Category: Health Care Policy

Human immunodeficiency virus (HIV) is a retrovirus that attacks and destroys the immune system’s helper T cells, placing a person at risk for further infection and disease. Spread by bodily fluids through sexual contact, coming in contact with infected blood, and with the use of infected drug needles or equipment, HIV is becoming more and more prevalent throughout the United States (US). According to the CDC, 1.1 million people in the US are living with HIV (Cotler, Yingling, & Broholm, 2018, p. 376). In the southern states alone, HIV diseases, illnesses, and death are higher when compared to any other region in the US (Rice et al., 2019, p. 2966).

Today, Atlanta, Georgia has a large population of lesbian, gay, bisexual, and transgender (LGBTQ). Men having sex with men (MSM), increased number of sexual partners without the use of condoms, and anal sex places these populations, as well as others, at high risk for HIV infections. The Georgia Department of Public Health noted, “2,698 persons in Georgia were diagnosed with HIV in 2017, for a rate of 31.2 per 100,000 people in ages 13 and older, ranking the city of Atlanta third on the list of metropolitan cities in the US with the highest prevalence of HIV” (2017, p. 1). Understanding this, healthcare providers today need to be the front line for helping patients prevent HIV infections through education, STD testing, and using pre-exposure prophylaxis (PrEP) medications in order to stop the spread of HIV. Using PrEP medications, such as Truvada or Descovy, for patients at high risk for HIV can reduce infection risk by 92% (Cotler, Yingling, & Broholm, 2018, p. 376). Healthcare providers, including nurse practitioners, play an important role in helping protect patients at risk for HIV by integrating education on HIV infections and discussing different HIV prevention methods with high-risk populations into daily practice. The purpose of this paper is to discuss the health promotion project completed on high-risk HIV patients in Atlanta, Georgia needing education on HIV and HIV prevention methods.

Learning Needs Assessment

Primary care offices in Atlanta, Georgia often see large volumes of gay, lesbian, bisexual, and transgender patients. The Piedmont Physicians Clinic in Atlantic Station, sees on average five to ten patients each day coming in requesting HIV testing, consults for HIV PrEP medications, or medication checks and refills using HIV PrEP medications. The practice includes three physicians and one physician’s assistant and sees roughly 300 adult and geriatric patients a week made up of various demographics and ages. Due to the geographic area in which the practice is located, patients are from all economic levels, including middle and upper-class adult and geriatric populations, from the Atlanta area. Roughly half of the patients have private health insurance, while the other half of patients are on state and/or federally funded public health insurance.

After speaking with the physician’s assistant (PA), the main opportunity for improvement of the educational gap was to further educate patients on HIV infections, how HIV is contracted, and how to prevent HIV infections with the use of HIV PrEP medications in high-risk patient populations. Many patients come in repeatedly to the clinic requesting sexually transmitted infection (STI) testing after practicing risky sexual behaviors with the fear of contracting STI’s and HIV. Interventions, such as handouts, could provide these patient populations with HIV prevention education in hopes of reducing these risky behaviors, thus reducing the chances of becoming infected with HIV. The Georgia Department of Public Health found, “1,715 HIV diagnoses (82%) were attributed to male to male (MSM) sexual contact; 94% of transgender cases were attributed to sexual contact, and 1,908 new diagnoses of HIV infections (71%) were among Blacks, and the rate of diagnosis was highest among Blacks” (2017, p. 2). With the increase in HIV infections seen in MSM patients, LGBTQ populations, and in the Black or African American populations in Atlanta, the PA felt providing physical handouts at each patient’s visit on HIV education and helpful interventions, such as discussing PrEP medications, would better serve the patients in this Atlanta community.

Learning Objectives and Strategy

After the discussion with Piedmont Physician’s PA regarding the learning needs of the high-risk patient population seen at the clinic, three learning objectives were formulated. The first objective, understanding of what an HIV infection is, discussed the virus itself and what the virus does to a person’s body once infected. HIV is a virus that once contracted the person will have for life, as the virus cannot be cured. The Centers for Disease Control and Prevention writes that , “HIV reduces the number of CD4 cells (T cells) in the body, making the person more likely to get other infections or infection-related cancers and can destroy so many of these cells that the body can’t fight off infections and disease” (2019). Though HIV cannot be cured, today there are medications known as antiretroviral therapy, that can minimize the viral load to make it undetectable if medications are taken diligently as prescribed. The second objective, knowledge of the transmission of HIV, discussed how the virus is transmitted and who is at risk. HIV is transmitted through blood, bodily fluids, sex (oral, anal, or vaginal), and needle or syringe usage. People participating in unprotected sex, coming into contact with semen, blood, pre seminal fluid, breastmilk, rectal or vaginal fluids can contract HIV. The CDC notes that, “For the HIV-negative partner, receptive anal sex (bottoming) is the highest-risk sexual behavior and with drug use, HIV can live in a used needle up to 42 days” (2019). The third objective, understanding of HIV prevention methods, included information on safe-sex practices and HIV PrEP medications. Prevention of HIV starts with safe sex practices, such as condom use, reducing the number of sexual partners, choosing less risky sexual activities such as oral sex, or abstinence. Cotler, Yingling, & Broholm (2018) write, “Newer strategies, such as HIV treatment and viral load suppression to reduce transmission and using PrEP for those at high risk of HIV acquisition are found to be the most effective in preventing new HIV infections” (p. 377). PrEP medications like Truvada or Descovy have overall good patient tolerance, minimal adverse effects, acquired no drug resistance, and reduced transmission rates by 67-75% (Feinberg, 2012, p. 521). Barriers to prescribing PrEP medications are minimal, including cost, patient non-adherence to treatment, and possible drug toxicity, yet can be managed using drug coupons for patients, medication re-check visits which include lab work to check for toxicity every three to six months.

In order for patients to become educated on the three objectives, three handouts (see appendix A, B and C) created by the CDC were given to each patient upon check-in at the beginning of the visit. Due to the fast-paced nature of the clinic, the handouts presented the most amount of education to the patient, providing education on HIV prior to meeting with the provider. These handouts allowed the patients to take home the information, allowed the ability to be referenced at any time or even to be passed along to others. When used in practice, these handouts prompted multiple HIV prevention discussion topics about PrEP medications during the visit. At the end of the appointment, the patients were provided with a survey to assess the benefit of using handouts for HIV education.

Project Design, Development, and Implementation

This project took place at Piedmont Physician’s clinic, located in Atlanta, GA on November 7-8, 2019. Piedmont Physician’s in Atlantic Station is owned and operated by Piedmont Hospital in Atlanta, Georgia. Each of the four providers were important to the project’s success through the two-way communication, recruitment of the patients, and always willing to help implement the project in any way possible. All providers expressed enthusiasm for the project and agreed there was a need for change in order to help improve HIV education and prevention.

The health promotion project was designed and developed with the help of the PA at Piedmont Physicians. Designed for patients to receive educational handouts, the project was aimed to be successful in furthering the knowledge of HIV infections, transmission, and prevention. Each of the handouts and the survey were used based on the clinic’s fast-paced environment as the handouts are given to the patients prior to each appointment and survey takes less than five minutes to complete. The project implementor will be able to assess the knowledge the patients have on HIV by using the survey questions and providing the patients with more education. This helps to further protect the patients by providing specific education with the hopes of helping prevent new HIV infections seen in the clinic.

Learning Theorist used in Project Design

Dorthea Orem, a nursing theorist, created the Self-Care theory of nursing. This theory, “focuses on assisting patients who require the help of a provider with guidance, support, with an environment that promotes personal development, and teaches patients how to cope with obstacles they may potentially face in the future” (Norwich University, 2017). Patients at high-risk for developing HIV often require extensive education in order to prevent new infections. This self-care theory helps patients initiate better and safer health strategies, provides guidance on various lifestyles, and teaches patients to care for the well-being in order to prevent HIV infections, increased health care appointments, and hospitalizations. Orem created a theory that helped providers give the patients the utmost care, while also teaching patients about self-care. This health promotion project aims at educating patients on HIV prevention, which focuses on not only provider prevention, such as PrEP medications, but also on patient prevention, such as safe sex practice.

Delivery

The Piedmont Physician’s Atlantic Station clinic sees roughly 300 adult and geriatric patients a week, including roughly 50 of those 300 patients coming in for STI or HIV related appointments. The participants for this project were adult patients, male and female, ages 18 to 40 who are patients at Piedmont Physicians Atlantic Station coming in for STI or HIV related appointments. The inclusion criteria included being adult patients at high-risk for becoming infected with HIV through unsafe sex or having same sex intercourse and patients wanting information and counseling on starting PrEP medications. Exclusion criteria would include geriatric patients, patient’s not eligible to be prescribed HIV PrEP medications, and adults with allergies to the PrEP medications used. Of the 10 adults who participated, eight were male, and two were female, with the mean age being 32 years old. Five of the patients were Black or African American and five were Caucasian.

Patients were given a brief history and description of the promotion project and asked to sign a consent form for participation. After signing consent, three CDC handouts (see appendix A, B, and C) on HIV basics, transmission, and prevention were provided to the patients upon check in at the front desk for an STI or HIV related appointment. The wait time after check-in is roughly 5-10 minutes, giving the patients time to read through each of the three handouts. Patients then completed each appointment with the scheduled provider per usual protocol. Prior to leaving the appointment, the patient finished with a survey to assess the benefit of the educational handouts.

Data was collected through 10 patient surveys on how well the patient felt educated on the knowledge of HIV, transmission of HIV, and prevention of HIV. Each of the surveys included six questions using the Likert scale and provided ordinal data to analyze the benefit of using the handouts to provide HIV education to high-risk patients.

Evaluation

The results of the survey concluded the HIV educational handouts were helpful in teaching high-risk patients about HIV, transmission, and prevention methods. On question 1, the participants concluded that 40% of patients felt educated on the understanding of HIV infections, while 60% felt uneducated on the topic. Question 2 found that participants found themselves 70% educated on how HIV is transmitted, while 30% neither felt educated or uneducated on the topic. Question 3 found that the participants found themselves 40% educated on the prevention of HIV, while 20% felt neither educated nor uneducated, 20% felt uneducated, and 20% felt very uneducated on the topic.

After receiving the handouts, patients overall concluded each person learned something new with each specific handout. Question 4 concluded participants felt 70% educated and 30% felt neither educated nor uneducated on HIV infections. Question 5 found participants were 80% were educated on HIV transmission while 20% of participants felt neither educated or uneducated on the topic. Question 6 concluded patients felt 90% educated on HIV prevention methods and 10% felt very educated on the topic. The increase in education with the handouts proved the rise in HIV awareness, transmission, and prevention methods with 10 participants was successful and necessary to preventing new HIV infections. Through this health promotion project, health care providers can use easy interventions, such as these handouts, to help promote healthier, safer lifestyles in patients who are at high-risk for HIV infections.

