Chapter 4 HEALTH AND DISEASE IN THE UNITED STATES DR. D. T. CAPPUCCI,JR.

 

 

4.1 Objective:

To provide the student with general remarks about health and disease in the United States 

4.2 Introduction

The development of a community health problem begins with the individual in the recognition and definition of illness, the threshold level that is tolerated by the individual before taking action and the type action selected. When society becomes aware that a problem exists (through morbidity, mortality, and socio-economics), the individual's problem is transferred from the private to the public sector. It may be necessary to conduct population-based investigations and to explore and detect those physiological, cultural and societal factors that may be responsible. The resolution of many unanswered questions will require continued research and analysis to increase the base of scientific knowledge.

The following are some factors considered in the overall assessment of the nation's health status:

• Average life expecting
• Years potential life lost
• Live births and birth weight
• Infant mortality
• Specific morbidity and mortality rates, e. g., heart disease and cancer
• Number of persons working in health care institutions
• Health expenditures
• Specific infectious diseases; i.e., tuberculosis and sexually transmitted diseases
• Major influences on health organizations are timeliness and accessibility to health data. Some major health resources available for decision-making are:
• Health and Nutrition Examination Survey (HANES) - a population-based survey in which the sample of persons is given an extensive clinical examination by standardized procedures. This may be accompanied by a National Health Interview Survey in which persons are asked how they feel.
• Regulatory functions of agencies such as the FDA, EPA
• Surveillance and monitoring resources such as the CDC publication, " Morbidity and Mortality Weekly Report"
• Hospital discharge surveys
• Joint Commission on Hospital Accreditation
• USDA

  Health planning is an effort on the part of some group or organization to alter the behavior and conditions of a specified population. No matter how objective or well-conceived the plan may be, it is important to note that health planners are usually engaged in deciding what is best for a population and what steps to pursue to this end. Politics, nevertheless, is an inescapable aspect of any public health activity. The following is a mechanism to effect rational planning. In general, planning is the designing of a logical sequence of steps to move us from where we are to where we would like to be:

• Defining the problem (The present state of affairs that is considered inappropriate, unsatisfactory, or needs to be corrected.)
• Data collected to define the problem and to support concepts of possible change.
• Goals and objectives are established. A focus on the target to reduce, modify, or eliminate the problem. Alternate ways of achieving the objective are devised, formulated and evaluated.
• Course of action for implementation, i.e., organizational considerations.
• Evaluation

  Program effectiveness depends on the manner in which health services are delivered to the people. As society becomes more complex, the planning, organization and management of health services becomes more difficult. Studies show that the most effective means of disease prevention and improved health status are outside of the boundaries of the medical care process and are closely related to

• (i) reducing hazards in the environment,
• (ii) improving nutrition, and
• (iii) adopting appropriate personal habits.

  It is important to note, however, that poor health and inappropriate life styles do not absolve society and health care professionals from the consequences of those life styles. 

4.3 Consensus Methods

The most significant feature in the history of human disease in the 20th century has been the rapid decline of many classical infectious diseases and a concomitant increase in noninfectious disease entities. The structural dichotomy between public and private sectors has been a long-standing tension for public health departments. Health problems commonly overlap with political and economic concerns for agriculture, environment, labor, and industry, as well as jurisdictional disputes on responsibility, coordination and communication with other governmental agencies. As a result, public and political groups and health departments become adversaries. The problem lies with the public's intolerance of ambiguity and their need for simple declarations. On the other hand, multiagency problems, contradictory standards, lack of scientific data make the public perceive that government wishes to block access to information. There is the temptation to be responsive and to minimize conflict, but the public health official cannot afford to trade scientific integrity for compromised public health and safety.

Formalized consensus methods are being utilized to solve problems in medicine and public health. The purpose of these methods is to define levels of agreement on controversial subjects and to present the findings to the public.

The system of medical care in any country reflects the traditions of the past and the social priorities of the future. The health care industry is vast and encompasses many divergent groups. The organization of health services is the sum total of how these divergent group interests are perceived, negotiated and resolved. While life styles, advanced medical technologies and social/political pressures influence the health organization, certain ethical considerations must be weighed. As state-of-the-art medical technologies become available, there has been a corresponding increase in both the financing of medical care and legal/ ethical issues, i.e., renal dialysis, organ transplantation, coronary by-pass surgery. The overwhelming priority suggests that medical care must be distributed in terms of need rather than in the ability to economically command them. There is a growing demand for government to underwrite the cost of medical care as a social and political right. Approximately 50 million persons are without health insurance in the United States with the numbers increasing.