Category: Health Care Policy

I am writing to urge you to reconsider your position on price increases that Nostrum Pharmaceuticals, LLC may apply to future medications – these pricing decisions can have a detrimental impact on patients, as these treatments often constitute a matter of life or death.

Nostrum Pharmaceuticals LLC is engaged in the formulation and commercialization of specialty pharmaceutical products and controlled-release, orally administered, branded, and generic drugs.

The impact that Nostrum can make towards the advancement of drug research and treatment of patients is immense, and as such, ethical and just pricing should be taken into more consideration.

This is in light of the recent price increase for a generic antibiotic that was first approved by the FDA in 1953. A report in the Financial Times states that Nostrum Pharmaceuticals “more than quadrupled the price of a bottle of nitrofurantoin from $474.75 to $2,392, according to Elsevier’s Gold Standard drug database.” This was a result of decreased competition in the market allowing you to make this sudden price adjustment. As liquid versions of antibiotics are already complicated to produce and inaccessible to patients, raising the price of oral nitrofurantoin makes it even more difficult for those in need to obtain this medication. Moreover, this was an established antibiotic that required no additional investment in innovation or research, not to justify any price increase.

I am most troubled by your response to the reasoning behind the sharp price increase, hence why I am writing to implore you to reconsider your judgment for future product developments. You stated that you have a “moral requirement to sell the product at the highest price” and that it is your moral duty to benefit your investors. Through this letter, I hope to show you that morality extends beyond shareholder activity and that price increases, both unethical and counterproductive, move society away from an ideal economy.

To begin, utilitarianism and deontology are two of the most prominent ethical frameworks that exist regarding morality, and the act of price increases for medication does not comply with either. From a utilitarian standpoint, the best course of action to take would be to choose the alternative that is likely to produce the greatest overall good – aka the happiness of the greatest number of people in a society or group. Increasing the price of antibiotics such as nitrofurantoin does not do so, as the price hikes produce more consequences than benefits. More people are harmed, public health is threatened, and substantial amounts of taxpayer money that could have been used for other issues are depleted. This is evident in the allocation of capital by the U.S. government, as the U.S. spends significantly more on drugs than any other country and on any other single segment of the federal budget. Despite this level of spending on healthcare, the United States still ranks 26th in the world in life expectancy – according to a survey conducted by the Kaiser Family Foundation, over 20% of Americans have difficulty affording their prescribed medications, 24% say they or a family member has not filled a prescription, cut pills in half or skipped due to high costs, and 80% say the cost of prescription drugs is unreasonable. Not only has this unreasonable amount of government spending on healthcare not produced ideal results, but it has also taken away capital that could have been allocated towards other programs in need like infrastructure repair, enhancement of education, and the creation of jobs. It is clear that price hikes do not produce the greatest overall good and are therefore unethical and immoral from a utilitarian standpoint.

Deontological ethics are marked by moral principles that can be universalized and how doing the right thing should be guided by certain overriding rights and duties. You say that your moral duty is to benefit your investors; however, this cannot be universalized, as it would lead to widescale market failure. Market failure is when a market left to itself does not allocate resources efficiently, and there are four causes: monopoly/monopsony, externalities, public goods, and asymmetric information. If all companies were to only act solely in favor of their shareholders, an ideal economy would not be reached. Regarding how Nostrum specifically contributes to market failure, it is evident that inefficiencies exist due to all four causes. By increasing drug prices without substantial reason, Nostrum is practicing the abuse of market power by exerting significant influence over the prices. Doing so also causes a negative economic side-effect as seen from above since less government spending is allocated towards other crucial segments. Beyond that, by prohibiting patients from accessing the medication they need as easily and quickly, less human capital is available within society, bringing down the overall potential productivity in the nation. Healthcare should be a public good accessible to all, and with immense price hikes, only the wealthy can afford their proper treatment. Lastly, there is immense asymmetric information between the suppliers and the consumers, as the suppliers are the only ones who have the treatment, distorting their incentives when conducting business. Through examining all the ways Nostrum is contributing to market failure resulting in significant inefficiencies in the economic system, it is evident that price increases are not ethical or moral from a deontological perspective as well.

Other than ethical frameworks like utilitarianism and deontology, there are important historical figures who have provided ideas of morality including Gandhi and Ruskin. Gandhi does not look to draw a line between ethics and economics and promotes moving beyond egocentric goals. Reducing access to medication for personal financial gain does not fall in line with Gandhi’s idea of economic equality, as Gandhi believes in giving back and the equalization of status – “the bulk of his greater earnings must be used for the good of the State.” An ideal economy stands for social justice and promotes the good of all equally, and any economics that promotes inequality and hurts the well-being of an individual or a nation is immoral. The increase in prices for medication hurts the well-being of both individuals and the nation as a whole and is therefore sinful. Though Nostrum should provide a reasonable return to shareholders, it should come out of voluntary recognition from consumers, not compulsory obedience as a result of financial incentives.

Ruskin, on the other hand, focuses on the maximization of social affection within the economy. He believes that wealth can only be acquired under certain moral conditions, such as honesty and justice. I acknowledge that Nostrum’s impact on society in acting unethically is hard to measure and can be easily overlooked if it means further financial gain to shareholders, but Ruskin believes in the development of the individual conscience first. He believes that society can only be transformed when the individuals are reformed, and personal honesty will lead to social honesty. He promotes the theory that the economy should be based on an ethical code of life and that an ethical basis should be the core of all social and financial endeavors. Nostrum can and should take that first leap in the larger pharmaceutical industry towards displaying more social affection through providing widespread access to medication.

Given that the United States is the only developed country that does not have government regulation on drug prices, it is only a matter of time before the law intersects with morality regarding healthcare issues for this nation, as the law is the external deposit of morality. In the meantime, I implore you to have Nostrum act as a socially responsible company by re-examining pricing decisions to be ethical, fair, and just. Drug pricing at pharmaceutical companies no longer reflects only innovation and research expenses but is more so dictated by marketing expenditures. The industry needs to restore a social contract that is built on a value-based system in which pricing is reflective of the health improvement that a drug can deliver. Through this letter, I hope it is evident that morality extends beyond simply benefiting shareholders, and that there should be a moral commitment to prioritize patients’ well-being above all else, as our individual and nation’s health is at stake.

I would be keen to hear your perspective on this matter, and you can reach me at cindy.li@stern.nyu.edu. I hope you heavily consider re-evaluating Nostrum’s role as a pharmaceutical company in society and the negative impact unethical drug pricing makes towards moving the nation further away from an ideal economy.   

I will be speaking to you all on the issues concerning a single-payer healthcare system. Okay, so raise your hand if you like free things. Let’s be honest—who doesn’t like free things? There was a study conducted where Americans were given a choice between a free item and a priced item. I was not surprised when I found out that ninety percent of Americans chose the free item. However, what if I told you that you would have to work longer and pay more money, so you could have the “free” item? Notice the number of hands that have gone down. That is what a single-payer healthcare system would be like in America.

A study was done in Sweden—a first-world country—on their healthcare system. The study proved that a universal health system is not the answer to the problems faced by Americans. It also showed that since the healthcare system is owned by the government, the system is weighed down with waiting lists. According to Warner Todd Huston,” Those waiting lists increase patients’ anxiety, pain, and risk of death.” If healthcare was free, it would allow our government to tax the rich and ration out the availability of healthcare. Subsequently, this would bring down the overall quality of healthcare. Furthermore, an important question to ask yourself is: why is healthcare important to me? Healthcare is important to me because it is vital to living. No one is immune from disease, nor are they secure from injury.

When I was a young child—around eight years old—I used to love to climb and swing on objects. I was also very clumsy; as a result, my mom would always call me a hypochondriac because I was always injuring something. One day I got the bright idea of swinging in between two desks after school. While I was swinging between the desks, I slipped and fell. This only resulted in a trip to the hospital and four stitches. While it was well over one thousand dollars, I received quick quality care. I probably would not have received this kind of care with a universal healthcare system. I am not here to bash any of you for your opinions but rather to show you why a universal health system would do more harm than good for our economy.

