Question

• Consider the U.S. national/federal health policies that have been adapted for the global health issue you selected from the WHO global health agenda. Compare these policies to the additional country you selected for study.
• Explain the strengths and weaknesses of each policy.
• Explain how the social determinants of health may impact the global health issue you selected. Be specific and provide examples.
• Using the WHO’s Organization’s global health agenda as well as the results of your own research, analyze how each country’s government addresses cost, quality, and access to the global health issue selected.
• Explain how the health policy you selected might impact the health of the global population. Be specific and provide examples.
• Explain how the health policy you selected might impact the role of the nurse in each country.
• Explain how global health issues impact local healthcare organizations and policies in both countries. Be specific and provide examples.

This is about covid 19

Answer 1

·ANSWERS

Many global health issues can directly or indirectly impact the health of the United States. Outbreaks of infectious diseases, foodborne illnesses, or contaminated pharmaceuticals and other products, cannot only spread from country to country, but also impact trade and travel.

The U.S. health care system has been undergoing significant transformation in recent years. The Affordable Care Act has ushered in new health coverage options, insurance market regulations, and consumer protections while at the same time promoting innovation in care delivery in both the public and private sectors. At the moment, however, the forecast for the law is unclear.

Regardless of what happens, state and federal policymakers will be expected to ensure that all Americans have access to affordable health care and to find the most effective ways of delivering and paying for care. The Commonwealth Fund’s Federal and State Health Policy program seeks to strengthen the capacity of legislators and officials to adopt and implement policies that can move the nation to a high-performance care health system. By building relationships with these important audiences, we’re able to connect them to the research produced by Commonwealth Fund experts and grantees.

Federal and State Health Policy efforts focus on:

• Getting evidence-based insights and analysis in the hands of federal and state policymakers, policy influencers, and stakeholders.
• Disseminating and sharing lessons learned in policy and practice.
• Helping states learn from one other and fostering dialogue among state and federal policymakers.
• Identifying the policy priorities of state and federal officials to inform The Commonwealth Fund’s programmatic strategies

1) Explain the strengths and weaknesses of each policy.

Advantages:

• · One of the great strengths of American healthcare system is its strong private sector orientation, which facilitates ready access to all manner of services for those with stable coverage and strongly encourages on-going medical innovation by product manufacturers.
• · An independent team of researchers in Washington State, frustrated by the slow federal response, started testing on their own. At state level, public health agencies stepped in to fill the vacuum in leadership.
• · The rapid advance of medical technology over the past half century has unquestionably improved the health status for millions of American citizens.
• · Employer-sponsored insurance has played a crucial role in retaining this strong private sector presence in the U.S. health sector. In general, employer-based insurance is flexible and can adjust quickly to changing patterns of accepted medical practice.

· Weakness:

• · The first challenge is the decentralization and weakness of the public health and disease surveillance systems. When facing a pandemic, a nation as large as the U.S. needs a central agency to collect and monitor data from abroad and from within the country to detect emerging disease threats early and coordinate a response. These functions are decentralized in the U.S.
• · Half of healthcare spending in the U.S. is private spending. Spending from our government is channeled through private delivery systems. Some weaknesses of that approach are that those private organizations operate with a high degree of independence. It is rare for the government to order them to change their procedures and coordinate except in a crisis.
• · They also rely on a fee-for-service revenue stream that depends on people coming in for face-to-face visits.
• · Second major challenge in this pandemic is the capacity of hospitals: bed capacities are lower in the United States than in most other high-income nations. In part this is because we let market forces, who can pay the most, drive the availability of services. There is a misallocation of resources: we have too few intensive care units’ beds and too few ventilators for the crisis we are facing.
• · Another third weakness is the lack of universal insurance coverage: we still have around 10% of the population lacking any health insurance and half of Americans reporting that they are underinsured.
• · Another weak point is that Americans may be in worse health than their counterparts in other countries. On average Americans are a bit younger than people in Japan or in Europe. But a higher proportion of the population suffers from chronic diseases: high cholesterol, diabetes, heart problems, and respiratory conditions. The excess burden of chronic diseases is partly a result of inadequate insurance and access to care.
• · It is not portable or owned by the worker. It therefore leaves large gaps in coverage for those loosely attached to stable jobs. Moreover, because many millions of workers change jobs and insurance frequently, there is little incentive for prevention—the financial rewards of improved health do not accrue to those making the investment.

