Thursday, February 21, 2013

Blog Assignment 4 - US Health Care

Health care is one of the most popular topics in the United States today. For this week’s blog assignment, we watched the documentary “US Health Care: The Good News”. This documentary examines an array of health care systems around the world and reports the their positives, negatives and differences between each system.

The Dartmouth Atlas Project started in 1973. At that time, researchers studied different towns in Vermont in order to track differences in treatment and cost. In Vermont, the researcher wanted to study the places that were not getting enough medical care. Instead of under service, they found extreme variation. In more recent studies with this project, researchers studied Medicare billing records. This resulting in the same findings in Vermont in 1973, which were huge variations in treatment and spending.

Access to health care is a very important concept in the world. Is it a right or a privilege to have this access? Personally, I believe that access to health care is more of a right than a privilege. There are many different factors that prevent Americans from getting health care and insurance, however, many Americans cannot help these factors. For example, a person does not usually choose to get cancer, but unfortunately it can happen. This person might or might not get the adequate health care for various operations to fight the cancer. This person could not receive the health care due to a preexisting condition or some other cause. One of the biggest reasons why I think everyone should have access to health care is the fact that the healthier a population is, the more productive a society will be. If every American had access to quality, affordable health care coverage, the whole nation would benefit from it. Another basic reason is that a nation could save a lot of money in the long run if every citizen had access to its health care. There will always be the problem of people abusing their right to health care, but it would be worse to have everyone earn it when there are many outlying factors that could prevent someone from getting the same access to health care.

This documentary visited various places in the United States and reviewed their health care systems. The first stop was Grand Junction, Colorado. This spot is thought to be the best medical system of them all, being a model for health care delivery. Here, doctors decided to take care of everyone in the town and get paid the same fee for the same treatment regardless of if the patient was rich or poor. In addition, a small portion of each doctor’s payment is withheld until the end of the year and then gets distributed based on the doctor’s overall performance. This system is interesting because there was little objection. The next stop, Seattle, Washington, had an innovation called coops, which was businesses being owned by their customers. In Seattle, the medical system that was examined was a corporation that was big on using technology to communicate with their patients. Doctors would use emails to treat their patients, and would increase face-to-face time with the patient when the latter would physically come into the office for a visit. I thought this was interesting because many medical systems today use technology for records, communication and more, but this corporation was astounded at how well the technology worked for them. The third place, Everett, Washington, had a system where the doctors owned the clinic. This stop was big on controlling the costs of health care and trying to reduce or even eliminate unneeded tests. This, in turn, would lower the cost of care for patients. I thought this place was intriguing because it was able to eliminate pharmaceutical representatives and samples, and actually lower the costs for patients overtime. Finally, the documentary stops near Dartmouth College to examine Hitchcock Medical Center. This center emphasizes patient involvement in treatment choices. By giving the patients more of a say in their treatments, this system was more successful because there were less surgeries and less unnecessary tests that saved a lot of money.

I believe that the way medical care is delivered in the places visited in this documentary can certainly be duplicated in the area I am from. One of the main reasons why I think this is because using modern technology in a medical system was proven to be more efficient, as shown in the documentary. This is an easy innovation to implement in modern medical systems and a good way to improve efficiency and reduce costs. However, it is essential to have strong leadership and commitment within the community for these programs to be effective, and these are some things that not every city has. There could be multiple reasons why the area that I am from has not implemented these elements into the medical system yet. Everyone, doctors, hospitals, physicians and insurance companies, must all be on board and cooperate together for the system to be successful.

Saturday, February 16, 2013

Blog Assignment 3 - Vaccine Wars

For this week’s blog assignment, we watched the Frontline Special “Vaccine Wars” which outlines the debate over vaccines in our world today. The video begins by showing various cases where vaccines have been linked to having serious side effects. One of the biggest side effects studied from vaccinations was autism. Through various interviews of normal, everyday people, this video effectively shows both sides of this debate over having a choice with vaccinations.

This video did influence the way I think about vaccinations. Before watching, I did not know that there was such a controversy over the issue. I also was unaware that vaccines could have the various side effects as big as autism. I was under the impression that everyone gets vaccines without question because they will keep you healthy. However, after watching this video, it is clearer why some people may object to getting some vaccines due to the side effects.

As explained in the video, herd immunity is the idea that when a group of people in a population is vaccinated against a disease, it will provide protection for other people in the population who are not vaccinated. This term is very important in the public health world today. When the small group of people is vaccinated, other people who live in the same area as that group may not have to worry as much about contracting the disease. That is to say, the risk of contracting the contagious disease becomes much lower because of the idea of herd immunity.

Vaccination can be different from other types of personal health decisions because it starts right at infancy. As explained in the video, newborns begin getting vaccines almost right after they are born. Because of this, parents and doctors are the ones who decide which vaccinations, if any, a child should get. Infants and children are incapable of making these decisions for themselves, so it is up to their parents more often than not to make the decisions for them.

There are many different reasons why children might not receive the recommended vaccinations. It is clear from the video that many parents wish that their children have a sort of natural lifestyle so they choose to skip some vaccinations. Another reason could be that a certain disease, like polio, is not prevalent in our world anymore. In this case, many parents do not have their children get that vaccination because they see no point to it. One of the biggest reasons, which is clear after watching this video, is that parents fear the side effects related to these vaccinations, so they opt out of having their children get the vaccines.