A universal healthcare system would allow every United States citizen to access healthcare free of charge. While I do not agree with this concept, some people suggest that a single-payer health system is not completely bad. They even propose that it has many advantages. One advantage of the universal health system is that it could save lives, and I agree this would be beneficial; however, it would also increase the wait time for medical services. This concept was proven in the study of Sweden’s health system. According to Warner Todd Huston,” For all Swedes who needed an operation in 2003, slightly more than half waited more than three months. The situation continues. Moreover, patients often wait in great pain and distress.”These patients spent over three months in extended pain and high anxiety because there were not enough medical services to fit the population in Sweden. Furthermore, this strengthens the idea that healthcare should be an exclusive right. Ken Perez argued,” By requiring no deductibles, copayments, or cost-sharing requirements, Sanders’ single-payer plan could result in greater demand for medical services than projected by Sanders and even Thorpe and the Urban Institute.” The outlook for doctors is steadily decreasing in the United States which is why the wait time would increase for medical services.

Moreover, some people observe that with a single-payer system, medical bankruptcies would decrease and encourage entrepreneurship. In another study done on Canada’s healthcare system, researchers found that the funding was completely reliant on current taxpayers. These hardworking citizens must fund the disproportionally large health needs of the elderly. It was also found that Canada ranks among the most indebted sub-sovereign borrowers in the world. According to Candice Malcolm,” In Canada’s single-payer system, citizens cannot pay directly for procedures, and they cannot purchase private insurance to cover services provided by the CHA. They must instead wait in line or seek health-care services outside the country. I do not agree with the idea of rationing out healthcare. What if it is a life-or-death situation? Then the patient’s family, along with the government, is left with the guilt of their loved one. Malcolm goes on to state,” The report showed that 29 percent of adult Canadians who fell ill and needed to see a specialist waited two months or longer, and 18 percent waited four months or longer, compared with 6 percent and 7 percent of Americans, respectively.” These patients suffered two months or more just to receive average health services. If America switched to this system, the wait times would double to accommodate our increasing population.

Lastly, some people advocate that single-payer healthcare would improve the overall health of the country. In my opinion, this concept would only lead to socialism, rapid inflation, and completely lessen the quality of healthcare. Moreover, the foundation of America was built on three strong principles: life, liberty, and the pursuit of happiness; however, no statement in the constitution that sanctions America to free healthcare. America is a society built on democratic principles. It would be leaning toward a socialistic culture if America switched to a universal healthcare system. According to ProCon.org,” Everyone has the right to a standard of living adequate for the health and well-being of oneself and one’s family, including… medical care.’ This statement was recognized by the United Nations Universal Declaration of Human Rights; as a result, some people advocate that this allows room for a universal health system. However, as a democracy, many people still hold that the free market should be able to decide the price and opportunity to access healthcare. Former President Ronald Reagan proclaimed,” One of the traditional methods of imposing statism or socialism on a people has been by way of medicine…and once socialized medicine is instituted, ‘behind it will come other federal programs that will invade every area of freedom” (ProCon). It would be almost tyrannical to tell the citizens of America to pay for everyone’s healthcare. The government would tax the big corporations that would raise the prices of goods causing rapid inflation. This would be a repeat of 1923 Germany.

The United States spends an average of $10,209 per person which is 2.5 times the average spent by single-payer health system countries. According to Ken Perez,” Citing the lower per-capita costs of health care in other industrialized countries that have single-payer systems, Sanders contends that national health expenditures (NHE), which are projected to total $3.5 trillion in 2017, would amount to $6 trillion less over 10 years under his plan compared with the current system. c Currently, the federal government pays for slightly less than one-third of NHE, about $1.1 trillion, funding Medicare, Medicaid, the Children’s Health Insurance Program, health insurance subsidies and related spending, and veterans’ medical care. d, under a single-payer system, the federal government’s expenditures for health care would increase significantly.” A single-payer health system would increase debt and it would decrease the quality of service. It’s a complete loss in all aspects; as a result, a universal health system would not work in the United States. While healthcare would be free, it would not be the same quality; therefore, I do not support the idea of a universal health system in America. It is not economically feasible.

This healthcare crisis will not defeat America. There are ways that you can help fix the broken system. The only logical thing to do is to create more jobs. If there are more jobs, more people can make money to buy health insurance. 3.6% of America is unemployed. While this is a peak low, I still encourage you to start a new business. Open that bakery. All these scenarios create more jobs that allow people to earn money to buy health insurance. With this solution, there would be no increased debt, no increased waitlists, and no doubled tax rates. When the foundation of America is united, a healthcare crisis will not divide us. 

Malaysia is one of the countries that provides high-quality service in terms of healthcare services and now it has come to be an alternate destination for medical tourism aside from Singapore, Thailand, and India. Since the year 2000, the number of tourists who seek healthcare in Malaysia has been increasing as people see it as an ideal destination for healthcare services (Chandran et al. 2017). Malaysia’s achievement in medical tourism could be recognized through its major competitive benefits which can be seen in terms of the great quality of healthcare offerings and the huge quantity of permitted hospitals (Mun et al., 2014). According to the Ministry of Health Malaysia, Malaysia has succeeded in creating the state as a regional hub for medical tourism where they provide excellent treatments and the best quality facilities and services. However, a few factors affect the supply of medical tourism in Malaysia such as experienced healthcare professionals and developed healthcare technology.

Experienced healthcare professionals

Firstly, medical tourism in Malaysia consists of many experienced doctors. Most of the doctors from Malaysia obtained training from respectable institutions all over the world such as the United Kingdom, United States, India, and Australia. Thus, living in a multi-cultural country, Malaysian healthcare professionals are also culturally attentive and multilingual. This shows that the patients don’t have to worry much as most of the medical personnel are fluent in English and also some other Asian languages such as Mandarin, Malay, Tamil, Hindi, and Bahasa Indonesia (Medical Tourism Malaysia, 2019). Moreover, this factor has contributed to Malaysia’s medical tourism industry. Based on a study by Herberholz and Supakankunti (2013), it was mentioned that well-trained medical experts are one of the keys to this achievement as well as the comfort of communication due to the presence of a multilingual health workforce (Hin et. al, 2013). Therefore, many tourists started visiting Malaysia for healthcare as Malaysia has many qualified doctors and nurses who eventually

Developed healthcare technology

One of the reasons why tourists prefer Malaysia is due to its constant innovation in healthcare technology. Malaysia provides high-quality convalescence services. Moreover, some hospitals are a one-stop destination for tourists by providing many options for the patients such as pre-operative consultations, post-operative rehabilitative treatments, and therapies (Chandran et al. 2017). Currently, Malaysia is promoting itself as the ‘Cardiology and Fertility Hub of Asia’ where it is strong in-vitro fertilization (IVF) and the success rates are also above the global average (2019). MHTC CEO Sherene Azli also mentioned that hospitals and clinics in Malaysia are now using Fourth Industrial Revolution technologies. This helps to get more accurate diagnostics and aids easier transfer of medical records from international patients. Apart from that, technologies such as artificial intelligence and big data help Malaysia to improve the patient experience (2019). These technologies owned by Malaysian medical tourism have kept tourists coming for healthcare.