· Today’s open-ended federal tax exemption for employer-paid premiums encourages overly expansive coverage, which is the fuel for rapid cost escalation.

2) Explain how the social determinants of health may impact the global health issue you selected. Be specific and provide examples.

Social determinants of health such as poverty, unequal access to health care, lack of education, stigma, and racism are underlying, contributing factors of health inequities. The Centers for Disease Control and Prevention (CDC) is committed to achieving improvements in people's lives by reducing health inequities.

Healthy People 2020 highlights the importance of addressing the social determinants of health by including “Create social and physical environments that promote good health for all” as one of the four overarching goals for the decade.

The Social Determinants of Health topic area within Healthy People 2020 is designed to identify ways to create social and physical environments that promote good health for all. All Americans deserve an equal opportunity to make the choices that lead to good health. But to ensure that all Americans have that opportunity, advances are needed not only in health care but also in fields such as education, childcare, housing, business, law, media, community planning, transportation, and agriculture. Making these advances involves working together to:

• · Explore how programs, practices, and policies in these areas affect the health of individuals, families, and communities.
• · Establish common goals, complementary roles, and ongoing constructive relationships between the health sector and these areas.
• · Maximize opportunities for collaboration among Federal-, state-, and local-level partners related to social determinants of health.

Emerging Strategies to Address Social Determinants of Health

• A number of tools and strategies are emerging to address the social determinants of health, including:
• · Use of Health Impact Assessments to review needed, proposed, and existing social policies for their likely impact on health
• · Application of a “health in all policies” strategy, which introduces improved health for all and the closing of health gaps as goals to be shared across all areas of government.

As COVID-19 continues to dramatically transform daily life for most Americans, health disparities are glaringly coming into view, further confirming the link between social determinants of health (SDoH) and health outcomes.Much of the dialogue that has dominated the national efforts to control the spread of the virus has focused on avoiding crowds and practicing social distancing, but there's a growing consensus about the role of economic and social conditions during this global pandemic

While population health leaders continue to explore ways to curtail the spread of the virus, they must also take SDoH into account. Otherwise, we risk not only undermining the efficacy of existing efforts but compounding existing inequalities

Food Insecurity

• Few things so vividly illustrate the complexity of the coronavirus outbreak and efforts to control its spread than the issue of food insecurity. Defined as lack of consistent access to enough food . food insecurity affects 11.1% of American households and one in seven house-holds with children for at least some part of the year.
• States are responding to these issues in different ways, but distribution remains a central challenge. That's why, in California, for example,The National Guard May be deployed as part of the state's efforts to reduce food insecurity.

Housing Insecurity

• "Shelter in place" is a new norm for millions of Americans, with the majority of the country's population now under orders to stay at home as much as possible. Yet as national unemployment rates continue to balloon — and more than three million   applying for unemployment benefits in a single week — many of those homes look increasingly precarious. And for the estimated 15,000 families with children under 18 that live for the most part unsheltered, the meaning of "shelter in place" itself remains unclear.
• The response on the part of the government so far has been mixed. Measures to freeze rent hikes for example, may offer valuable protection to many who are vulnerable right now, but they'll hardly matter to the more than 500,000 Americans who are currently homeless. The bigger picture, in both the short and long term, is that more affordable housing options and other solutions are desperately needed.

Access to Exercise Opportunities

• U.S. health officials warn that the coronavirus can be spread when traces of the virus are left on commonly used surfaces — say, dumbbells or subway poles. What's more, viruses that cause illnesses like COVID-19 are believed to be able to live on surfaces and inanimate objects for days at time. which is part of the reason health officials also urge Americans to take precautions when using shared spaces. Not surprisingly,most gyms are now closed in response to the escalating global pandemic.
• Over the short term, this is one area where higher-income Americans may directly experience adversity related to the coronavirus outbreak to a larger degree than lower-income peers. Of course, the keyword there is short term.

