2. Improve and control overall health Promote general well-being through a healthy lifestyle Differentiate between primary, secondary and tertiary disease prevention Responsibility for intervention Key Points
6. World Health Organization (WHO) Promoting development Fostering health security Strengthening health systems Harnessing research, information and evidence Enhancing partnerships Improving performance
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8. Exercise and fitness; Diet, nutrition, and eating right; Healthy lifestyle; Vaccination and immunization; Health screenings; Family planning; Mental health and mental disorders; Educational and community-based programs Lifestyle Objectives
9. Cancer Heart Disease Alcohol and Drug Use Cardiovascular and Cerebrovascular Diseases Effects of Negative Lifestyles
14. Occupational safety and health; Environmental health; Food safety; Oral health Health Protection
15. Healthy people living in every stage of life Healthy people in healthy places Healthy people in a healthy world People prepared for emerging health threats Health Protection Goals
16. U.S. Preventive Services Task Force Screening Counseling Preventive medication Availability & Utilization
17. Overseeing the maintenance of safe living and working environments such as: pure water; clean air; safe food; drug products; appropriate waste disposal; elimination of hazardous situations; and reduced risk of automobile accidents Cont’d.
19. Who offers disease prevention? How are prevention strategies being used? Availability and Utilization
20. Cynical of outcome Suspicious about pricing Skepticism and Cost-Effectiveness
21. Applying Existing Knowledge Assigning Responsibility Addressing the Issues Issues with the 3 P’s health PROTECTION, disease PREVENTION, health PROMOTION
22. Americans receive enough information Media Peers Healthcare Professionals Applying Existing Knowledge
23. Who should be held accountable for taking action? Dietician Society Individual Physician Government = The Individual Assigning Responsibility
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25. 1970’s = communicable/contagious diseases
26. Today = epidemic disordersAddressing System Issues
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28. Specialist versus GeneralistsAllergy/ Immunology - $158,000 Ambulatory - $ 80,000 Anesthesiology: General - $207,000 Anesthesiology: Pain Management - $315,000 Cardiology: Interventional - $290,000 Critical Care - $187,000 Dermatology - $ 195,000 Emergency Medicine - $192,000 Endocrinology - $171,000 FP (w/o OB) - $161,000 FP - Sports Medicine - $ 152,000 FP - Urgent Care - $ 128,000 Gastroenterology - $265,000 Medicine/Pediatrics - $139,000 Medical Oncology - $198,000 Neonatal Medicine - $286,000 Nephrology - $191,000 Neurology - $180,000 Addressing System Issues Obstetrics/Gynecology - $211,000 Maternal/Fetal Medicine - $286,000 Occupational Medicine - $139,000 Ophthalmology - $138,000 Ophthalmology Retina - $280,000 Orthopedic Surgery - $256,000 ORS - Hip & Joint Replacement - $330,000 ORS - Spine Surgery - $398,000 Pathology - $169,000 Pediatrics - $135,000 Podiatry - $128,000 Radiation Oncology - $241,000 Radiology - $201,000 Rheumatology - $179,000 Surgery - General - $226,000 Surgery - Cardiovascular - $336,000 Surgery – Neurological - $354,000 Surgery - Plastic - $237,000 Urology - $261,000 SOURCE: Allied Physicians, Inc., Los Angeles Times and Rand McNally. Updated June, 2006
~Healthy People 2010 "The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”~Place the responsibility of understanding and processing health information on the consumer rather than those who provide the information~Low health literacy is more prevalent among Older adults Minority populations Those who have low socioeconomic statusMedically underserved people ~Patients’ health literacy may be affected if they haveHealth care providers who use words that patients don’t understand Low educational skills Cultural barriers to health care Limited English Proficiency (LEP) ~Patients with low health literacy may have difficultyLocating providers and services Calculating dosagesEvaluating information for credibility and qualityAnalyzing relative risks and benefitsInterpreting test results Sharing their medical history with providers Seeking preventive health care Knowing the connection between risky behaviors and health Managing chronic health conditions Understanding directions on medicine ~How health care professionals can helpIdentify patients with limited literacy levels Use simple language, short sentences and define technical terms Supplement instruction with appropriate materials (videos, models, pictures, etc.) Ask patients to explain your instructions (teach back method) or demonstrate the procedure Ask questions that begin with “how” and “what,” rather than closed-ended yes/no questions Organize information so that the most important points stand out and repeat this information Reflect the age, cultural, ethnic and racial diversity of patients For Limited English Proficiency (LEP) patients, provide information in their primary language
~Health promotion is the science and art of assisting people in discovering changes necessary in their lifestyle to move toward an optimal state of health~Protect, maintain, and restore the health of individuals and the population at large~The promotion of good health practices is the process of enabling people to improve and increase control of their own health
~optimal health requires a balance of spiritual, social, emotional, intellectual, and physical health
