introtopublichealth-blog

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Final Post

When I first entered the class, I thought a lot of public health knowledge was more or less common sense: don’t smoke, eat right, work out, etc. However, it is a much more complex field than I had imagined. Policies that may work in one part of the world could have negative affects in other parts of the world due to cultural or religious beliefs. Also, different groups of people have different health issues, and can relate to race, socioeconomic status, education, gender, and a number of other factors. While medicine deals with more patient contact, public health saves more lives in general. I see public health as the “teaching a man to fish” method, giving people the tools and knowledge to live healthier lives. Learning about the long term effects of unhealthy behaviors definitely made me reflect on my own lifestyle choices, which I have tried to improve upon. In the future, I would like to be a part of health research, as I have a strong interest in statistics. The field of epidemiology really interests me and I was happy I was able to learn more about that in this class. By taking a look at mathematical trends, scientists are able to see the sources of health problems, making them easier to tackle.

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Growing Population

As world population continues to grow, natural resources are under increasing pressure, threatening public health and social and economic development. As we humans exploit nature to meet present needs, are we destroying resources needed for the future? Most developed economies currently consume resources much faster than they can regenerate. Most developing countries with rapid population growth face the urgent need to improve living standards but risk irreparable harm to natural resources on which they depend.

Water shortages, soil exhaustion, loss of forests, air and water pollution, and degradation of coastlines afflict many areas. Without practicing sustainable development, humanity faces a deteriorating environment and may even invite ecological disaster.

Sustainable development requires slower population growth. While the rate of population growth has slowed over the past few decades, the absolute number of people continues to increase by about 1 billion every 13 years, and the environment continues to deteriorate. 

Over the past 10 years, environmental conditions generally have either failed to improve or appear to be getting worse, a review of the evidence finds. For the future, how people protect or abuse the environment could largely determine whether living standards improve or deteriorate.

Despite international concern about the environment, nearly every environmental sector is still cause for concern:

o Unclean water, along with poor sanitation, kills over 12 million people a year. Air pollution kills 3 million more.

o In 64 of 105 developing countries, population has grown faster than food supplies. Overcultivation, largely due to population pressures, has degraded some 2 billion hectares of arable land -- an area the size of Canada and the United States.

o By 2025, with world population projected to be at 8 billion, 48 countries containing 3 billion people will face chronic water shortages. In 25 years, humankind could be using over 90 percent of all available freshwater, leaving just 10 percent for the rest of the world's plants and animals.

o Half of all coastline ecosystems are now under pressure because of high population densities and development. About half the world's population occupies a coastal strip 200 kilometers wide -- just 10 percent of the world's land surface.

o Over the past 50 years nearly half of the world's original forest cover has been lost. Current demand for forest products may exceed the limits of sustainable consumption by 25 percent.

o Since 1950, according to one estimate, some 600,000 plant and animal species have disappeared, and currently nearly 40,000 more are threatened. This is the fastest rate of extinction since the dinosaurs disappeared.

o Over the past 40 years ocean surfaces have warmed an average of over half a degree Celsius, mainly as a result of carbon emissions from fossil fuel use and from burning of forests. Global warming could raise the sea level by 1 to 3 meters as polar ice sheets melt, flooding low-lying coastal areas and displacing millions of people. Global warming also could result in droughts and disrupt agriculture.

Governments and policymakers must take immediate steps toward implementing sustainable development. Sustainable development means raising current living standards without destroying the resource base required to meet future needs.

In effect, the world needs to live off its "ecological interest" rather than using up its "ecological capital.” 

Steps toward sustainable development include using energy more efficiently; managing cities better; phasing out subsidies that encourage waste; managing water resources and protecting freshwater sources; harvesting forest products rather than destroying forests; preserving arable land and increasing food production -- a second Green Revolution; managing coastal zones and ocean fisheries; protecting biodiversity hotspots; and adopting a climate change convention among nations.

Stabilizing population through good quality family planning services would buy time to protect natural resources. It would also provide opportunities for women and families to raise their living standards.

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https://www.washingtonpost.com/national/health-science/cdc-gets-list-of-forbidden-words-fetus-transgender-diversity/2017/12/15/f503837a-e1cf-11e7-89e8-edec16379010_story.html?utm_term=.36422ae0c8cb

The Trump administration is prohibiting officials at the nation’s top public health agency from using a list of seven words or phrases — “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based” — in official documents being prepared for next year’s budget. Policy analysts at the Centers for Disease Control and Prevention in Atlanta were told of the list of forbidden words at a meeting Thursday with senior CDC officials who oversee the budget.

The question of how to address such issues as sexual orientation, gender identity and abortion rights — all of which received significant visibility under the Obama administration — has surfaced repeatedly in federal agencies since President Trump took office. Several key departments — including HHS, as well as Justice, Education, and Housing and Urban Development — have changed some federal policies and how they collect government information about lesbian, gay, bisexual and transgender Americans. For example, HHS dropped questions about sexual orientation and gender identity in two surveys of elderly people and has also removed information about LGBT Americans from its website.

