Category: Health Care Policy

The provision of health care in the United States (U.S.) does not function as a logical and interconnected system network designed to work together in a coherent manner. Instead, it is devoid of any unity and remains poorly structured in terms of funding, insurance delivery, distribution and payment processes. In a system that is fundamentally fractured and in which the different system components fit together only loosely, there is little standardization. Since a central agency like government does not control the overall operation of such a program, replication issues, confusion, inadequacy, inconsistency, and waste occur. Lack of planning, direction and coordination across the system leads to a complex and inefficient system. Therefore, handling or regulating is almost impossible. The U.S. health care program is short of offering equal care to all Americans and unable to provide cost-effective programs (Shi & Singh, 2019).

The Affordable Care Act (ACA) changed the U.S. health care system significantly. The goals of the law were to reduce the number of people who were not covered, make coverage more affordable, and improve access to care. Since the introduction of the ACA, an estimated 20 million people have become newly insured, and by federal tax credits and Medicaid expansion, about 24 million people have gained access to subsidized or free treatment. Notwithstanding these milestones, from the start, the legislation has encountered strong political resistance. Repeated calls from both sides of the political spectrum have been made to repeal the law and replace it with new laws or amend the law to accomplish certain goals. Since it was passed in 2010, there has been a strong push to repeal the ACA (Rand Health Care). Matter of fact, President Trump signed an executive order on his first day of office in January 2017, essentially abolishing small portions of the ACA dealing with taxes and fees (Shi & Singh, 2019). The American Health Care Act (AHCA) is an alternative to the Affordable Care Act, with modifications passed by the Senate in May 2017. The AHCA is making significant changes to the ACA, although it is not formally repealed (Rand Health Care). Congressional dysfunction and growing deep partisan divisions are becoming increasingly dim and one wonders whether this political gridlock will continue to be the new norm. The political impasse and the challenge of passing laws will only affect the needs of the American people.

Proposed Changes to a Highly Partisan Congress

A site of tremendous resentment and tension has become what was once considered a respected division of the federal government. The public approval of Congress now hovers just over 10%, a huge drop from just under 20 years ago to almost 50%. Increasing bipartisan partnerships and creating better conditions for legislative deliberation, negotiation and compromise is necessary in order to change a system that has become increasingly dysfunctional (Hewlett Foundation, 2016). A democracy that works well has become almost non-existent. There are a number of important issues that concern American voters. Health care and accessibility, efficiency, expense and reduction of health inequalities are at the top of the list.

A well-functioning government requires some degree of openness, responsiveness, and tolerance from both parties to pass good laws on behalf of the American people’s needs. In debating health policy proposals, initiatives that provide effective solutions to strengthen the U.S. health care system are highly partisan, with little or no likelihood of passing. In regards to health care, most Americans want to see a bipartisanship Congress who are willing cooperate through compromise. With the amount of rancor in place at the moment, it won’t be bipartisan for all members of Congress. Nonetheless, those who can be bipartisan will need to lead the way in proposing health care reform measures that would enhance all Americans’ health coverage. A suggestion would be to begin with items that can be agreed upon, to maintain successful provisions and to change the ACA’s controversial provisions. Bipartisan members of Congress need to collaborate and propose legislation with reasonably high levels of support from both parties. This would most likely have to begin at the middle of the ideological spectrum of ideologies with moderate members of Congress.

This writer also agrees with the suggestion of building new bipartisan partnerships is the belief that bringing together members of Congress and staff from opposing political parties for educational, informational, and social events would result in more interaction, better working relationships, and eventually more successful legislation. An example of this is the Rodel Fellowships in Public Leadership program of the Aspen Institute which selects 24 Rodel fellows each year. These fellowships are evenly split between Republicans and Democrats who have demonstrated the ability to collaborate across political and ideological lines for a two-year leadership development program (Hewlett Foundation, 2016). These proposed changes to a highly partisan Congress could possibly help members of Congress work together to pass meaningful health care legislation.

Conclusion

Currently, there are over 700 health care policy legislative proposals in Congress addressing the health care system at large (Evans & Fleming, 2019). Examples of these include legislative proposals which address high costs of health care, prescription drugs, insurance premiums, strengthening the ACA, Medicare and Medicaid reforms, hospital price transparency and competition, age band rating, telehealth services, long-term care services, to name a few (GovTrack, 2019). These are issues that affect every American. Unfortunately, few of these bills have bipartisan support necessary for them to be enacted in Congress (Evans & Fleming, 2019).

References

1. Evans, M.L. & Fleming, K. (July 7, 2019). 5 Key Healthcare Issues Pending in Congress: New Rules that Could Change How You Get Healthcare. Retrieved on December 30, 2019 from https://www.forbes.com/sites/allbusiness/2019/07/07/5-key-healthcare-issues- pending-in-congress-new rules-that-could-change-how-you-get- healthcare/#767be56b1ed9
2. GovTrack.us (2019). Bills and Resolutions. Retrieved from https://www.govtrack.us/congress/bills/
3. Rand Health Care (n.d.). The Future of U.S. Health Care: Replace or Revise the Affordable Care Act? Rand Health Care. Retrieved on December 30, 2019 from https://www.rand.org/health-care/key-topics/health-policy/in-depth.html
4. Shi, L., & Singh, D.A. (2019). Delivering Health care in America: A Systems Approach (7th ed). Sudbury, MA: Jones and Bartlett.
5. William and Flora Hewlett Foundation (October 13, 2016). In a polarized era, efforts to boost bipartisanship in Congress. Retrieved on December 30, 2919 from https://hewlett.org/making-bipartisanship-stick-in-congress/

Most countries in the world can get and provide good and ample medical coverage to each of their citizens throughout and give good healthcare facilities by the provision of universal health care coverage. Though this may be a factor that helps in the inclusion of all ages and all people in these countries, the United States of America offers a new and all-round system towards healthcare. This has impacted more than just the inclusion of all ages but also it has been able to give a hand in citizens in states that have a low life expectancy, a high mortality rate and most preventable hospital admissions. This leads to most of the states’ citizens to have a lack of medical health insurance amongst most of their populations. This system of provision of health care that has been developed in the United States is known as the Medicaid program.

History of the Medicaid Program

Accordance to the Title XIX of the Social Security Act that was signed into law in 1965, Medicaid was authorised and since then has been the largest health insurance program across the United States. As it was passed into law, Medicaid was designed to provide health coverage to low-income individuals that helped millions of these individuals with a massive healthcare boost. Federal guidelines that have been set by the United States Department of Health and Human Services (HHS) that assist each state individually to set their own Medicaid programs that fall under the Centers for Medicare and Medicaid Services (CMS) – a federal agency that governs the whole of the countrywide Medicaid program (2012, Kaiser Family Foundation).

Initially, the Medicaid program was intended and offered to people who were receiving cash assistance, but slowly through the years has been expanded to include and cover more population. As early as 1967, the Medicaid program provided health services for all children who qualified and slowly with federal laws being introduced in 1986, pregnant women were also added into the program under the Federal Poverty Level as a state option. 1989 became a revolution for all pregnant women and children under the age of six and proper coverage of up to 13.3% of cover. In 1990, children of all ages from the age of 6 to 18 were included by the federal government in the insurance program covering up to 100% of the cover (CMS, 2015). As the years progressed, the Children’s Health Insurance Program (CHIP) was established in 1997 and helped cover children in families with high incomes who do not qualify for Medicaid (Medicaid.gov.(n.d.). Program History).

Eligibility for the Medicaid Program

The state and federal governments take part in jointly financing the Medicaid program which constitutes of a vast set of laws that help not only to provide medical cover to the population but also offers benefits that help innovate the program for more potential applicants in society. Each state is eligible to determine all policies and programs individually and accordingly and then approved by the CMS so that each state is viable to receive the federal and state funds (CMS, 2017).

