Fluent Essays

501 The discussion requires a minimum of 300 words, 3 scholarly sources, including the textbook. Make sure that you use APA style with your references. Under no circumstances use any direct quotes. Any directly quoted or copied material will result in a zero for the assignment. Let’s be sure to write it in own work 100\% and give appropriately when using someone’s else work. Reference for textbook attached: Williams, S. J., & Torrens, P. R. (2008). Introduction to health services (7th ed.). Clifton Park, NY: Thomson Delmar Learning. Choose one of the following questions to respond to for this Unit’s discussion: Identify and describe at least two (2) reasons solo practitioners are joining group practices? OR Why is the hospital emergency department sometimes used for nonurgent conditions? What are the consequences? 1,500 word count and there is a total of 6 questions each (not including in-text citation and references as the word count), a minimum of 4 scholarly sources are required in APA format. For the 4 scholarly sources, one from the textbook that’s posted below and the other two from an outside source . Let’s be sure to write it in own work 100\% and give appropriately when using someone’s else work. Under no circumstances use any direct quotes. Any directly quoted or copied material will result in a zero for the assignment. Reference for textbook attached: Williams, S. J., & Torrens, P. R. (2008). Introduction to health services (7th ed.). Clifton Park, NY: Thomson Delmar Learning. Knowledge: What do you think is the most important thing to know about prevention? Important because _______________ Comprehension: What is your understanding of the role of prevention vs. treatment and what are the key issues? Application: Give an example of the contrast between prevention and treatment. Research the internet / library for a classic case study. Analysis: What are a few of the root causes of the trend toward prevention? What are the key root causes of the challenges for preventative healthcare? How do prevention and treatment models compare as to outcome? Synthesis: Offer a new idea / solution or your own or one you discovered through your research to address a particular problem or issue with either public health or ambulatory care. Pick one. Evaluation: How is your idea, or the idea of others that you found, better / same / worse than what is being done now? Why is it better? What improved outcomes would you expect from your idea? Has anyone tried the new idea before? If no, why? If yes, how did it work out? hca_501_unit_3.pdf Unformatted Attachment Preview P A R T TRI H R E E C A R D , Providers of Health Services A D R I E N N E 1 9 0 2 T S 141 Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. CHAPTER 6 Public Health: Joint Public-Private Responsibility in an Era of New Threats R I C A R D , Paul R. Torrens CHAPTER TOPICS LEARNING OBJECTIVES A Levels of Prevention D Historical Evolution of Health Promotion and Disease Prevention in the United States R The Structure of Organized Public Health I Efforts in the United States The Role of the Private Sector in Health E Promotion and Disease Prevention N Public Health in an Era of Terrorism and N Emerging Diseases E Upon completing this chapter, the reader should be able to 1. Understand the role of public health services in protecting the health of populations. 2. Differentiate the various levels of prevention. 3. Appreciate the history of public health in the United States. 4. Understand the roles and duties of each level of government in providing public health services. 1 9 0 2 T S 5. Appreciate the increasingly important role of the private sector in public health. 6. View public health services as a collective requirement of all participants in the health care system. Lester Breslow contributed to previous editions of this chapter. 142 Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. CHAPTER 6 Public Health: Joint Public-Private Responsibility in an Era of New Threats In the past, if one were discussing the organization of health services in the United States, that discussion would most likely not include a great deal of detail with regard to health promotion or disease prevention. It would probably not cover in very great detail the organization of governmental public health services either. Health services in the past meant curative and treatment services for the most part, and health promotion or disease prevention services were considered only peripherally, if at all. This is not to suggest that the providers of health R in keepcare services in the past were uninterested ing their patients healthy over a longI period of time. Rather, it is meant to suggest that the model C of health care in the past was focused around acute treatment of short-term illnesses (withAsome notable exceptions). Public health was the job for govR ernmental agencies and was seen as something quite distinct and very rarely overlappingD with curative and treatment services. , In recent years, fortunately, a new paradigm for health promotion and disease prevention has emerged that is based on a public-private A partnership to protect and preserve the health of the Dterrorism American public. The newer challenges of and emerging diseases have further enhanced the R urgency of this relationship. This chapter will examI ine this new paradigm of health promotion and disease prevention and will provide the E modern health care practitioner with a better framework for N understanding and