Friday, February 22, 2013

Affordable and Quality Health Care in the U.S.: Is it Possible?

This week’s assignment was to watch a documentary called US Health Care: The Good News. The documentary highlighted the problems within the U.S. Health Care System. Despite the United States being the richest and most industrialized country, it still has not provided health care for all of its citizens like other countries. The documentary focused on the Dartmouth Atlas Project that sought to provide examples in various towns and places in the U.S. like Seattle and Colorado that adapted practices within the medical system that developed affordable and quality health care by using innovative techniques. They found what worked in each of the towns and believed that these places ultimately could be models for the U.S. Health Care System.
I believe access to health care should be a right because everyone’s health is essential. In the country where you live I think it is a community duty to provide health care to everyone in that community. I do agree that, yes, people should be responsible for their own health, but also that others should play a role in the health of those people who are not qualified or as well versed and can’t provide that care for themselves. It just seems wrong to neglect or deny others health care just because they are poor or have some other inconvenience, especially because they may actually need it the most. I just believe there should be some type of balance within the system that lowers prices so that everyone has the same opportunity for quality health care.
During the video, a variety of towns were visited where the health care in those towns were not only affordable, but quality. Grand Junction, Colorado was revered as a model for the U.S. Health Care System. The town was one where it had 100,000 of the lowest medical cost in the United States. I thought it was really interesting how some of the doctors’ pay would be withheld until the end of the year and depending on whether they performed well would determine if they received a portion or all of that pay back. It takes some really dedicated doctors and self-responsibility to be able to limit one’s personal gain for the betterment of others. In addition to this, in Seattle, Washington, it was interesting how the hospital was consumer owned. They were very innovative in using electronic records instead of files which allowed patients to have more access to their own medical records. In the town of Everett, Washington, they began to use generic drugs to help cut down on overall costs. That was very important because these drugs basically contained the same ingredients. Lastly, in Hitchcock, Dartmouth, it was really innovative to allow the patients to be a part of their treatment choices because, after all, they will be the ones having to live with the surgeries and medications they undergo.
The medical care models in the video could be duplicated in my neighborhood and town. I just think there just needs to be the right people to initiate it and then diligent, dedicated physicians to follow through with it. There are many reasons why it has not happened yet. Perhaps physicians may want to continue earning the pay that they currently make and don’t want to see a dive. In addition to that, there just needs to be cooperation from all aspects. Getting many people to agree can be highly difficult because everyone has different motives and agendas, personal or otherwise. 

Friday, February 15, 2013

Vaccinations- Beneficial or Unnecessary

The video was about the ongoing controversy about the importance of vaccinations. Many people, mainly parents, are apprehensive about vaccinations and are also concerned that they may cause diseases and are actually more harmful than they are helpful. There are advocates and health care professionals who push the idea that vaccines are one of the best conventions of the modern world. They marvel at the idea and the ability to prevent diseases and epidemics that were once commonplace. On the other hand, there are people who view vaccinations as a threat. The public has become concerned with the side effects of these vaccines. One proposed side effect is Autism. There were many cases of parents who claimed that the MMR shot caused their children to regress and become Autistic. The health community argues that there was no evidence to support this claim, and yet people still believe it.  Older physicians know firsthand about the diseases that modern medicine has cured and think that the younger generations don’t appreciate these advances in medicine because they have not lived to experience them, nor do they know how quickly these diseases can spread.
Personally, I have never thought that vaccinations were harmful. I’ve always thought that the benefits outweighed the hazards. There were times when the thought might have come up that, “what if this shot will actually do me more harm than good?” I understand how parents can be concerned about the side effects of the vaccines, but I also think that they should keep in mind that the physicians and other health care professionals have the public’s best interest in mind. These people may also have children, so they have two reasons to try and fight these diseases that have caused epidemics in the past.
Herd Immunity is the notion that the more people in an area that have been vaccinated and therefore immune to a disease in a community, the less likely an outbreak will occur and spread in the case that there is an infectious person. This is directly related to the public health notion of vaccinations because the only way to get a community of immune people is for those people to actually have been vaccinated. Vaccinations are different from other personal health decisions because without them, a person has the ability and potential to infect an entire population. With the possibility to eradicate diseases, the cooperation of the public is necessary. With behaviors like exercise or diet, a person is only effecting themselves. In addition, I think the child’s parents are responsible for the health of their children. But I also strongly agree that they should recognize the risks that go along with their choices not to vaccinate. They should understand that they are not only putting their children at risk, but other people’s children as well. And as a parent who deeply cares for the health of your child, how could you not relate to the woes and concerns of other parents as well?
                There are many reasons why a child might not receive their recommended amount of immunizations. The parents are concerned that these vaccines contain harmful chemicals. With the internet, parents have access to cases where the vaccines have gone wrong. Parents also may think that physicians don’t offer them a choice to be vaccinated and view it as routine and necessary. Parents don’t understand the facts and the research that goes into prevention of epidemics, so they don’t have that information to base their decisions on because they aren't scientists.
                To increase vaccination rates I would present more evidence to the population that shows that these vaccinations do indeed do more good than harm. I would explain that there are rare cases where things may go wrong. Show them that yes it can happen, but the likelihood of that occurrence is less than if one does not get the shot at all and is vulnerable to disease. I think it would also be good to push the fact that world and international travel has reached highs like never before. With other countries less fortunate than the U.S., these diseases are actually a reality and a regular occurrence.  If people know that there are always people traveling and the ease with which it is to spread germs, they will be more aware that just because they think they are safe within their neighborhood or town, that doesn't mean others can’t come in. It would also be a good idea for the health care system not to seem so demanding or insensitive despite the good intentions of their measures. Perhaps there also may need to better policies in place as well.

