health legislation (law, ordinance, policy). Appropriate bill numbers or title of legislation clearly included. Location/jurisdiction the law is implemented within is clearly stated. 80.00 to 90.00 \% Satisfactory description of the public health legislation. Appropriate bill numbers or title of legislation are mostly clearly included. Location/jurisdiction the law is implemented within is mostly understood. 65.00 to 79.00 \% Limited description of the public health legislation. Appropriate bill numbers or title of legislation are difficult to understand. Difficulty communicating what location/jurisdiction the law is implemented within. 0.00 to 65.00 \% Description of the legislation is not included. Bill numbers/title of bill not apparent nor are is the location/jurisdiction the law was implemented within. Impact on Disparities, Population (s) and communities. Weight 15.00\% 91.00 to 100.00 \% Thorough description of policy impacts on groups (adults, children, gender, etc), communities (ethnic, socio-economic,status, urban, rural, etc..), or governments. Completely identifies and describes health disparities (differences across groups) and policy impact (Negative or Positive) on population experiencing the disparity. 80.00 to 90.00 \% Satisfactory description of policy impacts on groups, communities, or governments. Adequately identifies and describes health disparities and policy impact (negative or positive) on population experiencing the disparity.. 65.00 to 79.00 \% Limited or vague description of policy impacts on groups, communities, governments. Somewhat identifies and describes health disparities and policy impact (positively or negatively) and the populations experiencing this disparity. 0.00 to 65.00 \% Missing any/ all of these Comparison of health statistics and outcomes 91.00 to 100.00 \% Comparison of health statistics & impacts before and after legislation enacted. Thorough 80.00 to 90.00 \% Satisfactory comparison of the burden and distribution of the disease, injury, or health 65.00 to 79.00 \% Limited or vague comparison of the burden and distribution of the disease, injury, or 0.00 to 65.00 \% Comparison/ contrast missing COH 435 Public Health Legislation Paper – Signature Assignment Weight 15.00\% comparison of the burden and distribution of the disease (across age groups, ethnicity, gender, SES), injury, or health problem that legislation was intended to address before and after the legislation was enacted. problem that this legislation was intended to address before and after the legislation was enacted. health problem that this legislation was intended to address before and after the legislation was enacted. Economic- financial impact comparison Weight 15.00\% 91.00 to 100.00 \% Thorough and clear explanation of the financial impact (healthcare costs, productivity, etc...) on the prevalence, incidence of disease or injury, and the distribution of disease or injury the legislation has had on groups, communities, states, and government identified. 80.00 to 90.00 \% Satisfactory explanation of the financial impact on the prevalence, incidence of disease or injury, and the distribution of disease or injury the legislation has had on groups, communities, states, and government you identified. 65.00 to 79.00 \% Limited explanation of the financial impact on the prevalence, incidence of disease or injury, and the distribution of disease or injury the legislation has had on groups, communities, states, and government you identified. 0.00 to 65.00 \% Missing Integration of Policy, advocacy course concepts Weight 10.00\% 91.00 to 100.00 \% Many dimensions of policy and advocacy are well integrated into the writing and demonstrate command of course concepts 80.00 to 90.00 \% Several course concepts are included in the paper, and demonstrate a good understanding of the course concepts 65.00 to 79.00 \% Some concepts and terms are used correctly and demonstrate some understanding of course concepts. 0.00 to 65.00 \% No concepts included Mechanics- Grammar, Spelling, punctuation Weight 3.00\% 91.00 to 100.00 \% Rules of grammar, usage and punctuation are followed, spelling is correct with minor errors. Language is clear and precise; sentences display consistently strong, varied structure. 80.00 to 90.00 \% Few grammatical errors, but sentences could be clearer and more precise. Language is generally clear; sentences display varied structure. 65.00 to 79.00 \% many grammatical, punctuation, and spelling errors. Language uses undefined jargon, or conversational tone. 0.00 to 65.00 \% So many grammatical or spelling errors that the meaning of the paper is lost. Writing Style- Construction Weight 3.00\% 91.00 to 100.00 \% Information is well organized into excellently constructed paragraphs. Each paragraph has an introductory sentence, details relating to the introductory sentence, a concluding sentence. 80.00 to 90.00 \% Information is organized in well-constructed paragraphs. Each paragraph has an introductory sentence, details relating to the introductory sentence and a concluding sentence. Some 65.00 to 79.00 \% Information is organized into paragraphs but lacks detail and construction of paragraphs is weak. Some paragraphs are missing a structural piece. Paragraph transitions are missing or unclear. 0.00 to 65.00 \% Writing style is unprofessional and disorganized COH 435 Public Health Legislation Paper – Signature Assignment Paragraph transitions are logical. paragraph transitions need improvement. In-Text Citations, APA 6th Edition Weight 7.00\% 91.00 to 100.00 \% APA style in-text citations used throughout document with no errors and/or no quotations longer than 5 words. Two or more citations are included for each section of the paper. 80.00 to 90.00 \% APA style in-text citations used throughout document with minor errors and/or no quotations longer than 5 words. 1-2 citations are included for each section of the paper 65.00 to 79.00 \% APA style in-text citations with major errors throughout and/or one quotation longer than 5 words. One or less citations are included for each section of the paper 0.00 to 65.00 \% Missing APA 6th Edition Referencing and formatting Weight 5.00\% 91.00 to 100.00 \% APA reference page contains at least four reliable or scholarly sources and has no formatting errors. Some of the health statistics are derived from a primary data source, such as census or a data source such as BRFSS, CHIS, or another data source. 80.00 to 90.00 \% APA reference page contains four reliable or scholarly sources but has minor formatting errors. Health statistics are cited by source, but all sources are secondary, but reliable. 65.00 to 79.00 \% APA references page contains less than four sources, or one unreliable resource (non-peer reviewed or open to scientific scrutiny, such as a magazine article) and/or has major formatting errors. Data sources for health statistics are not referenced. 0.00 to 65.00 \% Missing 2 or more references or all references are not in APA style