Contextualization of Individual Risk Factors - Research Paper Example

HOUSTON- TEXAS What do Bruce Link and Jo Phelan mean when they argue that individually based risk factors must be contextualized? Give a specific and detailed case example (which may be either actual or hypothetical) of how someone’s location in society (gender, race/ethnicity, socioeconomic status, etc.) places him or her at greater risk of some particular disease outcome. What kind of intervention(s) would you recommend to reduce the risk—and why? Houston is the largest city in Texas alongside Pasadena and Beaumont cities. Houston is also the fourth largest city of the United States of America (HPFM, 2011). Incorporated in 1837, it is the core centre of Sugar- Baytown, the fifth largest metropolitan area in the United States. It also boasts of having the largest and most sophisticated medical centers in the world. It also gives recognition to the biggest scientific institutions in the world including the Mission Control Centre of NASA and Texas Medical Center. The city has given rise to a cultural diversity, incorporating tourist attraction areas like the Museum District (N.A.S.A, 2009). The socio-economic platform of this area relies on manufacturing, industrial production of energy sources, aeronautics, and transportation. Being a highly populated area of over 2.1 million residences, Houston has higher crime levels – for example, thefts – than other areas in Texas (U.S Census Bureau, 2011). The health conditions of the major community in Houston Texas are relatively higher than the in other Texas cities. Health barriers of the area are high rates of chronic and mental health conditions, low rates of preventive screening, poor health care services, low rates of preventive screenings, and unsafe neighborhood conditions (University of Texas Health Report, 2010). Bruce Link and Jo Phelan were basing their argumentation on stratification in the society where a person’s role in the community determines his or her health condition. A poor person in a community has limited access to better health facilities and, therefore, is vulnerable to the layman’s diseases. Medical care is expensive and limited. Some in the community seek other means of getting medical services, which are still inadequate. Reports indicate that rich people face diabetes and heart failures more than the poor (Public Health Report on Lifestyle Diseases- Houston, 2012). According to Bruce and Phelan, the diseases affect one stratum in the society more than they affect another. Surveys done by the University of Texas School of Public Health at the Institute of Health Policy found that 20% of Houston’s residents have either average or poor health conditions, especially the Vietnamese ethnicity. More than 50% of adults do not have health insurance in the area. 46% of Hispanic residents cannot afford the insurance. Houston has the lowest number of cancer screening in the United States. 7% of adults have the severe psychological stress, which is twice as many in comparison with the national numbers (University of Texas Health Report, 2011). Health disparities bias different ethnic groups of Houston’s population in terms of mortality, prevalence, forms of health care among others. The main diseases that affect the community include arthritis, HIV/ AIDS, cancer, obesity, and the heart disease. Factors that contribute to this minority health conditions include lack of health insurance, poor preventive measures, denial of signs of sicknesses, low numbers of multicultural medical professionals, and distrust of medical institutions. These are some of the problems that the minorities experience in their search for better health (University of Texas Health Report, 2011). 2. Suppose that you were in a position to allocate funding aimed at reducing health disparities in the city of Houston. What would you prioritize as (1) the single most effective short-term intervention (addressing critical needs in the next two years or so), and (2) the single most effective long-term intervention (targeted toward producing equity in health outcomes over the next twenty to thirty years)? Explain your answer. The interventions that can be put into place are many. First of all, information is power. Conveying information to the public about better health care is extremely crucial. Getting them to know their rights to quality health services and the need to have insurance is extremely beneficial. Secondly, the hiring of multicultural medics is critical. These are doctors who can be able to communicate effectively with the minority groups, offering the right treatment for them (HHDDR, 2008). Lobbying for cheaper medical insurance is also vital to ensure that most of the minority population gets access to quality health care. Addition of health facilities is also crucial to enable the minority get healthcare services closer to them, and enable faster response to emergencies (like