Tag Archives: health promotion

Academia, Health Care

Strategic Planning: Strategies & Tactics

Seattle Children’s Hospital (2011, n.d.) was the first pediatric specialty care hospital founded west of the Mississippi River. Seattle Children’s Hospital, supported by the philanthropic efforts of the community, performs at the cutting-edge of pediatric medicine and research. With nearly 60 pediatric specialties and award-winning research faculty, Seattle Children’s Hospital presents expertise in the field of pediatric medicine.

Services

Seattle Children’s Hospital (n.d.) is a pediatric specialty care center associated with the University of Washington to provide medical and surgical residents with the hands-on practical experience and education needed to succeed in the medical profession.

The hospital (Seattle Children’s Hospital, n.d.) has many specialized programs, or sub-specialties, within its pediatric specialty, including urgent and emergency care, oncology and hematology, craniofacial, orthopedic and sports medicine, a heart and transplant center, neonatology, neurosurgery, and general and thoracic surgery.

Seattle Children’s Hospital (n.d.) also boasts an award-winning research facility dedicated to treating and eliminating pediatric disease.

Strategic Planning

The strategic plan of Seattle Children’s Hospital (2011) focuses on the hospital’s vision and four specific goals:

  1. provide the safest, most effective care possible,

  2. control and reduce the cost of providing care,

  3. find cures and educate clinicians and researchers, and

  4. grow responsibly and provide access to every child who needs us (p. 2).

In order to succeed in reaching these goals, the hospital’s plan must have directives that outline the strategies and tactics useful in attaining the goals.

Strategy

Strategy is the broad means directed towards attaining strategic goals. As Seattle Children’s Hospital’s (2011) strategic plan demonstrates, in order to achieve the means of providing the safest, most effective care possible, “[the hospital] will standardize our care processes and strengthen our systems to prevent and respond rapidly to medical errors” (p. 5). This strategy is broadly stated, provides direction, and acknowledges that failures may still occur, which allows for the provision of a secondary, or backup, strategy for response to these failures.

Tactics

Tactics are the individual steps made within a strategy towards attaining a specific goal. Tactics should be moral, safe, efficient and effective towards the strategic goals. For instance, the strategy of “[standardizing] our care processes and [strengthening] our systems to prevent and respond rapidly to medical errors” (Seattle Children’s Hospital, 2011, p. 5) is well-stated, yet broad. In order to employ this strategy, tactics must be employed that are specific to meeting the described goal. In this case, Seattle Children’s Hospital (2011) has identified that “[completing] the transition to an electronic medical record system” (p. 5) is a specific means that can be used to help fulfill this particular strategy and meet the described goal.

Another tactic not presented in Seattle Children’s Hospital’s (2011) strategic plan but helpful in attaining the goal of improved patient safety and drawn from the strategy of “[standardizing] … care processes and [strengthening] … systems” (p. 5) would be the formation of an anonymous, voluntary self-reporting system in which a nurse or physician submits a card detailing a medical or surgical error in the spirit of identifying processes and systems in need of improvement.

Discussion

Strategic plans are guided by strategic goals, and strategic goals can have many strategies that are employed and useful in meeting the stated goals. It is also true that a plethora of tactics can be employed for each strategy.

Strategic plans are often based on lofty, yet attainable, goals. In order to meet these goals, one must only ask a simple question: How? With each broad answer, a continuous and recursive series of How? can be used to work the strategy into a number of manageable tactics to use to reach that lofty goal.

References

Seattle Children’s Hospital. (2011). Shaping the future of pediatric healthcare: Strategic plan 2012 to 2016. Retrieved from http://www.seattlechildrens.org/pdf/strategic-plan-2012-2016.pdf

Seattle Children’s Hospital. (n.d.). About Seattle Children’s. Retrieved from http://www.seattlechildrens.org/about/

Academia, Health Care, Public Health

Comparing Hospital Care in My Area

Living in northeastern Connecticut, I find myself equidistant from two area hospitals. As a health care provider and consumer, I feel that it is important to choose the professionals who will provide my care based on fact. Websites created by the Joint Commission (2011) and the U.S. Department of Health and Human Services (HHS; 2011) prove to be a helpful repository of information regarding the safety and quality of care delivered by hospitals and practitioners across the country.

Using these two websites, I will compare the three closest hospitals to my zip code: 1) Day Kimball Hospital (10.3 mi), 2) Harrington Memorial Hospital (10.0 mi), and 3) Windham Community Memorial Hospital (21.7 mi). The mean distance from my home to these hospitals is 15.85 mi. with all three being acceptable by me in distance and time in the case of an emergency. Day Kimball Hospital (DKH; 2011) is a 104-bed acute care facility located in Putnam, Connecticut. Harrington Memorial Hospital (HMH; 2009) is a 114-bed acute care facility located in Southbridge, Massachusetts. Windham Community Memorial Hospital (WCMH; n.d.) is a 130-bed acute care facility located in Windham, Connecticut.

General process of care measures account for best practices in medicine and health care. The Surgical Care Improvement Project has set goals preventing untoward cardiac effects during certain surgical procedures along with infection control measures. According to Health Compare (HHS, 2011), cumulative scores for each hospital based on general process of care measures in the Surgical Care Improvement Project are as follows: DKH=0.954, HMH=0.901, WCMH=0.935. Another general process measure aimed at providing the standard of care of heart attack victims is the Heart Attack or Chest Pain Process of Care. The cumulative scores for these reported measures are: DKH=0.967, HMH=0.973, WCMH=0.956. Another cardiac related measure is the heart failure process of care measure. The cumulative results are: DKH=0.950, HMH=0.873, WCMH=0.893. Pneumonia process of care measures are important to gauge the appropriateness of treatments provided to stave off further development of respiratory failure and sepsis, two highly conditions with increase mortality. The cumulative scores for the pneumonia process of care measures are: DKH=0.932, HMH=0.860, WCMH=0.955. The last general process of care measure reflects the adherence to best practices in treating and managing children’s asthma; however, none of the three hospitals provided data for any of the process measures of this category.

