Morbidity and Mortality with End-Stage Renal Disease - Research Paper Example

Montgomery, End Stage Renal Disease, and Healthy People 2020 I. Introduction This work focuses on people with end stage renal disease in Montgomery, Alabama. The work is a health needs assessment executed in relation with Healthy People 2020. The United States federal government has been conducting ten-year programs for at least the last 20 years. In 1990 or thereabouts, Healthy People 2000 was launched by the U.S. Department of Health and Human Services to guide public health initiatives for the next 10 years or up to 2000. In 2000 or thereabouts, Healthy People 2010 was launched to guide work for the next 10 years or up to 2010. Finally, in 2010, Healthy People 2020 was launched to guide health work for the next 10 years or up to 2020. Sometime during the mid-period or thereabouts of each of the ten-year programs, a mid-course review is conducted. For instance, the mid-course review for Healthy People 2010 was started to be published in December 2006. Presumably, therefore, a mid-course review for Healthy People 2020 will be done sometime 2015 or thereabouts. The launching of Healthy People 2020 was announced by the U.S. Department of Health and Human Services through an official press release on 2 December 2010. According to the U.S. Department of Health and Human Services (2011), there are four overarching goals in Healthy People 2020. First, the attainment of “high-quality, longer lives free of preventable disease, disability, injury and premature death.” The second overarching goal is the achievement of health equity, elimination of health disparities, and improvement of health of all groups. The third overarching goal is the creation of social and physical environments that promote good health. Finally, the fourth overarching goal is the promotion of a quality of life, health development, and healthy behaviors across all life stages. The four overarching goals are declared in the official website of the U.S. Department of Health and Human Services for its healthy people programs in www.healthypeople.gov as well as in a brochure produced in November 2010. We assess the relevance of Healthy People 2020 in relation to End Stage Renal Disease, particularly for Montgomery in Alabama. II. Montgomery, Alabama According to the U.S. Department of Housing and Urban Development (2010, p. 4), the population of Montgomery was estimated at 366,900 as of 1 July 2010. Approximately, 60 percent of the population resides in Montgomery County. Further, according to the U.S. Department of Housing and Urban Development (2010, pp. 4-5), Montgomery’s population was growing at an average of 1.3 percent annually during the 1990s but the population growth rate dropped to 0.1 percent annually since 1 July 2008. Unemployment rate in Montgomery was at least 10.1 percent in 2010 compared to the usual unemployment rate of only 4.1 percent from 2003 to 2007 (U.S. Department of Housing and Urban Development, 2010, p. 2). For at least in the short run, the unemployment figures are not likely to improve given the bleak economic forecast by many analysts for the United States and the global economy. Montgomery’s population is in about 137,300 households in 2010 and about one third of the households are renters (U.S. Department of Housing and Urban Development, 2010, p. 5). The median family income in Montgomery is $56,400 (U.S. Department of Housing and Urban Development, 2010, p. 9). This means that half of families live below the median family income. In contrast, an international study in 2004, placed at a minimum of $90 the daily cost of maintenance for people with end-stage renal disease (Sandoz et al., 2004, p. 454). Meanwhile, Arikan (2005, p. 149) placed at roughly $22,644 the annual cost for hemodialysis while at roughly $22,350 for peritoneal dialysis. This means that households having a family member suffering from end stage renal disease will have a lower quality of life given the burden that they will have to carry. III. Morbidity and Mortality with End Stage Renal Disease Hall and Chertow (2007, p.1) estimated that “end stage renal disease (ESRD) affects over 1,500 people per million population in countries with high prevalence, such as the USA and Japan.” Following the Hall and Chertow 2007 estimate, we can place the incidence of morbidity to end stage renal disease in Montgomery at around 550 based on a population of 366,900 as of 2010. Note that if the 550 are distributed proportionately into various income groups, it is highly likely that at least half of the 550 or around 225 have difficulties in being able to financially afford the health management required for their condition. According to Arikan (2005, p. 148), the mode of life support for end stage renal disease plays a role in the death or mortality from the disease. Intermittent peritoneal dialysis is seldom used because