From the days of Hippocrates unto the present, the prevalence of poverty is all too well known in the field public health. Social and economic classes of the world display an overwhelming gap in quality of life and healthcare. The complexities of social norms and cultural behaviors create a healthcare system filled with chasms of misunderstanding. The concepts of social influences on the health of a population are population perspective, social context of behavior, contextual multilevel analysis for improving public health, development and life course perspective, and general susceptibility to disease (Berkman, 2000). These concepts of social influences are a major factor leading to low income families poor life choices and inevitably higher rates of morbidity due to these choices. Furthermore, these social influences lead to tobacco use and the health risk contributed to its use.

        Even with the move for reform, there is an ever widening gap in the quality of healthcare given to people living in some of the world’s poorest locations (Berkman, 2000). Gaining an understanding of social and economic effects on healthcare will one day serve to reduce these gaps in healthcare, but this realization is still far off. For instance, poverty, one of the world’s greatest social problems, is also one of the world’s greatest health risk factors. It is hard to overlook the significance of class with respect to alcohol, smoking, and tobacco-related illness. An evaluation of risks factors that lead to premature health loss draws a clear line between the classes (Khan 2006). 

        A variety of social factors impact health care in both how healthcare is administered and who will gain access to needed medical care. How these factors influence the system and determine health policies impact the healthcare needs of people around the world. For example, the social capital in a population has always affected the over all health of that population (Hawe, 2000). Furthermore, extensive research conducted into the disparities of healthcare is increasing the understanding of how poverty and other social and economic factors affect the health of a population. 

        There are 20 known compounds in tobacco that cause cancer in lab animals and are considered to cause cancer in humans. Airborne exposure to tobacco smoke raises the risks to lung cancer; when other airborne contaminates are added the risk is even greater (Hecht, 1999). Tobacco smoke and secondhand smoke is considered one of the greatest risk factors contributing to lung cancer. Exposure through inhalation by smoking or through secondhand smoke can raise the risk of persons with a greater predisposition to lung cancer. The most at risk to passive smoking are the children of smoking parents (Hecht, 1999).

Lower class people are exposed to health risks such as smoking, over-eating, and poor diet due to the social influences and norms that are class driven. Moreover, with lower standards of living and less access to healthcare and medical insurance, these class-driven determinates are more likely to decay the health of a class.

        Tobacco (Nicotine spp., L.) is plant that looks like and is in the same family as the potato, but this plant is a quiet killer of millions. The chemical nature of the tobacco plant contains more than 600 chemical additives and more than 40 types of carcinogens. Research estimates that healthcare costs linked to smoking are as high as $2 billion per year or more, with the costs linked to each smoking-affected birth averaging $1,142 to $1,358 (MacKenzie, 1994). Each year there are about 440,000 smoking-attributed deaths in the United States (Thun, 2002). Of this 440,000, about half of them had lung cancer (Wei, 2000). There are 20 known compounds in tobacco that cause cancer in lab animals and are considered to cause cancer in humans (Hecht, 1999). 

        The pedantic move to slow tobacco use in the United States has proven the difficulty in getting people to put the pack down. Tobacco related health conditions are growing at an alarming rate and include cardiovascular disease, COPD, and emphysema. The problem is the overwhelming lack of education in lower socioeconomic groups on the consequences of the tobacco use. Moreover, the resources given to the problem cost the nation over $100 billion in lost productivity and healthcare related expenses (MacKenzie, 1994). The nearly non-existent educational training given to smokers on the health risk due to tobacco use leaves many smokers confused on where to go or what to do to access help. Furthermore, the interventions in public schools lack the element of consequence, serving more to stimulate the desire to experiment. There is more wrong with the system than the high cost of smoker-related healthcare; there is a barbed fence maligning the truth--people in poverty are more likely to smoke and, subsequently, suffer from smoking complications due to a lack of accessible healthcare.

        The health risks associated with tobacco use are linked to genetic, social, environmental, psychological, and physiological factors (NIH 2004). These factors are often overlooked, and providers rarely evaluate why a person started smoking and why they continue. Addiction has a strong pull on a user and behavioral factors can often render a tobacco user unable to quit smoking. Moreover, socioeconomic influences such as income, neighborhood, and housing type bring about a generational cycle that is often difficult to break (Berkman, 2000). As behavior and social status will continue to influence health choices through out one’s life, factors such as age, gender, race, ethnicity, and socioeconomic status can potentially raise the health risk (Whitlock, 2002). For any tobacco prevention program to work the program has to understand the many types of behaviors that result from genetics, social, environmental, psychological and physiological factors, age, gender, race, ethnicity, and socioeconomic status and how these factors relate to the tobacco user or potential user.

Annotated Bibliography:

American Lung Association. (2005). Quit Smoking Action Plan,  American Lung Association.Retrieved 09/21/2007 from, http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=117062

       

        The American lung association shows the importance of a smoking prevention program and action plans that lead to lower smoking rates in the population. Through the use of social marketing and smoking cessation classes the hope is to reduce health risks from tobacco use. The American lung association stated the need for action plans in children as a prevention measure and for greater adult health. The American Lung Association works to show the need for community understanding in the fight against the damage of smoking.

Barendregt. (1997). “The Health Care Costs of Smoking.”

        The New England Journal of Medicine. Volume 337:1052-1057.

The article evaluated the cost of smoking on society. As healthcare costs are rising world wide the need to lower cost is sought through prevention measures. As costs are on the rise from preventable disease the world will look for interventions to tobacco related illness. Smoking is becoming increasingly unacceptable by society. Moreover, it is clear that the risks of smoking are great and serve to bring about greater potential risk in areas such as heart disease, stroke, lung cancer. Because healthcare links to society and its collective opinion, a behavior such as smoking that is considered socially unacceptable will be limited by society. This holds true with the clear health risks of smoking and exposure to second-hand smoke. 