Key Takeaways

• Even as the coronavirus situation continues to evolve, it has already radically altered the texture of daily life for nearly all Americans. Yet how and where those impacts are felt conform to an all-too-familiar pattern, with lower-income and other vulnerable populations bearing a disproportionate share of the risk. It's a vivid illustration of how closely linked SDoH are to overall health outcomes. Food and housing insecurity, and access to exercise opportunities are only a few factors where we'll continue to see spikes in the number of individuals affected. Public health leaders should expect surges in the number of individuals impacted by social isolation, unemployment, and changes in income.
• To lessen those risks and help drive better outcomes, policymakers, payors, and others must keep SDoH top of mind as they carry out the vital work of treating patients and preventing the further spread of the virus. And to support mobilization efforts, Healthify has compiled a list of resources across CDC, state health departments, and city health departments and is continuing to add to the list.

3) Using the WHO’s Organization’s global health agenda as well as the results of your own research, analyze how each country’s government addresses cost, quality, and access to the global health issue selected.

Health Care Systems: Three International Comparisons

• The troubling state of health care in the United States has drawn policymakers, business leaders, and health experts to search for viable ways to reform a system that, by most accounts, was in the throes of an unprecedented crisis.
• America's interest in other nation's health care systems has been spurred by growing discontent over the seemingly inverse relationship between health care expenditures and the access to necessary services in the U.S. health care system.
• Every other advanced industrial nation has virtually universal access to decent medical care, at much lower cost than in the United States. Escalating U.S. health care costs are linked inextricably to the particular system of health care organization, delivery, and financing that has evolved in the United States.
• Industrialized countries have chosen different approaches to addressing their shared concerns.
• In this health care systems of three industrialized democracies: the United States, Canada, and the Netherlands are compared .

The United States

• The United States is primarily a capitalist society, where goods and services are provided in exchange for money. Health care delivery has followed this model in a fee for service system. In other words, the patient directly pays the doctor who provides the service.
• There have been increasing numbers of health insurance systems, however, because most people cannot afford the cost of new high-technology services. While being called "health" insurance, it is actually "illness 'insurance, which pays some or all of the costs of medical care in case of illness.
• About 85% of the U.S. population is covered by insurance plans, and insurance now pays the majority of health care costs. Insurance pays about 90% of the money spent on hospital care, and 74% of the money paid to doctors [Iglehart, 1992a].
• Health insurance is available from several sources. Private health insurance is provided by private companies. Subscribers pay health insurance companies a monthly fee for health insurance. In return, the company agrees to pay the doctor and hospital costs if the subscriber gets sick. There are different levels of coverage that a subscriber can purchase, but the cost of a health insurance policy is also set by the amount of risk the subscriber is willing to take.
• The more expense the subscriber is willing to pay, as either deductible or co-payment, the less the insurance company will charge for the insurance. Some Americans purchase their own health insurance, but most employers pay for the health insurance of its workers [Iglehart, 1992M. Often this insurance is considered an employment benefit in addition to the employee's salary. A third provider of insurance is the United States government by designating part of its budget for health care which flows into two main programs for medical insurance.

The Medicare system provides medical coverage for those over age 65. In addition, younger people with certain disabling illnesses or injuries are eligible for Medicare coverage. Those who are under age 65, but do not have health insurance because they are too poor to afford it, are eligible for medical coverage through Medicaid. Medicare is funded by federal income taxes, while Medicaid is funded by a mixture of state and federal taxes. Thus, medical insurance for those who cannot obtain it elsewhere is actually paid for by the more affluent citizens--not directly, but through taxes.

In order to get Medicaid assistance, someone must apply for and prove that he or she is poor enough to qualify for the program. Furthermore, only 42 percent of qualified people receive Medicaid assistance. Medicaid programs vary from state to state, but the low fees and administrative bureaucracy can be so difficult that some doctors refuse to see patients with Medicaid insurance [Igl&nart; 1992a; Grumet, 198~ij.

Freedom of choice is one of the great advantages of the American health care system. Doctors can choose where to practice medicine, and patients can choose the doctor from whom they want to receive care Because of the combination of government and private insurance funding for medical care and research, medical care of high technical sophistication is available.

