The US demographic overview for the last 100 years demonstrated the fact that the percentage of elderly people has considerably increased for a number of reasons to be analyzed. It is necessary to underline the fact that the significant factor in the population growth is related to large retirement settlements and increased recreational opportunities. Besides, the research demographic center, having developed a report of elderly population growth, explained this phenomenon with sunny and warm climate; it is necessary to stress that improved conditions for retired people impacted death rate reduction. Rapid increase of elderly people can be observed in Southwest of the USA; it is connected with high immigration level, as it was informed by Immigration Subcommittee of the USA. The entrance of more than 1 million illegal and legal immigrants influenced the increase of general population rate in the country, providing impact on the number of elderly people living in the USA. (US Population Growth, 2009)
The analysis of US trends influencing the growth of the population is to be performed through national, economical and regional trends development. It should be stressed that the expansion of business sphere, economic opportunities and creation of larger number of working places impacted the population rate over the last century. The United States is considered to be the richest nation; its economy is evaluated in $13 trillion allowing the population enjoying constant raise of living standards. Comparing the country to other nationalities’ trends, it is necessary to underline the fact that China stands near American population structure on the basis of economic growth analysis. Taking into account gradual modernization of Chinese republic, one should stress that the population is on the way to progressive urbanization through industrialization of agrarian economy and modernization of coastal cities. The transformation of military structures and country’s position strengthening on the international level impacted population restructuring and national power. Nevertheless, the contrast population trends to the USA can be presented on the basis of Iranian domestic trends analysis. the country faces deep structural weaknesses in economic development, demographic pressures and political uncertainty. High unemployment level is one of the central problems affecting population internal structuring; it is necessary to stress that the nation suffers pronatalist policies reducing the population growth and leading to considerable demographic pressure. (Gordon, and Button, 2008)
Dependency ration is considered to be age-population ratio covering the dependent and productive part including people presenting labor force, and those who do not. The 20th century showed a steady rise of age dependency ratio; in accordance with scientific analysis, there is a sharp necessity in changing the conventional thinking ways about dependency ratios providing impact on US elderly population. The demographic aging problems are related to economic dependency. It is necessary to stress that the changes in labor force participation covered by age-sex structure will lead to the balance shift of non-working older people to working ones. As a result the shift will impact the relation between support requirements and financial aspects of older persons, touching social ability to provide funds security. The analysis of dependency ration demonstrates the idea that elderly economic ration is the ratio of noninstitutionalized and economically inactive persons of 65, towards civilian active population of 16. The change in the age dependency rate will affect the economical dependency development within American elderly population restructuring. (Siegel, 2003)
Aging is an inevitable natural process, which, however, passes differently in every person. An individual is influenced by diverse systems in the environment, such as changes in history, policy, and social institutions, as well as by their community, organizations, race, or social class. This paper investigates the aging of an older adult and the impact of systems on this process. Information for the analysis was obtained through the interview conducted in San Diego, CA. The format of the interview is a written transcript. The person involved in this interview is my coworker’s father. The interviewee is a 71-year-old male White Caucasian.
He is single, owns a home, and lives by himself. The paper is guided by the empowerment theory, which is expected to be useful for understanding the behavior and experiences of the interviewee. Empowerment theory is applicable in social work as a process that comprises the initiative and action of individuals aimed at taking over control in lives, gaining power, and broader access to social resources. Empowerment is crucial for elderly people who frequently experience inequality due to their physical or mental ailments.
Developmental Experiences
The interviewee is 71, which means he is in the period of late adulthood that is generally considered to begin after the age of 60 or 65 (Ashford, LeCroy, & Wiliams, 2017). The developmental task typical of this age is “integrity versus despair” (Ashford et al., 2017, p. 453). In this context, integrity means the ability of an individual to combine one’s experience and history with evaluation and acceptance of life. The process of aging presupposes becoming more reflective and introspective. Current satisfaction and the feeling of integrity in older adults depend on the extent to which their life has been rewarding and meaningful (Ashford et al., 2017).
Old age and aging are of interest to scholars and philosophers because the share of people older than 65 in American society is growing and is expected to be 88.5 million by 2050 (Ashford et al., 2017). Still, older adulthood is not a homogenous period and can be divided into three sub-periods such as young-old (aged 65-74), middle-old (75-84), and old-old (85+). Each of these sub-periods has its developmental peculiarities that predetermine people’s behavior and life on the whole.
BB, the interviewee, is 71 and thus belongs to the young-old sub period. People of this age are usually still active in the community and preserve relationships with family and friends. Some get involved in volunteer activities or dedicate time to adult education.
Moreover, some young-old adults are still employed part- or full-time both due to a strong personal desire to work and financial need. Individuals in this sub-period can be very sensitive about retirement. While some consider it as a way to new opportunities and freedom, others can lose meaning in life without work. On the whole, the majority of people in this age group preserve the ability of productive management of their talents.
People in late adulthood experience diverse changes that are typical of aging. For example, older adults observe the loss of memory, deterioration of intellectual function, decrease in mobility, and increase in disease rates. Changes occur in physical systems, in the brain, and in memory. However, negative changes that are part of normal aging can be partially prevented or at least postponed.
Thus, Erickson, Gildengers, and Butters (2013) investigate the impact of physical activity on brain plasticity in late adulthood and come to the conclusion that a greater amount of physical activity reduces cortical atrophy and improves both brain function and cognitive function. Also, the researchers provide evidence of a positive influence of physical activity on the natural capacity of the brain for plasticity. Moreover, physical activity has the potential to reduce the incidence of such neurocognitive and neuropsychiatric disorders like depression (Erickson et al., 2013).
BB has some traditional daily routines. He gets up and usually goes for a walk outside with a cup of coffee and has a habit of walking a lot. In summer, BB does a lot of yard work because he loves flowers and thus does a lot of planting. Traditionally, he goes for dinner with his friends. Also, he has tropical fish as pets and a part of daily routine. Judging by research evidence, BB has a chance for successful aging because his activity and involvement in different daily routines contribute to the preservation of brain plasticity. Also, the man has the talent to mix activity and rest because he combines dynamic actions such as walking and gardening with less active such as sitting and enjoying watching his tropical fish or going for dinner with friends.
BB identifies his developmental strengths and limitations. Thus, the interviewee considers that getting up in the morning and walk is one of his major strengths, and he is happy to stay active at his age. He says, “The strength I have is getting up every day and going for a walk, working in the yard, looking at the beautiful scenery.” Still, there are certain limitations, and the man is aware of them. First of all, BB admits that his joints do not function as well as before, and the “body does not work as good as it used to.” Also, the interviewee shares that remembering doing some things or simply following daily routines is already a challenge, which is another developmental limitation.
On the whole, BB admits that forgetting things or the names of people is one of the problems he experiences with aging. In fact, cognitive failures related to attention, inhibition, working memory, and executive control are frequent among older adults. Hitchcott, Fastame, Langiu, and Penna (2017) investigate cognitive failures among the aging population and conclude that such failures increase in old age, and some of them are interrelated with depressive symptomatology. In turn, depression can develop in older adults who do not follow successful aging patterns and experience problems in one or some of the successful aging dimensions.