The longtime CDC analyst, whose job includes writing descriptions of the CDC’s work for the administration’s annual spending blueprint, could not recall a previous time when words were banned from budget documents because they were considered controversial.

This is a gross misuse of government power. It is clear that the words taken out are to avoid certain topics that President Trump may not want to fund. The fact that this has never been done before is enough to make it scary, and that the words mainly relate to a more liberal health agenda.

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Medical Care and Public Health

10 Key Components of Medical Care 1.   Monitor population health status to identify and solve community health problems.     2.  Diagnose and investigate health problems and health hazards in the community. 3.  Inform and educate people about health issues.   4.  Mobilize community partnerships and action to identify and solve health problems. 5.  Develop policies and plans that support individual and community health efforts.     6.  Enforce laws and regulations that protect health and ensure safety.     7.  Link people to needed personal health services and assure the provision of health care when otherwise unavailable.   8.  Assure competent public and personal health care workforce. 9.  Evaluate effectiveness, accessibility, and quality of personal and population-based health services.   10.Conduct research for new insights and innovative solutions to health problems.

     Medical care involves patients, services, providers, administrators, facilities, assurance/oversight, and governance. The key dimensions of public policy are access to care, coverage/financing, and quality of care/safety.       The patients are the people receiving individual services. These services include primary care, specialty care, subspecialty services, diagnostic services, treatment, mental health, pharmaceutical care, dental, vision, occupational health assessments, physical therapy, rehabilitation, long term care, and end of life care.       The clinical work force includes surgeons, physician assistants, nurse practitioners, RNs, LPNs, aides, dentists, podiatrists, optometrists, chiropractors, naturopaths, pharmacists, physical therapists, nutritionists, psychologists, social workers, case managers, and patient educators.      The average age of nursing workforce is getting older, during the last decade, 20,000 nurses retired per year, after 2020, that number will be 80,000 per year, the supply of nurses is projected to increase after 2020, even so, shortage is forecasted through the Baby Boom years. Administrators include health care executive leaders, administrators, board members, laboratory staff, diagnostic services staff, clerical and patient support staff, facilities staff, food service staff, and consultants.      Facilities include ambulatory care clinics, emergency departments, hospitals, long-term care, community health centers, school-based clinics, family planning clinics, local health departments, retail clinics, mobile vans, and dialysis centers.      Assurance includes accreditation of training programs, licensure, laboratory safety, quality of care protocols and systems, radiation safety standards, FDA: drug regulations, facility safety regulations, and certificate of need laws.      Governance includes executive and administrative leadership, boards of directors/trustees, local, state and federal policy and regulation impact all aspects of the health care system, public policy often intervenes when there are “market failures” or market inefficiencies, negative outcomes, of particular importance is public policy that addresses the “Triple Aim.”

Affordability: prices of services meet clients income and ability to pay Accessibility: location of supply aligns with location of clients or demand Availability: size or volume of the supply meets client’s needs accommodation: delivery of healthcare accommodates client’s needs acceptability: healthcare providers accept all clients regardless of their characteristics

     In 1965, amendment created to the Social Security Act of 1935 (Title XVIII). Provides social insurance for the elderly and disabled, with a nationwide eligibility and benefits. It is a defined benefit plan with no limit to annual spending, covers 55 million people, age 65 and older or under age 65 if disabled by end stage renal disease (kidney failure) or ALS  (Lou Gehrig’s Disease).

     As far as insurance coverage of the population, health insurance is connected with employment and it is still not available to everyone, it is all very political. Additionally, the health care system exacerbates and create social inequities in health. The U.S. spends more on health care than any other nation, yet ranks poorly on most population health measures such as life expectancy, infant and child mortality rates, premature mortality rate, incidence and prevalence rates of specific diseases, suicide, firearms injuries, homicides, and foregoing needed health care because of costs. Many Americans do not receive health care when needed, receive it too late, or receive poor quality care. Pathways to better population health do not generally depend on better health care, yet 95% of health investments in the U.S. are spent on personal health services.

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Maternal and Child Health

Improving the well-being of mothers, infants, and children is an important public health goal for the United States. Their well-being determines the health of the next generation and can help predict future public health challenges for families, communities, and the health care system. The objectives of the Maternal, Infant, and Child Health topic area address a wide range of conditions, health behaviors, and health systems indicators that affect the health, wellness, and quality of life of women, children, and families.

Pregnancy can provide an opportunity to identify existing health risks in women and to prevent future health problems for women and their children. These health risks may include:

Hypertension and heart disease

Diabetes

Depression

Intimate partner violence

Genetic conditions

Sexually transmitted diseases (STDs)

Tobacco, alcohol, and substance use

Inadequate nutrition

Unhealthy weight

The risk of maternal and infant mortality and pregnancy-related complications can be reduced by increasing access to quality preconception (before pregnancy), prenatal (during pregnancy), and interconception (between pregnancies) care. Moreover, healthy birth outcomes and early identification and treatment of developmental delays and disabilities and other health conditions among infants can prevent death or disability and enable children to reach their full potential.

