Submitted by Renee Van Sickle
The United States falls behind in healthy outcomes when compared to other countries. According to the Commonwealth Fund, 2011 report, “The U.S. health system performance continues to fall far short of what is attainable, especially given the enormity of public and private resources devoted nationally to health. Across 42 performance indicators, the U.S. achieves a total score of 64 out of a possible 100, when comparing national rates with domestic and international benchmarks” (Schoen, 2011). Moreover, the U.S. was unsuccessful in improving access to care, system efficiency, racial and ethnic disparities, and healthy outcomes. The United States is in dire need of restructuring healthcare that provides affordable services to all individuals to include; but not limited to, disease prevention and health promotion. “The biggest change we can make isn’t how we provide health care-it’s when. Right now, we have a “sick care” system, and we need to invest in a “health care” system” (Sebelius, 2011). In light of this the government had no option but to step in and begin to reformulate how care is provided to Americans. Never before in the history of America has the government had such a role in the health of citizens and never before has there been such an obvious need as today. Although there is much controversy over the Affordable Care Act (ACA), it is agreeably necessary for the future health of the nation. The Affordable Care Act is expected to improve the overall health of the U.S. by targeting the gaps identified by the Commonwealth Scorecard. One manner to improve overall health scores of America is addressed by the vision and mission of Healthy People, 2020. The vision of Healthy People 2020 is to create, “A society in which all people live long, healthy lives” (Healthy people 2020, 2012). The purpose of this writing will address the manner in which the government plans to focus on in order to improve the health outcomes of the U.S. through disease prevention and health promotion strategies implemented through the Affordable Care Act.
The results of the Commonwealth Healthcare Scorecard produce clear evidence there is a problem in the United States when it comes to health promotion and disease prevention. Various lifestyle habits are thought to contribute to the onset of disease and premature deaths. A recent study conducted by PlosMedicine, 2011 revealed shocking results. Tobacco smoking and high blood pressure were responsible for an estimated 467,000 deaths, followed by obesity and inactivity with nearly 1 in 10 deaths (Danaei, et al., 2011). It may be concluded then, that the largest mortality effects were the result of poorly managed or preventable diseases. The ACA has a heavy burden to bear and much improvement needed in the management of chronic disease and in improving disease prevention through a healthier lifestyle, education, preventable disease screenings, and improving the environment in which we live. Close focus is set for future improvement in the areas of; ischemic heart disease, stroke, diabetes, cancer, liver cirrhosis, tobacco abuse, pancreatitis, alcohol disorder, and finally traffic injuries and violence.
Legislation and Policy Description
The Affordable Care Act of 2010 created the Prevention and Public Health Fund (PPHF) to focus on public health and prevention of disease (RWJF, 2012). Prior to the PPHF, the primary purpose of the public health department was to identify and track disease, maintain adequate food and water supplies, educating the public regarding new health concerns, and prepare for potential disasters and disease outbreak. With the implementation of this legislation the meaning of public health will take on a new role; an expanded role. In order to accomplish such a task, the very infrastructure of the public health department will require remodeling. Collaboration at the government level will keep trends of disease prevention and promotion using a multidisciplinary team approach in addressing health issues and ensure adequate supplies of needed vaccines, or other essential medication or equipment. The primary task of the council for the PPHF was to implement the nation’s first overall prevention health strategies and to ensure all federal agencies involved in public health do so in a coordinated effort. This council identified four areas of focus: elimination of health disparities, creating healthier communities, providing preventative screening services within clinical settings, and helping consumers make healthier lifestyle choices (RWJF, 2012). A portion of the money funded by the government was used to strengthen the nation’s primary care workforce by supporting the educational efforts and endeavors of physicians, physician assistants, and advanced nursing programs. Further money was allotted to the efforts of tobacco reduction programs, improving nutrition and physical activity programs in school age children and families. Still another $182 million was made available for clinical prevention efforts used to improve access to preventative screenings and immunizations and increasing awareness of the upcoming benefits gained through the ACA. Finally a small portion was allocated to individual community transformations that encourage a healthier more active lifestyle and provide a safer, healthier community in which to live.
Promoting healthy habits begins at birth and need to continue through the golden years of life. Healthy living choices play a large part in the reduction of chronic disease. Lifestyle choices such as, poor dietary habits, lack of exercise, tobacco and alcohol all contribute to disease processes leading to chronic illness. Educating the community to adopt a healthier lifestyle requires a community wide approach and should be spearheaded through the community health department and carried through to local community schools, and government agencies to ensure not only healthy and safe children, but also a healthier environment for all to reside.
