discussion and response PHM-02
Jambo
Discussionandresponse-PHM-02.docx( Two pages)Discussion_PHM-02
For your initial post, review the following resources related to public health as a “commons”: Health Care and the Tragedy of the Commons The Tragedy of the Commons Revisited
Next, find and share an example of “the tragedy of the commons” in your own community. Share some examples of ways public and community health professionals can respond to the “tragedies.” In response to two of your peers, offer suggestions for how public health law could solve their community’s tragedy. This discussion will help you consider community challenges and potential responses; you will learn public health leadership and problem-solving skills. Be sure to consider this discussion activity as you develop the milestones for Part I of your Final Project, the proposal letter.
Response ONE –PHM-02
I thought it was insightful for Charles Hugh Smith to observe that the way healthcare is consumed in the US is an example of the tragedy of the commons. “When everyone sees the commons as “free for the taking,” then the commons is soon destroyed for all (Smith, 2015).
If we think of healthcare resources as a finite amount, it certainly does make sense for those who need services to get them as many and as often as they can, if they are not paying for them. Another interesting phenomenon at play is that psychologically, people don’t value what has been given to them for free. It has been observed that if a person has paid for something, it validates the value of the item purchased.
The 6 pillars which appear to be bankrupting the U.S. healthcare system are:
1. Unhealthy diet
2. Sedentary lifestyle
3. Poor health education
4. Environment not conducive to a pedestrian way of life
5. Lack of self-responsibility for health
6. Pharmaceutical model of illness-care (Smith, 2015)
I agree with all of those factors resulting in less than ideal healthcare delivery to the public.
The way the pharmaceutical model of care presently taught in medical schools and delivered to the US population is that there is a “pill for every ill”. Doctors are taught to arrive at a diagnosis and then assign a medication to the patient in order to treat the symptoms of that person’s health issue. Our current medical system is not set up to dig deeper to find the cause of the symptoms and address it from that point. Whether it is diabetes, hypertension, insomnia, infertility, depression, there is a pill for it. And if that pill doesn’t work, we will try another one. And if that pill give you unpleasant effects, we can give you another pill to combat those side effects.
When patients are getting their office visit and their medications paid for, they think nothing of making any improvements in their own health. It is when they have to pay out of pocket do they ration care. When you spend your own money, you are generally more careful than when you are spending someone else’s money. I can’t help but feel that we may get better outcomes if, rather than having universal healthcare with insurance coverage for all, we were all allowed health savings plans from pre-taxed income to be able to spend that money as we saw fit.
I had a good experience of the tragedy of the commons this past Friday. I saw a patient for a follow up visit after her steroid injection for her low back pain. She has chronic pain which keeps her from getting around without a cane and keeps her from doing housework. She has had several steroid injections already for her pain but they last a very short period of time. She weighs 340 pounds and I had to educate her that as long as she was carrying that much weight on her frame, no injection therapy would be effective for her pain. The solution to her problem is serious weight loss but instead, her PCP referred her to the orthopedic practice for injections. Not only are these injections limited in how much relief they can give her but repeated steroid use can potentially contribute to diabetes and osteoporosis.
I feel that education on good eating habits with a focus on weight loss (and smoking cessation) for those who need it should be a mandatory part of care and should be made obligatory before a patient is accepted in a practice for care. Of course emergency situations should be handled differently but interventions and medication should come after lifestyle changes, not the other way around.
Smith, C. H. (2015, February 26). U.S. Healthcare and the Tragedy of the Commons. Retrieved fr
Tragedy Of The Commons...
Charles Smith's 2015 article comparing the US healthcare system to the Tragedy of the commons was very insightful and provided different realizations of the state of health in the US. Fixing healthcare has been a daunting task for many administrations for decades and decades. In 2010 there seemed to have been a fix but this was not to be. Smith points to the problem of self interests and no personal accountability. People want more money in their pockets so they skip what they deem as unnecessary medical care, because they feel they pay too much towards healthcare. On the other hand, people who qualify and receive any type of free services just take advantage and over utilize those resources. Providers are concerned about their profits along with the pharmaceutical and equipment companies. No one seem to care that Americans spend more overall on healthcare but are less healthy than other similarly developed countries. It has become a broken system on it's way to a catastrophic end. Smith points out some issues that I agree are essential to some of the problems the US faces. Manufacturers have deceptive food labels and provide poor quality food. Individuals always seem to be in a hurry and so they make poor choices for quick meals, often with limited healthy options. Many people also generally lead a more sedentary lifestyle and are less active and so less healthy. Infrastructure also complicates this by not allowing opportunities for more recreation sites and pedestrian activity. Not many states have bike lanes, while in Dutch and Scandinavian cities a large majority of people bike or walk everywhere. Individuals want a quick fix pill and the pharmaceutical companies benefit from this. It seems the goal of research in some instances is another pill instead of a cure for the illness. Overall, public education on health and many of these factors are poor. In some cases people just do not care.
I recently had a situation where a pediatric patient was being discharged with prescriptions for a nebulizer machine and medications for the machine. The parent however, having knowledge that the health facility had been given machines to hand out to those in need after a recent disaster, pretended to not be able to discharge as normal and fill the required prescriptions. The parent attempted to get both the medicine and equipment for free, even though there was insurance coverage, other back up emergency insurance services, and very little out of pocket expense. It was free so it was desired. If everyone had made themselves available to obtain free medication even though they were able to fill prescriptions through normal routines, then our 'commons' for sure would have collapsed, and we would not have been able to serve those that were really in need.
Ways that public health and community health can respond to some issues of the 'commons', is to always be cognizant of the goal to serve the public good, but remember and recognize the politics involved in doing so. The goal however is to always be vigilant in upholding public health principles and providing essential services, following policy, or the system will collapse. Public health is mostly about population based services and not individualized care, however the system per se, has a social obligation to fulfill. Continued education about self health, public health and personal responsibility is necessary. Health workers themselves can also practice judicious use of resources when it comes to a 'everything is free' type of program or scenario.
References
Fadul, R. ( 2009). The tragedy of the commons revisited. New England journal of medicine. 361. doi: 10.1056/NEJMopv0907258
Smith, C.H. ( 2015). U.S healthcare and the tragedy of the commons. Retrieved from SNHU PHE-610 data base. http://www.oftwominds.com/blogfeb15/healthcare-TOC2-15.html.