Along with process of care measures, outcome of care measures are also important as they reflect the ability of each hospital to manage the risks of mortality and morbidity in caring for their patients. Outcome measures are based on both death and readmission of heart attack, heart failure, and pneumonia patients. For all three hospitals, DKH, HMH, and WCMH, the cumulative results for outcome of care measures were not statistically different from than the national rates in all categories. Health Compare (HHS, 2011) reports these measures as such.

One final measure that I find important in choosing a hospital is the patient satisfaction scores. Cumulative scores of the Survey of Patients’ Hospital Experience allow us to compare the three hospitals: DKH=0.695, HMH=0.701, WCMH=0.677.

In ranking each of the three hospitals, I used an average of the cumulative scores for each hospital’s measure discussed above. The final score, according to the averages of the Hospital Compare (HHS, 2011) scores, is: DKH=0.900, HMH=0.862, WCMH=0.883; therefore, my first choice of hospitals, according to the data presented in Hospital Compare is DKH with WCMH being second and HMH third. According to this data, though, each of the three hospitals appears to be equitable with the others striving in some measures and faltering in others. This is also evidenced by Quality Check (The Joint Commission, 2011), which shows a graphic representation of the same overall data, National Quality Improvement Goals and the Surgical Care Improvement Project, used by HHS (2011). Quality Check (The Joint Commission, 2011) compares quality data with the target ranges of other hospitals.

According to Quality Check (The Joint Commission, 2011), DKH met all the target goals while exceeding the goals set for infection prevention. HMH failed to meet the pneumonia care goal, but met all other goals. HMH did not exceed any of the goals. WCMH failed to meet the heart failure care goal, but met all other goals. WCMH did not exceed any of the goals.

In considering the data from Hospital Compare (HHS, 2011) and Quality Check (The Joint Commission, 2011), it is clear that this data can be used by consumers to make more informed decisions regarding their health care. Though the methods in this paper might be questionable and simple, consumers may disregard some measures while favoring others, depending on their perception of what measures are important in judging the provision of the care that they might receive. Additionally, the data used for the comparisons, many times, accounted for a small patient population; however, each hospital serves comparable communities with comparable levels of service. This may be a consideration when performing scientific statistical analyses, but that would be beyond the scope of this paper.

The provision of health care must be ethical, just, and equitable. Allowing consumers access to data regarding the performance of hospitals in their area can provide additional insight to patients when choosing their health care provider.

References

Day Kimball Hospital. (2011). Sevices and locations: Day Kimball Hospital. Retrieved from http://www.daykimball.org/services-and-locations/day-kimball-hospital/

Harrington Memorial Hospital. (2009). About us: Harrington at a glance. Retrieved from http://www.harringtonhospital.org/about_us/harrington_at_a_glance

The Joint Commission. (2011). Quality check. Retrieved from http://www.qualitycheck.org/ consumer/searchQCR.aspx

U.S. Department of Health and Human Services. (2011). Hospital compare. Retrieved from http://www.hospitalcompare.hhs.gov/

Windham Community Memorial Hospital. (n.d.). CEO’s message. Retrieved from http://www.windhamhospital.org/wh.nsf/View/CEOsMessage

Academia, Health Care, Public Health

A Novel Approach to Combat Heart Disease

According to Hansson (2005), cardiovascular disease is fast becoming the number one killer in the world among in developing countries and the Western world, due mainly to the correlation of increased rates of obesity and diabetes (Haffner, Lehto, Rönnemaa, Pyörälä, & Laakso, 1998; Miller, 2011; Willer et al., 2008). The goal of eradicating heart disease by the end of the twentieth century has been missed as cardiovascular disease is still responsible for 38% of deaths in North America. There has been much research over the last three decades regarding correlations between cardiovascular disease, obesity, and diabetes. Miller et al. (2011) identifies, based on the current literature, a number of metabolic syndromes in which elevated triglyceride levels are responsible for significantly increasing the risk of cardiovascular disease and the risk of death from a cardiac event.

Risk factors for cardiovascular disease, including smoking, hypercholesterolemia, and diabetes, which have positive predictive value for CVD, include a positive family history, hypertension, male gender, and age (Haffner, Lehto, Rönnemaa, Pyörälä, & Laakso, 1998; Hansson, 2005; Koliaki, 2011).

Demographically, according to NHANES 1999-2008 (as cited in Miller, 2011), Mexican American men (50 to 59 years old, 58.8%) are at the greatest risk with the highest prevalence of elevated triglyceride levels ( 150 mg/dL) followed by (in order of decreasing prevalence) Mexican American women ( 70 years old, 50.5%), non-Hispanic White men (60 to 69 years old, 43.6%), non-Hispanic White women (60 to 69 years old, 42.2%), non-Hispanic Black men (40 to 49 years old, 30.4%), and non-Hispanic Black women (60 to 69 years old, 25.3%).