Berkman, (2000). Social Epidemiology (pp.27-28). New York, New     York: Oxford University Press Inc.

Berkman, 2000 looks at the value of social epidemiology and how it relates modern healthcare. Understanding of social and cultural values and norms affect the health of a population is instramental to evoking change with in a population.

Chassin. (1990). The natural history of cigarette smoking: predicting  young-adult smoking outcomes from adolescent smoking        patterns.Health Psychol. Volume 9(6)

        Chassin stresses the importance of adolescent smoking prevention programs. Childhood smoking leads to adulthood health concerns that could have been prevented. The article stated that early adolescent intervention is key to prevention of adult onset pulmonary and coronary disease. The risk adolescent smoking is far to great to ignore. 

Cook. (1999). Health effects of passive smoking-10: Summary of       effects of  parental smoking on the respiratory health of      children     and implications for research.
        Thorax. 1999 Apr;54(4):357-66.

        Cook evaluated the risk of passive smoking on children. The article stated that there would be significant health benefit to children if parents stopped smoking. The study showed the critical need for intervention with respect to passive smoking and childhood health. 

Glantz. (1995). Passive smoking and heart disease. Mechanisms and  risk. JAMA Vol. 273 No. 13

       

        The risk of passive smoking was evaluated by Glantz looking particularly at heart disease associated to second hand smoke. The risk of second hand smoke is a clear dander health. The longer the exposure the greater the risk of heart disease from reduces blood flow. Moreover, every day exposure to second hand smoke will have negative affects to the cardiovascular system.  

Haiman. (2006). Ethnic and Racial Differences in the Smoking-Related        Risk of Lung Cancer. The New England Journal of      Medicine.Volume         354:333-342

        Haiman show that tobacco reacts differently based on ethnic and racial variances. The study evaluated the virulence in lung cancer with respect to ethnic and racial background. The study indisputably showed that tobacco is a killer, and while race and ethnicity is not a problem to big tobacco, it is a leading health concern in parts of the world stricken with poverty.

Hecht. (1999). Tobacco Smoke Carcinogens and Lung Cancer.

      Journal of the National Cancer Institute, Vol. 91, No. 14, 1194-1210

        There are 20 known compounds in tobacco that cause cancer in lab animals and are considered to cause cancer in humans. Airborne exposure to tobacco smoke raises the risks to lung cancer; when other airborne contaminates are added the risk is even greater. Tobacco smoke and secondhand smoke is considered one of the greatest risk factors contributing to lung cancer. Exposure through inhalation by smoking or through secondhand smoke can raise the risk of persons with a greater predisposition to lung cancer.

Iribarren. (1997).Effect of cigar smoking on the risk of cardiovascular         disease, chronic obstructive pulmonary disease, and cancer in       men. New England Journal of Medicine 1199;340:1773-1780.

        Iribarren evaluated the affects of cigar smoking on 17,500 men aged 30 to 85. The study showed men who smoked cigars had a higher rate of obesity, heart disease, 1.45 times more likely to develop COPD. Overall the study showed there were health risks linked to cigar smoking. The study also showed that cigar smokers were twice as likely to get cancer of the throat, larynx, esophagus and lung as non-smokers.

Isaacs. (2004). “Class-The Ignored Determinant of the Nation’s Health.” The New England Journal of Medicine. Volume 351:1137-1142

The nation’s health is at risk to preventable disease. Class is a major factor in the fight against preventable disease. Isaacs looks at social and cultural determinants with regard to class and how health is affected by class. Class will always be linked to health and leading factor that leads to good or bad health choices. An evaluation of risks factors that lead to premature health loss draws a clear line between the classes.   

Khan. (2006). “Geographical aspects of poverty and health in    Tanzania: does living in a poor area matter? Heath policy and       Planning: Volume 21 Issue 2, p110-122

       

        Khan looked at how poverty affects one health. The article evaluated the health risk linked to poverty. Geographical aspects of poverty and health in Tanzania linked and poverty leads to poor health. It is hard to overlook the significance of class with respect to smoking and tobacco related illness. 

Lindblom, E. (2003). National Center for Tobacco-Free Kids

Retrieved 09/21/2007 from http://www.healthierohio.org/

documents/CostSavings.pdf#search='how%20has%20tobacco%20affected%20healthcare'

       

        Research estimates that healthcare costs linked to smoking is as high as $2 billion per year or more, with the costs linked to each smoking-affected birth averaging $1,142 to $1,358. The direct additional healthcare cost associated to smoking expectant mothers due to birth complications are high enough that many states are moving to change healthcare policies with respect to healthcare coverage.

Meis. (2002). Development of a Tailored, Internet-based Smoking Cessation Intervention for Adolescents. Journal of Computer-Mediated Communication. Vol.7

        Meis stated that it is also important to determine what elements of smoking cessation program are meaningful to the test audiences so that this can be highlighted in the program. Moreover, due to the complex nature of today’s youth it is instrumental to understand what appeals to them and what they understand. Once this is understood it is possible to formulate and restructure the marketing strategy with the data gathered from the test phase. With a new more focused marketing strategy the target audience will be more receptive and motivated to action.

Shohaimi (2003). Residential area deprivation predicts smoking habit independently of individual educational level and occupational social class. A cross sectional study in the Norfolk cohort of the European Investigation into Cancer (EPIC-Norfolk). Journal of Epidemiology and Community Health Volume 57:270-276

        Shohamimi stathed that poverty peered with tobacco use soon becomes a volatile mixture that degrades the health of many generations. This degradation leads to high rates of chronic illness such as obesity, heart disease, cancer, and diabetes. Over time the lack of quality healthcare brings about an increase in the morbidly of such diseases. Moreover, poverty is a chronic disorder that magnifies illnesses, which, while mostly treatable by today’s medicine, are exacerbated by lack of intervention and lead to premature death. Moreover, poverty is a factor that leads to higher levels of health risk. 