Many factors can affect pregnancy and childbirth, including:

Preconception health status

Age

Access to appropriate preconception, prenatal, and interconception health care

Poverty

Infant and child health are similarly influenced by sociodemographic and behavioral factors, such as education, family income, and breastfeeding, but are also linked to the physical and mental health of parents and caregivers.

There are racial and ethnic disparities in mortality and morbidity for mothers and children; in particular, maternal and infant mortality and morbidity are highest for African Americans. These differences are likely the result of many factors.

Conditions in the places where people live, learn, work, and play affect a wide range of health risks and outcomes. Environmental and social factors such as access to health care and early intervention services, educational, employment, and economic opportunities, social support, and availability of resources to meet daily needs influence maternal health behaviors and health status

The determinants that influence maternal health also affect pregnancy outcomes and infant and child health. Racial and ethnic disparities exist in infant mortality and can be partly attributed to disparities in social determinants of health. Child health status varies by both race and ethnicity, as well as by family income and related factors, including educational attainment among household members and health insurance coverage. Child health status and well-being can also be influenced by access to high-quality health care, such as that received through a medical home and maternity care practices that promote breastfeeding and safe sleep environments.

The cognitive and physical development of infants and children may be influenced by the health, nutrition, and behaviors of their mothers during pregnancy and early childhood. Consumption of recommended amounts of folic acid before and during pregnancy can reduce the risk for neural tube defects. Breast milk is widely acknowledged to be the most complete form of nutrition for most infants, with a range of benefits for their health, growth, immunity, and development. Furthermore, children reared in safe and nurturing families and neighborhoods, free from maltreatment and other adverse childhood experiences, are more likely to have better outcomes as adults.

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Nutrition with a Focus on Early Development

This semester I volunteered at a preschool where I had the opportunity to learn about nutrition and health of preschoolers. This relates to the community level of the ecological model, as preschools can influence healthy behaviors. 

Good nutrition is essential for survival, physical growth, mental development, performance, productivity, health and well-being across the entire life-span: from the earliest stages of fetal development, at birth, and through infancy, childhood, adolescence and on into adulthood. Food insecurity is a household-level economic and social condition of limited or uncertain access to adequate food (Coleman-Jensen, Gregory, & Rabbitt, 2017). Globally, food insecurity is associated with micronutrient deficiencies, and an estimated 4.5 billion people worldwide are affected by some form of nutrient deficiency, the most vulnerable group being young children (Coleman-Jensen, Gregory, & Rabbitt, 2017). Nutrition in preschoolers is extremely important because this is a critical developmental stage. At my site, the Foundations Preschool, the families are mainly low-income, which are the families that may not have access to the money to buy nutritious foods.

Preschools such as the Foundations Preschool have the opportunity to greatly improve the nutrition of preschoolers through various means, as child-care settings provide time “to promote healthy eating and physical activity behaviors” (“Preventing Obesity,” 2011). While Foundations is able to provide breakfast, lunch, and snacks to its students, I think it would be extremely beneficial for the school to have adequate funding for sack dinners for children that need them. No child should have to go to bed hungry. Additionally, to help parents or other family members, community centers could hold food drives and then have the food available to struggling families. Community centers could also be a place to host dinners for eligible families. With the intense stress of financial difficulties, it can be hard for families to prioritize health and nutrition. Many families will turn to fast food and other cheap fixes, leading to issues with diabetes and obesity. Low-income children are nearly twice as likely to become obese than are middle and upper income children (Miller, 2013). If parents and teachers are able to start their preschoolers young with eating right and getting physical activity, then they will become accustomed to it and develop healthy habits for the rest of their lives. While some may say it is possible for any person to lead a healthy lifestyle, it is substantially more difficult for those in poverty because “low-income families generally have less access to both healthy food choices and opportunities for physical activity” (CDC, n.d.). Affluent families can afford to have their children participate in extracurricular sports activities that keep them active and social, which those in poverty do not have access to. Preschools of low-income families can help decrease this discrepancy by getting children outside and running around, helping them reach their daily activity goals. Also, sports could be introduced at this age, which helps build teamwork and camaraderie, as well as physical motor skills.

The help of several outside parties would be crucial to health and nutrition improvements in low income preschoolers as well as their families. The government could help motivate schools and community centers to implement programs by offering funding and other monetary incentives. More affluent community members could be motivated to donate food or money to schools and community centers by a sense of community and good will. I could work with organizations to raise awareness of the issues low-income children face when it comes to nutrition, through ads or other promotions. These could feature statistics about children’s health and development. Also, preschools could raise money by reaching out to local stores and having the “round up for charity” program go towards healthy food for their children. In terms of stigmatization, sack dinners could be potentially stigmatizing in schools because it may target some children as being lower income, but it would likely not be a problem in schools where a majority of the kids need sack dinners. Parents and family members may also feel a stigma when going to community centers to get food or dinners, or disappointed that they cannot provide for themselves. This could be prevented by ensuring supportive people are working there, and because all of the families there will be struggling, they will understand each other.

