Health Politics, Power, Populism, and Health

Introduction

The health care scenario worldwide is heading dramatic change and due importance is being given to research and testing of medicines. From ancient times itself, the personal health of each citizen is considered as the health index of a ‘healthy nation’. Changes in lifestyle and food habits created more and more diseases and some of them are out of human control. ‘Health Politics, power, populism and Health’ by Mike Magee, MD examines the hidden stories and trends behind health care systems in the United States.

The patient rights and health system reform in the United States is an issue that is under discussion and much more reformatory measures are taken by the government and are influenced by famous physicians like Mike Magee, MD, and others. It is predicted that a new health care model which is capable of humanizing the system with team-based approaches and home-centered health care is to have emerged and will take over the existing system.

Only systematic planning can save the health care system and non-governmental organizations can play an important role in future developments. In the existing health care system in the United States, due importance is given to the patient-physician relationship and its basic principles are based upon compassion, partnership, and understanding. From another viewpoint, there is a productive cross-sector partnership between government, industry, academia, and non-governmental organizations.

To have an idea on the topic, there must be a clear-cut examination on a wide range of policy issues, health care system changes, and on the prediction of a new age of health populism. Health care issues of the day are becoming more and more complex and the topics discussed under are Globalization, Aging, The evolving patient-physician relationship, Home health care, Women’s health, Chronic diseases, Caring of seniors, End-of-life care, Improving health care value, etc.

Placing Health in Context

Globalization

Health Politics, power, populism, and Health are closely related topics and they influence each other. Some problems evolve when the influence is transformed to mere overpowering and negative. But positive influence strengthens the bond between these topics. Nowadays, more and more people are becoming health conscious and they know that a sound mind in a sound body creates longevity. It is evident that there is a relationship between health care and globalization. But it becomes more complex when developing countries face the problems of the AIDS epidemic, malnutrition, unsanitary conditions, and the lack of proper medical treatment.

But it can be argued that globalization can improve the administration of health care because it has been based on the utilization of the potential of the market incentives and is employing private business innovation. According to Ronald Labonte and Ted Schrecker, the importance given to health care is influenced by the lifestyle of the people: “contemporary globalization, and in particular contemporary cities, with reference to a “space of flows” of both money and information. Flows of direct importance to health include those involving people and ‘lifestyles’ defined by consumption patterns.

The declining cost of international travel means that people (and communicable diseases) move across borders with increasing ease – a phenomenon now familiar from the example of SARS (194) and of special concern with respect to influenza transmission.” ¹ Due to globalization the world is considered as a single village, he/she can move across the border so easily. This creates the problem of worldwide transmission of communicable diseases like SARS and influenza.

Or improving the administration of health care has been based on utilizing market incentives and employing private business innovation to combat the lack of health care. But some others argue that the lack of health care in developing countries is because of globalization which displaces economic and social systems. Globalization is helpful to the health care system but most of the people are away from the benefit because they are still uninsured. So as to make use of Globalization as a medium to enrich the healthcare system as an effective one more concern and effort must be shown by the government and other non-governmental organizations.

Aging

The problems that are confronted by the old people are to be considered with more seriousness. But it is a fact that the elder citizens are not treated well in their own homes and in the hospital. Moreover, there is limited time for the care and treatment of the elders. The new generation had to realize that the same thing is going to happen for them in the future.

There is a special branch in science for the study of old age problems namely geriatrics. Research programs and studies are conducted under this branch. Aging is a natural process and it must be regarded as a stage of maturity. In our society, aging is considered mental as well as physical. Family circumstances influence one’s mental aging. When a man/woman attain the age above 60, we consider them as senior citizens. But the real aging or the depletion of inner strength occurs around 70. A person who is living with his/ her grandchildren is blessed because he/she can lead a normal peaceful life. The new generation can acquire so many things from their grandparents. They can share their experience in their childhood with their grandchildren.

But when an elderly person is bedridden, the whole change takes place in the family atmosphere. Nobody pays any attention to the person who is in the mouth of death. The problem is that when we are enjoying health we will not think about ill-health. This is the same in the case of the care given to aged people. Some sons and daughters are not ready to leave their parents in the mouth of death. So they simply leave their parents in old age homes. Here also they face lots of problems like alienation and depression. The doctors, nurses, palliative caretakers, caregivers, psychologists, etc. can help the old generation. The only thing that the old people expect from their children is care. So it is the responsibility of society to give back love and care to the aged people.

Today all over the world, the proportion of people aged over sixty years is growing in cause of long life expectancy and deterioration of fertility rates. Aging is a universal process happens during person’s lifespan. All the people involved in this process. No one can break the wall. Aging is related with health, growth, maturation and illness. Normally after 30 years people more conscious about their health.They began to depend others for help.

In 30s human abilities reached its own zenith. With the help of modern medical science many adult people are enjoying good health. A lot of existing factors influence the caring of old people that including physical health, mental health and emotional well being etc. “Ageing is a privilege and a societal achievement. It is also a challenge, which will impact on all aspects of 21st century society. It is a challenge that cannot be addressed by the public or private sectors in isolation: it requires joint approaches and strategies.” ²

With the help of modern medical science, exercises, health care programs and effective counseling we can prevent the trials and tribulations of aging. It may be a surprising factor that in America common people spend a huge amount of money for healthcare especially in old age. In America nursing homes could take everything you have. Majority of senior Americans will require some kind of long term care in their life time.

Normal aging

The aging process in individuals is need not be harmful.In old age, hair thin and turned grey. The organs would be lost their bodily functions and the production of digestive enzymes decreases. The body becomes failure to absorb nutrition from food. An existing factor is that our life style, social status, family systems, genitival variations etc. affect aging. Americans followed nuclear family systems. So the aged people in America face lack of care and protection in their old age. They are in their whims and fancies. Emerging of new family system and social changing aging became more dreadful.

The evolution of patient physician relationship

To provide health to all there must be a change in attitude and on patient physician relationship. To provide health to all due care must be given to the individual, the family, the community, and to the society because individual is connected to the family, the family is connected to the community and the community is connected to the society. Doctors must involve directly in assigning patients in decision making.

Here, the doctors can act as social leaders and educational leaders to make a difference in the society. The scientific side of health care is direct patient care and at the core it is relationship building measures. According to Ben S Gerber, MD and Arnold R Eiser, MD, today’s patients are more informed and educated so the doctors must be so careful and must try to promote the quality electronic sources of medical information. “Today, there is greater acceptance of mo patients are informed and educated patients. Healthcare providers can take advantage of this unique opportunity to create, support, reference, and promote awareness of quality electronic sources of medical information. Still, practitioners may differ according to the extent they embrace this technological revolution and make it part of the patient-physician relationship.” ³

The health information that the patients possess is sometimes a blessing to the doctor. But some patients show hesitation to accept the innovation in the field of technology. But the doctors are ready to accept the same for the development of their profession. Health in 21^st century is focused upon reaching ones full human potential. The aim of a good, socially committed doctor must be to make a difference in people’s lives, but it is challenging, changing, Interesting, and the doctor must be prepare to give a lot of oneself.

Trust is the connection between the patient and the doctor. Earlier, the doctor was considered as an incarnation of god to help the patient. But the situation changed and there is less trust on the doctor. So as to regain the trust, health system must change its outlook. Now the patients are well informed of the medicine and about the quality of the treatment. So confidence building measures must be taken by the doctors to regain their lost influence on the patients. This is essential for the smooth functioning of an effective health care system.

Home health care

Home health care is another important factor but it is under threat because the poor economic background of the families forces the people to make difficult decisions on health care. Mike Magee points out that there are high uninsurance rates in health care and those who are uninsured cannot enjoy the benefits of protection under insurance. A national survey of 686 customers conducted by NAIC (The National Association of Insurance Commissioners) found that 22 percent reduced visit to their doctor and 11 percent cut back the number of prescription drugs they take. When we check the reason behind this phenomenon, it is evident that the root cause is economic not negligence.