Siegel, (2004). Emerging Threats to Public’s Health-The Need for        Social Change. Marketing Public Health, (pp. 5-7) Sudbury, MA:      Jones and Bartlett

Siegel states the need for social change to prevent loss of social health. As a whole the need for social change is greatly needed in society. The use of marketing public health is a tool that is needed. The threats to public health from tobacco products are great and through the use of marketing the hope is prevention through social change. Furthermore, Siegel states the important of determine what in the marketing strategy will illicit motivation to act. Siegel also states the importance of evaluating an intervention program to ensure that it is working in accordance with the design format. 

Weitzman. (1990). Maternal Smoking and Childhood Asthma.

        PEDIATRICS Vol. 85 No. 4

       

        Weitzman states that passive smoking by children is associated by an increase in lower respiratory disease and lower pulmonary function. There is also a possible link to childhood asthma and passive smoking. The need for further research is required to have a greater understanding to the link between passive smoking and lung disease in children. Moreover, there is a link between childhood lung disease and maternal smoking.

       

Wolf. (1988). Cigarette smoking as a risk factor for stroke. The Framingham Study. JAMA. Vol. 259 No. 7, February 19, 1988

        Wolf evaluated cigarette smoke and its link to stroke. Therelative risk of stroke in heavy smokers who smoked more then 40 cigarettes perday was twice that of light smokers. The risk to health from heaving smoking is far greater then that of light smoking. Moreover, as smokers decrees smoking there is a noted change in health.

Sloan. (2005). The Price of Smoking. The New England Journal of      Medicine. Volume 352:2143-2144

Sloan evaluated the burden on society from the smoking. The overall costs from smoking are reflected in the needs from more and more healthcare as smoker’s age. Each year the burden on society grows as smokers grow older and seek out care for chronic disorders.  

Sloan. (2004). The Smoking Puzzle: Information, Risk Perception, and        Choice. The New England Journal of Medicine. Volume 350:1060

The risks of smoking are clear in the vast data showing the many deaths and chronic illnesses brought by tobacco use. Still there is the right of choice for the consumer to smoke and use tobacco product. The right of choice is the determinate that impedes most progress in the reduction use, for youth are slowly enticed to use tobacco product as soon as they are of age and are able to exercise freedom of choice, if not before. The need for cultural change is shown my the many lives that are lost due to a very preventable tobacco related disease.

  Medical services expenditures in the U.S. continue to increase, deeply cutting into the GDP more and more each year. The majority of these expenditures are due to diagnosis and treatment of chronic diseases and conditions such as diabetes, obesity, cardiovascular disease and asthma (U.S. Department of Health and Human Services, 2003).  The problem with these expenditures is that these disorders are preventable by a change in lifestyle. An overwhelming flow of resources are used in treatment of easily preventable disorders, so why is there not a push for preventative measures. One could conclude that there is a break in the communication chain. Alternatively, is there a direct link to key economical factors that inhibit healthier lifestyles?

            Perhaps inadvertently the economic structure has cohesively linked itself to a lifestyle of Big Mac’s and supper size fries. Morgan Spurlock, in a witty and satirical documentary, says that this nation is well into a “fast food epidemic” (Utichi, 2004). The film goes on to build a theory that the nation is in a crisis brought on by a fast food era. Conditions such as diabetes, obesity, and cardiovascular disease can be linked to a fast food lifestyle. Furthermore, the fast-paced American culture encourages fast food consumption over more healthier and nutritious food choices. 

The four food groups have been a staple in nutrition education for years. The underlining problem is that while children are receiving this well-meant education, they are at the same time inundated with commercial after commercial on the pleasures of fast food. With more single parent families and two household income families, time is hard to come by. These and many other factors play a role in the fast food craze culture of the United States. Why, then, does the government knowingly expend so much resource on treating fast food junkie fallout? 

The fact is, it is often harder to change a lifestyle than to find cheaper ways to treat conditions such as diabetes, obesity, cardiovascular disease and asthma (Longest, 2002). Moreover, there are large amounts of revenue generated from both the medical treatment and the fast food industry. Forcing adults to change their lifestyles would be like, as the cliché’ goes, “biting the hand that feeds you.” Educating children on how to live a fit and active life with proper exercise and a well-balanced diet will break this cycle of dependence.  Research has always shown that it is cheaper and more effective to motivate people when they are young and before bad habits form rather than to try to change them when they are older and set in their ways. 

References

Longest, B. B. (2002). Health policymaking in the United States, 3rd ed. Chicago: Health

            Administration Press.

U.S. Department of Health and Human Services. (2003). Prevention makes common “cents”.

Retrieved June 15, 2005 from http://aspe.hhs.gov/health/prevention/

Utichi, J. (2004). Review - Super size me. Retrieved June 15, 2005 from

            http://www.filmfocus.co.uk/review.asp?ReviewID=114

Though the healthcare systems of the Military, Veteran’s, and the private sectors are very different, the mission is the same:  to provide quality healthcare to its patients.  However, there are key fundamental factors that set these systems apart from each other. Factors such as budget, billing, type of care given, and political influence serve to outline the types of polices that these very different systems have. Though the mission is the same at each facility, there are political and economic factors that dictate, direct, and limit the policy-making procedures of each. 

