nursing healthcare wk2/PROJECT

Access to Coverage

Access to Coverage Does Not Necessarily Mean Access to Care, Nor Does It Ensure a Healthy Population

“Frameworks for Action in Policy and Politics” chapter of our course textbook beautifully describes the crux of policy and political issues regarding access, coverage, delivery, and outcomes of health care in the United States. Your course textbook says it perfectly that “. . . access to coverage does not necessarily mean access to care, nor does it ensure a healthy population.”

In the United States, our health care system is philosophically built upon an assumption that if we build an excellent (and expensive) health care system delivered by the highest credentialed professionals, we will have the best outcomes. Our population will be the healthiest in the world, and our citizens will live the longest.

We know that that is not true. And, this chapter is replete with data to support that truth. And, why is that? We have not paid sufficient attention to what our authors write as the “upstream factors,” or the social determinants of health. Heiman and Artiga (2015) define the social determinants of health as “the structural determinants and conditions in which people are born, grow, live, work, and age" (p. 2). They include such factors as socioeconomic status, education, the physical environment, employment, and social support networks. Policies that address the social determinants of health are the ones that promote:

· Safe environments

· Education

· Adequate housing

· Economically thriving communities with employment opportunities

· Access to affordable and healthful foods

· Models for addressing conflict, such as trauma-informed approaches

The social determinants of health are powerful predictors of an individual’s health and wellness. Poverty, lack of transportation, unsafe living environments, inability to find healthy food, lack of educational opportunities, and inability to find useful employment—all of these factors are associated with poor health outcomes. All the technologically advanced medical treatments cannot heal an individual who cannot find healthy food, lives on the street, and has no job or transportation to get to a place of employment.

Social Determinants of Health

Review each factor to know more.

Transportation Lack of Public Transportation Systems to Aid the Poor in Employment and Educational Opportunities and Obtaining Health Care

Federal, state, and local funding and building of mass transportation systems within cities

Food Food Deserts and Food Insecurity Contributing to Adoption of Poor Eating Habits, Obesity, and Malnutrition

State and local funding for farmers' markets and tax-break incentives for the building of supermarkets in economically disadvantaged areas in cities and in rural areas

Housing

Lack of Affordable Housing and Services for People with Mental Health Conditions and Substance Use Disorder

Federal, state, and local funding and policies for supportive housing and wrap-around services for homeless individuals and funding for addiction treatment services

Health-Care

Lack of Health-Care Services in Underserved Areas

Federal, state, and local support for federally qualified health centers, health professions educational payback grants for professionals who serve in underserved areas, and expansion of Medicaid for childless adults between nineteen and sixty-five years, making less than 133% of the federal poverty level

Federal, state, and local funding and building of mass transportation systems within cities

One cannot improve each of the social determinants of health absent consideration of the political aspects. We discussed political philosophies in our first lecture this week. Refer to Box 1-1 (Political Aspects of the Social Determinants of Health) from your course textbook for the list. Several keywords emerge in this list: inequities, poor and disadvantaged, evidence, and political will. In the previous week, we also looked at the policy process (Longest). We can use the policy process to determine how to go about addressing the social determinants of health and thus improve the health status of those who live in the zip codes that reflect poor health outcomes.

In the “Frameworks for Action in Policy and Politics” chapter, focus on the following sections: politics, policy analysis and analysts, interest groups and lobbyists, the media, science and research, and the use of power. The Heiman and Artiga reading further elucidates the social determinants of health. And, the Substance Abuse and Mental Health Services Administration (SAMHSA) brief describes an approach on trauma-informed care that creates a model for delivery of services for those with the poorest health indicators.

Reference:

Heiman, H. J., & Artiga, S. (2015). Beyond health care: The role of social determinants in promoting health and health equity. Retrieved from http://kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/