U.S. Vulnerable Population and Health Policies - Essay Example

? Running Head: Health Science U.S. Vulnerable Population and Health Policies Institute: Which has a greater influence on a person’s health: individual choices and actions (micro perspective) or community policies and resource availability (macro perspective)? Discuss three reasons why you selected one over the other. Health is highly dependent upon an individual’s social behavior and his/her economic condition. Abundant evidence is available in micro and macro data signifying that a large number of health indicators are directly related to numerous dimensions of economic prosperity (Smith, 1999). More elaborately, people earning high income are most likely to invest more in their health since they have access to better resources such as food, sanitation and health care. Furthermore, there are significant gaps in our apprehension of how the changes in social and physical environment influence the shifts in weight change, dietary intake and patterns of physical activity. However, great development has been made to analyze some characteristics of this intricate relationship. As a result of this development, considerable evidence has been found suggesting that environmental factors such as community policies and resource availability have great impact over an individual’s health as these macro and community level factors determine his/her dietary habit, physical activity and body structure. Hence, the environment is known to be the external context that depicts the individual and household behaviors. Moreover, the built environment that includes the design and physical elements of a city such as the infrastructure of roads, bike paths, sidewalks, etc. and the density of commercial, residential, industrial and forest areas have deep impact over the health of every individual of the society. Other key macro level factors influencing an individual’s health are the legal and policy factors. There exists massive change in the systems of processing, production, shopping and distribution of food behind the major shifts in the dietary habits and physical activities of the people all over the world. The new lifestyle has increased the accessibility to the energy dense foods along with reducing the activities of energy expenditure. 2. Select two vulnerable populations (chronic obstructive pulmonary disease (COPD/AIDS alcohol, tobacco, marijuana and other drugs abuse). After completing the learning activity, Public Health Information and Data Tutorial, locate data and describes trends associated with the physical, psychological, and/or social health of the populations selected. This paper is based upon the observation of the physical, psychological and social health of people vulnerable to alcohol, tobacco, marijuana and other drugs abuse who agreed to participate in the survey of public health information. Data was obtained from two different vulnerable populations: one comprised of high school students and the other included young professionals. It was observed in the survey that the most common casual reason for taking tobacco, alcohol and other drugs included: peer influences, the characteristics of home and community, general perception that they are not much harmful and availability of the substances. Moreover, the study revealed that the economic condition of a community also plays a significant role in the use of tobacco, alcohol and other drugs. On observing the behavior of the drug users, it was found that the use of drugs contributed to the following: Violence, sexual assaults and road accidents. Suicidal behavior. Academic and job issues. Risky sexual behavior. Trouble with the law enforcement officers. Health issues like acute respiratory illness, heart disease, stroke, chronic obstructive pulmonary disease, short-term-temporary loss of memory, sexually transmitted diseases, and even cancers of lungs, oral cavity, larynx, etc. Psychological dependence, decreased motivation, anxiety, distrust and depression. Failure in exams and in professional tasks, delinquency and unwanted pregnancy. The use of drugs leads to both short term and long-term consequences. The long term consequences are unimaginably acute and sometimes even fatal as they cannot be noticed early but are evident when they have caused enough damage (Newcomb and Locke, 2006). 3. Why are the groups you selected more vulnerable than the others? The most vulnerable population refers to the communities who have been found to be most at risk, underserved or marginalized. I consider that the alcohol or substance abusers, mentally ill and disabled and homeless persons are the three most vulnerable populations amongst the rest of the high risk groups. I have placed the alcohol or substance abusers and the mentally ill and disabled under the category of most vulnerable people because of their ignorance to their health condition whereas the reason for classifying the homeless persons in to this listing is the lack of essential resources and services for them. Moreover, all the three populations are dependent upon some sort of the support services as they are incapable or incompetent to help themselves. These people barely survive in the emergency room as they are picked by the ambulance whenever the temperature gets extremely chilling or hot. Females from these populations also get raped, conceive unwanted pregnancy and suffer from unexpected disease when they are not prepared for such catastrophes. It is obvious that the health care needs of these populations are very much similar to their normal counterparts but it is the result of early intervention or lack of prevention that these people often get more advanced health issues. These people are more likely to lack medical insurance than other individuals. Furthermore, the lack of social support among these groups of population is another issue of grave concern. Also, the individuals from these populations are more likely to get HIV positive or AIDS as they practice unprotected sex and re-use needles or syringes to inject substances or medicines (Martens, 2001). 