In the private sector, factors that limit growth are the number of patients within the system and the ability to remain competitive. In the Military and Veteran’s Health systems (MHS and VHS, respectively), congress and the national budget limit growth. The budget granted to Military and Veteran’s Health systems is also directly proportional to the volume of care given. One very important factor in the both the MHS and VHS is that the care is given free of charge to their patients. Therefore, the capital used for a healthcare system is truly a powerful force that drives a system’s policies. 

The cost of healthcare in the Military, the Veteran’s, and the private sector is on the rise and is expected to continue to rise without slowing (House Affairs, 2005). Take for instance the pharmaceutical needs of patients. This high cost service has put a great deal of pressure on Military and Veteran systems as well as private sectors. The medications given to the 9.1 million beneficiaries within the MHS are all free of charge to the patient. This is also true for VHS patients and their medications needs. This service is costly to these systems, and due to this, policies ensure that medications are only prescribed when there is a clear need. Moreover, as these costs are rising, the systems are changing policies in order to control costs. An example of this is reclassifying key medications to a non-formulary category (House Affairs, 2005).

In conclusion, the Military, Veterans, and private sectors are very different but the goals of quality care are the same. All three of these systems provide quality care to their patients with respect to the mission and policies mandated by the system. Furthermore, while one system may often face factors that the others do not, political and economic pressures are faced by each these organizations.   The pressures on one system can cause another to transition its policies to accommodate fluid reform.   Regardless of the type of organization, all these factors cause the systems to constantly form new policies and change current policies.   

References

House Affairs. (2005). TRICARE moves three medications to non-formulary status. Retrieved

June 30, 2005 from http://www.ha.osd.mil/asd/20050425.cfm

 

In these difficult economic times, healthcare must come to the front. From a socio-economic burden influenza has left its mark throughout known history. The massive death tolls and economic hardship is felt greatest in what world poorest countries but not limited to them. The 1918 flu that battered the world for a year left a wake of dead and a world scrambling to understand how and why. The burden that is thrust upon the world with each outbreak of influenza in deaths alone is unimaginable but the economic burden is all too clear. In the United States influenza accounts for 1-3 billion of the nations direct medical cost (Szucs, 1999). Losses due from lost earnings and future lost earnings due to death are a staggering 10-15 billion a year (Szucs, 1999). In a rough estimate about 9% of the world’s population will contract influenza infections each years with the greatest burden falling on children and elderly (Szucs, 1999). Moreover, as an investigation into the factors that make flu such a world issue it gets more and more complicated with more and more underlining social and economic burdens that the world faces as a whole. Influenza has become the equalizer of nations and no one nation is safe from the clandestine ever changing virulence. The burden is great and just how great will depend on the ability of our leaders to see this danger and plan for the next pandemic. Our economic systems growing pains in recent weeks should be a call to action to improve or nation’s healthcare system. Moreover, how flawed is our healthcare system will it fail when we need it most?

Szucs, (1999), The socio-economic burden of influenza, Journal of Antimicrobial Chemotherapy, 44, Topic B, 11-15

Welcome to today’s class on the Power Corruption Cycle.   “Nearly all men can stand adversity, but if you want to test a man’s character, give him power.” (Afsaneh Nahavandi). Throughout time we have seen great leaders and horrible leaders blaze across our history in both the economic and political sectors. Take some time to think about some leaders that you feel have made a major impact on history and our day-to-day lives. Many of you will have thought of people like Lido Anthony Iacocca, Adolph Hitler, Ronald Regan, George Bush, Caesar, Cleopatra, Martin Luther King, Jr, Theodore Roosevelt, Saddam Hussein, Margaret Thatcher and Alan Greenspan. This list could go on forever and still we could think of more men and women who have lead and changed the world for right or for wrong.

Now I want you to think why these men or women have entered into your thoughts? What makes a good leader and what can cause a leader to make bad decisions or to become corrupt? The key is power. Power can cause a leader to become corrupt and absolute power corrupts a leader absolutely.(Afsaneh Nahavandi). When looking at leaders of today one very corrupt leader comes to mind, Saddam Hussein. April 28, 1937, was to be the birth date of Saddam Hussein to a poor landless peasant family in the village of Ouja. (The Iraq Foundation). He would soon rise to become one of the world’s most noted leaders. On July 16, 1979, Saddam Hussein was sworn in as President of the Republic of Iraq. (The Iraq Foundation). In the years leading up to his presidency, his party, the Ba'thists, worked to remove all opposition. This would affectively give him power and authority over a nation without any checks and balances. 

Power without accountability can and will lead to negative and catastrophic consequences. This is the first step in the power corruption cycle. 

Power corruption cycle. (Afsaneh Nahavandi).

 

1. Power with access to resources without accountability
2. Distance from employees
3. Inflated view
4. Employee Reactions: Compliance and flattery, Submissive behaviors and dependence.
5. Consequences: Poor decisions, Coercion, Low opinion of employees, Ethical violations, more distance.

Saddam formed an inflated view during the distancing phase when he enforced many years of purges to remove opposition. With his absolute and unchecked power growing the people of the nation moved to compliance and flattery. With the nation in full submission and totally dependant on the government, Saddam moved to the last phase or the consequence phase.  March 1974 The Kurdish towns of Zakho and Qala'at Diza are razed to the ground. 8,000 Kurds disappear from the village of Barzan. (The Iraq Foundation). Through the years leading up to the Gulf War and the present day war there would be countless murders and mass deportations of any that opposed the views and leadership of President Hussein. 

In conclusion leadership without accountability will soon be corrupt and will cause series of consequences. It is the position of leadership that will determine the depth of these consequences. A manager of a small store may cause the loss of profits and a leader of a nation may cause the deaths of countless thousands. From this we have learned that the cycle of corruption begins to test the leader’s character and the resolve of a people.