Working with the children at site gave me personal examples of struggling families and helped me put faces to the cause. All of the children are so fun and each have such individual spirits that deserve to be nourished properly. I have a special interest in public health, and health issues relating to proper nutrition and diet are extremely serious, especially among American children. The class helped me to understand and see the severe differences in health outcomes for high income children and low income children. Children do not get to pick the families they are born into, and they are certainly not given equal opportunities. People must work on the individual, interpersonal, community, and societal levels in order to improve the health and therefore the overall well being of low income children and their families.

References Center for Disease Control. Obesity among low-income preschool children. Coleman-Jensen, A., Gregory, C. A. & Rabbitt, M. P. (2017). Definitions of food security  . Retrieved November 25, 2017, from https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security/ Miller, A. (2013). Self-regulation. Children's Nutrition, Robert Wood Johnson Foundation. (2011). Preventing obesity among preschool children: How can child-care settings promote healthy eating and physical activity.

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Food Safety

Key facts

Access to sufficient amounts of safe and nutritious food is key to sustaining life and promoting good health.

Unsafe food containing harmful bacteria, viruses, parasites or chemical substances, causes more than 200 diseases – ranging from diarrhoea to cancers.

An estimated 600 million – almost 1 in 10 people in the world – fall ill after eating contaminated food and 420 000 die every year, resulting in the loss of 33 million healthy life years (DALYs).

Children under 5 years of age carry 40% of the foodborne disease burden, with 125 000 deaths every year.

Diarrhoeal diseases are the most common illnesses resulting from the consumption of contaminated food, causing 550 million people to fall ill and 230 000 deaths every year.

Food safety, nutrition and food security are inextricably linked. Unsafe food creates a vicious cycle of disease and malnutrition, particularly affecting infants, young children, elderly and the sick.

Foodborne diseases impede socioeconomic development by straining health care systems, and harming national economies, tourism and trade.

Food supply chains now cross multiple national borders. Good collaboration between governments, producers and consumers helps ensure food safety.

     Foodborne illnesses are usually infectious or toxic in nature and caused by bacteria, viruses, parasites or chemical substances entering the body through contaminated food or water. Foodborne pathogens can cause severe diarrhoea or debilitating infections including meningitis. Chemical contamination can lead to acute poisoning or long-term diseases, such as cancer. Foodborne diseases may lead to long-lasting disability and death. Examples of unsafe food include uncooked foods of animal origin, fruits and vegetables contaminated with faeces, and raw shellfish containing marine biotoxins.

     The burden of foodborne diseases to public health and welfare and to economy has often been underestimated due to underreporting and difficulty to establish causal relationships between food contamination and resulting illness or death.

     Safe food supplies support national economies, trade and tourism, contribute to food and nutrition security, and underpin sustainable development. Urbanization and changes in consumer habits, including travel, have increased the number of people buying and eating food prepared in public places. Globalization has triggered growing consumer demand for a wider variety of foods, resulting in an increasingly complex and longer global food chain. As the world’s population grows, the intensification and industrialization of agriculture and animal production to meet increasing demand for food creates both opportunities and challenges for food safety. Climate change is also predicted to impact food safety, where temperature changes modify food safety risks associated with food production, storage and distribution.     

     These challenges put greater responsibility on food producers and handlers to ensure food safety. Local incidents can quickly evolve into international emergencies due to the speed and range of product distribution. Serious foodborne disease outbreaks have occurred on every continent in the past decade, often amplified by globalized trade.

Thought and Conclusions

      Unsafe food poses global health threats, endangering everyone. Governments should make food safety a public health priority, as they play a pivotal role in developing policies and regulatory frameworks, establishing and implementing effective food safety systems that ensure that food producers and suppliers along the whole food chain operate responsibly and supply safe food to consumers.Food can become contaminated at any point of production and distribution, and the primary responsibility lies with food producers. However, a large proportion of food safety incidents are caused at the home or in markets. The population must be educated in the the roles they play, such as adopting basic hygienic practices when buying, selling and preparing food to protect their health and that of the wider community.

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https://www.wgrz.com/article/news/health/flu-virus-spreading-in-ny-prompting-public-health-alert/71-499229483

The flu virus has spread among hundreds of New Yorkers statewide recently, prompting health officials to require unvaccinated health care workers to wear surgical masks. The flu warning comes as 1,820 laboratory-confirmed cases of influenza have hit 54 out of 62 counties and all boroughs of New York City, state data show. There have been 612 flu-related hospitalizations reported and no pediatric deaths.