The Obamacare – also known as the Affordable Care Act – was passed as law in 2010 in and enacted under the Medicaid program. This law helped the society to access medical care without various medical insurances charging more or denying health insurance to people who had pre-existing conditions. The law also provided 100% of the federal government’s funding. This also went on to the fact that the law authorised other states to simplify and modernize their health plan processes of enrolment. With this law passed into the Medicaid program, there was no longer a preference in who got privileges of the Medicaid program but almost everyone was eligible. This included low-income families, pregnant women, children, individuals with disabilities, seniors, individuals in need of long-term care, and some states low-income adults ages 18-65, without dependent children, commonly referred to as childless adults (CMS, 2013).

Benefits of the Medicaid Program

The Medicaid program was expanded with the inclusion of Obamacare into law that had held more benefits into anyone eligible to it that the previous package that Medicaid offered. These benefits were set up as mandatory benefits in most states and optional benefits in some that offered more than what the CMS had put out as a must for each individual to get.

Mandatory benefits as per the Medicaid program include inpatient and outpatient hospital services, Nursing facility services, Home health services, Physician services, Rural health clinic services, Laboratory and X-ray services, Ambulatory patient services, Hospitalization, Mental health services and addiction treatment. This also included rehabilitative services and devices, paediatric services, transportation to medical care and Prescription drugs.

Optional benefits included eyeglasses, hospice and personal care, respiratory and TB related services, occupational therapy and speech, hearing and language disorder services. All of these and much more differed from state to state depending on which state provided what (Ellis, 2004).

Advantages and Disadvantages of the Medicaid System

Through Medicaid coverage, in an attempt to achieve insurance coverage all around Texas for low-income individuals, there has also been the following as advantages to the introduction and integration of Medicaid to the state:

1. The cost of health care services has been cut by half with the federal government taking care of the other half. (p. Milbank Memorial Fund [2005])
2. The State of Texas has designated networks that help foster the provision of the Medicaid program through administrative networks.
3. There is a reduced number of uninsured individuals in the state.
4. There has been a reduced burden of cost-shifting to employers and also other purchasers of private coverage, and health care providers.

Though with these advantages, there have been downward spirals into the Medicaid program which may include:

1. Some of the citizens of the state prefer to seek health care services in the private sector and choose to go over the government’s initiative to lowered healthcare services.
2. In helping the backing of the federal government to help in the program, at times state funds may be a factor in them being inadequate to help fund the n program fully.
3. The future may seem dark with some of the eligible individuals being pushed off the list in new future as the state seems to believe they do not qualify for the same benefits as others who are already eligible (Milbank Memorial Fund, 2005).

Conclusion

The Medicaid program has evolved from one that covers specific categories of very low-income people bringing to light expanded coverage and flexibility. The program has started out targeting children from low-income residences now has come up to include a vast majority of eligible individuals across the state of Texas. With the escalating costs of the Medicaid program in proportion to the increase in eligible beneficiaries and health care costs, there are discussions about potential opportunities to reform the program. Proposals to reform Medicaid often consist of common themes, such as resetting eligibility limits, changing the required benefits, redesigning delivery systems, incentivizing providers to improve quality of care with value-based initiatives, and shifting the balance of federal and state financing and responsibilities.

When investigating the impacts of Medicaid, the emotional parts in social insurance spending and the portion of GDP committed to human services have raised worries about the negative effect of medicinal services cost swelling on the U.S. economy. The impacts are probably going to happen over all segments of the economy – governments, organizations and families – as all these interrelated parts assume a significant job in the arrangement, financing and utilization of medicinal services in the US. For instance, federal, state and nearby governments gather charges from organizations and family units to back general medical coverage programs and to straightforwardly give medicinal services to families.

Organizations give work to US families and furthermore give medical coverage to their representatives. Families are the last customers of social insurance and furthermore bear some frequency of human services costs. In this report we independently recognize the impacts of medicinal services costs on the total economy and on every single one of these interrelated parts. In any case, note that the impacts of human services costs on one segment are probably going to influence results in different divisions. For instance, looked with rising social insurance costs governments may endeavor to decrease wellbeing spending by diminishing qualification for general medical coverage, thusly expanding reinsurance rates among families. The expansion in social insurance expenses may likewise incite governments to raise charges, increment getting or lessen interests in other basic parts, for example, instruction and framework, smothering monetary development and influencing the two organizations and family units

Some of the time there is an absence of inspiration for people to work when Medicaid covers themselves and kids if the most extreme pay isn’t met. Having the option to get Medicaid while not working or working hardly any hours is an advantage for some individuals. In all sincerely individuals see no motivation to show signs of improvement occupations or a wellspring of salary since they are disabled by the advantages they are getting. There is a path around working more hours to get free medicinal services for self as well as family.

There are many opportunities for individuals to receiver Medicaid, whether it’s income, no income household reason etc. In certain states the expenses and advantages of an earlier endorsement instrument by Health Departments audits the requirements for the arrangement of chose kinds of exorbitant social insurance and administrations. The audit is made preceding the arrangement of the administration and Medicaid installment for the administration is dependent upon the aftereffect of the survey. Expenses incorporate program organization and structure handling. Advantages incorporate the estimation of administrations which are either denied or changed because of the earlier endorsement process. The investigation shows that three of the seven earlier endorsement classes are cost-advantageous regardless of discouragement benefits. For the other four classifications, the aftereffects of this investigation have been utilized to propose new strategies (ldh.la.gov).

Partner support, starting with program plan and proceeding through the assessment, is basic to a fruitful Medicaid care the board program. Partners ought to be included during each phase of the program to construct support for it, give proposals to its plan, and take part in assessment and persistent quality improvement exercises. Partners incorporate senior Medicaid and office administration, the Governor’s office, the supplier network, the patient and backing network, the State council, and the Centers for Medicare and Medicaid Services (CMS). Including partners during all phases of a consideration the executives’ program can prompt early purchase in, fruitful program structure, and foundation of long-haul support for the program. The accompanying subsections plot three procedures to draw in partners recognizing ‘champions’, setting up connections and discussing routinely with partners, and overseeing desires for the consideration the board program. Rivals of Medicaid have questioned the law, regularly summoning an ethical contention that it damages individual and states’ privileges. In any case, in their endeavors to undermine the law, huge numbers of its most vocal enemies are submitting their very own ethical offense. The dismissal by a few Republican-drove conditions of the Affordable Care Act’s Medicaid development to give medicinal services access to many America’s poor isn’t simply factional legislative issues; it’s unethical. Luckily, states can sign on to Medicaid development whenever, so it’s not very late for residents to press their state heads to put individuals in front of partisanship and help Americans out of luck (ahrq.gov).

While each state’s arrangement of commitment methodologies and motivating forces is exceptional, the exhibits share two expansive objectives. These objectives incorporate structure mindfulness of the expenses of care and urging recipients to change certain wellbeing practices. As an end-result of thinking about the expenses of their consideration and additionally looking for preventive consideration, each state gives taking part recipients money related prizes as well as improved advantages. These understood agreements between the state and recipients can be straightforward or complex, which thus request contrasting degrees of understanding and key conduct from members to acquire the potential prizes.

It is said that on July 30, 1965, President Lyndon B. Johnson marked into law enactment that built up the Medicare and Medicaid programs. For a long time, these projects have been ensuring the wellbeing and prosperity of a huge number of American families, sparing lives, and improving the financial security of our country (Cms.gov).