~six-point agenda addressing two health objectives, two strategic needs, and two operational approaches~Health development is directed by the ethical principle of equity: Access to life-saving or health-promoting interventions should not be denied for unfair reasons, including those with economic or social roots~One of the greatest threats to international health security arises from outbreaks of emerging and epidemic-prone diseases. Such outbreaks are occurring in increasing numbers, fueled by such factors as rapid urbanization, environmental mismanagement, the way food is produced and traded, and the way antibiotics are used and misused~Areas being addressed include the provision of adequate numbers of appropriately trained staff, sufficient financing, suitable systems for collecting vital statistics, and access to appropriate technology including essential drugs~Evidence provides the foundation for setting priorities, defining strategies, and measuring results~WHO uses the strategic power of evidence to encourage partners implementing programes within countries to align their activities with best technical guidelines and practices, as well as with the priorities established by countries~WHO participates in ongoing reforms aimed at improving its efficiency and effectiveness, both at the international level and within countries
~Healthy People 2020 “Challenges individuals communities and professionals, indeed all of us to take specific steps to ensure that good health as well as long life, are enjoyed by all~The first goal of Healthy People 2010 is to increase the life expectancy for people of all ages and improve their quality of health (increasing from 47.3 years to nearly 77 years). Quality of life reflects on the general well-being, sense of happiness, and satisfaction with our lives and environment. ~The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population including gender, race or ethnicity, education or income, disability, living in rural localities, or sexual orientation***WORD DOCUMENT for focus areas
~individual lifestyle choices are the target of the majority of health promotion strategies and campaigns~exercise and fitness includingphysical activity~healthy lifestyle includingtobacco use;alcohol use;obesity;injury and violence prevention
~Some diseases are attributable to negative lifestyle behaviors such as: cancer, heart disease, alcohol and drug use, cardiovascular and cerebrovascular diseases~Diseases caused by negative lifestyle behaviors make up nearly half of all hospital visits annually
~MontanaMethProject is a large-scale prevention program aimed at significantly reducing first-time meth use through public service messaging, public policy, and community outreach~Largest advertiser in Montana, reaching 70-90% of teens three times a week~Two years after launching the MethProject in Montana, adult Meth use has declined by 72% and Meth-related crime has decreased 62%.
~dedicated to reversing America’s costliest disease. Right now, 1 in 3 adults and 1 in 5 children struggle with obesity. Taxpayers, governments and businesses spend billions on obesity-related conditions each year, including an estimated $147 billion in medical costs.
~Health service providers and educators play important roles in creating awareness of the need for health promotion and developing strategies to increase participation in health promotion activities~Because they are based on the individual’s own lifestyle factors
~ United States Department of Labor~Centers for Disease Control and Prevention World Health Organization~U.S. Food and Drug Administration~CDC
~CDC has created a set of four overarching Health Protection Goals, which are supported by a number of strategic goals and objectives~All people, and especially those at greater risk of health disparities, will achieve their optimal lifespan with the best possible quality of health in every stage of life~The places where people live, work, learn, and play will protect and promote their health and safety, especially those people at greater risk of health disparities~People around the world will live safer, healthier and longer lives through health promotion, health protection, and health diplomacy~People in all communities will be protected from infectious, occupational, environmental, and terrorist threats
~USPSTF was convened by the U.S. Department of Health and Human Services to determine how providers use preventive services and the effectiveness of available interventions.~recognizing that appropriate preventive services can reduce morbidity and mortality from disease and thus potentially reduce expenditures, the USPSTF analyzed three categories of preventive services
~Federal, state, and local departments of public health, labor, and transportation are responsible of overseeing the maintenance of safe living and working environments such as:
Primary disease prevention is the base of all the types of preventions. It broadly centers on the prevention of disease and injury. The target person for primary disease prevention is the average person who is living without illness. The most common example of primary prevention is through the use of vaccines. We have all received vaccines, whether it was for hepatitis or the flu, they all are categorized as primary disease prevention. Another form of primary disease prevention is seen in individuals with diet restrictions. The American Heart Association has suggested that individuals who have a high risk for coronary disease reduce the amount of sodium in their daily intake. Primary care will be discussed into more detail in Chapter 13.Secondary disease prevention is closely related to the primary disease prevention, however the main difference is that secondary is more disease specific and is aimed at high risk groups. This is directed at asymptomatic people who have already developed risk factors for a disease but in whom the disease itself has not become clinically apparent. An example of secondary disease prevention can be seen if a female who has family history of cervical cancer receives a pap smear. Chapter 14 goes more into depth about secondary care.Tertiary disease prevention is fairly diverse from the previous types of preventions, it is actually practiced on people who have already acquired the disease. The basis for tertiary prevention is to limit the complications and decrease the severity of the disease. It’s the physician’s goal to reach those before it leads to a reliance on drugs or a permanent disability. The use of insulin therapy to help prevent complications with diabetes is an example of tertiary prevention.