Public health officials this week urged New Yorkers to get vaccinated to combat the virus, which has arrived early to North America this year. Experts are predicting this may be a particularity bad flu season as the cases piled up before the traditional peak. Many might think of the flu as a temporary setback and inconvenience that comes with the territory during the late fall and winter months, but the reality is that it can be a very dangerous disease. In New York, there were 19 pediatric influenza deaths over the past three seasons and nearly 11,200 flu-related hospitalizations each season.Most health insurance plans cover influenza vaccines. Individuals and families without health insurance should check with their county health department to find out if local clinics will be held to provide free or low-cost vaccinations. Those 18 years of age and older may also be able to get their influenza vaccine at a local pharmacy. State health officials recommend that everyone six months of age or older receive an influenza vaccination.

It is clear that the flu vaccine is very important, and should possibly be mandated. It is a contagious disease, which poses a threat to many people. The vaccine makes it preventable, which can allow people to get through the season without their life being put on hold by health issues.

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https://www.hsph.harvard.edu/news/press-releases/childhood-obesity-risk-as-adults/

If current trends in child obesity continue, more than 57% of today’s children in the U.S. will have obesity at age 35, according to a new study from Harvard T.H. Chan School of Public Health. The study also found that excess weight in childhood is predictive of adult obesity, even among young children. The researchers used new computational methods and a novel statistical approach to account for long-term population-level trends in weight gain. They pooled height and weight data from five nationally representative longitudinal studies of 41,567 children and adults. Using these data, they created 1,000 virtual populations of 1 million children up to age 19 that were representative of the 2016 U.S. population. They then projected height and weight trajectories from childhood to age 35. The results showed that obesity will be a significant problem for most children in the U.S. as they grow older. For example, the study found that 3 out of 4 two-year-olds with obesity will still have obesity at age 35.Also, even children without obesity face a high risk of adult obesity. The study estimated that for youth ages 2-19 in 2016, over half will have obesity at age 35—and that most of these youth do not currently have obesity.

It is clear that the government must implement policies and programs to prevent excess weight gain, starting at an early age. Plenty of cost-effective strategies have been identified that promote healthy foods, beverages, and physical activity within school and community settings.

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Aging

At present, 8% of the world population is over 65 years of age, and this percentage is expected to increase to 20% in 20 years, with many of these people being older than 80. For example, it is estimated that in Italy there will be more than one million people over 90 in the year 2024 and, in China, it is estimated that 330 million people will be older than 65 and 100 million will be older than 80 in 2050. 

The demographic determinants of the aging population are lower fertility rates during the past decades owing to multiple causes, reduction in mortality due to longer life expectancy, and migration, though to a lesser degree.

Aging and medicine

Increasingly, partly as a result of advancements in the treatment of chronic diseases, surgery or interventional procedures for conditions that were managed with palliation in the past or whose causes were not understood, and also as a result of new medications, people are living longer.

Aging of the population is a challenge for medicine because of the growing number of elderly patients and their many implications: comorbidities, better defined in this group as multi-morbidities, many of them very costly, as is the case of cardiovascular diseases, cancer, chronic renal disease and diabetes, and their respective complications due to the time when chronic diseases are diagnosed. Moreover, elderly patients have limited physiological reserve and many of them are frail and deconditioned, especially when they are in their eighties. This results in higher pharmaceutical costs for the control of diseases that cannot be cured, and also creates a risk of worsening of adverse effects and a faster course to disability and dependence.

The elderly and public health

In healthcare, primary care of patients with chronic diseases must be emphasized, followed by the multidisciplinary approach to the elderly patient, education for the prevention of abuse against the elderly, its diagnosis and reporting. Priority must also be given to the creation of mental health centers for the elderly, and to the establishment of top-quality, cost-effective acute care models for patients at home and in the hospital. This will require the involvement of scientific societies and training of staff in geriatrics, starting with undergraduate students with a longer exposure to the study of this discipline, and the promotion of geriatric subspecialties. All this requires the participation of the political and economic sectors that must be made to understand the importance of looking for adequate care solutions for the elderly, with their positive implications for the health and quality of life for people in this age group.

In June 2005, during the XVIII World Congress on Gerontology in Rio de Janeiro, the project on Friendly cities: a guideline by the WHO was presented. With the participation in the research of 33 cities of all the continents, the project defined a friendly city for the elderly as the one that ‘encourages active aging through the optimization of opportunities for health, participation and safety in order to improve the quality of life of people as they age’ and proposed, among several things, the creation of a clean and pleasant environment, the importance of green areas and of level, non-slippery surfaces, priority for pedestrians, emphasis on safety, construction of friendly buildings with adequate stairways, ramps, elevators and signaling, and urban transportation with special rates and preferential seating for the elderly. Implementation of these guidelines requires the participation of the public and private sectors, because they are considered part of the health policy; moreover, the elderly population comprises more vulnerable groups such as old people living in rural areas, indigenous populations and women, who must also be the focus of care. Consequently, policies must provide for monitoring of the quality of life of the elderly, using indicators that show the progress achieved in their implementation in the different regions.