References

1. Chandran, S. D., Pakeer Mohamed, A. . s. h. a. h., Zainuddin, A., Puteh, F., & Azmi, N. A. (2017, August). Medical Tourism: Why Malaysia is a Preferred Destination? ResearchGate. https://www.researchgate.net/publication/320646448_Medical_Tourism_Why_Malaysia_is_a_Preferred_Destination
2. Chandran, S.D., Puteh, F., Zianuddin, A., Azmi, N.A., & Khuen, W.W. (2018). Key Drivers of Medical Tourism in Malaysia. Journal of Tourism, Hospitality & Culinary Arts, 10(1), 15-26
3. M. (2020b, April 17). Innovation as a driver of Malaysia’s medical tourism success. Malaysia Healthcare Travel Council (MHTC). https://www.mhtc.org.my/mhtc/2020/03/16/innovation-as-a-driver-of-malaysias-medical-tourism-success/
4. M. (2019, May 3). Malaysia’s medical tourism is on a high. Malaysia Healthcare Travel Council (MHTC). https://www.mhtc.org.my/mhtc/2019/05/03/malaysias-medical-tourism-on-a-high/
5. Medical Tourism Malaysia. (2019, December 9). Malaysia Healthcare: World-Class Quality Care for Your Peace of Mind. https://medicaltourismmalaysia.com/2018/09/01/malaysia-healthcare-world-class-quality-care-for-your-peace-of-mind/

In the United States, we are home to many unique laws, freedoms, and opportunities. Whether you want to own a firearm or open your own business, you have the option and opportunity to do so. The United States in a lot of ways is comparable to other well-established nations and while we like to think that we are constantly the number one country, that just boils down to the subject matter. For instance, according to Experian, as of 2018 in quarter four consumer debt reached an all-time high as the United States ranks number one in the world for consumer debt. However, when most people think of that they just think of stuff. They don’t typically think of the biggest causes of debt which are home loans, student loans, and most importantly medical bills. I chose healthcare as my topic because there are so many misconceptions about a universal healthcare system without people realizing we already have Medicare in place. Medicare, which is run by the federal government, is a very well-respected and well-received program.

Healthcare in the United States is such an extraordinarily broken system that it’s honestly amazing that we still have this system in place today. According to The Balance “In 2015, the Kaiser Family Foundation found that medical bills made 1 million adults declare bankruptcy. Its survey found that 26 percent of Americans aged 18 to 64 struggled to pay medical bills. According to the U.S. Census, that’s 52 million adults. The survey found that 2 percent, or 1 million, said they declared bankruptcy that year.” This is simply because if people’s wallets are not big enough for treatment, we simply let them die. We have fundamentally built a system where we are forced to pay a middleman oh May or may not cover you in case of emergency. Does not seem crazy? Read that again. We pay for “insurance” which is a middleman who may or may NOT cover you in an emergency.

As this 2020 election rolls around you definitely may have noticed that health is a very issue. It is very important to note that the United States is the only established nation to not have a universal healthcare system in place. When you hear talk of places like Venezuela it is almost always in the negative form of a socialist system. The irritating part about that argument is they don’t tell you that it wasn’t socialism that led to the fall of Venezuela. There are many to list the fall event because when it comes to health there are many countries that have an established universal healthcare system that is “socialized”.

Some of these countries are but are not limited to, Sweden, Canada, Denmark, the UK, Russia, Finland, Norway, the Netherlands, and so many others. In an academic article published by New Internationalist, they interviewed a woman about a medical emergency that left her a week in the hospital. “Rebecca Randel, a 39-year-old graduate student, is a case in point. In 2009, Randel had what she calls ‘a classic American healthcare experience’ when a week in hospital for emergency treatment left her with $24,000 in medical costs. ‘I would have nightmares about how to pay my bills,’ she says.” Unfortunately, Rebecca’s experience isn’t unheard of in fact it is very common.

One of the biggest counterpoints for a universal healthcare system in the United States is the cost. People who oppose Medicare for All always ask how are going to pay for it. They also ask how much it’s going to cost and if they could stay with their doctor. Robert Blank, who wrote Transformation of the US Healthcare System: Why is change so difficult? Listed some reasons as to why the system is ok where it’s at. Some of these reasons include how the Affordable Care Act “implements guaranteed issue and community rating nationally so that insurers must offer the same premium to all applicants of the same age, sex, and geographical location regardless of pre-existing conditions, Introduces minimum standards for health insurance policies and removes all annual and lifetime coverage caps, and mandates that some healthcare insurance benefits will be ‘essential’ coverage for which there will be no co-pays.” While this is a good starting point and before we get into cost, let’s first talk about what is Medicare.

Medicare is the federal health insurance program for individuals who are 65 or older, younger individuals with disabilities, and people with End-Stage Renal Disease. (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD) Medicare covers dental, vision, medical, hospital, and prescription drugs. Some say that Medicare is the “Cadillac plan” of insurance and they would be right.

So how much would this all cost? Well, Business Insider states that “A recent, well-publicized study by the Mercatus Center— a libertarian free-market think tank — put the price tag at $32.6 trillion over 10 years.” While that is true, what they left out is that our current healthcare system costs $40 Trillion over 10 years. A universal healthcare system would save 7 trillion dollars. As for keeping your doctor, of course you can. You are pretty much guaranteed to be with that doctor unless you explicitly change.

Wouldn’t it be nice to keep your same doctor and not be charged co-pays which are essentially a private tax? Wouldn’t it be nice to not have to worry about being stuck with insane healthcare bills? Wouldn’t it be nice to have peace of mind that no matter what you will be covered? That’s what a Medicare for all bill would entail. Medicare for all insurers everybody and insures them well. This bill also eliminates healthcare as a bargaining burden and de-links healthcare and employment which could ultimately raise your wages. The time is now for a revolution in our healthcare system. The System is made for the people by the people. 2020 is a year of change and what better way to start than with our own lives?

Works Cited

1. Amadeo, Kimberly. “Do Medical Bills Bankrupt America’s Families?” The Balance, The Balance, 30 May 2019, www.thebalance.com/medical-bankruptcy-statistics-4154729.
2. Blank, Robert H. “Transformation of the US Healthcare System: Why Is Change so Difficult?” Current Sociology, vol. 60, no. 4, 2012, pp. 415–426., doi:10.1177/0011392112438327.
3. Bryan, Bob. “Here Are Some of the Biggest Arguments against Bernie Sanders’ ‘Medicare for All’ Plan, Which Is Gaining Popularity among Democrats.” Business Insider, Business Insider, 14 Oct. 2018, www.businessinsider.com/medicare-for-all-plan-arguments-against-bernie-sanders-plan-2018-10.
4. “Consumer Debt Reaches $13 Trillion in Q4 2018.” Experian, 28 Aug. 2019, www.experian.com/blogs/ask-experian/research/consumer-debt-study/.
5. Kahn, James G. “The Case for Medicare for All.” New Labor Forum, vol. 28, no. 2, 2019, pp. 52–56., doi:10.1177/1095796019837941.
6. Ross, Andrew. “You Are Not a Loan: A Debtors Movement.” Culture Unbound: Journal of Current Cultural Research, vol. 6, no. 1, 2014, pp. 179–188., doi:10.3384/cu.2000.1525.146179.

 

Introduction

The impact of the socio-economic and health status of a country is immense on the population of a country. However, it has been seen that the impact vary from country to country. The impact on developing countries and developed countries are completely different. In every country, there are many subgroups of people who are called the natives of the country. Their impact on the socio-economic and health status of the country is worthy of discussion. In this report, the point of discussion will involve the impact of the subgroup of people and middle-income families in New Zealand. This report will also critically evaluate the impact of the Pacifica group of people on the socio-economic and health status of the country. The comparison of the aforesaid status has been made with the other countries of the world, especially with the developing countries.

Task 1:

Critically reflect on the health and the socio-economic status of AotearoaNewZealand population, including sub groups like Māori, Pacifica, and middle-income families. Choose one subgroup and critically discuss the impact of their socio-economic status on access to the NZ healthcare system and their health outcomes.