 

Sources:

Nahavandi, A. (2003). The Art and Science of Leadership, Third Edition. Upper Saddle River, N.J.: Prentice Hall Pearson Education, Inc. 

The Iraq Foundation. (2002). Biography of Saddam Hussein of Tikrit. Retrieved 02/25/05 from, http://www.iraqfoundation.org/research/bio.html

With the growing cost of medical care a great burden is put upon the world’s resources to treat and prevent chronic diseases. Primarily due to advances in medical science and an overwhelming number of poor life choices, chronic disease has become the world’s leading cause of death (Yach, 2004). Cardiovascular disease rose to become the leading chronic disease in 2002, with cancer; chronic respiratory disease; and diabetes following closely behind (Yach, 2004). Worldwide, these mostly preventable chronic diseases caused the deaths of 29 million people. The staggering burden on society due to lost productivity and rising healthcare costs leaves many nations clamoring to find a solution. 

One would think that a preventable chronic disease would be easily be extinguished through preventative measures such as educations and governmental policy. However, as billions are spent in the hopes of preventing chronic disease, barely a dent has been made in this growing global problem. This is due to a world of fearless smokers and binge eaters who want the government to bail them out after decades of poor life choices. Clearly the damage is done for the current aging generation, but there is hope for the next. For, educating youth on good life choices will lead to greater quality of life and better health. The hope is to reduce chronic disease through prevention, surveillance, and control.  

There is a great task ahead for chronic disease treatment and prevention. One generation requires acute and long-term care and another generation truly needs to understand the implications of poor life choices. The World Health Organization (WHO) has worked to set prevention, surveillance, and control measures to aid in the chronic disease crisis the world faces. Unfortunately, people will not change overnight. However, through social marketing and cognitive dissonance changes can occur in individual minds and hopefully cause them to make wise life choices.

Reference:

Yach. (20040. The Global Burden of Chronic Diseases,

            Overcoming Impediments to Prevention and Control

            JAMA. 291:2616-2622.

Fragmentation of the healthcare system is not a new problem and has been around for some time. The soaring need for healthcare and high-costs care has caused such proliferations in recent years. Is quality health care at risk due to the due to the rise of specializations in the health industry? What are the desirable and undesirable aspects of this fragmentation?   Should actions be taken to slow or stop this trend? These are questions will be examined in this report, Health Care at Risk. 

There are three factors that affect the overall quality of healthcare, according to a US Primary Care Policy Fellowship in 1994. “Three barriers to healthcare are shared by all vulnerable populations: inaccessibility of care, fragmentation of care, and cultural insensitivity on the part of care providers”. (Campos-Outcalt D, Fernandez R, Hollow W, paragraph #3, 1994) In looking at health care fragmentations, it is also important to consider inaccessibility and cultural insensitivity as a whole in assessing this healthcare disability. Each populations has it own set of vulnerabilities that set in motion a chain of fragmentation in the healthcare system. Populations such as patients with physical disabilities, mental disabilities, cultural differences, geographic separation, or limited economic resources due to system limitation are unable to enter the health care system efficiently. (Campos-Outcalt D, Fernandez R, Hollow W, paragraph #2, 1994)   Extenuating factors that are meant to improve the overall care of the patient soon become barriers to quality health care.

For example, a 19-year-old female with a 2-year-old son is presented at an urgent care center with strong case of depression and the inability to keep food down. Upon testing she is found to be 2 months pregnant. She is promptly referred to the Welfare department to apply for Medicaid. She has not finished school and is unable to fill out all the forms needed to get adequate care. About two weeks after her visit to the ER she is informed that Medicaid will cover her. With some difficulty she is finally able to locate a provider that will take Medicaid. At the same time her two year old has had no well-baby check ups and is behind on all vaccinations. The system becomes more fragmented when she is found to have complications that if caught earlier in the pregnancy could have been treated. 

Due to the complication, her current provider will no longer see her out of fear that it is outside the scope of his practice. This then forces her to search for another provider that will see her with the complication.  Three weeks have gone by and she is able to get a referral to a specialized OB practice that will take on her care. Problems arise when Medicaid will only pay for two ultrasounds, leaving her with the choice to pay for the additional ultrasounds herself or forego the needed care. Late in her pregnancy she is referred to the WIC office to monitor her and her toddler’s dietary needs. Again more paper work is required, and to complicate things further the WIC office is across town and due to a lack of transportation she is unable to make all her appointments. 

As she gets closer to the delivery date she become so frustrated with the system that she considers abortion, which in her case is easer to get than to have the baby and care for it. The problem with the system is that the fragmentation is subtle and while important to the healthcare system is cumbersome and cryptic to the patient. Is quality healthcare at risk due to the due to the rise of specializations in the health industry? Yes, the system set in place to organize and develop the flow of care often obstructs and inhibits quality patient care. Patients are often faced with difficult decisions on whether or not to receive care and even at times where to go to get the necessary care. Notable care issues quickly arise in vulnerable populations that are unable to adapt to the fragmented complexities of the healthcare system. Fragmentation of healthcare soon leads to poorer patient outcomes. (Linda Mann, paragraph #1, 2004)

What are the desirable and undesirable aspects of this fragmentation?   Notable desirable aspects of fragmentation are better long-term care within specialized fields such as mental health, cardiology and diabetic care. In some healthcare systems, patients can be diagnosed with special need such as Coumadin therapyand Pneumonia without even entering the healthcare system. (Linda Mann, paragraph #10, 2004)

 Undesirable effects are mostly due to a lack of communication within and outside the healthcare system. Patient records are not freely released to providers, not affording providers with key information with respect to patient care. Should actions be taken to slow or stop this trend? Action should be made on a consolidated effort to streamline the health care system with an effort to reduce fragmenting. The more the system fragments the farther it isolates itself from the patient. By working to reduce communication problems and by opening the system between specialized care and routine care there will be a greater opportunity to homogenize the care given regardless of the source. 