Haffner et al. (1998) describe the importance of lowering cholesterol levels in those with diabetes mellitus type II as they both contribute to increases in mortality and morbidity from cardiovascular disease; therefore, efforts should be focused on identifying risks to heart health starting at age 30 with concomitant risk factors of diabetes or dyslipidemia, or any combination of two or more identified risk factors. More specific screening should begin at age 40 with Mexican American males and all other demographics suffering from any one of the secondary risk-factors, and at age 50 with all other ethnic demographics, regardless of the presence of risk-factors.

Specific screening for the at-risk population should include diagnostic percutaneous transthoracic coronary angiography (PTCA) and angioplasty, if needed. PTCA is a method of introducing a catheter through an artery to the coronary arteries of the heart, guided by radiology, to diagnose specific narrowing of these vessels, at which time a repair (angioplasty) can proceed immediately. PTCA, according to Koliaki et al. (2011), is the gold standard of diagnosing the presence and degree of atherosclerotic CVD. Currently, the standard for initiating PTCA requires a more acute presentation, typically complaints of chest pain or some other cardiac related illness. However, the proven safety and efficacy of PTCA may allow it to be used more as a screening tool as well as a primary coronary intervention in acute cases.

Utilizing the diffusions of innovations model of behavior change, public health entities can provide specific information to encourage interventional cardiologists to employ this technique as a focused CVD screening tool for at-risk populations (“Culture and health,” 2012). Adoption, however, is conditional on remuneration; therefore, a public health task force at the national level should investigate the potential for spending versus savings, and if significant, should disseminate the information to third-party payors (heath insurance providers, etc.) to ensure coverage when required. Additionally, grassroots efforts should be two-pronged, focusing on both the affected communities and the physicians most likely to contact the at-risk community. For the at-risk community, using mass-media, the message should simply be to discuss your risk with your physician, stop smoking, eat healthy, and exercise. The message, itself, needs to be conveyed in an effective manner, however. For the physicians, using mass-mailing and professional development campaigns, the message needs to more complex outlining risk versus reward, cost-effectiveness, and the potential for impacting a growing trend of heart-related death and disability. The American Heart Association has a proven track record of effective mass-media campaigns as well as professional development programs. So long as PTCA can be considered as an effective and cost-saving screening tool, the American Heart Association should certainly be involved in sending the message out.

Like with the proliferation of television advertisement of pharmaceuticals, using diffusions of innovations, we can get the heart-healthy message to the communities that would most benefit and the providers who can facilitate appropriate and novel screening and treatment techniques. We have already failed to eradicate CVD by the turn of the century, but if we think outside the box and develop novel approaches to consider, we may still have a chance at effectively lowering the incidence and prevalence of CVD in the years to come.

References

Culture and health. (2012). Public health and global essentials (Custom ed.; pp. 213-226). Sudbury, MA: Jones & Bartlett.

Haffner, S. M., Lehto, S., Rönnemaa, T., Pyörälä, K., & Laakso, M. (1998). Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. New England Journal of Medicine, 339(4), 229-234. doi:10.1056/NEJM199807233390404

Hansson, G. K. (2005). Inflammation, atherosclerosis, and coronary artery disease. New England Journal of Medicine, 352(16), 1685-1695. doi:10.1056/NEJMra043430

Koliaki, C., Sanidas, E., Dalianis, N., Panagiotakos, D., Papadopoulos, D., Votteas, V., & Katsilambros, N. (2011). Relationship between established cardiovascular risk factors and specific coronary angiographic findings in a large cohort of Greek catheterized patients. Angiology, 62(1), 74-80. doi:10.1177/0003319710370960

Miller, M., Stone, N. J., Ballantyne, C., Bittner, V., Criqui, M. H., Henry N. Ginsberg, H. N., … Council on the Kidney in Cardiovascular Disease (2011). Triglycerides and cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 123(20), 2292-2333. doi:10.1161/CIR.0b013e3182160726

Willer, C. J., Sanna, S., Jackson, A. U., Scuteri, A., Bonnycastle, L. L., Clarke, R., … Abecasis, G. R. (2008). Newly identified loci that influence lipid concentrations and risk of coronary artery disease. Nature, 40(2), 161-169. doi:10.1038/ng.76

Appendix

P.E.R.I. Problem Identification

The health problem I have identified is cardiovascular disease (CVD). According to Hansson (2005), CVD was expected to be significantly reduced or eliminated by the turn of the century; however, cardiovascular disease remains one of the leading cause of death globally with a rise in obesity and diabetes incidence (Willer et al., 2008). The two primary factors contributing to CVD are thought to be hypercholesterolemia, or high cholesterol levels in the blood, and hypertension, or high blood pressure, and although Koliaki et al. (2011) shows no predictive value between obesity and CVD, there remains a strong correlation between obesity and diabetes (Haffner, Lehto, Rönnemaa, Pyörälä, & Laakso, 1998; Hansson, 2005). A better look at the emerging literature might provide insight as to why attempts to control cholesterol and blood pressure have largely failed to eradicate CVD.

Koliaki et al. (2011) contend that smoking, hypercholesterolemia, and diabetes have positive predictive value for CVD while a positive family history, hypertension, male gender, and age, though predictive, are significantly less specific. Considering the causative risk factors and admitting the difficulty in changing age, family history, and gender, altering smoking status, cholesterol levels, and severity of diabetes and blood pressure have all been shown to decrease the risk of CVD. However, like genetic factors such as family history and gender, researchers are finding difficulty in controlling cholesterol levels effectively in many patients, especially those with concommitant diabetes mellitus (Haffner et al., 1998; Willer, 2008). However, statin-type cholesterol-lowering medications appear to have other protective effects than merely lowering cholesterol (Hansson, 2005).

