The decision, plans and actions that are undertaken by a community or authority with the aim of achieving specified health care goals is said to be a health policy (WHO, 2011). A health policy is particularly important since it is through it that health authorities can plan and make decision for the future and able to prioritize to deal with existing challenges. The existing challenges in health today have greatly overwhelm expectations. It is with effective health policies that will manage the expectations. Health policies can be grouped into various categories, including personal health care policy, pharmaceutical policy and public health policies. Public health policies are critical since they reform the general population health.
Some of the public health policies are vaccination policies, alcohol abuse and tobacco usage control policies. Health policies are comprehensive and cover how to finance the quality of care and health equity amongst other health issues. The World Health Organization (WHO) is mandated to develop global health policies and to set guidelines on how nations should develop their own policies. This essay will look at the context that reform a health policy using the United States as a case study.
The United States of America, hereafter referred to as the United States (US) is a federal republic made up of 50 states and a federal district. The US covers a large and extensive geographical region occupying most of North America. The social and geographical demographic are therefore quite different across the states. The health policies of US should therefore be reformed by these geographical and social difference as well as political contexts. It is important to note that US has a bi-partisan democracy with the republicans and the democrats each championing this ideology. We shall therefore review how these factors help to reform the health policies in America today and how the policies are affecting the lives of Americans.
There are three main areas that reform a health policy within a nation. These include; situational factors which are the transient factors reformed mostly by politics; structural factors which are the unchanging factors within a society like the economic development of a state; and finally the cultural factors which are influenced by the people’s beliefs and cultures. A nation’s health policy may be reformed by one or all of these factors. Cultural factors, for instance, play an important role in health matters that concern religious groups. Abortion laws in the US, States which are dominated by Christians are often strict since Christianity does not support abortion (Devettere 2010, p. 266).
One area that politics reforms policies in public health is insurance. National health insurance in the United States, unlike neighbouring countries such as Canada is supported by a dual system (Boychuk 2008, p. 10). The system combines public health insurance with private health insurance. Private health insurance is usually provided by employers. Those who cannot afford either of the two plans remain uninsured. Un-insurance levels in the US remains high depriving the many poor citizens access to quality healthcare system. Private healthcare on the other hand has far much more challenges yet members pay lots of funds.
Privatisation is synonymous to commercialisation and most of these healthcare providers are chasing profits and deny deserving patients insurance claims. Privatisation was thought to be a solution to healthcare systems in America as it brings competition and choices to the market. It however turned out that choice is just as illusion when it comes to health care and every citizens, irrespective of their financial well-being deserves access to quality and affordable healthcare (Gumbiner & Gumbiner 2006, p. 23).
The nurses, who are majorly responsible for public health, have been vocal about the way politics have been shaping policies in America. Abood (2007) in her article “Influencing Health Care in the Legislative Arena” in The Online Journal of Issues in Nursing asserts that politics, laws, and regulations in the healthcare environment are imposed by government agencies, insurers and institutions. The bodies that develop the policies do not put into full consideration the implementation. Nurses and patients are therefore often caught in the middle between meeting healthcare costs and providing quality care. The cost of healthcare continues to rise in America today while the number of uninsured patients was over 42 million or 13.4 in 2013 (Levy, 2014). The poor co-ordination between the development of policies and those tasked with implementation is continuously putting the lives of patients at risk while driving up implementation costs of the policies (Schuen et al, 2006). The current state of public health cannot allow for such bureaucracy and improvement on healthcare performance should be a matter of importance to any visionary nation. Improvement policies should be drafted and implemented to address the fact that costs are rising and access is deteriorating while the quality varies depending on the location of access (Carey, 2006). Nurses have formed association to ensure that the healthcare policies are to benefit patients. Membership and those voted to the professional association is made mandatory to ensure that they are united (Cheary and Totter Betts 2005, pp. 211-215).
The powers of the senate and the Congress in the legislations process of US is equally felt in health policies. The constitution does not explicitly give discusses power over healthcare or grants this to any authority, after all, the US constitution was written over two centuries ago when public health was not a major concern. The congress however, has power to tax and spend for the general welfare and greatly influences the development of health policies in the United States (Patel &Rushefsky 2014, p. 9). The responsibilities of the Federal Government has since grown and many development in the American healthcare system is credited to the National Government. These include grants and emergency relief to the States; health safety-net program such as Medicaid, Medicare, and State Children’s Health Insurance Program (SCHIP) and other mandates and regulations either funded or unfunded by the government (Colby, 2002). Such programs have helped improve the general health of Americans today and shows that politics have the capacity to influence health policies that will be helpful to the society.
Social factors affect individual and public health directly hence reform health policies. Health complications in early life should therefore be avoided to ensure a healthier future. Vaccination policies have been developed to help children enjoy a healthy childhood because most of the diseases they suffer, though treatable, have permanent effects. Polio and measles are some of the diseases that have been successful contained through vaccination policies (Doblhammer 2004, p. 15).