In time there will be benefits from fragmentation but it will come more fluidly as the levels of information flow are streamlined and patients are given greater freedom in choice of care. Patients do benefit from knowledge and the patient’s choice of specialized care or general care should be a right. Moreover, the health care system should focus on the needs and rights of its patient base, giving a great range of latitude to vulnerable populations most affected by system-wide fragmentation. The rewards of opening and specializing are to the great benefit of both the patient and the healthcare system. However, this should never come at the expense of the overall quality of patient care.

References:

Campos-Outcalt D, Fernandez R, Hollow W, et al. (1994). Providing quality health care to vulnerable populations. US Public Health Service Primary Care Policy Fellowship. Retrieved 05/05/05 1600 from, www.primarycaresociety.org/1994d.htm

Griffith, J. R. & White, K.R. (2002).  The well managed healthcare organization(5^th ed.). Chicago, IL: Health Administration Press.

Linda Mann. (2004). From “silos” to seamless healthcare: bringing hospitals and GPs

back together again. Retrieved 05/04/05 1500 from, http://www.mja.com.au/public/issues/182_01_030105/man10274_fm.html

 

Public health surveillance is crucial to ensure that public health resources are directed in the best possible manner. Data gathered from both active and passive surveillance is used to facilitate and respond to any public health threat accurately and productively (Checkoway, 2004).   The goal is to provide a surveillance system that is a collaboration of local, state and CDC surveillance that brings quality data to those that can bring about the greatest good( CDC, 2006). Active surveillance is a process by which providers are contacted by public health authorities to evaluate current disease rates. Conversely, passive surveillance is when public health authorities rely on providers to alert authorities of current disease rates (CDC, 2006). Passive surveillance is often used in occupational health exposures; a drawback to this is as much as 40 percent of exposures go unreported to public health officials (CDC, 2006).

            In the article “Intellectual Impairment in Children with Blood Lead Concentrations below 10 mg per Deciliter” (Canfield, 2003), both passive and active surveillance were used to provide accurate data concerning the effect of lead exposures below 10mg/dl (Canfield, 2003). Passive surveillance was used by an evaluation of reported cases by providers. It also aided in evaluation and determination of lead concentrations. Active surveillance was through the participant children between 24 to35 months of age (Canfield, 2003). Participants had blood samples collected to determine blood lead concentrations. With both active and passive surveillance, patient who had lead concentrations bellow 10mg/dl were evaluated for intellectual deficits that could be contributed to lead exposure (Canfield, 2003).  The article clearly demonstrated that both active and passive surveillance are crucial to the exposure studies and both have value to the objective of the studies. Implementing both methods brings a level of accuracy to the study that balances and qualifies the studies outcome.

Resources:

Canfield RL, Henderson CR, Cory-Slechta DA, et al. (2003). Intellectual impairment in children with blood lead concentrations below 10 mg per deciliter. N Engl J Med, 348, 1517-26.

CDC. ( 2006). Framework for Evaluating Public Health Surveillance Systems for Early Detection of outbreaks. Retrieved 07/05/07 from, http://www.cdc.gov/epo/dphsi/phs.htm

Checkoway, H., Pearce, N., & Kriebel, D. (2004). Research methods in Occupational Epidemiology (2nd Ed.). New York: Oxford University.

Community-based intervention (CB) strategies are often used to prevent disease in low income communities. Recently community-based interventions have been primarily employed for the prevention of diabetes in rural development and urban planning. Diabetes is a growing nationwide health concern, yet in many cases it can be prevented or controlled through diet. The uses of community-based interventions are concentrated in many areas. Areas such as behavior modification and social, cultural, community, and environmental factors that contribute to health disparities are primarily used to aid in the prevention and control of diabetes (Goodman, 2006).

It is important to target community-based interventions of diabetes due to its strong link to cultural views on health. For instance, many people are predisposed to diabetes due to their cultural attitudes about diet and exercise. It is important to note the values and perceptions of a particular culture or ethnic group as this will be a significant factor leading to preventable chronic disease. Therefore, it is critical to target scocial change stemming from the cultural base; in this manner there will be lasting community-based interventions. Moreover, as cultural awareness is a leading part of interventions there will be greater progress in chronic disease prevention. The move to encourage healthful living requires systematic understanding of cultural norms and values that serve to form the community’s perceptions on what is healthy and what is not. 

Reference:

Goodman, (2006), Applying Comprehensive Community-based Approaches in    Diabetes Prevention: Rationale, Principles, and Models.

             Journal of Public Health Management & Practice; Nov/Dec2006, Vol. 12 Issue 6, p545-555

 In looking back at the aftermath of 911 there is one strong resounding fact:  America is strong. A great nation and a great people were cut and cut deep. The trembling foundations of the trade towers resonated throughout the American and world economic structure. How is it that with this charge from an enemy bent on the destruction of American economic power that in 2003 there was 2.4% growth? (Free Republic,03). 

I would have to say that the dot.com bubble, Enron hysteria, WorldCom lies, AOL lies, Tyco stealing, and the overall lack of ethical practices were far more destructive to the over economic health of the United States. (Free Republic,03). People know that they can not trust a murdering highjacker but they should have peace of mind in their retirement and their nest egg investments. The problem lies somewhere in the minds of some of the world’s most powerful executives; they lost touch with the little guy. When people lose their trust in the market due to untrustworthy CEO’s, it will not come back quickly. 