The circumstances of health care involving the indigenous people in New Zealand differ according to the social, political and social characteristics of their environment in particular. The health circumstances also differ according to their interaction with the non-indigenous people of New Zealand. New Zealand is grouped among the OECD countries and has been experiencing the creation of a huge gap between the wealthy and middle-class people. The issues of inequality need to address by the government as that will help in creating a society that will be fair. The equal opportunities should be given to every class of people and properly screening the areas in which the improvement is needed. Inequality gives rise to economic challenges, political challenges, and ethical challenges. As per the opinion of Pihema (2017), this leaves many people behind in the changing economy. The inequality patterns of New Zealand have been well established. Apart from the inequality based on income or wealth, the scale of inequality in New Zealand is almost equal to Australia, Japan. Recently, a poll section has been taken which has said that the huge gap between the rich and the poor or middle-class people is creating an imbalance in the sector of wealth for the New Zealanders..Income is the major determinant of health and there is significant relation between the low income and poor health. Financially deprived families have more morbidity and mortality rates.while the adequate income is responsible for many other health determinants like good housing, nutrious diet and quality education. If they lack good education they are not able to trust the system which will cause unemployment, poor housing and the consequences are drastic, the life expectancy decreased, the higher risk of chronic diseases like metabolic diseases, cancer and cardiovascular diseases associated with the lifestyle factors like smoking and drug abuse and suffer from mental distress (zambas and wright,2016)

The Pacifica people are more prone to the adverse effects of health as they do not receive the facility of adequate housing. It is difficult for them to have access to proper health care facilities. They are discriminated which results in the lower income of the Pacifica People. The lower income takes away the right of this type of person to have access to proper nutrition and appropriate housing facilities.

Compared to the reference groups of the decile one Europeans who have a life expectancy has the greatest value. As per the opinion of Roskruge, Poot& King (2016), when the life lost was compared between the Pacifica men and the Pacifica women it has been seen that 9.5 years lost for The Pacifica men and 7.1 years was lost for the specific women. Smoking something has been

the biggest cost for printing morbidity and the mortality rate in the OECD countries, which includes New Zealand. As per the view of Reynolds (2016), smoking has been recognized as the major cause for various types of cancers cardiovascular diseases and respiratory diseases in adults. High exposure to smoking cigarettes has been recognized as one of the major risks for sudden death in infants and illnesses in the respiratory tract. The people of Maoris and Pacifica smoke largely compared to the total population of New Zealand. As per theopinion of Lipsey (2016),in the year 2006, it has been seen that 8.1% of the Pacifica children below the age of 15 used to live in a house with at least one smoker. This is established by. factor specific people who are very strict about smoking at home to be specific, it can be said that there and unsupportive of smoking in the house. Timely access to an effective health care system is an important factor for health-positive outcomes in the case of both the rates of death and the impact of chronic conditions on the Pacifica people. According to the opinion of Parackal (2018), primary care is referring to the health care which is provided within the community. It includes the health education provision and the services of prevention treatment and the coordination of illnesses that are less serious.

Proper maintaining of the Primary health care services will lead to the necessary referral of the secondary services. According to the view of Doolan-Noble (2015), apart from the Department of Emergency Services for Primary Care at the initiation step for the health system, they are very important for identifying the illnesses which are serious and then proceeded to the secondary or emergency services. The services for Primary health care are centered around the GP and the practicing of nursing services recently has been seen that the expansion of the primary services has been done which involves disciplinary teams and a wide range of health care services. Pacifica people have access to the services of child health care services regarding preventive measures. In the year 2006, many people were enrolled in Plunkett and percentage counts to 90. This percentage of infants was given the proper clinical assessment, services of parent education and health promotion. The infants of Pacifica not like the other Europeans and are more like the infants of Maoris

Maori population assumed 12%of GP visits which are less as compare to others, and 30% of visitors are young population between the age group 14to25 years and the percentage is higher (58.9%)at maori health providers than the private, community health care provider(11.8%and 19.4%) respectively(MOH,2019)

Due to the cost factor, 14% of adults do not visit GPs that data is similar as in 2006, and 3%of children did not report in past years. Ministry of Health started the initiative in 2008 to provide additional funding to encourage free GP consultation for the children under the age of 3 that will result in decreasing the unmet needs of GPs due to cost factors. Primary health organizations are the basic structure of health through which the government provides accessibility to general practitioners and provides funding to them to ensure that people enroled with PHO can get essential primary care. According to the opinion of Walters (2016), proper screening of the health problems, which are potential at the early stage, especially for the seriousdiseases. These diseases do not show symptoms at all. The proper and effective screening will help a person to get rid of serious diseases. The constructive way of processing the screening methods will be helpful for the people. According to the view of Olaison, Torres &Forssell (2018), it often happens that specific people with discriminated against based on caste, creed, religion, and social class, therefore, it is important to screen their serious illnesses in order to save them from life-threatening diseases. As per the opinion of Ross (2017), discrimination leads to bad habits like smoking and alcohol consumption. It is making them depressed as inequality is highly practiced in New Zealand and has been the greatest matter of concern.

Task 2

Provide a Critical Examination of the Aotearoa New Zealand Health system, including historical analysis, Funding, and Primary, Secondary and Tertiary Levels of Healthcare. Critically discuss how this system compares with that of your own country (if not from NZ).

The health system of New Zealand after the settlement of Europeans was run by the English system and there are both public and private health care services . In the year 1900 the Department of Public Health was built the main function of this was to look at the health of New Zealanders. And it is funded by taxation system. In 1983 the health boards were the main authorities in the health care system. Provide economic sources to hospitals and the government provide sources to the primary organization (cumming et al .,2014)

The prime motto of. healthcare organizations provide healthcare services to patients and give their best for the fast recovery of patients. As per the view ofLangmore (2017),  to provide appropriate health care services to patients, modern technological infrastructure such as ECG (electrocardiogram), X-ray machines, medical lasers, infusion pumps, MRI machines, and many other pieces of equipment are required. The cost of implementing such advanced devices within healthcare organizations requires huge capital investments and skilled labor. Healthcare in remote and rural areas of New Zealand has not competed in affording such a huge amount of capital and this reduces the efficiency of providing effective healthcare services to healthcare seekers (Keene et al. 2016). As compared with other developing countries and New Zealand, the healthcare system of New Zealand is much better as it is marching towards fast development. It is found that the health care system that prevails in New Zealand has undergone rapid and tremendous growth and development.

The tremendous growth and development of the healthcare system in New Zealand is attributed to the development of fiscal rules and regulations. The Social Security Act 1938 developed by the New Zealand government has initiated reform activities within the healthcare system of New Zealand (ssa.gov, 2017). This law has enforced healthcare providers present in New Zealand to improve and innovate their healthcare system so that effective and high-quality treatment can be provided to patients. This law has started health insurance to be provided to common people and this has benefited many people in New Zealand)

In New Zealand, most of the funding for healthcare comes from Vote Health and it is found out that Vote Health has provided funds amounting to $16.142 billion from 2016 to 2017 (health.govt.nz, 2018). The other funding source of New Zealand that contributes to healthcare are ACC (Accident Compensation Corporation), government agencies, and private sources. Private source of funding in the healthcare system includes insurance company. One of the latest funding sources that is capable of generating a huge amount of capital is crowdfunding. In the era of modern technology and networking, the crowdfunding approach to collecting funds is beneficial. Through social media, awareness of the requirement of huge capital investment for the healthcare system can be created. Interested people can contribute funds as per their capability. According to the opinion of Ali & Narayan (2015), the capital collected from different sources of funding is used to improve healthcare care facilities and also for providing free healthcare services to needy people. Compared with the funding source of New Zealand with developing countries it is found that developing countries have government-sponsored hospitals where healthcare facilities are provided to people at low cost. However, the quality of service in government-sponsored healthcare institutions is below standards. Apart from this, developing countries have less number of healthcare care practitioners who can provide efficient healthcare services to patients. As per the view of Carter (2016), the scarcity of healthcare professionals has degraded healthcare facilities in developing countries. As per the view of Knight-de-Blois (2015), the absence of appropriate healthcare professionals and healthcare technologies has deteriorated healthcare services in both developing countries and developing countries.

When immediate and emergency services are not provided to patients in need the death rate increases and this degrades the fame and reputation of a country. To avoid such a scenario, New Zealand needs to develop appropriate methods and strategies. When required, examples of developed countries can be adopted for enhancing healthcare facilities.