of an annual survival rate of only less than 10 percent. In contrast, continuous ambulatory peritoneal dialysis or CAPD results to a higher survival rate of 62% per annum. The principal causes of mortality from end stage renal disease are cardiovascular and infection (Arikan, 2005, p. 148). Mortality from cardiovascular causes covers 43 to 41 percent of the cases of mortality while mortality from infection covers 16 to 23 percent of the cases (Arikan, 2005, p. 148). Meanwhile, as is true for the entire US and Japan, morbidity and mortality from end stage renal disease is also expected to increase regardless of the increasing income pressures (Kuchta, 2007, p. 35). IV. Health Risk Confronting People with Renal Disease The major risk confronting many people in Montgomery affected by end stage renal disease is their likely inability to shoulder the full costs of managing the condition. As pointed out by Arikan (2005) continuous rather than intermittent dialysis will lead to longer lives and lower mortality from end stage renal disease. Confronted with low incomes, American families would likely be forced to choose the mode condition management that is intermittent, leading to higher mortality. Further, the other risks mentioned by Arikan (2005) to be applicable only to underdeveloped countries may apply to some sectors of the Montgomery as well as the entire United States population, if the US economy does not recover fast enough from the ongoing crisis. For instance, in developing countries, Arikan (2005, pp. 148-149) pointed out that “a combination of poor living conditions, inadequate dialysis, malnutrition, hypoalbuminemia, and frequent blood transfusion makes dialysis patients prone to a variety of bacterial, viral, and fungal infection.” V. Three Key Healthy People 2020 Objectives and End Stage Renal Disease All the overarching goals of the Healthy People 2020 are actually important and relevant for Montgomery. However, perhaps the most important are the first two and the fourth goal or objectives. Actually, the specific objectives of Healthy People 2020 are too numerous to enumerate and objectives organized as goals (or broad objectives) are more appropriate to consider for Montgomery when considering the relevance of Healthy People 2020. Perhaps, a good way of summarizing the three most relevant goals or objectives are as follows: longer lives, better quality of life, and elimination of disparity. The first objective pertains to having longer lives and is relevant to end stage renal disease patients. The second objective pertains to health equity: end stage renal disease patients must have equal access to having longer lives regardless of their social circumstances. Finally, the third most relevant item is the fourth goal of having a better quality of life. In summary, the midcourse review of Healthy People 2010 pointed out that although accomplishments were made, the accomplishments have not been enough to remove the inequality of access to health services. Similarly, the issue of equality of access to health services, better quality of life and longer lives must be realized for end stage renal disease patients. VI. Key Healthy People 2020 Objectives and Alabama Health Objectives The key objectives of Healthy People 2020 of the federal government coincide with the latest documents of the Alabama Department of Public Health on health. As implied in the 2020 document of the Alabama Department of Public Health, the key concerns of the Alabama Public Health Department are longer lives, elimination of disparity, and improvement of the quality of life (p. 2). This is implied in how the Alabama Department of Public Health identified the key indicators in monitoring her achievements. The health indicators being used by Alabama to monitor how she is implementing Healthy People 2020 reflects the priorities of the Alabama Department of Public Health. In summary, the priorities of Alabama are no different from the priorities of the federal Department of Health and Human Services. VII. Achievement of the Key Healthy People Objectives in Alabama The Alabama Department of Public Health improved life longevity in Alabama from 75.8 years in 1995 to 76.8 years (Alabama Department of Public Health, 2010). However, in Alabama, white Americans have longer longevity at 78 years while African Americans have a lower life longevity of 71.1 years. Other than a declaration of targets in Alabama Department of Health (2010, p. 9), key data on Alabama achievements pertaining to end stage renal disease are unavailable. However, it is worth noting that based on the 2010 Alabama document, the actual incidence of end-stage renal disease in Alabama for the total population in 1998 was 37.3 per 1000,000 compared to the Alabama target of 28.9 (incidence was 78.3 among African Americans compared to 22.1 among White Americans in 1998). Further, unfortunately, in the Alabama Department