dealing with the major health problems of the public. N E 1 9 To understand the new framework 0 for health promotion and disease prevention, it is important first to provide background information2about the levels of prevention, as included in theTterms primary, secondary, and tertiary prevention. Without S a clear understanding of the levels of prevention, LEVELS OF PREVENTION it would be difficult to understand the relative 143 roles of the public and the private sectors with regard to the enhancement of the health of the public. Primary prevention means averting the occurrence of disease. It includes those measures that are applied or brought into effect before disease is present. These may include general attempts to promote better health by efforts to educate the public, to establish standards of appropriate sanitation, to apply specific methods of protection such as immunizations, to remove occupational hazards, and to protect from known carcinogens. Primary prevention focuses on the promotion of healthy lifestyles and specific protections from known hazards. Secondary prevention means halting the progression of disease from its early, unrecognized stage to a more severe one and preventing the complication or sequelae of disease. It focuses on early diagnosis and/or prompt treatment of a health problem that would otherwise have serious impacts on the health of individuals. This means identifying the presence of a problem before it breaks the clinical horizon and before it becomes symptomatic in most cases, although it also includes attempts to discover disease early while it is still effectively treatable. In the case of coronary artery disease, for example, secondary prevention would focus on identifying individuals at high risk for disease— people, for example, who have a strong family history of heart disease, a history of heavy smoking, a lack of exercise, or a blood lipid profile that is abnormal. These early screening efforts can lead to more specific and focused tests and examinations that might further establish the early diagnosis of potential disease while it can still be constructively handled. Tertiary prevention involves the prevention (or at least, the limitation) of the effects of disease once it has been identified. This level of prevention operates on the premise that simply because disease is present does not mean that its course should be allowed to run unhindered. In the case of coronary artery disease, for example, tertiary prevention would include efforts at cardiac rehabilitation and Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. 144 exercise programs, control of stress, maintenance of optimum weight and diet, and possibly adherence to a medical regimen that might reduce the future risk of further worsening of the disease. In the new paradigm of public/private partnership in health promotion and disease prevention, there is a role for both the public and the private sectors at each level of prevention. Sometimes the roles are quite different and separate; other times the roles are similar, and perhaps overlapping, requiring some collaboration and coordination. The R important message, however, is that there are several different levels on which health promotion and I disease prevention can focus and a wide variety of C interventions that can be sponsored by both public A and private sectors. R D HISTORICAL EVOLUTION OF, HEALTH PROMOTION AND DISEASE PREVENTION IN A THE UNITED STATES D To understand the present circumstances in the R United States with regard to health promotion I and disease prevention, it is important to review the history of public health activities in the United E States. Much of our tradition and organizational N framework for public health activities in the United States today is the product of the thinking and acN tions of previous generations (Brockington, 1956; E Rosen, 1993). Therefore, it is important to know these developments and to understand how they affect our current thinking. 1 In the eighteenth century in the United States, 9 public health activities were, for the most part, limited to individual cities and were focused 0 on protection of the public in those cities from dis2 eases introduced by travelers arriving from elsewhere. Early public health efforts in the United T States in the eighteenth century focused on inspecS tion of ships arriving in harbors along the eastern sea coast and included laws for the isolation and PART THREE Providers of Health Services quarantine of persons suspected to be carrying diseases that might be spread to the general population. In some of these cases, local governments established institutions (pest houses) to voluntarily (or involuntarily) contain suspected disease carriers until they either became noninfectious or, more likely, expired from their illness. During this period, the focus of public health activity in the United States was carried out by local governments and was limited to preventing the introduction of disease into the populations of port cities. The nineteenth century marked a great advance in public health and was described by C.E.A. Winslow as “the great sanitary awakening” (Winslow, 1923). In this period, problems of sanitation were identified as a cause of disease, and public health efforts were focused on the improvement of social and environmental conditions. Housing, water supply, and sewage disposal were all the focus of organized public health activities, with the intent of reducing the disease burden on