Healthy People 2020 and the Center for Disease Control and Prevention (CDC) has placed a concerted effort in addressing this American crisis by furthering health education in schools, public health departments, and primary care providers. According to the CDC, 23% of Americans report no leisure time physical activity, 24% report eating 5 or more servings of fruits and vegetables per day, approximately 1 in 5 Americans currently smoke tobacco, and 17% report binge drinking of alcohol at least once a month (CDC, 2012).
The public health department involvement by way of evidence-based practice is creating guidelines to ensure the needs of each community are met. The first step in this approach is a windshield view of each community to gather data indentifying specific community health needs. Once a community has identified particular needs a systematic review of evidence-based guidelines will be implemented. A Task Force on Community Preventative Services (TFCPS) has systematically reviewed more than 200 interventions to produce evidence-based recommendations on population-level interventions with topics currently including adolescent health, alcohol, asthma, birth defects, cancer, diabetes, health communication, health equity, HIV/AIDS, sexually transmitted infections and pregnancy, mental health, motor vehicle injury, nutrition, obesity, oral health, physical activity, the social environment, tobacco use, vaccines, violence, and worksite health (Retrieved October 8, 2012, from, www.thecommunityguide.org). More so, The Reinvestment Act of 2009 allocated $650 million to “carry out evidence-based clinical and community-based prevention and wellness strategies addressing preventable chronic disease and improving public health. Furthermore, the Patient Protection and Affordable Care Act of 2010 mentions “evidence-based 13 times in Title IV, Prevention of Chronic Disease and Improving Public health will provide $900 million in funding to 75 communities during 5 years through Community Transformation Grants (Jacobs et al. 2012). If the health of America is to improve, the people of America need to make major changes in lifestyle habits. Congress is supporting this endeavor as evidenced by allocated task forces, councils, and available grants.
Heart disease is a major cause of hospitalization, and one of the leading causes of death in the U.S. It is estimated that 30% to 70% of all hospital admissions for medication-related illness are attributed to poor adherence, resulting in billions of dollars in additional healthcare costs annually (Mosca, et al. 2011). Improvement in adherence to treatment regimes requires a team approach to further educate as well as provide proper follow up using evidence-based practice. Prevention focuses to improve heart health will continue with smoking cessation, programs that increase physical activity, follow up regarding medication compliance, dietary intake guidelines, weight management programs, improvement in hypertension control, and management of hyperlipidemia. These interventions are a focus of the ACA to aid in the reduction of heart disease.
Physical Activity and Nutrition
Lack of physical activity and unhealthy eating is a contributing factor to cancer, diabetes, and cardiovascular disease. The Department of Health and Human Services, State Indicator Report on Physical Activity, (2010) reports a U.S. National average of adults physically active at 64.5%, those highly active, 43.5%, and those with no reported leisure-time physical activity at 25.4%. The National percentage of youth in grades 9-12 who are physically active is a mere 17.1%, whereas those who report daily physical education in schools are 30.3%. Promoting physical education within local schools and ensuring playgrounds throughout the community is an effort to help encourage children to move from the television set to the play yard thereby increasing physical activity. Many cities are actively planning bicycle paths to encourage safety for those who choose an alternative means of transportation or bicycle for leisure activity. Furthermore, the building of urban subdivisions now must meet government codes that include a playground within the subdivision plan and provide a plan for accessible sidewalks to encourage individuals to walk, jog, or run in a safe area close to home.
In 2002, a total of 37% of adults were overweight, and 22% were obese. This percentage has been increasing in the U.S. over the last few years. (Healthy People, 2010). Ensuring that nutritional school lunches are provided will help promote healthier eating habits. Educating the public regarding healthy meal choices are modifiable health risk behaviors that would encourage health promotion in the U.S. With many individuals and families growing accustomed to fast food restaurants over the last few years, it is no doubt part of the reason for poor dietary habits today.
Healthy People 2020 set nutrition and weight goal objectives that include: reducing the amount of Americans that are overweight, reducing the number of iron deficient diets, increasing intake of fruits, vegetables, and whole grains. Meanwhile, decreasing the amount of daily intake of saturated fats and sodium in the diets of Americans will help improve the overall healthy diet of individuals. Furthermore, the ACA is hoping to increase the proportion of work places offering diet and weight management education, increase nutritional education provided in primary care visits, and increase the number of states that have state level policies encouraging retail outlets providing foods encouraged by Healthy People 2020 dietary guidelines. Additionally, to meet the needs of school age children, there will be an increase in the number of states with adequate nutritional standards in schools as well as encouraging schools to offer healthy food and beverage choices.
