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730Final.docx
Take-Home Final Exam
MPA-730- Health Disease, and Medical Care
Chaela Griffin
Professor Dr. Martin
1) According to the textbook, the homeless population is considered to be amongst the vulnerable and populations at risk (Shi & Singh, 2017). In relation to this, in the United States women and children as well as veterans and the severe mental ill comprise majority of the homeless population. Furthermore, in correlation to class notes, vulnerability is determined by the conjunction of three main characteristics: Predisposing, Enabling, and Need. Predisposing characteristics can be defined as attributes that lead to vulnerability that involve demographics—gender, age and race, social structure—geographic location, where a personal spends most of their time, and belief systems (Shi & Singh, pg. 270, 2017). Whereas the characteristic of need can be defined as an individual’s evaluated health status and quality-of-life factors. For example, a need factor could be if a person has HIV or chronic disease. Also, the vulnerable population is comprised of those who are underserved, medically underserved and disadvantaged, underprivileged, and American underclasses. In regards to the homeless population having access to health care is defective, due to the enabling characteristics. For example, enabling characteristics correlate to socio-economic status, individual assets—human capital, and mediating factors such as access to health care. In addition to this, due to the vulnerability and enabling factors the homeless population lack minimum requirements for health insurance (Shi & Singh, 2017). Thus, they are unable to obtain any treatment for their medical needs. Furthermore, this population lacks financial barriers, transportation to travel to and from the medical centers if required, a lack of address and primary care physicians, cannot pick up medication, unsanitary, and unable to be a productive member of society (Shi & Singh, pg. 272, 2017).
In relation to the chart in 11.2, certain populations are at risk for poor physical, psychological, and social health more than others. Some major factors that resonated with me most were: African Americans have 665% higher homicide rates in comparison to non-Hispanic whites, AIDS and Homicide are the two leading causes of death in Hispanics, as well as alcohol use is 43% in Hispanics (Shi & Singh, pg. 273, 2017). The fact presented about African Americans having a 665% homicide rate is eye opening because this is more than a majority so it is more likely some of color will die due to murder. In reference to AIDS and homicide being two leading causes of death was something I did not know prior to reading this textbook, and alcoholism was not much of a surprise but it was unbeknownst to me that 43% of this population is expected to drink (Shi & Singh, pg. 273, 2017). Moreover, Korean Americans have a fivefold incidence of having stomach cancer and an eightfold incidence of having liver cancer, is something that stood out because there is a preconceived stigma that Asian Americans are considered to be the healthiest population (Shi & Singh, pg. 273, 2017). Amongst the Native American population, it was reported that poverty is associated with high injury relating to high mortality rates in children, and the rate of death due to alcohol is 7 times greater and the suicide rate is 3.5 times greater than the national averages. This population is considered to be the most at-risk population due to poverty and choices of living this directly affects their offspring, thus, the high mortality rates in children due to injury is a result of potential abuse from unhappy parents. Also, alcoholism and suicide amongst this group could be a direct correlation to ancestral PTSD from genocide and exile.
2) In reference to class discussions and the text book, the four main determinants of health consist of: Predisposition— a person’s genetics or heredity make up, an individual’s behavior and how they live their life-lifestyle, a person’s access to medical care, and an individual’s social and environmental factors such as income inequality or geographic location (Shi & Singh, 2017). The government plays an active role in trying to eliminate health disparities or address leading health concerns within the population. For example, the Healthy People initiative was established in 1980 to address the nation’s health objectives within a 10-year increment plan (Shi & Singh, pg. 41, 2017). Moreover, the initiative of the program includes a combination of preventative services, medical care, promotion of health, education and increase incentives to access. In order to address the main determinants of health, Healthy People projected a plan for the year 2020 with the goals to: make it easily accessible to attain high-quality, longer lives with the elimination of preventative disease—premature deaths, achieve health equity—eliminating disparities, creating social and physical environments that promote good health; promoting quality of life—health behaviors and health developments (Shi & Singh, pg.41, 2017).
The United States has both market and social justice aspects in health care because the theoretical principle of market justice and social is to distribute medical services based on individual’s willingness and ability to pay; the promotion of fair distribution of health care to make it equitable for all. Lastly, there are four main strategies for social and medical points of intervention which are: Social or public policy interventions- such as OSHA which is an illness and injury prevention program, Community-based intervention which could be an “exchange needle” program in place to promote health and eliminate risky behavior, health care interventions— electronic medical records, and individual level interventions- such as reducing the use of alcoholic or smoking to improve the quality of life.