The goal is to prevent complications and help the elderly retain their independence for activities of daily living, in particular self-care, and to help them function; otherwise care for the elderly would require more spending and/or time from the economically active population. The goal is to reach old age in the best possible health, delaying the onset of disability, with a focus on quality, dignity and wellness, rather than on number of years.

Aging should not be considered a problem of unmanageable size, because it should be the result of achievements in better mother and child care, and conditions that help enhance life expectancy from birth.

All of the above points to the fact that our approach to aging must be holistic, with policies directed to the comprehensive care of this population. This approach should change the paradigm that the elderly are disabled and incapable of contributing to cultural and society, and should focus on creating a self-sustainable society that can guarantee a life of quality for its elderly people.

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https://nacla.org/news/2017/11/29/cuba’s-hiv-sanatoriums-prisons-or-public-health-tool

From 1986 until 1994, Cuba quarantined people living with HIV in medical facilities called sanatorios, or sanatoriums. Though tuberculosis sanatoriums were common throughout the world during the late nineteenth and early twentieth centuries, Cuba was the only country to open such institutions in response to HIV. It was a controversial public health approach that drew fascination and criticism from U.S. and other commentators. Freedom of movement, human rights advocates proclaimed, was fundamental to ethical governance. Therefore, isolation was dehumanizing, and ultimately stigmatized the communities most at-risk for infection.

However, advocates have pointed to the success of containment as a public health tool and the high standard of living provided to those residing in the sanatoriums. Many patients refused to leave the sanatoriums once they became voluntary in 1994. At the time of the policy change, they told reporters “we have many friends, we feel useful, we keep busy.”  Not only were the sanatoriums places where medical services and scientific research could be concentrated in the face of a global epidemic, they served as a community for many despite the hardship of isolation. The sanatoriums made sense to the Cuban government in a society committed to universal healthcare and the prioritization of the collective good over individual agency. Some people even willingly infected themselves to access the comforts of the sanatoriums, unaware of the ramifications of HIV.

It is unclear weather the sanitariums were a good or bad idea at the time. At first thought, I immediately jumped to the conclusion that they were unethical. However, after reading the article I see both sides and why they were created. Especially because people wanted to stay.

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Health Disparities in LGBT People

Research suggests that LGBT individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights. Discrimination against LGBT persons has been associated with high rates of psychiatric disorders, substance abuse, and suicide. Experiences of violence and victimization are frequent for LGBT individuals, and have long-lasting effects on the individual and the community. Personal, family, and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBT individuals.

Eliminating LGBT health disparities and enhancing efforts to improve LGBT health are necessary to ensure that LGBT individuals can lead long, healthy lives. The many benefits of addressing health concerns and reducing disparities include reductions in disease transmission and progression, increased mental and physical well-being, reduced health care costs, and increased longevity.

Understanding LGBT health starts with understanding the history of oppression and discrimination that these communities have faced. For example, in part because bars and clubs were often the only safe places where LGBT individuals could gather, alcohol abuse has been an ongoing problem.Social determinants affecting the health of LGBT individuals largely relate to oppression and discrimination. Examples include:

Legal discrimination in access to health insurance, employment, housing, marriage, adoption, and retirement benefits

Lack of laws protecting against bullying in schools

Lack of social programs targeted to and/or appropriate for LGBT youth, adults, and elders

Shortage of health care providers who are knowledgeable and culturally competent in LGBT health

The physical environment that contributes to healthy LGBT individuals includes:

Safe schools, neighborhoods, and housing

Access to recreational facilities and activities

Availability of safe meeting places

Access to health services

The need for more research to document, understand, and address the environmental factors that contribute to health disparities in the LGBT community is very important. As part of this work, we need to increase the number of nationally-representative health-related surveys that collect information on sexual orientation and gender identity. No longer can the LGBT community be affected by such serious health detriments, especially when it comes to the lives of young people. Discrimination in a health care setting is extremely toxic, and could cost the lives of many. 

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https://www.kff.org/other/issue-brief/public-health-in-puerto-rico-after-hurricane-maria/

Public Health in Puerto Rico after Hurricane Maria

On September 20, 2017, Hurricane Maria made landfall in Puerto Rico. A “Category 4” storm when it hit the island, Maria was the strongest hurricane to hit Puerto Rico in almost a century, and it caused significant, widespread damage. The total number of people who died due to Hurricane Maria is unknown; as of November 4, officials have confirmed 55 deaths from the storm on the island, but the death toll is feared to be much higher.