Important aspects of aging are finding meaning and identity. The interviewee shares that are finding identity took him about 20 years, and he realized the significance of “stopping and smelling the roses,” which means that it is necessary to find pleasure in simple things and be able to stop in the endless pace of life to enjoy the moment. BB remembers his way to finding meaning and claims that he came to the importance of thinking positive and staying independent as meaning in life.
Normative aging patterns are observed in several dimensions. The first one is biophysical dimension, which comprises biophysical growth and development. In respect of aging, physical changes include reduction of strength as well as reduction of the rate of metabolism (Ashford et al., 2017). The interviewee also observes some physical deterioration, which is normal for his age. However, the man tries to stay active and thus contributes to maintaining his body healthier.
Although his joints are not as flexible as they used to be, BB does not complain of joint pain, which is frequent among older adults as well as foot pain. In late adulthood, chronic diseases make up a set of biophysical risks. The majority of old people have more than one chronic health condition, which decrease the quality of life. The interviewee does not speak in detail about his health problems but it is evident that he takes care of his health because he orders medication online to manage health condition. Psychological dimension involves age-related changes in cognitive development and information processing.
Cognitive decline is normal in aging people and the interviewee already observes some problems with memory. One of the psychological risks for older adults is cognitive impairment, Alzheimer’s disease, and other dementias. Still, BB does not have any significant problems with mental health at the moment. Social dimension involves groups and families, which are vital for older adults. The focus here should be on the necessity of support provided by both family members and community. This support is particularly important for individuals who retire because community can involve older adults for some volunteering positions.
Macro Theory and the Person’s Life
A macro theory used in this paper is that of empowerment. It roots back to the need to empower people who were oppressed due to certain reason and did not have equal opportunities with other individuals. As related to the problem of aging, the theory of empowerment can be applied for developing a tool for providing older adults with opportunities and resources that they lose because of age as well as physical or mental impairments.
In the context of this paper, empowerment theory will be used to contribute to understanding of the impact of the systems in the environment on the interviewee. Empowerment theory mainly deals with human empowerment through providing social action for individuals who lack access to necessary resources and aims to achieve social justice (Turner & Maschi, 2014). As related to people in late adulthood, empowerment can include provision of services necessary for daily routines, development of interventions that help people take control over their lives and follow the patterns of successful aging (Shearer, Fleury, Ward, & O’Brien, 2010). It can be achieved through broader access to social resources for older adults on the whole and those with serious health problems in particular.
BB, similarly to other people, is inevitably influenced by diverse systems in the environment. Changes in history have had the most general impact on BB because he has already lived a long life and historic alterations caused changes in the life of society and its members throughout the world. The influence of social institutions is not evident from the interview. For example, although BB went to church with his mother, he did not become religious. At the same time, his work as a social institution was a significant part of his life because he worked for the state for more than 20 years.
The empowerment theory can be used for further analysis of BB’s experiences. First of all, society on the whole and its particular current issues empower critical thinking of the interviewee. For example, BB is strongly disturbed with the problem of weapon and shootings at schools and is eager to discuss this issue. The community also has some empowering potential because the man has friends among the community members and they go to dinner together.
Therefore, it can be stated that community stimulates the activity of the man. The impact of race and ethnicity on the life of the man is not explicit in his life story because as a white Caucasian man he was not likely to be oppressed or discriminated. At the same time, social class is meaningful in the life of a person. BB worked for the state and probably had a worthy income because he can afford a house even living alone. Also, working experience taught the man to stay active and this habit is useful for him.
Another aspect of empowerment related to BB’s experiences is the use of technology. The majority of older adults are not familiar with digital technology and do not have necessary skills to operate devices (Hill, Betts, & Gardner, 2015). Nevertheless, technology has a potential to facilitate older adults thus empowering them. The use of technology to order medication or remind about some arrangements or daily routines empowers the interviewee and provides him with certain benefits compared to those individuals who do not apply information technology.
Conclusion
On the whole, aging is a complicated natural process that is under the impact of many factors. When a person enters a period of late adulthood, he or she experience changes in diverse dimensions such as biophysical, psychological, and social. One of the key concepts to consider in late adulthood is the developmental stage of integrity versus despair. In this respect, it is important to find meaning and identity to contribute to successful aging and approach normative patterns of aging.
The man interviewed for this work managed to find both identity and meaning and can be considered an example of successful aging. He is in a functional age and tries to stay active and follow his daily routines. The interview was a useful experience of communication with an older adult whose life has been rich in events. It was surprising that a person in late adulthood lives alone but BB does not look his age and it is evident that he enjoys what he does.
Another surprising fact was much physical activity in his daily routine. The man takes long walks and works in yard, which is good for him because activity in late adulthood stimulates brain function. One more discovery was the awareness of BB about information technology, which is not typical for people of his age. Thus, the man orders medication online and makes use of reminders that are good for people who observe problems with memory.
On the whole, I suppose this experience will positively influence my career in social work because I had an opportunity to apply the knowledge obtained during the course to practice and check my ability to analyze information discovered in an interview. Probably, I will focus my work on individuals in late adulthood because it is both challenging and interesting to help people overcome age limitations and make use of opportunities they still have.
References
Ashford, J. B., LeCroy, C. W., & Wiliams, L. R. (2017). Human behavior in the social environment: A multidimensional perspective (6th ed.). Pacific Grove, CA: Brooks/Cole.
Erickson, K I., Gildengers, A. G., & Butters, M. A. (2013). Physical activity and brain plasticity in late adulthood. Dialogues in Clinical Neuroscience, 15(1), 99-108.
Hill, R., Betts, L., & Gardner, S. (2015). Older adults’ experiences and perceptions of digital technology: (Dis)empowerment, wellbeing, and inclusion. Computers in Human Behavior, 48, 415-423. Web.
Hitchcott, P., Fastame, M., Langiu, D., & Penna, M. (2017). Cognitive failures in late adulthood: The role of age, social context and depressive symptoms. PLOS ONE, 12(12), e0189683. Web.
Shearer, N., Fleury, J., Ward, K., & O’Brien, A. (2010). Empowerment interventions for older adults. Western Journal of Nursing Research, 34(1), 24-51. Web.
Turner, S., & Maschi, T. (2014). Feminist and empowerment theory and social work practice. Journal of Social Work Practice, 29(2), 151-162. Web.
Figure 1: Total health care expenditure in the US as a percentage of GDP, Source OECD.
Health care demand has been increasing constantly in the US. According to the OECD data, the total expenditure on healthcare in the US as a percentage of GDP has continually increased (see figure 1). There has been a 17 percent increase in expenditure share in GDP from 2000 through 2007 and a huge 207.6 percent increase since 1960. The share has increased from 5 percent in 1960 to 16 percent in 2007 (OECD). This indicates that there has been a rise in demand for health care services.
This paper examines the demand for health care in the US. The question therefore arises is that what determines the demand for health in the US. Michael Grossman pointed out that demand for health or rather “good health” is a function of “shadow price” determined by various factors like age, education, income, etc. which is negatively related to heath demand (Grossman 225). Therefore, age is one of the key factors that affect the demand for health care.