In order to combat the growing concern of cardiovascular disease and, ultimately, the increasing mortality from the same, the American Heart Association (AHA) has published a scientific statement paper regarding the latest literature and research (Miller et al., 2011). AHA has taken the lead in cardiovascular health and strives to promote best practices based on the available evidence. By promoting AHA’s position using mass-mailing campaigns to physicians practicing in primary care, emergency, cardiology, and endocrinology, we can be assured that the right message is being disseminated rapidly to those most inclined to intervene. As more physicans in the identified roles adopt the latest evidence-based practice, more at-risk patients can be screened for CVD and the contributing factors. As screening paradigms become more focused, more of the at-risk population will be identified sooner which will allow for earlier intervention decreasing overall mortality and morbidity from CVD.

P cardiovascular disease
E Causes: DM, type II; dyslipidemia (hypercholesterolemia); smoking; diet; exercise; gender; age
Burden: increasing mortality and morbidity globally
R Diabetes mellitus screening and control, HTN screening and control, statin-type medication prescription, PTCA screening recommendations, smoking cessation
I AHA position, public health mailing campaign, cadre of physician groups
Academia, Health Care, Public Health, Society

Community Health: How Healthy is My Community?

I currently reside in Windham County, Connecticut. Windham County is primarily rural with one community, Willimantic, comprising most of the urban demographic. Windham County is functionally divided in half (north to south) in regards to health and hospital services. Primarily, Windham Community Memorial Hospital serves the west and Day Kimball Hospital serves the east. Accordingly, the eastern and western portions of the county may not be representative of each other, yet both are represented as a singular group when considering county-based statistics. This is a shortcoming of county-based statistics. In this instance, Willimantic, in the western portion of Windham County, may negatively affect the statistics of towns like Killingly, Pomfret, and Putnam, in the eastern portion of the county, due primarily to an increase in impoverished populations residing in Willimantic (U.S. Census Bureau, 2002). Additionally, data is lacking for a number of measures, according to the Community Health Status Indicators Project Working Group (2009), but continuing efforts will be made to increase reporting over time.

According to the U.S. Census Bureau (2008) and the U.S. Department of Health and Human Services (2009), the population of Windham County is 117,345 and is predominantly white (94.3%) with the remaining (5.7%) divided among, in order of predominance, Hispanics, Blacks, Asians and Pacific Islanders, and American Indians. The particularly vulnerable populations identified are adults age 25 and older who do not hold a high school diploma, are unemployed, are severely disabled and unable to work, suffer major depression, or have recently used illicit drugs. The uninsured rate in Windham County is well below the 16% national average at 9.5% (Newport & Mendes, 2009; U.S. Department of Health and Human Services, 2009).

Windham County fares equal or better in most measures, at least within the margin of error; therefore, I feel that Windham County, though not exceptionally healthy, is better than most and striving to meet the national standards (U.S. Department of Health and Human Services, 2009). For example, though the incidence of cancer and subsequent death resulting remains higher than peer counties, Windham County falls well within the expected range of death measures and exceeds peer counties in homicide, stroke, suicide, and unintentional injuries. Windham County also falls below the national standardized target for both stroke and coronary heart disease deaths. Infant mortality and birth measures seem representative of peer counties. Windham County also meets or exceeds environmental standards in all cases except for two reports of E. coli infections. There were also reports of five cases of Haemophilus influenzae B, two cases of Hepatitis A, and three cases of Hepatitis B — the only unexpected cases of infectious diseases reported. Pertussis incidence was limited to 25% of expected cases.

Windham County is not exceptional, but living here gives me the sense that the focus is on preventative care rather than acute care, which might explain how the health goals are being achieved overall. The report from the U.S. Department of Health and Human Services (2009) is in agreement.

References

Community Health Status Indicators Project Working Group. (2009). Data sources, definitions, and notes for CHSI2009. Retrieved from http://communityhealth.hhs.gov/

Newport, F. & Mendes, E. (2009, July 22). About one in six U.S. adults are without health insurance: Highest uninsured rates among Hispanics, the young, and those with low incomes. Gallup-Heathways Well-Being Index. Retrieved from http://www.gallup.com/poll/121820/one-six-adults-without-health-insurance.aspx

U.S. Census Bureau. (2002). Census 2000. Retrieved from http://www.ct.gov/ecd/cwp/view.asp?a=1106&q=250616

U.S. Census Bureau. (2008). Population estimates: Annual estimates of the resident population by age, sex, race, and Hispanic origin for counties in Connecticut: April 1, 2000 to July 1, 2008 [Data]. Retrieved from http://www.census.gov/popest/counties/asrh/files/cc-est2008-alldata-09.csv

U.S. Department of Health and Human Services. (2009). Community health status indicators report. Retrieved from http://communityhealth.hhs.gov/

Academia, Health Care, Politics, Public Health, Society

Addressing Health Disparities

It is troubling to many people to see any person suffering in our society. It is even more troubling to see inequality extend to whole ethnic and racial groups within our society. We certainly do not want to be an unjust society, and we certainly want every member of our society to benefit from the technological gains made in the last century.

One of the more troublesome areas that many view as unjust is health and health care. It is unfortunate that some members of our society suffer from disparities in health. For instance, immunizations and vaccines for most of the common deadly pathogens are readily available, yet many people fail to immunize themselves or their family.

