NATIONAL AND STATE INIATIATIVES

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• NATIONAL AND STATE INIATIATIVES

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• CULTURAL BELIEFS AND VALUES

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• BELIEF IN SCIENCE LED TO THE APPLICATION OF THE
  SCIENTIFIC METHOD TO MEDICINE
• THE MEDICAL MODEL OF HEALTH CARE DELIVERY IS
  FOUNDED ON ADVANCES IN SCIENCE AND TECHNOLOGY.
• THE MEDICAL MODEL HAS FUELED THE TREMENDOUS
  GROWTH IN MEDICAL SCIENCE AND TECHNOLOGY
  INNOVATION.
• THE U.S. HAS BEEN LEADING THE WORLD IN NEW
  MEDICAL BREAKTHROUGHS.

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• THESE DEVELOPMENTS HAVE HAD NUMEROUS IMPLICATIONS
  FOR HEALTH SERVICES DELIVERY.

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• THEY INCREASE THE DEMAND FOR THE LATEST TREATMENT
  AND RAISE PATIENTS EXPECTATIONS OF FINDING A
  CURE.
• MEDICAL PROFESSIONALS HAVE BEEN PREOCCUPIED
  ALMOST EXCLUSIVELY WITH CLINICAL INTERVENTIONS,
  WHEREAS THE HOLISTIC ASPECTS OF HEALTH AND USE OF
  ALTERNATIVE THERAPIES HAVE BEEN DEEMPHASIZED.
• HEALTH CARE PROFESSIONALS HAVE BEEN TRAINED TO
  FOCUS ON PHYSICAL SYMPTOMS.

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• FEW ATTEMPTS HAVE BEEN MADE TO INTEGRATE
  DIAGNOSIS AND TREATMENT WITH HEALTH EDUCATION AND
  DISEASE PREVENTION.
• THE CONCERN WITH NONHEALTH HAS FUNNELED MOST
  RESEARCH EFFORTS AWAY FROM THE PURSUIT OF HEALTH
  INTO DEVELOPMENT OF SOPHISTICATED MEDICAL
  TECHNOLOGY. COMMITMENT OF RESOURES TO THE
  PRSERVATION AND ENHANCEMENT OF HEALTH AND
  WELL-BEING LAGGED FAR BEHIND.

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• MEDICAL SPECIALISTS WHO USE THE LATEST TECHNOLOGY
  HAVE BEEN HELD IN HIGHER ESTEEM AND HAVE EARNED
  HIGHER INCOMES THAN GENERAL PRACTITIONERS AND
  HEALTH EDUCATORS.
• THE DESIRABILITY OF HEALTH CARE DELIVERY
  INSTITUTIONS, SUCH AS HOSPITALS, IS OFTEN
  EVALUATED BY THEIR ACQUISITION OF ADVANCED
  TECHNOLOGY.

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• WHILE BIOMEDICINE HAS TAKEN CENTRAL STAGE,
  DIAGNOSIS AND TREATMENT OF MENTAL HEALTH HAVE
  BEEN RELEGATED TO A LESSER STATUS, BUT
  DIFFICULITIES IN IDENTIFYING CERTAIN BEHAVIORS TO
  BE INDICATIVE OF MENTAL HEALTH DISORDERS HAVE
  BEEN AT LEAST PARTICALLY RESPONSIBLE FOR THE
  SECONDARY STATUS OF MENTAL HEALTH SERVICES IN THE
  HEALTH CARE DELIVERY SYSTEM.
• THE BIOMEDICAL MODEL HAS ALSO ISOLATED THE SOCIAL
  AND SPIRITUAL ELEMENTS OF HEALTH.

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• AMERICA HAS BEEN A CHAMPION OF CAPITALISM. DUE
  TO A STRONG BELIEF IN CAPITALISM, HEALTH CARE HAS
  LARGELY BEEN VIEWED AS AN ECONOMIC GOOD, NOT AS A
  PUBLIC RESOURCE.

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• A CULTURE OF CAPITALISM PROMOTES ENTREPRENEURIAL
  SPIRIT AND SELF-DETERMINATION.
• INDIVIDUAL CAPABILITIES TO OBTAIN HEALTH SERVICES
  HAVE LARGELY DETERMINED THE PRODUCTION AND
  CONSUMPTION OF HEALTH CARE - WHAT SERVICES WILL
  BE PRODUCED, WHERE, AND IN WHAT QUANTITY, AND WHO
  WILL HAVE ACCESS TO THOSE SERVICES.