Conclusion

As it is evident the need for HIV prevention and education is expanding, the recognition of the aforementioned points is paramount; namely, prevention of HIV through the use of safe sex practices, as well as the new methods of using PrEP medications in high-risk patients. The use of PrEP medications is a fairly new prevention strategy since the FDA approved Truvada in July 2012 and now there are different options are available for HIV prevention as well as education throughout the healthcare system. Additionally, the use of HIV handouts can provide further education for patients and lead to more patient/provider discussions on prevention methods, ultimately decreasing the amount of newly diagnosed HIV infections.

Identify and discuss health policies that apply to the topic. (This requires approximately 600 words and is to be supported with evidence and in-text referencing).

Throughout this review on the health issue of Sudden Infant Death Syndrome (SIDS) explore and examine the policies and guidelines applied to the health problem. According to Mayo Clinic (2018) that Sudden infant death Syndrome does not yet have a treatment; however, they claim there are safe sleeping practices to reduce risk. According to New South Wales Government Health [NSW government health] (2018), the policy Babies – Safe Sleeping Practices (NSW government health 2018) provides staff in NSW Public Health Organisations (PHOs) guidelines to assist staff in reducing the risk of Sudden Unexpected Death in Infancy (SUDI) and SIDS. Within the policy’s guidelines, provides vital messages outlines for safe sleeping practices. The first key message is for babies to sleep on their backs and prevent side and tummy sleeping (NSW government health 2018). Babies – Safe Sleeping Practices (NSW government health 2018) guidelines also suggest that infants should sleep on their backs and prevention of prone and side sleeping for the reduction in risk to the child. According to Sidebotham et al. (2018), vital practices for safe sleeping to keep head and face uncovered, maintaining a smoke-free environment before and after the birth of the child. Within Babies – Safe Sleeping Practices (NSW government health 2018) guidelines hold the same suggestion for safe sleeping practices such as keeping face uncovered and keeping the smoke free environment (NSW government health 2018). There is a lot of evidenced backing breastfeeding babies for reducing SUDI, encouragement of mothers breastfeeding is implemented within the Babies – Safe Sleeping Practices (2018) guidelines. Jeffery (2018) suggests that to reduce the risk of SUDI and SIDS, mothers should be breastfeeding their babies. The practices provided by the policy are back with strong evidence-based literature. Therefore, it is relevant to the health issue and offers affective methods backed by evidence-based prevention strategies for the prevention of SIDS and SUDI.

The primary health care strategies can be based on supporting families and identifying risk factors for vulnerable families. In addition to Babies – Safe Sleeping Practices (NSW government health 2018) policy, linked between policy directive Maternal & Child Health Primary Health Care Policy (NSW government health 2018) supports and facilities staff and families identify risk factors through comprehensive primary assessment models (NSW government health 2018). The central linking aim of this policy is to keep families safe. Therefore, its scope is to identify potential risks such as unsafe sleeping practices with infants. An assessment is to be conducted within the policy which provides time stage assessments, this time staging is Antenatally, postnatally, six to eight-week checks. The purpose of these checks is to monitor health aspects that continue to assess physical, medical, psychosocial, and support networks that may lead to inadequate care of families. Therefore, in relating to SIDS, comprehensive primary health can identify risks that may lead to insufficient practices for safe sleep. Sidebotham et al. (2018) claim that identifying high-risk families and providing support can drastically reduce the risk of SUDI and SIDS. However, Sidebotham et al. also argue that the labelling of high-risk for intervention can be problematic. Such groups as single mothers and families in poverty can potentially lead to a disconnect with health care providers resulting in a marginalised and stigmatised population. The Maternal & Child Health Primary Health Care Policy (NSW Government Health 2018) is to guide staff to monitor and assess families, yet a has the potential to be negative. However, the central policies purpose is to identify risks and provide further support, such as reducing SIDS and SUDI.

Apply principles of health promotion, and primary health care relevant to the topic. (This requires approximately 250 words and to be supported with evidence and in-text referencing).

Health promotion regarding Sudden Infant Death Syndrome and Sudden Unexpected Death in Infancy, such organisations promote the awareness and assist the development of health policies such as Red Nose Australia. Ottawa Charter for Health Promotion provides a foundation for health promotion, create supportive environments: Red Nose Australia employ this standard by the development and fundraising for family support. The promotion of SIDS/SUDI within Australia has developed a world-class research and funding as claimed by Red Nose Australia that the reduction of SIDS has reduced to 85% (Red Nose 2019). In addition, the Ottawa Charter for Health Promotion suggests Build Healthy Public Policy: intern this has been achieved through NSW government health (2018), by implementing effective health policies that support staff and families affected by risks of SIDS and SUDI. The services within NSW health service continually promote strategies which are founded in evidenced-based. Therefore, SIDS and SUDI health promotion has effectively been applied by Red Nose Australia and effective policies within the public sector supporting health professionals and families. Another example of health promotion principle can be found with the Evidence-based approaches (NSW government health 2019), which is evident within SIDS/SUDI based policies and strategies. Such as the Babies – Safe Sleeping Practices (NSW government health 2018) applying evidence-based practices within the public health policy (NSW government health 2018). The principles for primary health care explore the fundamental factors in the intervention for successful health providing and determinations of the consumer (WHO 2019). The issue of SIDS and SUDI is widespread; however, the access ability to reach families that require the need for information and assistance can be detrimental. WHO (2019) indicates that one important principle of primary health is the ‘universal access to care and coverage on the basis of need.’. The Safe to Sleep campaign was started to cover the essential information and contact resources for families in need (NIH 2014).

Discuss how advocacy applies to the topic. (This requires approximately 200 words and to be supported with evidence and in-text referencing).

Advocacy is a fundamental providing care for the patient consumer; the role of the care provider is to ensure the treatment to the consumer is safe and well informed. Through this care, advocates are still required to be informed on cultural and spiritual differences to provide the appropriate needs to individuals about health issues (Mortell 2018). Regarding SIDS and SUDI advocacy, Sidebotham et al. (2018) claim that the act of providing information and access to resources ultimately is the foundation of advocacy for this issue. However, advocacy is also for the promotion of driving change and improvement within families that are in bereavement support and the funding for research into SIDS (Red Nose 2019). Furthermore, promoting and engaging advocates within the health care system is an essential aspect of advocating. Health care clinician support regards the education of SIDS for health professionals who are in contact with consumers is a necessary resource for providing the safe care needed that is required in the prevention and support for SIDS and SUDI (Jeffery 2018). Therefore, education for health professionals and consumers fundamentally is advocating for the client in need.

Apply the principles of equity, rights and access applicable to this health issue as relevant to Aboriginal and Torres Strait Islander families. (This requires approximately 450 words and to be supported with evidence in-text referencing)

In Australia, the Government commenced a campaign to rectify the issues inflicting the Aboriginal-indigenous and Torres Strait Islander health gap. Freemantle & Ellis (2018) reported that the Aboriginal and Torres Strait Islander communities require further strategies input for reducing the cause in SIDS and SUDI. Vulnerable populations within Australia are susceptible to poor access to health care with low attendance rates to General Practitioners and primary health care providers (Smith 2018). In review, the social justice framework had been introduced to improve the cultural and spiritual divide within western medicine healthcare and Indigenous practices. Therefore, the cultural differences and isolated aboriginal and Torres strait islander population creates challenges in providing health care. Social Justice framework refers to the universal principles such as Equity, Access, Participation and Rights of individuals (Smith 2018). A campaign such as Closing the Gap was introduced to achieve equality and reform the health status and life expectancy for Aboriginal and Torres Strait Islander people. Therefore, the bases of improving health status in the vulnerable populations were to resolve the issues of equity, access, participation and rights to the consumer (Australian Government 2013). Whereby working in partnership strategies, that provide a rights-based approach in providing equal opportunities, ensuring availability, quality and accessibility of services, therefore, disadvantaged populations can work towards better health status applying equal rights for Aboriginal and Torres Strait Islander people. Red Nose (2018) inform that there remain an unacceptable higher rate of SIDS and SUDI within the Aboriginal and Torres Strait Islander people. Therefore, specific safe sleeping programs were developed, such as the Keeping Bub Safe with a partnership with Indigenous communities that are relevant to the culture and further education.

Harvard References.

1. Australian Government 2013, NATIONAL ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH PLAN 2013–2023, viewed 20th October 2019, https://www1.health.gov.au/internet/main/publishing.nsf/content/B92E980680486C3BCA257BF0001BAF01/$File/health-plan.pdf
2. Freemantle J, Ellis L. An Australian Perspective. In JR Duncan, RW Byard, SIDS Sudden Infant and Early Childhood Death: The Past, the Present and the Future, eBook, Adelaide, pp. 1-4 chapter 16, viewed 20th October 2019, https://www.ncbi.nlm.nih.gov/books/NBK513382/
3. Jeffery, HE 2018, ‘Future Directions in Sudden Unexpected Death in Infancy Research’, In JR Duncan, RW Byard, SIDS Sudden Infant and Early Childhood Death: The Past, the Present and the Future, eBook, Adelaide, pp. 1-6 chapter 14, viewed 17th October 2019, https://www.ncbi.nlm.nih.gov/books/NBK513394/
4. Mayo Clinic 2018, Sudden infant death syndrome (SIDS), viewed 17th October 2019, https://www.mayoclinic.org/diseases-conditions/sudden-infant-death-syndrome/diagnosis-treatment/drc-20352804
5. Mortell, M 2018, ‘A patient advocacy dilemma: Is it theory…practice… or an ethics gap? A qualitative analysis’, Singapore Nursing Journal, vol. 45, no. 3, pp. 17–26, viewed 16th October 2019, http://search.ebscohost.com.ezproxy.usc.edu.au:2048/login.aspx?direct=true&db=c8h&AN=135629280&site=ehost-live
6. National Institutes of Health 2014, Sudden Infant Death Syndrome (SIDS) and Other Sleep-Related Causes of Infant Death: Questions and Answers for Health Care Providers, viewed 16th October 2019, https://www.nichd.nih.gov/sites/default/files/publications/pubs/Documents/SIDS_QA_HealthCareProviders.pdf
7. New South Wales Government Health 2018, Babies – Safe Sleeping Practices, viewed 18th October 2019, https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2019_038.pdf
8. New South Wales Government Health 2018, Maternal & Child Health Primary Health Care Policy, viewed 17th October 2019, https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2010_017.pdf
9. Red Nose 2019, Advocacy, viewed 11th October 2019, https://rednose.org.au/page/advocacy
10. Red Nose 2018, Reducing the risk of SUDI in aboriginal communities, viewed 18th October 2019, https://rednose.org.au/page/reducing-the-risk-of-sudi-in-aboriginal-communities
11. Sidebotham P, Bates F, Ellis C 2018, ‘Preventive Strategies for Sudden Infant Death Syndrome’, in JR Duncan, RW Byard, SIDS Sudden Infant and Early Childhood Death: The Past, the Present and the Future, eBook, Adelaide, pp. 1-8 chapter 12, viewed 17th October 2019, https://www.ncbi.nlm.nih.gov/books/NBK513383/#_NBK513383_pubdet_
12. World Health Organisation 2019, The Ottawa Charter for Health Promotion, viewed 10th October 2019, https://www.who.int/healthpromotion/conferences/previous/ottawa/en/index1.html
13. World Health Organisation 2019, Chapter 7: Health Systems: principled integrated care, viewed 16th October 2019, https://www.who.int/whr/2003/chapter7/en/index1.html

Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society (World Health Organization, 2019). It outlines priorities and the expected roles of different groups; and it builds consensus and informs people (WHO, 2019). Health care policy implicates the nursing field on so many levels. There are around four million nurses practicing in the United States of America, Nurses have the potential to change and influence policy change on a local and global level (Brokaw, 2016). When nurses are influencing they are being advocates for the patients that they care for. Nurses play an important role in the development and implementation of healthcare policy. Nurses need to be skilled in patient care as well as in interdisciplinary teamwork, informatics and technology, implementing evidence-based practice, and quality improvement (Brokaw, 2016). Health care policy encompasses the design and establishment of health insurance plans to allow local communities to afford efficient and quality medical care. As such, these policies are essential in ensuring proper training of medical practitioners, the safety of drugs and medical equipment, administration of public programs and promotion of community health care.