Statement of Problem
The American population has been aging over the last few years and has been identified as one of the reasons for the rapid growth in health care expenditure (Newhouse 5). This increases the demand for a different health policy to tackle the aging population. Researchers have often posed the question – of the aging population is driving the healthcare demand in the US. Reinhardt has shown through his study that the aging population will have a strong effect on the health expenditure in the country and will put pressure on the labor market and economy of the country (37). Given this scenario, the logical question that arises is the demand for healthcare among the aging pupation and what factors drive the demand for the same.
Aim
This paper studies National Health Data of the US to establish a model for estimating the demand for healthcare among the older pupation of the country. The paper is important as it aims to demonstrate how the demand for aged pupation gets shaped. This research is important for policymakers, as it will indicate the autonomous factors that may help in determining the demand for health.
Literature Review
Research on Old Age and Demand for Health Care
The aging population in the US has been a concern for both the academician and policymakers alike. There has been a lot of research on the aging problem and the effect it was having on the health expenditure of the economy. These studies mainly focused on the macro-level analysis of aging and healthcare expenditure. Newhouse reports that the aging population has been increasing in America, which has increased the expenditure on median care (6).
Newhouse points out that even though there has been a rise in the aging pupation in the country, there has not been a substantial increase in the amount spent by individuals at hospitals. Thus, indicating just a marginal increase in the health care cost assuring from an increase in hospital expenditure. Therefore, the price of healthcare cannot be solely determined by the cost of hospitals or medical services as they indicate a partial scenario (Newhouse 12).
He points other that other cost factors like insurance have a greater impact on the health bill of individuals, especially the aging population, than others. Therefore, the demand for health will also depend on the cost of insurance, which is reflected through the expenditure done by individuals on health insurance. Other than this, another cost that has been mentioned by Newhouse is expenditure on prescribed medical bills. This demonstrates the amount consumers spend on the purchase of medicine for their treatment. This is not reflected in the number of bills paid for hospitalization. Newhouse, therefore, concluded that demographic variables played a minor role in the increase in healthcare expenditure.
He showed that between 1950-87, the change in healthcare was by 15% due to demographic change, whereas the health care expense of the US increased by five times. Therefore, he concludes that age is not a determining factor in the increase of health care expenses. In another research, Westerhout (27) showed that there has been an increase in GDP share in healthcare expenditure due to the aging pupation. However, no study has tried to identify the demand for healthcare and the factors that affect the healthcare of the older pupation.
Zona and Muysken have shown in their research that an increase in income has affected the preference or demand for health positively, which has led to a decline in growth (170). Thus, they point out that information on human capital is necessary for growth. They point out that good health is a necessary condition for people to continue their productivity in the labor force. Further, they also show that health is produced under conditions of decreasing return to Investment. Therefore, this indicates that health care is reduced, and the labor is shifted to the human capital, then growth will fall. In terms of aging pupation, this
This paper on the aging population of the US concentrates on identifying the demand function for health for the older pupation of the country and the factors that affect their demand. For this research, Grossman’s model for demand for health is used.
Grossman’s Model
Michael Grossman did one of the seminal works in estimating demand for medical care from the point of view of the patient as the sole actor in taking health care decisions. Grossman conjectured that the demand for medical care is a derived demand as medical services are not consumed as an immediate need, rather, to maintain or improve on a certain other good that i.e. good health (Grossman 234). Therefore, health was considered to be a durable good. Thus, it must be noted that as Grossman presented the decision to health care from an individual point of view, therefore, “it represents a suitable behavioral model to describe the demand for initial contacts, which are usually initiated by the patient” (Pohlmeier and Ulrich 341).
Gossman’s model is based on demand for health as an investment towards better health, which would help the individual to work more. In this model, he considers health as the end product of a productive process, and the individual chooses his utility maximization. In a more simplified assumption of the Grossman model, when only one period is considered, then the utility (U) of the aged people will depend on health (H) and consumption (C).
Healthcare can be expressed as a production function, which is based on health inputs (M) and that helps in the transformation of health. Grossman uses the concept of production function embedded into the theory of consumer behavior to establish the difference between health as an output and healthcare services as one of the many inputs to produce the desired output (Grossman 228). Therefore the health function derived is H(M, C) wherein, H’>0 and H’’<0 (Wagstaff 94). From this function, the marginal product of M is found to be an increasing function of the resources for health and the availability of technical knowledge.
Therefore, whenever, there is a technological breakthrough in medicine, it is expected to increase H’. This also indicates the individuals who have a higher level of education will have better knowledge about health care and services than the lesser educated people. Thus, the budget constraint can be derived using the last two premises
PcC + PmM = Y
where Pc and Pm are the prices of consumption (C) and healthcare (M) respectively. Y is the income which is the maximum limit of the available money to be spent and is used as a “proxy command over resources” (Wagstaff 93).
Therefore, Grossman points out that individuals choose C and M to maximize U subject to the constraint function and health production function. Therefore at an optimum level
U1/U2 = π/Pc ≡ [Pm/H’]/Pc
Here π is the cost incurred by the consumer to create an extra unit of health. For deriving the demand for health care by the aging population, it must be noted that as people grow old their capacity to contribute to the production
For this study, it is assumed that the rate of depreciation varies with age. Grossman asserts that an individual gains an initial stock of health, which depreciates with age. This depreciation is at an increasing rate after some period of the life cycle and this can be increased by increasing investment in healthcare (Grossman 237). Grossman points out that the gross investments made by an individual are in the form of health variables like medical care, diet, cigarette smoking, alcohol consumption, and exercise.
Thus, following Grossman it is assumed, that as individual ages, his capacity to work and contribute to production reduces due to a reduction in physical capacity, therefore, increasing the depreciation in health stock of the individual. Thus, the demand for health changes with change in the rate of depreciation with age. Thus, Grossman postulates that health capital falls over age (Grossman 238). However, Grossman points out that even when there is a fall in the demand for health capital by the consumer, there will be a fall in the supply of health capital, as the gross investment falls (238).
Thus if there is an excess supply of health capital, then individuals will have a greater incentive to close the gap by increasing gross investment. Conversely, if the change in supply were lesser than the change in demand for health capital, the gross investment will fall over the life cycle (Grossman 239). Therefore, to understand the demand for health care by the aging population, the change in the supply of health care must be greater than the change in demand for health capital to increase gross investment over the life cycle.
Thus, following Grossman’s model, it can be deduced that health, as a commodity is obtainable through investment made by individuals in the health capital and other commodities. The health capital and another commodity together form the budget constraint for the individuals. For this research, health is taken to be a function of health care available to the aged Americans.
Data
The data is collected for the US from national surveys. The main data is collected from the American Community Survey (U.S. Census Bureau), and statistics of the aging population of the US from the US Census Bureau Decennial Census (Federal Integrated Forum for Aging-Related Statistics). Information in income and expenditure has been derived from the Bureau Of Labor Statistics website (Bureau of Labor Statistics)
Figure 2 shows the consumer expenditure by consumers of all ages and expenditure of 65+ cohorts on health care only.
The figure distinctly shows that for the period under study, there has been a higher average expenditure by people over 65 years on health care than the overall average expenditure on it in the US for all ages. This demonstrates that the demand for health care is higher for older people. For this research, we consider old people higher than 65 years of age. Further, the change in health care expenditure made by the alder generation has fluctuated over the period from 1995 to 2008. This indicates that the demand for health care has fluctuated, and it has declined considerably in 2006-07 for individuals above 65 years. The question that will be tried to answer in this paper is what changed the demand for healthcare in this age cohort.