I do not agree with the comment of an anemic economy. It is what we make of it and America has overcome greater than this. Moreover, while the attacks of 911 did cause the economy to weaken and people did lose trust, it was mostly due to the lack of truthfulness of top level CEO’s.  I would also have to say that the CEO is looking at two buckets, one with truth and the other with puffed-up lies. There are those who chose to lie to the public about their earnings and those who told the truth. Tell the truth and loose investors, or lie really well and keep them--perhaps even add new investors. The bullish truth about the average person’s perception of CEOs today is that they are as trustworthy as politicians.

I find it hard for the economic leader to feed the human spirit when they have none of their own. The goal of honesty and loyalty to the consumer should be the basis of their strategy. Peace of mind starts with knowing the truth so that one can overcome the negative and capitalize on the positive. I agree that deeper communication is the key, but it must be the truth in order to hold the trust of the investor and the spirit of the company. “Effective leaders in tough times can actually do a great deal to impact the economy and keep our country on its feet.” (Villeneuve,01). This holds true and it is key to the economic power of this great nation. Because of this leaders should be held accountable for any actions that may cause harm to the economy. These are hard times, but I believe that it is primarily due to the greed and lack of ethical leadership of some of today’s top leadership. Most of all employees are investors in the company and they need to both trust the leadership and the economy. I fond the article of Villeneuve to be clear on one point leadership has the power to make changes good or bad. 

Sources:

Free Republic. (2003). Blue Chip economists trim U.S. growth forecast. Retrieved 03/15/05 from, www.feerepublic.com/focus/f-news/908995/posts

 When looking at the service of Medicare created in 1965, one can only hope there was the best of intentions behind its lofty goals. The truth is Medicare created jobs and has served to provide healthcare to more than 40 million older and disabled Americans. The goal of providing healthcare in 1965 to older and disabled Americans was both idealistic and well received. Nevertheless, as with any other “benefit”, problems arose by both poor quality of service and inadequate funding. Moreover, through the years Medicare became a political tool of power.   Finally, every administration since its conception has dabbled with the policies and services Medicare provides. For example, in Nov. 25, 2003, the Bush administration included a new prescription drug benefit (CBS News, 2003).

The changes to Medicare where deemed necessary due to the rising costs of medications and the debilitating burden that soaring costs put on the beneficiaries of Medicare. In 2002, the United States spent $162.4 billion on prescriptiondrugs with only about 22% of this paid for by the Government and 44% by personal healthcare prescriptions (Frank, 2002). The root of the problem lies in the inability of elderly and disabled Americans to be able to cover the rising price of prescription care. Each year the costs of prescription care are on the move up and out of the reach of most people on Medicare. This growing problem has forced many elderly and disabled people to choose between good health and paying one’s bills.

Beginning in 2006, the main provisions of the new legislation would allow seniors to purchase coverage for their prescription drugs as well as require higher-income seniors to pay more for Medicare Part B coverage (CBS News, 2003).  Estimates under this new program would have drug insurance premiums of about $35 a month and a deductible of $250 (CBS News, 2003). Seventy-five percent of costs would be covered until the recipient’s drug costs reach $2,250, after which there would be no drug coverage until drug costs reach $3,600, or approximately $5,100 in overall expenses (CBS News, 2003). After $5,100 in expenses, the plan would cover about 95% of prescription costs (CBS News, 2003). Even with political and special interest influences directing the policy, the Medicare reform goal was reached.   

Congressman Charles Grassley, R-Iowa, an architect of the bill, and many insurance and pharmaceutical companies were involved in setting the agenda for this policy reform to Medicare (CBS News, 2003). Together, with the support of the President, these parties and many special interest groups worked to set the formulation of change. Grassley stated that, “now was the time to act for it may be years before another opportunity comes along (CBS News, 2003).” The role of interest groups such as the nation’s various elderly and disabled groups served to display the needs and values hoped for in future reforms. Governmental leaders in both the Senate and the current administration worked to provide a service to beneficiaries that fell within current and future budgets. At times, the lofty $395 billion legislation was ignored and caused a great deal of political and public unrest.

This legislation was very controversial and in many cases proved to be more of a detriment than an improvement to Medicare.   Senate Democratic Leader Tom Daschle called the bill a "bailout for the HMOs and insurance companies (CBS News, 2003).” The administration stated that the change to modernize Medicare would have savings of between 15 percent and 25 percent off retail prices. The caused the many out-spoken critics to argue that White House estimates were inflated (CBS News, 2003). Many critics even stated that the pharmaceutical companies were the winners of this bill at the expense of low income Americans.

The stated goal of the administration was that it was time to modernize Medicare.  One factor that contributed to reaching this goal was the addition of electronic medical informatics. This electronically stored data is invaluable to evaluating both the financial viability and the practicality of medical procedures. The ability to evaluate patient data with respect to cost analysis was a crucial factor leading up to reform (Longest, 2002).   

In conclusion, the need to reform Medicare was clear and certain. The leadership at the time took decisive advantage of timing and resources in order to advance their goals and ideals. Moreover, the parties of interest and influence worked to motivate and render change. Even with all the political balancing acts, President Bush signed the bill, and it will take effect in 2006.  And while the initial goals were not entirely reached, the concept and practical value of the change can, in the future, prove to be of great value. The question to ask is whether people will appreciate it or cause it to become even more of a burden on society and political power tool.

References

CBS News. (2003). Medicare drug bill nears passage. Retrieved July 1, 2005

from http://www.cbsnews.com/stories /2003/11/25/politics/main585478.shtml

Frank, R. (2002). Prescription-drug prices. New England Journal of

Medicine. Retrieved July 1, 2005 from http://content.nejm.org/cgi/content/full/351/14/1375

Longest, B. B. (2002). Health policymaking in the United States, 3rd ed. Chicago:

Health Administration Press.