Health care policy has had a drastic impact on the nursing profession. Health care policy can affect whether or not some one is receiving care compared to when some is not receiving care. Policies can affect the care provided to communities, cost of procedures and medications, and also the geographic regions that provides these medical services.

Health care policy also affects nursing in the care that is provided. Nurses are an important part of providing exceptional care to the patients that we treat everyday, and it is important for the voices of these nurses to be heard. Nurses can bring valuable input when it comes to health care and policy change. Nurses are faced with a lot of adversaries, and there for need to speak up when it comes the health care and help redefine policies.

As advanced practice nurse, we must advocate for our patients, and relay their messages to our high ups, such as doctors, and politicians. We need to help make our community/country a better place to live, grow and work. We work to provide the best possible care, as we work with infants, children and adults. It is our duty to advocate for them, as sometimes the feeling that they do not have a voice, in the issues that affect them.

This paper will discuss the importance of the health care policy: the rising cost of prescription drugs, how a policy change can impact Americans, and how politicians can help change the policies of medications.

Identification of selected health care policy

If anyone has taken prescription drugs, they know that drug prices has been on the rise in the last few years. A report in January 2019, found that oral medications rose from 9 percent a year from 2008 to 2016 and injectable medications rose more than fifteen percent (Kodjack, 2019). Why is there such an increase on medications? It was found that the skyrocket of medications is due to the cost of medications, not expensive new therapies or improvements in existing medications (Kodjack,2019). Drug manufacture companies claim the rise is due to new therapies or improvements. This issue affects everyone in the United States, whether they be men, women and children but what drew this attention was patients that come into the hospital. Many of the patients are admitted and even re admitted are due to the fact that they cannot pick up their prescription drug medications. They always say “my medications are to much, and I have to choose between them and everyday living expenses.” It is so sad that medication expenses are on the rise. In one article in the Indy Star, a young girl who was aged 25, spoke about how much her insulin medication has gone up in the last year. Though she has private insurance, she is still unable to provide the means for the remainder of her medications. She has to ration the medication that she is given from her pharmacy. This unfortunately has lead to her not receiving the proper care and medication she needs to treat and manage her type 1 Diabetes mellitus (Rudavsky, 2019). When all else fails, she has to turn to her sister who is also diabetic, to help out her out . This leads to her sister having a smaller supply for herself as well. It is considered to be a never-ending cycle. “As many as one in four, people on insulin had to ration their medication (Rudavsky, 2019).

Prescription drugs have been substantial contributors to health care inflation. Pharmaceuticals account for about ten percent of total health care costs (Kesselheim, Huybrechts, , Choudhry, Fulchino, Isaman, Kowal, & Brennan, 2015). A survey completed by National Center for Health Statistics researchers’, Robin A. Cohen and Maria A. Villarroel, found that about 8% of adult Americans don’t take their medications as prescribed because they can’t afford them (Lewine, 2015). As we know not taking medications has serious consequences, as it could lead to heart attacks, strokes, unnecessary complications related to a prior/treating condition and more hospitalization. With the high prices of medications, many Americans are not filling their prescriptions, looking to other countries to fill them, or asking their doctor for a different medication. In a study completed in March by Consumer Reports found that one in three Americans (32 million people) where hit with a price increase on their medications. It had a cost of 63 dollars more for a drug that was routinely taken and few of those surveyed paid over five hundred dollars (Consumer Reports, 2016). Some Americans have insurance, whether through private or government assistance, but even then the copays/the amount paid by insurance is still extremely too high (Lewine, 2015). As of 2019 drug makers raised the prices on more than 250 prescription drugs according to RX Saving Solutions (Lovelace,2019).

Description of student selected-identified solution

There is never an easy answer on what can be done to help decrease the prices in prescription medications. In the Consumer Report Best Buy Drugs poll, seventy-seven percent of Americans feel that the government should enforce the drug companies to lower the prices of medications (Consumer Reports, 2016).Currently the United States, does not control prices, because they assume that the pharmaceutical companies would compete with each other, which would result in lower prices. This has allowed pharmaceutical companies to set their own prices. As a result of this, in the United States we have one of the highest drug prices in the world (Gronde, Uyl-de Groot, & Pieters, (2017). Pharmaceutical companies are saying that the drug increase has been modest (Lovelace, 2019).

An idea could consist of the government to set a limit on out of cost expenses when it comes to medications. In 2015, in regards to the Affordable Care Act, California enacted a law that states citizens would not pay more than two hundred fifty dollars per month, for a single prescription or five hundred dollars for high-deductible plans (Consumer Reports, 2016). The rise of drug prices was a big debate in the 2016 Presidential campaign.

Other countries such as Germany, Belgium, Luxembourg, and the Netherlands are working with drug companies to negotiate set prices (Gronde, Uyl-de Groot, & Pieters, (2017). This would allow the government to help regulate prices and spending costs that Americans would have to spend when going to pick up their prescription medications.

A positive solution to the setting of limited spending would be that Americans would not have to spend as much on medications. People would be able to afford not only their medications but also their everyday life expenses, such as their bills, food, clothing and gas for their vehicles. People on a fixed income such as those living on social security and their pensions would be able to live more comfortably and not be so stressed out. The American people would need to support these k by going to their doctor and receiving medications from their doctor or nurse practitioner. We would also need to take these medications. If price was no longer and issue, than our concern on prices should drop. We would need to show the government that we support the change of having a lower cost for medications. Patients would also need to talk to their doctors about switching to generic brands of medications, as this would allow cheaper prices to happen as well. Generic medications would also help keep the prices down and low.

As a measurable outcome we would be able to see the amount of money Americans are saving on their medications, and using that money else where. This would allow them to spend more on actually taking care of themselves, as in obtaining healthy food and vegetables. They would not have to pick or choose what is more important to them. As it was mentioned above, many Americans would benefit from a change and help from the government, and feel that it is necessary for the government to help and step in with the rise in medication costs.

Two challenges that could interfere with this new policy change could be that consumers are questioning if drug innovations would happen. Some people feel that the drug companies would stop making new drugs and that we would be stuck with the current ones that we have on the market. One other challenging issue is the shortage of generic drugs at times. Between the years of 2007 and 2012 the number of generic medication shortages went from 154 to 456. Many of these drugs were only made by a certain number of manufactures ( The Hutchins Center on Fiscal and Monetary Policy,2017).

One solution to help fix this, would be for the Food and Drug Administration to wok with drug regulators in other countries to create a common system through which drug companies can easily submit applications to manufacture generic drug (The Hutchins Center on Fiscal and Monetary Policy, 2017).

Identification of Elected Official

One Politician that supports the slashing of prescription drugs prices is Vermont Senator Bernie Sanders. He also has the backing of the Democratic house leaders. Through out his bid for the 2016 Presidential campaign, one of his campaign goals was to help alleviate the rising costs of prescription medications. He listed lowering prescription drug costs as one of his main priorities, that he would like to accomplish ( Lovelace,2019). He recently wrote a letter to a drug manufacture Catalyst Pharmaceuticals Chief Executive Officer Patrick J. McEneny saying he was profoundly concerned that his action would cause patients to suffer and or die (Soga, 2019). Bernie Sanders would support the idea of lowering prescription medication, because one of his main focuses, in Washington D.C., is trying to persuade the politics on capital hill, to try and come up with a solution to help bring down the cost of medications for the American people. Bernie Sander is working on passing laws to help Americans, by making sure that the drug prices in the United Stats are not higher than Canada, the United Kingdom, France, Germany and Japan (Rudavsky, 2019).

Conclusion

It is so important for politicians such as Bernie Sanders to help fight the health policy concern of the rising prescription drugs that are affecting millions of Americans every year. As it was noted, other countries have where the government is regulating the medications that are provided to their citizens. It is a shame that as big as this country is, that we are paying so much money out of pocket, and even with insurance we are paying so much money. As a result of the high spending, Americans are looking to spend money in other countries to obtain their medications, which could result in other issues and concerns. Safety is so important, and we need to make sure that the patients we are treating are getting the correct dose and amount of medication that they need. This is one of the hottest political issues in 2019 and 2020. Hopefully with some powerful policy change we can help the American People achieve better prices on the medications they need to survive.

Abstract:

On the exit of Tsars Central Asia including Kazakhstan was plagued with malaria, leprosy, polio, diphtheria, and tuberculosis.[footnoteRef:2] The general mortality rate was 30.2 per 1000 inhabitants and infant mortality rate was 272.0 per 1000 births. In 1913, average life expectancy was under 32.0 years, and 0.4 doctors were available per 10,000 inhabitants in Kazakhstan.[footnoteRef:3] The condition in Russia was not far better and as such soon after October 1917, Communist regime in Moscow established, in June 1918, the People’s Commissariat of Health, a central body for directing the entire health work of the nation under the supervision of Dr. Samashko,[footnoteRef:4] to bring a change in the existing set-up and make health sector modern to combat diseases, as well as for winning the population to the Soviet cause. [2: SaltanatSulaimanova, In the Tracks of Tamerlane: Central Asia’s Path to the 21st Century, Daniel L. Burghart and Theresa Sabonis-Helf (Eds), National Defense University Press, Canada, 2004, p. 224.] [3: A. K. Patnaik, History of Civilizations of Central Asia, Vol. 4, p. 580; Howard M. Lecher, Health Care Policy in Four Nations, USA, 1978, p. 203.] [4: Soviet Communism: A New Civilization, p. 655.]