3) According to the textbook, the significance of the gatekeeping role in primary care in order to reduce costs is implied to be, the permission needed (a referral) for a patient to be seen by a specialists or allowed to be admitted to a hospital (Shi & Singh, 2017. This is a tactic to prevent patients undergoing unnecessary treatment. Summarily a gatekeeper is in charge of who/what enters or leaves the gate-permission must be granted upon entry.
The textbook states, community health centers were established since the 1960’s to reach and serve the medically under severed or disadvantaged regardless of insurance or compensation (Shi & Singh, 2017). In relation, CHC’s play a primary role in healthcare for the underserved because they offer services easily attainable that is funded through the government. The CHC’s are assessed by the quality, accessibility, and cost-effectiveness. A major challenge CHC’s face is funding. Although the Affordable Care Act made strides to provide funding for the CHC’s it is stated that Medicaid reimbursement has declined due to an increase in patients on Medicaid.
4) In most recent studies in relation to access and utilization of healthcare it is found that the elderly population spends majority of their time in hospitals in comparison to the younger population (Shi & Singh, 2017). Moreover, it is found that even after the preparation for bearing a child, women are admitted to the hospital more likely than men however men have longer stays. Also, the black community utilizes hospital services more frequently than whites or Caucasians and those who are considered poor or underserved spend more time than non-poor individuals (Shi & Singh, 2017). However, there are multiple factors that contribute to health outcomes such as education and behaviors of these various groups which in turn, result in differences in utilization and access. For example, someone who is elderly has to stay on top of their health because they are at much higher risk for chronic diseases in comparison to someone who is much younger (Shi & Singh, pg. 199, 2017). The vulnerable population are at high risk to acquire more medical attention than someone who is not amongst this group and women have a longer life expectancy than men so it is imperative women stay abrupt on their health (Shi & Singh, 2017). Also, due to the increase of population there is a greater demand for services and majority of patients seen utilize the governments primary insurers Medicare and Medicaid (Shi & Singh, pg. 199, 2017).
There is a total of eight hospitals that differ in services provided and the demographics that is served. The difference in hospitals consist of: Community, Public, Private Non-for- Profit hospitals, Private for-profit, Specialty, Psychiatric, Rehabilitation, and Teaching hospitals. Community hospitals are non-federal and primarily short stay facilities that offer services to the general public, operated by the government on a state and local level (Shi & Singh, pg. 199, 2017). An example of a community hospital would be a federal hospital or prison hospital like Bellevue. Public hospitals are government owned and offer services on a state and local level. The individuals served primarily by public hospitals are veterans and native Americans as well as military personnel. Private non-for-profit hospitals are also loosely referenced as voluntary hospitals that are privately owned by non-government entities, allowing the facility to make a profit but are not required to pay taxes (Shi & Singh, pg. 199, 2017). For example, a hospital like St. Jude’s would be considered as a Private non-for-profit hospital and it is found that facilities operated by a religious group is deemed superior. Private for-profit hospitals are also known as investor-owned hospitals established to operate for financial benefits and is operated by individuals—corporations. Specialty hospitals and facilities can include Psychiatric and Rehabilitation hospitals whereas others can perform services in a particular area of medicine, such as cancer. Psychiatric hospitals are used to diagnose and treat mental ill patients, provide social work and psychological help (Shi & Singh, pg. 199, 2017). The Psychiatric facilities take on transfer patients from general hospitals and are government owned. The rehabilitation hospitals are considered to be specialty facilities where specialized therapeutic services are offered to restore functionality in patients with a disability due to crime or accidents. The government and state share ownership of these facilities. Lastly, teaching hospitals are meant for medical students in pursuits to become a health care professional, offering one or more graduate residence programs and approved by the American Medical Association. Furthermore, teaching hospitals are associated with major universities as well as deliver specialty care to patients.
