Healthcare in the United States has undergone considerable changes for little over the last hundred years. Although the conversations about formal arrangements from the state to improve health care delivery in the country began in the early 20th century, the available history of quality health care before 1960 contains fragments of unrelated events, contrasting with the streamlined systems that are evident today (Sheingold & Hahn, 2014).However, events that happened prior to 1960 played a significant role in shaping the current robust health system.
Recognition of the need to make deliberate efforts to improve the quality of health in the US in the 1960s was an accumulation of efforts stretching back for almost a century (Marjoua & Bozic, 2012).These efforts generated discussions on the need to reform the health care system and culminated in the repeal of the Social Security Act in 1965.The provisions of the Social Security Amendment resulted in the creation of two critical health programs: Medicare and Medicaid. The introduction of these programs shattered the barriers that existed between the health care system and the federal government and was the first major effort by the US government to provide universal insurance coverage to the public(Sheingold & Hahn, 2014; Marjoua & Bozic, 2012). Arguably, the amendment stands out as one of the landmark reforms that have ever been made to the health care system in the United States history.
Medicare provides insurance coverage for the elderly. Its introduction was mooted when it became clear to the Lyndon Johnsons administration that private insurance providers were incapable of providing health insurance coverage to elderly patients. On the other hand, Medicaid offers financial help to a particular category of people-children, pregnant women, people with disabilities, parents with eligible children, and the elderly that need nursing home care. The defining characteristic of these groups of people is that they have limited financial resources to pay for healthcare services hence the governments intervention (Marjoua & Bozic, 2012). After 48 years of existence, the health care system once again underwent a major revision after the enacted Affordable Care Act 2010 came into force in January 2014.
How Health Care Systems Interact with Public Health Initiatives
Like the form of Social Security Act of 1935, the amendments of 1965 experienced some challenges in meeting the health needs of the public. That is, after the enforcement of Medicare and Medicaid, there was a realization among stakeholders in the healthcare system that quality of services to patients was an essential component of health delivery. As a result, these programs have been revised over the years to accommodate the health needs of the public in the context of the social, political and economic realities of a particular period (Marjoua & Bozic, 2012). Due to quality issues associated with the two programs, reforms became imperatives to the stakeholders of the healthcare system hence the enactment of the Affordable Care Act (Obamacare) in 2010.
The history of quality in health care can be traced back to hundreds of years ago to pioneers such Ignaz Semmelweis, Florence Nightingale, and Ernest Codman. Semmelweis was a 19th-century obstetrician who emphasized and popularized the importance of hand washing in medical care. Florence Nightingale, the English nurse, made major findings in regards to quality of health care. While treating injured British soldiers in Eastern Europe, Nightingale discovered that poor living conditions were associated with high mortality rates among soldiers at army hospitals. Moreover, Ernest Codman, an American surgeon, pioneered the setting of hospital standards, emphasized strategies that helped to assess the quality outcomes of health services (Burstin, Leatherman, & Goldmann, 2016; Sheingold, & Hahn, 2014; Marjoua & Bozic, 2012). Inferentially, the discoveries of the mentioned early medical practitioners demonstrated that the quality of circumstances in which individuals live can play a significant role in influencing the quality of healthcare outcomes. For this reason, Burstin et al.(2016) post that health care reforms in the recent decades have focused more on the circumstances that make people sick and those that aggravate the conditions of sick patients.
Despite having the most technologically intensive medical practice globally and also being the highest spender in health care among the developed nations, the health outcomes in the US are inferior compared to other developed countries. This scenario stems from the failure of Americas health system to provide care to a considerable size of the population (Chernichovsky & Leibowitz, 2010). However, quality strategies which have been implemented in the recent years have refocused their attention to the health of the population. This approach is meant to forestall sickness and also reduce chances of worsening of illnesses in already affected persons (Burstin et al., 2016) by instituting various interventions that create conditions that were pioneered and popularized by Semmelweis, Nightingale, and Codman. As a result, the Public Health initiatives were born.
The Public Health initiatives are a host of strategies and action plans that seek to guide health activities and planning across the United States in so far as reduction of exposure of populations to circumstances which may worsen their medical conditions or cause new infections (CDC, 2017). These strategies and action plans improve the health of communities through enhanced access to treatment and also emphasizes on preventive measures such as modification of individual behaviors that are deemed to expose people to risks of infections. For instance, public health initiatives platforms are used to create awareness on the dangers of the use of tobacco products (Montini, George, Martin-Mollard, & Bero, 2010). These initiatives focus are premised on the role of communities, education of the public, environmental risk exposures, the economics of public health initiatives, and the role of government agencies in actualizing high-quality outcomes among populations. The evidence-based practice provides a framework upon which these initiatives are implemented.
