Cancer is a major health issue in low-income areas with medically underserved populations in places with no or few health care facilities and clinicians. There are disproportionate distributions of cancer health challenges in the US based on ethnicity, race, and socioeconomic status. Consequently, these factors have influenced morbidity and mortality associated with cancer in different ways. Hence, one must observe cases of cancer, diagnosis stages, prognosis, and patient outcomes.
At any given time, racial minorities, immigrants, and people within the lower socioeconomic levels fall within the medically underserved groups. Medically underserved groups believe that the health care system could be responsible for perpetuating health inequality. One could attribute effects of these disparities to several factors such as inhibition of cancer prevention, screening, detection, patient follow-ups, and subsequent treatment.
Several factors have contributed to barriers that affect the community. Majorities are underinsured or insufficiently insured, lack of cancer awareness programs, transportation barriers due to remote location of the community, busy rural ER clinical services, rural residence without permanent health care facilities, and lack of contact or relationships with health care providers.
Cancer affects African American disproportionately due to barriers responsible for inequality in health care provisions (Ferrante, Wu and Dicicco-Bloom, 2011). As a result, health care stakeholders have adopted various advocacy programs to improve provisions of health care services to medically underserved African Americans in rural locations.
A summary of advocacy program on the issue
Patient navigation (PN) has been a successful advocacy program for cancer patients. The program aims to lessen disparities in the provision of health care services by focusing on causes of disparities. It has focused on cancer prevention, screening and early detection, cancer treatment, and follow-up care among the medically underserved populations and locations.
Past studies have established that patient navigation was effective in enhancing health care outcomes among cancer patients in medically underserved locations (Robinson-White, Conroy, Slavish and Rosenzweig, 2010).
Attributes that made the program effective
- Improving communication among cancer patients, health care providers, policymakers, survivors, and other stakeholders, including family and community members
- Health care coordination
- Providing financial support
- Providing child care services and transportation
- Keeping and arranging for the required medical records
- Managing and facilitating treatments and follow-ups
- Community involvement and outreach programs
- Facilitating participation in clinical trials
A plan for health advocacy campaign that seeks to create a new policy or change an existing policy
Description
The new policy will aim to improve the provision of health care services for cancer patients in medically underserved locations among African Americans. Specifically, the policy will focus on the majorities at high risks of cancer complications and poor health. The policy shall focus on a twofold strategy approach by focusing on the relevant through addressing the immediate health concerns and possible future health challenges. At the same time, it will challenge the existing disparities in health care provisions, which have negative impacts on the quality of health and well-being among African Americans in remote locations.
Proposed policy solution: advocacy policy for change in health care provision
- Reducing chronic cases of cancer among African Americans by cancer control risk factors
- Promoting psychological and physical well-being
- Supporting healthy aging in the community
- Addressing inequalities in health care provisions in remote locations
Specific objectives of the policy
- Identify inequalities in health care provisions as key factor that affects African American health status and well-being
- Recognize that remotely located African Americans have diverse health needs based on their economic status
- Prioritize changes in life stages as contributors to cancer
- Identify the segment at high risks of cancer
- Developing a system that is responsive to African Americans health needs by concentrating on prevention and promotion of healthy habits
- Promote collaborative fight against cancer through program monitoring and evaluation by collecting and analyzing data and then sharing knowledge gained as a part of evidence-based practices
- Address long queues in ER, which are significant barriers to health care provisions
Overall, the modification in policy should address reasonable insurance coverage and health care affordability to marginalized populations. At the same time, it should reduce the number of underinsured. It will also address the plight of health care providers, who work in such marginalized environments. The goal is to enhance investments in rural health care facilities to address long-term health care outcomes among medically underserved populations. It would also increase awareness programs in remote locations.
Methods of establishing support for the policy
This policy shall rely on collaborative processes. Hence, it shall account for health needs of the immediate beneficiaries and engage decisively with politics in policymaking processes. Political decisions heavily affect health care provisions and well-being of this segment of the population in remote locations. The policy shall adopt reliable support and use of reliable information in order to develop efficient and effective processes of solving cancer among African Americans by analyzing societal health problems and public policy affairs. On this note, the policy shall:
Engage internal stakeholders in all processes
When internal stakeholders participate in all processes of policymaking, they will own and feel as a part of the entire policy. Involving internal stakeholders earlier will ensure that the policy identifies and addresses major health concerns in the location. Late engagement and discovery of the challenges may impede the progress of the policy.
Internal stakeholders will provide valuable insights in the development processes to avoid surprises in the later stages of policy implementation.
Realistic expectations
The policy shall develop trust among stakeholders through open processes in order to establish realistic expectations among stakeholders. The policy shall ensure that personal feelings, differences in opinions and distrust do not affect the process negatively.
