Pubh 102 1nd EditionExam # 2 Study Guide Lectures: 12 - 21Health Disparities- Healthy People 2010, 2020 Goals- 2010 Goals – Increase quality and years of healthy life; eliminate health disparities among different segments of the population- 2020 Goals - Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; Achieve health equity, eliminate disparities, and improve the health of all groups; Create social and physical environments that promote good health for all; Promote quality of life, healthy development, and healthy behaviors across all life stages. - Types of health disparities (i.e., racial & ethnic, gender, geographic location)- Gender- Disability- Geographic Location- Sexual Orientation- Race & Ethnicity- Income & Education/Social Class- Why do people with disabilities experience poorer health?- Reduced access to health care & health promotion- Less attention to co-morbid conditions- Increased vulnerability to secondary conditions- Leading causes of death in US by race/ethnicity-- Relationship between household income and health status- Underlying causes of higher rates of morbidity and mortality- Genetics- Lifestyle/behaviors- Environmental factors/justice- Poverty/SES (lack of resources)- Discrimination & institutionalized racism; stigma (lack of trust)- Lack of effective prevention programs tailored to specific community needs- Lack of access to quality health services- Ideology- Childhood exposures- Neighborhood conditions- Segregation (neighborhoods and schools)- Globalization- Political power- Educational & health literacy differences- Social determinants – reflect social factors and the physical conditions in the environment in which people are born, live, learn, play, work and age. Also known as social and physical determinants of health, they impact a wide range of health, functioning and quality of life outcomes.- Availability of resources to meet daily needs, such as educational and job opportunities, living wages, or healthful foods- Social norms and attitudes, such as discrimination- Exposure to crime, violence, and social disorder, such as the presence of trash- Social support and social interactions- Exposure to mass media and emerging technologies, such as the Internet or cell phones- Socioeconomic conditions, such as concentrated poverty- Quality schools- Transportation options- Public safety- Residential segregation- Tuskegee Study- 1932 - 1972 in Macon County, AL- Study racial differences in natural history of untreated syphilis to end point – death!- Men were told they were receiving treatment when they were NOT! - “Effective” Study- Employed Black physician (Dr. Dibble) and nurse (Eunice Rivers)- Used incentives: free exams, food, transportation, burial stipends-- Review Dr. Dixon’s presentation (posted on BB)US Healthcare System- Estimated annual cost of healthcare in the US - $2.6 trillion or 17.9% of GDP- Higher than any other industrialized nation- Includes the organization, financing, admin. program & services provision- US health system issues- Economic – - As a country, we spend more $$ on “health care” than any other industrialized country; powerful part of US economy BUT we are not healthier, our services are not affordable, and manypeople (47 million) are uninsured and do not have access- Who pays for healthcare? 1) Government (40%)(Medicaid, Medicare, VA, etc.)2) Private insurance (33%)3) Out-of-pocket (12%)- What is SCHIP? How is it paid for?- State Child Health Insurance Program (SCHIP) a. Enhancement to Medicaid b. Jointly funded by Federal govt. & statesc. Funded in part by tobacco tax – depends on state!- Utilization trends - Who’s using the system?- Vary immensely by demographics:- Aging population- Diversity in the population- Income/insurance statuso 18%* of all Americans = 47 million do not have insurance- Family structure- Specific chronic conditions (e.g., cancer, HIV/AIDS)- Resources trends - Supply to meet demand?- é medical subspecialties, ê primary care (GPs)- ê community hospitals, length of stay, admissions, etc.- é hospital employees & outpt. services- é types of insurance plans (HMOs, PPOs); “managed care”- Paying to keep people OUT of hospitals- Basic understanding of Affordable Care Act (read Kaiser Family Foundation)- ACA Implementation: 2010-2018- Reforming private health insurance market- Provide better coverage for those with pre-existing conditions- Improving prescription drug coverage in Medicare- Extend the life of the Medicare Trust fund by at least 12 years- Health insurance exchanges- How does health insurance work? (watch YouTube video)- Insured/Member v. Insurer/Plan- Premium – payment an insured person makes on an insurance policy- Deductable – amount the insured pays before the policy (insurance co.) starts to pay- Co-Pay – specific amount insured pays (out-of-pocket) for health-care services at the time the costs are incurred with theinsurer paying the remaining costs; typically a fixed amount- Co-Insurance – same as co-pay except the amount is a % (80/20; 60/40)- In-Plan/Out-of-Plan (Network)- Gatekeeper (Primary Care Provider)- Insurance coverage- 47 million (18%) of U.S. citizens without insurance- Prior to ACA, 19-25 y/o largest group of uninsured- Now, largest segment (22%) of uninsured adult population = 26-34 y/o- AA & Hispanics more likely to not be insured…but 45% are white- 26% uninsured have family income of $20K-$40K - 3/4 are employed or living in household with family member(s) who workInfectious Diseases & Control- Types of disease- Infectious - any Dz caused by a pathogen (DZ producing agent -“germ”…virus/bacteria/fungi)- Non-infectious – any Dz not caused by a pathogen (asthma, CVD, obesity)- Communicable - an infectious disease that may be passed from individual to individualo While they are often used synonymously, the terms infectious disease and communicable disease do not have the same meaning.o A communicable disease is an infectious disease that is easily spread from one species to another. o As such, all communicable diseases are infectious diseases, but not all infectious diseases are communicable. (e.g., infected cut, tetanus.)- Contagious disease is a very communicable
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