Hurricanes can have serious health impacts. Immediate/Short-term impacts include physical injury or death, and drowning. Medium and long term impacts include limited access to food and safe water, contamination of water and food sources from waste, debris, and other pollution, disruption of services at hospitals, clinics, and other care facilities, reduced ability to access health care, medicines or other essential health items, increased risk from infectious diseases due to lack of safe water, adequate hygiene, and sanitation, growing burden from unaddressed chronic disease care needs, such as cancer and diabetes, and mental health issues including stress, depression and suicide. 

The article mentions health impacts in food/water/sanitation, health care infrastructure, other infectious diseases, and mental health. 

Given the state of emergency on the island and the fact that many basic services are still not fully functioning, the full impact of the Hurricane on public health is difficult to assess. What is clear is that even before Hurricane Maria struck Puerto Rico, the island faced a host of economic and public health concerns, and that the storm exacerbated many of these challenges while introducing new ones. Concerns may change over time as the immediate crisis response transitions to recovery, and additional health issues may manifest over the longer-term. Ultimately, the public health toll from the storm on the people of Puerto Rico will depend on a number of factors including the level and effectiveness of external support, and continued attention to and funding for response and recovery from policymakers now and going forward.

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Mental Health

The burden of mental illness in the United States is among the highest of all diseases, and mental disorders are among the most common causes of disability. Recent figures suggest that, in 2004, approximately 1 in 4 adults in the United States had a mental health disorder in the past year—most commonly anxiety or depression—and 1 in 17 had a serious mental illness. Mental health disorders also affect children and adolescents at an increasingly alarming rate; in 2010, 1 in 5 children in the United States had a mental health disorder, most commonly attention deficit hyperactivity disorder (ADHD). It is not unusual for either adults or children to have more than one mental health disorder.

Mental health is essential to a person’s well-being, healthy family and interpersonal relationships, and the ability to live a full and productive life. People, including children and adolescents, with untreated mental health disorders are at high risk for many unhealthy and unsafe behaviors, including alcohol or drug abuse, violent or self-destructive behavior, and suicide—the 11th leading cause of death in the United States for all age groups and the second leading cause of death among people age 25 to 34.

Mental health disorders also have a serious impact on physical health and are associated with the prevalence, progression, and outcome of some of today’s most pressing chronic diseases, including diabetes, heart disease, and cancer. Mental health disorders can have harmful and long-lasting effects—including high psychosocial and economic costs—not only for people living with the disorder, but also for their families, schools, workplaces, and communities.

Fortunately, a number of mental health disorders can be treated effectively, and prevention of mental health disorders is a growing area of research and practice. Early diagnosis and treatment can decrease the disease burden of mental health disorders as well as associated chronic diseases. Assessing and addressing mental health remains important to ensure that all Americans lead longer, healthier lives.

In discussion, we talked about mental health with a focus on college students. College students are extremely vulnerable to mental health issues because of their high stress lives and moving away from home. We came up with different intervention ideas for Universities to implement, such as more mental health awareness at presentations given to incoming and new students. Early intervention is crucial, because talking about mental health also helps lower the social stigma, encouraging more people to be open about their health. 

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She Took On Colombia’s Soda Industry. Then She Was Silenced. 

Dr. Esperanza Cerón is the head of the organization Educar Consumidores, which is a proponent of a proposed 20 percent tax on sugary drinks that was heading for a vote that month in Colombia’s Legislature. The group had raised money, rallied allies to the cause and produced a provocative television ad that warned consumers how sugar-laden beverages can lead to obesity and diet-related illnesses like diabetes. Though the WHO cites a sugar tax to be the most effective policy tools for cutting consumption of what nutritionists call a “liquid candy,” the soda industry and businesses hurt by the tax create fierce backlash. A Colombian government agency, responding to a complaint by the nation’s leading soda company that called the ad misleading, ordered it off the air. Then the agency went further: It prohibited Dr. Cerón and her colleagues from publicly discussing the health risks of sugar, under penalty of a $250,000 fine. Also, Dr. Esperanza Cerón had two strange men on motorcycles follow her home, and basically threaten her with death if she did not stop sharing the health knowledge. Dr. Cerón and her team got a Pyrrhic victory two weeks ago when the country’s Constitutional Court overturned the consumer agency’s decision to silence Educar and ordered the agency to “abstain from censoring any other ad related to public health in the future,” according to the ruling. Postobón, a large soda company in the country, created a new drink “Kufu” which is a mango flavored beverage that they are advertising with public health benefits. However, the drink contains 13 grams of sugar, more than half the daily recommended level for children.

This article is important because it highlights a few really interesting ideas. The battle between health and freedom is a big part of the issue, and shows that the fight is not exclusive to America “land of the free.” Also, the battle between science and business/government is highlighted, and is extreme because the woman was threatened and harassed over her sharing of knowledge. Adittionally, the response from Postobón is troubling because it shows the use of health as merely advertisement. Their drink still has extreme amounts of sugar, but if they label it as healthy, many people will still buy and drink it, thinking they are at lower risk than if they were drinking soda.