Identification of all stakeholders
Although the policy shall have key stakeholders, it will not ignore other important stakeholders in health care provisions. Hence, it will account for all stakeholders’ roles, agendas, objectives, and expectations. In every project, there are always important stakeholders who must agree with the project. In addition, there are also others, who may pose the greatest threat to success of the policy. The project shall categorize all stakeholders based on their levels of importance at all levels. Moreover, it will focus on needs of stakeholders at all levels. This would ensure absolute support for the new policy.
How to influence policymakers
The policy shall use best practices and successful programs of the past based on data to influence policymakers. For instance, the policy will cite examples of success programs based on the study by Sara Rosenbaum, Emily Jones, Peter Shin, and Leighton Ku (2009). This study established that advocacy programs reduced health care disparities significantly among the medically uninsured and underserved populations (Rosenbaum et al., 2009). It will also identify weaknesses in the current policy in order to improve on them, such as uninsured and underinsured, lack accessibility to healthcare facilities and financial support.
Application of attributes to the policy
The policy shall apply the best attributes of patient navigation among cancer patients in order to reduce health care disparities. It will adopt health care provision for change and long-term outcomes by addressing the immediate concerns and long-term challenges. On this note, the policy shall use multidimensional approach, collaborative processes, monitoring and evaluating, financial support and management, and other supports needed.
Legal considerations
Modifying the existing legislation
The proposed policy seeks to modify the existing policy on health care provisions based on its weaknesses and inadequacy to serve African Americans in rural areas with cancer. The points of interests, which the proposed policy seeks to modify in the current policy, include the following:
- The current policy does not provide funding for the uninsured and additional funding for the underinsured. The modification shall advocate for funding allocation for this medically underserved population.
- The existing policy does not acknowledge the unique health needs of African Americans in remote locations. The proposed modifications shall account for low-income status of the population, lack of accessibility to health care facilities, and poor health promotion in the region.
The policy shall improve on the current one by being progressive through putting African Americans on the political agenda in order to improve their health status and well-being.
- The policy modification shall focus on key areas, which the existing policy has not addressed effectively. These shall include adequate funding, availability of health care facilities and care providers, accessibility of the area, healthy aging, and racial impacts of health care provision.
How existing laws could affect the advocacy efforts
This is a public health policy issue. Hence, it is under the current laws and regulations that guide the provision of health care services to all communities. These laws and regulations could be formal, informal, and other influential decisions that local, state, and federal entities make. The role of the current policy should address several interrelated public health challenges either directly or indirectly and develop a guideline that provides a framework for responding to challenges among African Americans in remote locations. The current policy has failed to highlight challenges that the community faces and assist in determining how stakeholders should respond to these needs under the law. Responses would include provision of health care services, changes in legislation, and financial support among others.
Therefore, the advocacy and public policy must work collaboratively in order to identify and set forth the required changes so that they can address these needs. There should be no competition because advocacy will act as a factor for facilitating or influencing public policies for change. Exchange of information will be effective for the program.
Analysis of the methods used to influence lawmakers and other policymakers
Heath care provisions should not be apolitical because inputs and supports from legislators and policymakers are crucial for the success of the program. Political processes should not compromise professional standards or affect relationships among health care stakeholders (International Council of Nurses, 2008). Racial prejudice against African Americans in the past could influence their opinions about involving politicians and policymakers in the process. Therefore, the role of the advocate is to ensure that such thoughts do not interfere with the belief in the project. The nurse must make the community to acknowledge the role of politics in the process differently, as supporting rather than opposing.
Politicians must understand that they make policies, which determine behaviors, choices, and the provision of health care services among African Americans in remote locations. The major role of advocacy is to change such policies that politicians and policymakers make. In this case, the health care resources are in the hands of few. This has led to poor provisions and distribution of health care service to the racial minorities in remote locations.
Advocacy for modification of the current laws would ensure that the medically underserved groups gain recognition for their health challenges. In addition, the effort would also influence lawmakers to ensure equitable distribution of health care resources in order to solve immediate and long-term health challenges among African Americans in remote locations.
The challenge could be how to influence lawmakers to modify the current policy. On this note, the advocate shall review how policymaking process works by focusing on comprehending how lawmakers make and enforce public policies (Milstead, 2011). This would allow the advocate to understand important decision-makers who need to be influenced in the process of modification of existing legislation.
- Identifying key decision-makers, policies they implement, the level of consultation, accountability, and responsiveness
- Understanding how public policies are implemented and enforced
- Persuasion with facts on health care disparities and their negative effects on African Americans
- Gaining direct access to key decision-makers on public health issues
- In case the responses are poor from lawmakers, the disruption and litigation may influence lawmakers and other policymakers.
Obstacles
The article has highlighted few obstacles associated with political processes and provided solutions in the above section. Nevertheless, there are still some. For instance, local authorities cannot change any laws at the grassroots level even if the conditions of African Americans advocate for the need to modify public policy on health care. On this note gaining accessibility to key decision-makers at the national level may take time. However, prior planning may alleviate such challenges.