Figure 2: Consumer Expenditure on Health Care.
Table 1: Descriptive Statistics.
Education
Average length (Days) of hospital stay
Income
Consumer Expenditure
High School or Diploma
Bachelor or Higher
PPI Hospital
Food
Health Care
Health Insurance
Medical Services
Mean
69.3
16.2
126.13
6.1
22943.4
3759.5
2278.7
1825.2
634.92
Standard Error
1.1
0.6
4.24
0.1
726.6
96.9
109.2
108.3
21.79
Median
69.7
15.9
121.20
5.95
23100.5
3700.5
2266
1697
648.00
Standard Deviation
3.78
2.06
14.69
0.41
2517.01
335.80
378.42
375.07
75.49
Sample Variance
14.26
4.25
215.66
0.17
6335355.72
112762.27
143198.42
140678.33
5698.81
Kurtosis
-1.03
-0.96
-0.82
1.58
0.08
-1.27
-1.49
0.09
0.63
Skewness
-0.01
0.21
0.75
1.35
0.25
0.47
0.16
0.97
-0.36
The data shows that the data collect for the research is shown through the descriptive statistics table below (see Table 1). All the data are collected for the years 1995 to 2006. The study descriptive table presents the mean, median, standard error, standard deviation, variance, skewness, and kurtosis of the sample data used for the study. The empirical research uses data from the variables that will be considered for determining the demand for health following Grossman’s model are self-reported health status, days lost due to hospital/illness, income, price of hospitalization, and education level.
The demand for the good health of an individual will depend on the amount of the level of education, which is divided into two groups viz. high school and higher and Bachelor and higher. The effect of these two levels of education will be seen on the demand for health. The mean value of the first variable is found to be 69.3 while that of the second variable is found to be 16.2. This indicates that on average 69% of the population has the education of high school or above in the period under study, and 16.2% of the 65+ individuals have an educational background of Bachelor or above.
The second variable that is taken for the research is the average number of days spent by the individual in the hospital. This shows the number of days a sick a person has been sick. 6.1 give the mean average number of days a person has been in hospital. The average income of people above 65 years is $22943.4 for 1995 through 2006. The mean value for the consumer expenditures is found to be as follows – food is 3759.5, health care is 2278.7, health insurance is found to be 1825.2, and medical services are 634.92. The demand for health will depend on this independent variable.
For this research, following Grossman, it is believed that health, as a desired commodity is dependent on various factors like educational attainment, expenditure, and average time spent in hospitals. Education is one of the most important determinants of health as determined by Grossman. Education in terms of production function provides efficiency to the producer. Similarly, in the case of health, education is expected to play a positive role to gain a greater amount of health. of good health. The producers’ price index (PPI) is taken as a measure for the price paid by the people to attain services in hospitals.
Therefore, the mean PPI for hospitals is found to be 126.1. This would provide the amount of price paid by the individuals to attain good health. The mean income for people above 65 years is found to be $22943.4. This variable is used to determine the budget constrain for the individual. The consumer expenditure on goods related to health and health-enhancing commodities is found to be food, health care, health insurance, and medical services.
Figure 3: Self-reported health status of people 65 years and above.
The dependent variable is the self-reported health status of the individuals above 65 years of age. Figure 3 shows the number of people above the age of65 report that their health condition is good (indicated by the blue bar) and fair and poor (indicated by red bar). Health status reporting is a measure used to understand the number of people who felt that good health was a part of their well-being and perceived it to be a desired commodity. Therefore, in order to produce this good health, different actions are taken for instance investment in insurance, or expenditure on food, etc. further, attainment of education also helps in betterment of health stock.
In case of applying this model to the old age cohort of above 65 years, it must be noted that most of the people above the age of 65 years are retired. Therefore, the time left for living becomes another factor that determines the demand for good health for people. Moreover, it is conjectured that with increase in age, as the life expectancy declines, there is a greater demand for good health, and therefore, heath care. Thus, increasing the cost incurred on heath. Therefore, the desire to live is the time that the individual is expected to live for the next period of his life, and that is the time he intends to maximize through investment in health bettering avenues. Thus, life expectancy at 65 is embedded into the utility function of health. The following section will describe the statistical analysis that is undertaken using the data collected.
Data Analysis
The analysis will first establish a correlation all the variables that are being studied. The correlation analysis is presented in table 2. The table shows that for people above the age of 65 years, the correlation between self reported good health and the other independent variables.
Table 2: Correlation Analysis.
Good Health
Life Expectancy at 65
Length of Stay (Days) of hospital stay
PPI Hospital
High School or Diploma
Bachelor or Higher
Income
Food
Health Care
Health Insurance
Medical Services
Good Health
1
Life Expectancy at 65
0.92
1.00
Length of Stay (Days) of hospital stay
-0.81
-0.88
1.00
PPI Hospital
1.00
0.92
-0.80
1.00
High School or Diploma
0.90
0.88
-0.93
0.89
1.00
Bachelor or Higher
0.97
0.93
-0.92
0.96
0.97
1.00
Income
0.94
0.89
-0.91
0.93
0.97
0.97
1.00
Food
0.98
0.95
-0.82
0.98
0.87
0.95
0.92
1.00
Health Care
0.98
0.96
-0.88
0.97
0.92
0.97
0.95
0.98
1.00
Health Insurance
0.99
0.88
-0.74
0.99
0.86
0.93
0.92
0.97
0.95
1.00
Medical Services
0.68
0.72
-0.76
0.69
0.80
0.77
0.71
0.65
0.74
0.59
1
The data in Table 2 shows that good health has a strong negative correlation with length of days in the hospital, indicating, that as there are higher days in the hospital, people would be in a greater position to lose their stock of good health, as the depreciation of investment made on health over the years. Further, the correlation analysis shows that there is a strong positive relationship between life expectancy at 65 and health status. As reported earlier, with higher life expectancy, there will be greater confidence in having good heath, thus, reducing the demand for health care, and increasing the demand for health.
Thus, as people expect that they will live longer, and will have a greater time to remain productive, there is a lesser demand for heath and therefore less demand for health care. This corresponds to the assertion of Zona and Muysken who point out that the main aim of the aged pupation is more to reduce proximity to death than to attain better health (Newhouse 19). However, as there is a decline in life expectancy, there will be an increased demand for health which will be reflected through a higher level of investment in healthcare, thus, increasing health care demand. However, this study postulates that though life expectancy can be a good indicator for health demand, there is a strong relationship between good health demand and life expectancy.
Demand for good health is found to have increased over the years, as there has been an increase in the PPI of hospitals. Good health has a stronger relationship with higher education level than at lower education level, indicating that good health is contributed more with higher education. Further, the popular assertion that with an increase in income, there is a higher demand for health care (Zona and Muysken) is substantiated through this correlation analysis.
The correlation is found to be 0.94, which is a strong correlation with good health, and therefore, indicates that higher is income, higher in the level of good health. Further, health is found to have a strong positive correlation with higher expenditure made on food (0.98), health care (0.98), and health insurance (0.99). However, a relatively less strong positive relation (0.68) is identified between good health and medical services expenditure.