Numerous individuals know that the present social insurance framework is in a tough situation and needing change. The encounters of numerous individuals rehearsing regarding genuine social insurance are rousing them to take on some type of a backing job so as to impact an adjustment in strategies, laws, or guidelines that administer the bigger medicinal services framework. This kind of backing requires venturing past their own work on setting and into the less natural universe of strategy and governmental issues, a world wherein numerous medical attendants don’t feel arranged to work adequately. Effective strategy backing relies upon having the power, the will, the time, and the vitality, alongside the political abilities expected to ‘play the game’ in the administrative field.

Democrats have been battling to verify all-inclusive medicinal services for the American individuals for ages, and they are pleased to be the gathering that passed Medicare, Medicaid, and the Affordable Care Act. Democrats are mainly focused on safeguarding and securing the Affordable Care Act and the genuine feelings of serenity it has brought to a huge number of Americans, and they will battle all endeavors of whoever is attempting to revoke the law and remove social insurance from countless Americans. This ensures that everyone is safe and not effected.

References

1. “Medicaid”. Department of Health | State of Louisiana, www.ldh.la.gov
2. Fishman, Eliot. “Medicaid Policy And Partisan Politics: A New Dynamic”. Medicaid Policy And Partisan Politics: A New Dynamic | Health Affairs, 15 Oct. 2019, www.healthaffairs.org/do/10.1377/hblog20191015.597909/full/
3. “Opponents of Medicaid Expansion Put Politics over People”. The Christian Science Monitor, The Christian Science Monitor, 11 Apr. 2013, www.csmonitor.com/Commentary/Opinion/2013/0411/Opponents-of-Medicaid-expansion-put-politics-over-people

The new provision of work requirements and reporting was proposed by the Trump Administration’s Centers of Medicare and Medicaid in 2018 (Latham, 2018). This provision requires people to either involve in 80 hours of job or community engagement per month to be eligible for Medicaid unless they get an exemption. Exemption of these requirements applies to pregnant, 50 years and older populations, students, caregivers and people with disabilities, who are deemed unfit for any kinds of jobs (Anna L.Goldman, Steffie Woolhandler, David U. Himmelstein, David H. Bor, & Danny McCormick, 2018). It has been a controversial topic in America since its introduction (Sommers, Fry, Blendon, & Epstein, 2018). While some people may argue this to be a remarkable policy, there are others who oppose this idea. I will briefly present some of the arguments for these policies on this paper.

There have been arguments that though the new policy regarding the work requirements have been enacted many people are still unaware of these requirements. Enough information about these policies has not been communicated to people which put them in risk for losing their coverage (Musumeci, Rudowitz, & Lyons, 2018). Even those who are aware of these policies might have difficulty navigating the process, setting the online account and reporting their hours. Issues of internet access, computer skills, and literacy might hinder the process of reporting (Musumeci et al., 2018). For instance, a person living in the rural area of the country who has no internet access and no computer literacy cannot be expected to have an online account through which he could report his hours. The question is, under those circumstances, would it be fair to declare him ineligible for the Medicaid which might be his only option to access to health care? Similarly, the vulnerable populations like homeless and unemployed people who live in faraway isolated areas whose immediate need would be food and shelter would they care enough about reporting the time? Meanwhile, as a result of policies as such, they will also lose their coverage (Musumeci et al., 2018). Moreover, Medicaid is for people with low socioeconomic status. There are many people in America who are poor even though they have jobs. So, the people who might not get consistent hours in their jobs will certainly lose their coverage under the new policies.

While there may be arguments on how government aids and assistance might result in disincentive to work for low-income individuals, opponents put forward the idea of how these new policies of work requirements put more apprehension on people and affect both their physical and mental health severely (Latham, 2018; Musumeci et al., 2018). Those who rely on Medicaid for their health care are likely to have negative health outcomes as they lose their coverage (Musumeci et al., 2018). For instance, a Medicaid beneficiary who gets his prescription for management of severe hypertension and diabetes will be severely affected without the insurance. A study done in 2018 predicts that if these requirements were to be applied nationwide with the application of all exemptions, 2.1 million Americans could be at risk for losing their coverage soon (A. L. Goldman, S. Woolhandler, D. U. Himmelstein, D. H. Bor, & D. McCormick, 2018). Just when many people have been benefitted by the expansion of Medicaid coverage under ACA, these requirements will leave a huge chunk of Americans insured (Center on Budget and Policy Priorities, 2018). Undoubtedly, this would impose negative health outcomes for many people.

When we are trying to defeat chronic diseases and other health problems through the medical miracles and innovations, government policies like this would push back the victory America has been trying to make in the health sector. I can only think of health being a privilege rather than right in a situation like this. Those who are already in bad shape due to economy, disabilities and limited health care will possibly be in worst shape after these requirements. On the brighter side, arguments on how work requirements can give Medicaid beneficiaries a sense of dignity and responsibility towards the community have been proposed (Chougule, 2018; Rosenbaum, 2018). Amidst the brighter and darker sides of these work and reporting requirements, I personally feel risks outweigh the benefits in this case. Hence, before implementing any new policies, the people in power should study analyze the multiple facets of the issues so that most people get benefitted by any new policies.

Pre-exposure Prophylaxis (PrEP), is an HIV prevention policy mostly for gay and bisexual people living in the UK. It involves using ARVs on those that are HIV negative and other comprehensive packages to prevent HIV transmission (Steward Kate, 2016), The importance of the policy is to create awareness and initiate people on the effective of ANT by health professionals to suppress HIV activity in the bodily fluid to prevent the risk of HIV transmission and other STI to one another (Eakle et al, 2018). Several researchers including the PROUD Trial discovered that PrEP is scientifically proven successful to reduce 86% exposure of HIV transmission. This had caused a stable rate of HIV transmission in the UK for past years. However, PrEP faces the challenges of ignorance of its efficacy. People are more likely to engage in unprotected sex to use PrEp afterwards. ( McCormack et al., 2015). Secondly, failure to comply with dosage intake as it is required to be taking daily to increase the adequate level of drugs in the tissue that are vulnerable to HIV infection (Fonner et al., 2016). For some years now PrEP has been unavailable in the UK because of the cost and not funded by the NHS. Instead is been under deliberation by the NHS England and HIV Clinical Reference Group (CRG) as they are planning to make it available from this year (PHE, 2019). To break these barriers, individuals need to be fully informed regarding PrEP efficiency, adherence of ARV drugs and encouraged to consistently use a condom to avoid being exposed to HIV.

HIV and AIDS prevention intervention programmes are strategies established by different government, private and charity agencies to minimise the spread of HIV through merging of behavioural, biomedical, and structural interventions (Avert, 2019). South Africa National Strategic Plan (NSP) 2017 to 2022 is a 5 years initiative in partnership with the National, local government, civil society, and private organisations to tackle HIV, TB and STIs. The mandate of this scheme is to establish a zero-tolerance on infection, minimise unequal right and sexual violence against women, health inequalities, stigma, and discrimination on those living with HIV (NSP, 2017). NSP was successful to break the cycle of HIV transmission and extended the intervention to the target population using different organisation. It provided the resources needed and deliver an integrated treatment to HIV which generated motivating feedback from society ( Kathlyn et al., 2018).

Nevertheless, health care workers were unable not to trace the patient’s data during the period of care in the result of the poor information system. Secondly, 70% of health facilities experience a shortage of ARV drugs and health care workers. This because of a reduction in the 2016 fiscal budget by the national department of health (NDOH) results in an insufficient fund to hire doctors (Kathlyn et al., 2018). However, introducing an electronic data recording system to monitor ART will improve accurate monitoring and evaluation services for delivering long term care (Meg Osler et al., 2014). Again, using a national supply chain action plan monitoring scheme linked with, stakeholders, DOH and National Health Insurance Policy can resolve these issues of shortage ARV of drugs and health care workers (Christopher, 2016; DOH, 2016).