The opinion of the supreme court of the United States of America is that the federal minimum wage and overtime laws do not apply to home care workers: “The Supreme Court on Monday in a 9-0 decision ruled that federal minimum wage and overtime laws do not apply to home care workers, the AP/Lincoln Journal Star reports (Yost, AP/Lincoln Journal Star, 5/11). In the case, Evelyn Coke, a 73-year-old immigrant from Jamaica, filed a lawsuit against New York-based Long Island Care at Home to challenge Department of Labor regulations that exempt home care workers from the laws.” ⁴

The court proclaimed the decision on the case by Evelyn Coke, a 73-year-old immigrant from Jamaica, to challenge Department of Labor regulations that exempt home care workers from the laws. So the health infrastructure, doctors and nurses, ability to access the treatments of modern medicine is based on the minimum wage. This enriches the possibility of a country to be stable whether economically, politically or socially.

Moreover, the protection of insurance must be extended to the uninsured mass and the houses must be redesigned so that the home also can play an important role in supporting good health. The health care practices that an individual shows in a society are obtained from his/her family. So the parents can play a much significant role in molding the character and conduct of the child. Special attention must be given for the proper ventilation of the home because it will result in a positive influence on the health of the whole family members.

Women’s health

Women’s health problems are closely linked to issues like birth control and abortion. The neo federal health proposal is clearly targeting women’s access to birth control and abortion. There was a legislation of abortion in US Supreme Court in 1973 which ensures the women from further problems related to birth control and abortion. In America organizations like American Medical Association and American nurses Association conduct campaigns to ensure that women get medical services and important information. The foretold legislation and rule points out the right of refusal include objections to common forms of birth control.

In America groups like Planned Parenthood is of the fear that the new rule may override state law. Related to this issue US conference of Catholic Bishops expressed their strong support for this proposal. From another point of view, the quality of drugs that women use during pregnancy may affect their health. Michael R. Foley, MD points out those women are to be blamed because usage of unwanted drugs causes their ill health.

According to him, “More than 90% of pregnant women take prescription or nonprescription (over-the-counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some time during pregnancy. In general, drugs, unless absolutely necessary, should not be used during pregnancy because many can harm the fetus. About 2 to 3% of all birth defects result from the use of drugs other than alcohol.” ⁵ During the stage of pregnancy no drug must be used without the prior knowledge of the doctor. The drugs that are used by the mother at the stage of pregnancy may affect the health of the child.

So government must seek advice of the doctors and nurses who can provide valuable information and must try to stop this sort of misguided proposals. As the ill health of the women folk affects the health of the society, it is a threat to the proper functioning of an ideal society. Economic status is another reason for the ill health of women. When a woman in a family is economically independent, the whole family benefits from it. When a woman in a family is suffering from some disease, the whole family had to suffer the consequence. So, women’s health problem is a topic which requires proper attention.

Scientific progresses

The scientific progress made in the field of health care in America needs to be addressed. Stem cell research program is capable to find out remedy to so many diseases and is advancing with new innovations and development. Stem cells possess remarkable potential to develop many different cell types in the human body. Moreover, it can also act as a repair system for the body. For example, when a stem cell is divided each new cell has potential to remain a stem cell or another type of cell with a more specialized function. Now, adult stem cell lines are created for 10 additional human diseases.

Cell advance online publication, laboratories of C. Cowan, K. Hochedlinger, G. Daley. 2008 states that now scientists are capable to generate and compare induced pluripotent stem cells from individuals with the same disease but different symptoms. But when the discussion is based on embryonic stem cells, then plot thickens because it is beyond morality. According to Jessica Reaves, “In political terms, however, the ascension has been less smooth.

At the heart of the stem cell debate is a battle over abortion — but with a twist. Yes, these are cells from embryos. And according to the religious orthodoxy, an embryo is life. Indeed, some pro-life advocates have likened using stem cells for research to what Nazi doctors did during World War II. But these cells also hold great promise for millions of ailing patients and their families.” ⁶

In our religious society, an embryo is considered as a new life. During World War II, Nazi doctors used to conduct research using stem cells. Scientists at National Cancer Institute(NCI) reports that mouse embryonic cells can be used to predict human breast cancer risk. Some privately funded scientists reported improvement in a mouse model of muscular dystrophy (MD) treated with muscle cells derived from mouse embryonic cells. But from another view point stem cells hold great promise for millions of patients and their families.

Privacy in health politics

Privacy in health care plays a significant role in current curing methods. For promoting enough mental and physical health it is an in evitable factor. Majority of doctors and other health care providers provide care to older adult. They advocate enough privacy in diagnosis and ailment. In the field of chronic diseases both patients and doctors compelled to practice some privacy in treatment.

They have a lot of sociological and psychological factor affects the process of curing. This topic also related to the economic status of older adult and the economic implications of health care. The emergence of elder homelessness and psychic vibrations demands privacy. In America, a large number of elder adults require some kind of long term health carte in their life. In case of infectious diseases like AIDS patients will expect a kind of confidential.

Most of all the HIV testing methods like Rapid HIV test, Western Blot test and ELISA test are highly serious and covert.. “Privacy and security policies must be coordinated and developed openly – with abundant public input – in order to ensure a high degree of trust. Many privacy and security frameworks are in existence, and we need to leverage the work that has been done as we apply these principles in the area of health IT.

Further, this is both iterative and informed. Technological solutions are being advanced to support the confidentially of patient data and to accommodate current and future policy decisions.” ⁷ So it may be considered that the trust between the doctor and the elderly patient plays the key role in maintaining the privacy of the patient. The given data makes clear that in America, the government already has a concrete framework in place and policies related to privacy and security including The Privacy Act the storing and transmission of sensitive patient data and keeping drug abusers information are highly serious work.

HIPAA

The misuse of health information of the patients by the doctor is the violation of privacy. Every patient who is ready to share his/her private matters trusts the doctor. But sometimes the health information of the patient may be misused by the doctor or others related to the doctor. This cannot be encouraged because it is the violation of privacy. In USA, There are emerging so many disputes related to the unauthorized use of health information of the patients. So the government is forced by the public to implement certain policies to protect the health care information from further misuse. Moreover, authorities established a set of national standards for the protection of certain health information.

For the protection of privacy, US Department of Health and Human Services issued the privacy rule to implement Health insurance Portability and Accountability act of 1996 (HIPAA). This rule is capable to address the use and disclosure of individual’s health information called ‘Prophet Health Information’. This is aimed to put standards for individual’s privacy rights to understand and control how their health information is used.

Within the Department of Health and Human Services a special office for civil rights is responsible for implementing and enforcing the privacy rule.

As earlier pointed, the aim of the Privacy Rule is to safeguard the right of the patient from further exploitation. “A major goal of the Privacy Rule is to assure that individuals’ health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public’s health and well being.” ⁸ As the part of health care system, the rule is helpful to provide and promote high quality health care. Moreover, it strikes a balance between the doctor and the patient. The rule is designed to be flexible not to be concrete and is aimed to cover the variety of uses.

Equity and justice

The term equity and justice are closely related topics in healthcare and prevention process.In the field of caring older adult equity and justice consumes a vital role. In America a number of hospitals exposed in cause of aggressive billing practice.A large number of elder people in America require long term healthcare and other curing methods. In case of these people equity and justice are crucial. Majority of them depend health care organizations and nursing homes.

Large number of old people suffered lack of care and ailment.Aging is a normal process no one can escape this. Most of the people were suffering from physical and mental problems in their old age. Isolation is another vital problem in their se3tting time o0f their life. Corruption in Insurance companies made a lot of adversities for old people. Defective billing system, adversities in claiming, medical clearance and financial exchanging are made some difficulties.