5) Case: E-Cigarettes
In relation to this case study, the United States cigarette market is segmented by three groups: Existing cigarette smokers, former smokers, and non-smokers (Quelch,2014). The first group which is comprised of existing smokers may benefit from an electronic cigarette because there is an absence of actual tobacco, the user can smoke at his or her own leisure indoors and out, there are multiple flavors, a limitation to smell, and the consumer can decide the nicotine strength. In tangent to group one, group two can benefit from e-cigarettes because they are less toxic, and the taste of menthol can give the illusion of smoking an actual cigarette. The non-smokers group can use the benefits an e-cigarette because there is assorted flavors, there is an absence of second hand smoke, there are no toxins, it proposes a certain image of being cool, and there is lack of social stigma in comparison to group one and two (Quelch,2014).
In response to the rivalry of cigarettes vs. e-cigarettes, tobacco companies should invest in e-cigarettes due the closely related businesses. For instance, if the tobacco companies were to invest into e-cigarettes there would be an increase in manufacturing and revenue (Quelch,2014). In addition to this, tobacco companies can lower the prices and tax on cigarettes to potentially increase sales, push for regulations on e-cigarettes by lobbying, or buy acquisition over e-cigarette companies. Although e-cigarettes pose to be similar to actual cigarettes, they have the potential to also pose some public benefits. For example, the elimination of the harsh smell from actual cigarettes can be a public benefit because it prevents second hand smoke (Quelch,2014). Also, a public benefit from e-cigarettes could be the prevention of contributing to global warming by the release of harmful chemicals. However, e-cigarettes can adversely increase the chances of cardiovascular risk, promote convenience smoking, cause dependency amongst youth, the vaper can be considered a pollutant and e-cigarette companies can make misleading product claims (Quelch,2014). Young adults and Children have a higher risk of becoming addicted to cigarettes due to peer pressure, the stigma that smoking is “cool,” or by predisposing factors (Quelch,2014). Although, e-cigarettes are considered to be an alternative for smoking real cigarettes, they are not regulated. The government should put regulations on e-cigarettes by promoting limitation ads, increasing taxes, posing an age limitation, regulate the vapor or synthetic chemicals used, and study long-term effects of e-cigarettes.
6) Case: Life, Death, Poverty Rights
South Africa is located at the most southern part of Africa stretching from the South Atlantic to the Indian Ocean (Spar,2005). The neighboring countries are Zimbabwe, Botswana, and Namibia. Furthermore, South Africa has 9 provinces and 11 languages that is spoken (Spar,2005). The population of South Africa is comprised of 55 million people with the life expectancy of 60 years of age, 64 years of age for women and 57 years of age for males. The former president was Zuma and the current president is Ramapo’s (Spar,2005). According to the article, South Africa has the highest prevalence of HIV in the world; there is a lack of healthcare and limitation to access of medication as well as government interventions (Spar,2005). Moreover, this leads to the problem of the AIDS epidemic; Individuals are not receiving adequate care due to the lack of education, lack of access, expensive medication, practice of safe and healthy lifestyles, government implementation, and scarce resources of pharmaceuticals.
The blame of the AIDS crisis can fluctuate between the government, the victim(s) as well as the Pharmaceutical companies. The Pharmaceutical companies could be the blame for individuals not receiving proper medication due to unaffordable prices, lack of providing information on the drugs distributed, and most importantly lack of educating individuals on the risk the medication poses. The government is at fault for not addressing and providing education on the epidemic, providing information on health risk, establishing interventions that could potentially save lives, and promote save sex. Although the government is primarily at fault, the consideration of an individual’s behavior plays a substantial role as well. In relation to this, a person needs to take ownership in their risky behaviors they partake in. The practice of safe sex should be emphasized and promoted instead of the promotion of discretion amongst those who have HIV/AIDS. Also, individuals should take ownership of their lives and take preventative measures by getting tested, using condoms, continue annual/semi-annual screenings, and practice monogamy. Moreover, if I were to be an employee of Doctors without Borders I would propose an incentive initiative plan that would pay for the schooling of children and young adults, in exchange for their commitment to practice healthy lifestyles. This proposal will offer full-time tuition for boys and girls that are active members in participating in annual and semi-annual screenings, promotion of practicing safe sex, and education programs implemented to teach them about the disease, how it is acquired, and ways to prevent contracting it. Also, if I worked for the South African Ministry of Health, I would propose a youth outreach mentorship program that involves children and young adults who have HIV/AIDS and educate their community and young peers about the epidemic, which can also be a conductive way to create jobs for individuals in the population due to their economic harsh ties. Furthermore, the role of a Brazil Pharmaceutical firm, I would propose a huge involvement with the highest risk which would be prostitutes. Brazil is known for many things, beautiful sights, great food and of course the women. Prostitution is legal in Brazil which means the disease is spreading faster than most parts of the world. An impactful and solution to lessen the spreading would be to hand out condoms and informative pamphlets to travelers and guest of the country and educating the prostitutes on the effects of the disease and introduce treatments or options for a healthier path. For the World Health Organization, I would reiterate the basics of HIV prevention worldwide. I feel that in today’s society STI’s are common, so common that they are beginning to lose its importance in preventing. Most people know what the effects are but lack the knowledge of how its spread, signs of contact and options on preventing friends or partners from contracting. For the Pfizer, I would propose revolution of policies, Low cost on medication and push for more generic brand drugs rather than name brand.