Introduction:

Soviet medical administrators strongly opposed the traditional practices; fearing the spread of disease was unmanageable for the traditional healer’s whose influence at the local level was far and wide.[footnoteRef:5]Since the Soviets believed that religious practices, povertyand illiteracy played as great a role as microbes in illness the state charged medical professionals with fighting disease not only through the application of scientific knowledge about microbes and vectors but also through a struggle against the social conditions viewed as fundamental to creating an environment in which diseases thrived.[footnoteRef:6] [5: Donald A. Bar & Mark G. Field, “The Current State of Health Care in the Former Soviet Union: Implications for Health Care Policy and Reform”, American Journal of Public Health, Vol. 86, No.3, 1996, pp. 307-308.] [6: Leonard J. Bruce-Chawtt, Malaria Research and Eradication in the USSR, WHO, 1959, pp. 739-740.]

Institutions for Implementing the Healthcare System:

Beginning in 1928, the Soviets intended to facilitate the transformation of the cultural superstructure at a time when industrialisation and collectivisation provided for fundamental changes in the economic substructure.[footnoteRef:7] There was no place in this new order for vestiges of a superstitious, irrational and unscientific past. Traditional healers, who included shamans, mullahs, and folk doctors, found themselves the targets of a vigorous propaganda campaign meant to drive the indigenous population into the hands of the newly trained biomedical doctors, nurses, and midwives.[footnoteRef:8] Beginning with the early 1920’s the Kazakh Ministry of Public Health conducted a large scale medical propaganda campaign, radio programmes, posters, films, lectures, and staged public spectacles on health and hygiene,[footnoteRef:9] that reached the most remote parts of the country.[footnoteRef:10] For the most part, the effort was to persuade the population to distrust traditional healers, even though occasionally the state resorted to coercive methods, such as arrest and imprisonment of Kazakh traditional healers.[footnoteRef:11] The development of biomedical institutions in Kazakhstan, even if it was a clear expression of power and control, was but meant for the health and well-being of potential contributors to the Socialist economy. [7: Paula A. Michaels, The Russian Review, Vol. 59, 2006, p. 163.] [8: WHO, Health care in transition: Kazakhstan, London, 1999, p. 9.] [9: M. A. Bykov, Sanitarnogigienicheskieocherki I zdravookhranenie v raionakhSyr-Dar’inskogookruga, Chimkent, 1931; c.f. Paula A. Michaels, The Russian Review, Vol. 59, p. 167.] [10: It was on account of the policy made in Moscow administered through a centrally organized hierarchical structure, i.e. the republic level to the oblast or city administrations, then to the subordinate rayon level. Since the policy adopted, involved feldsher (paramedic) stations at the village level, district (rayon) and regional (oblast) levels, topped by an assortment of advanced institutions at the national level, where services were in principle, accessible and mostly free to everyone; Mark G. Field, Health Care in Central Asia, pp. 68-70; Paula A. Michaels, Journal of the History of Medicine, Vol.59, p. 318.] [11: Paula A. Michaels, The Russian Review, Vol. 59, p. 160.]

Even if Kazakhs reluctantly accepted the new medical system the government did create facilities where after the number of doctors grew from 452 in 1927 to 1,571 in 1937.[footnoteRef:12] Until the founding in 1931 of the V.M. Molotov Kazakh Medical Institute (KazMI), all Kazakh doctors received training outside the republic. Even after the institute was opened, the majority of doctors continued to come from outside the republic, transferred there by the USSR Commissariat for Public Health.[footnoteRef:13] One of KazMI’s primary missions was the creation of a cadre of indigenous medical workers. As of 1931, only 30 to 35% Kazakh physicians served the indigenous population.[footnoteRef:14] Even after KazMI began graduating students in 1935, the number of Kazakh graduates remained quite small in the pre-War years. Kazakhs were more numerous at lower levels of the medical profession, working as nurses, midwives, and physician’s assistants; still they could not serve the population wholly. In 1935 there were 14,604 health workers in Kazakhstan, but among them just 2,015 were Kazakhs i.e, 13.8% of the total number of health workers.[footnoteRef:15] [12: Paula A. Michaels, The Russian Review, Vol. 59, p.165.] [13: “Tsentral’nyiGosudarstvennyi Ark1933-iiu hivRespublikiKazakhstana”, Ed. Kul’turnoestroitel’stvo v Kazakhhstane; c.f. Paula A. Michaels, The Russian Review, Vol. 59, p.165.] [14: “Tsentral’nyiGosudarstvennyi Ark1933-iiu hivRespublikiKazakhstana”, Ed. Kul’turnoestroitel’stvo v Kazakhhstane; c.f. Paula A. Michaels, The Russian Review, Vol. 59, p.165.] [15: David Lane, Ethnic and Class Stratification in Soviet Kazakhstan (1917-1949), Cambridge University Press, Cambridge, 1975, p. 181.]

The number of hospital beds expanded from 3,767 in 1928 to 16,290 in 1941 yet most were concentrated in Slavic urban and industrial areas, and thus were beyond the reach of the region’s indigenous population, which was often served by itinerant medical teams that passed through nomadic and semi-nomadic encampments for a few days or weeks at a time.[footnoteRef:16] Nevertheless in agricultural areas, the state established temporary clinical facilities to servecollective farmers during harvesting and sowing seasons. Among other duties, these young, temporary medical cadres bore responsibility for transmitting health awareness to Kazakhstan’s villages and as such showed positive results as Soviets accomplished their objective of lowering rates of infectious diseases.[footnoteRef:17] [16: Paula A. Michaels, The Russian Review, Vol. 59, pp. 318-322.] [17: Paula A. Michaels, The Russian Review, Vol. 59, pp. 318-322.]

On the occasion of the 25thanniversary of the October Revolution in 1942, numerous public health officials asserted that the Soviets had washed away all the evils of the Tsarist past.[footnoteRef:18] In subsequent decades, dramatic improvements in the field of health were undoubted. By 1960-61, there were 1,620 general hospitals in Kazakhstan with 77,000 hospital beds, 560 polyclinics, 704 health posts, 34 medical and sanitation units, and 3,940 feldsher-midwife posts.[footnoteRef:19] With the great emphasis on preventive medicine some common diseases like malaria, leprosy, polio, tuberculosis and diphtheria including cholera, plague, smallpox, typhus, relapsing fever etc. were brought under certain degree of control by 1960s through widespread preventive measures like mass vaccination and immunization[footnoteRef:20] as the incidence of typhoid was reduced by 80%, diphtheria by 75% and scarlet fever by 55%.[footnoteRef:21] [18: Kazakh Commissar for Public Health claimed that the “The Great October Socialist Revolution transformed the face of old Russia. Colonial exploitation of Kazakhstan, with its darkness, ignorance, and cultural backwardness has disappeared forever.”His deputy, Tleugabylov, enthused that, “casting off the chains of their damnable past, a friendly family of Kazakhs including many others marched hand in hand with the great Russian people along a vast, bright path [to the future].” c.f. Paula A. Michaels, The Russian Review, Vol. 59, p.173.] [19: Medical Services in Central Asia and Kazakhstan, 1963, p.109.] [20: A. K. Patnaik, History of Civilizations of Central Asia, Vol. 6, p. 580.] [21: “The Russian Health care System: Sick in so many ways”, 2007, www.La Russophobe.com]

The measures that were taken in Kazakhstan were so concrete that the health status of the people showed a lot of improvements. Mortality rates, both infant and general, dropped sharply, the expectation of life correspondingly rose and the general health of the population improved largely, reducing the rate of infant mortality, by opening new children’s hospitals and clinics and by increasing the number of pediatrician’s. Women and infant mortality rate declined substantially. For example, between 1940 and 1960, there was a fivefold drop in infant deaths in Kazakhstan. The general life expectancy reached 43 years in 1942, and nearly 70 years at the time of disintegration of Soviet Union as compared to 32 in 1913.[footnoteRef:22] The birth rate was comparably high, 36 per 1000 population, in 1960, 40% above the all Union average. It was the aim of authorities that all confinements should take place in hospital conditions and new maternity homes were constantly being opened to make this possible. There were 11,000 maternity beds and 410 kolkhoz maternity homes, more than 500 women’s and children’s clinics including 196 in rural areas and 11,500 beds in children’s hospitals and more than 1,700 children’s doctors in Kazakhstan in 1961.[footnoteRef:23] In addition all the kolkhozes were being encouraged to build their own maternity homes.[footnoteRef:24] [22: Medical Services in Central Asia and Kazakhstan, p.123; A. K. Patnaik, History of Civilizations of Central Asia, Vol. 6, p. 580; WHO, Regional Office for Europe, 2007, www.who.com.] [23: Women’s consultation centers, maternity homes, health stations at factories and offices, midwife and gynecological institutes and so on were mainly for expectant mothers, and were able to handle all the births in the country; Soviet Communism: A New Civilization, pp. 670-674; USSR: Questions and Answers, 1917-1967, p. 322; Rising Infant Mortality in the U.S.S.R. in the 1970s, Washington, 1980; Ethnocultural Identity and Induced Abortion in Kazakhstan, p.319.] [24: Medical Services in Central Asia and Kazakhstan, p. 124.]

Achievements in Healthcare System:

The result was that the infant mortality dropped almost five times in the years between 1940 and 1960 even though the death rate of new-born babies, particularly premature ones, was still high.[footnoteRef:25] General mortality declined by 71% and infant mortality by 90% at the close of 1960s.[footnoteRef:26]While in 1937 the death rate in the USSR in general was 40% below the death rate in Russia in 1913 and was constantly being reduced implying a much higher life expectancy, on the other hand the birth rate increased constantly. Even just from 1936 to 1937 the birth rate increased by 18%.[footnoteRef:27] In spite of the growth in population the authorities and health ministries of the republics in the Union took measures to provide substantial infrastructural facilities to measure the health standards of the people. It was therefore mandatory for the entire adult population, to undergo a compulsory medical check-up once every two years. As an example; 104.4 million people were examined by the doctors throughout the Soviet Union in 1965 alone.[footnoteRef:28] [25: Examining the reason for this the Health Minister of Kazakhstan remarked in 1961 that a survey was done in 1960 only 78.6% of new-born babies had been visited by doctors in the first three days after discharge from the maternity home; Medical Services in Central Asia and Kazakhstan, p. 124.] [26: The consultation centres looked after children in the area up to age of three. They regularly examined the both healthy and sick children in specialized departments and at home and taught mothers how to protect their children’s health, vaccinate children against smallpox, tuberculosis, diphtheria, polio, etc. and supervised the work of the infant- feeding centers where mothers received supplementary food for their babies. Children after reached the age of three were constantly looked after by the district clinic up to the age of 14, or until they finished school. Due to these efforts, with the passage of time Soviet children became stronger, taller, and healthier; USSR: Questions and Answers, 1917-1967, p. 323.] [27: N. A. Abdurakhimova, History of Civilizations of Central Asia, Vol. 6, ChahryarAdle (President),UNESCO, Paris, 2005, pp. 139-140.] [28: Between 1926 and 1959 there was an 8.5 times increase in the number of medical personnel for the USSR as a whole, but as for the Central Asia and Kazakhstan is concerned the increase was 21 times; “Chislennost, Sostav I Razmeshcheniye SSSR”, Moscow, 1961; “Kazakhstan Press (KP)”, 19.05.1961; c.f. Medical Services in Central Asia and Kazakhstan, p.37; A K. Patnaik, History of Civilizations of Central Asia, Vol. 6, p. 580; Health Care Policy in Four Nations, p. 203.]