They have a lot of external factors affect them like political status,, economical status, policies, social back ground, family status etc. If it failed to practice equity and justice in health care the life of patients become goes on its trials and tribulations.Even though policies are stable in America problem of justice and equity are visible. Social evils like racial discrimination, caste system, terrorism have a vital role in this issue. It may be an exaggerating factors that majority of black people in America under the sufferings of equity and injustice.

Cross section partnership

Cross section partnership is a term which is usually used in business sector. But in this modern world it is also applicable to the health care system. It is evident that the government cannot handle the whole policies of health so the implementation of policies is sub contracted to non governmental organizations and multinational companies. In a modern society there are certain social challenges which demands cross section partnership. They may be social, economical, or political challenges. But to a narrow extent cross section collaboration or partnership is public-private partnership. ⁹

It is more fluid in nature and involves multiple transactions. It may be long term across continents and down to local settings. When it is a long term entity, it is beneficial to all. The partnership deal of multinational corporate can be considered as the best example. In its function the traditional partnership in health system is far behind. The success of cross section partnership is in the co ordination of various sectors. In a successful cross section partnership in health care system we can see the co ordination of government, industry, non governmental organizations and multinational companies.

But there exists the risk of conflicting interests and failure to work together effectively as a team with different ideas and interests. But there is another problem of inequality and overpowering. Some multinational companies can overpower the non governmental organizations. Here, the solution is to remain flexible as the part of the team. The key for success in a cross section partnership is compliance, responsiveness and transparency in deals. The question is that is the cross section partnership beneficial to health care system in a country. Only the future developments can answer the foretold question.

Risk management

Major risk functions affecting the burden of diseases

Risk management in Health Care assumes greater significance as health care becomes effective only when there are less of risks and more of protection to the health care needs of the patients. For this, it is necessary to identify the areas of potential risk and to adapt possible safeguards to bring the risk factor under control. An effective risk management for health care system should not only be aimed at the patients; it should also take into account the protection and safety of healthcare workers and the maintenance of desired infrastructural facilities. It is to be ensured that hospitals provide the best sort of treatment without showing any negligence and there is no doubt that proper risk management positively contribute to the good name and financial return of the hospital.

For example, the safe handling of chemotherapy drugs has been a potential risk factor for healthcare professionals who prepare or make use of them. The major risk factor of the drug is that it causes “chromosomal damage and may also cause damage to normal skin and necrosis of compromised skin.” ¹⁰ Therefore, it is mandatory that all healthcare workers who handle the drugs are provided with sufficient personal protective equipment and are offered the necessary training.

The use of powder-free latex gloves has been identified as an effective strategy to fight the risk factors with regard to the use of chemotherapy drugs. No doubt, risk management measures should primarily focus on quality of health services and patient safety. For this the risk management system in hospitals should resort to risk identification and analysis, ensure patient satisfaction, provide education and training to the people involved, design highly effective service excellence tools, and there should a risk management team that takes care of individual cases and incidence where risk management is essential.

One of the major challenges in the risk management in Health Care is to ensure the safety and quality of many medical products. In this respect, the measures undertaken by the FDA deserves primary attention. The major goal of FDA is to “assure the safety of the many products it regulates-everything from drugs for humans; drugs and feed for animals–those you consume or those that you adore; biologics such as gene therapy, blood and vaccines; medical devices from tongue blades to pacemakers; to foods and food additives; cosmetics, diagnostics; and some things you may not realize, like microwave ovens and other radiation-emitting devices.” ¹¹

It provides the risk factors As well as the benefits of using a particular medical product and enables the patients to decide whether it is needed for him. For this, the most innovative scientific advancements and techniques are being employed by the FDA. The scientists at the FDA “help to establish standards for product performance and potency, provide data to support regulatory decisions on product safety and information to consumers for the safe use of products, and provide the basis for science-based regulatory policies.” (Henney).

The other Agencies that try to reduce the amount of risk factors in the Health Care System are The National Incident Management System (NIMS), The Health Resources and Services Administration (HRSA) and the “Hospital Incident Command System (HICS).” All these bodies aim to enhance quality and risk reduction.

The importance of Health Care Reforms

Various health reforms have been enforced in the Federal State. However, they have not been successful in offering universal insurance coverage or for curbing the cost of treatment. There is a large amount of disparity in the access to health care in rural and urban areas. There is shortage for health care providers in the rural area. The best way to tackle this issue is to offer health insurance and adequate coverage to the rural folk.

As Tony Marinello (1994) makes it clear, “physicians are more likely to locate in rural areas where a sizeable portion of the residents have health insurance because adequate coverage helps ensure that they will be paid for their services.” ¹²

Besides, rural health clinics, mid-level medical practitioners and physicians who work among rural areas have a great role to play in providing ample health care to the needy patients in these regions. The services of visiting physicians can be made use of in rural areas where health care services are not established on a regular basis. The managed network care is an innovative step and the introduction of preferred provider organizations (PPOs) for 20 rural electric systems established by the NRECA in 1993 has enabled easy access to health care in the rural areas.

Similarly, Health maintenance organizations, or HMOs that provide health care services to the affected mainly in urban and metropolitan areas, need to extend their services to the rural areas and continuously assess the nature and quality of the services provided. When more health services providers are attracted to health insurance to rural residents, there is likely to be a healthy competition among such organization and this will increase the quality of health care products and services, and would accelerate the marketability of rural communities.

The global spread of Tobacco

The global spread of tobacco is a problem that affects the health care system because more and more are being addicted to it. Any one can see the statutory warning “smoking is injurious to health, tobacco cause cancer” etc, on a cigarette case. But one who is addicted to smoking will not be ready to give up the habit. In this context, W.H.O gained permission from its members to start negotiating an international legal instrument to curb the global spread of tobacco. It is aimed to strengthen transnational controls in tobacco. The interesting fact is that the tobacco producing countries are also the victims of tobacco related health problems.

It is a fact that most of the smokers are in developing countries. The health problems related to the use of tobacco cannot be considered as the problem of certain countries only. The whole world can be considered as the victim of tobacco. Phyllida Brown points out that the policies and specific protocols that are created by W.H.O will be helpful to control the global spread of tobacco. “Specific protocols to be agreed within the convention will address cigarette pricing policies, antismuggling measures, advertising and promotion (including promotion on the internet), and cigarette labeling. The negotiating committee is likely to be made up of government representatives, not only in health ministries but also in trade, finance, and agriculture ministries.” ¹³

The W.H.O assembly discusses the matter and most of the members agreed to take remedial measures. Some of the tobacco exporting countries supported the proposal of W.H.O, because these counties were also the victims of tobacco related health problems. But some other countries like Greece and Turkey, which are tobacco exporting countries promised lukewarm support. It is because the economy of these countries relies mostly upon the revenue from tobacco export. But the problem of tobacco as a cause of health hazards reduces its importance as a thing which gains money by exporting.

Unhealthy alcohol use

Unhealthy alcohol use is not only a personal problem but also a social problem. When a person gets addicted to alcohol, it affects his/her health. It creates problems in the family and his/her surroundings. There is a high chance for an alcohol addict to become an anti-social. This anti-social behavior keeps his/her friends and relatives away. To an extent, consuming alcohol brings about a reducing of inhibitions and increased relaxation. But large amount use of alcohol results in loss of control, dizziness, sickness, loses of consciousness etc. It slows down the reacting time, reducing in ability to take rational decisions.

The social behavior of the addicted person will be less tolerated by family members, friends and relatives. Some of the social problems created by alcohol addiction are domestic violence and violent crime. Another problem is losing of inhibition which creates aggressive behavior. This results in relationship problems. So it can be seen that the problems that are created by alcohol addiction is enormous.

