Public Health

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ISSUE 1: Surveillance

Problem 1. Surveillance/Monitoring- Diseases
Stress on surveillance
NEED FOR INFORMATION- who what where when why
Interruptions in the quantity of care- continuity of care issues
More vector-borne diseases, data collection- might not be in system- if not hospitalized, 25% get reported IF diagnosed properly
Areas- where no reason to conduct surveillance, not covered, reportable diseases but
Mosquito traps, birds die- West Nile- know vector around
Monitoring- different states do differently, test differently, systems in place

ISSUE 2: Availability of Health Care / Providers

When facilities destroyed because in path of whatever hits- people susceptible- leave, people need to be available to provide these services- doctors gone, etc
No money coming in- how continue to run? Not available to give care to those who need and now no longer employed- problems
Need system of health care providers paid on federal level- have safety net

Health Insurance

1. Not about what being covered, as much as who has insurance!
Access to health care vs. access to insurance
Access to care that we care about
Problem= insurance already problem- going to exacerbate problems already exist
Quality of health care changes with changes in policy
Create larger need (those with means still better off), but social justice problem is issue- putting more pressure on- illuminating how woefully inadequate health insurance is; stress on insurance system

Policy Changes

Infections, early detections
Basic health services- this is what we're talking about; need to sell it to public and those in charge, politically- get regulatory legal changes necessary to get legal infrastructure needed in future

Environmental Justice

Need to add immediacy- greater the problem- affects everyone- public attention
Your neighborhood as well as someone else's- PUBLIC PROBLEM
Not just those with resources, that can afford it- can buy insurance- have good medical care, preventative wellness plans, etc- don't care as much?
National health identifiers- substitute for national system: regulated- centralized
Electronic records- helps, uniformity at least
Logistical barriers to sharing information, fragmented- insurance companies
Proprietary information- think it can be used against you- medical records outcomes, infections, etc- needed
BUT- this will have to be done at federal level
Interruptions in care- chemotherapy stopped- loss of records- how to get system
NOT DOING ANYTHING for populations not even on map- don't have health insurance
What sells= problems of middle class- but environmental and social justice issues exacerbated by this
Why catastrophe hits- we see these people- then fall off map again

States / Local v. Federal

Fragmentation of Public Health System

CDC
Research
Hard to leave it to States- NEED nationalized medicine- Medicare for example- get everybody in- basic medical care- benefits=national record-keeping system- have some idea where flu epidemics- now extrapolating from emergency room admittances, etc
Europe gets data, we don't have it
Not going to happen; recognize working in fragmented system- how to take steps?
At minimum- CDC trying to standardize electronic record-keeping so info can be shared
Strip people's names, at least get standardized system
Local/State ability- when power goes down- cant refuel- cant refuel- cant bring in food
Need to be sustainable but keep lines open
How- preparation for disasters
Blood/organs- storage

Red tape- moving facility- organ moving to facility available to do Medicare transplants- federal system to only certain locations- have to go through process of Federal Register- etc- takes time- How going to deal with catastrophy- something happening quickly

Not always similarly situated people- locations, areas- not going to put organs near Gulf Coast- is this fair?? Insurance implications

Expectations of people- differ
Learn from our mistakes- past disasters, hurricanes, etc

Immediate/Short-term Catastrophes
Everything we do seems to be dealing with immediate crises
Long-term- changes- gradual-
Beef up infrastructure to deal with this- need to address

Other Issues

Relocations

Psychological health toll, mental health
New Orleans- not same place if move in 300 miles
Long and short term mental health

Disasters/Fear of Disease

Psychological effects, paranoia- leads to problems- resistant mosquitos
Insurance system largely aimed at acute problems- not as much basic mental health, fear, wellness, nutrition, exercise

Access to fresh fruits/vegetables- public health implications
Food banks- crises

Human Populations

Killing ourselves off? Maybe part of evolutionary cycle, our species not meant to continue; How much are we fighting something we can't win? Where best to put our efforts?
Carrying capacity of earth- at what point does push past tipping point
Population growth- Earth will decide if we ignore- either we step in and do something- or Earth will attempt to reach equilibrium- might not be in human species best interest

Political Pressures

- example rebuilding 9th Ward- global warming suggests New Orleans might not exist in future- rebuild?
Fight over whether, when and how much to rebuild
But insurance pays it- don't want to pay to build new- subsidized
Use public money to do it!
Choice
Don't choose to have mosquitoes in county, choose to rebuild, etc
Cost/benefits analysis- early documentations of disease- save money? Helps with transmission of diseases?

Immigration Policy implications

Not surveillance- not in system- and stay out of public eye- don't pay attention to them
CANT DO THIS- just as important to check on these people, still living in country- affected by disease- privacy issues? = worry about shared medical record access

Public Health good avenue to use- all want to help human health- all understand Makes political will- stuff gets done

Fragmentation Problem/ Solution? Template

1. Existing laws- patchwork of existing laws/regulations etc
Fragmented- all affected in some way by these types of changes
Harder than environmental area almost- not near as much as "national health approach" as we need to

2. NEED for data/surveillance- of populations
Especially those not even on radar, immigration concerns
Ongoing treatments, and research
Ability of public health system to illuminate problems- disease, etc
Infant mortality high- we're not doing very well- its getting worse
Climate change- exacerbate current problems, no borders- international or between/among states- state governments
Fragmented non-nationalized system limiting our ability to both respond and plan
National- beyond individual agencies- policy goals- fostered as much as possible
Cant address bigger issues- on local level, need administration- over all-need hook- Ex. facility uses Medicare/Medicaid- federal can attach funding "conscience clauses"- but only reaches these facilities
Fragmentation make impossible to account for public health effect going forward
System in place- can account for acute problems but not long-term changes happening


3. HAVE to change by statutory reform
Laws and regulations- has to be funded
Because no single agency- CMS (oversees medicare/Medicaid), etc, PHS, CDC-but all do certain specific things- tiny little jurisdictions
No central agency to do this- need environmental health agency- need ONE- all these do a little of it
At very least- national health body

Many supporting health care reform- nationalized program- dealing with 40 insurance companies- etc
Private care only- incentives

No depository for information- communicable diseases, too piecemeal
Stuff we're not tracking and we need to track that's probably going to hurt us
By time you realize should be tracking something probably too late
Impact of air and water pollution- reversible quality of life

Hide issues- don't want to deal with- ex: lead
Better deal with acute issues- we feel able to deal with

4. At best, we might be able to have vibrant, robust set of information we need
At worst, not getting better- have to start somewhere
Impacts on attitudes- acceptance of surveillance- (London for ex) privacy rights-government leave me alone- interferes with our ability to do what we need to do
Free capitalism- undermines quality of life, expectations- lots of money or failure-cultural, lifestyle changes

Preventative- surveillance
Private, public- greater good- invest in infrastructures that will allow us to address more holistically- AIDS reporting for example

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