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Responses to the use of public health authority
Pillemer, Francesca Alina Matthews Harvard University 2010 해외박사(DDOD)
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The potential uses of public health authority are broad. They range from smaller powers, such as prohibiting smoking in the workplace, to greater powers, such as large scale quarantine. Across this spectrum, public health officials and decision makers rely on the public to comply with public health recommendations and to maintain necessary political support. This dissertation addresses the relationship between public support and public health authority on the issues of pandemic preparedness and sexual education policy. For pandemic preparedness, this dissertation also investigates the perspectives of decision makers on the uses of public health authority. Section 1 uses public opinion data from 4 countries (United States, Hong Kong, Taiwan, Singapore) and regression techniques to explore the predictors of support for non-pharmaceutical interventions (NPIs), such as quarantine. We find that the predictors of NPI support vary widely by region. However, ethnic subgroups are generally less supportive of punishment for non-compliance. Prior exposure to face mask usage also results in increased support for future face mask usage, as well as other NPIs. Cultural issues and prior experiences may account for the variations in response to policies. Section 2 analyzes national public opinion data with regression techniques to investigate predictors of both sexual education policy and political motivation. Associations with political motivation are evaluated for both different policy preferences. Predictors of policy support were shown to be distinct from the predictors of political motivation. While religious affiliation and conservative ideology were both significant predictors of policy preference, religious affiliation was not a significant predictor of political motivation for abstinence-only supporters. This may reflect some form of political organization. For section 3, I conducted interviews with 15 high-level decision makers for public health emergencies in Massachusetts on the subject of altered standards of care. Interviews focused on event-likelihood, advice and information sources, ethical preferences and decision-making. We found a low-level of consensus for ethical preferences, which were often driven by varied principles. Consensus for more extreme public health interventions was greater than consensus for less extreme interventions. In contrast to the current literature, not all decision makers used an ethical framework in their approach.