HIV Prevention England (HPE ) is a national co-ordinated integrated scheme sponsored by PHE and part of Terrence Higgins Trust registered charity (THT) in the UK in collaboration with NHS clinics, General Practitioners, local authorities, and faith communities (PHE, 2019). HPE goals are to deliver a contemporary service utilising support network, outreach, and mass media to inspire the society and extend adequate support and standard care to those vulnerable to HIV in England (Avert, 2019). HPE intervention was successful to expand HIV testing facilities, HIV Self-Testing approach (HIVST), distribution of free condoms, immediate diagnostic and treatment to stop further transmission and tackled health inequalities within people living with HIV and AIDS (THT, 2019; NICE, 2018). Although, individuals were concerns about a breach of confidentiality due to a public HIV test. The fear of testing HIV positive as this could cause stigma in society. Nevertheless, introducing a straightforward HIVST with an accurate diagnostic result will make it available for people to use anytime, reduce stigma, promote confidentiality and HIV testing uptake. Although, there is a risk of harm with HIVST. Therefore, individuals need to be counsel before uptaking HIVST to prevent self-harm (Doddds et al., 2018; Wizel et al., 2016).

Health inequalities was another challenge encountered during the implantation of NSP initiatives in South Africa. Health inequalities are socio-economic differences in health outcomes that exist between individual of diverse gender, age and ethnic background which causes poor health conditions, increases in morbidity rate and low life of expectancy (Upton & Thirlaway). While health equity is the fairness in the distribution of health resources to obtain adequate health and wellbeing of the individual in a community regardless of the protected characteristics, (APHN, 2015). Marmot Review Fair Society Healthy lives (2010) suggested that lack of education, low income, poor housing, unemployment, unhealthy lifestyles choices, social activities people engage in, the decisions made by the government and poor access to health services are significant causes to health inequalities. These variations are been referred to as The Determinant of Health (Dahlgren and Whitehead, 1992).

South Africa experience an unfair distribution of income because 20% of the population top hierarchy’s is living with 68% of the country’s income should be invested in the health care system, support services, housing and transportation for the entire society (IMF, 2020). Those living with HIV and AIDS were unable to afford HIV drugs and access proper medical treatment. There are 2.8 number of hospital beds and 1.3 nurses and midwives per 1000 population in South African (World Bank, 2015). Again, People living with HIV and AIDS are been stigmatised and discriminated from their peers, families, and society. They find it difficult to get a job as unemployment among the youths is uncommon to compare to the emerging market. There is a reduction in labour supply, poor generation of tax and revenue. Consequently, has caused a shrank in Gross Domestic Product (GDP) and the Income Per Capita in urban areas are twice as the rate identified in rural provinces. Gender inequality and violence against women has been a major concern. The women are less likely uneducated, and unemployed because they are not allowed to participate, and advance in the political systems (Sia et al., 2016). About 8.8 per in 100,000 population of women are physical injuries, sexual assault and murdered by their intimate sexual partner causing them vulnerable to HIV infection (Frade & De Wet-Billings, 2019).

To reduce health inequalities in South Africa, the issue of corruption should be addressed by the government and ensure that everyone benefited from the country resources. Again, the government should implement policies that will improve access to women education, social grant, standard health care system to all, create employment opportunities and skills development for the youth to boost taxation and revenue and reduce the high cost of living (Omotoso & Koch, 2018). Moreover, women should be given equal right to take part in the political and socio-economic system and their sexual reproductive right should be respected by all. Also, family members and peers of an individual living with HIV and AIDS should avoid stigma and discrimination to reduce health inequalities (Amin, 2015).

In the UK not all communities are benefiting from HPE. 51% of bisexual and gay communities living in the UK are more likely to experience stigma and discrimination in schools and workplaces (THT, 2020). They are unable to access sexual health services due to the places they live while some might not want to attend because they do not want to reveal their sexual identity to health care workers. Those that attend are more likely to stay a longer time during the appointment. This is because there is 2.9 number of hospital beds and 8.3 nurses and midwives per 1000 population in the UK. Those that lived in a more deprived area are likely to experience poorer health outcome as the average life expectancy is ………………. All these factors have an impact on people’s mental health and result in less life expectancy (World Bank, 2015; PHE, 2014).

To reduce health inequalities the UK government should implement policies that target a change in a behaviour lifestyle, invest in more deprived so that people that live in this area will have full access to health care services. There should be a fair distribution of the income and provision of social support to an individual living with HIV and AIDS. Investment should be made in housing so that individuals without shelter could access homeless service, mental health support and social protection for those on low income and unemployed (Smith & Morkandlik, 2015). Moreover, provision of immediate access to ART to those living with HIV is likely to increase their life expectancy 15 years longer to compare to those that started treatment later (May et al, 2011).

‘The Immortal Life of Henrietta Lacks’, by Rebecca Skloot (2010) tells a story of a poor African American woman whose cancer cells were extracted without her awareness or consent and used for medical research at a lab of the Johns Hopkins University hospital. These cancer cells, later known as HeLa cells would become a major breakthrough in the field of medical research. The story is told from the viewpoint of a reporter who was diligent and thorough in collecting large amounts of information via documents and through interviews of people who were involved in the case. This book sheds light on the morality and legal aspect of the obtainment and experimentation of a person’s cells. The underlying theme throughout this story was the issue of consent as this woman’s cells were extracted for experimental reasons without her awareness and consent. This violation of trust set the stage for many of the healthcare laws we have today regarding a patient’s consent and privacy (Deitz, 2017). Social determinants of health such as gender, race, and economic status played key roles in the story of Henrietta Lacks. Through her story, in relation to ethics, millions of lives were impacted in a positive way.

The author exposed decisions that were made by medical personnel throughout the case which were considered unethical (Dimaano & Spigner, 2017). One such decision was the failure to inform Henrietta of the possible medical risks accompanying her treatments. The act of ignoring Lacks’ expression and symptoms of pain and proceeding through these treatments without administering proper pain management measures, combined with the lack of ascertaining the patient’s consent were clear indicators of an unethical process. As Henrietta’s condition began to worsen and her cancer cells metastasized, a research project was underway that would lead to an enormous medical discovery. Even though this was for the advancement of medicine, and the benefit of the many, the process was conducted unethically (Dimaano & Spigner, 2017).

Throughout this case, there was never any mention by medical personnel to Henrietta and her family of their professional objective to extract and reproduce her cells which is a wrongful practice and quite unethical (Dimaano & Spigner, 2017). So the question can be raised as to why the medical scientists proceeded in this regard. This was a time when medical institutions did not place any emphasis on ward patients, especially since they did not pay for their treatment, and minority members were even more obstructed. These scientists acted in a way with the goal in mind of advancing medical research that they thought would be a positive research endeavor for the masses but went about it in a flawed and unethical manner.

Quite a few social determinants of health (Marmot, 2005) were key themes throughout this case. One such determinant was race. As Henrietta Lacks became ill and sought medical attention, she would be treated in a hospital that was racially segregated at that time. There was a section of the ward meant exclusively for black patients which Henrietta had to go according to the established hospital rule of that day. In this ward, it was reported that doctors and other medical personnel were not as diligent and treated patients in a more lackadaisical manner than the wards who treated white patients.

Medical research scientists and doctors treated Henrietta’s family in an unprofessional manner throughout the whole process. For instance, her family members were unaware that literally trillions of Henrietta’s cells were being sent around the world for medical treatment and research until about twenty years after she had died. The family was kept unaware, were fed lies, and were ignored with their questions and concerns. This inevitably led to a general feeling of mistrust when Rebecca Skloot initially attempted to communicate with the family to discuss Henrietta’s case for the book.

