You are an analyst for a federal agency. Congress has ordered your agency to come up with policy options to find a cure for birth defects. You recognize that (a) birth defects have many causes, (b) some can be treated, (c) some can also be prevented, but (d) not all of them can be “cured.” You analyze this issue using the core functions of public health and the problem-solving process outlined under Core Functions of Public Health.
Based on the information about spina bifida in this chapter, you decide it should be the focus for policymaking on birth defects. You decide to propose four options to Congress: more research on treatment of spina bifida, more health education for women about folic acid, more promotion of birth control to reduce the proportion of unplanned pregnancies in the country, and new regulations to increase the amount of folic acid in grain products. You may also see other options, so be sure to discuss them!
1. For each option, what would you need to know to determine effectiveness? Cost-effectiveness?
2. What are the tradeoffs in each course of action?
3. Who would support this option, who would be opposed, and does it matter?
4. Is there a single best option? Why?
Before addressing the questions, it’s essential to establish the core functions of public health and the problem-solving process.
Core Functions of Public Health:
- Assessment: Systematically collect, analyze, and disseminate information on the health of the community.
- Policy Development: Develop comprehensive public health policies based on scientific evidence.
- Assurance: Ensure that necessary health services are available and accessible to the population.
Problem-Solving Process:
- Define the problem: Clearly articulate the issue and its scope.
- Identify potential solutions: Generate options for addressing the problem.
- Evaluate options: Assess the potential effectiveness, feasibility, and impact of each solution.
- Implement the chosen solution: Put the selected option into action.
- Monitor and evaluate: Continuously assess the effectiveness and impact of the implemented solution.
Now, let’s address the questions regarding the proposed options for addressing birth defects, focusing on spina bifida:
- More research on treatment of spina bifida:
- To determine effectiveness: Need to know the current state of research, potential breakthroughs, and feasibility of translating findings into clinical practice.
- Cost-effectiveness: Assess the cost of research against potential health outcomes and long-term healthcare savings.
- More health education for women about folic acid:
- To determine effectiveness: Understand the current level of knowledge among the target population, potential barriers to education, and strategies for effective dissemination.
- Cost-effectiveness: Evaluate the cost of education programs against the potential reduction in spina bifida cases and associated healthcare costs.
- More promotion of birth control to reduce the proportion of unplanned pregnancies:
- To determine effectiveness: Assess the impact of increased access to birth control on unplanned pregnancy rates and subsequent reduction in birth defects.
- Cost-effectiveness: Compare the cost of promoting birth control with the potential healthcare savings from preventing birth defects.
- New regulations to increase the amount of folic acid in grain products:
- To determine effectiveness: Evaluate the evidence linking folic acid fortification with reduced spina bifida rates, potential implementation challenges, and unintended consequences.
- Cost-effectiveness: Assess the cost of fortification against the potential reduction in spina bifida cases and associated healthcare costs.
- Tradeoffs:
- Research: High cost and uncertain outcomes.
- Health education: Requires significant resources for implementation and may have limited reach.
- Birth control promotion: Potential opposition from religious or cultural groups.
- Folic acid fortification: Potential resistance from food industry stakeholders and concerns about excessive folic acid intake.
- Support and Opposition:
- Support: Public health advocates, medical professionals, affected families.
- Opposition: Industries affected by regulations, anti-birth control or anti-folic acid fortification groups.
- Single Best Option: There isn’t a single best option as each approach addresses different aspects of the problem and has its own set of benefits and challenges. A comprehensive strategy that combines multiple approaches might be most effective, such as a combination of increased research, education, and regulation.
In conclusion, the most effective approach would likely involve a combination of strategies addressing research, education, and regulation to comprehensively address the issue of spina bifida and birth defects. It’s essential to consider the unique circumstances, resources, and stakeholders involved in each option to develop a well-rounded policy response.