Regression analysis is done to form the demand equation for good health. For the analysis, the self-reported status of health is taken as the dependent variable. According to the Grossman model, the desired commodity of an individual is ‘good health’. Therefore, a linear regression analysis will be used to determine the expected relation between the desired ‘good health’ of people above 65 years. The independent variables, which are found to be strongly related to good health from the correlation analysis, are presented in table 3. The regression analysis results are explained below.
Table 3: Regression analysis for good health.
Regression Statistics
Multiple R
0.99790978
R Square
0.99582393
Adjusted R Square
0.98851581
Standard Error
8.79902523
Observations
12
ANOVA
df
SS
MS
F
Significance F
Regression
7
73848.8936
10549.8419
136.262649
0.00013638
Residual
4
309.69138
77.422845
Total
11
74158.585
Coefficients
Standard Error
t Stat
P-value
Lower 95%
Upper 95%
Lower 95.0%
Upper 95.0%
Intercept
-196.912115
545.802371
-0.36077549
0.73651336
-1712.30244
1318.47821
-1712.30244
1318.47821
Life Expectancy at 65
0.57907341
24.2700494
0.02385959
0.98210743
-66.8053865
67.9635333
-66.8053865
67.9635333
Length of Stay (Days) of hospital stay
-23.8593563
33.6730228
-0.70855998
0.51770708
-117.350656
69.6319429
-117.350656
69.6319429
Income
-0.00373367
0.00685185
-0.5449145
0.61477039
-0.02275745
0.01529011
-0.02275745
0.01529011
Food
0.08006658
0.05871792
1.36358009
0.24439803
-0.08296049
0.24309365
-0.08296049
0.24309365
Health Care
-0.03930478
0.0646465
-0.60799548
0.57602011
-0.21879223
0.14018267
-0.21879223
0.14018267
Health Insurance
0.16980836
0.05871788
2.89193611
0.04447636
0.00678139
0.33283533
0.00678139
0.33283533
Medical Services
0.14936126
0.06859878
2.17731663
0.09502915
-0.04109948
0.33982201
-0.04109948
0.33982201
The regression statistics given in the first table of table 3, gives the value for Multiple R, which has the value 0.997. This shows that there exists a very strong relation between the dependent variable good health with the independent variables taken for the study as it is value is very close to 1. As the Multiple R is found to be very close to 1, it can be intuitively concluded that there exists a very strong relation between demand for heath and PPI for hospital, education, consumer expenditure, and income variables. Therefore, it can be states that the least square regression line for good health will fit in to the data points. Further, a linear relation between good health and the independent variables is also established through a high value of Multiple R.
The ANOVA table presents the ANOVA analysis for the regression analysis. This data when considered presents the coefficients that would help us generate the demand for good heath equation. There the regression equation thus derived is
Health = -196 + 0.57 PPI of Hospital – 23.8 Length of Stay at hospital -0.00373367 Income + 0.08 Health Care + 0.16 Health Insurance + 0.149 Medical Services
Therefore the least-square regression line shown above demonstrate that for old individuals above the age of 65 years, if the PPI level increases by 10% there will be an increase in demand for health by 0.57*10% indicating an absolute increase of -0.571. Similarly, there would be an increase in the heath when there is an increase in consumption of health care, which indicates availability of health care too, health insurance, and medical services. As the significance F is less that 0.05 at 95% significance level, the overall analysis is statically significant indicating that the established least square equation can be extended into a model.
As health increases, there will be a lower demand for health care. However, when there is a longer stay in the hospital, there would be a decline in health, thus increasing the demand for health care. Intuitively it can be argued that as there is an increase in the expenditure of 65+ people in health insurance, medical service, etc. there is also increased health, which inversely reduces the demand for medical services.
Conclusion
The significance of the study is a derivation of a demand function for good health in the US. The study shows that, as there is greater investment in health and food, which results in higher and better health quality. This inversely reduces the demand for health care. Income is found to hurt health i.e. higher income results in lower health, which may be due to overexertion at the age of 65 or above, or consumption of goods, which are harmful to the health.
Therefore, at higher income levels there is a greater demand for healthcare. However, with lower income, health care demand also reduces. Higher insurance consumption results in greater health perception, which reduces the demand for medical services. Therefore, for policymakers, it is important to note that at an age above 65 years, that if the health care facilities and consumption of health-giving products like food can be increased, there will be the availability of better health for the older people, and therefore, less requirement for health care facilities.
Bibliography
Bureau of Labor Statistics. 2010. Web.
Federal Integrated Forum for Aging Related Statistics. 2010. Web.
Grossman, Michael. “On the Concept of Health Capital and the Demand for Health.” The Journal of Political Economy, Vol. 80, No. 2. (1972): 223-255. Print.
Newhouse, Joseph P. “Medical Care Costs: how much Welfare Loss?” The Journal of Economic Perspective, Vol. 6, No. 3 (1992): 3-21.Print.
Pohlmeier, Winfried and Volker Ulrich. “An Econometric Model of the Two-Part Decisionmaking Process in the Demand for Health Care.” The Journal Of Human Resources, Vol. XXX, No. 2 (1995): 339-361. Print.
Relnhardt, Uwe E. “Does The Aging Of The Population Really Drive The Demand For Health Care?” Health Affairs, Vol. 22, No. 6 (2003): 27-39. Print.
U.S. Census Bureau. U.S. Census Bureau. 2010. Web.
Wagstaff, Adam. “The Demand for health: A Simplified Grossman Model.” Bulletin of Economic Research, Vol. 38, No. 1 (1986): 93-94. Print.
Westerhout, W. M. T. “Does Ageing Call for a Reform of the Reform of the.” CESifo Economic Studies, Vol. 52, No.1 (2006): 1–31. Print.
Zona, Adriaan van and Joan Muysken. “Health and endogenous growth.” Journal of Health Economics, Vol. 20 (2001): 169–185. Print.
Getting older is the worst fear in an individual’s life and society is there to enhance the fear with its obsession with youth. According to Mitch Alborn, the author of Tuesdays With Morrie, aging is the most widespread phobias of contemporary society. Through the ages, man has searched for various methods and techniques to delay the signs of aging. The industries dealing with anti-aging products are in a highly profitable state because more the life spans more the use of these products.
Most of the countries of the world share the same view regarding the issue of the fear of aging (Alborn, 1997, p.117-118). But it is very unethical that the advertisements of the anti-aging products are always featured on younger-looking people within the age limit of thirty to thirty-five. This is a real problem of society and this paper would evaluate this aspect through parameters of the social-cognitive theories.
According to social-cognitive theorists, observation is the best technique to acquire knowledge that enhances the processing of the human personality. (Weiner et al, 2003, p.216). In other words, people learn new skills by mere observations only. According to Albert Bandura, people learn through three basic patterns, which are observing live models, listening to the words spoken by the model and looking at the symbolic models, and following their whereabouts (Bandura, 1976, p.181).
Among all these the last one that to look at the symbolic models is the most influential to shape the attitudes of people. In any kind of movie, billboard, or advertisement, no person with wrinkles is to be seen. Only the youths represent as if the world belongs to them. This again makes the aging ones more afraid of getting old, whereas in a family the older ones are regarded as the valued members. This contrasting behavior creates uncertainty which again gears the fear of aging.