The most important health effect of Alcohol addiction or abuse is that it depresses the brain. The memory of the addict is not like a normal one. Other problems of excessive use of alcohol are liver damage, stomach cancer, and heart disease. It reduces the sensitivity to pain.

Alcohol has a long history as a medicine. But now it had become a social problem which affects the health care system. By the excessive use of alcohol, the whole body system is got affected. It results in physical, behavioral and emotional changes.

The staff members of the ‘Do It Now Foundation’ points out that the problem of alcohol addiction must be considered as a social problem because it affects all socioeconomic and ethnic groups in society. “All socioeconomic and ethnic groups in society are affected, but overuse is most common among younger people. According to a recent survey, more than 15.9 million Americans are considered “heavy” drinkers, while 30 percent of the high school class of 2006 reported being drunk at least once during the month preceding an annual survey.” ¹⁴

The overuse of alcohol can be seen among the young people. Even the students who are studying in schools are not away from the influence of alcohol. So it must be considered that ethyl alcohol is a real drug which causes death, crime and health and behavioral problems. Remedial measures must be taken by the health policy makers to help the humanity from the claws of Alcohol.

Mental Health Care for Older People

The health care issues associated with the older people and the aged need to be addressed effectively. One of the widespread mental problems faced by older people is depression due to isolation, death of the spouse and other relatives, and lack of socialization. Even though many consider depression as a normal process with older people, Carol L. Jenkins and Sarah B. Laditka conclude that “depression is not part of the normal aging process and emphasized the importance of early diagnosis and treatment.” ¹⁵ One of the most disheartening facts regarding the treatment of older persons is that there is not much medical healthcare and mental health care.

The concept of managed care for older people has been much advocated. However, it is recognized that managed care very often increases the competition among such organizations and subsequently lead to fragmentation of the over all service offered to the older people. The enormous finding that is required to meet the mental health care problems of the older people is yet another area of concern and for this the governmental funding and the voluntary services of various non- governmental agencies are necessary.

The role of Community Health Centers

Community Health Care Centers play pivotal roles in the provision of effective and timely health care needs of the people. As Juniper Lesnik suggests the community Health Care Centers in America act as “a proposed solution to the dual national problems of access to care and the shortage of primary care doctoring” ¹⁶ and has made drastic changes in the field of primary health care. The universality and equal access to health care are the two major goals of the community health centers.

Even though, America is scientifically and technologically developed than other world nations it is sad to note that the health care system of the nation has not succeeded to cope up with those changes. It is evident from the thought provoking statistical data provided by the US.Census Bureau that 45 million Americans, almost 15.6 percent of the population permanently lives without getting any sort of health insurance. The large number of specialized physicians has resulted in the inadequacy of family doctors and primary health care centers.

Risk Management in health care system

The Institute for Crisis, Disaster and Risk Management (ICDRM) at the George Washington University, under contract to the Veterans Health Administration (VHA) had been working for the development of health care management in the United States of America. The theory and principles of emergency management for healthcare systems is developed by this institute. When the world is facing the problems of health care without planning and focus, the initiative by the institute is much important.

The health care facilities operated by health care institutes in US are the components of a national, integrated, health care system. Other facilities in US for health care management are hospital chains, consortium facilities and, for-profit organizations. The field of hazard management is another field of health care which captured much attention and importance after the 9/11 terrorist attack. Related to this, comprehensive emergency management is focusing on its basic principles: mitigation, preparedness, response and recovery. The foretold terrorist attack broadened the importance of emergency management of health care.

The emergency management program is based upon emergency management tools, guides and processes. It is based on a methodology to co ordinate strategically across disciplines, jurisdictions, levels government, and the public-private interface. This is developed to implement Programs, developing education and training, assessment of after action performance which is based on the assessment of the existing health care system. It is aimed to perform its task in actual emergencies and disasters, achieving lasting program improvement through organizational learning.

There is a broad scope for the successful emergency management (EM) for the facilities. It is evident that the foundational concepts, long-standing emergency management principles and guiding documents for EM and incident management prove that it is applicable to health care systems. From the viewpoint of a physician, his/her primary goal is to provide ‘surge’. EM aims at the same goal and it is termed as organizational resiliency.

When we go through the state and national levels of emergency management, there emerges a new significance. Building a healthy New Mexico, Bureau of Health emergency management points out that: “Emergency response has taken on a new significance statewide and at the national level. The Bureau of Health Emergency Management works in conjunction with other local, state, tribal and federal agencies and entities, and are taking the lead in health emergency preparedness, prevention, response and recovery; planning, training and education.” ¹⁷

The Bureau of Health Emergency Management in New Mexico is an organization working for the Health Emergency Management and it works with other local, state, tribal and federal agencies. Moreover, lt is a leading organization in Health emergency management in New Mexico. For the proper functioning of EM, there must be an emergency operation plan (EOP), to provide organization-wide guidance for response and recovery actions, and to serve as the guiding document for addressing the full range of activities.

Incident Command System (ICS) and the Application of Strategic ICS Principles are considered as the management foundation of healthcare system emergency response and recovery. Moreover, it is directly related to health care systems. The organizational structure of this system transformed it into an effective medium for health care. “ICS principles applied in a context that guides effective integration of an individual healthcare organization into the overall response: within a local community, a State, an inter-state region, and the Federal government response.” ¹⁸The ICS principles guide an individual health care organization into the overall response. It is not limited to a certain context, but it is applicable within a society.

Healthcare System Emergency Response and Recovery is another factor of the existing health care system which is focused on development to further enhance and recovery program. “Important considerations for managing the recovery of the organization are presented, utilizing ICS principles within the EOP. Finally, how to address and incorporate hazard-specific issues into response and recovery actions are outlined.” ¹⁹

The Healthcare System Emergency Response and Recovery is formed to address and incorporate in Hazard-specific issues into response and recovery actions. The task of health for all can be attained by the co ordination of these agencies and programs.

The EM program is entitled to conduct important activities related to system implementation, evaluation, and to create improvement in the health care system. Education and training for the smooth functioning in emergency and risk management is another task of EM program. ²⁰ The health care emergency management organizations must undergo a certifying process and it must be conducted by a certifying organization. The certifying organization is entitled to develop, implement and to manage the certifying process. This includes the managing and development of the assessment instruments, administering them to participants, and revising them. “The certifying body will have organizational autonomy to make decisions based solely upon scientific research and professional judgment.” ²¹

For the proper functioning of the certifying body, it must be independent and autonomous to make decisions based on scientific research and professional judgment. The professional certification organizations must be administratively independent of government agencies.

It is better to stand apart from professional associations and similar organizations.

The health care department litigation service provided by the health care team is highly beneficial to the people. This team is highly skilled in counseling the health care clients on practice management and risk management issues. Their aim is to protect the clients against litigation claims. The team is equipped to provide their service on a variety of litigation matters like health care litigation and medical staff matters.

Health care providers are facing a professional liability insurance crisis. So the medical professional liability concerns and sets forth an idea to reduce the risk of health care providers and organizations including the basic factors of the health care system. To get a clear cut idea about the problem we shall go through a comparison and contrast between the systems of risk management in hospitals in USA and hospitals in Taiwan.

By comparing it is evident that both the systems possess its own strength and weakness. But it must be remembered that there is a difference in culture between these two countries. In both these countries there were weaknesses to be improved and strengths to be continued. By the study there originated a change among the doctors and nurses that the improvement in risk management resulted in a better understanding of the problem and perhaps it may lead to the realization that their parents also possess the right to be treated in a better condition.