Primary health care involves the services of nurses, which have improved a lot in the present day. New Zealand has developed a country that is helping the improvement of health care services. According to the opinion of McKenzie (2019), the cost of healthcare services has also decreased due to the high discrimination of the Pacifica, and Maoris people. This has been seen that proper training and education have been provided to the nurses and they have been educated properly to provide better healthcare services to the people of New Zealand, especially the Pacifica and the Maoris as they have been pushed to the back and have indulged in many ill practices. According to the opinion of Carter et al. (2016), when compared with the developing countries, it has been seen that their economic progress is not that high and they are trying hard to take it to the top position. The cost of healthcare facilities is not that much low when compared to developed countries.

The secondary health care services consist of the specialized way of taking care of the patients. Specialized doctors or physicians come under this group. According to the opinion of Heap (2019), the government of New Zealand has made some regulations that will force specialist doctors to care for the Pacifica. The surgeons are grouped under the tertiary category of health care services, as, not all cardiologists are heart surgeons. The more specific approach to the health care services of New Zealand than the secondary health care services is considered as the tertiary health care services.

India has a combined health care system that includes public and private health providers. private healthcare providers mostly distribute their services in urban areas they mainly focus on the secondary and tertiary levels of care. The New Zealand health system is almost similar to India. The services are provided by government and non-government agencies that include primary, secondary, and tertiary levels of care. In India, the sub-centers, primary health centers, and community health centers make up the basic infrastructure of the public health care system. This system is based on population norms, the subcenter covers (3000-5000 ) population, the primary health center covers(20000-30000)and the community health centers provide services to(80000-120000)population. These centers provide primary and secondary levels of care. The district and sub-district hospitals cover about 2.8 lakh population and provide tertiary care to the population. There are also charitable trusts and voluntary organisations that provide services to mankind.

Healthcare in Japan is mostly considered to be a universal type of healthcare. Universal healthcare means that medical treatment for Japanese citizens is provided and paid for. This system is accessible to all citizens, as well as non-Japanese citizens staying in Japan for more than a year. This is quite different from healthcare in the United States, however, there are a few similarities.

The biggest difference between and Japan’s healthcare and the United States is that America has healthcare is based on a for-profit insurance system, while Japan’s has a fixed fee scheduled system. This means that in Japan, procedures and drug costs are the same throughout the country, whereas our prices differ vastly per state.

Even though healthcare in Japan is considered universal, it is not completely free. Some fees will be required to be paid out of pocket by the citizen. Currently, there are two types of public health insurance in Japan. These public health insurances are as follows: Social Health Insurance or Employees’ Health Insurance (SHI) and National Health Insurance (NHI). SHI is for individuals with a full-time job and all healthcare is paid for through your salary check. NHI is for everyone else, such as students, freelancers, and people with jobs that do not use SHI. In addition to having to pay monthly premiums into the public health insurance system, Japanese citizens pay 30% of their medical bills themselves. These bills are tightly regulated by the state so that they never become unaffordable for citizens (Wise, 2015). Visitors in Japan also have the same healthcare options as citizens, depending on their employment and marital status.

Japan uses both traditional medicine and holistic medicine. It is not uncommon for households to use both for alternative ways of healing. For instance, Kampo medicine is a herbal medical system that has been around for thousands of years. This method of healing has been meticulously arranged based on the reactions that the human body gives to therapeutic interventions. Kampo stems from the roots of ancient Chinese herbal medicine and is commonly prescribed by doctors all over Asia. Additionally, acupuncture has been an important part of Japan’s medical practice and system for thousands of years. This is another form of holistic healthcare that is still widely used in Asian cultures today.

Culture can play a large role in medical interactions and outcomes. Culture influences how an individual might view an illness or treatment. Some cultures believe illness will be cured by a higher power and refuse medical treatment because of such beliefs. This is also another reason why herbal medicine and therapeutic medicines are still very common in Japanese healthcare regimes. Culture also heavily influences a person’s diet and exercise, which in turn, influences a population’s health overall. For instance, diet and exercise are viewed differently in Japan than it is in America. Overall, Japan is a very thin society. Only 3.7% of Japanese are individuals obese, (compared to 38.0% of Americans) the need for healthcare in Japan is much lower (Townsend, 2018). This is partially due to their different view on diet and exercise.

For example, traditional Japanese dishes tend to be eaten slowly and in small bites with chopsticks. Traditional main dishes usually include some form of seafood or tofu, and sometimes natto with optional small amounts of red meat or eggs. Side dishes are typically seaweed or vegetables, and raw or pickled fruit. Consuming snacks is also not as common as it is in Western societies.

Japanese individuals also walk more daily than more Americans. For instance, they walk an average of 3.5 miles to our 1 mile daily (Townsend,2018). As Japan has a large population, their means of travel are also very different. Japanese people also tend to walk more because of the higher costs of driving in Japan. It is uncommon for a traditional Japanese family to own a vehicle due to this.

Japan’s healthcare system also includes yearly body max index testing and expects most people to stay in their range. In 2008, the Japanese Ministry of Health, Labor, and Welfare introduced the Metabo Law, which requires men and women between the ages of 40 and 74 to have their waist circumference measured annually. The waistline circumference limits are 33.5 inches for men and 35.4 inches for women (Stephen, 2018). Within this law, citizens are required to stay within range and will be given notice if they are not. Your doctor will then suggest a specialist, which will provide you with a diet and exercise plan to assist you.

On average, Japanese people also have one of the lowest mortality rates in the world. The average life expectancy of a Japanese male is 81 and for females, it is 87. Their dietary patterns are characterized by low intake of red meat, high intakes of fish, plant foods, and no sugar-sweetened beverages, which are thought to be linked to relatively low mortality from cancer and ischemic heart disease and low prevalence of obesity (Tsugane, 2020).

In conclusion, the country of Japan has a vastly different vision for the healthcare of its people. The main reason for that is based on their deeply ingrained culture. Furthermore, Japanese citizens have low obesity rates because of diet and management and exercising more on average than most Westernized countries. Japan has obtained an inclusive form of universal healthcare because they are much healthier as a society. The United States should strive to reform a system that will also aim to improve the health of its citizens. This will not only grow our healthcare system but the overall health and well-being of our country.

Universal Health Care

Medical costs for uninsured people in the United States are exorbitantly high, and insurers’ policies usually focus on profit margins rather than providing medical care. These situations are inconsistent with American values ?? and norms, and it is time for the United States to provide universal insurance to all citizens. As with education, health care should be seen as a fundamental right of all citizens of the United States, not just a privilege for the wealthy.

One of the most common objections to universal health insurance is that it is very expensive. In other words, UHC will raise taxes significantly. Providing medical care to all U.S. citizens would be expensive for taxpayers, but they need to assess how much it costs, and more importantly, how much would be too much when it comes to opening up universal health insurance. People with health insurance already pay a lot, but uninsured people pay exorbitant prices. It is difficult to compare the cost of publicly funded medical care with the cost of current insurance premiums. Still, some Americans, especially low-income earners, may benefit.

While UHC will cost Americans a few hundred dollars more each year, we should consider what kind of country we want to live in and what kind of ethics we represent if we are willing to refuse healthcare for others to save several hundred dollars. There is little room for compassion and love in a system of harsh individualism and business priorities. It’s been too long for Americans to realize the callousness with which American hospitals are forced to turn their backs on the sick and poor. UHC is a healthcare system that adheres more closely to the fundamentals that so many Americans profess and value and now is the time to reach its full potential.

Another typical argument for UHC in the United States is that other equivalent national health systems such as the United Kingdom, France, and Canada are bankrupt or plagued by problems. UHC opponents claim that sick people in these countries are facing long lines or waiting lists for basic health care. Opponents often accuse these systems of not being self-sufficient, leading to large deficits each year. There is a fair amount of truth in these arguments, but Americans should remember to put these issues in the context of the existing US system. Indeed, people in countries with universal healthcare often have to wait to see a doctor, but we in the US also have to wait, and sometimes book appointments weeks in advance, just to wait a long period in the doctor’s waiting rooms.