However, on the personal ground, from the parameters of the cognitive social learning theory, it should be stated that Alborn is successful in evaluating the problem but there is a failure of understanding in this context. Alborn failed to explain the context of media’s ignorance related to aging. It is true that this aspect of aging is related to death but then, death is a reality of life. Nevertheless, media try to avoid issues related to age and it is a fall-out of the modern society’s affection with youth and meaningless embarrassment associated with individuals growing old.
Elderly people require intensive care and attention round the clock, but many of them either do not have anybody in their family to pay attention to them or their family members are too busy to do so. Being a primary caregiver for an elder can be a difficult job. The hours are time-consuming and it can be a wearisome and anxiety-provoking duty, for even the most enduring person. However, society and media seem to bracket this aspect as a completely welfare-related clause and isolate this aspect of reality. Thus, the perception of age is never well-received by the community and there is such a fear related to aging.
From a marketing or financial point of view, the same truth is understandable. The elderly population lacks purchasing power, which, incidentally, is the driving force of any marketing company. Thus, it can be seen, even in this criterion, the elderly population fails to gather the attention that is required. Society watches this from a distance. It understands the problem and becomes cautious about the problem.
However, the solution to this problem is a tendency to remain ignorant about the issue of aging and it can well be stated that this ignorance corresponds to a phobia of the unknown. This is unknown if the condition of an individual’s old age and therefore there is an aspect of phobia related to old age. This is an extremely shameful malady but it is reality and Alborn rightly noted the initial problem related to the issue of old age phobia.
So, whatever Alborn said, needs explanation as it is not all-encompassing the fact behind the real reason of the phenomenon of aging, and the society’s urge to conceal the process. It is the ignorance of the people of our society regarding the fear of aging and in many cases, this is related to the ideas of incapability of one’s physical activities and looking after oneself. Being aged a man either loses mental strength or tries to keep himself detached from the company of others. The very idea of aging instantly gives vent to the idea of death which is more fearful and it threatens the survival of that person.
So aging is highly related to the idea of death which is the ultimate truth and also the vent for the phobia of aging. According to Alborn, the idea which rules the world is being young and looking young. But his explanation is not complete because there are other points to be discussed based on the current socio structure and religious beliefs.
References
Alborn, M. (1997). Tuesdays with Morrie: An old man, a young man, and life’s greatest lesson. New York: Doubleday.
Bandura, A. (1976). Social learning theory. Saddle River, NJ: Prentice Hall.
Weiner, I., Freedheim, D., Millon, T., Learner, M. (2003). Handbook of psychology: personality and social psychology. Hoboken, NJ: Wiley.
Even for people that remain extraordinarily active while they are aging, considering leisure opportunities at some point is critical. However, the described change should not be perceived by an older adult as the sign of them becoming useless for the business setting. Instead, their contribution to the organization and the fact that they have deserved their time off should be emphasized extensively. The described task gains increasingly more weight in the rural setting, where the process of aging is amplified and accelerated (Hash, Jurkowski, & Krout, 2015). Therefore, strategies for assisting older adults to transfer to a new stage of their development and retain the extent of their activity are important goals.
Main Features
Despite a common misconception, retiring does not imply becoming less active. As the podcast with Deenaz Patel has shown, a range of adults, even in the rural setting, tend to remain very active during their retirement years (“Aging in rural places – Part 7, retirement & leisure for older adults,” 2014). The described situation is also typical for older adults that live in a facility since, with the amount of financial support offered to them, options such as cruising and help tourism, remain open (Hash et al., 2015). Therefore, it is essential for older adults to receive the necessary support to express themselves and explore options for remaining engaged even after they retire.
Conclusion
Moreover, it is critical to ensure that the healthcare needs of older adults in the rural setting are met fully. While the target demographic tends to be less frail than their urban counterparts, establishing control over the well-being of older adults in the rural environment is still necessary. For this purpose, health education and the supervision of local nurses and social workers is required (Hash et al., 2015). Thus, older adults will receive the support and encouragement needed to keep the quality of their lives high.
High-quality healthcare services should be accessible to everyone, yet, due to imperfections in the infrastructure of rural areas, people living in the specified environment may have difficulties accessing healthcare. There are other barriers toward healthcare in rural areas, which include the lack of health literacy, qualified staff members, and effective nurse-patient communication (Halter et al., 2016). However, by improving the reciprocity between a patient and a nurse with the help of different types of media, one can address the issues temporarily, at the same time working on long-term goals such as building new facilities in the vicinity of rural households.
The problem of service accessibility coupled with alterations in demographic levels within rural communities can be seen as the key barrier to delivering healthcare services to rural residents. As Krout explains, “The combination of a lack of formal services and demographic changes affecting rural communities and families may put rural older adults at risk of social isolation”. The described issue concerns both infrastructure and the lack of qualified staff members in the rural healthcare context. For this reason, reconsidering the quality of patient-nurse communication should be seen as the primary task, whereas long-term goals will include creating more employment options and training opportunities for nursing experts in rural settings.
Conclusion
The application of innovative media tools to encourage the patient-nurse conversation while new facilities are planned to be constructed and the infrastructure is being updated should be regarded as important options for improving care for rural residents. The described approach will also help to increase the rates of health literacy among the target population, thus preventing the instances of severe health issues. By maintaining communication with the rural population and keeping the community informed about the available options for health management and treatment, a nurse will contribute to managing public health issues successfully.
References
Halter, J. B., Ouslander, J. G., Studenski, S., High, K. P., Asthana, S., Woolard, N., Ritchie, C. S., & Supiano, M. (2016). Hazzard’s geriatric medicine and gerontology (7th ed.). New York, NY: McGraw Hill Professional.
Krout, J. A. (2015). Providing services to rural older adults. In K. M. Hash, E. T. Jurkowski, & J. Krout, Aging in rural places: Policies, programs, and professional practice (pp. 119-132). New York, NY: Springer Publishing Company.
Nowadays, an increase in the elderly population can be observed, and it leads to a higher demand for services, establishments, and facilities providing care for this vulnerable part of society (Fields & Dabelko-Schoeny, 2015). A senior citizen may choose to age in the comfort of their home or a specialized institution. In the first case, the necessity to stay an active participant in social life may be satisfied through dynamic aging settings. There is a variety of places that can accommodate the elderly or help to fulfill their needs for community interactions, and among these places are community settings and places of worship. These types of facilities are necessary to ensure that as many senior citizens as possible have access to resources that would allow them to age in a positive and inclusive environment.
One of the senior centers providing care for the elderly in NYC who are over 60 years old is founded by the Carter Burden Network. The services provided there include arts and cultural events, gatherings dedicated to health, advocacy, supportive counseling, money management, and end-of-life planning (Burns, 2017). The elderly can fulfill their socialization needs by attending a variety of events offered, thus, ensuring their frequent encounters. For instance, the elderly may participate in weekly health and wellness workshops designed to educate senior citizens about maintaining their well-being (Burns, 2017). Educating the elderly is one of the main goals of the establishment besides involving them in communal and active lifestyles. Moreover, a volunteering program is also available in the center: the main requirement for potential facilitators is previous experience in organizing workshops. On the other hand, transportation may be a problem for senior citizens, especially those who have mobility issues – it is the area that may be improved.