As a public health policymaker, I would make it a main goal to increase vaccination rates. One way I would do this would be by educating the public about vaccinations and showing them the many benefits. It is true that there can be risks with the various vaccinations out in the world, but I would be sure to show that the benefits immensely outweigh the risks. I would use specific data, statistics and results in order to prove my point in this situation that overall vaccines would benefit the population of the world more than harm it.

Friday, February 8, 2013

Blog Assignment 2 - Smoking and Lung Cancer

This week’s blog assignment, we read an article by Takeshi Hirayama titled Non-smoking Wives of Heavy Smokers Have A Higher Risk of Lung Cancer: A Study From Japan. It outlines the relationship between smoking and lung cancer, dealing with second hand smoke in particular. The experiment studied non-smoking women aged 40 and above and their risk of developing lung cancer based on their husbands’ smoking habits. These adults were followed by “establishing a record linkage system between the risk-factor records, a residence list obtained by yearly census, and death certificates”. Not so surprisingly, the results of the experiment were that the wives of heavy smokers were more at risk of getting lung cancer than wives of non-smokers and that this relationship was significant in agricultural families. The alcohol drinking habits of these husbands proved to have no effect on the wives developing lung cancer. Finally, the article talks about passive smoking versus direct smoking and their effects. The experiment showed that there was a significant relation between how much the husbands smoked and the death of their wives from lung cancer. In addition, the study proved that the effects of passive smoking were one half to one third of direct smoking.

I found it interesting that the study looked at alcohol consumption habits of the husbands as well and compared the results with the smoking habits. It seems that the results would clearly not be similar to each other because the two habits are very different when it comes to affecting the wife’s risk to getting lung cancer. However, it is possible that using the results from the husband’s alcohol consumption habits clearly support and help prove the claim that smoking habits of the husband affect his wife’s risk of developing lung cancer the most.

In this experiment, thousands of adults, 40 years of age or younger, were followed by various methods. The study followed these adults “by establishing a record linkage system between the risk-factor records, a residence list obtained by special yearly census, and death certificates” (183). By designing the study in this way, the leaders of the experiment are able to set their own parameters and change it up when needed. In addition, the experiment divided up the different variables, which made it easier to see the obvious differences in results. With the variables separated, it is less likely to have conflicting variables, meaning that the variables would not affect each other in the experiment.

The results of this study clearly support second-hand smoke as a cause of lung cancer. When comparing husbands’ smoking habits with the risk of developing lung cancer in their non-smoking wives, there seemed to be a huge relation between the two. The specific results from the experiment show this relation. In addition, it is important to note that the same relationship was followed, but instead of smoking habits, the husbands’ drinking habits were used. This results of this experiment showed that the husbands’ drinking habits had little to no effect on their wives’ risk of developing lung cancer. Therefore, it is clear that the results of this study support the claim that second-hand smoke can be a huge cause of lung cancer.

Friday, February 1, 2013

Blog 1 - Women Binge Drinking

For this week's blog assignment, we read an article called Vital Signs: Binge Drinking Among Women and High School Girls. The article stated that alcohol consumption, and more specifically, binge drinking, accounted for almost 23,000 deaths in the United States. It also highlighted the fact that drinking has lead to many other health related issues. The article defined what binge drinking is, who binge drinks, and steps that can be taken to prevent binge drinking. It summarized an experiment on binge drinking among women, recording the prevalence, frequency and intensity of drinking, and recorded its results. The experiment used two main methods to record data: BRFSS and YRBS. Although these methods acquired data for the experiment, there were some obvious flaws. In the end, the experiment concluded that binge drinking was very common, and that the women, in particular, who did binge drink often did it frequently and intensely. Also, the data recorded from high school girls was very similar to that of older women, aged 18-24 years old.

Because this article is about binge drinking and the different health issues that are produced from it, it is definitely an important public health issue. As the article states, binge drinking can not only lead to death in serious cases, but it can also lead to other health issues like liver disease, heart disease, stroke, cancer and more. These health issues associated with binge drinking are very serious in our world today because they can lead to various hospital visits at which doctors will spend countless medical supplies trying to save the person's life. In addition, one can look ahead and see that binge drinking can lead to unplanned pregnancies and injuries or even death that are associated with drunk driving. Therefore, binge drinking in general is an important public health issue that must be addressed.

In general, I am not surprised by the results. Both methods of collecting data concluded that current alcohol consumption was around 50% in high school girls, which, unfortunately, does not surprise me. The article also discussed the different results between women of different incomes, which I thought was interesting, but not surprising. People with higher income tend to binge drink more than people with lower income. It was very interesting to see the difference in prevalence of alcohol among the different races in high school girls, given that it was about a 10-20% difference. The two methods used to collect data, BRFSS and YRBS, definitely have accuracy issues because they are self-report data. Not all people in the age group used for the experiment attend school, which is where the experiment was conducted. In addition, as the article states, alcohol consumption and binge drinking results are often "underreported in surveys because of bias". It is very true that the methods used in this experiment could be flawed because of various factors such as missing kids on the day the surveys were conducted, kids not completing the surveys with total honest, and so on. It can be said that these flaws, along with others, in the methods used to collect data are enough to call for another method to compare and contrast results.

I think that the article does a good job in listing various efforts one could do to try to prevent the prevalence of binge drinking among women. The ones that stuck with me were to "maintain limits on the days and hours when alcohol is sold", increase the price of alcohol, which could cause the girls to not want to buy it, and "maintain and enforce age 21 years as the minimum age for legal drinking". The last one, however, could be enforced more in some situations in order to thoroughly prevent minors from obtaining alcohol. Various other methods can be implemented in our world in order to prevent further binge drinking among women and the other health issues that can result from binge drinking.