Saturday, February 9, 2013

Non-smoking Wives and Lung Cancer

The effects of second-hand smoke on the development of lung cancer have long been a topic of interest in the health field. A study, Non-smoking wives of heavy smokers have a higher risk of lung cancer: a study from Japan, by Takeshi Hirayama, interviewed and followed over 250, 000 adults in 29 health centers and 6 prefectures across Japan. Of these, 91, 540 wives were followed for 14 years. Throughout this time the wives and their husbands were asked independently about their daily lifestyle habits. In the study they also categorized the participants by age and how many cigarettes they smoked a day. They also tested if the husbands'other habits impacted the wives' health such as alcohol and found that they did not. They also identified other variables that could have an impact on the development of the disease such as urban and agricultural factors. The study found that mortality increased up to twofold and those couples who lived in rural areas were more likely to have lung cancer because they were more likely to be around each other more often.

This study was very interesting because Japan seemed like an ideal place to do the study seeing that only 15% of the women smoke while 73% of the men did.  Accurate results could be expected because the study was conducted over an extended amount of time because the researchers actually followed these people for 14 years. This study proved significant because it proposed a link between non-smokers and lung cancer rather than what might have been expected which is that direct smokers would have lung cancer. It also produced evidence that supported their claim. I think it was interesting that they defined the category of non-smokers by breaking them into groups of rural and urban couples to further analyze. I thought it was important that they also tried to find links between smoking and other diseases that others might propose to counteract their findings.

The advantage of using the type of study design used here is that the data was based on real people’s lifestyles and not simulations. Also, because one is following around the same couples for an extended period of time, the data collected is coherent and consistent. They did not require the participants to alter their behaviors which lessened the likelihood that they would drop out or alter their responses.

The study seemed effective because it made use of a population where the amount of male smokers in Japan greatly overcomes the population of female smokers. The fact that the lung cancer rates in both groups were similar showed that some other factor besides direct smoking could have impacted the women’s chances of developing the disease. Of course, there could be other factors that could have been observed like food and family history and housing and working environments. The study included a large number of participants, one of the ways to ensure a cause and effect relationship. A problem that could be presented is that although this was cohort study, and they did not make people change their lifestyle behaviors, they still could have received false information as a result of recall and report bias. For instance, a husband might not report exactly how many cigarettes they have had in a day because they do not want to seem like too much of a heavy smoker. In addition to this, they had to make sure there was an absence of confounding variables by trying to relate other habits to lung cancer.  I think the study overall was a good study because it was like a foundation for future findings that we know of today that allow us to be more careful of the habits of people we are around and the environments we are in.

Saturday, February 2, 2013

Binge Drinking Among Adult Women and Underage Girls

The article titled, “Vital Signs: Binge Drinking Among Women and High School Girls — United States, 2011”, provides information and statistics about female alcohol users and binge drinkers. There were two surveys conducted that focused on either adult women or high school girls. The first is CDC’s telephone survey from the Behavioral Risk Factor Surveillance System (BRFSS) and the second is CDC’s Youth Risk Behavior Surveillance System (YRBS). Both methods include all 50 states and DC and produce results that quantify the number of those who participate in binge drinking, the frequency at which they drank, and the intensity of the drinking on those occasions. Each group was also analyzed further by categorizing them based on age and ethnicity. The BRFSS reported that binge drinking was most common among women between the ages of 18-24 with 24.2% of the 12.5% that was found to be the prevalence of binge drinking. The YRBS reported that the prevalence among high school girls was 37.9%. Overall, binge drinking was more common among adult women who also drank more frequently and more on those occasions. It was also concluded that the wealthier a person was ($75,000 or more) the more likely they were to binge drink. So, if someone binge drank they are likely to do so more often and consume a large amount at that time. Factors that make women more subject to alcohol exposure are the pricing, marketing, and availability of alcohol. Even more, the article states five limitations in the report that could skew the outcome of the data such as bias as a result of self-reported data, underrepresented portions of the population, low response rates, youth who do not attend school, and the definition of how many drinks actually count as binge drinking. Furthermore, the article presented advice for decreasing the prevalence of alcohol use in women.
Public Health has everything to do with preventing and controlling disease. Binge drinking and excessive alcohol use does, in fact, affect the health of the population. The risk factors of binge drinking such as unintended pregnancies, deaths, diseases, and injuries directly relate to the mission of public health. It is important for people in this profession to understand alcohol use and analyze data to be able to successfully prevent diseases and health problems associated with this behavior such as liver disease and hypertension. It is important to recognize the harmful effects of alcohol despite the fact that it is glorified in the media.
It was surprising that the statistics for alcohol use in women was similar for underage girls despite the age difference. In addition to this, it never appeared to me that underage girls were more exposed to alcohol relative to women than for underage boys relative to men. I just assumed that men and boys would be heavier alcohol consumers in today’s society. An issue with the accuracy of the self-report data may be that some people may falsify some information they provide on the survey because they do not want to appear to be heavy drinkers.
            The prevalence of binge drinking among high school and college students can be reduced by taking certain measures. Encouraging parents to monitor their children’s actions and developing alcohol education programs inside and outside of schools can greatly impact the choices that they make. Also, stricter policies can be put in place that discourage excessive alcohol consumption. In the incident that the laws are violated, tougher consequences can also be put in place for those who commit misdemeanors.