When a program is capable to create a change in the society, one can say that it is effective. So it cannot be evaluated that a health care system which is proved to be successful cannot be evaluated or approved as successful. The world is undergoing change and one health care policy in a society may not be successful in another society. So it will be more valuable and effective to find out a policy which is applicable for the whole world. So the focus of the healthcare reform must be focused upon the patient not upon the multinational company which can influence the political field. It is evident that there must be an immediate change towards the patients and others who are still uninsured.

Infectitious diseases

The infection of HIV is another major health problem that the citizens of the United States face. Earlier the doctors managed clinical care of the patients, examined, listened the histories of the patients, diagnosed the disease and recommended certain treatment. But it became a Herculean task to diagnose the disease because a single disease may have more than one variation. Tukumbi Lumumba-Kasongo of Africa points out that the health system of a country whether it is developed or not is influenced directly by the living condition and standard of the people. In Africa the rate high rate of HIV infection is due to the economic condition, political corruption, deep poverty, social desperations, gender inequalities, and the social condition.

“However, it is intellectually and historically undeniable that despite the efforts mentioned above, which were supposedly intended to improve African conditions out of the economic fiasco, high level of political corruption and instability, deep poverty, social desperations, and profound gender inequalities, social conditions continue to decline in an alarmingly way.” ²² It is clear that the health problem in Africa is closely related to the Socio- economic and political fields. In this stage doctors can play an important role in this situation because now they does all the tasks of a doctor had to do and they are expected to and are expected to be team leaders in education and also to be the social leaders. So the old definition given to a doctor has been broadened and is undergoing positive changes.

HIV testing

Today at the end of 2003, an estimated 1,039000 to 1,185,000 persons in USA were living with HIV. Each year around 16-22 million people in the United State are tested for HIV. A large number of people were unaware of their HIV infection. ²³ Today HIV testing is incoming a new era. As law makers, health care and insurance executives, health officers are making essential changes in their fields to make certain that more people will know their HIV status. They give more importance on regaining health to block the spreading of HIV virus. The last twenty years, deliberate counseling and testing programs have helping thousands of people to know their HIV status.

WHO has developed two tools to assist countries with equipping individuals with the knowledge and skills to establish policies and testing performs it makes sure that they are responsible for reporting accurate results. The common laboratory tests used to diagnose HIV infection detect antibodies to the virus that are presented in the blood or oral fluids. Various types of HIV testing methods are mentioned here:-

1. Rapid HIV Antibody tests- It is the widely acceptable testing package. Standard HIV testing practice requires up to two weeks for results. But the Rapid test results give results up to 5-60 minutes. It only tests blood. Here a finger tip sample of blood is composed from an individual and transferred to a vial where it mixed with a developing solution. This package includes16 modules including video CD, DVD.presentations, slides, trainers guide etc. However, the statistical data is quite alarming: “With an estimated one out of four HIV-positive Americans unaware of their infection, increased opportunities for testing are critical. Rapid HIV antibody tests provide new opportunities to improving access to testing in both clinical and non-clinical settings and increasing the number of people who learn their results.” ²⁴ Majority of doctors, health officials and organizations prefer Rapid HIV test. Based on human and sociological factors Rapid HIV test is better option than others.
2. Confidential HIV testing-You informed your name when testing.A medical officers access the test results. You will get information about the revealing of the results. Standard blood tests (ELISA)-It is the first standard antibody test and it is the most widely acceptable test. Here an initial sample of blood is used the following testing process. It is considered as the cost effective method. It is the first showing test widely employed. Here a person’s serum is applied to a plate to which HIV antigens have been attached. If antibodies to HIV be present in the serum they may be bind to these HIV antigens. After the process of washing these substances we can get the result Results are reported as a number.
3. Urine Antibody HIV Test (Western Blot Test)-This is used as a substitute for standard blood test. Here uses the urine sample and Urine Western Blot Technique detect HIV antibodies. This is based on the movement of proteins. Here use an electrical current for the movement of proteins. “ Whereas ELISA measures antibody to whole virus and gives a “positive,” “negative” or indeterminate test result, Western blotting is a more specific test. It allows one to visualize antibodies directed against each viral protein. For this reason, it is a confirmatory test for a positive HIV ELISA. In an HIV Western blotting, proteins are electrophoresed into a gel. As the proteins migrate through the gel they are separated based upon size and charge. Characteristically, smaller proteins migrate through the gel faster than larger proteins.” ²⁵ The process of HIV testing is so complicated and it helps the doctor to decide the proper treatment to the patient. Western Blot Test is considered as the popularized method in the field Of HIV testing.
4. Oral Mucosal Transudate tests.-In this process a treated pad placed a person’s mouth. The pad collects oral fluids. If the person affected HIV t he fluid contains antibodies.
5. Home Testing Kit. – This is a process that does it yourself. Here the blood sample send to the laboratory.The test results provides through telephone. It is also a cost effective testing procedure. In case of undeveloped countries these methods are highly expensive.

Chronic diseases

The diseases like SARS which are spread through air hinders the works of health care system as a whole and the direct interaction with people by health workers is also under threat. But innovations in health care system resulted in the increased lifespan of the people. In United States, health consumerism resulted in a dramatic change in 1983 as a part of the civil Rights movement. Because of this up rise people came to realize that they need to take care about their health.

According to David P Fidler, the policies related to the health care must be based on foreign policies because globalization promotes the chance of the transmission of diseases like SARS. As he makes it clear, “The emergence of health as foreign policy presents opportunities and risks for health promotion that can be managed by emphasizing that public health constitutes an integrated public good that benefits all governance tasks served by foreign policy. Any effort to harness globalization for public health will have to make health as foreign policy a centerpiece of its ambitions, and this task is now health promotion’s burden and opportunity.” ²⁶

So the awareness among the people that they can protect themselves from further infection can be considered as a milestone in health care history. Now the patients know about basic organs, it’s functioning, cause of diseases and how to prevent diseases. Mike Magee says that the doctor’s duty is to save not only the people but all of the people who are trying to improve the health care system. For example doctors can help the nongovernmental organizations which are working for the improvement of health care system. Public service projects can be undertaken by teenagers who can involve in immunization or clear needle exchange.

The doctor, nurse, social worker, psychologist, sociologist, economist etc can improve health care. But health care is a very serious responsibility which requires 24/7 job. It is considered as a noble job but the co ordination of the various factors in the best ratio results in best result.

Chronic diseases are long lasting diseases. Nowadays it is a great threat to humanity which claims the life of millions of people all over the world. Chronic diseases are mostly found in the third world than the wealthiest countries. But the developed countries like America are not an exemption. “In 2000, approximately 125 million Americans (45% of the population) had chronic conditions and 61 million (21% of the population) had multiple chronic conditions.

The number of people with chronic conditions is projected to increase steadily for the next 30 years”. It shows that chronic diseases are tightening their grip in middle class countries, as well as in the wealthiest countries. It is dreadful to realize that most men are having one or more chronic conditions. ²⁷ Medical world has been identified various types of chronic diseases which are more destructive than infectious diseases. The most devastating chronic diseases of modern times include heart diseases, cancer, genetic disorders, respiratory diseases, diabetes etc. The list is extending day by day.

Changes in life style, related environmental conditions, lack of nutrition, Care coordination among people having multiple chronic conditions, lack proper communication between doctors and patients etc make one affected with chronic diseases. Modern man lead fast-paced life and they don’t have enough time for proper health care and sanitation. Moreover, the symptoms of chronic diseases appear only after many years, and if they are identified at the primary stage itself, it will be comparatively easy for doctors to suggest proper treatments, and the opportunities for prevention also are there. When it is lately recognized, it would be in an incurable state.

Michael Morton makes it clear when he says,” Chronic diseases often take a long time to diagnose, leading to self-doubt. Older patients, meanwhile, frequently tell members of her demographic they are too young to be sick, adding to the sense of isolation. Chronic disease may also not be visibly present, causing some to question whether there is an actual problem.” ²⁸ It is to be noted that old men are mostly affected with chronic diseases than youngsters. But the youngsters affected with chronic diseases generally fails to identify it in the beginning because its symptoms appear only much later.