Communities are considered integral in actualizing the objectives of public health initiatives. This strategy connects with residents and local leaders within a community to facilitate action plans. Community involvement may involve education of the community on the dangers of certain behaviors on individual health. Communities may further be involved in support of the sick and the elderly (CDC, 2017). This is to ensure that populations access to care with the help of people they relate well within the community.
Environmental exposures focus on the extent to which exposures to environments contaminated with harmful chemicals within the community. It can also involve assessment of risks to which certain populations are exposed, especially in areas that have been adversely affected by crime, drug abuse and poverty and evaluation of such risks ability to cause diseases in the current circumstances and the future (CDC, 2017; Salam, Li, Langholz, & Gilliland, 2003).Efforts in this respect are meant to be preventative. Economics of the initiatives and government agencies are meant to facilitate community initiatives.
The evidence-based framework encompasses a host of interventions in the health sector which have been proved through scientific enquires as effective in addressing health issues affecting the public. Evidence-based practices aim at reducing the risks to which a given population is exposed by designing of action plans that are specific and communal (Prabhakaran, Singh, & Reddy, 2011). Stated in another way, it focuses on preventative/palliative methods that have worked in mitigating risk exposures. For instance, studies on the increase of taxes and other forms of regulation on tobacco products have shown that such measures reduce tobacco consumption. The effect is even more significant in on younger persons and those that hail from low-income environments due to higher levels of price-elasticity for tobacco consumption (Prabhakaran et al., 2011; Montini et al., 2010). Such measures can be effective in encouraging quitting among smokers since they have been proved effective through public health initiatives.
Current Event and Health Care
Since the Obamacare became effective in 2014, several objections have been raised in regards to the effectiveness of the Act. The Trump administration has shown the interest to repeal the Affordable Care Act for what the Republicans term as the negative effects of socialized health care. This is likely to deny millions of Americans who access insurance cover since the Act took effect. Increase in efficiency in the delivery of care is also likely to be compromised if the Act is repealed as being touted by the Republicans. As a result, recent improvements in the health sector appear to be headed backward (Oberlander, 2017).Although recent attempts to repeal Obamacare have been shot down in the Senate several times, whatever happens to the Act(repeal or replacement) in the future will have a far-reaching impact on the healthcare system in the United States.
Religious and Cultural Impact on Public Health Initiatives
A majority of people are affiliated with a religion or some form of faith. Religion affects attitudes to medication which, in turn, influence health outcomes (Arousell & Carlbom, 2016).According to Arousell and Carlbom, (2016) sexual disparities exist between Muslims and Christians in sexual and reproductive health care outcomes. These discrepancies are as a result of the variant perceptions, behaviors and attitudes in matters of health held by different categories of people (Hernandez & Blazer, 2006). Given this, it is crucial for health initiatives to consider the religion of the target populations when designing strategies and action plans in public health initiatives.
Social and cultural factors on health play a pivotal role in determining the quality of health outcomes. Variables such as ethnicity, gender, sex roles, poverty and derivation, immigration status and acculturation, and social networks influence health outcomes. Social and cultural factors influence behaviors, attitudes, perceptions, and incomes, among others. The enumerated factors have been to influence to access medical services and also recovery processes of patients (Hernandez & Blazer, 2006).
Americas health care system has made significant progress since the introduction of Medicare and Medicaid in 1966. Whereas attention in the 1960s focused on access to medical care, todays efforts emphasize on the quality of health outcomes of populations as the most viable strategy to tackle health care problems in the country. This is what is by public health initiatives championed in health care. As of today, the health care system is much better than what it was a few decades ago despite the political uncertainty in regards to the Affordable Care Act. This has been realized by continuously adopting evidence-based practices which inform the process of designing medical interventions for communities.
Arousell, J., & Carlbom, A. (2016). Culture and religious beliefs in relation to reproductive health. Best Practice & Research Clinical Obstetrics & Gynaecology, 32, 77-87. doi:10.1016/j.bpobgyn.2015.08.011
Burstin, H., Leatherman, S., & Goldmann, D. (2016). The evolution of healthcare quality measurement in the United States. Journal of Internal Medicine, 279(2), 154-159. doi:10.1111/joim.12471
CDC. (2017, May 23). National H...
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