However, the outrageous cost of medical care in the United States is one of the greatest disadvantages of our system. Costs are rising at a faster pace than most other expenses. Total health care expenses in the United States were about $666 billion in 1990, accounting for 12% of the gross domestic product, the highest percentage in the world [Iglehart, 1992M. In 1990, health costs were rising at 12% per year. Many Americans believe this rate of growth is out of control and must be slowed [Igiehart, 1992aj. Even with this large expenditure, 36 million Americans 17 percent of the total population who have no health insurance.

The only options available to these people for medical care are hospital emergency rooms, public clinics, or physicians offices where they pay out of pocket or are treated as charity patients. Uninsured Americans often do without preventive care for manageable conditions, such as treatment for chronic illnesses like high blood pressure or maternity care, but this is something that they are denied [Iglehart, 1992a].

Administrative costs of health care are also high because of the multiplicity of funding sources, insurance carriers, payment mechanisms, and hospital administration systems.,

Health maintenance organizations (HMO's) and preferred provider organ17~tion~ (PPO's) are the most common examples. In a HMO, subscribers pay a set fee to be a patient in return for an agreement that the HMO will cover all the patient's medical care at no additional cost. The doctor who works for the HMO is paid a salary by the HMO. The HMO makes money if it does not spend all of the fee on health care; thus, the HMO has an incentive to keep the patient as healthy as possible by providing preventive health care

Canada

Canada also has a capitalist economy and its health care uses a fee-for-service system, but its plan is administered by government entities. In this system, there is universal coverage for health care services; moreover, all Canadian citizens are covered! Each of Canada's 10 provinces manages itself, but there are very few differences.

Furthermore, most of the cost of the plans is paid by the provincial governments through subscriber premiums and through taxes.

The Canadian government provides additional funds to the provinces through a system of grants and the transfer of funds generated from personal and corporate income tax revenues.

For example, all residents of Ontario are entitled to participate in the health plan regardless of age, health status, or financial means. A payroll tax on employers pays 13 percent of the provincial expenditures, and general taxation provides the rest of the province's contribution. The benefits covered in the plan include doctors' services in the office and in the patients' home, hospital care in a ward of four or more patients, prescription drugs in the hospital, and care in long-term facilities such as nursing homes. However, the plan does not cover drugs taken at home, dental care, or cosmetic surgery.

Doctors are paid according to fees which are determined by negotiations between the provincial government and an association of doctors. Hospital expenditures are also regulated by the government. In other words, all expenses regarding expenditures are monitored and approved by the government.

Canada also has its advantages and disadvantages. The main advantage is that there is universal health care coverage. Health care costs are also rising in Canada, but because each province has only one payment source, the administrative costs are appreciably lower. As disadvantages, the control of hospital expenditures has created a situation where some forms of technology such as cardiac surgery have led to increasing waiting lists and delays faced by patients. The physical condition of some hospital facilities have also deteriorated because they lack sufficient funding for maintenance.

The Netherlands

The Netherlands has adopted a third system which is socially administered. Three sources of health-care funding exist in the Netherlands: the sickness funds, private health insurance, and the Exceptional Medical Expenses Act.

Approximately 62 percent of the public receives health services from the sickness funds. There are about 35 regional funds, and they serve all individuals and their families whose income is below a specified level. A national "general fund" supports the sickness funds which is itself supported by contributions from employers, employees, retirement funds, and unemployment funds. The rest of the population (38 percent) purchases private insurance. The cost of the insurance is based on the age and sex of the purchaser, and employees who purchase insurance receive a contribution from their employer. Finally, the Exceptional Medical Services Act, covers the cost of long-term care and maternal and child health services. This fund is supported by government contributions and mandatory contributions by employers [Kirkman-Liff, 1991].

Doctors in the Netherlands are either family doctors or specialists who are paid on a fee-for service basis.

Family doctors are paid by private insurance or by the sickness funds, and family doctors are the ones who decide when a patient needs to see a specialist. Hospitals are all nonprofit, and they annually receive income from the sickness funds and the private insurers in their area. Similar to the U.S. and Canada, rising health care costs and administrative costs in the Dutch system are genuine concerns .