Other social determinants of health (Marmot, 2005) in this case was that of economic status and education, or lack thereof. Henrietta Lacks was poor and lived in poverty her entire life. In a time of racial oppression, Henrietta worked tough jobs and found it extremely difficult to advance beyond a poverty status.

Both poverty and lack of education was a combination that kept people like Henrietta struggling throughout their lives. The lack of education was a derivative of being poor. During this time, it was common for the children of poor families to work in order to provide much needed money to support that family. By working, children would not be afforded the means or the time to go to school.

Poverty was also a contributing factor in the lack of good healthcare. When Henrietta started feeling ill, her life experience with racial inequality, poverty status, and lack of education, lessened her confidence so much that she felt that seeking medical treatment would not be beneficial. Therefore, her delay in treatment allowed her cancer cells to spread. To make matters worse, when she finally sought treatment, she was misdiagnosed quite possibly given the wrong treatment – as she would later be misdiagnosed twice. As a patient in the segregated public (non-paying), it could be assumed that she did not receive the same level of quality care and treatment as those in the white or paying ward.

In conclusion, Henrietta Lacks’ ‘HeLa’ cells (Skloot, 2010) were in fact a major advancement in medicine, attributed to saving lives and improving the quality of life for many. In this particular case, the practice of research with a patient’s cells, or any living tissue for that matter, without receiving consent from the patient or family, has led to new standards and laws today that protect the patient’s right to consent (informed consent) as well as their privacy such as the Health Insurance Portability and Accountability Act (HIPAA) (HHS, 2020). Also, because of Henrietta Lacks, patients today are required to be informed of any financial matters that are associated with the use of their tissue (Deitz, 2017).

The extraction of Henrietta’s cells for medical research outside of her consent tells the story of an absence of ethical standards. However, her famous story has provided us today with ethical standards in healthcare that are mandated and required, providing patients with an overall improved quality of healthcare.

References

1. Deitz, Justine. (2017). Henrietta Lacks lives on. Health law and Policy Brief. Retrieved from: http://www.healthlawpolicy.org/henrietta-lacks-lives-on/.
2. Dimaano, C., & Spigner, C. (2017). Teaching from The Immortal Life of Henrietta Lacks: Student perspectives on health disparities and medical ethics. Health Education Journal, 76(3), 259–270. https://doi.org/10.1177/0017896916667624
3. Health and Human Services (HHS). (2020). Health Insurance Portability and Accountability (HIPAA). Retrieved from: https://www.hhs.gov/hipaa/index.html.
4. Marmot, M. (2005). Social determinants of health inequalities. International Centre for Health and Society, University College London, 1–19 Torrington Place, London WC1E 6BT, UK. https://doi.org/10.1016/S0140-6736(05)71146-6
5. Skloot, R. (2010). The Immortal Life of Henrietta Lacks. New York: Crown

“VA insurance is refusing to pay his surgical bill since the surgery was not performed at a VA hospital and Jason is currently appealing that decision” (Khan, 1). This is a problem majority of veterans may face when needing assistance with bills or money. Veterans’ benefits system has been around ever since the 17th century when pilgrims passed a law to protect citizens who joined the army to protect against Pequot Native Americans. These laws protected any soldier injured or ‘disabled’ in battle protecting the colonies. In 1776 when colonies declared independence from England, they made notice of needs for their soldiers/veterans. Pension was also a part of benefits during the Revolutionary War to encourage citizens to enlist into the military. Since then, benefits have slowly been chipping away and have been tampered with, making the process of receiving benefits difficult for veterans. Veterans need compensation, veterans face many hardships in their daily live, they will need support and compensation to strive in the world. The United States needs to aid veterans, the country can do this by increasing veteran’s entitlements, fixing and organizing veterans benefits and healthcare enrollment systems by increasing staff for these systems, simplifying the process of application for health care, accepting and organizing applications and enrollments in a timely manner, and also investing more money into veteran’s benefits and health care systems.

VA has dated back to five hundred years ago but still nothing has changed the support systems for veterans are not the best. United States veterans have always been treated poorly, veteran health treatments have also been getting worse. “The United States veteran’s benefits system traces its roots back to the 17th century when the Pilgrims of the Plymouth passed a law protecting citizens who joined the colony army to defend it against the hostile Pequot Indians. The colony made certain that any soldiers disabled in the defense would be supported by it” (Ousley, 1). The United States has always had a support system for veterans but since the 17th century it has never been a well-structured support system. Veterans have always received abysmal health care after they had gotten back from war. The country has always treated veterans extremely poorly, even during the 1800s. In history, it’s been shown that the United States have barely made efforts to improve on supporting veterans. “In 1783 mutinous Pennsylvania troops surrounded Pennsylvania’s Independence Hall to press the Congress for back pay. Medical and hospital care for veterans in the early days of the Republic were the responsibility of the individual states… Nearly thirty-five years later, in 1811, the federal government authorized the first domiciliary and medical facility for veterans” (Roche, 1). The country has merely made efforts if any at all to support veterans. Congress only aided veterans when forced to. This has shown that the United States needs to make veterans a priority by improving the assistance given to them. The country needs change and should support veterans. In fact, the United States has been doing the opposite of aiding veterans, in the past couple hundred years the country has been taking benefits away from veterans. “During the late 1800s Southern Democrats in the Congress successfully introduced the first major legislation to chip away at veteran’s entitlements” (Ousley, 1). Veterans have never received proper health care after veterans got back from war, now the government is starting to minimize veteran’s entitlements. Not only are veteran’s support systems substandard because of the government chipping away at entitlements but also because of the process of obtaining support from the government as a veteran.

The government claims to work with veterans to the best of the government’s ability, but the process of getting support has been horrible for years. Many of our veterans who have even fought on the frontlines with mental health issues have not received VA health care. In Devine’s article ‘307,000 Veterans May Have Died Awaiting Veterans Affair Health Care’ page two he states Scott Davis said thousands of veterans who have returned from combat in Iraq and Afghanistan have not received health care because of being incorrectly placed in the enrollment system backlog (Devine, 1). Explaining that most veterans do not even get close to receiving health care. Before the country improves veteran’s health care system the government will need to make the process of receiving health care is easily accessible in the first place. The process of enrollment is extremely complicated, but besides the process being complicated, the process of enrollment is also an enormous hassle, some veterans are too old or may not have money to afford a computer, but a computer is needed to upload information. Health care has been so difficult to access that only eleven percent veterans have received health care. The process of applying and receiving health care is extremely inconvenient “The online medical records and online benefit applications are insane. People that answer phones say veterans have to download old forms and upload new information and not all vets can do that and not all vets have computers. Most days you can’t get through on phone. I spent more than a year updating records to include my wife and our baby” (Khan, 1). The enrollment system needs to be updated and needs to be adapted to veterans’ needs. The enrollment system has to be more organized if the government wants to make a change in supporting veterans and their health care. The process of enrollment is extremely tides and due to this many people have not applied. “As of June 30, the VA sent letters to 302,045 veterans asking them to submit required document to establish their eligibility, and 34,517 of those veterans have since been enrolled for care, the VA said” (Devine, 3). Less than half of veterans receive health care after they get back from war, this shows how difficult the process of receiving health care as a veteran is. The government claims to attempt to make improvements to help veterans but nothing in the process of receiving health care seems to get better. The United States government has to do a better job of getting health care to veterans, the government needs to improve the process of receiving healthcare let alone improving VA healthcare. Therefore, the government should put more time and money to support veteran’s health care by organizing enrollment systems and placing more money into healthcare programs. Not only are veteran’s support systems substandard because of the process of receiving health care but also because of the time it takes to enroll to get health care.