Immunization and vaccination programs have eradicated smallpox and polio and have all but eliminated the threat of measles in the United States (U. S. Department of Health and Human Services [DHHS], 2000). With influenza and pneumonia causing 30,000 to 41,000 deaths in the U. S., annually, the importance of vaccinating against these diseases is quite evident. Obviously, lacking immunity to a deadly pathogen is a disparate condition of health status, and Hispanic and African American populations are vaccinated with less frequency than Whites. How are these issues being addressed?

On the international level, the United Nations (2009) is addressing health disparities by attempting to eradicate poverty on a global scale. Unfortunately, many of these global initiatives have created an environment rife with economic turmoil that we are just now starting to see and understand. Though the premise of helping people out of poverty is very noble, the reality seems to be that we can only offer means for people to help themselves. Otherwise, we risk thrusting whole populations into a world they know nothing about, setting them up for failure. Poverty is based on local economy, and I believe that these interrelated problems are best addressed on the local levels with assistance from states, nations, and global endeavors. The people must direct their own path for a successful transition. They must take responsibility for their own successes and failures.

The United States addresses these concerns on a federal level, offering guidance to states and municipalities in ways to address them. One of these methods is a report from the U. S. Department of Health and Human Services. Healthy People 2010 (DHHS, 2000) has two stated major goals: 1) to increase quality and years of healthy life, and 2) to eliminate major health disparities. There are also 467 objectives in 28 focus areas designed to further these two major goals. Immunization is one of these focus areas.

According to the CDC’s National Center for Disease Statistics (2010), the goal of achieving a 90% immunization rate for children 19-35 months of age is close to being reached. The combination diphtheria, tetanus, and pertussis (DTP) vaccine (85%) and pneumococcal conjugate vaccine (75%) are the only two recommended childhood vaccines that are not being administered at least 90% of the time. According to DHHS (2000), the goal for DTP vaccination was 80% in 2000. It appears that this goal has been reached and exceeded.

Conversely, older adults, age 65 and greater, are at an increased risk of contracting illnesses that could be prevented by vaccination. “In 1999 approximately 90 percent of all influenza and pneumonia-related deaths occurred in individuals aged 65 and older” (Centers for Disease Control and Prevention, Office of Minority Health and Health Disparities, 2007, para. 2). DHHS (2000) does not state a quantitative goal for vaccinating noninstitutionalized older adults, though it does mention a need to “increase the proportion of noninstitutionalized adults who are vaccinated annually against influenza and ever vaccinated against pneumococcal disease” (p. 42). In 2000, 46% of the population in the U. S. were vaccinated against pneumococcal disease, and 64% were vaccinated against influenza (DHHS, 2000). In 2009, pneumococcal disease vaccinations increased by 15%, whereas influenza vaccinations increased by only 3% (Centers for Disease Control and Prevention, National Center for Health Statistics, 2010).

Striving to eliminating health disparities is a noble endeavor; however, the mere fact of attaining this goal contributes to the increase of health care disparity. By increasing the health care delivery model for one at-risk population, we must accept negative gains in the delivery of health care for all other populations. This is an example of the law of conservation describing the divisional nature of finite resources: when an isolated system undergoes change, its change in entropy will be zero or greater than zero (Negi & Anand, 1985). This concept is better stated as it applies to the zero-sum game of our economics today. Kathleen Madigan (2010), in a Wall Street Journal blog post, stated, “More spending in one area has to be financed by less purchases elsewhere” (para. 5).

Two conclusions can be drawn from observing this phenomena in health care. First, if people are spending their health care dollars on other staples, such as food, clothing, and shelter, then we should see a decline in the health of individuals that are making these choices. Second, within health care, in order to increase a focus on one population, an equal negative effect will be seen in all other population groups.

In all aspects of health care delivery, care should be taken to ensure just and equitable delivery of care regardless of socioeconomic factors, race, gender, religion, or creed. All people should have access to the minimum required care in order to maintain a healthy and productive life. We can counsel and educate our patients and clients to best health practices, but we cannot, however, force people to choose health over other facets of their lives.

References

Centers for Disease Control and Prevention, National Center for Health Statistics. (2010). Immunization. FastStats. Retrieved from http://www.cdc.gov/nchs/fastats/immunize.htm

Centers for Disease Control and Prevention, Office of Minority Health and Health Disparities. (2007). Eliminate disparities in adult & child immunization rates. Retrieved from http://www.cdc.gov/omhd/AMH/factsheets/immunization.htm

Madigan, K. (2010, August 3). With wallets thin, consumers face zero-sum game. Real time economics: Economic insight and analysis from the Wall Street Journal. Retrieved from http://blogs.wsj.com/economics/2010/08/03/with-wallets-thin-consumers-face-zero-sum-game/

Negi, A. S. & Anand, S. C. (1985). The second law of thermodynamics. A textbook of physical chemistry (pp. 241-289). Retrieved from http://books.google.com/

United Nations. (2009). The millenium development goals report: 2009. Retrieved from http://www.un.org/millenniumgoals/pdf/MDG_Report_2009_ENG.pdf

U.S. Department of Health and Human Services. (2000, November). Healthy People 2010: Understanding and improving health (2nd ed.). Washington, DC: U. S. Government Printing Office.