To create high health standards Kazakhstan had more than 13,000 doctors and 53,000 feldshers, midwives and nurses by the year 1961.[footnoteRef:29]That means there was one doctor for every 859 inhabitants. There were 23.8 physicians per 10,000 inhabitants in 1970 and 38.3 in 1981 in the entire Soviet Union as compared to 1.5 physicians per 10,000 inhabitants in 1913 in Russia.[footnoteRef:30] The ratio of doctors in Kazakhstan was not the least as there were 21.8 in 1971 and it rose to 38.7 in 1988 doctors for 10,000 inhabitants.[footnoteRef:31] It was a huge accomplishment as compared to 0.4 doctors per 10,000 populations in pre-Soviet days. Since by then education standards had also risen and medical education was well received by the Kazakh population more so by females, therefore by the 1970s about three fourths of the total number of doctors in Kazakhstan was female.[footnoteRef:32] By organizing the health system in such a way, the entire population was involved directly, and hence felt very strongly about improving the health of the nation.[footnoteRef:33] Accordingly habits and attitudes of the people changed dramatically from the pre- Soviet days not only in Kazakhstan but throughout the Union.[footnoteRef:34] [29: “Chislennost, Sostav I Razmeshcheniye SSSR”, Moscow, 1961; “Kazakhstan Press (KP)”, 19.05.1961; c.f. Medical Services in Central Asia and Kazakhstan, p.37; A K. Patnaik, History of Civilizations of Central Asia, p. 580; Health Care Policy in Four Nations, p. 203.] [30: SankarBasu, Culture and Civilization of the USSR, New Delhi, 1985, p. 120.] [31: A K. Patnaik, History of Civilizations of Central Asia, Vol. IV, p. 58] [32: Bejoy Kumar Sinha, The New Man in Soviet Union, New Delhi, 1971, p.185.] [33: It was pointed out that in 1956, 1.3 percent of the entire population of the Soviet Union including Kazakhstan worked in one way or another in the field of public health; Elizabeth Brainerd, “Reassessing the Standard of Living in the Soviet Union: An Analysis Using Archival and Anthropometric Data”, The Journal of Economic History, Vol. 70, No. 1, 2010, pp. 83-99.] [34: Sigerist (a prominent scholar of the time) describes some of his experiences in 1936: “The habits of the Soviet people have changed radically in a very short time. The cities are spotlessly clean, and the foreigner soon learns that cigarette butts are not supposed to be thrown on the street but into special cans placed at every corner. I remember a long railroad ride from Moscow to Kazan during which the conductor came to clean my compartment every two hours, which was more often than I liked. When I asked her to let me sleep in peace, she said ‘Well, citizen, I have to clean the compartment because the inspector may come in at any station, and the car must be kept as clean as it was when we left Moscow – but I will do it without disturbing you.’ No visitor is allowed to go into food factories, medical institutions, or nurseries without sterilized gown and cap. Such regulations may sometimes seem exaggerated, but they are part of great educational programmes and far-reaching results cannot be expected unless there are strict rules which must be followed literally”; “The Russian Healthcare System: Sick in so many ways”, www.LaRussophobe.com]

Health thus became a force of unity wherein Soviet accomplishments succeeded tremendously with every passing day, providing equal opportunities to the diversified populations across Kazakhstan without any ethnic divisions. All Kazakh population thus reached to almost western standards of living in just 70 years even if there were still shortfalls in many areas. The benefits that came to Kazakhs in social sector were felt more around the end of the World War II as till then they resented the moves of Soviets unsuccessfully and therefore, Slavs got benefited, as was found in case of supervisions and higher jobs that were occupied by them because of their accepting the programmes launched in education, health, industry, etc.

Conclusion:

Soviet education and health thus were guarantee to unify not only sexes but also all nationalities to serve the purpose the Soviet leadership desired for them and in the process all of them got better material status after reaching to about 100% literacy levels and attaining better health status. This was not a mean achievement for both Kazakhs and Russians to transfer from below 10% to absolute figures, both for men and women, in a period of just fifty years and attain for themselves gains in all works of life. Soviet education and health provided no opportunities for dividing the diversified nationalities and wherever these existed, those were on political grounds or else because of management skills of the Communist leadership that grew and enlarged in all walks as dictators and as supervisors to keep an eye and check the lives of the people.

Policies regarding health are essentially plans that are subsequently put into action. These policies help to guide health care professionals in providing care to achieve specific health-related goals. (WHO, 2019). My personal interpretation of health policy is basically rules and regulations set forth by various government agencies to guide health care professionals in providing evidence-based, ethical medical care. A health care policy is considered to be successful if it can clearly define goals and targets for both the short and long term. (WHO, 2019). Health policies that provide guidance to health care professionals are created and regulated by local, state and federal governments. Due to the fact health policies are created and regulated by government agencies health care professionals often have limited knowledge of how to become involved with policy-making.

I admit prior to this course I had very limited interest in health policy, mostly because I didn’t think health care professionals had a true role in helping to determine and guide health policy. Professionally I’m a member of the Academy of Nutrition and Dietetics. Through my membership I receive research articles and email blasts with emerging information that impacts registered dietitians (RDs). A portion of these communication emails focuses on public policy. Most of the work the academy is doing focuses on funding for obesity programs and programs for food security across the federal government. Personally, I never read much into these articles because I originally thought that I wouldn’t have a say in what was happening. This week’s readings had me interested and I took some time to go back through those deleted files and read up on the work the Academy of Nutrition and Dietetics is doing. Currently there is a focus on the Treat and Reduce Obesity Act which was first introduced in 2017. Due to increase costs accrued with a nation suffering from obesity, an act was passed that allows coverage under Medicare for behavioral therapies associated with obesity. Providers that are not primary care physicians will be able to provide obesity related therapies and subsequently bill for them. (Congress.Gov, 2017). The bill was reviewed twice before it died. The academy called on support from RDs in promoting the bill by acting as an advocate for the profession. There was a call to action to get more involved, to share our voice, to write to local senators and to get involved with state sponsored RD advocacy groups to promote the passing of this bill. A new bill was later established recently, on February 28, 2019, and it is currently in the first stage of the legislative process. (gov.track, 2019). It is amazing what can be accomplished through continued support and advocacy for a health-related event or concern. I admit I didn’t participate in any of these call to actions. I didn’t think my one voice would make that much of a difference. I also admit, that I’ve lost passion in my professional field because I feel that RDs are under-utilized experts in disease management, including obesity. This got me to start thinking that I can’t expect anything to change for the profession, and I can’t expect to regain my passion for the field if I continue to sit silent. Following this week’s readings and assignments I realized the importance for health care professionals to get more involved in policy and to speak up. We hold a lot of evidence based knowledge and I imagine what could be accomplished for health care in the United States if health care professionals took a more active role in policy-making. I can honestly say going forward, I will pay closer attention to what is sent in those emails and actually look at the “how you can get involved portion”. As a health care provider and future administrator I cannot expect to improve the way health care is governed if I do not use my voice.

The Role of the Healthcare Professional in Policy Making

When discussing health care policy and the role of the health care professional in policy making, most professionals would have limited knowledge regarding the process. Personally, I know I have limited knowledge of how a health care professional has a role in policy making. This is most likely due to the fact that health policy decisions aren’t made by the professionals who do the hands on work. Health policies are created and regulated by various officials within the three branches of government. Political factors play a greater role in the creation of policies than the decision-making process of health clinicians and providers. (Blendon, 2001). Health care professionals can have a more active role in the creation of health policies, but first there must be a general understanding of how policies are created with regard to health care. Health care policies that are enacted upon in a federal level utilize the three branches of government. On a federal level, selected officials write policies with feedback from multiple medical professionals. (Duquesne University, 2018). Senators and representatives of the state create the policy. The president either approves or denies (vetoes) the policy. Finally, the judicial branch will interpret the policy should it be approved by the president. (Dusquesne University, 2018) Next, health care providers must understand who key decision makers are in the policy they wise to be more involved it. (Blendon, 2001). For example, if a health care professional wants to address policies created at the local level, they must understand who governs these policies, who the board members are that vote on the policy and what factors are taken into consideration regarding the policy. In understanding who is a part of the decision making process, health care professionals can work with these individuals and build a rapport with the idea that their expertise can be utilized for future policy regulation. Finally, a health care professional must decide their course of action, what they wish to do and accomplish. (Blendon, 2001). Professionals can become more involved in the political processes by understanding personal resources. A professional may have ties to a local ombudsmen, may know someone with ties to a senator and may simply be involved with the local government. Once they establish resources needed in the policy-making process providers can began to focus on areas that interest them to help promote the change they wish to seek. (Blendon, 2001).

In my own understanding, health care professionals can play a role in the decision-making portion regarding health policies by first understanding areas they excel in and are passionate about. They can further promote these areas by becoming more involved in community outreach and local and state governments. Specific medical organizations, such as the one I’m apart of for RDs, can help medical professionals voice their opinions and promote understanding on important topics regarding policies. In health care professionals becoming more involved in their local and state governments they can help to educate and provide evidence-based information to the individuals who vote on and ultimately determine current and future health care policy. In promoting their voice on a state level, and working with legislation they can help to be involved in the decision-making progress on a federal level in an indirect way.