Enrollment for health care takes so long that some veterans have died waiting for enrollment into health care. Veterans dying while waiting for health care is not a rare instance, many have veterans may have died while waiting for application to health care or enrollment to health care. According to Curt Devine on page one of ‘307,000 Veterans May Have Died’, “The VA’s inspector general found that out of about 800,000 records stalled in the agency’s system for managing healthcare enrollment, there were more than 307,000 records that belonged to veteran who had died months or years in the past” (Devine, 1). Before the process of receiving health care veterans needed to enroll, but even enrolling is a huge problem. These numbers have shown that enrolling in healthcare takes so long that veterans have died from waiting for enrollment not even just waiting to receive health care. Accepting health care takes so long veterans died before receiving health care and support. Even when applied veteran’s application enrollment can take up to or even more than a decade to process. “In one case, a veteran who applied for VA care in 1998 was placed in ‘pending’ status for 14 years. Other veteran who passed away in 1988 was found to have an unprocessed record lingering in 2014, the investigation found” (Devine, 1). After have gone through the process of application and actually applying veterans still have problems with the process of enrolling. In these two specific incidences it has shown that process of enrolling has been just as extensive and lengthy as applying. Veterans have fought for our country and have earned the right to their benefits. Though veterans are supposed to receive health care and benefits they clearly do not. “People fought, and who earned the right to VA health care, were never given VA health”, – Davis said. “They literally died while waiting for VA to process their health care application” (Devine, 1). The country needs to shine light upon this issue, this is because many veterans risk their life and donate their life to this country but essentially do not receive anything in return. Enrollment and application are one of many significant issues dealing with veterans receiving their benefits and healthcare. The country must fix and organize veterans benefits and health care system, to do this the United States needs to fund and invest more money into these systems. Not only are benefit and health care systems unorganized because of the lack of time invested into them but also because of the lack of staff invested into these systems and programs.

Organization has been an immense complication dealing with VA healthcare system. Due to these applications, and enrollments to the VA health care system have been disarranged, and veterans that are already in the healthcare system have not been receiving proper care. According to Suzanne Gordon “There are two primary reasons for the problem of wait times. One has to do with Congress’ consistent failure to provide adequate funding so that the VA could hire more staff to care for an increasing number of veterans who live longer with complex service and age-related health problems” (Gordon, 1). Shortage of staff is taking an immense toll on the VA health care system. If there was more staff, situations dealing with the management and organization of VA health care system would be altered immensely. More staff is needed in these programs and systems if the United States wants to make a change in the way veterans are treated. Shortage of staff is a choice, the United States VA system could hire more employees, if wanted to but no efforts have been made. Suzanne Gordon stated that the employment of more staff has been refused ‘persistently’ by the United States health care system (Gordon 1). Employment of more workers and staff is a choice that could be made for the better but no action has been taken in the right direction. For this to happen, to employ more workers more funding and money needs to be invested into this health care system. The lack of staff is due to the shortage of funding and investments into the VA health care system, if progress is to be made, more money is needed to be invested into the system.

Health care systems have been lacking funding for many years, this troublesome matter must be fixed by increasing resources for health care systems and programs and increasing funding for health care systems and programs. There have been attempts to increase funding for Veteran Affair health care system, but action has yet to be taken. In 2014 Senator Bernie Sanders proposed a bill that would distribute twenty-one million dollars to healthcare, education, and other services for US veterans. Republicans “block killed that bill” (Gordon 1). Though there have been attempts to increase aid to veterans there still has not been an increase. The country needs to take action by increasing funding and investing more money into veteran’s health care systems and programs. Lack of funding leads to a system with hardly any workers, a system with hardly any workers becomes an unorganized system. “There are two primary reasons for the problem of wait times. One has to do with Congress’ consistent failure to provide adequate funding so that the VA could hire more staff to care for an increasing number of veterans who live longer with complex service and age-related health problems” (Gordon, 1). Lack of funding is the basis of many if not all issues dealing with VA healthcare systems. Lack of funding is the reason behind disorganization throughout the health care system which is the umbrella to problems such as complications with applications and also enrollments. United States as a country has to work together to eliminate issues like these.

A step has been taken into a different direction President Donald Trump has recently released a new budget proposal. Many people have been asking for more investments into the VA healthcare system and other beneficial programs, though in the past few years budgets have been low and benefits has been down, this change could potentially change VA systems entirely. President Donald Trump explained that the new budget proposal will reflect the commitment of the President to supply veterans with services and benefits that the they deserve (Wentling, 1). This reasoning behind improving and funding the VA is not just because the citizens of the United States have spoken out but because the President is attempting to connect to veterans and the citizens. This will allow the situation in which veterans have been treated abysmally in the past to calm down, it will allow the president to breakdown and analyze this situation. The step President Trump is making is in the right direction and may solve the issue dealing veterans benefits and healthcare. It is aimed towards arguably the important and significant points towards veterans’ healthcare. The proposal asked for one hundred ninety-eight billion dollars for the VA for 2019, exceedingly more than the current one hundred eighty-six billion dollar budget, it would place emphasis on veterans mental health care (Wentling, 1). This point is extraordinarily important, the PTSD (Post Traumatic Stress Disorder) epidemic has been a massive deal recently in which many people are affected by it. This point on veteran’s mental health care alone is very much needed. The question of where the country would get the money for improvements and investments in VA healthcare now arises. This new budget proposal plans to include cuts to domestic agencies and social programs instead would spend money on defense, homeland security and the VA (Wentling, 1). Veterans have been hurting for money and this was a step into a different direction. This would take money from an accessorial tool and bring money over to a major issue that the United States has been dealing with for years which would be how to fix and improve VA health care systems. A way this may directly affect VA health care is by reforming the VA choice program, which grants veterans access to receive medical care in a private sector (Wentling, 1). Minor adjustments from moving money from a segment of everywhere to invest into one program may go a long way. Taking action and investing money is exceedingly important and may help fix more than just one problem.

To fix these issues dealing with Veteran Affair Health Care the country must invest more money into the veteran’s health care system and programs. This will allow organization to take place, which in turn would allow and assist more veterans to receive their aid and health care they deserve. More money will allow a substantial amount of people to be employed to help serve veterans and their needs. In addition, instead of ‘chipping away’ at veterans benefits as a country the United States should do everything in its power to take care and watch over its veterans. Veterans have donated a fraction if not their whole life to their country and its military, the United States should do everything in its power to repay the veteran. Nowadays in many cases the veterans do not receive much in return. President Donald Trump is striving to turn into the right direction attempting to finance the VA health care system. Investing money into VA health care system and programs will alter the path it has taken and will now start supporting veterans. The VA health care system will now start giving veterans the support and aid they deserve.

Before attempting to understand how the standard of mental health care is tied to larger issues within the prison system, it is important to establish how mental health care is insufficient in a broad sense. When looking at the rates of mental illness within the incarcerated population, it becomes clear that a strong system of mental health care is absolutely vital. As of 2014, 73% of women and 55% of men in state prisons, 61% of women and 44% of men in federal prisons, and 75% of women and 63% of men in local jails had at least one mental health problem (James and Glaze, 2019). This is not simply an issue of lack of initiative in seeking mental health care on the part of individuals with mental illness, as “even psychiatric patients who are actively being treated often get tangled up in the criminal justice system: in 2012, researchers reported that 12 percent of adult psychiatric patients receiving treatment in the San Diego county health system had been incarcerated; in 2013, 28 percent of Connecticut residents being treated for schizophrenia and bipolar disorder had been arrested or detained” (Varney, 2019). This data clearly shows that not only are a large majority of inmates mentally ill, but an unfortunate number of individuals with mental illnesses will end up in the prison system.