                  

How does the external environment (stakeholders, regulations, accrediting agencies, etc.) affect the policymaking process? This is a very important question to ask when policymaking in healthcare. These external factors have a very large role in healthcare policymaking.   One must understand the external environment and what it offers the system. It is first important to look at and define what these external factors are. Knowing these forces then will serve to define the role they play in the process of healthcare system policymaking. 

Stakeholders are primary reference groups, those who contribute regularly to the organization’s defined mission. That is, these groups circulate the necessary capital to maintain specific programs within the health system. These entities thereby have a great deal of influence on organizational policies with respect to the programs that they sponsor. This can prove to be major factor in how policies are formed and why. Due to the overwhelming importance of their contributions, external pressures from these interest groups are often heavily considered when policies are formed.

Regulations are rules or orders issued by an executive authority or a government’s regulatory agency that has the force of law (Merriam-Webster, 2005). Regulations also come from within the organization itself and contribute to the formation of its policies. Regulations in an organization are necessary to maintain order and balance within the system. Without the implementation of regulations, the policies of the organization would have little or no value in the delivery of quality patient care. Regulations, both internal and external, help to form a system that is responsive and effective to patient need and rights.

There are many regulatory authorities within the medical field. Such authorities as FDA, OSHA, and Health and Human Services work to form regulations that improve the safety and care of all within the healthcare system. These agencies also mandate and enforce these regulations in all areas of their authority. Fines and restrictions put on healthcare organizations ensure the system follows and adheres to every regulation. To ensure the system follows the regulations, they often write them into the healthcare system’s policies. 

At times regulations are not followed; this is when accrediting agencies step up to the plate and evaluate procedural and regulatory shortcomings. Accrediting agencies such as CAP, or College of American Pathologist, and JCAHO, or Joint Commission, ensure that healthcare systems are following both internal and external policies and regulations (Longest, 2002). CAP is an accrediting agency that accredits laboratory and pathological practices within a healthcare system. JCAHO is an accrediting agency that accredits the entire healthcare system (Longest, 2002). These accreditations are voluntary and serve to show if the healthcare systems policies and regulations are working and actively practiced throughout the organization. 

Clearly, many external pressures influence policy making with in an organization. Healthcare systems have a great deal of regulations that formulate the systems policies. Regulating agencies and accrediting organizations serve as guides in the right direction holding the healthcare system accountable to both internal and external regulations and policies. Policy making in a healthcare system is an arduous task filled with legal and ethical regulations.

In conclusion, the goal of policymaking is to foster a system that polices itself and is responsible for its actions. However, there may be external forces such as stakeholders, CAP, JCAHO, FDA, and OSHA that influence the policies and regulations of the system. It is up the healthcare policymakers to ensure that the system holds to the rule and regulations it sets. The healthcare system is responsible for both organizing and formulating policies that do not negatively affect the quality of care given. It is up to policymakers to ensure the policies and regulations of quality healthcare are in place; it is up to caregivers and providers within the system to adhere to those policies and regulations.

References

Longest, B. B. (2002). Health policymaking in the United States, 3rd ed. Chicago: Health

            Administration Press.

Merriam-Webster. (2005).  Merriam-Webster On Line Dictionary. Retrieved June 16, 2005 from

http://www.mw.com/cgibin/dictionary?book=Dictionary&va=Regulations&x=15&y=13

 

Gentle Sea

The gentle sea billows along the shore

It takes with it the remnants of my past

And though I am sadden by the loss

I see a future rich with salty winds and deep blue skies

There by the gentle sea I find a grain of sand much like me

Broken by the waves battered by the wind and free

It is by the gentle sea that I find myself and I am set free

Free to walk free to glide free to be

The gentle sea so blue so sweet

It billows along the shore

It tells a story so bright I shed my self

Wash over me gentle sea Wash over me

Wash away that part of me I dare not see

Take it deep far away forgotten for all time

The gentle sea now a part of me

 Science is theory that requires a level of faith to believe that has become a religion. An example of this would be the big bang theories were clearly there were no witnesses to gather data of the creation of the universe. Moreover, all unknowns require the concept of faith and faith is the root of understanding. Religion is clearly a bondage to a belief or concept.  Science is not bound but the theorist is bound to a concept or theory of what is perceived rational understanding. It is here were religion and science fold together in order to balance human understanding. 

 

The factor that causes STD’s to continue in incidence and prevalence is the lack of education to the primary carriers of STD’s. To educate grade school childeren on condom use is not the most effective means of control. High risk groups that engage in acts that are proven to spread STD’s should be the target of education and control measures, not children still learning their colors. I believe that too much time and money is misdirected and the cause is disregarded. 

            When there is an outbreak, the goal is to target the ill for quarantine not the healthy. Then why when it comes to STD’s do we give condoms to children and not homosexuals and promiscuous adults. The truth is political correctness and the fear of alienating a group of society has caused greater proliferation of STD’s. The Center for Disease Control stated in a 2004 reported on HIV that almost 70 percent of AIDS sufferers had acquired it through homosexual sex or intravenous drug users.

            To prevent the spread of STD’s, it is crucial to educate all who will conduct high risk sexual activity. Moreover, it is important to ensure that high risk individuals understand the risks to themselves and potential partners. Furthermore, to target an STD training and prevention program to children is flawed and doomed to fail. If morality and abstinence is not taught to a child, then as a child becomes an adult circumstances such as a monetary shortage may halt a condom purchase. The goal should be not to politicize the problem but address the issue with the facts. It is my opinion that STD’s will continue to be a world problem due to non-monogamous homosexual and heterosexual behavior.