7) The economic impacts Dr. Vagelos and Merck must consider the cost of research and medication production, the financing of long term investments, the funds occurred over time, in pursuits to find the correct formula, the expiration of the patient, and poverty and access. The organizational impact that must be considered is there is a lack of organizational presence in Africa, which affects the destruction of drugs, also in aligned within the company’s original goal to serve the people regardless of cost, this factor must be considered because the company will lose money instead of receiving profit if thee meds are administrated. Furthermore, the strategic impact that must considered is the difference in test animals in comparison to humans, may cause severe reaction. Also, the image of the company can be greatly affected because the company is well known and have to maintain a certain image in completion with other pharmacy companies. Merck & Co. is a pharmacy company that is a large non for profit that is driven by research and science. Although I’m aware of the outcome, Merck & Co. should not invest in Campbell’s idea due to a lack of sufficient research proving its effectiveness. Also, Investment in Campbell’s idea would be bad for Merck & Co because they wouldn’t benefit financially. For instance, if I would invest in Campbell’s Idea and scientists came to me with similar pursuits, I would not invest because I will take great loss. In reference, though it may be beneficial to the greater good, proving the services will hurt my company. As a business owner it’s difficult to make decisions based off good will when it comes down to the bigger dollar. Without disrespect to any unfortunate people, would rather focus on my business than lose profits even if it for a good cause.
The stakes of administering the drugs for free may cause disturbance in the industry because other scientist and companies will try to pursue the same thing, being that its unprofitable it will be a negative for the company. Knowing the outcome, I believe Merck shouldn’t give the drug away. There is a lot at stake in taking responsibility to distribute the drug such as the fall of his business if the drug is unsuccessful or have negative reactions. If Merck gave the drug away, I wouldn’t publicize the decision in case of the previous reasons and by keeping it private it gives his company a thoughtful integrality and can easily bounce back in case of any flaws in the drug.
8) Haiti, although beautiful and rich with culture, is a developing country with a tragic history of natural disasters, poverty, racial tension and political failures. The most vulnerable children to be malnourished are the ones located in rural areas, newborns, children under two and EBF children. Some underlining causes of malnutrition in kids in Haiti include but doesn’t exclude food security, socio economic status—low income families, high prices in food, poor access to health care, as well as preventative measures vacancy. According to the article, Haiti was declared to be under the state of an emergency because majority of the population’s children were moderately acute malnourished with little to no resources available, for long periods of time. In relation to the article, NGO’s did not want to follow Dr. Marhone’s suggestion to address the malnutrition because her proposal was not evidence based. Furthermore, there were a lack of resources without a treatment follow-up, and the proposal was flawed because there were different protocols with patients who were Moderately acute malnourished and considered Severe Acute Malnutrition. The Ministry of Health should consider an educational program that teaches mothers the benefits of breastfeeding, how to breastfeed, and educate mothers on ways to access high protein foods to feed their children. In 2008 the treatment plans for malnutrition included Akamil nutrition counseling, enriched milk and breast feeding programs. Malnutrition is not prevalent on a global scale because it is underreported and they’re economic and political policies in place to address malnutrition.
References:
Shi, L., Singh, D, A., (2017). Essentials of The U.S. Health Care System. Burlington, MA: Jones & Bartlett Learning.
Thank you in advance for a great semester.