the public by improving the physical environment. As in the eighteenth century, these activities in the nineteenth century were generally carried out by cities and local governments, with the thrust of organized public health services being carried out on a local level, not necessarily on a state or national one. In Massachusetts, Lemuel Shattuck published a landmark report in 1850 (Report of the Sanitary Commission of Massachusetts) that, for the first time, collected vital statistics on the population of Massachusetts, pointing out the variable threats to health throughout the state as a result of variable sanitary conditions (Shattuck, 1850). His report recommended, among other things, new census schedules, regular surveys of local health conditions, supervision of water supplies and waste disposal, and special studies on specific diseases such as tuberculosis and alcoholism. Probably most important was the recommendation of the establishment of a State Board of Health to enforce sanitary regulations. Massachusetts did set up such a State Board of Health in 1869, becoming the first state in the United States to do so. Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. CHAPTER 6 Public Health: Joint Public-Private Responsibility in an Era of New Threats From the late nineteenth century to the early twentieth century, many of the sanitary threats to public health were brought under control, and emphasis shifted to the prevention of acute illnesses by use of increasingly available immunizations and vaccinations. This shift of emphasis from sanitary and environmental threats toward individual bacteriological threats to health signaled a major change in the role of health departments. In previous years, organized public health services focused more on problems that were sanitary and environmental in nature and did not necessarily involve R individual people; the efforts were more engineering I in nature than they were directly clinical. After the turn of the C century, public health activities began to turn more directly toward the prevention of diseaseA in individual people. Organized public health activities R moved away from structural protections of food, D personal water, sewage, and housing toward more and individual protection through immunization , of children. Organized public health activities remained largely local government activities, but there now began to be increasing state government A activity in public health as well. D As the twentieth century began to progress, federal government activities grew with regard to speR cific health problems related to children. The United States Children’s Bureau was formed in I1912, and the first White House conference on child E health was held in 1919. The Sheppard-Towner Act of N 1922 established the federal Board of Maternity and Infant Hygiene; this act provided administraN tive funds to the Children’s Bureau and also proE vided funds to the states to establish programs in maternal and child health. It also established a pattern of federal-state relationship that 1 was to become standard in later years, with the federal government requiring individual states to9develop a plan for providing services, to designate 0 a state agency to administer the program, and to report on 2 operations and expenditures of the program to the federal government. States that didTnot wish to comply with these regulations were deemed S setting ineligible to receive federal funding, thereby the model of the federal practice for establishing 145 guidelines for public health programs and providing funds to the state to implement programs meeting these guidelines. The Social Security Act of 1935 further expanded the federal government’s leadership role in setting national directions for public health; it also further solidified the federal-state partnership with regard to the delivery of public health services in the United States. Under the terms of the Social Security Act of 1935, grants were provided to the states for aiding state and local health departments to provide maternal and child health services as well as the expansion of the work of state and local governments. This marked the first major effort of the federal government to see that a nationwide system of state and local government public health organizations were put into place. By the time that Joseph Moutin issued his landmark report on local public health services in 1946, almost 80 percent of the total United States population had some access to organized local public health services. These services may not have always been of great depth, but at least a national framework of organized local public health services had been established (Moutin, Hankela, & Druzin, 1947). The period of the New Deal in the 1930s also had a profound effect on the development of governmental public health services, but this effect was unfortunately somewhat negative with regard to the leadership of state and federal government activities. During these times, there was considerable pressure to expand the delivery of personal health services, both curative and preventive, more broadly to the public at large, and there was even some consideration by Franklin Roosevelt’s administration of a mandatory, universal health insurance program that would cover the entire population. Because the role of the federal government in so many other areas was aggressively expanding, it was believed that perhaps there might be a similar expansion of governmental role with regard to the direct provision of health services. Unfortunately, the political backlash against the expansion of the role of the federal government in the direct provision of health services—led primarily Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. 