Opportunities for Policy Making: Current and Future Roles:

To be honest, I had to research how a RD may get more involved with policy making. As I expressed before, I always shied away from this topic. Policies are intimidating, but so far this class has opened up my eyes regarding how an RD can get more involved in policy. Policies just look frightening but taking the time to read them, research them and dissect them helps to promote my confidence in springing into action. Getting involved is a lot simpler than I originally thought. Through my research I learned getting involved is as simple as reading, writing, speaking, volunteering, starting, joining, getting involved, meeting officials and being brave enough to be a change. (integrativeRD.org, 2017). As an RD the number one way to get involved is to simply read, read what is happening in the news in terms of health and health care reform, read to understand the information and be well-versed in present topics. Another way to get more involved is to write, write about what interests me and about evidence based practice. Write to local newspapers, local mayors, state governors and even state senators which can help to promote my feelings and voice being heard on multiple levels. Join some type of political organization or governing body with regards to health and nutrition. Being present, showing my face and interacting within those organizations can help to promote my ideas and voice. Get more involved by attending a town meeting, an advocacy meeting, or get more involved on an election campaign, with special attention being paid to those who support dietitians or health care in general. Once again, showing up and being present to share my expertise will help to support positive change. I can’t just assume my ideas won’t be taken into consideration it seems simple but if you don’t ask, the answer is always no. Meet with legislators on the local, state and federal level and offer assistance with policy making, or with ideas for future policies on health care topics. Finally, an RD can get more involved by “being the change” and running for a government office or a position on a government advisory board. (IntegrativeRD.org, 2017). I also learned a valuable tool as I get more interested and involved in public policy. The Academy of Nutrition and Dietetics has an “Action Center” on their website. By simply clicking the “Take Action” button you can send a message to a member of congress on any nutrition related actions. (Eat Right Pro, 2019). I was stunned to learn this and actually embarrassed I didn’t know it existed until now. After completing my research getting involved isn’t as scary and impossible as I originally thought. While some individuals may be interested in running for office to truly promote change, just because I want to promote change on a smaller level doesn’t mean my ideas should never be heard. As I begin to pay more attention to policy issues sent via my Academy of Nutrition membership, I’m challenging myself to step up and become more involved if a topic interests me. It might be as simple as writing a letter or just becoming more versed in the topic. However, practicing now will be an important skill I take with me as a future hospital administrator.

My future career goals include becoming an administrator involved with renal dialysis. I worked in the field of dialysis for a short time period but was intrigued by the amount of nutrition involved with the kidney. I learned a lot during my time there and met some incredible patients with poor outcomes due to limited resources. Across the board individuals on dialysis fight for medication coverage and have poor outcomes due to the inability to pay for medications and food. I had some patients who had to decide between paying their electric bill, buying food, or picking up their medications. Medications are crucial in controlling phosphorus levels, calcium levels and decreasing secondary conditions that decrease quality of life. When I decided to purse my masters in Health Care Administration I knew my future goals instantly, I’d like to make a significant difference in those individuals’ lives by changing policies that regulate prescription drugs and binder medication reimbursement. I can also make a difference by getting more involved with bills and acts that promote food security especially in the elderly population or for those with lower socioeconomic status. I can get involved with this by reading more on coverage under Medicare and Medicaid for phosphate binders and assistance programs currently in place. I can get more involved with the National Kidney Foundation and stay true to my original career by getting more involved in the Academy of Nutrition. I can write to, and interact with senators and congressmen on the need for reform on these issues as well. I may not make a huge difference but if I improve the life of just one individual on dialysis I will feel accomplished that I made a significant impact on someone’s life.

How Health Care Professionals Can Be More Involved With Policy Making

Health care professionals from various fields can become more involved with policy making effortlessly. I think a common misconception from medical providers, myself included until now, is that to become involved or become a voice in policy making you must run for government office or be involved with a governmental agency. Health care professionals can become involved with health care policy making by four simple steps. These steps include advocacy, policy, lifelong learning and philanthropy. (Olson, 2016). Simply stated, being an advocate for the profession a medical professional works in is a huge first step in become more involved with policy making. Being an advocate includes promoting the profession, staying on top of recent happenings of the profession and being involved in call to action type scenario’s when input is needed. Second, understanding current policies that related to the profession and health care organization or the type of care provided. Being well-versed in these topics helps professionals to write to public health officials, congressmen and senators to share their personal thoughts and the reasoning behind what should occur. Committing to life-long learning for the profession, and not shying away from areas that concern policy making and hot-topics in legislation. To make an impact in regards of policy making, health care professionals want to be viewed as the expert in their chose field and a sound voice of reason for whatever the health care policy is promoting. Without adequate learning and understanding of these policies and the profession, when a medical professional’s voice is sought after to establish or amend a policy, it may not be used if the professional is not well educated on the topic. Finally, becoming more involved through policy is easy by becoming more involved in philanthropy opportunities. Professionals who get out into the community for health care related activities such as blood drives, walks and 5K’s or community days will build trust with elected officials and individuals within that area. Building a rapport is a huge step in helping to be sure an individual’s voice is heard and respected when a need for policy making arises.

In short, showing up and being more vocal with regards to health policy is important when professionals are looking to become more involved. Showing up may be researching current events and writing to senators or using a system such as the “call to action center.” Showing up may also mean attending advocacy meetings, town hall meetings or assisting senators in writing policies or running for office. Regardless of what type of route the health care professional wishes to take in terms of policy making, some type of action can be done by every individual to impact health care and the future of health care.

References

1. Blendon, R. & Mebane, F. (2001). Political Strategy 101: How to Make Healthy Policy and Influence Political People. Journal of Child Neurology. Vol 16. (7). 513 – 519. Retrieved March 25, 2019 from https://eds-a-ebscohost-com.ezproxy.snhu.edu/eds/pdfviewer/pdfviewer?vid=2&sid=e0d5aeb8-a28a-4bcb-b45b-c04dee3d4623%40sdc-v-sessmgr03
2. Congress.Gov. (2017). H.R. – 1953: Treat and Reduce Obesity Act. Retrieved March 25 2019, from https://www.congress.gov/bill/115th-congress/house-bill/1953
3. Duquesne University. (2018). How Healthcare Policy is Formed. Retrieved March 25, 2019 from https://onlinenursing.duq.edu/blog/healthcare-policy-formed/
4. Eat Right Pro. (2019). Action Center. Academy of Nutrition and Dietetics. Retrieved March 25 2019, from https://www.eatrightpro.org/action-center
5. Gov.track. (2019). S.595 – Treat and Reduce Obesity Act of 2019. Retrieved March 25 2019, from https://www.govtrack.us/congress/bills/116/s595/text
6. IntegrativeRD.org. (2017). 10 Ways Dietitians Can Get Involved in Policy and Advocacy (infographic). Academy of Nutrition and Dietetics. Retrieved March 25, 2019 from https://integrativerd.org/10-ways-dietitians-get-involved-policy-advocacy-infographic/
7. Olson, K. (2016). Influence through Policy: Four Steps YOU can take. Reflections of Nursing Leadership. Retrieved March 25 2019, from https://www.reflectionsonnursingleadership.org/commentary/more-commentary/Vol42_2_influence-through-policy-four-steps-you-can-take
8. WHO. (2019). Health Policy. Retrieved March 25 2019, from https://www.who.int/topics/health_policy/en/

While scientific evidence, in theory, plays a crucial role in predicting issues that influence the health care policy agenda, its role, in reality, does not always reflect this. Sutherland, et al. (2012) asserted that science and public policy makers have always gone hand in hand, the significance of one to the other has always been acknowledged but in recent times there has been an evolving discussion on how to optimally achieve this. This has continued to the point where ‘evidence-based policy’ is highlighted as the standard to which democracies should aspire. This, in turn, has established a platform for scientists, working in both the natural and social fields, to work collaboratively with various specialists in processes related to policy-making (Sutherland, et al., 2012).

An example of this was seen in the previous government administration of the United States (hereafter U.S.), where the U.S. government utilised the expertise of scientists as advisors who actively served on the President’s Council of Science and Technology. However, while this relationship is beneficial, it is not without its dissenters as some aspects of recent health care science have created controversy on the basis that these scientific facts represent divergent views from religious and other beliefs. Another example of how the political agenda usurps scientific evidence occurred in the U.S., during the presidency of George W. Bush. His administration curtailed stem-cell research because the research involved testing on aborted fetuses, which went against President Bush’s religious beliefs.

Religiosity is not the only other factor influencing the policy agenda. Based on evidence from the U.S., partisan politics also affects health care policy. This was demonstrated in the passing of the Affordable Care Act (ACA). Some observers would not be of the view that the ACA was partisan in nature, since a Republican, Mitt Romney, created it in Massachusetts, and a Democrat President, Barack Obama, got it passed through congress making it federal law. However, the Trump administration has taken steps to repeal the ACA even without an alternative plan. From this, it is lucid that the ensuing conundrum about the ACA is partisan in the way that it has been treated with by politicians, even though people of the U.S. from both political parties benefit from the ACA’s policies. This is very disheartening because health care should be non-partisan as it concerns the life and welfare of human beings.

The World Health Organization (WHO) (2019) stated that policies once developed might change over time as a result of multiple pressures. Whenever the environment becomes unstable, then the dynamic surrounding the policy shifts and changes are accelerated. This can result in previous policy decisions, which were beneficial being reverted. Then as the crisis evolves, the guiding framework for that policy dissolves. One could argue that, if Senator John McCain had not notoriously shown the thumbs down sign as Republicans attempted to rescind the ACA in the early days of the Trump administration then possibly the U.S. would have faced an even greater debacle regarding its health policy, subsequent to this vote. This unfortunately reveals how health care policy is arrived at, at least in the U.S., and clearly it is not related to any science, except political science.

This further illustrates that while scientific evidence might be among the most important factors predicting the issues that get onto the policy agenda, it is often, second or third tier and there is no guarantee that if these issues do get on the policy agenda that they will remain there.

The literature indicates that government action more times than not does reflect the interests of the most powerful groups. I support this perspective. A study conducted by Gilens and Page (2014) indicated that elites in the economy, business interests and organised groups have a significant impact on U.S. government policy. What powerful groups lack in numbers they make up for in money and within political circles, funding speaks volumes. Rennie (2016) stated that as a result of an ideological shift in the 1970s, this heralded a re-evaluation of how corporations saw themselves as part of civic society. Eventually, the notion of special interest replaced that of civic duty and the public sector became fair game.

An example of how special interest groups have influenced politics in the U.S. is reflected in the National Rifle Association’s (NRA) ability to wield power over Congress because they provide campaign funds. As a result of this, liberal and conservative congressional members alike circumvent or vote against gun control policies despite the fact that the Centre for Disease Control (CDC) and other key health care organizations have repeatedly identified gun violence as a public health threat. This arrangement exists because in order to be re-elected, there must be an availability of funds. To access these funds, politicians realise that they must acquiesce to the requests of certain groups who hold the moneybag for their campaigns. This translates into politicians advocating for the interests of the few and this is what eventually sets the agenda for policy discussions.

The overarching agenda of the government is often informed by the campaign’s agenda. The candidate promotes his/her agenda on the basis or hope that the majority in fact wants what s/he is promising to deliver. This agenda is then framed by problems and alternative solutions that gain or lose the attention of the public. The foregoing forms the basis of majoritarian electoral democracy. However, the majoritarian electoral theory does not account for variables relating to wealthy persons and special interest groups. William Domhoff (cited by Gilen & Page, 2014) offered insight into how high power groups and people work through charities, think-tanks, and opinion influencing machinery and politicians to set the agenda for key issues that dominate policy making notwithstanding the democratic election process.