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Tobacco and Health 

When our parents were young, people could buy cigarettes and smoke pretty much anywhere. Ads for cigarettes were all over the place. Today we're more aware about how bad smoking is for our health. Smoking is restricted or banned in almost all public places and cigarette companies are no longer allowed to advertise on TV, radio, and in many magazines.

Almost everyone knows that smoking causes cancer, emphysema, and heart disease; that it can shorten your life by 10 years or more; and that the habit can cost a smoker thousands of dollars a year. So how come people are still lighting up? The answer, in a word, is addiction.

Smoking is a hard habit to break because tobacco contains nicotine, which is highly addictive. Like heroin or other addictive drugs, the body and mind quickly become so used to the nicotine in cigarettes that a person needs to have it just to feel normal.

People start smoking for a variety of different reasons. Some think it looks cool. Others start because their family members or friends smoke. Statistics show that about 9 out of 10 tobacco users start before they're 18 years old. Most adults who started smoking in their teens never expected to become addicted. That's why people say it's just so much easier to not start smoking at all.

It's not only cigarettes that get people dependent on tobacco. Hookah are water pipes used to smoke tobacco through a hose with a tapered mouthpiece. There's a myth going around that hookahs are safer because the smoke is cooled when it passes through the water. Experts say hookahs are no safer than cigarettes — and since they don't have filters and people often use them for long periods, the health risks might be even greater. Hookahs are usually shared, so there's the additional risk from germs being passed around along with the pipe.

Also beware of electronic cigarettes (e-cigarettes), which contain cancer-causing chemicals and other toxins, including a compound used in antifreeze. These battery-operated devices use cartridges filled with nicotine, flavorings, and other chemicals and convert them into a vapor that's inhaled by the user.

Hookahs and e-cigarettes that are sold will need to be approved by the FDA, and companies will need to post health warnings so that people know their risks. But one thing is still certain: there's no such thing as a "safe" nicotine product.

The consequences of this poisoning happen gradually. Over the long term, smoking leads people to develop health problems like heart disease, stroke, emphysema (breakdown of lung tissue), and many types of cancer — including lung, throat, stomach, and bladder cancer. People who smoke can develop skin problems like psoriasis (a type of rash), and are more likely to get wrinkles. Also, they have an increased risk of infections like bronchitis and pneumonia.Many of these diseases limit a person's ability to be normally active, and they can be fatal. In the United States, smoking is responsible for about 1 out of 5 deaths.Smokers not only develop wrinkles and yellow teeth, they also lose bone density, which increases their risk of osteoporosis, a condition that causes older people to become bent over and their bones to break more easily. Smokers also tend to be less active than nonsmokers because smoking affects lung power.

In discussion, we emphasized that tobacco is extremely negative for your health. We also discussed how advertising for big tobacco in older times is very similar to advertising for big food today. They both manipulate the emotions of consumers and try to down play the health risks. Both are addictive, obviously nicotine more so, and both disproportionately affect those in poverty. The ecological model was also used to showcase different factors that can affect a persons life choices and resulting health outcomes. 

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Affordable Care Act

      The Patient Protection and Affordable Care Act (PPACA) 2010 HR3590, or Affordable Care Act (ACA) for short, is the health care reform law in America and is often called by its nickname Obamacare. The Patient Protection and Affordable Care Act is made up of the Affordable Health Care for America Act, the Patient Protection Act, and the health care-related sections of the Health Care and Education Reconciliation Act and the Student Aid and Fiscal Responsibility Act. It also includes amendments to other laws like the Food, Drug, and Cosmetics Act and the Health and Public Services Act. Since being signed into law, additional rules and regulations have expanded upon the law.

     The Affordable Care Act helps to reform the healthcare system by giving more Americans access to quality, affordable health insurance, and helps to curb the growth of healthcare spending in the U.S. All Americans with health insurance have access to some new benefits, rights, and protections, which ensure that they can get treatment when they need it. The ACA protects consumers from some of the worse abuses of the health care and insurance industries. It makes insurance more affordable by reducing premium and out-of-pocket costs for tens of millions of families and small business owners who had been priced out of coverage in the past. Also, the law spreads risk equally to all insured to end discrimination. In the past, you could be discriminated against based on gender or health status. Costs could differ wildly due to factors like age. The ACA limits discrepancies in what you can be charged, and to do this, it required that all Americans who can afford to maintain “Minimum Essential Coverage” began maintaining it in 2014. Many who can’t afford coverage were exempt from the requirement to maintain coverage. It set up a new competitive health insurance marketplace  (healthcare.gov) giving tens of millions of Americans access to group buying power and allowing them to compare plans and receive cost assistance. 

     I think the affordable care act is extremely important and I’m sad to see it attacked by the current government. Nobody asks to be sick, and all people are equally deserving of the opportunity to be healthy. This is a serious social justice move because many of the people previously uninsured were minorities. The act helps, but inequalities in health care are still prominent in the United States.