Similar to the senior center, Heath Evangelical Church in Cardiff views senior citizens as an indispensable part of their congregation and, more broadly, their church family, where seven out of the 12 elders are aged over 60 (Orchard, 2018). Heath Evangelical Church treats seniors with the respect that is supposedly common to all cultures, with no regard for the cultural background. Unlike the senior center created by Carter Burden Network, the axis of Heath Evangelical Church is prayer meetings and Bible studies, of which senior citizens are the most frequent and active goers (Orchard, 2018). Furthermore, the church provides voluntary help for the elderly in their homes, which embodies Felician Values, such as compassion and respect for human dignity. Church membership gives emotional support, which helps to combat depression and loneliness among retirees.
Both the senior center and the place of worship investigated here share similar attitudes in approaching the incorporation of the elderly into their social life. Nevertheless, the church does so in a more natural way, and the intentionality of the process is not evident in this case. Moreover, in the church, the elderly have an opportunity to interact with diverse age groups. Senior citizens who have access to an active aging setting or to places of social gathering, where they are treated with attention and concern, have more substantial opportunities to live a fulfilling and engaging communal life. The strain that the four aspects of aging (physiological, social, physiological, and cognitive) put onto senior citizens can be to a degree alleviated by the help that active aging settings provide.
The process of aging affects every organism in a unique way specific to each individual. The brain, as the most complex organ in a human’s body, is especially susceptible to drastic changes from a plethora of factors. The life experience of each person matters in this situation the most, as the brain’s cognitive functions develop alongside it. This essay compares the effects of aging on normal and diseased brains.
Main body
Human brains age at varying speeds and are not bound to lose their elasticity over time. The slow deterioration of cognitive functions is not a genetically programmed process (Nikhra, 2017). A healthy brain begins to lose its stability and the regular rate of functioning due to such factors as accumulated stress, hormonal changes, microvascular insults, changes in calcium metabolism, and demyelination (Nikhra, 2017). Therefore, increased stress (e.g., depression, loneliness, anxiety), hormonal diseases, and various abnormalities in one’s organism can lead to a faster loss of cognitive function (Donovan et al., 2016). These factors suggest that a diseased brain is generally a product of outside negative influences on a normal brain.
It is possible to train one’s brain through continuous mental and physical activities to retain a high level of cognitive abilities with aging. It is worth noting that people with higher education and active lifestyles maintain their mental skills for longer due to higher cognitive reserves (Nikhra, 2017). The stored knowledge helps with social cognition in older adults, as past experiences for them are easier to access than registering new information.
Another example of the effects of aging on human brains is that older people have fewer social interactions. Social status plays a vital role in contributing to a functioning brain, as more extensive social networks allow for long-term social contacts (Donovan et al., 2016).
Conclusion
Therefore, social interactions with older people can provide them with healthier brains for more extended periods. People with diseased brains could find themselves unable to uphold social processes, and their disease will only get worse. In conclusion, appropriate training of one’s brain in the form of physical and mental exercises helps in slowing down the loss of cognitive functions.
References
Donovan, N. J., Okereke, O. I., Vannini, P., Amariglio, R. E., Rentz, D. M., Marshall, G. A., Johnson, K. A., & Sperling, R. A. (2016). Association of higher cortical amyloid burden with loneliness in cognitively normal older adults. JAMA Psychiatry, 73(12), 1230–1237. Web.
Nikhra, V. (2017). The aging brain: recent research and concepts. Gerontology & Geriatric studies, 1(3), 35-45. Web.
The establishment of laws marks the crossing over from policy formulation to policy implementation. The national organization Alas Strategic Plan, 2003-2008 exemplifies the implementation phase of Longest’s model in that it has structured rulemaking and operation into a cyclical feedback process. As such, when formulated rules are operationalized, gaps and new knowledge are fed back to the rulemaking activity to amend regulations.
This is a continuous cycle as depicted in the model. The five-year strategic plan of The Administration of Aging (AoA) exemplifies the importance of having a rulemaking stage during the implementation of national aging health policy. Formal rules have been developed into five broad strategies or regulations. It appears that you are aware of the vital need to use rulemaking as a starting point to health policy implementation in order to bring about the intent of the policy.
Main body
The regulations stipulate what needs to occur for strategic goals to be achieved; for example, Goal 1 stipulates that there be an “increase” in the number of older people accessing health supports. The AoAs strategic goals are constructed to indicate how human, financial and other health-related resources will be managed to make the goals of the policy possible. The Longest model stipulates that the implementation phase of the policy-making process is essentially about management. Each strategic goal of the AoA has several objectives, and each objective states an aim to be achieved toward meeting the strategic goal (e.g., “strengthen AoAs capacity to provide information…”).
The second step in the implementation of public laws is the operation of the policy. How to operationalize the processes needed to achieve the outcomes. This normally includes assessment and measuring activities according to Longest’s model. The AoA incorporates evaluation and monitoring regulations within its operationalization of goals; for example, Goal 1, Objective 1.2, Strategies: “Conduct analysis of research findings…”.
That the AoA plan includes the potential for modification parallels Longest’s contention that policies exist in a dynamic world and need to be able to adapt to changes in other phases due to external factors. Additionally, the AoA strategic plan reflects the political nature of Longest’s model in that various stakeholders is involved in determining the viability of the operation of the rules made. The Assistant Secretary for Aging coordinated the Administration of the strategic plan.
The implementation phase of the strategic plan exemplifies Longest’s depiction of greater involvement of executive branches of government. The rule-making portion of the plan illustrates the complex task of breaking down the simplified laws into distinct elements that each target achievement of that law being implemented (Greener, 2006). The plan reflects the difficulties in juggling priorities and ensuring all stakeholders are accounted for during this interpretation process. In turn, the operationalization of strategies to achieve the objectives of each overriding strategic goal provides a comprehensive description of how rules will be applied in the real world of national health.
Overall the AoA strategic plan mirrors the circular flow of information that Longest emphasizes as critical to policymaking, in that the plan is able to be continuously modified as circumstances change. In this way, the plan demonstrates the open system nature of the policy-making process. The format and content of the AoAs strategic goals present a complex managerial process, reflecting the national scope of the aged care policy. Despite the huge endeavor that has been undertaken, the AoAs strategic plan exemplifies Longest’s claim that the scale of the project does not negate his model’s requirement for the implementation phase to be a two-prong process;
rulemaking;
operation.
As such, AOA demonstrates that although complex, the implementation process is comprised of distinct hierarchical stages that are interrelated. Ultimately, changes to public health policy need to be implemented effectively in order to achieve expected health outcomes.
Ideology of Implementation
Ideology plays a large role in Longest’s model given the political and moral concerns involved in the policy-making process. The model illustrates how USA political leaders approach policy issues, such as seeing them not as a rigid solution, but rather a dynamic and flexible set of strategies that demonstrate values upheld within the community at the time (Kronefield, 1997). For example, the AoA strategic plan reflects the 21st-century value of all individuals, regardless of age.