The number of people in the world, affected with chronic diseases increase day by day. A study of World Health Organization says that chronic diseases will lead the world to many problems and it may even hinder the macroeconomic development of many countries. The study continues to state that 80% of chronic diseased men belong to low middle class countries and the World Health Organization predicts that “there will be a total of 64 million deaths in 2015. Deaths from chronic diseases will increase by 17%between 2005 and 2015, from 35 million to 41 million.” ²⁹ The given data reminds us of the fearful reality that there isn’t much action taken for preventing chronic diseases and death tolls will increase.

A number of factors increase the predominance of chronic diseases. Increased life expectancy together with the aging of society, and the continuous usage of new drugs, the medical procedure also convert fatal diseases into chronic. Many modern clinicians and policy makers are giving more and more attention to the chronic conditions. They focus their studies mainly on multiple chronic conditions which is found in most of the chronic diseased. They have also found out that most of the chronic conditions are preventable through a behavioral change. Though these modern systems of chronic prevention and treatment have been proved success, changes in health care system are still necessary to help the persons affected with chronics.

Many modern organizations, government programs such as Medicare and Medicaid, private employers and some private insurance agencies are working for the betterment of these chronic diseased persons. “Sixty-six million people with chronic conditions have private insurance coverage, and their care accounts for about 70% of private insurance spending.” ³⁰

It is hopeful that many governmental and nongovernmental organizations have come forward for the betterment of the chronics which is inevitable of modern times.

Fear, violence and safety

Fear, violence and safety are mutually interrelated. Fear varies in men, women and in children. When men are in fear of their job, family, etc women generally fear of their physical insecurity. But in children’s case, they are fearful of many things around them. Such kind of fear, sometimes lead them to violence and their safety itself become a question. Recent news appears from different part of the world about the violence among school children.

Modern children, in particular experience anxiety, fear, and a sense of personal risk. A very careful approach is needed for the betterment of these children who may risk their own life with these behavioral problems. Friends, family members, loved ones, caregivers and adults can influence children. Parents can easily take away the fear and tension from the minds of children by talking to them about violence and personal safety. They should be given proper training to manage rising concerns. Mental Health America puts forward some suggestions for the parents to handle their children properly. ³¹

First of all, they should be encouraged to talk. They should be allowed to express their concerns and to express their feelings. Provide them with proper awareness about violence and give concern to their opinion also.

Violence is an act of aggression which may be physical or psychological harassment. The fear of violence can be considered as a stress factor that may cause physical and psychological problems. The targets of violence are the health care workers, social workers, who are working in public. The problem is away from the media because the victim may mistakenly blame themselves for the assault and resist reporting the problem. A patient who is admitted in a hospital for treatment has a right to refuse the medication. The care giver is put in between doctor and the patient and the refusal of treatment may become violent and aimed at the care giver not at the doctor.

The problems that are faced by the workers at their workplace are more important. Statistics Canada released a report on workplace violence in 2007 stating: “Given the lack of national data on workplace violence, the nature, severity and prevalence of the problem has been difficult to quantify.” ³² Moreover, the psychological problems which are the end products of violence reduce the emotional equilibrium of the society as a whole.

The problem of violence is ill defined and under reported concern for health care workers. A survey which was conducted among emergency department employees prove that violence is frequent and has a substantial effect on staff wellbeing and job satisfaction: “Most of the respondents felt that violence included witnessing verbal abuse (76%) and witnessing physical threats or assaults (86%).” ³³ After the 9/11 attack fear management in USA attracted much attention. Any sort of violence is creating fear and tension among the people. Violence is a public health issue because it spoils the emotional balance of the society. Strict implementation of existing laws against violence may help the government to create a healthy atmosphere. For a healthy society government must give due attention to food safety and road safety.

Caring for seniors

It is the responsibility of an individual to support the older members of the society and this support and care must be extended to our grandparents, parents, children, and to the next generation. Due care must be given to the care of seniors because there is a lot to learn from them. To an extent, they can help doctors by providing valuable information about treatment of diseases in older days. Leslie Green who interviewed Mike Magee, MD, the author of ‘Health Politics, power, populism and Health’ quotes his words:

“How are we going to properly move systems to support the older members of our society and to refashion and redesign homes so that the homes will be able to support good health, not only for our grandparents, but for our parents and children and grandchildren as well? I think teenagers who are involved in science and science clubs and potentially in careers in health care in the future should be interested in providing leadership in terms of advancing health within their communities.” ³⁴ The politics of the health care reflects the needs of the people and due care and attention must be given to bring doctors, nurses, and patients together. The needs of the patients must be considered and the issue of public health needs to be looked at from a population stand point.

Some people consider that death while treatment is the right care and they are ready to spend much of their final weeks seeing specialists, undergoing tests and to consume new drugs. The problem is that many of them die attached to machines in hospitals. In some hospitals patients are pushed into unwanted treatment. But from a doctor’s viewpoint, it is his/her duty to save the life of the patient. Julie Appleby points out that “While researchers are able to show differences in costs, the real question remains how much of those additional hospitalizations, tests and doctor visits resulted in better care or better quality of life? Finding answers to that question is difficult and controversial, but health policy experts say doing so will become increasingly important as the U.S. seeks ways to slow the rapid rise in health care spending.” ³⁵

But the opinion of health experts in USA is that the rapid rise in health care spending must be reduced and the government is planning to do so. But problem of old people is attracting less attention and there is a controversy among the medical practitioners on the effectiveness of modern health care. But when the longevity is increased the rate of infection also increased. Some people consider their aged parents as a curse and are not willing to provide proper care. In USA end of life care is so expensive and an aged person can expect his death in the hospital not in the home. Chronic illness cause more death without end of life care.

The increased cost on additional hospitalization, tests and doctor visits resulted in better care or better quality of life. Finding answer to the question of the expensiveness of the treatment is without answer but it is important that the government is going to slow the rapid rise in health care spending. Moreover, the right of the patient to choose the best and effective treatment must be considered by patient’s relatives and the doctors. So it is essential that the US health system could find better ways to reduce hospitalization at the end of life by providing more in home services.

End of life care

End –of-life care is a controversial topic because human beings are unwilling to accept the reality of death and it is a practical problem for doctors to predict death with accuracy. End –of-life care means the hospice benefits or integrated care for people who are dying. Hospice eligibility for a patient is that the doctor must certify the patient that he/she has a life expectancy of six months or less if the terminal illness runs its normal course.

The patients who are suffering from chronic diseases suffer a lot because this fragmented and uncoordinated situation keeps them away from medical attention. The benefit of this care is restricted to the patients that are certified of a six month life expectancy. Joshua M. Wiener and Dr Jane Tilly points out that in USA ‘End –of-life care’ financing and delivery is fragmented and uncoordinated. “End-of-life care—the period of time when patients are seriously ill with the condition that will cause their death—in the United States is fragmented and uncoordinated, with little integration of medical and long-term care services.

The SUPPORT study, the largest research project examining end-of-life care in the United States, found that, far too often, people die in pain, isolation and perhaps needless expense.” ³⁶ Moreover, the care must be provided within the period of illness, not after death. But the fact is that policy and availability of services and care in the vast majority of American states are inadequate. The treatment provided for the nursing home residents is inadequate.

All these facts points to the same cause that the help and care is not reaching the people who need it. Medicare is a social insurance for older people, or persons with disabilities. Medicaid is a federal state health care program for the low income population. Both are the sources of financing for End –of-life care in USA. Medicare and Medicaid provide a number of services including medical, social, psychological, and spiritual support for dying patients.