Currently many individuals that are uninsured do not have the capabilities to receive routine screenings for preventable cancers. Sadly, for these individuals, when treatment is sought, the results are often devastating. The future promise of the ACA is to increase the amount of routine screenings for cancer to all U.S. citizens. Through routine screenings offered, there will be a reduction in the amount of preventable cancers. Screenings for breast cancer, cervical cancer, and colon cancer will be a part of routine care offered through disease prevention efforts of the ACA.
Smoking continues to be a risk behavior by many Americans. President Obama has his own struggle with smoking cessation although he admits that he is 95% cured as of a February 11, 2011 press report, (Quit Net, 2011). Despite previous efforts to educate the public regarding the effects of smoking, the U.S. continues to have a percentage from 21% in 2004 with a slight drop to 17% in 2010 (The Commonwealth Fund, 2011). According to statistics the greatest age impact for smoking is age 25-44. Statewide statistics vary with the highest number of citizens who smoke residing in Indiana and the lowest percentage of smokers call Utah home. The National Institute on Drug Abuse (NIDA) goes on to state that approximately 75% of those who attempt smoking cessation, experience relapses in the first six months, and that attempts more than once are usually required before a person is fully recovered. Smoking is a leading contributor to heart disease, lung disease, and cancer. Healthy People 2020 and the CDC are beefing up educational efforts to reduce the number of tobacco users. Health departments and hospitals are offering smoking cessation classes and products to help reduce the number of individuals partaking in this habit.
Teaming up together for a healthier environment are Healthy People 2020, and the World Health Organization. Defining the environment, Healthy People 2020 states, “all the physical, chemical, and biological factors external to a person, and all the related behaviors” (Healthy People 2020, 2012). Together, these groups are working to improve outdoor air quality by reducing pollution, improving water conditions by removing toxic substances and hazardous waste in surface and ground water, educating the public regarding radon gas, lead, and other potentially dangerous toxins within our homes and within our environment. The improvement of both indoor and outdoor air pollution will aid in the reduction of asthma, and chronic lung disease as well as cancer. Inadequate heating, sanitation, as well as dangerous molds discovered in dwellings are a hot topic today. Additionally, the public health department is enforcing educational efforts informing citizens regarding electrical, and fire safety to help reduce accidental injuries. Likewise, educating the public regarding the toxic effects of lead-based paint that may exist in older homes and offering blood levels of lead to improve the safety of individual homes is a screening that is advocated by the ACA. Among these concerns exists the protection of environmental disaster by participating in disaster preparedness and chemical warfare. Hospitals and community health departments are moving forward to improve care for individuals in any given situation or disaster that may impact their community by participating in drills and educating key players in the proper management of disasters should they occur.
Education in Disease Management
Today more than ever the health care recipient is a well informed consumer. Individuals demand to understand their disease and how it impacts their lives. Likewise, primary care providers, nurses and health care professionals are participating in transdisciplinary care to involve the patient in the management of their disease and help them make informed decisions. Individuals that take ownership of their disease process improve compliance and thereby reduce hospital readmissions. Home health care as well as nurse-lead clinics will offer better management and education for the health care consumer of the future. With the implementation of tele-health, and electronic records there will be an improved quality and a seamless healthcare delivery system nationwide with the potential to be globally accessible. Educating the public is the key to future healthcare success. A recent analysis found that, “For each 10 percent increase in local public health spending, significant reductions were found in the rate of infant deaths as well as deaths from diabetes, heart disease, and cancer” (Mays, & Smith, 2011). Furthermore, it is discovered that tobacco cessation screening programs, alcohol abuse abstinence programs, and educational services regarding chronic illness management would potentially save billions of dollars in the long run, while coincidentally improving the overall health of Americans. The ACA has put forth efforts to boost educational dollars to help educate healthcare consumers of tomorrow.