Critical and urgent care is always treated right away in other countries, just like in the United States. The main difference, however, is the price. Even those with health insurance are not immune to the soaring costs of healthcare in the United States. Every day, an American is diagnosed with cancer, but the only possible therapy is often considered ‘experimental’ by insurance companies and therefore not offered. The patient has to pay out-of-pocket for the therapy if he does not have health insurance. However, these costs can be so high that the patient will have to choose between less effective but covered therapy, no treatment at all, or trying to pay for treatment and incurring unwanted consequences. financially conceivable. Medical costs can quickly reach hundreds of thousands of dollars in many situations, forcing even the wealthiest families to lose their homes and stay in debt for the rest of their lives. Many Americans may face this unwanted situation at some point in their lives, but they still choose to take financial risks. US citizens need to encourage lawmakers to adopt UHC, which offers safe and affordable coverage, rather than endangering health and financial well-being.

Contrary to what opponents claim, a universal healthcare system will save lives and improve the health of all Americans. Why is public education widely accepted, but not public health care? It’s time for Americans to see health as a social right, just like education and law enforcement.

The World Health Organization (WHO) has defined healthcare as, ‘A good health system delivers quality services to all people, when and where they need them. The exact configuration of services varies from country to country, but in all cases requires a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; well maintained facilities and provision to deliver quality medicines and technologies.’

‘Right to live’

Part III of our constitution has stated certain fundamental rights for the citizens of India. In particular we will be looking at Article 21.

So what is Article 21?

“No person shall be deprived of his life or personal liberty except according to procedure established by law.”

Article 21 confers on everybody the elemental right to life and personal liberty. It is the foremost basic of human rights, and acknowledges the sanctity of human life. This article provides right to life and personal liberty except on the ground of procedure established by law. Over the years, this Article has undergone a sea change and has; become the most important and fundamental right. Now, the Article stands not simply for the right to Life and personal liberty, but conjointly the right to dignity and all different attributes of human temperament those are essential for the full development of a person.

A simple understanding of this right would bring us to a conclusion that health is a necessary aspect of a good healthy and prosperous life. Therefore healthcare should already be a part of Right to live, which if were true would make the whole purpose of this project useless!

However here’s where we come across a loophole…Article 21 of the Indian Constitution guarantees the right to life and personal liberty. Here, the expression ‘life’ denotes the life with dignity and not only the mere survival with having a wider explanation to have everything to live a life of a better standard. Article 21 puts a limit on the power of the State given under Article 246, read with the legislative lists. Thus, Article 21 does not recognize the Right to Life and Personal Liberty as an absolute right but limits the scope of the right itself.

‘Does this mean that the Constitution doesn’t give Healthcare any importance?’

NO. Though the right to health has not been expressly identified in the Indian Constitution under Article 21 still the Supreme Court of India has declared the right to health as a constitutional right taking references with the International Law. Constitution of India is the supreme law of the land which advocates every other law of the country. Furthermore, it is not only a Fundamental right but even the Directive Principles of State Policy do have certain provisions for a better standard of health hence it is the duty of the state to implement the directives to give the citizens more benefits on the right to health. Article 21 of the Indian Constitution shouldn’t be interpreted alone it ought to be combined with additional articles such as Articles 38, 42, and 47 to have a clear understanding of the character of the responsibility of the State to ensure better health conditions within the scope of the right to health.

‘So, should healthcare be a fundamental right?’

A report published in The Lancet states that, ‘Some 2.4 million Indians die of treatable conditions every year.’

Poor care quality leads to more deaths than insufficient access to healthcare–1.6 million Indians died due to poor quality of care in 2016, nearly twice as many as due to non-utilization of healthcare services (838,000 persons).

Almost 122 Indians per 100,000 die due to poor quality of care each year, the study said, showing up India’s death rate due to poor care quality as worse than that of Brazil (74), Russia (91), China (46), and South Africa (93) and even its neighbors Pakistan (119), Nepal (93), Bangladesh (57) and Sri Lanka (51).

A calculable 8.6 million deaths in low- and middle-income countries every year are due to conditions treatable by healthcare, of which 5 million result from poor quality of care and 3.6 million from insufficient access to care, according to The Lancet Global Health Commission on High Quality Health Systems.

After observing such shocking statistics the answer seems very obvious ‘YES HEALTHCARE SHOULD BE A FUNDAMENTAL RIGHT’

But in reality if the answer was that simple it would have been implemented long ago…

‘More than a million of 8.6 million preventable deaths were from neonatal conditions and tuberculosis in people who accessed the health system but received poor quality of care in 2016. An estimated 81% of cardiovascular deaths, 81% of vaccine-preventable diseases, 61% of neonatal conditions and half of maternal, road injury, tuberculosis, HIV and other infectious deaths were due to poor quality of care.’

Just access to health care isn’t enough and good quality care is required for better outcomes. Citing the example of India’s Janani Suraksha Yojana (Maternal Safety Scheme). Started in 2005, the programme offers cash incentives to encourage women to give birth in health facilities. It has “increased facility delivery however failed to measurably scale back maternal or newborn mortality”, report notes. While it led to 50 million births in health facilities, many of them occurred in primary care centres that did not have sufficiently skilled staff to address maternal and newborn complications.

High-quality care involves thorough assessment, detection of asymptomatic and co-existing conditions, accurate diagnosis, appropriate and timely treatment, referral when needed for hospital care and surgery, and the ability to follow the patient and modify the treatment course as required.

‘Can health & healthcare be used synonymously?’

Health and health care need to be distinguished from each other for no better reason than that the former is often incorrectly seen as a direct function of the latter. Heath is clearly not the mere absence of illness. Good Health confers on a person or group’s freedom from illness – and the ability to realize one’s potential. Health is thus best understood as the indispensable basis for outlining an individual’s sense of well being. The health of populations is a distinct key issue in public policy discourse in each mature society usually determining the deployment of huge society. They include its cultural understanding of ill health and well-being, extent of socio-economic disparities, reach of health services and quality and costs of care and current bio-medical understanding about health and illness.

Health care covers not just medical treatment but additionally all aspects pro preventive care too. Nor can it be restricted to care rendered by or financed out of public expenditure- inside the govt sector alone however should embody incentives and disincentives for self care and care paid for by private citizens overcome over health problems. Where, as in India, private out-of-pocket expenditure dominates the cost financing health care, the effects are bound to be regressive.

‘How much does the government spend on Healthcare?’

The amount India spends on public health per capita each year is Rs 1,112, less than the price of one consultation at the country’s top private hospitals–or roughly the cost of a pizza at many hotels. That involves Rs 93 per month or Rs 3 per day. At 1.02 % of its gross domestic product (GDP)–a figure that remained nearly unchanged in 9 years since 2009–India’s public health expenditure is amongst the lowest in the world, lower than most low-income countries which spend 1.4 % of their GDP on health care, consistent with the National Health Profile, 2018, released by union minister for health and family welfare, JP Nadda, on 19 June. India spends 1.02 % of gross domestic product (GDP) on public healthcare, compared to 1.4 percent by low-income countries, the new data reveals. The recent Human Development Report published by the United Nations Development Programme has yet again highlighted India’s poor development outcomes compared to its peers. India’s abysmal ranking in development outcomes is primarily owing to its skew disbursement priorities. To put it simply, 16% of total central government expenditure is locked away in subsidies whereas only 5.3% goes to education, health and water and sanitation put together. The subsidy spending is extremely regressive, benefiting the wealthy far more than the poor.

The statistics above give a very clear image of the current state of healthcare in India . To sum up the above paragraphs; India’s expenditure on healthcare is embarrassingly low, schemes put out by the government fail to get effectively implemented . Subsidies offered by the Government aren’t reaching the targeted population.

Before diving into the reasons of poor healthcare, to be specific why aren’t these government policies working, we need to first look at the recent government policies made on healthcare.

Recent Government policies

The National Health Mission (NHM) was launched by the government of India in 2013 subsuming the National Rural Health Mission and National Urban Health Mission. It was further extended in March 2018, to continue until March 2020.