Academia, Health Care, Public Health, Society

Cultural Influences on Health Disparities

Disparities in the availability, access, and delivery of health care are a great and growing concern. Some of the factors leading to disparite health include race, socioeconomic status, and gender (Chen, Martin, & Mattews, 2006). Chen et al. describes how race and socioeconomic status are major factors in the United States, based on the Healthy People 2010 data (U.S. Department of Health and Human Services, 2000). According to the results of this study, our public health efforts seem to be misguided. As the researchers of this study indicate, “race and SES effects on child health are best understood in concert, rather than separately” (p. 705). The differences in race and socioeconomic status are a factor only to White and Black children when looking at prevalence rates for activity limitations and circulatory conditions, as illustrated by Chen et al. in Figures 1 and 2. These figures show that higher education actually has a small but negative effect on the health status of Asians and Hispanics while having a dramatically positive effect on Blacks. Additionally, in Figure 3, Chen et al. show a significant negative effect of education on incidence rates for acute respiratory conditions. There is no significant relationship for the same with regards to Whites or Blacks.

This study shows that there are certainly correlations between race, economic status, and differences in the health status of children in America, but these factors might only be relative. We need to understand if other factors can be identified as causative. In order to explain how Whites and Blacks share correlations while Asians and Hispanics share correlations, we might consider the length of time each population has been exposed to American culture. Whites and Blacks have been in America for over 300 years while Asians and Hispanics have migrated more recently. In addition, there is also evidence of attitude and preference differences for minorities towards health care, though the Institute of Medicine (2002) marginalizes this phenomena in their study.

As a health care provider and regardless of the causes of disparities in health status, it is advisable that I understand these causes so that I may better direct a patient’s care with a holistic understanding of the patient.

References

Chen, E., Martin, A. D., & Matthews, K. A. (2006). Understanding health disparities: The role of race and socioeconomic status in children’s health. American Journal of Public Health, 96, 702-708. doi:10.2105/AJPH.2004.048124

Institute of Medicine. (2002). Unequal treatment: What healthcare providers need to know about racial and ethnic disparities in health. Retrieved from http://www.nap.edu/html/unequal_treatment/reportbrief.pdf

U.S. Department of Health and Human Services. (2000). Healthy people 2010: Understanding and improving health. Washington, DC: Author.

Academia, Emergency Management, Health Care, Public Health, Society

Immunization and Infectious Disease Mitigation

Cultural Models of Immunization and Infectious Disease Mitigation

The members of some communities, such as Puerto Rico, do not understand the scope and severity of some infectious diseases until they become infected (Pérez-Guerra, Zielinski-Gutierrez, Vargas-Torres, & Clark, 2009). The lack of a basic understanding of illness and infection poses a roadblock to mitigating disease transmission within the community. For Pérez-Guerra et al., the perception of severity and mitigation is important as they investigate the difference in attitudes towards dengue infections because dengue cannot be controlled by vaccine and must be mitigated by community participation in mosquito abatement activities. Other infectious diseases, however, can be controlled by vaccine, but efforts to limit infection are met with ignorance or misconceptions (Lau, Griffiths, Choi, & Tsui, 2010; Leask, Sheikh-Mohammed, MacIntyre, Leask, & Wood, 2006).

Public health officials, in concert with community leaders, should seek to educate affected communities about the infectious diseases they face along with effective mitigation strategies and the importance of vaccination, if available. Coreil (2010) describes the importance of cultural models in “[gaining] a deeper understanding of the cultural context of behavior” (p. 83). If behaviors are not understood, then it will be difficult to redirect them. Reaching out to community leaders has the added effect of allowing the leaders to alter the message just enough so that it might be effectively communicated to the community.

Providing a cultural health model allows for a larger scope of audience while effectively tailoring the message so that most of the target audience will appreciate the nature of the message. Approaching health behaviors from a cultural stand-point also offers the advantage of allowing peer support to propagate messages through out the community. This might be especially true when dealing with a multitude of subcultures where the message might better be disseminated via interpersonal means. Eventually, the message will be received by many individuals who will begin to have discussions with others in the community. For communities where individuals are not likely to speak to each other regarding personal health-related matters, the cultural health model allows a general message to reach each individual.

References

Coreil, J. (Ed.). (2010). Social and behavioral foundations of public health (2nd ed.). Thousand Oaks, CA: Sage.

Lau, J. T. F., Griffiths, S., Choi, K. C., & Tsui, H. Y. (2010). Avoidance behaviors and negative psychological responses in the general population in the initial stage of the H1N1 pandemic in Hong Kong. BMC Infectious Diseases, 10(139), 1-13. doi:10.1186/1471-2334-10-139

Leask, J., Sheikh-Mohammed, M., MacIntyre, C. R., Leask, A., & Wood, N. J. (2006). Community perceptions about infectious disease risk posed by new arrivals: A qualitative study. The Medical Journal of Australia, 185(11/12), 591-593. Retrieved from http://www.mja.com.au/public/issues/185_11_041206/lea10999_fm.pdf

Pérez-Guerra, C. L., Zielinski-Gutierrez, E., Vargas-Torres, D., & Clark, G. G. (2009). Community beliefs and practices about dengue in Puerto Rico. Pan American Journal of Public Health, 25(3), 218-226. doi:10.1590/S1020-49892009000300005

Academia, Health Care, Society

Living Longer and Happier Lives

As we age, we tend to question our mortality and how much longer we have left to live. Not that we can do much about this in order to extend our lives by this time, but if we question our health earlier, we may be able to affect positive change in order to have a longer and more productive quality of life. Dan Buettner (National Public Radio [NPR], 2008; TED, 2009) discusses how difficult it can be to control the effects of aging, but he also offers some options based on his observations of what are termed blue zones. Blue zones are geographic and cultural areas of the where people tend to live longer and healthier lives.

Buettner (NPR, 2008; TED, 2009) describes simple measures that can contribute to increasing a productive life. More importantly, he has uncovered what they do not do. The people who live in these blue zones, according to Buettner, do not tend to take daily supplements, pills, or extracts. Instead, continuous and simple movement for exercise coupled with a sensible cultural diet seems to have the biggest impact.