So, who offers all the three different kinds of disease prevention? All of the necessary services are available by means of physicians, physician’s assistants, nurse practitioners, nurses, dentists, health clinics, departments of public health and many others. These strategies are being used by employers who provide health insurance. They are interested in changing the focus to promoting their employees to gain a healthy lifestyle, rather than treating illness. They want to keep their employees healthy in order to keep down insurance costs. Therefore, they try to give every member of staff the opportunity to utilize preventive services.Some companies provide a facility to exercise, incentives (paid time off), or they might organize exercise groups.Pictured here are two pictures of the walkstation. The maximum speed reaches only 2mph, so it lets you walk at a comfortable speed and accomplish work all while burning calories. Why these walkstations seem like a good part to promoting a healthy lifestyle, they come with a hefty price tag of over $4,000.
Preventive services have proven to show accurate results in many studies, however many providers and patients are cynical of the actual outcome and the price which follows. Because most physicians who provide thesepreventive services never follow their patients to determine if they have been positively affected by the intervention, it has caused some doubt when the physician promotes different services. In order to make services more cost-effective, physicians are tweaking component costs, acquiringrisk profiles for patients, and limiting the frequency of interventions.
In the past, the U.S. healthcare system hasbeen focused on treating andcontrolling disease. So, the idea of switching the focus to protection, prevention, and promotion is quite a challenge. Although most people realize that shifting the focus will eventually been beneficial, it is difficult for themto grasp because results will not be physically evident for long period of time.
Most Americans receive a fair amount of knowledge of how to be healthy, it is then up to them to take that information and use it. Information is conveyed through media by means of commercials, product packaging, and flyers; word of mouth; and from their physicians.With this in mind, one tends to wonder what context are the choices being made? For instance, evidence has clearly shown that cigarette smoking leads to negative consequences and we have all seen the anti-smoking commercials on TV. However, individual and societal efforts have not changed the decisions of people choosing to partake in the tobacco use. Similar problems can currently be seen in the coalition to stop obesity. The bottom line suggests that the general public has enough material available to them; the concern is how the U.S. Health Services System should apply existing information to attain a healthier change.
Who should be held accountable for taking action on these functions? Should the individual, physicians, dieticians, government offices, or society as a whole be in charge? The division of the responsibilities is very vague. As in many situations, one group believes that the other group is taking action, when, in fact, they are not. Most people would agree that it is each individual’s responsibility to take control of their wellbeing. However, a dilemma arises when outliers come into play. Competency is a huge factor. If an individual cannot make their own decisions, they should not be held liable for the maintenance their health status. This affects, but is not limited to, people diagnosed with mental disabilities. Another predicament occurs when peer pressure comes to mind. Many people have been in a situation where they feel pressured to partake in activities out of their comfort zone. A person does not start using cocaine, excessively drinking alcohol, or smoking cigarettes with the hope of becoming an addict; they think that they will only use it on occasion to have a good time. However, as a person’s body adjusts to the regular drug use, they do become addicted. These people hit limitations when trying to quit; such symptoms include agitation, fatigue, lack of pleasure, depression, anxiety, irritability, sleepiness, restless behavior, increased appetite, or extreme suspicion (Heller). It is easy to criticize someone from the outside without fully understanding what they are going through. Therefore, it is critical that a person’s competency is taken into account.
Epidemiologic Transition In the past several decades, the focus of diagnosis and treatment has been directed at communicable and contagious diseases. Technologic advances have allowed for interventions to help control and/or eliminate many of the illnesses. However, the average American’s lifestyle has caused these common communicable diseases to switch to epidemic disorders. A familiar example of the current way of life includes little physical activity combined with a diet high in calories. Heart disease, lung cancer, and diabetes have grown into the more frequent diseases in Americans and some of the most common causes of death (CDC).
Reorientation toward primary careThe United States has one of the most advanced health care systems in the world, and it contains a large amount of physicians in the workforce. On average, there are two specialists for every one generalist. This is due, in part, to the increased wages which specialist make compared to that of a generalist. The low amount of general practitioners has lead to expensive care and a limitation in the access to primary care.These prices reflect the physician’s salary in there first year.
Technologic Advances New research studies are continuously producing results that help promote health and prevent disease. One major advance in medical progression was the mapping of the human genome. The 13 year long study indentified 25,000 genes and 3 billion base pair sequences. By unraveling DNA, the origin of several diseases were discovered. By understanding what part of the genome is affected, it is easier to diagnose and sometimes treat diseases.
Managed Care Managed care has the opportunity to give immediate results. It can improve health status and quality of life, which in turn fends off more serious disorders. Because the effects of disease prevention can’t be seen for a long length of time, most people dis-enroll out of their health plan before they can take advantage of the benefits.
Level of InterventionIntervention to promote healthy behavior can be aimed at one of these three tiers. Individual – individual responsibilities mainly consist of choices about diet, exercise, and risky behavior Community – The community as a whole takes duty when there is a major epidemic, such as water contamination or gas leaks. Social – mainly affects individuals through subliminal messages and commercials.
Insurance Coverage for Preventive Services There are many different kinds of insurance plans; some cover more than others. Generous insurance plans may sometimes cover weight loss interventions, smoking-cessation classes, drug-abuse treatment, and mental illness services. Other basic packages may only contain a few of these services. In the United States, more people have leaned toward basic coverage plans, because they fear they will never use the offered services