Since not all of the problems that face a country can be addressed, there is intense competition for responsiveness to a particular group’s agenda. Groups must also compete to earn their spot on the agenda. Birkland (2007) opined that as issues come to the forefront, there are many approaches and in order to keep the issue on the agenda, these groups must continuously reiterate them so that they are actively considered. If that particular approach to a problem prevails in a policy debate, then the issue/group will get the attention it desires. If these groups already have a powerful congressional member championing their cause, then it is possible to make great inroads even if the majority disagrees with the policy proposed.

Taken together, from the discussion above, one can see how special interest groups provide a fundamental link between the government and what ultimately gets on the agenda. These groups however, are further connected to the economy and may be a powerful non-majority force behind the scenes that wield political influence in their favour.

In recent years there have been both enabling factors in the redistribution of health care resources, as well as, factors that have restrained this. Enabling factors are illustrated in the move by over twenty countries to establish social health insurance to increase health funding with the intent to extend this coverage to entire populations, and in so doing provide health care at an affordable cost for all (Carrin & James, 2005). In Canada for example, over CAD$50 billion was given to various provinces to assist with hospitals, health care costs, prescriptions and doctor-patient care (Wolfson, 2018). This is supported by a commitment of 40% of Canada’s fiscal budget towards health care. However, health care costs for countries like Canada have begun to increase in comparison to GDP and this has created challenges for advancing health care redistribution (Stabile, 2011).

In some countries, bold moves in the right direction have now become hindered by failure to commit financial resources to support health care redistribution (Maeda et al., 2014). This is perhaps the most significant reason that resources cannot be redistributed to where they are needed. It is always money that dictates who gets what. Additionally, while there have been many new technological advances in medicine, it is often the case that these do not reach the majority who could benefit from them. This is because there is no active allocation of funds for creating access to these technologies to those in resource-poor communities, seniors, or the aged with limited education, and consumers in regions with limited access to the internet and other digital technologies. Nambisan and Nambisan (2017) have stated that health care organisations then began to bear the brunt of the burden and had to create novel and proactive strategies to help create equity in the allocation of benefits. However, this is easier said than done.

Another restraint related to the financing of health care and its redistribution, which causes people at the community level, in remote areas and of underserved populations to be unable to access health care, is that health care providers might be reluctant to open practices where they can get access. Practitioners may not want to provide medical services in remote areas because the population wouldn’t be able to financially support it. Underfunding from the government further restricts this. Furthermore, in those areas where underserved populations frequent, there may also be a dearth of health care facilities because of said lack of funding compounded by lack of security and low interest from the state and federal governments.

Competing issues on the policy agenda add further pressure to the situation. The aforementioned attempt to repeal the ACA by the current U.S. government administration is one such issue. Before the ACA was stripped of many of its features, the health care plans were more affordable, and more Americans could afford health care insurance. However, since the current administration, much of the benefits have been rescinded and the high deductible and premium costs are not affordable for even some middle class Americans. This repeal is being pursued, despite the law’s success because a powerful few do not want the ACA to be the overarching health care policy in the U.S. Critics of the repeal have suggested that a part of the underlying cause for the repeal is racism and dislike for former U.S. President, Barack Obama. Another example, was when politicians did not commit funding to support HIV/AIDS social programs, which made the HIV/AIDS epidemic worse, in part, because many people including politicians shunned the LGBT community when they could and should have allocated funds that could have helped to lessen the impact of the disease at a time when it was on the rise.

Other factors that have hindered the restructuring of health care are uneven allocation of power, social, economic, environmental and structural disproportions. These are considerations that come into play because power and resource distribution are dissimilar along lines of race, gender, social class, sexual inclination, gender expression, and other dimensions of individual and group identity (National Academies of Sciences, Engineering, and Medicine, 2017). This is especially the case because much of these groups have only recently gained acknowledgement or are still battling for equality and have little power in the longstanding institutions of government, which at times rejects the equality that members of these groups have attained, such as same-sex marriage.

In proposing solutions to enable health care redistribution, the best way to overcome the politics of health care is that the government needs to assume a greater role in providing finance for health care services. This may require an increase in the taxes people pay but it would perhaps still work out less to the amount some people pay for a year’s worth of insurance in premiums or insurance deductibles in the existing system.

In the case of the U.S., more is spent in health care dollars per person than any other country in the world, and yet their ranking in the provision of health services is very low (OECD, 2018). Perhaps it is the structure of the health care policy that is the issue. In light of this, many people believe that health care in the United States must be re-organised if everyone is to be able to access health care; as it is an inalienable right guaranteed in the Constitution. De Klerk and Salazar (2018) stated that health care policy simply does not cater to many people because they cannot afford it. Rather the system is a microcosm of societal inequalities with high-deductible, high co-pay plans that have become the usual in the provision of health care. This is evident in 29% of patients who reported that they did not seek health care because the cost was prohibitive (De Klerk & Salazar, 2018).

Nambisan and Nambisan (2017) suggest that informing people about how they can access existing health care facilities is part of the solution. They also advocate for health care organizations promoting innovation by allowing research to be carried out at their facilities. This would allow some people to experience new technologies. However, while these ideas are useful if the population that often has limited access is willing to pay for the services or, if there is a social service willing to pay for them, this is not always the case.

In summary, the main factor enabling health care redistribution is financing, in that there has been greater commitment by some governments to spend substantial amounts on health care. This has been further supported by the provision of social health insurance in some countries. Ironically, while financing enables this process, it is also the main factor hindering health care redistribution in countries where enough funds are not committed to the poorest and sickest of the population or where health care policies exclude such communities. Health care practitioners who are perhaps unwilling to establish practices in underserved populations and vulnerable communities because of the personal, financial and security risks involved further compound this issue. This therefore, stymies the move to reorient health care delivery toward chronic disease prevention and management, while key health services remain inaccessible at the community level.

References

1. Birkland, T. A. (2007). Agenda Setting in Public Policy. In F. Fischer, G. J. Miller, & M.
2. S. Sidney (Eds.), Handbook of Public Policy Analysis (pp. 63-78). Boca Raton, Florida: CRC Press.
3. Carrin, G. & James, C. (2005). Social health insurance: Key factors affecting the transition towards universal coverage. International Social Security Review, 58 (1), 45 -64. https://doi.org/10.1111/j.1468-246X.2005.00209.x
4. De Klerk, K., & Salazar, M. (2018, July 17). It’s time for a single-payer health care system in the US. Here’s why. The Do. Retrieved from https://thedo.osteopathic.org/2018/07/its-time-for-a-single-payer-health-care-system-in-the-us-heres-why/
5. Gilens, M. & Page, B. I. (2014). Testing Theories of American Politics: Elites, Interest Groups, and Average Citizens. American Political Science Association, 12 (3), 564-581. doi:10.1017/S1537592714001595
6. Maeda, A., Araujo, E., Cashin, C., Harris, J., Ikegami, N., & Reich, M. R. (2014). Universal Health Coverage for Inclusive and Sustainable Development A Synthesis of 11 Country Case Studies. Washington DC: International Bank for Reconstruction and Development / The World Bank.
7. Nambisan, S., & Nambisan, P. (2017). How Should Organizations Promote Equitable Distribution of Benefits from Technological Innovation in Health Care? AMA Journal of Ethics, 19 (11), 1106-1115.
8. National Academies of Sciences, Engineering, and Medicine. (2017). The Root Causes of Health Inequity. In Baciu, A., Negussie, Y., Geller, A. & Weinstein, J. N. (Eds.), Communities in Action: Pathways to Health Equity. Washington D.C.: National Academies Press.
9. OECD. (2018). Spending on Health: Latest Trends. OECD. Retrieved from http://www.oecd.org/health/health-systems/Health-Spending-Latest-Trends-Brief.pdf
10. Rennie, G. (2016, June 8). Lobbying 101: how interest groups influence politicians and the public to get what they want. The Conversation. Retrieved from https://theconversation.com/lobbying-101-how-interest-groups-influence-politicians-and-the-public-to-get-what-they-want-60569
11. Stabile, M. (2011). Paying for the healthcare we want. In The Canada We Want in 2020 Towards a strategic policy roadmap for the federal government. Retrieved from http://canada2020backup.see-design.com/canada-we-want/wp-content/themes/canada2020/assets/pdf/en/Canada2020_E_Full-2.pdf
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13. Willemsen, M.C. (2018). Scientific Evidence and Policy Learning. In Tobacco Control Policy in the Netherlands (pp.165-182). London: Palgrave Macmillan, Cham.
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15. World Health Organisation (WHO). (2019). Understanding health policy processes. WHO. Retrieved from https://www.who.int/hac/techguidance/tools/disrupted_sectors/adhsm_mod5_en.pdf?ua=1

Many people know Health care in Scotland is free and people believe that everything under the NHS is provided with this ‘free health care’. This is not always the case. As I was sitting in the waiting room of an orthodontist a young boy came out from his checkup. At the desk, he was told that because he lost his first brace, the second set would have to be bought yourself. Obviously, this would be a shock. Turning up to an appointment which didn’t cost anything unless you decided to buy anything separately. When you have your first appointment at the orthodontist they will tell you whether the NHS has agreed to pay for the brace. This basically means if it was declined you would be made to pay for everything to start with but saying these people often believe that it will always be given out to patients free of any charge. The NHS only provides free healthcare and extras to a certain extent, and these benefits are all funded through universal taxation.

In most countries today where you need to pay for your health care and checkups. In the United Kingdom our National health service for England, Scotland and Wales are the NHS which was founded in 1948. The point of free health care is to respond to everyone’s circumstances and necessities, but should we still get free health care when many UK citizens are wealthy enough to pay for it.

When talking about the NHS there are many advantages and since thousands of people in the Uk have had free healthcare it would become difficult to suddenly put prices on everything. As Scotland, Wales and England have never had to pay for checkups and prescriptions many people don’t realise how much of impact-free healthcare is on people’s lives. I may only be speaking about one country but there are over 40 countries in the world who provide free healthcare to residents.

In Scotland, a large amount of the NHS is paid through by tax from people’s incomes. It has been said that the NHS will never get rid of free emergency treatments to patients in the UK. This means if someone was in an accident they would not have to pay for surgery or medical care. In 2003 the National Insurance for NHS financing was expanded. It increased the tax that comes from peoples wages to change through tax coming from wages for different advantages.

In many people’s opinions having the luxury of healthcare with is free means people can have a chance to speak one on one with a qualified doctor or nurse about your health and any concerns you may have. This may not seem like a huge reason why having a good healthcare system is beneficial but it has been said that talking to someone can lead to long term benefits. Having health checks tries to put attention on lowering the possibility of different illnesses. A type of illness which has been proven to have lowered means that a patient’s blood vessels can be narrowed or blocked then causes heart attacks, chest pain or stroke.

When people have worries about their health some people go straight to the internet for advice. If you are looking for medical information or concerns the internet shouldn’t be the first thing people look at. This is because the internet is full of incorrect facts and can make people worried about potential problems.