4. Which of the following do you feel has a greater impact on health status: social status, social capital, or human capital? Justify your choice Social capital has been found to have positive influences over the health of people as it leads towards better welfare of the public (Blane, Brunner & Wilkinson, 1996). Social capital is referred in this paper as the stock of networks used for producing goods and services and health is a by-product of this process. In this definition, networks refer to the relationships among people. The state is responsible to provide collective goods such as clean water, policing, health care services and health insurance. Inglehart (1997) defined social capital as a scheme of trust and patience that gives rise to extensive networks of voluntary affiliations. Human capital that includes social class, education, etc. is known to be the prime determinant of a person’s health. Social capital that constitutes formal and informal links of a person with others has been identified as the primary and major determinant of public health. Since society is a conglomeration of relationships or networks, thus, social capital can be referred as a new mechanism of asserting many known forms of social amalgamation. Memberships in formal organizations can increase the accessibility to hospitals and healthcare, as for instance, a health insurance program associated with employment in the US or the mandatory health services facility for the citizens of a welfare state. Since the face-to-face informal networks provide informal care and companionship, thus, they are beneficial for both physical and emotional health. Hence, people who possess less social capital will be vulnerable whereas those who possess more social capital will be comparatively healthier. 5. After viewing the online presentation, Race, ethnicity, and health care. (Kaiser Family Foundation, 2007), answer the following question: What role does medical insurance coverage play in healthcare disparities experienced by minority populations? Poorer health care services are given to the racial and ethnic minorities as opposed to the health care available to the non-minorities, even if the factors of accessing health care that include income and insurance status are controlled (Institute of Medicine, 2002). According to recent studies, English language skills and immigration status are important factors affecting disparities in accessibility and coverage of health care (Lillie-Blanton and Hudman, 2001). The citizenship status of a person is required not only to be eligible for the programs like SCHIP – State Children’s Health Insurance Program or Medicaid but also to be able to attain employment that provides health insurance benefits. Moreover, English language skills are required to be able to fill out the insurance application forms or to discuss health issues with a medical practitioner. The Urban Institute carried out a national survey NSAF – National Survey of America’s Families in the year 1999 so as to unfold the impact of citizenship status, race/ethnicity and English language skills over the health care accessibility, health insurance coverage and health care quality by focusing over the minorities. The inability to acquire adequate health coverage, the geographical differences, the cultural barriers, the communication gap between the patient and the health care provider, the inability to access health care and the provider stereotyping have been identified as the vital sources of racial and ethnic disparities in health care provision. Hence, easy accessibility to health insurance coverage and better English language skills along with increased incomes for the minorities will certainly result in reducing the racial and ethnic health disparities. 