The main programmatic components include Health System Strengthening in rural and urban areas for – Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases. The NHM envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people’s needs.

The National Health Mission seeks to ensure the achievement of the following indicators: –

• Reduce MMR to 1/1000 live births
• Reduce IMR to 25/1000 live births
• Reduce TFR to 2.1
• Prevention and reduction of anemia in women aged 15–49 years
• Prevent and reduce mortality & morbidity from communicable, non- communicable; injuries and emerging diseases
• Reduce household out-of-pocket expenditure on total health care expenditure
• Reduce annual incidence and mortality from Tuberculosis by half

And much more..

A few policies under the NHM are :

1. Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) program:
2. Rashtriya Bal Swasthya Karyakram (RBSK)
3. The Rashtriya Kishor Swasthya Karyakram
4. Janani Shishu Suraksha Karyakaram

Apart from the above mentioned schemes the NHM has also launched various other policies.

The most recent policy the government has put out is the National Healthcare policy (2017)

The main objective of the National Health Policy 2017 is to achieve the highest possible level of good health and well-being, through a preventive and promotive health care orientation in all developmental policies, and to achieve universal access to good quality health care services without anyone having to face financial hardship as a consequence.

It seeks to strengthen the health, surveillance system and establish registries for diseases of public health importance, by 2020. It aims at achieving universal health coverage and delivering quality health care services to all at affordable cost. This Policy looks at problems and solutions holistically with private sector as strategic partners. It seeks to promote quality of care; its focus is on emerging diseases and investment in promotive and preventive healthcare. The policy is patient centric and quality driven envisages strategic purchase of secondary and tertiary care services as a short term measure to supplement and fill critical gaps in the health system.

‘The government has provided us with so many policies, but why is our healthcare system still lacking?’

1) Infrastructure of Government Hospitals:

Most of the hospitals/dispensaries particularly in villages do not have even basic infrastructure.

2) Govt. Subsidies

Excessive price controls that do not allow for a fair competition to the producer have resulted in lowered investment in research and development, reduced quality and lower production, leading to unethical trade practices and choice to the consumers. They have created companies focused on competing almost entirely on cost, with little interest in quality and innovation. Indeed, this reality is what led to the gradual shortening of the list of drugs under price controls from the 1970s to 2010s. After all, of what use are lower prices to patients if the products are inferior or simply unavailable?

Looking at the recent example of price controls imposed on coronary stents for heart disorders, at least three manufacturers of high-quality stents with demonstrable value to patients have since requested to exit the market. These companies are feeling neglected and cornered. Reports suggest that, in spite of price cuts, the stent placement procedure costs continue as before, with hospitals merely assigning the costs elsewhere in the package offered to the patient. If this isn’t a failure to achieve the desired outcome, what is? At the end, who suffers? It’s the patients.

3) Lack of synergy between research institutes and govt.

Although there’s an excessiveness of health analysis establishments in Asian country, there is little synergy between them. One major cause for concern is restricted use of the health management data system as a proactive management tool in government health programmes. There is additionally inadequate linkage between research institutions and also the implementation wing.

4) Lack of awareness

Consumers’ personal choices and behaviors are significant determinants of their overall health, and those who fail to take personal responsibility for their health can cost the system billions of dollars each year

5). Stark divergence in healthcare outcomes within the country:

Healthcare being a state subject, the healthcare outcomes have remained divergent supported by the standard of the state administration. While North India is the most populated part of India, it has one of the most underserved healthcare infrastructures in the country. Consequently, while hundreds of children died in hospitals in Uttar Pradesh last year, Kerala managed to contain the deadly Nipah virus outbreak within weeks.

Another recent problem that has risen is the overwhelming influx of patients in compared to the underwhelming amount of doctors.

‘A Doctor’s Perspective’

A survey by the Indian Medical Association (IMA) in 2015 revealed that nearly 75% of doctors in India have confronted some type of violence and threat at some point in their careers. Exemplary punishment of culprits of violence should be a component of the central law. Suitable amendments must be brought in IPC and CrPC

The main reasons attributed to violence against healthcare staff are:

1. The absence of adequate economic investment in healthcare.
2. Little and medium private health awareness foundations, which give a major portion of medicinal services administrations are confined and disorganized. Every one of these elements causes disappointment among people in general, and they take on their dissatisfaction onto specialists.
3. The other factors attributed to violence against doctors are poor quality of emergency care, the poor mechanism for grievance redressal, poor emergency network among hospitals, poor communication skills of healthcare workers, high patient load, lack of proper training of healthcare staff, high work load and political obstruction in emergency clinic affairs.

‘What is the negative impact that could happen if Healthcare was made a Fundamental Right?’

1. Libertarian position:

This can be summed as follows: while health, in certain preventative aspects, may require a degree of engagement from the state, in a world cleansed, for the most part, of epidemics and the most dangerous communicable diseases, it is the individual who is responsible for her health. And if she falls sick, she must pay for it—and not just monetarily but also in a punitive sense—for having been irresponsible enough to fall ill (through neglect, etc.,) and impose a social cost on society. Consumers’ personal choices and behaviors are significant determinants of their overall health, and those who fail to take personal responsibility for their health can cost the system billions of dollars each year

2. Living Conditions:

The other set of arguments usually stated against creating health a right are the pragmatic ones, to do with the capacity of the state to deliver on such a promise—where is the money going to come from?, where are the hospitals?, where are the trained health workers?etc. Those who support health as a fundamental right counter the above criticisms by citing that it’s not solely the individual who is to blame for her health but conjointly the circumstances in which she lives and works, and these are often not under her control.

For example, Delhi is the world’s most polluted city. In winter particularly, you can barely venture out in the morning smog without catching an infection. Isn’t the state responsible for controlling pollution? If health was a fundamental right, then the government would be compelled to think seriously about the pollution aspect or the environmental impact when, say, granting permissions for new industries or framing development policies.

3. A right to health care could cause people to overuse health care resources:

When people are given universal health care and aren’t directly chargeable for the costs of medical services, they may utilize more health resources than necessary.

Conclusion

Law is an important public health tool that plays a critical role in protecting the health of the general public. Right health is central to all human rights and denial of health right would mean denial of all human rights. The framers of the constitution incorporated right to health in the Directive Principles of State Policy (DPSP) which enjoins the state to provide comprehensive, creative, Therefore, entitlement to healthcare must be ensured by developing specific statutes, programs and services..Health care at its essential core is widely recognized to be a public good. Its demand and supply cannot thus, be left to be regulated solely by the invisible had of the market. Nor can it be established on examination of utility maximising conduct alone.

This brings us to our main question, ‘Should healthcare be a fundamental right?’

After critically analyzing the state of healthcare in India, the law backing the concept of health and healthcare, the hitch in the healthcare of our country, and the disadvantages or negative impact of Healthcare being a Fundamental Right… it is safe to say both arguments ‘for and against’ have equally notable arguments. Hence there is no clear cut conclusion to this question due to its complexity in nature. The purpose of this project is not to give you the answer to the question..but to question and analyse the answers that are out there.

Three prominent global health issues

Understanding the basic steps of how global issues impacts the world as a whole requires a collective effort from every individual. There are many global health issues on the up-rise; this is a summary of three prominent ones such as environmental, economic, and agriculture factors that negatively influence our economy today.

Environmental factors: studies by McMichael, A. J., Friel, S., Nyong, A., & Corvalan, C. (2008), have shown there has been a significant amount of changes in soil, water, climate, natural vegetation, and landforms. Environmental factors include everything that changes the environment we live in directly/indirectly, some factors are visible, while others cannot be seen. When basic survival needs are disrupted by devastating storms, flooding, droughts, and air pollution, diseases are more easily spread across large groups of people. The aim of global health focuses on the prevention of environmental challenges in the first place. “Climate change is thought by many global health experts to be the greatest threat to human health, global policies to mitigate mankind’s contribution to climate change are gaining traction.” ( McMichael, A. J., et al 2008). Recent studies have also pointed out that legislation in China, India, the US, and many European countries is introducing policies that regulate household energy consumption on a large scale while encouraging industry progress toward environmentally conscious practices. (McMichael, A et al, 2008).