146 by the American Medical Association—was successful in forcing public health officials to assume a more cautious attitude toward the role of government assistance. It became quite clear that there was no strong political support for the expansion of governmental health services, at least in the curative area, and many public health officials limited their activities to those programs and functions that were of a more traditional nature (i.e., sanitation, immunization, early detection, and confinement of communicable diseases) rather than R risk the wrath of organized medicine. This did not mean that the organized public health efforts Iof local, state, and federal government were reduced C in volume, but it did mean that the governments A were much more cautious in expanding the scope of their services, being careful to keep them within R the confines of prevention and not venturing into D treatment. Indeed, it should be pointed out that the feeling , in the United States was so conservative with regard to the federal government’s role in health care that a cabinet-level department focusing on the A health of the United States’ people was not estabD lished until 1953, almost 180 years after the establishment of the republic! Various public health R activities had been initiated by the federal governI ment over the years, but it was not deemed necessary, or possibly, politically feasible, to haveEa federal “department of health,” as health was seen N as a personal matter involving private physicians and their patients. It should be pointed out that this N same type of thinking governed our nation’s E thoughts with regard to education and social welfare: these also were seen as local matters in which the federal government should not be involved,1at least not directly. The creation in 1953 of a federal 9 Department of Health, Education, and Welfare (HEW) provided a national focus for developing 0 and implementing federal government policy with 2 regard to these three important areas. In the period of 1953 to the present, there has T been a great expansion of governmental activity S focused on the public’s health, much of it in the traditional public health areas, but much more in PART THREE Providers of Health Services programs and functions related to the provision of personal health services. The passage of the Medicare and Medicaid programs in the mid-1960s is generally not seen as an expansion of the federal government’s traditional public health role, but in retrospect, the passage of these financing mechanisms for the expansion of personal health services probably has had as major an impact as any of the previous, more traditional public health activities. One further important development in public health thinking and theory was the passage of the federal Health Planning and Resource Development Act of 1974 (PL 93-641). Under this law, the federal government provided the funds to individual states for the establishment of a State Health Planning and Development Agency whose purpose was to plan and control the future development of health services—primarily hospitals—in the United States. The thinking behind the passage of this law was that there needed to be a coordinated planning effort to ensure that the proper type and volume of health services were available in equitable fashion throughout the United States, and that this could be carried out only by some type of publicly mandated planning effort to coordinate and regulate the development of these services. Although this national health planning effort was really a public health effort in the broadest sense, it was never fully connected to the already existing public health structures in the country and was never fully accepted as a legitimate public health activity by many formal public health professionals. The implementation of the Health Planning and Resource Development Act of 1974 was complicated and filled with significant controversy throughout the country; the law has since been allowed to lapse on both federal and state levels, and there is presently no direct attempt, by either federal or state governments, to plan the distribution of personal health services. Lessons from History What can be learned from this review of the evolution of organized public health efforts in the United Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. CHAPTER 6 Public Health: Joint Public-Private Responsibility in an Era of New Threats States? What important political, social, and cultural trends can be identified that will tell us more about the current and future status of public health in the United States? There are several major points to emphasize. First, it should be pointed out that organized public health activities in the United States began in local, seaport communities and only gradually expanded to state and federal government agencies. Indeed, the Constitution of the United States reserves to the states all functions (such as health) R governnot specifically earmarked to the federal ment. For most of our country’s history, I public health was an activity that was primarily carried C out by a local or state governmental agency, and it was only after World War II that itAwas perceiv ... Purchase answer to see full attachment