The Bureau of Justice Statistics, a government agency focused on reporting statistical analyses about the justice system, compiled data from 45 states who responded to surveys about the conditions of health care in their facilities. An important consideration to make before presenting the data is that it was gathered at the state level, and therefore, may obscure variability within states. Despite that caveat, the data offers a solid initial look at the processes of psychiatric care within prisons. In regards to mental health screenings, every state reported that they offer screenings to “at least some prisoners during the admissions process”, which raises the question of which prisoners are and are not being screened (BJS, 4). The data was further broken down to say that one state provided mental health screening only as needed and based on whether a prisoner had a history of mental health issues. Of the thirty-one states who offered information about who is responsible for screenings in their facility, psychologists and psychiatrists were only responsible in seven of these states. The majority had either some other form of licensed mental health care provider (including master’s-level social workers) or nurses. Having less than qualified individuals administering the screenings runs the risk of losing the nuance that psychiatrists and psychologists are trained to observe in mental illness diagnoses. Screenings for suicide risk had the same results: at least some prisoners were screened (Chari et al., 4). Offering screenings on a discretionary basis is a major cause for concern, considering there is a significantly higher number of individuals with mental illnesses in prisons compared to mental health hospitals. Furthermore, the primacy of this screening process suggests that it is the first step towards receiving care, and if it is only administered to some, those who do not receive it are initially barred from access to care. Given the importance of treating mental health issues as quickly as possible, this can be a dangerous oversight.

In contrast with the high numbers of incarcerated individuals with mental health issues, the Bureau of Prisons classified only 3% of the prison population as requiring routine care for mental illness. This comes as a direct result of policy changes intended to shore up the quality of mental health care in these institutions. Unfortunately, but unsurprisingly, the change in care demanded was not accompanied by any further resources to do so. In response, many institutions began treating fewer individuals instead. In combination with the issues seen in the screening process, there is clearly reason to believe that many, if not most, of the incarcerated individuals who would benefit from receiving mental health treatment are not receiving it.

Given that people of color are more likely to be in the prison system due to systemic profiling, it is important to consider how mental health care needs and the actuality of treatment received may differ for inmates of color compared to white inmates. In 2016, “Black people were 2.17 times more likely to be arrested, 3.5 times more likely to be incarcerated in jail, and nearly five times more likely to be incarcerated in prison nationwide than white people” (Prins et al., 2012). One primary issue, both in and out of prison, is the issue of receiving a diagnosis in the first place. Black prisoners were, as of 2017 data, 20% less likely to receive a mental disorder diagnosis. White, non-Hispanic prisoners were also 26% more likely to be diagnosed than Hispanic inmates. The root of this disparity can be found in the methods of diagnosis. Recalling the BJS data that reported mental health screenings were administered on a discretionary basis, there is a risk that the discretion could fall, with or without intention, along racial lines. Furthermore, the actual screening process has its flaws. A study conducted by Seth J. Prins, Fred C. Osher, Henry J. Steadman, Pamela Clark Robbins, and Brian Case attempted to assess the generalizability of the Brief Jail Mental Health Screening. They found that the lower likelihood of black and Latino inmates screening positively could be linked to the fact that “Blacks and Latinos had somewhat lower odds than Whites of endorsing two or more symptom items but had appreciably lower odds of endorsing items regarding prior mental health service utilization” (Prins et al., 2012). The biased idea that everyone has equal access to mental health services ignores the role of class and the overlap of class and race in previous mental health care access.

Along the same lines, sexual minorities are not only incarcerated at higher rates disproportionate to the percentage of the population that they make up, but once incarcerated, they are more likely to experience mistreatment, harsh punishment, and sexual victimization. Additionally, sexual minority inmates were more likely to have a past history of sexual abuse. Higher rates of sexual victimization are linked with worsening mental health, as seen in the application of the diathesis-stress model for most serious mental illnesses.

Roughly 17% of transgender Americans, and 50% of black transgender people, have been imprisoned. The issues transgender people face are many in the prison system. They risk being incorrectly housed with the wrong gender, or as a dangerous alternative, being placed in solitary to avoid housing them with either group. Additionally, they are often denied hormones and adequate treatment. Both of these issues feed into worsening mental health. Beyond the logistical failings of transgender people in prisons, they have to worry about their safety, as well: “Trans women’s degree of satisfaction with their body is associated with mental health outcomes…Transphobia-based violence was significantly associated with anxiety, depression, and body satisfaction. Body satisfaction was associated with mental health diagnoses. Bootstrapping revealed significant indirect and total effects. Body satisfaction mediated the relationship between transphobia-based violence and mental health. Clinical intervention that promotes body satisfaction, including access to gender confirmation therapies, especially hormone therapy, may prevent negative mental health outcomes among trans women. Individual intervention, however, is not a panacea for structural discrimination. Attention to structural interventions that reduce gender minority stressors, including transphobia-based violence is necessary” (Klemmer et al., 2018).

The role of capitalism and the prison-industrial complex in the failure of mental health care in prisons is extensive. Overcrowding reduces the chance of all inmates who need mental health care receiving adequate treatment. As previously mentioned, stricter regulations around the quality of care were not accompanied by the funds necessary to extend that higher quality care to the entire prison population. For this reason, there is reluctance on the part of prisons to offer care to anyone they do not absolutely have to. This restricts care to only those most visible, and based on issues with screening, the most visible population will most likely be white. Not only does overcrowding place restrictions on care, but it also negatively impacts mental health.

Intentional lack of adequate mental health care in prison has more than one positive capitalistic outcome: it saves them money when the inmate is still imprisoned and allows them to make more money when the inmate eventually returns after being released. Mentally ill inmates have been found to have higher recidivism rates. The issue of recidivism is tightly connected to the issue of homelessness after release. Many inmates, particularly those who are members of minority populations, and especially those who are mentally ill members of those populations, struggle with finding a home and a job after being released. Adding the search for health care to that list puts an undue burden on mentally ill ex-inmates and increases their likelihood of recidivism in the long run. In regards to homelessness broadly, “formerly incarcerated people are nearly 10 times more likely to be homeless, and rates of homelessness are especially high among people of color. Lack of housing can significantly worsen mental health problems” (Prins et al., 2012).

While an understanding of the current conditions in prisons, both broadly and specifically in regard to mental health care, shows a clear need for change, it is not as simple as mild adjustments. It comes down to the question of whether to reform the current system or abolish it and build something new from the ground up. As Fran Beale discusses in ‘Double Jeopardy: To Be Black and Female’, the work we do cannot simply be about highlighting the issues we see in the old, “a revolutionary has the responsibility…of creating new institutions that will eliminate all forms of oppression” (Beale, 100). With reform, only so much can be done. When rebuilding with a rotten foundation, there will always be some level of corruption. The advantage to prison abolition is removing ourselves entirely from that system and opening the door for something more fruitful, and most importantly, more just in a way that considers Patricia Williams’ distinction between what is legal and what is just. She defined legality as the word of the law, without any of the emotions, whereas justice requires subjectivity. In her own words, “When a society loses sight of those ideals and grants obeisance to words alone law becomes sterile and formalistic; lex is applied without jus and is therefore unjust” (Williams, 1991, pp.138-139). Our current system is, as she says, all lex and no jus.