Some people considers that death while treatment is the right care and they are ready to spent much of their final weeks seeing specialists, undergoing tests and to consume new drugs. The problem is that many of them die attached to machines in hospitals. In some hospitals patients are pushed into unwanted treatment.

But from a doctor’s viewpoint, it is his/her duty to save the life of the patient. Julie Appleby points out that “While researchers are able to show differences in costs, the real question remains how much of those additional hospitalizations, tests and doctor visits resulted in better care or better quality of life? Finding answers to that question is difficult and controversial, but health policy experts say doing so will become increasingly important as the U.S. seeks ways to slow the rapid rise in health care spending.” ³⁷

But the opinion of health experts in USA is that the rapid rise in health care spending must be reduced and the government is planning to do so. But problem of old people is attracting less attention and there is a controversy among the medical practitioners on the effectiveness of modern health care. But when the longevity is increased the rate of infection also increased. Some people consider their aged parents as a curse and are not willing to provide proper care. In USA end of life care is so expensive and an aged person can expect his death in the hospital not in the home. Chronic illness cause more death without end of life care.

The increased cost on additional hospitalization, tests and doctor visits resulted in better care or better quality of life. Finding answer to the question of the expensiveness of the treatment is without answer but it is important that the government is going to slow the rapid rise in health care spending. Moreover, the right of the patient to choose the best and effective treatment must be considered by patient’s relatives and the doctors. So it is essential that the US health system could find better ways to reduce hospitalization at the end of life by providing more in home services.

Science and society

The term science and society consumes a major role in health care and other activities. In medical context they have some broad level meaning. The modern medical field demands the emergence of innovative discoveries and findings. Most of all developed countries like America, England ,France are spending a huge amount in each year to support brightest scientists with the best inventions.The society expect a kind of better co –operation with science. Science provides both technological inventions which helps early diagnosis and treatment and promote moral values.Science centers educate people for the effective preventions methods.

Today we4 can understand that law cost preventions methods could help the people very well. Science provides qualitative work experience and effective practice for health workers and doctors. Infectious diseases like HIV, Tuberculosis, Pneumonia needs, and the patients need more human considerations. Here the society needs some kind of humanistic approach for both diagnosis and treatment. We can strongly argue that modern scientific technology contributes a lot of innovative ideas for preventing genetic and chronic diseases.

In USA, so many health care policies are implemented to improve health care effectiveness. The roles that are played by non-governmental organizations, public and private players, health care suppliers, and industry experts is crucial and it may lead to improvement in existing health care system. The rate of patients who are benefited from the existing system is less. For example less than one third of patients with chronic diseases in the US and UK get effective treatment. ³⁸

From an economic view point, the elimination of ineffective health care can save billions spent on diseases. The large amount of money spent on research work for the improvement cannot be considered as wastrel but it can create effective solution for the problems. The improvement in health care results improvement in quality of life for patients. So it can be considered as a policy that ensures the quality of life.

But the treatment of chronic diseases must get much attention because to be infected with chronic disease is considered as the end of life. Here, the patient must be treated with sympathy and empathy. Bluecross Blue shield association points out that “Care of chronic disease needs to take place within and outside the traditional medical system, and a greater investment in prevention is paramount. We can’t look to the medical system alone to improve chronic care-its reach is too short and healthcare behavior change is not its core competency. A broader set of stakeholders, including schools and employers, needs to play an active role in driving effective care, particularly prevention;” (Improving Health Care Value: Quality and Cost).

Looking to the industrial sector it is evident that employers must promote healthy employee behaviors. They must try to understand and track health care spending of their employees. The health care organizations face some political barriers and this hinders the from further effective care practices. There must be a collaborative approach by public private partnership. To attain fully fledged improvement in health care, all the sections of our society must co operate and work for the bright future.

Improving health care value

To improve health care values, innovations must be implemented to patient physician relation and health populism. It includes the trust between the patient and the physician. When strict laws hinder the doctor from sharing the personal details of the patient, he/she will be ready to share even minute details of their health condition. To improve the health care values of a country, the existing health care system must be analyzed.

Megan Landes points out that, internal health care priority of a nation can be evaluated on the basis of the economic condition of the people. According to him, one “can expand the scope of context to include both an evaluation of a nation’s internal health care priorities and overriding global economic inequities. Recognizing the role of developing nations in the global economy, we see that it is not entirely by choice that developing countries provide a standard level of care that does not include adequate MTCT prophylaxis. Developing countries are in fact given very little option under the continuing reverberations of the 1980s debt crisis.” ³⁹

Moreover, it is the duty of the patient and the doctor to protect and develop the health care values of the society. It must be considered that the health care values are based on compassion, partnership, and understanding.

The changes that can be noticed in health care system in the United Stated have a direct impact on individual health and on overall health as a society. Moreover, physicians are of the opinion that health care is the most humanistic profession. But the younger generation faces a serious problem of obesity and it hinders the growth of health care as an effective one. Change in the lifestyle made the people lazier and there is limited time for physical exercise.

So the problem of obesity among the people must be considered as a serious health problem. According to Maria Isabel Matamala, the real reason behind the problem of obesity is the lifestyle of eating junk food which is promoted by food industry. “For example, who would choose a lifestyle that consists of eating junk food if these products weren’t promoted by the food industry? Who would chose drug addiction and alcoholism if our daily life wasn’t driven by fierce competition, job insecurity, violence, fear of failure or the various inequities generated by the dominant economic model? Would any female head-of-household choose to live in extreme poverty? These are the “lifestyles” of millions in the world today.

Could we call these socially-induced self-inflicted wounds?” ⁴⁰ From the viewpoint of a doctor, health problems and lifestyle is interconnected. So the lifestyle that is accepted by a society directly influences the health of the individual. A positive change from the side of the mass can influence the health care system of the country and it will reflect in the health of fore coming generations.

Improving of health care value is considered as a tiresome task to health policy makers and doctors. It must be handled carefully because it results in a positive or negative influence in the existing society. Absence of good evidence can result in harmful care. For example, in 1980’s studies proved that limited evidence in autologous bone marrow transplant/high dose chemotherapy was more effective than conventional chemotherapy for treating metastatic cancer.

So the government should ensure that new comparative information is disseminated to the needy. Moreover, the health policies must be targeted to improvement in medical field. According to Phyllis Yale and Kara Murphy, “The Institute should ensure that new comparative information is disseminated to providers, patients, and others. Because experts estimate that medical research currently takes 17 years to be incorporated into practice, it is especially important that this information be provided in formats providers easily can use. The Institute should work with medical societies to develop consensus practice guidelines drawing on the Institute’s research, and electronic health records should be required to incorporate these guidelines into their clinical decision support systems.” ⁴¹

There must be more research institutes to handle research programs so as to combat newly arrived diseases. So as to handle this situation effectively, the guidelines’ evidence based standards should create rebuttable presumptions concerning the standards of health care that the providers are expected to meet in medical malpractice cases. Moreover, institutes like AHRQ should be protected from political pressures, to establish its reputation as a credible source for information on evidence based medicine. When the research is free from external influence, we can expect better results and it will improve the whole health care system.

Findings and Conclusions

Findings

1. The health care system is undergoing tremendous change but the benefit of the innovative change does not reach the needy that are uninsured.
2. The funding and grants that are allotted to research works must not be considered as wastrel because time will prove its value.
3. The co ordination of various factors in a society results in successful health care.
4. Future of research in health care is bright because many new diseases like SARS are detected worldwide.
5. The problem of longevity, new diseases, care of senior citizens, women’s healths are the topics that are to be dealt with due care and attention.