Comparisons

• When these three systems are compared using 1989 data, per capita health expenditures were $2,354 in the U.S., as compared to $1,683 in Canada and $1,135 in the Netherlands. Personal health services consumed 11.8 percent of the gross domestic product in the U.S., compared to 8.7 percent in Canada, and 8.3 percent in the Netherlands .
• It should be noted that the GDP of the United States is higher than that of the other countries; therefore, the United States' higher percentage of health care expenditures is significant.
• While it is difficult to compare how well health care is working in relation to other countries, the easiest way to measure differences is by reviewing statistics such as life expectancy, infant mortality (deaths in the first year of life), and perinatal mortality (deaths within seven days of birth). Life expectancy at birth in the U.S. is 71.5 years for men and 78.3 years for women; in Canada, 73 years for men and 79.7 years for women; and in the Netherlands 73.3 years for men and 79.9 for women. Infant mortality is 10 percent in the US, 7.2 percent in Canada, and 6.8 percent in the Netherlands. Perinatal mortality has been suggested as a better measure of the effect of medical intervention; it is 9.7 percent in the US, 7.6 percent in Canada, and 9.2 percent in the Netherlands.
• What these outcomes shows that better health care does not necessarily result from higher expenditures on care.
• There are also many factors that affect health, including social and cultural conditions, social and economic status, and different priorities. The traditional way of assessing health status is to analyze age-adjusted, statistical data on mortality, life expectancy, and morbidity or illness.
• A major problem in using vital statistics to make international comparisons of health arises from differences in reporting and compiling the statistics, especially in the timing of recording births and deaths.
• There are limitations in using only mortality data as the indicator of health status; with more people living longer than ever before, measures of health other than death are necessary to characterize the disease and disability patterns of an aging population. Similarly, there are limitations in using only disease incidence as the indicator of health status; as more people receive medical care it is likely that more people will be diagnosed, thereby increasing the number of conditions reported in health surveys.
• Regardless of the system that each country has invoked, the goal is to produce a system that will provide the highest quality of health care to the greatest number of people. Bill Clinton is trying to make health care policy improvements within the United States, and his goal is to create a system that will provide health care for all Americans while simultaneously reducing costs.
• The largest battle, however, is that Clinton is fighting conflicting opinions about claims to medical treatment. Health care is viewed as a privilege in America rather than a right, and policymakers are encountering problems because it is difficult to form a universal health care plan when people have different views on distributing services.

World Health Organization

• In the early 19th and 20th centuries, international discussions recognized the need for creating an international health organization.
• The international community founded the World Health Organization in 1948, dividing the globe into six regions, and over the past 50 years it has gathered data in order to make assessments of global health and to project future health trends. The cross--national analyses they provide enable us to consider lessons from abroad, and to compare ourselves to our global neighbors
• The World Health Organization's focus has shifted from infectious diseases to developmental progress, but the present global situation has forced WHO to focus on reforming health care systems because of a decrease resources, both economic and supplemental.
• WHO works with the various countries in order to noticeable improvements, and the organization's role takes on two main forms: direction and coordination of international health work and technical cooperation with countries.
• The organization works with each country in order to create a strategy that will best support their needs. In order to suggest reforms that will yield successful results, WHO gathers statistical information, which includes vital statistics and disease surveillance. It can then carefully analyze the data in order to endorse a health care program that will support a country's strategy.
• The main goals of WHO are to strengthen national health services, promote and protect health, prevent and control specific health problems, and promote medical health research in an effort to foster a healthier global environment.
• The 1998 World Health Report makes predictions to the year 2025 which are generally optimistic. It states that the socio-economic developments and major advances in health have benefitted people in most countries, and that these people will continue to prosper unless there is a major economic crisis. Ironically, the major problem lies within this statement because progress has not been universal. Clearly, health care systems will become increasingly important to prosperous nations as the growing number of elderly people increases.

4) Explain how the health policy you selected might impact the health of the global population. Be specific and provide examples.

The welfare state is potentially an important macro-level determinant of health that also moderates the extent, and impact, of socio-economic inequalities in exposure to the social determinants of health. The welfare state has three main policy domains: health care, social policy (e.g. social transfers and education) and public health policy.

Understanding the impact of specific public health policy interventions will help to establish causality in terms of the effects of welfare states on population health and health inequalities.