In some instances, political leadership may resist any changes to the current policies. Therefore, the advocacy program shall adopt two basic for legislators. The program shall combine both condemnatory and collaborative approaches in order to address such challenges. The process shall involve highlighting health discrepancies within the current policies and proposing the best alternatives that would offer the desired health outcomes to African Americans in remote locations. If these approaches fail to work, then the program shall adopt disruption and litigation.
Ethical consideration
The US Constitution protects the right to advocacy or lobbying under the First Amendment. Hence, nurses and communities have rights to participate in decisions that influence their lives. However, it is important to address ethical issues in lobbying.
Fairness
It is unethical to pay or influence policymakers’ decisions by paying or compensating them in any ways to favor the modification of the policy. Receiving payments for other expenses incurred to support a policy is not a fair practice. Hence, the advocate shall not pay or compensate legislators for expenses incurred due to the program.
The ease of accessibility to legislators is also a major source of concern. People at the remote location lack fairness when it comes to gaining accessibility to lawmakers. This is critical when others can easily gain easy access to them. The nurse shall make prior arrangements with key decision-makers in order to enhance chances of accessibility.
Local leaders may also attempt to influence the advocate to drop the bid to change the policy. The nurse shall remain professional throughout the process and avoid personal and private concerns of others.
Transparency
Lack of transparency could present ethical dilemmas to the process. One way of avoiding lack of transparency is to register and file all matters explored in the meeting with all stakeholders, including legislators. The advocate shall enhance frequencies of reporting and open processes with all meetings with policymakers.
The advocacy shall avoid ‘earmark strategy’ i.e., last minutes rush so that policymakers can study the proposed modifications and provide their inputs (Berry and Brown, 2007). The advocate shall ensure that the proposed modification have all relevant details and sufficient time for reviews.
Common Good
Health care lobbyist shall represent the common good of health care provisions among medically underserved in rural locations. Hence, the role of the advocate nurse would be to provide facts about the desired modifications at all levels of policymaking. There should be no compromising on public good.
On the other hand, the advocacy shall ensure fairness to policymakers by engaging them in the process to understand their inputs. This is a process of ensuring that the common good for African Americans remains and presented at all levels of policymaking. Hence, different views are necessary to develop strong modification objectives for the existing public policy.
Ethical laws and reporting requirements for the advocacy program
The nurse shall ensure ethical practices throughout the lobbying process. One way to ensure ethical standards is to ensure that all stakeholders understand the process of lobbying and important decision-makers who can influence the process. Hence, the nurse will register and file a report on all matters discussed with all stakeholders during advocacy.
The nurse would also maintain the NAN codes of ethics by focusing on integrity of the profession, practices, and self-integrity in order to shape public health policies. This would improve health care environments for medically underserved and uninsured African Americans in remote locations living with cancer. Moreover, it would improve conditions for health care provisions in remote areas and reflect the value of the profession (American Nurses Association , 2011).
Ethical challenges unique to the population
Africa Americans in this area are racial marginalized segment of the population. Hence, advocacy program must recognize their socioeconomic status, beliefs, racial considerations, and other factors that could influence their beliefs and behaviors toward health care policies, politicians, and advocacy.
The advocacy program shall recognize unique needs of African Americans with attention to their gender, ages, socioeconomic status, and race. As a result, the new public policy shall rely on the discourse of the target beneficiaries and not views of lawmakers alone.
All adopted policies shall be applied with absolute concerns to race and other characteristics, which make African Americans in rural areas different from the rest. The aim is to reduce health care disparities in the current policy and include the needs of the minorities in the modification.
References
American Nurses Association. (2011). Code of Ethics. Web.
Berry, C. E., and Brown, N. (2007). United States: New Lobbying And Ethics Law Taking Effect—Take Steps Now To Ensure Compliance. Web.
Ferrante, J. M., Wu, J., and Dicicco-Bloom, B. (2011). Strategies Used and Challenges Faced by a Breast Cancer Patient Navigator in an Urban Underserved Community. Journal of the National Medical Association, 103(8), 729–734.
International Council of Nurses. (2008). Promoting Health: Advocacy Guide for Health Professionals. Geneva, Switzerland: ICN.
Milstead, J. A. (2011). Health Policy and Politics: A Nurse’s Guide (4th ed.). Burlington, MA: Jones and Bartlett.
Robinson-White, S., Conroy, B., Slavish, K. H., and Rosenzweig, M. (2010). Patient navigation in breast cancer: a systematic review. Cancer Nursing, 33(2), 127-40. Web.
Rosenbaum, S., Jones, E., Shin, P., and Ku, L. (2009). National Health Reform: How Will Medically Underserved Communities Fare? Web.