Conclusions

By concluding it is to be stressed that the existing health care system in USA is undergoing a tremendous change. The patient rights and the health system reform may benefit the millions who are uninsured and suffer from the consequences. The policies must be based on the society as a whole and there must not be any restriction on accessibility to health care benefits. There is high scope for a new health care system which is capable to take over the existing system with a humanized out look and a new home centered health care. The change in policy issues may result in health care system changes and in a new age of health populism.

The existing consciousness in health resulted in longevity and this creates highly critical problems in the nuclear family set up and the society. The life style of the individual and the trust between the patient and the doctor influence the end result of the health care policies. It is the responsibility of the society to help the people who are suffering from chronic diseases. The policy of health to all can be attained only by solving the problems of women. Due care must be given to research work because the over exploitation of natural resources had resulted a bad effect upon nature. At any time new diseases may be formed and spread.

When diseases spread through soil, water and air, no boundary and border can get in the way of it. The funding for research must be under the control of all nations because the disease does not affect only a single nation.

The research to find out medicine for certain diseases may happen new findings and it can be useful in other fields like Agriculture, science and technology, Tele-communication, Education, Remote sensing peace keeping etc. Research programs that are undertaken must be beneficial to the society as a whole not to any particular section of the society. Innovative Health care policies, end of life care for the aged and needy, support given by the care givers, health populism and health consciousness may lead the health care system to a new era of growth and development.

Recommendations for further research

These are the recommendations:-

1. Further Research to unveil the potential of new innovative fields like biotechnology and nanotechnology in health care.
2. Use of Scientific methods in early diagnosis of disease and treatment.
3. Further studies for the effective co ordination of various factors within the health care system.

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Footnotes

1. Labonte, Ronald., and Schrecker, Ted. Globalization and Social Determinants of Health: Analytic and Strategic Review Paper. uOttowa. Institute of Population Health. 2005, p.20.
2. Ageing and Life Course: The world is Fast Ageing – Have we Noticed? World Health Organization. 2008.
3. Gerber, Ben. S MD., and Eiser, Arnold. R MD. The Patient-Physician Relationship in the Internet Age: Future Prospects and the Research Agenda. 2001.
4. U.S. Supreme Court Rules Home Health Care Workers Not Entitled To Minimum Wage, Overtime Pay. Medical New Today. 2007.
5. Foley, Michael R. MD. Drug Use during Pregnancy. MERCK Manuals. 2007.
6. Reaves, Jessica. The Great Debate Over Stem Cell Research. TIME in Partnership with CNN. 2001.
7. Kolodner, Robert. MD. Protecting Patient Privacy in Healthcare Information Systems. US Department of Health & Human Services. HHS. 2007.
8. Summary of the HIPPA Privacy Rule: HIPAA Compliance Assistance. United States Department of Health and Human Services, OCR privacy brief. 2003, P. 1.
9. Magee, Mike. Qualities of Enduring Cross-Sector Partnerships in Public Health. Elsevier Article Locator. The American Journal of Surgery, Vol. 185(1).
10. Risk Management Programs: Guide to Safe Handling of Chemotherapy Drugs. Ansell. 2003.
11. Henney, Jane E. Mid-America Coalition on Health Care Managing Medical Risk: Current and Future Challenges. US Food and Drug Administration. 2000.
12. Marinello, Tony. Health Care Reform: What Happened This Year, What Will Happen Next Year. Management Quarterly. Vol. 35(3). 1994.
13. Brown, Phyllida. WHO Agrees Measures to Stop Global Spread of Tobacco Use. 1999.
14. Staff. Alcohol: Fast Facts. Do It Now Foundation. 2007.
15. Jenkins, Carol L., and Laditka, Sarah B. Mental Health Care for Older Persons: Networking as a Response to Organizational Challenges. Policy Studies Review. Vol. 17(4), 2000.
16. Lesnik, Juniper. Community Health Centers: Health Care as It Could Be. Journal of Law and Health. Vol. 19(1), 2004.
17. Building a healthy New Mexico. Bureau of Health emergency management.
18. Barbera, Joseph A et al. Emergency Management Principles and Practices for Healthcare Systems: Unit 2: Incident Command System (ICS) and the Application of Strategic ICS Principles. The Institute for Crisis, Disaster, and Risk Management (ICDRM) at the George Washington University (GWU); for the Veterans Health Administration (VHA)/US Department of Veterans Affairs (VA). Washington, D.C. Emergency Management Academy Veterans Health Administration. 2006.
19. Barbera, Joseph A et al. Emergency Management Principles and Practices for Healthcare Systems: Unit 4: Emergency Management Instruction, System Evaluation, and Organizational Learning for Healthcare Systems. The Institute for Crisis, Disaster, and Risk Management (ICDRM) at the George. Washington University (GWU); for the Veterans Health Administration (VHA)/US Department of Veterans Affairs (VA). Washington, D.C.. 2006.
20. Emergency Management Principles and Practices for Healthcare Systems: Unit 5: Appendices. The Institute for Crisis, Disaster, and Risk Management (ICDRM) at the George Washington University (GWU); for the Veterans Health Administration (VHA)/US , Department of Veterans Affairs (VA). Washington, D.C., 2006.
21. Emergency Management Principles and Practices for Healthcare Systems: Unit 5: Appendices. The Institute for Crisis, Disaster, and Risk Management (ICDRM) at the George Washington University (GWU); for the Veterans Health Administration (VHA)/US , Department of Veterans Affairs (VA). Washington, D.C., 2006.
22. Lumumba-Kasongo, Tukumbi. A Reflection on Welfare State within the Context of Liberal Globalization in Africa: Is the Concept Still Relevant in the Search for Social Progress Policy Alternative in Africa? Maputo, Mozambique. 2005.
23. HIV Testing in Healthcare Settings. Department of Health and Human Services. 2008.
24. Rapid HIV Testing. Departments of Health And Human Services, Centers For Diseases Control and Prevention. 2008.
25. Western Blot Activity. The Biology Project –Immunology. University of Arizona. 1998.
26. Fidler, David P. Health as Foreign Policy: Harnessing Globalization for Health. Health Promotion International. Oxford University Press. 2007.
27. Anderson, Gerard., and Horvath, Jane. The Growing Burden of Chronic Disease in America. Practice Articles. Public Health Reports. P. 263. 2004.
28. Morton, Michael. Redefining Health. The Daily News Tribune. 2008.
29. Preventing Chronic Diseases: A Vital Investment. World Health Organization, Canada Public. P. 57. 2005.
30. Anderson, Gerard., and Horvath, Jane. The Growing Burden of Chronic Disease in America. Practice Articles. Public Health Reports, 2004.
31. Factsheet: Talking to Kids about Fear and Violence. Mental Health America. 2007.
32. Eliminating Violence in the Work Place. CUPE. 2007.
33. FERNANDES, Christopher M.B. MD et al. Evidence: Violence in the Emergency Department: A Survey of Health Care Workers. CMAJ. 1999.
34. Green, Leslie. What It Means to Be a Physician-An Interview with Dr. Magee. Universitat Pompeu Fabra Barcelona. 2005.
35. Appleby, Julie. Debate Surrounds End-of-Life Health Care Costs. 2006.
36. Wiener, Joshua M., and Tilly, Jane Dr. End-of-Life Care in the United States: Policy Issues and Model Programs of Integrated Care. PubMed Central. 2003.
37. Appleby, Julie. Debate Surrounds End-of-Life Health Care Costs. 2006.
38. Improving Health Care Value: Quality and Cost. Blue Cross Blue Shield Association. 2007.
39. Landes, Megan. Can Context Justify an Ethical Double Standard for Clinical Research in Developing Countries? Globalization and Health. 2005.
40. Matamala, Maria Isabel. Health Care Models in the Context of Globalization. BNET. 2004.
41. Yale, Phyllis., and Murphy, Kara. Improving Healthcare Effectiveness. Bain and Company. 2007.