6. Describe the program and answer the following questions: What are the strengths of the program? What are the potential weaknesses of the program? The objective of community based public health programs is to make quality health care services accessible to all without any discrimination or disparity. In December 2006, Equity in Preparedness Program was initiated in Boston to cater the vulnerable populations with disabilities and/or mental illness (Long, 2008). The program took on board the local experts in the areas of emergency response and management, health care communities, public health care, public welfare and safety and academia. Across the board, three common areas of issues were identified that are: evacuation procedures at the time of an emergency situation, adequate communication medium and continuity of services. Numerous action procedures were developed through the program so as to address the identified problems. Specific suggested solutions included: information or health related materials to be printed in Braille or in large font size for the visually impaired people, or closed captioned for those who are hearing impaired. The program stressed upon the significance of augmenting the content of the communication messages at the time of an emergency. As a result of this, a universal design was agreed upon that was based upon the principle that the design of the communication and environment tools should be such that the message is conveyed and understood by as many persons as possible. For this purpose, the emergency and health related materials need to incorporate the systematic use of pictures/images so that it could be understood by all, even the various vulnerable populations like those individuals who are physically impaired or lack English language skills. 7. Compare and contrast public versus private sources of payment for the care of the vulnerable. Present an overview of 3-5 trends that are affecting vulnerable population’s ability to pay for healthcare services. Numerous public and private sources have been busy in fulfilling the needs of the most vulnerable populations. The provision of health care services, the creation of hospitals, the social insurance programs and the income transfer programs are some examples of the public interventions for the vulnerable populations. Besides these public programs, there is a major contribution of the private sources, such as the voluntary and non-profit organizations, in providing medical and preventive services to the vulnerable population. Many public sources serving the needs of the vulnerable populations carry out their operations under the ownership of public and non-profit organizations as part of apprehensive public policy. The historical data of programs related to health services and insurance reveal that the issues of vulnerable populations have given rise to numerous different sorts of institutions, programs and interventions. Such public programs form an essential component of the present approach for providing health care services to the vulnerable. The behavior of the recipients of one program at the time of enrollment further determines their qualification to the health insurance coverage. There are various social welfare programs in the US such as the cash assistance, health insurance, employment, social policy, training, etc. that are distinct programs catering the needs of the vulnerable populations but these may also, overlap with one another (Anderson et al., 2003). Thus, these programs can function as enrollment vehicles for other program(s) since the qualifying condition for one program may lead to the qualification or rejection for some other related program(s). As for instance, the cash assistance program conventionally leads to the enrollment of women and children with low income in to the Medicaid programs. 8. According to the text, there are two strategies that can be used to evaluate program outcomes: cost-benefit analysis and cost-effectiveness analysis. Select a community-based program. Examine the program outcomes. Answer the following question: Are the program outcomes presented from a cost-benefit perspective or a cost-effectiveness perspective or both perspectives? A major public health issue is identified to be the mental disorders among homeless persons. It has been found that the community based programs catering the needs of the vulnerable homeless population are generally employed to fulfill the local housing requirements and not the needs related to the mental wellness of such populations. The transitional housing scheme is the most common community based program for the homeless population that provides social support and services along with a reliable place for living up to the period of two years. In this paper, we will analyze the cost-effectiveness and cost benefit of the transition housing scheme by investigating the participant mental behavior upon the completion of the transitional housing scheme along with discussing the factors of the program that determine the success of the participant. Success in the transitional housing scheme was determined through two outcomes that are: completion status of the program according to the clinical observation and the housing status after completion and discharge. The statistics of this community based program found that 52 percent of the participants were determined as successful, after 2 years of housing, through the clinical observation and 84 percent out of these successful participants were able to attain housing status after getting discharged from the program (Dolbeare, 1996). Also, this study revealed that this community based program of transitional housing was unable to adequately address the mental needs of the homeless people as it only addressed the housing issue of the population. Hence, the evaluation of the outcomes of this program incorporates both perspectives: cost benefit perspective and cost-effectiveness perspective. 