Economic Factors: Despite continuing progress in the field of medicine, some communities in rural areas across the world still lack access to basic health education and health care. As a result, they face endemics such as sexually transmitted diseases (STDs), high child mortality rates, and basic nutrition. All these preventable problems could be alleviated by reducing the disparities that isolate these populations; some disparities are also related to geography, with rural communities facing the greatest shortage of basic medical needs. Poverty the number one disparity which is the cause of income inequality leaves individuals and families not being able to afford healthcare. ( Benatar, S. R., Gill, S., & Bakker, I. 2011).

Agriculture: Animal health is naturally intertwined with humans; in recent years humans have favored mass production based on the clearest connection which occurs within the food chain, as humans grow, process, and consume food on a large scale. Whereas in other parts of the world, animals are also relied on just for food consumption but for transportation, draught power, and clothing. In these parts of the world animal health is crucial and works hand in hand with human health. Practices such as irrigation, pesticide use, and waste management can influence animal health, making disease transmission a concern at every stage of the food supply chain. Pathogens originating from animals or animal products play such a significant role in disease transmission. (Hazell, P., & Wood, S. 2007). The list of global health issues continues to grow and can be overwhelming. The solution to these issues is never quick and easy but working more diligently to organize our understanding of cause and effect will help future researchers provide and set structures in place to yield positive results.

References

1. Benatar, S. R., Gill, S., & Bakker, I. (2011). Global health and the global economic crisis. American Journal of public health, 101(4), 646–653. doi:10.2105/AJPH.2009.188458
2. Hazell, P., & Wood, S. (2007). Drivers of change in global agriculture. Philosophical Transactions of the Royal Society of London. Series B, Biological sciences, 363(1491), 495–515. doi:10.1098/rstb.2007.2166
3. McMichael, A. J., Friel, S., Nyong, A., & Corvalan, C. (2008). Global environmental change and health: impacts, inequalities, and the health sector. BMJ (Clinical research ed.), 336(7637), 191–194. doi:10.1136/bmj.39392.473727.AD

Question

Critically explore the relationship between ‘the syndemics model of health’ and the ‘social determinants of health and illness’. Please indicate clearly where you are positioned in the relationship between these two approaches, illustrating the reasons for how and why at the same time.

The social determinants of health and illness are characterized as the social settings in which individuals grow, live, and work and macro institutional structures that frame the circumstance of everyday life. These macrostructural forces include political systems, economic /social policies, economic organization, and social norms (WHO, 2017). On the other hand, the Syndemics model of health adopts an interdisciplinary biosocial approach, which illuminates how and in what ways intergenerational biological pathways and the synergistic interactions of social, environmental, and biosocial determinants generate and enhance multiple disease/illness clustering within individuals and social groups. The purpose of this paper is to 1. Critically explore the relationship between ‘the Syndemics model of health’ and the ‘social determinants of health and illness’’; and 2. Through using a Syndemics ethnographic example of HIV/AIDS susceptibility in Black and Latino men in New York, indicate where both ethnic groups are positioned in the relationship between these two approaches, illustrating the reasons for how and why at the same time.

As already mentioned, the ‘syndemics model of health’ and ‘the social determinants of health and illness’ are two separate, however, intersecting and affiliated structures that can be used as a dichotomous framework to holistically analyze and examine determinants of health and illness. Essentially, the Syndemics model uniquely explores, measures, and determines how evolutionary micro and macro biosocial determinants promote and reproduce pathogenic diseases and illnesses that operate and cluster within individuals and collective populations. On the other hand, the social determinants of health and illness identify and exclusively examine how micro and macro social factors act as a fundamental vice of social stratification which effectively determines individual and collective levels of health and wellbeing, thus influencing disease and illness experience.

The Syndemics model of health centers on the interdisciplinary biosocial framework, which theorizes how the biological and sociocultural evolution of human beings produces biosocial factors and inheritance which act in synergistic ways to structure social and cultural environments that govern and enhance the biosocial reproduction of disease and parthenogen interaction in individuals and whole populations, which is passed through generations (Brown, et al, 1998). The syndemics model of health critically explores how micro and macro biosocial and biocultural factors, environments and inheritance interact synergistically to shape and reproduce interdependent, complimentary sequential parthenogens and diseases which encourage and promote the adverse ramifications of illness and disease cooperation (Singer et al, 2017). Syndemics uses both biological and macro sociocultural lenses to investigate how multiple disease and illness parthenogens are transmitted through biosocial inheritance and factors, why they cluster in specific societies and cultures, and the substantial adverse impacts this has on the health of individuals and whole populations.

Unlike syndemics which utilize the biosocial framework to examine disease clustering in populations, the social determinants of health and illness focus on the social model of health. Effectively, the social framework of health examines how contemporary individual socioeconomic determinants such as gender, income, ethnicity, lifestyle factors, poverty, and the class of employment, education, and living environments, combined with economic, political, social, and cultural institutions precisely and discursively determine collective and personal health (Germov & Poole, 2011). According to the AIHW (2012), social determinants are measured on a socio-economic continuum called the social gradient of health, which analyses how individual and collective health, well-being, disease, and illness experience are directly correlated with socioeconomic class and status. The gradient explores how health and disease are determined by social inequality in the distribution of assets such as money, power, social connectedness, and education (Link & Phelan, 1995), demonstrating that individuals who attain higher socioeconomic status attain higher levels of health and wellbeing compared to middle and low socioeconomic income earners (AIHW 2012). Consequently, those in lower socioeconomic positions are burdened with higher rates of morbidity and mortality, compared to individuals who attain higher socioeconomic positions (AIHW, 2012)

As explained, the syndemics model of health and the social determinants of health and illness are two separate, yet intersecting and affiliated conceptual frameworks that individually examine how health and illness are structured through biosocial/cultural inheritance, and contemporary individual and collective social determinants which shape our social world. A study undertaken by (Wilson et al, 2014) uses a Syndemics based approach to investigate the rise in rates and susceptibility to HIV among Latino and Black Males located in New York. In New York, Latino and Black males experience higher susceptibility and rates of AIDS/HIV infection, which is linked to the intergenerational transmission of structural biosocial factors within a socially marginalized context (Wilson, et al 2014). Through this view, the effect of the intergenerational transmission of social subordination and marginalization reinforces structural and symbolic violence which contributes to the contemporary health and social problems among Latino and black men including poverty, intergeneration trauma, incarceration, and substance abuse which contributes to risk-taking behavior leading to high susceptibility to HIV/AIDS (Wilson, et al, 2014). Through this framework, we can locate how the socially subordinated position of Black and Latino men in American society is attributed to biosocial factors/inheritance which structurally reproduces symbolically violent sociocultural environments that intergenerationally redistribute biological parthenogens and disease clustering, thus experiencing poor levels of wealth and wellbeing, thus contributing to illness and disease experience.

In conclusion, the syndemics model of health and the social determinants of health and illness are two separate, yet intersecting and affiliated conceptual frameworks that individually examine how health and illness are distributed and structured within individuals and whole populations. The social determinants of health and illness focus on the social model of health and are measured on the social gradient of health which examines how contemporary determinants such as ethnicity, employment, education, income, and socioeconomic status is directly related to levels of health and wellbeing, as well as disease and illness experience. On the other hand, the Syndemics model of health centers on the interdisciplinary biosocial framework, which theorizes how the biological and sociocultural evolution of human beings produces biosocial factors and inheritance which act in synergistic ways to structure social and cultural environments that govern and enhance the biosocial reproduction of disease. Through this paper, I have 1. Critically explore the relationship between ‘the Syndemics model of health’ and the ‘social determinants of health and illness’’ and 2. Through using a Syndemics ethnographic example of HIV/AIDS susceptibility in Black and Latino men in New York, indicate where both ethnic groups are positioned in the relationship between these two approaches, illustrating the reasons for how and why at the same time