One of the observations that I have made over the years is that as physical movement declines, physical and emotional strength wane. For example, an otherwise healthy 70 year old woman who accidentally falls and breaks her hip decreases her life expectancy drastically unless physical rehabilitation is utilized to regain her activity level (Keene, Parker, & Pryor, 1993; Lyons, 1997). It is vitally important to maintain a healthy level of activity throughout life.

Diet is very important. Buettner (NPR, 2008; TED, 2009) credits adding nuts to the diet for an average increase of three years of life. The way in which our bodies use energy is very important, and we must supply it with a fuel that is efficient. A wholesome diet, I believe, is the best diet, especially if divided by five or more meals a day.

We cannot have a conversation about improving overall health without addressing some of the unhealthy vices that we tend to indulge in. Instead of outlining each and every thing that is detrimental to our health, I will say that moderation should be the way to combat the effects of vices. We need to enjoy life, and I feel that the mere enjoyment leads to a longer and healthier life; therefore, to strictly limit indulgences would seem to be counter-productive. Moderation should certainly be the way in which to address these issues.

We all want to live longer and healthier lives, but genetics does play a role. There are some aspects of our lifestyle that we are finding that we can change for the better, and the alternatives are not that bad. So long as we live healthy lives, we can enjoy life more completely.

References

Keene, G. S., Parker, M. J., & Pryor, G. A. (1993). Mortality and morbidity after hip fractures. British Medical Journal, 307, 1248-1250. doi:10.1136/bmj.307.6914.1248

Lyons, A. R. (1997). Clinical outcomes and treatment of hip fractures. American Journal of Medicine, 103(2), S51-S64. doi:10.1016/S0002-9343(97)90027-9

National Public Radio (Producer). (2008, June 8). Can ‘blue zones’ help turn back the biological clock? [Audio podcast]. Retrieved from http://www.npr.org/templates/story/story.php?storyId=91285403&from=mobile

TED (Producer). (2009, September). Dan Buettner: How to live to be 100+ [Web Video]. Retrieved from http://www.ted.com/talks/dan_buettner_how_to_live_to_be_100.html

Academia, Clinical, Emergency Management, Emergency Medical Services, Health Care, Public Health

Botulism: A Measurement of Occurrence

 Botulism, caused by the Clostridium botulinum bacterium, is typically caused by poorly prepared, home-canned foods and can cause symptoms as simple as blurred or double vision to full body paralysis, sometimes causing death (Centers for Disease Control and Prevention [CDC], 1996). The incidence of botulism is said to be extremely low with only 126 reported cases in the United States in 2003; with only eight attributable to foodborne vectors, the predominant cause is accidental contamination (CDC, 2004).

One of the concerns regarding botulism is its toxicity. Botulinum toxin is the most potent toxin known to man (CDC, 2006). This potency lends to botulinum’s ability to be used as an agent of bioterrorism, though most of the known cases have been shown to be accidental in nature (CDC, 1996; CDC, 2006). Another concern is the accidental or negligent contamination of any food prepared for wide distribution, such as canned vegetables from a large manufacturer.

Surveillance is important to identify each and every case in order to have the most accuracy possible when considering increasing or decreasing trends of incidence and prevalence of the disease. The cause of any increase or decrease in incidence of botulism should always be investigated.

Any increase of incidence could identify a possible problem while a decreased incidence could foretell efficacy in the efforts of mitigation. More appropriately, though, as Friis and Sellers (2009) show, further identification should be made in order to focus on specific descriptive factors, such as affected populations, the geography of these populations, known vectors, and factors of time. This process will ensure that more accurate trends are observed.

For instance, the CDC (2004) has stated that in a typical year, such as 2004, the incidence of botulism is less than 200. With incidence reporting covering the entire United States, increases or decreases in this crude number serve only to identify general changes in frequency; whereas, further identification of certain characteristics of the disease pattern will help to further isolate affected individuals and etiologies (Friis et al., 2009). Within the CDC’s (2004) data, infant occurrence of botulism is identified as the major contributor to incidence, thereby isolating the remaining occurrences to adults. The CDC has gone further to separate the incidences of botulism into three groups, infant occurrence, foodborne infection, and wound infection. A separate group is reserved for other occurrences relating to the use of pharmacological botulin.

Using descriptive factoring of the 2003 CDC data (2004), further geographic isolation of occurrences show that infant occurring botulism is fairly wide-spread with a small number of incidences in each of twenty-two States, though California and Pennsylvania account for about half of the reported infant occurrences. Foodborne and wound occurrences of botulism were isolated to Alaska, California, Colorado, Oregon, Utah, and Washington. Texas had the only two reportable cases classified as “Other”. Theoretical assumptions can now be used to show that the problem in Texas is resolved but should continue to be monitored, and food safety education projects should focus on home-canning in the western regions of the United States.

In conclusion, epidemiology is an important means of understanding and identifying causation and etiology, as well as preparing for mitigation and outbreak response. In this example of botulism, I have identified localization of the disease, common pathways of infection, or vectors, and means of helping to mitigate future occurrences of the disease. Botulism numbers are quite low, but dealing with other diseases of larger scale, grouping the data into useful subsets will assist in following the progression of the disease from outbreak to outbreak and in consideration of mitigation techniques employed.