The NHS in Scotland has chosen to expand profits for parts of the health care to about £700 million. This creates more jobs to be available and allows more equipment, surgeries and medication paid for. In the last 60+years, the NHS in the Uk’s budget has increased around £140 billion.

Many people in Scotland don’t realize that prescription from the NHS was charged years ago. The SNP (The Scottish National Party) decided to change medication which is given by the NHS to be free for anyone in Scotland. This did not follow England as they are changed around £7. Although most people pay for their medication its free for children, people who take in very low earnings or people who have serious illnesses. Is this fair that only half of the company pays and the other doesn’t? Should we have to pay for our prescriptions again? This may come across that everyone in Scotland actually gets everything under the NHS free. Well, that’s not correct. In Scotland, we have a higher tax charge compared to England and Wales which people may argue to say that’s why we have free medication prescribed.

In a recent vote in parliament about leaving the EU, many people were worried it would affect the NHS in many different ways. If they decide to leave we would no longer be able to use the European Health Insurance cards. It would make travelling anywhere in the EU more difficult and if you needed any medical care you would need to pay.

After researching about this topic of NHS Free Health Care, I have discovered that it may sound like Scotland is provided with more, but realistically they are not. Although England and Wales have to pay for their medication, it is such a small part of the NHS which is not given to them. All checkups and most surgeries are provided free. Once I leave school and follow onto my future career I will have a better understanding of paying taxes to the government, which is where most of the money from the NHS comes from. I personally think there shouldn’t be any change to the NHS in England, Wales and Scotland by the way they don’t charge for health checkups for anyone who has worries. Letting patients communicate with experts in the NHS can put people at ease. Depending on their situation NHS free health care has helped thousands of people in the last 71 years. Taking this away from people would mean that many people who have very low incomes would struggle to afford to get help.

The world health organisation (2014) states that mental health is a condition of mind which includes psychological, social and emotional well-being. Mental health can also be a great factor in how an individual feels, thinks and act thereby determining how a person handles stress, make choices and relates to other people around. The US department of health and human services further state that mental health is a very important aspect of health as it affects every stage of life, from childhood through to adulthood.

Weich et al. (2006) details some factors that contribute to mental health problems, they include: family history, trauma or abuse (life experiences), biological factors such as brain or genes chemistry.

Benefits of good mental health

A good or Positive mental health allows people to: achieve their full potential; work productively; cope better with life stress; make meaningful assistances to their communities.

Ways to maintaining good mental health include: 1) getting professional help if needed; 2) liaising and interacting with other people; 3) being positive as it helps the mental strain; 4) participating in physical activities; 5) getting enough rest and making sure to sleep; 6) development coping skills or mechanism.

Trends in mental illness

Common mental disorders otherwise known as CMD are mental states which cause different types of depression or anxiety and lead to high emotional stress which in turn affect daily functions and the prevalence of CMD is telling on the society at large (Stansfeld et al., 2014). The proportion of individuals with high CMD diagnosis remained stable between 2007 -2014 as there were no significant increase in the statistics from the survey conducted by Stansfeld et al. (2014), however, the long term has seen increase in cases (6.9% of 16 to 64 year olds in 1993, 7.9% in 2000; 8.5% in 2007; 9.3% in 2014).

Adult psychiatric morbidity survey (2014) in their article “Health and wellbeing in England” highlighted the following statistical trends in mental health in England:

1. One in six adults had a common mental disorder (CMD): one woman in five women, and one man in eight. They state further that since 2000, overall rates of common mental disorder in women in England have increased, but remain stable in men.
2. Reported and documented rate of self-harm incidence increased in the population since 2007. This can be attributed to greater awareness about mental health.
3. Young females also emerged as a high-risk group, with high rates of common mental disorder (CMD, self-harm, posttraumatic stress disorder (PTSD) and bipolar disorder. The gap between young women and young men increased according to this survey.
4. Most mental disorders were more common in people living alone, in poor physical health, and not employed. Claimants of Employment and Support Allowance (ESA), a benefit aimed at those unable to work due to poor health or disability, experienced particularly high rates of all the disorders assessed.

CMD symptoms in men remained stable since 2000, while there was a marked increase in cases reported involving women. Reports of self-harm amongst men and women did increase from 2007-2014. Adult psychiatric morbidity survey (2014), Survey from Department of Health (2014) postulated that in 2014 one in five young adult women had history of self–harming. The department of health further states that most of the young people who reported self-harm did not seek professional help thereafter. The department carries on further stating that in the long term this behaviour is detrimental as it can turn to a coping mechanism for people dealing with some form of CMD and this may lead to higher suicide rate in the population.

Since 2007 increase in CMD has been prevalent amongst midlife men and women (55) and high in young women aged 16-24 (Stansfeld et al., 2014). The gap has increased overtime in the rate of symptoms between young me and women and the statistics from the survey conducted by Stansfeld et al. (2014) demonstrate this with the statistics below:

1. In 1993, 16 to 24 year old women (19.2%) were twice as likely as 16 to 24 year old men (8.4%) to have symptoms of CMD.
2. In 2014, CMD symptoms were more common in women of that age (26.0%) than men (9.1%). CMDs were more predominant in certain groups of the general population which included Black women, adults under the age of 60 who lived by themselves, women who lived in big households, individuals not in employment.

Conclusion

According to Zivin et al. (2015), the reduction of Common mental disorders like anxiety and depression has become a major public challenge for the NHS over the years. CMD are linked and associated with social and physical problems and in most cases can end or result in social and occupational malfunction and physical impairment. CMD are a serious and important source of distress to people with symptoms and even those around them are affected which in turn affects the society at large. In most cases anxiety and depression remain undiagnosed and treatment is not received by individuals suffering from it.

Zivin et al. (2015) concludes that if mental health is left, unattended or untreated, CMDs will lead to long term social, occupational and physical disability and can lead to premature mortality.

The health and well-being of all people should be a number one priority, especially to those veterans, military and their families. Unfortunately, it is not a priority. There has been a lot of research done throughout the years that portrays the negative consequences our veterans and military undergo through the transition of military life to civilian life. I admit that when the Trump administration has taken over, health care for veterans and those on active duty have become somewhat better. I strongly believe in order to address this concern, it needs to begin the moment they enlist.

My uncle served in the U.S. Navy for many years. He explained the many great benefits they receive, as well as their families. However, it seems that when it comes to health issues and well-being, improvement could be used. A study published on January 1, 2020 in the American Journal of Preventive Medicine examined 9,566 U.S. veterans throughout a 3-year span. Well-being concerns were generally notable for recently isolated veterans, with numerous veterans revealing that they had chronic physical (53%) or mental (33%) well-being conditions.

If our armed forces willingly go into the line of fire to protect and serve the people, how is their health and well-being even an issue? I strongly believe that from the moment they enlist until the moment they are no longer walking this Earth, we should be making sure they are healthy physically, mentally, and emotionally. Their families should also be treated as such. They should have constant check-ups, whether that means a physical, a therapy session, or counseling. While many can argue that they have the Veterans Affairs to assist in this situation, sometimes problems are caught too late.

Since these individuals are away from their families and under a lot of stress, they may not be able to or have access to the help they require immediately. Sometimes, by the time they are retired and have the time to seek the medical assistance, they find out they have many medical issues that could have been prevented if caught earlier on. While we are fortunate enough to have the U.S Department of Defense (DoD) and the U.S. Department of Veteran’s Affairs (VA), these approaches do not suffice the care needed. The cost of this is expensive. Also, clinicians and arrangement experts must conquer existing knowledge barriers.

In the long run, while most people are concerned with the cost, we tend to forget our veterans and what they represent. We need to value the enlisted, retired, and their families for all of their sacrifices. It would be excellent to provide better quality of care and affordable care as well for these men and women. We represent the red, white, and blue of the American flag that our ancestors fought to grant us freedom. In order to give thanks for the beloved gift they bestowed upon us, we must take care of those fighting and those who fought for our country.

As we are in the center of a presidential campaign where several politicians are debating the need for a huge health reform, it is important to talk about the current health care policy focusing so heavily on cost and relatively little on quality. Health insurance remains a big topic in American policy, with critical discussions about affordable care provision and the overall expense of health care. The purpose of health care coverage is to separate individuals from high cost pressures on health care and to promote access to health care. Policies linked to coverage influence how Americans receive health care, how insurance companies are compensated for it, and what benefits they do and don’t provide. Debates on whether to minimize the amount of individuals lacking health care, if Americans will have to be compensated for their employers, whether their deductibles are too big, or whether to adjust the rates needed by government compensation plans, fall into this range.

There are three aspects of health care reform to address in the American health care system: quality, expense and access. Cost and quality are the two groups that are similarly relevant individually. Improving access to health care will increase the cost for consumers, and payers. Often we will allow health care alterations that have a significant effect on access, quality and cost. While examining health care policies, it is important to analyze, consider and talk about the consequences for cost, quality and access. According to the U.S System Performance graphic on the Edx page, the speaker displays the 2011 Health Cost Per Capita. The United States becomes the most wealthy country in the world. The reader made a brilliant point that because we invest too much money relative to other nations, one would conclude that we are better off. This is the furthest from the truth, there are certain inherent expenses, such as the gross domestic (GDP) that can be described as the overall value of the economy. Many times when healthcare is brought up in conversation, I question, why are we not afforded the opportunity to have universal healthcare, sure many countries have adopted this and even implemented this policy.

While certain analysts can see problems affecting the health care system as interrelated, the public frequently focuses at a given moment on one or two concerns that are more relevant for the government to address. For starters, when questioned in April 2006 what they felt were the two most significant health or health care problems to be resolved by the government, Americans listed health insurance expenses as a main concern (39%), followed by uninsured/ access to treatment (25%) and Medicare/seniors’ health care (14%). 1% ranked standard of treatment as one of the most critical primary and/or health service concerns (Kaiser Family Foundation Poll 2006b).

Referencing the textbook, ‘Delivering Healthcare in America’ by Leiyu Shi mentions many people opted out of enrolling in health insurance through an employer because of fear or not being able to financially afford premiums (Shi & Singh 2014). People choosing not to be covered by an insurance company causes many to be insured resulting in high medical bills and debt. Again this is another issue that shines a light on the cost of healthcare in America being insane which results in people sacrificing their health due to financial fears. To help combat the issue of having many citizens not being able to afford health care the Obama Administration implemented The Patient Protection and Affordable Care Act of 2010. This act was one of the most successful reforms in U.S History. This is influential because citizens do not have to supplement quality of care due to lack of funds. Sacrifices like these are being made often by working citizens. It is inhumane and unethical for citizens, hopefully the current presidential candidates deeply consider universal healthcare with no stipulations and restrictions like pre existing medical conditions making access to care beneficial and convenient for everyone at no cost.

It seems like the policy makers and the government have their work cut out to make the U.S Healthcare better but is beneficial in the long run.