births), which would reduce infant mortality (Texas Medical Center Annual Report, 2011). One short term intervention is the maintaining diabetes levels of the population, especially in the minority groups in Houston. Diabetes is the main factor contributing to 80% of mortality among the minority. Over two million Latin Americans have diabetes, but hospitals diagnose only half of them. Diabetes is a lifestyle and an inherited disease which has been exceptionally hard to fight and which causes a lot of health problems in Houston. Contributing factors are obesity and psychological distress that the population faces on a daily basis. Curbing this will enable people to know their diabetic status and start taking measures to prevent development of the disease. Diabetic testing ensures that the minorities also know their health conditions such as their HIV status, and the statistics will also help the city in prioritizing of funds and other utilities in the fight for better health standards (Texas Medical Center Annual Report, 2009). Long term intervention can include hiring of multicultural medical staff. Since labor force is one of the most durable resources in a metropolitan city, it ensures that hospitals take care of their patients better. This helps communities to trust, especially the minorities who feel they are treated with prejudice in hospitals. It also curbs language barrier that enables the medics to offer services faster and efficiently. These medics are in a position to work for many years, training other staffs on how to handle patients producing a better crop of healthcare givers who are more adverse in relating to the patients and the ethnicities at large (Harris County Health Reports, 2012). 3. What do you believe might make a person with activity limitations more likely—or less likely—than his or her nondisabled counterpart to receive a diagnosis of mental disorder, or to abuse alcohol or drugs—and why? Give a real or hypothetical case example. The United States Department of Health and Human Services established the Office of Disability in 2002. Eliminating disparity among the disabled and ensuring that they participate fully in a normal community life is the goal of the office. People with disabilities face many risks that lure them into drug and substance abuse. Some of these factors are medication and health problems, failure to identify potential problems and access to prevention and treatment services (USDHH, 2010). People with disabilities tend to use more drugs than the rest of the nondisabled population. Drug addiction and substance abuse affects over 1.5 million disabled people every year, (The Substance Abuse and Mental Health Services Administration, 2002) while over 50% of people had spinal or brain injury. This is because many of the disabled find it hard to be integrated into the society and to find jobs, and, therefore, they live an anti-social life that entails drugs and substance abuse, which usually ends up in a severe addiction or a suicide. Prevention and treatment of addictions in disabled people is limited and incomplete in most help centers in the United States as in the case of unavailable formats in accessing information written in Braille for the blind. Also, the disabled on wheel chairs cannot see information put in high places. Recording films exclude the handicapped failing to educate them about diseases such as HIV/ AIDS. All this misleads the disabled to think that the medical department does not care for them and gives them the notion that they cannot be at a level of transmitting diseases such as HIV/ AIDS (SAMHSA, 2011). In treatment centers, they experience cultural insensitivity and biasness, so they avoid medical attention when they need help. Most of the medical personnel do not have the knowledge of communicating with the disabled – they know neither sign language nor Braille (Healthy People, 2010). An example is a prisoner who raped a dumb girl; after she was taken to a hospital, taking her statement took much time since no one knew how to communicate in sign language; due to this, Post- Exposure Prophylaxis was delayed, so the girl risked to be infected with HIV. 4. Briefly summarize the history of the Tuskegee Syphilis Study, noting key points at which decisions were made that, in retrospect, stand out as ethical violations in the treatment of human research participants. Explain how the memory of such decisions continues to fuel mistrust of powerful medical and public health institutions. What kinds of measures, if any, do you believe might help overcome this mistrust? How, and under what conditions? The Tuskegee Syphilis Study was conducted for 40 years, from 1932 to 1972, in Tuskegee, Alabama. It entailed studying the effects and evolution of Syphilis in 600 African American men who knew that they were suffering from the “bad blood” disease. Half of them had already acquired the disease and the rest were infected by the