Works Cited

1. Beale, Frances. ‘Double Jeopardy: To Be Black and Female’. The Black Woman: An Anthology, edited by Toni Cade Bambara, 1970, pp. 90–100.
2. Chari, Karishma et al. ‘Bureau of Justice Statistics (BJS) – National Survey of Prison Health Care: Selected Findings’. Bjs.Gov, 2019, http://www.bjs.gov/index.cfm?ty=pbdetail&iid=5705
3. James, Doris, and Lauren Glaze. ‘Bureau of Justice Statistics (BJS) – Mental Health Problems of Prison and Jail Inmates’. Bjs.Gov, 2019, http://www.bjs.gov/index.cfm?ty=pbdetail&iid=789
4. Klemmer, Cary L., et al. ‘Transphobia-Based Violence, Depression, and Anxiety in Transgender Women: The Role of Body Satisfaction’. Journal of Interpersonal Violence, Mar. 2018, doi:10.1177/0886260518760015.
5. Prins, Seth J. et al. ‘Exploring Racial Disparities in the Brief Jail Mental Health Screen’. Criminal Justice and Behavior, vol. 39,5 (2012): 635-645. doi:10.1177/0093854811435776.
6. ‘Protected and Served?’. Lambda Legal, 2019, https://www.lambdalegal.org/protected-and-served/jails-and-prisons
7. Thompson, Christie, and Taylor Eldridge. ‘Why so Few Federal Prisoners Get the Mental Health Care They Need’. The Marshall Project, 2019, https://www.themarshallproject.org/2018/11/21/treatment-denied-the-mental-health-crisis-in-federal-prisons
8. United States Government Accountability Office. FEDERAL PRISONS: Information on Inmates with Serious Mental Illness and Strategies to Reduce Recidivism. 2018, https://www.gao.gov/assets/700/690090.pdf Accessed 14 Dec 2019.
9. Varney, Sarah. ‘By the Numbers: Mental Illness Behind Bars’. PBS Newshour, 2019, https://www.pbs.org/newshour/health/numbers-mental-illness-behind-bars
10. Williams, Patricia. The Alchemy of Race and Rights. Harvard University Press, 1991.

Poor solid waste management is a common environmental issue that not only affects developed, but developing countries as well. Landfills, recycling failures, and poor waste transfers characterize it (Environment Victoria, 2015). Poor waste management is an environmental issue because it not only creates “eyesores,” but also emits toxins, leachate, and greenhouse gases (Environment Victoria, 2015). These characteristics cause environmental pollution through surface water contamination and soil contamination (Environment Victoria, 2015). Indeed, many materials that make up solid waste contain toxins and other harmful gases that affect the environment.

Poor solid waste management is a common cause of concern for communities and governments alike because of its impact on local communities. Experts say it could cause health problems by increasing the level of pollutants in the atmosphere, albeit slowly and in small quantities (Rushton, 2003). Low birth weight is a health issue commonly reported among newly born babies living around landfill areas. Cancer studies also show a direct relationship between poor solid waste management and a high incidence of cancer (Rushton, 2003). Similarly, people living around landfill areas report respiratory problems and congenital malformations by living around landfill areas (Rushton, 2003). These health challenges show that poor solid waste management is a public health issue.

The above-mentioned health issues affect local populations through different kinds of exposure. For example, respiratory problems often occur through air pollution because landfills release contaminants in the air (Environment Victoria, 2015). People inhale them through their lungs and have poor health as a result (Rushton, 2003). Poor solid waste management also affects human beings through soil contamination. Plants absorb these chemicals from the soil and people ingest the chemicals by eating the plants (Rushton, 2003). Landfills also affect the health of local communities through surface water contamination. When people use this water to drink, bathe, or feed their livestock, they get sick. Therefore, the potential for solid waste contamination covers three areas – air, water, and food (Environment Victoria, 2015). Everybody is exposed.

The concern for contamination arises from an established risk assessment. The health effects highlighted in this paper emerge from scientific studies that have proved that poor solid waste management has a negative impact on people (Environment Victoria, 2015). Therefore, the burden of proof is there. This proof makes it impossible to use a precautionary approach to explain the public health issue.

Based on the health effects of poor solid waste management, and its multiple channels of exposure, this health issue is a major concern. However, few people pay attention to it because they believe that it mainly affects people who live close to landfill areas (Environment Victoria, 2015). Their lack of concern exacerbates the seriousness of the health issue because it increases people’s risk exposure to landfill waste. There needs to be greater awareness regarding this public health issue because, similar to global warming, which affects people around the world, pollution in one landfill area is bound to affect people from other areas as well (Environment Victoria, 2015).

Before writing this paper, I overtly knew about the level of pollution going on through poor solid waste management. However, I did not fully comprehend the types of health risks caused by the environmental issue. For example, I did not understand the multiple exposure channels of landfill contamination. Similarly, I did not understand that landfill waste contamination in one area of the country could affect the food supply in another part of the country. Generally, my views about this health issue changed after discovering that everybody is at risk of landfill waste contamination.

During the second half of the semester, I tried to prioritize getting enough sleep at night by altering my behavior in a number of ways. Previously, I proposed that I would improve my time management in order to reduce my stress levels and have more time to sleep. At the beginning of every week, I looked at my schedule and set aside time during each day to work on my assignments and study for any quizzes or exams. With this method, I was able to use my spare time more wisely and I noticed a decrease in my stress levels. Whenever I was able to get more work done during the day, such as in between classes or as soon as my classes ended, I was more relaxed at night and went to sleep earlier than I would have if I had waited until later in the day to do my work. I also tried to improve my study habits to increase my efficiency and energy levels. Rather than studying for long periods of time, I tried to get into the habit of studying for 30-minute intervals with 5-minute breaks in between. During these breaks, I made sure that I drank water and got up to stretch to avoid fatigue. I noticed an overall improvement in my ability to focus and study effectively, which helped reduce my stress. I felt more comfortable going to sleep earlier knowing that I had accomplished enough during the day. In addition to improving my time management, I tried to be more honest with my family and friends whenever I felt overwhelmed with work or stressed about not getting enough sleep. I find that it is extremely helpful to talk to people that care about you and your well-being because they will always tell you what you need to hear. If I felt particularly stressed, I called my mom or dad because they always remind me that my well-being is more important than my work. I also made more of an effort to let my roommates know when I was not sleeping enough because of school. They act as a great support system, especially because they are dealing with the same kind of stress that I am. One barrier that persisted through the second half of the semester was my off-campus job. This barrier functions in the living and working conditions of the socio-ecological model. The company that I work for requires a minimum of 15 hours each week, which can take up a significant amount of time that could be spent doing schoolwork. This barrier has persisted because the minimum hour requirement is not something that I can change unless I decide to quit my job. However, I think that I was still able to increase the success of my behavior change despite the persistence of this barrier. There is still room for improvement, but, overall, I was able to strengthen my time management skills.

This activity has shown me just how essential behavior change is to the promotion of public health. Over the course of the semester, I was able to observe and record how sleep impacts my physical, mental, and emotional health. If I slept for 4-5 hours one night, I felt exhausted and unable to focus during my classes the next day. If I received 4-5 hours of sleep for multiple nights, my immune system weakened and I became sick. For example, there was one week during which I had multiple midterm exams and I did not sleep enough due to stress and staying up late to study. A few days after these exams were over, I became sick with an upper respiratory infection that eventually developed into bronchitis. This is a prime example of the power that we can have over our health if we practice healthy behaviors. Health-related behavior is a vital element of public health, which means that the improvement of health-related behaviors is crucial to public health ventures and policy. The leading causes of death in the United States are unquestionably shaped by certain health-related behaviors. Maintaining a healthy weight, eating a balanced diet, exercising, and not smoking, are all health-related behaviors that can reduce the risk of/prevent leading causes of death such as heart disease, cancer, and chronic lower respiratory disease. Today, there is an overwhelming amount of evidence that suggests a link between individual health-related behaviors and an increased risk of morbidity/mortality. This, in addition to the fact that the pattern of disease in the United States has shifted from infectious to noncommunicable, stresses the importance of promoting and enabling healthy behaviors via public health measures. This activity has demonstrated how difficult changing individual behavior can be. Public health officials/programs need to focus on how to put individuals on the path to improved health behavior as well as provide the resources and support that people need to maintain positive changes in their behaviors. I strongly believe that the future of public health is dependent on these changes at the individual and, ultimately, the population level.