The Legislative Debate
Much of the controversy existing today stems from the allocated money and congressional members wishing to spend money to ax the program; using the money for various purposes including a source of savings to pay for the repeals of the ACA. Many of the members of congress view this fund with ridicule. Wyoming Senator Mike Enzi, termed the prevention fund a “slush fund… to build sidewalks, jungle gyms, and swing sets.” (RWJF, 2012). Likewise, a recent study reveals, “People who live within a half mile of lots of parks and fields go on fewer walks than those who don’t have much parkland nearby” (Pittman, 2012). Furthermore the debate is ongoing regarding the rising cost of health care that many feel will occur through the ACA proposal to allocate spending on educating Americans regarding a healthier lifestyle while taking a walk outside is free. More so, many continue to debate the constitutionality of the ACA and mandated insurance coverage. Still more debate exists on whether prevention efforts actually reduce costs, and more confusion remains over what constitutes disease prevention or attempts to detect early disease such as mammography screenings and if consumers will be compliant with educational efforts to improve health. Finally, the Congressional Budget Office reports that historically, preventative clinical services leads to higher, not lower, overall medical spending which further impedes the already struggling budget.
Affordable Care Act Focus
Disease Prevention and Health Promotion
The Affordable Care Act (ACA) will have a considerable impact on the overall health of the U.S. An expansion of Medicaid eligibility is proposed for those below federal poverty level; opening doors to health care accessibility to individuals who have had to wait, or do without. Medicare coverage will improve with the closure of the “donut-hole”. Furthermore, individuals with pre existing illnesses will no longer be turned down for health coverage. Children’s health programs will also expand to cover more children and families. Furthermore preventable illness education efforts, screenings, and immunizations will be provided through insurance coverage that is available for all Americans. Communities will focus on a healthier community from individual care and expand to the educational system. Nurse-lead Clinics and Medical Model Homes will reach out to care for families through direct care and educational programs that will help individuals make healthier choices for tomorrow. For the first time in America, those who are U.S. citizens will partake in a system of health care delivery that is designed to help all families and children receive necessary care and preventative services that in return will hope to increase the Commonwealth Fund scorecard results in the future.
Certainly, there will be a future influx of newly insured Americans that will surely pose a critical shortage of primary care providers. Advanced nurse practitioners will have more hands on care to the consumers with orchestrating autonomy to the care needs of individuals to provide holistic care involving the individual and provider, rather than insurance companies who employ others to make decisions based on the bottom dollar. The ACA will impact the future and provide care that individuals deserve rather than placing a burden on the consumer to decide if one should purchase medication or groceries for their family.
Personal Point of View
Results of the Commonwealth Scorecard disappointingly brought the United States condition of health to a sickening halt. The 2011 National Scorecard comprised of a set of 42 indicators of health care system performance. These indicators include health lives, quality, access, efficiency, and equity. Sadly, the U.S. average score was ranges from a low of 53 to a high of 75. There is a long way to go for improving the health of America. Advance practice nursing is the key to unlocking the door to quality, accessible, affordable health care. Nurses have historically stepped up to the plate in times of disaster. The nurse has always stood in the batting cage ready to take a swing at moving the health of Americans from mediocre to quality. When given the right tools and the “go ahead” the nurse will take control of the situation and see communities through one patient at a time. Just as Florence Nightingale so long ago made a voice in the darkness to advance the profession of the nurse, so will the nurse of today move the profession to the advancement of tomorrow to heal the nation one at a time. The ACA support of nurse education and autonomy to function at the fullest educational level and skill knowledge will pave the way for a healthier America. Nursing has always advocated prevention and wellness; advocating for the good of those they care for, the future prediction is viewed with excitement because for the first time there is a voice behind the nurse. The profession of nursing at each level will have the ability to function to the fullest educational training and skill level to care for the future of America.
Health promotion and disease prevention is an attainable goal for the U.S. only by way of implementation of the Affordable Care Act. The health of tomorrow will be greatly impacted by the availability of insurance to all individuals. Health screenings will identify early diseases that may be managed properly or cured. Immunizations will ensure all individuals are afforded the opportunity to be safeguarded against preventable illnesses. Additionally, this will reach global implications through the use of holding virus outbreaks and the like at bay. Educating individuals and families on healthy living will promote an overall reduction in the onset of diseases such as heart disease, hypertension, and lung diseases. More so educating individuals with smoking cessation, nutritional habits, alcohol consumption, and lack of physical activities will reduce the risk of disease. Implementing healthy habits in the youth today will inadvertently promote a healthier tomorrow. Insurance availability to all individuals will reduce health disparities and limit the reduction of visits to a provider for illnesses or management that previously would have been ignored. Building safer, healthier communities will engage the comment, “it takes a village to raise a child”. In this case, it takes government involvement to improve the health of America.
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