of Public Health (2010), data on life longevity are not disaggregated across diseases but it should follow that data for end stage renal patients are not so different from the aggregate. Given the life longevity and median income figures in Alabama, it follows that health disparities continue in Alabama with regard to access to a better quality of life and life longevity. These matters must be addressed in Montgomery, Alabama, and elsewhere in the United States. The issue of disparity must be addressed for end stage renal disease and all ailments. VIII. Objective Most Pertinent to People with End Stage Renal Disease The most important of all goal or objective for people with end stage renal disease is the elimination of disparity. This means that access to a better quality of life and access to longer lives must not be prevented by obstacles like incomes, race, or gender. Formulating the key goal or objective this way addresses three important goals or objectives for people with end stage renal disease in a relatively comprehensive way. In other words, while improving the quality of life for patients and promoting longevity must continue to be the overarching goals or objectives, equity of access based on race, gender, and socioeconomic status must remain and apply as among the overarching health goals or objective, whether for Montgomery , the entire Alabama, or the entire United States. IX. The Need for Strategic Interventions On Behalf of People with Renal Disease Given the high cost of managing an end stage renal disease, it is most likely that many patients in Montgomery as elsewhere in the United States, will not able to afford the financing required for managing their condition. Rather than waste the money on bailouts on firms that have caused the American crisis, American taxpayers’ money will be spent better if the quality of life of people affected by end stage renal disease is improved with federal funding. In the American Journal of Nursing, Kuchta et al. (2007, p. 35) suggested that a way forward would be for patients to change policies from their bedside. Patients can invite lawmakers to visit their wards and convince them to increase federal funding that will improve the quality of life of people suffering from end stage renal disease. According to Kuchta (2007, p. 36), the method has worked in 2003: patients and nurses have educated more than 350 federal and state lawmakers and have secure legislations that improved the lives of people suffering from end stage renal disease. The same strategic intervention can be done now. The same theme is in the literature review of King et al. (2007). Empowerment of people with end stage renal disease was the key theme of King et al. (2007). In their work, King et al. (2007, p. 55) identified that the main elements of empowering patients include self-determination, partnership, effective communication, promoting a caring environment in the nursing and medical setting, goal setting with the patient, socio-political awareness, understanding the complexities of politics, and construction of knowledge. According to King et al. (2007, p. 52), other than genuinely improving the lives of patients, the said notions can “inform nursing practice.” It is also possible that an empowerment enterprise that can be performed by nurses as they assist their patients, can build patient s’ self-esteem, sense of fulfillment and achievement, and lead them to a better quality of life. References Alabama Department of Health. (2010). Healthy Alabama 2010. Alabama: Alabama Department of Health. Arikan, H. (2005). The growing global burden of end stage renal disease. Marmara Medical Journal, 18 (3), 143-150. Hall, Y. and Chertow, G. (2007). End stage renal disease. Clinical Evidence, 10, 1-15. Kuchta, K., VansBuskirk, S., and Houglum, M. (2007). Helping patients with end-stage renal disease. American Journal of Nursing, 107 (5), 35-36. Sandoz, M., Ess, S., Keusch, G., Schrwenkglenks, M., and Szucs, T. (2004). Swiss Medical Weekly, 134, 448-458. Tims, S., King, L., and Bennet, P. (2007). Empowerment for people with end stage renal disease. Renal Society of Australia Journal, 3 (2), 52-58. U.S. Department of Health and Human Services. (2006). Summary of progress. In: MidCourse Review of Healthy People 2010. U.S. Department of Health and Human Services. U.S. Department of Health and Human Services. (2010, 23 November). Healthy people 2020 framework. A brochure. Washington: U.S. Department of Health and Human Services. U.S. Department of Health and Human Services. (2011). About healthy people. Retrieved 12 November 2011 from http://www.healthypeople.gov/2020/about/default.aspx U.S. Department of Housing and Urban Development. (2010, July 1). Comprehensive housing market analysis, Montgomery, Alabama. A published report. U.S. Department of Housing and Urban Development: Office of Policy Development and Research. Read More