Availability of resources to meet the health needs of a society is another factor that influence policy making in healthcare. Every policy requires capital for implementation. The capital includes healthcare workers, supplies, and infrastructure. The United States is a developed nation and has better facilities than most of the other nations in the world (Mooney, Knox, & Schacht, 2014, p. 48). It would be expected that this would translate to high quality care but it is not always the case. America has a large population to support, most of which are suffering from chronic and lifestyle diseases (Edlin, Golanty, & Brown, 2014, p. 13). The available funds and resources are therefore being used to help these groups of people. In order to address the problem, policies are being drafted to minimise the risk of lifestyle diseases. Obesity is a big concern in America today with nearly two-thirds of adult Americans being classified as obese or overweight (Finkelstein & Zuckerman, 2010). The prevalence of diabetes in the US has more than doubled in the last two decades (Flegal, Carroll, Ogden, & Johnson 2002, p. 1724). Many American health policies nowadays are geared towards improving the lifestyle and healthy eating habits of the citizens.
The social determinants of health that need urgent attention and should form the basis of health policies include daily living conditions. Daily living conditions include healthy physical environment, fair employment and access to health care (Commission on Social Determinants of Health, 2008). The other is distribution of resources and equity in heath programs. Since health policies are meant to address the health challenges facing communities, the social aspects that determine a population’s health should be critical when considering remedy for social health problems interventions. One way of approaching the issue is having the community handle the issues that are unique to them. The US allow its States to formulate health policies within their areas of jurisdiction as long as the said policies do not conflict an existing national policy.
As earlier mentioned, one of the modern day health issues in America is obesity. The specific cause of obesity is not clear but a number of factors are known to contribute to obesity. Genetics is said to play a role in the cause of obesity but many cases today are caused by poor lifestyles. Americans today eat larger portion size calories more than that required by the body to maintain their health (Hellmich 2003. The rate of calorie intake is quite high and hence people gain weight quickly. Fast food is also readily available and most of the sumptuous food adverts are by fast food companies. Opportunities to exercise is also limited with availability of aided mobility everywhere. Most Americans either drive or catch a bus/taxi to work and most buildings are fitted with lifts, so people rarely use the stairs. Due to irregular and illegal use of land, sidewalks are no longer available in many residential areas, thus escalating the problem.
Obesity costs America billions of dollars yearly (Edelstein 2006, p. 107), and with the ever increasing prevalence, the cost is likely to rise in the future. It has also been shown that obesity in children is as bad, if not worse, than it is in adults (Kopelman & Stock 2005, p. 283). The future of America or any other nation is pegged on the youth and children who are expected to grow to become important members of the society. A number of health policies have therefore been developed to solve this problem. Most of these policies are however, seeming to fail, but all the same, development of these polices is a step in the right direction. Various states have enacted legislations to control obesity. School based programs have shown to be effective in reducing obesity in school going children (Veugelers & Fitzgerald 2005, p. 432). Children consume healthy food low in calories and are engaged in before and after school programs that help them stay healthy. Other school based efforts include limiting sales of fast food in school and improving physical and health education. Schools are also some of the few public institutions that have facilities for physical activities. School going children are the beneficiaries of this health policy as America tries to limit obesity prevalence rates in children.
Community based legislations have also been enacted to reduce prevalence of obesity amongst adults. These policies includes taxation, menu labelling, and transportation policies. Snack taxes has been introduced in many states to discourage intake of fast food. Powell and Chaloupka (2009, p. 229) in their article in the Milbank Quarterly March 2009 issues argue that by increasing the prices of unhealthy food, while at the same time decreasing those of healthy food, encourages low body weight within a community. Other commodities that are associated with obesity are also being taxed. Taxation of cigarettes and alcohol proved to be efficient in controlling their consumption and hence the cancers associated with them. Taxation on low nutritional foods is borrowing from this success story and hopes to realize the same benefits. About 30 states in America including D.C. thus far have laws that imposes taxes on low nutritional foods (Chriqui et al 2008, p. 227). While these taxes remain highly controversial, the proponents argue that such taxes should be used to drive healthy living campaigns (CSPI, 2000).
Menu labelling is mandatory in many American states today. Nutritional information must be displayed on menus and boards in restaurants. The target is fast food outlets so that consumers can decide on what to take from an informed point of view. (The American Medical Association, 2007). Studies have shown that most Americans are keen on the calories they take and yearn for such information on the menus of their fast food restaurants (Rudd Centre for Food Policy and Obesity, 2009). Menu labelling is still a new idea and many restaurants fear that sales will decrease if the policy is fully implemented.
The policies America has adopted to put obesity in check seems to have had a slow start. It might still be early to conclusively say that they are not efficient but with the increasing prevalence rates, it would be wiser to review polices early enough so that they can achieve their purposes. It is expected that more positive results will be achieved in the future when the stiff opposition facing implementation of polices weathers down. For now, the little achievements made by such polices have been overshadowed by the increasing prevalence rates.
From the analysis of the contexts shaping health polices in the United States, it can be said that health policies formulation require a constant cyclic process for its success. Policies should be formulated collectively, tested and implemented and evaluated from time to time in order to improve them. It is also clear that many policies fail due to selfish ambitions and politicians should let experts have a say in formation of policies that affect their daily working. With or without policies, individuals ought to realise that personal health is one’s own responsibility and should do all it takes to maintain it.
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