9. What kinds of economic policies might reduce health inequities and improve the overall health of most Americans? Social and economic policies should emphasize more on the area of health inequities as they tend to improve the overall health of the entire population in a more cost effective way. It is important to evaluate the outcomes of a social and economic policy in relation to: population-health, implementation-issues and other health-policies-and-programs. An economic policy that is casual and cost-effective towards health-care may not be supported by many, simply because it is considered to be unfeasible under the political and technical perspectives. As for instance, the cigarette smoking issue unfolds that how policies not directly related to health can pose adverse influence over it. Initially, the U.S. policy related to cigarettes focused over commerce and agriculture and did not consider its health effects. Such policies gave rise to smoking, after which it was finally realized that smoking has resulted in the rise of chronic diseases. But the severe damage was done before the casualty was eventually determined over the span of decades. However, the consensus developed still doubted that the reduction of cigarette consumption was politically, technically or ethically doable (Marmot, Kogevinas, and Elston, 1987). After all, policies from taxation to restrictions on advertisement, purchase, selling and usage of tobacco products, which were absolutely outside the conventional domain of health, were imposed and found to be more cost-effective and feasible in contrast to the medical efforts to inhibit the adverse impact of smoking. Hence, it is important to encourage, design and implement the social and economic policies after evaluating the potential new health programs through clinical trials. 10. Should knowing about the health effects of social policies change the value that Americans place on those policies - why or why not? Provide two specific examples in your discussion. The so-called health system in the U.S. has not been developed with the sole objective of producing health. In fact, health-care is one of the determinants of health and that too is relatively minor by some measures. Hence, the U.S. still shows poor statistics for the key measures of health even after investing trillions of dollars on medical services (Schoeni, House, Kaplan, and Pollack, 2008). National health reforms should address this gap through adopting measures that promote health and manage diseases. Thus, a basic re-orientation is required in understanding health care and its effects on health. Therefore, the U.S. authorities should emphasize services on primary care, standardize insurance benefits, better manage and prevent chronic illnesses through rewards, expand community health centers and develop information system keeping patient records. Moreover, the U.S. policy makers should also evaluate the health related affects of policies in areas other than health care, which include agriculture, taxation, urban planning, education, housing and transportation. Reforms as such in the American policies will ensure not only health among the people but also minimize the staunch disparities in health that divide the American people into groups of well-off and worse-off. A genuine health system is attainable through health reforms that not only produce health but also fairly distribute it to all without any discrimination. For this purpose, promising programs and policies have been suggested, some of which are already under implementation in various parts of the country. These policy measures include provision of: better housing stock and food supply, safe areas for exercise, income supports, better opportunities and education and secure nutrition. References Anderson, G. et al. (2003). “It’s the Prices, Stupid: Why the United States Is So Different from Other Countries,” Health Affairs, Vol. 22, No. 3, pp. 89–105. Blane, D., Brunner, E., & Wilkinson, R. G. (1996). Health and social organisation. London: Routledge. Dolbeare, C. (1996). Housing policy: A general consideration. Westport, CT: Oryx. Inglehart, R. (1997). Modernization and postmodernization: Cultural, economic and political change in 41 societies. Princeton: Princeton University Press. Institute of Medicine (2002). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press. Lillie-Blanton, M. and Hudman, J (2001). Untangling the Web: Race/Ethnicity, Immigration and the Nation’s Health, American Journal of Public Health, 91(11): 1736-38. Long, S.K. (2008). On the road to universal coverage: impact of reform in Massachusetts at one year. Health Aff. 27:W270-W284 Marmot, M.G., Kogevinas, M. and Elston, A.M. (1987). “Social/Economic Status and Disease.” Annual Review of Public Health, Vol. 8, pp. 111-35. Martens, W. H. (2001). A review of physical and mental health in homeless persons. Public Health Review, 29(1), 13-33. Newcomb, M.D., Locke, T. (2006). Health, social, and psychological consequences of drug use and abuse. In: Epidemiology of Drug Abuse. US: Springer. Smith, J.P. (1999). Healthy bodies and thick wallets: the dual relation between health and economic status. Journal of Economic Perspectives, 13, pp. 145-166. Schoeni, F.R., House, S.J., Kaplan, A.G., and Pollack, H. (2008). Making Americans Healthier: Social and Economic Policy as Health Policy. U.S.: Russell Sage Foundation. Read More