Also, the plan acknowledges the social and health concerns of the aged as a marginalized group within the community. Given the “graying population” in the industrialized world, it is pertinent that the AoA plan is developed to account for an increasingly older population. The Longest model provides for ideological inclusion in the implementation phase by delineating two tasks that feedback into each other. Rulemaking is modified by operations, creating a flexible process of implementation that reflects the ideology of a rapidly changing physical world and social values. The feedback of the cyclical process allows for social changes in values and expectations to modify rules as needed.
Longest’s implementation phase depicts the significant influence of political ideologies on the processes of rulemaking and operation. The political characteristics of the process of policymaking are not explicit in the model but are implicitly illustrated. This illustrates how the overall policy-making process is not a rational thinking activity but is subject to personal biases and agendas of those who are in power, and of those who will be the targets of the policy.
As such, the drive behind policymaking, according to the Longest model, is not to simply find the best solutions at providing a national health system using debate and other public forums of discourse. Similarly, policies are not rationally chosen on their merit of being able to best support national health aims. Hence, interest groups’ preferences, bargaining power of stakeholders, vote trading, and other personal biases are all external factors that act upon the policy-making process, influencing the final policy decisions as to how to implement public health laws.
As such, it appears that Longest has acknowledged the lack of empirical research to drive decision-making at the executive level of government, instead of policy formation is influenced by the personal agendas of those in power.
His model accurately shows, in this case, that not all the stakeholders are acting in the best interest of all affected by national health policy. However, the self-interests of stakeholders are regulated in Longest’s model by the inclusion of the feedback cycle which depicts the evaluation of rules and regulations by those affected by them, to allow for modification. The model is also an example of how ideologies of different stakeholders are accounted for by allowing a two-step cyclical implementation phase so that self-interests and public interests can be assessed, commented upon, and incorporated into the policy where suitable.
Conclusion
In this way, it can be argued that ideology will at times replace good judgment by policymakers. As such, suggests Longest’s model, government policymakers determine that an assortment of laws and measures are needed to specifically shape the composition, size, and rates of change of national health. Whereas in the past it was the government that took sole responsibility for the provision of public services duties (e.g., provide hospitals), the impact of these public duties were generally were subsidiary to an intended purpose (e.g., national public health).
Longest illustrates how the harnessing of government powers through policymaking to achieve goals has developed a new relationship between government and citizens, which requires the inclusion of social values and expectations.
References
Greener, I. (2006) Comparative health policy. Public Administration, 84(2), 500-511.
Kronenfeld, J. J. (1997). The Changing Federal Role in U.S. Health Care Policy. Boston: Praeger/Greenwood Publish.
All over the world, people have engaged in searching for a remedy against aging. There is a part of human nature that creates the need to avoid death and live forever. The gods of Olympia and people of Hindu origin used to drink a special kind of nectar, which they believed to negate death. Human growth hormone (HGH) is currently in use by people in a bid to achieve the same objective. Weil observed, “So pervasive and deep-rooted is the belief in age-reversing substances that an incalculable amount of time, energy, and money has gone and still goes into the discovery, promotion, and marketing of such drugs” (38). One such research was conducted by Dr. Daniel Rudman in 1990. The methods he used in this research and conclusions were documented in the New England journal of medicine on the 5th of July 1990. The aim of this paper is to analyze this research and outline its relevance to exercise and sports.
Towards the end of middle adulthood, the composition of the human body goes through a sequence of progressive changes. The lean body mass reduces in size while the mass of adipose tissue enlarges. This results in a change in the structure of the body. These changes are part of the process of aging and cannot be avoided. Dr. Rudman proposed that “reduced availability of growth hormone in late adulthood may contribute to such changes” (33). Five years later, he conducted research that included an experiment to prove his theory.
The Research
The first step was to recruit men aged 61 and above. He did this by interviewing them after placing a newspaper ad in the local dailies. He then made sure that these individuals were free of diseases, had a 90 to 120% body weight in relation to age standard, and that their growth hormones could be checked regularly without a problem. After doing all the eliminations, he remained with 95 men who met the set criteria. Further elimination took place and this was based on medical history, the concentration of plasma IGF-1, radiography results, blood cell count, and urinalysis results. Twenty-one men remained and were enrolled in the year-long experiment. They were divided into two groups, group 1 with 12 people and group 2 with 9.
Within the 12 month duration, men in group 1 were administered with 0.03 mg per kilogram of manufactured human growth hormone, while the nine men in the second group did not receive any treatment. The levels of plasma IGF-1were recorded each month. The bone density, the mass of adipose tissue, and the lean body mass of each individual were also measured. These are shown in table 1.
Results
Dr. Rudman observed that:
All the men remained healthy, and none had any changes in the results of differential blood count, urinalysis, blood-chemistry profile, chest radiography, electrocardiography, or echocardiography during the 12-month protocol. Specifically, none had edema, fasting hyperglycemia (>6.6 mmol of glucose per liter), an increase in blood pressure to more than 160/90 mm Hg, ventricular hypertrophy, or a local reaction to human growth hormone, nor did their serum cholesterol or triglyceride concentrations change significantly. In group 1, however, both the mean systolic blood pressure and fasting plasma glucose concentration were significantly higher (P<0.05 by matched-pair t-test) at the end of the experimental period than at the end of the base-line period (127.2″5.2 vs. 119.1″ 3.6mm Hg and 5.8″ 0.2 vs. 5.4″ 0.2 mmol per liter, respectively) (Rudman 3).
It was observed that the levels of IGF-1 of group 1 members increased and matched the levels related to youth (500-1500 U per liter). There was no alteration in the levels of IGF-1 in the second group that did not receive treatment. Their levels remained less than 350 U per liter. There was an 8.8% and 14.4% rise and fall in lean body mass and adipose tissue respectively in the group that received treatment.
In this study, 21 individuals were taken to represent all men of age 60 and above with less than 350 U per liter of plasma IGF-1 concentration. Much as the outcome is true, the chosen number is too little to use for generalization. Other than that, the men selected for this research had a good health record. They were almost a hundred percent healthy. The research, therefore, is not sufficient for a whole society. The research focused on old men. Including women in the conclusion of the research would be inappropriate (Weil 36).
Relevance of the research
As a result of the research discussed in this paper, a conclusion can be made that some HGH work. Human growth hormones are used in hospitals in children suffering from dwarfism. It is administered to them to improve their stunted growth. Due to the conclusion by researchers that HGH improves muscle activities, medicine manufacturing companies have gone the extra mile in producing them in abundance. The target market for such drugs is sports personalities. People use these drugs along with exercise in order to improve their muscles and become the best in sports (Bahrke and Yesalis 353).
References
Bahrke, Michael and Yesalis, Charles. Performance-enhancing substances in sport and exercise. New York: Human Kinetics Publishers, 2002. Print.
Rudman, Daniel. “Effects of Human Growth Hormone in Men Over 60 Years Old.” The New England Journal of Medicine 323.1 (1990): 1-6. Web.
Rudman, Daniel. Growth Hormone: Body Composition, and Aging. London: Geriatr Society, 1985. Print.
Weil, Andrew. Healthy Aging: A Lifelong Guide to Your Physical and Spiritual Well-Being. New York: Knopf Publishing Group, 2005. Print.