• Socio-economic inequalities are associated with unequal exposure to social, economic and environmental risk factors, which in turn contribute to health inequalities. People with higher income, employment and educational opportunities have lower mortality and morbidity .
• Social inequalities in health are widespread,
• for example in Europe where an estimated 80 million people are living in relative poverty . Important European differences in health outcomes have been attributed to variations in how the welfare state is administered .
• The welfare state is therefore potentially an important macro-level determinant of health which also moderates the extent, and impact, of socio-economic inequalities in exposure to the social determinants of health.
• The welfare state has three main policy domains: health care, social policy (e.g. social transfers and education) and public health policy.
• This planned umbrella review examines the latter; its aim is to assess how European welfare states influence the social determinants of health inequalities institutionally through public health policies.
• Understanding the impact of specific public health policy interventions will help to establish causality in terms of the effects of welfare states on population health.
• The World Health Organization emphasises how public health refers to ‘all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole’.
• The system of administering public health to populations could be the private or voluntary sector, but in European welfare states, it is most usually instigated by governments—centrally, regionally or locally.
• Welfare states may impact the health of citizens either indirectly through influencing the social determinants of health (e.g. through changes to social policy such as education, social security and housing) or directly through health care systems or policies aimed at promoting public health specifically
• The nature of public health interventions means their influence percolates into many aspects of how we behave, live and work. For the purposes of this review, we categorise these interventions into fiscal policy, regulation, education, preventative treatment and screening. It is also helpful to consider the broad areas by which local and national governments may intervene and regulate.
• Global health is the goal of improving health for all people in all nations by promoting wellness and eliminating avoidable disease, disability, and death. It can be attained by combining population-based health promotion and disease prevention measures with individual-level clinical care. This ambitious endeavor calls for an understanding of health determinants, practices, and solutions, as well as basic and applied research on risk factors, disease, and disability.

For Example:

In the United States, an area of study, research, and practice has emerged to contribute to the achievement of global health. The U.S. global health enterprise involves many sectors (both governmental and nongovernmental) and disciplines (within and beyond the health sciences) and is characterized by intersectoral, interdisciplinary, and international collaboration. U.S. leadership in global health reflects many motives: the national interest of protecting U.S. residents from threats to their health; the humanitarian obligation to enable healthy individuals, families, and communities everywhere to live more productive and fulfilling lives; and the broader mission of U.S. foreign policy to reduce poverty, build stronger economies, promote peace, increase national security, and strengthen the image of the United States in the world.

The U.S. government, along with U.S.-based foundations, nongovernmental organizations, universities, and commercial entities, can take immediate concrete action to accelerate progress on the urgent task of improving health globally by working with partners around the world to scale up existing interventions, generate and share knowledge, build human and institutional capacity, increase and fulfill financial commitments, and establish respectful partnerships.

5) Explain how the health policy you selected might impact the role of the nurse in each country.

In the hospital setting, nurses play a vital role in helping patients learn how to make healthy choices at the bedside, understand their doctor's diagnosis, and how to manage symptoms. They then arm them with the best information at discharge, so they understand what to do once they get home.

Nurses’ influence on health policy protects the quality of care by access to required recourses and opportunities.

• Nurses have individual views on health care issues and influence health care policies in different ways. With a common understanding of nurses’ policy influence as a concept, nurses will recognize the importance of policy making in the health sector and their influence on this process and also on patients’ outcomes.
• Nurses’ influence in health polices protects patient safety, increases quality of care, and facilitates their access to the required resources and promotes quality health care .
• The nursing profession is based on the science of human health and the science of caring. It operates from a framework that values all people in a holistic way and seeks to foster and advance people’s health throughout their lifespans and across all levels of society.
• Through policy work, nurses can and should influence practice standards and processes to assure quality of care. Nurses who influence policy help shape the care that will be provided today and tomorrow. Policies also impact resource allocation to support delivery of healthcare.

• More than ever, nurses are present in every healthcare setting and possess a unique role in formulating policy
• Many of the leading nursing organizations promote active participation by nurses in policy formulation. For example, the American Association of Colleges of Nursing emphasizes the role of nursing in policy and identifies, in its Essential   documents, the expected policy involvement that should be addressed in educational programs at the baccalaureate, master’s, and doctoral levels of professional nursing, including advanced practice.
• The National League for Nursing and the American Nurses Association also expect nurses to address policy as part of their professional role.
• ..........................