researchers. This concluded with many men dying and their children born with congenital syphilis. The practice halted after leaking to the press in 1972 and shocking the world (New York Times, 2008). The African American community mistrusted the health centers due to the rumors that the Anglo-Americans introduced the HIV to the community. Ethical rights have been broken in the result, causing the mistrust among American citizens, especially the minorities. The ethical issues include not telling the participants the details of the research and, therefore, denying them the choice of whether they are to engage or not engage into the program (Code of Federal Regulations, 2012). The second issue is withholding of treatment from the participants thus making them suffer and even spreading the disease unknowingly to their sexual partners. This breached the fundamental rights of participants who have the right to receive treatment. The third capitalized on racism grounds. Only the African American men participated. This ended up being a clouded study. Fourthly, no documented facts prove these incidences took place, making the operation a ghost activity (New York Times, 2008). Measures that can be set to ensure this never happens again include choosing willing participants in a medical testing program, giving them information about everything as regards the medical procedures they will be undertaking, choosing all races to avoid racism, and keeping documented records of the cases, ensuring transparency and accountability of human ethics. On top of this, the National Human Investigation Board has been created to ensure that medical participants receive adequate treatment (NHIB, 2009). 5. What role has doctors’ professional dominance historically played in creating ethical problems in medical care? What role does bioethics, as institutionalized in today’s American health care system, actually play in limiting doctors’ professional dominance? (Hint: Think and write about what professional dominance entails, and how doctors’ position within the hierarchy of the health care community—as well as within society at large—has influenced the kinds of decisions they have been allowed or even expected to make. Bioethics refers to the study of the ethics governing the development of medicine in relation to human rights. Since the Tuskegee study, significant developments have been made to ensure that no human rights are violated in the relationships between doctors and patients. Religion also plays a tremendous role in bioethics, especially in the termination of pregnancy on medical grounds and life termination connected with respirators and organ transplants. Codes of ethics matter as per the Institute of Society, Ethics, and the Life Science bridging the gaps of life and medicine (Code of Federal Regulations, 2012). Doctors are at the top of the hierarchical medicine field, even though there are forces such as boards governing them. If a doctor acts arrogantly, it may result in a patient’s death on a table. Many people have been suing doctors for not preserving a patient’s life during a surgery, forgetting to take medical appliances out of a patient’s body after a surgery, and for other malpractices. Many of the doctors testify trying to help patients; they raise questions whether this is enough (Impact of Health Care, 2011). The termination of human life has been in the very heart of the discussion. If a person has been in a coma for ten years, is a doctor justified to terminate the life of such a person? Is a doctors justified in committing abortion? These are just some issues in the context of which some doctors keep violating a religious morality and the code of human ethics (NCBI, 2008). References Link, Bruce G. and Jo Phelan. 1995. “Social Conditions as Fundamental Causes of Disease.” Journal of Health and Social Behavior 35(Extra Issue):80–94. Houston Department of Health and Human Services. 2008. “The City of Houston Health Disparities Data Report: March 2008.” Houston, TX: City of Houston. Retrieved April 4, 2012 http://www.houstontx.gov/health/disparity.pdf “The State of Health in Houston/Harris County 2009.” Retrieved April 4, 2012 http://houstonstateofhealth.org/The_Houston_State_of_Health_2009.pdf Turner, R. Jay, Donald A. Lloyd, and John Taylor. 2006. “Physical Disability and Mental Health: An Epidemiology of Psychiatric and Substance Disorders.” Rehabilitation Psychology 51(3):214–23. Thomas, Stephen B. and Sandra Crouse Quinn. 1991. “The Tuskegee Syphilis Study, 1932 to 1972: Implications for HIV Education and AIDS Risk Education Programs in the Black Community.” American Journal of Public Health 81(11):1498–1505. Gamble, Vanessa Northington. 1997. “Under the Shadow of Tuskegee: African Americans and Health Care.” American Journal of Public Health 87(11):1773–78. : Annas, George J. 1991. “Ethics Committees: From Ethical Comfort to Ethical Cover.” Hastings Center Report 21(3):18–21. Read More