References

Centers for Disease Control and Prevention, U. S. Department of Health and Human Services. (1996). Botulism (Clostridium botulinum): 1996 case definition [CSTE Position Statement No. 09-ID-29]. Retrieved from http://www.cdc.gov/ncphi/disss/nndss/casedef/botulism_current.htm

Centers for Disease Control and Prevention, U. S. Department of Health and Human Services. (2004). Surveillance for Outbreaks of Botulism [Summary of 2003 Data]. Retrieved from the Centers for Disease Control and Prevention website: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/files/Botulism_CSTE_2003.pdf

Centers for Disease Control and Prevention, U. S. Department of Health and Human Services. (2006). History of Bioterrorism: Botulism. CDC Emergency Preparedness and You [Podcast]. Washington, DC: CDC Bioterrorism Preparedness and Response Program.

Friis, R. H., & Sellers, T. A. (2009). Epidemiology for public health practice (4th ed.). Sudbury, MA: Jones & Bartlett.

Academia, Health Care, Public Health

Health Promotion: Workplace Health Screening

Cardiovascular disease (CVD), diabetes mellitus (DM), and colorectal cancer (CRC) are all significant health concerns facing us today (Anonymous, 2005; Bagai, Parsons, Malone, Fantino, Paszat, & Rabeneck, 2007; de Koning, 2009; Korhonen, Jaatinen, Aarnio, Kantola, & Saaresranta, 2008; Matthews, Nattinger, Venkatesan, & Shaker, 2007). In the U.S., CRC is estimated to kill 56,000 people per year, while, in the U.K., the numbers are around 16,000. (Anonymous, 2005). CVD is on the decline but is expected to continue to have a global impact, taking off the most years of life, and DM creates a 4-fold increase of dying from CVD (de Koenig, 2009).

Through efforts at targeting healthy lifestyle changes, the mortality of these diseases has decreased over the past few years, but the numbers remain high, and studies suggest that identifying those people with risk factors or early signs of disease helps to both treat for the disease effectively and decrease the overall incidence (Anonymous, 2005; Bagai et al., 2007; de Koning, 2009; Matthews et al., 2007).

As Bagai et al. (2007) point out, health promotion activities focused on screening are notably scarce within the workplace. Researchers, Hamashima and Yoshida, have shown that early detection of CRC is effective at decreasing overall morbidity (as cited in Bagai et al., 2009). Bagai et al. attempted to apply this reasoning within the confines of a typical Canadian work environment by introducing CRC screening to the men and women of the Toronto police force. With workplace screening programs being limited in Canada, Bagai et al. hoped to show the effectiveness of these screening programs, and they were successful, but unfortunately, the participation in the study was limited.

Another study (Matthews et al., 2007) aims at increasing CRC screening among the residents of the Midwestern States in the U.S. The literature seems to suggest that participation in screening procedures is contingent on education and insistence by the physician, specifically.

Not only does this correlate to the thought that the primary care physician has an important role in screening and detecting disease, but in order for workplace screening programs to be successful, the physicians need to make the recommendation that the patient uses the screening programs available to him or her.

Korhonen et al. (2008) used the waist circumference criteria (women: 88 cm; men: 102 cm) set forth by the American Heart Association and the National Heart, Lung, and Blood Institute to assess the effectiveness of at-home screening for CVD and DM risk by using a simple questionnaire and a tape measure. Taking very little time and requiring little expertise, this process could be incorporated with any workplace screening program to increase its efficacy.

Increasing these screening programs, particularly within the workplace, should target the population most at risk to CRC, CVD, and DM. Targeting specific risk groups to educate about these diseases should ultimately lead to a higher survivability, decreased incidence, and lower morbidity rates. More research should be aimed at studying the effects of more targeted workplace health screenings to understand how this tool could be best implemented to provide better screening for CVD, DM, CRC, and, perhaps, other pathological processes.

References

Anonymous. (2005). Colorectal cancer: Not an embarrassing problem. Lancet, 366, 521. doi:10.1016/S0140-6736(05)67030-4

Bagai, A., Parsons, K., Malone, B., Fantino, J., Paszat, L., & Rabeneck, L. (2007). Workplace colorectal cancer–screening awareness programs: An adjunct to primary care practice? Journal of Community Health, 32(3), 157-167. doi:10.1007/s10900-006-9042-4

Cyranoski, D. & Williams, R. (2005). Health study sets sights on a million people. Nature, 434, 812. doi:10.1038/434812a

de Koning, H. J. (2009). Testing at home—the screening of the future? European Journal of Public Health, 19(1), 5–6. doi:10.1093/eurpub/ckn120

Geltman, P. L., & Cochran, J. (2005). A private-sector preferred provider network model for public health screening of newly resettled refugees. American Journal of Public Health, 95, 196-199. doi:10.2105/AJPH.2004.040311

Korhonen, P. E., Jaatinen, P. T., Aarnio, P. T., Kantola, I. M., & Saaresranta, T. (2008). Waist circumference home measurement – a device to find out patients in cardiovascular risk. European Journal of Public Health, 19(1), 95–99. doi:10.1093/eurpub/ckn090

Matthews, B. A., Nattinger, A. B., Venkatesan, T., & Shaker, R. (2007). Colorectal cancer screening among Midwestern community-based residents: Indicators of success. Journal of Community Health, 32(2), 103-120. doi:10.1007/s10900-006-9038-0

Smith, G. D., Ebrahim, S., Lewis, S., Hansell, A. L., Palmer, L. J., & Burton, P. R. (2005). Genetic epidemiology 7: Genetic epidemiology and public health: Hope, hype, and future prospects. Lancet, 366, 1484-1498. doi:10.1016/S0140-6736(05)67601-5