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• FINANCING OF HEALTH CARE THROUGH INDIVIDUAL
  HEALTH INSURANCE COVERAGE HAS MADE ACCESS TO
  HEALTH CARE A SOCIAL PRIVILEGE.
• A CLEAR DISTINCTION EXISTS IN THE TYPES OF
  SERVICES BETWEEN POOR AND AFFLUENT COMMUNITIES,
  AND BETWEEN RURAL AND URBAN LOCATIONS.
• THE CULTURE OF INDIVIDUALISM EMPHASIZES
  INDIVIDUAL HEALTH RATHER THAN POPULATION HEALTH.
  MEDICAL PRACTICE HAS BEEN DIRECTED AT KEEPING THE
  INDIVIDUAL HEALTHY RATHER THAN THE ENTIRE
  COMMUNITY HEALTHY.

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• PRINCIPLES OF FREE ENTERPRISE AND A GENERAL
  DISTRUST OF BIG GOVERNMENT HAVE KEPT THE DELIVERY
  OF HEALTH CARE LARGELY IN PRIVATE HANDS.
• A SEPARATION EXISTS BETWEEN PUBLIC HEALTH
  FUNCTIONS AND THE PRIVATE PRACTICE OF MEDICINE.

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• Medical Model
• Delivery of health care that places its primary
  emphasis on the treatment of disease and relief
  of symptoms instead of prevention and promotion
  of optimum health

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• WHAT IS HEALTHY PEOPLE?

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• Healthy People 2010 is the prevention agenda for
  the Nation.

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• It is a statement of national health objectives
  designed to identify the most significant
  preventable threats to health and to establish
  national goals to reduce these threats.

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• Healthy People 2010 builds on initiatives pursued
  over the past two decades.

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• The 1979 Surgeon Generals Report, Healthy
  People, and Healthy People 2000 National Health,
  Promotion and Disease Prevention Objectives, both
  established national health objectives and
  served as the basis for the development of state
  and community plans.

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• Healthy People 2010 offers a simple but powerful
  idea provide the objectives in a format that
  enables diverse groups to combine their efforts
  and work as a team.

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• It is a roadmap to better health for all and can
  be used by many different people.

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• DEVELOPMENT OF HEALTHY PEOPLE 2010 OBJECTIVES

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• The 28 focus areas of Healthy People 2010 have
  been developed by leading Federal agencies with
  the most relevant scientific expertise.

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• The development process was informed by the
  Health People Consortium an alliance of more
  than 350 national membership organizations and
  250 State health, mental health, substance abuse,
  and environmental agencies.

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• HEALTHY PEOPLE 2010 IS ABOUT IMPROVING HEALTH
  THE HEALTH OF COMMUNITIES, AND THE HEALTH OF THE
  NATION.

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• GOAL 1 INCREASE QUALITY OF YEARS OF HEALTHY LIFE

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• Life Expectancy
• Life expectancy is the average number of years
  people born in a given year are expected to live
  based on a set of age-specific death rates. At
  the beginning of the 20th Century. Life
  expectancy at birth was 43.7 years. Today the
  average life expectancy is nearly 77 years.
  Projected to be 79.2 years.

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• Life expectancy for persons at every age group
  also has increased during the past century.
  Based on todays age-specific death rates,
  individuals age 65 years can be expected to live
  an average of 18 years more years. Those aged 75
  years can be expected to live 11 more years.

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• Women outlive men by 6 years.

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• QUALITY OF LIFE
• Quality of life reflects a general sense of
  happiness and satisfaction with our lives and
  environment.

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• Health Related quality of life reflects a
  personal sense of physical and mental health and
  the ability to react to factors in the physical
  and social environment.

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• Global assessments, in which a person rates his
  or her health as poor, fair, good, very
  good, or excellent can be reliable indicators
  of ones perceived health.
• In 1996, 90 of people in the U.S. reported their
  health as good, very good, or excellent.

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• ACHIEVING A LONGER AND HEALTHIER LIFE THE
  HEALTH PEOPLE PERSPECTIVE.

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• Healthy People 2010 seeks to increase life
  expectancy and quality of life over the next 10
  years by helping individuals gain the knowledge,
  motivation, and opportunities they need to make
  informed decisions about their health.

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• GOAL 2 ELIMINATE HEALTH DISPARITIES
• Gender Overall, men have a life expectancy
  which is 6 years less than that of women, and
  have higher death rates for each of the 10
  leading causes of death.

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• Race
• Even though the Nations infant mortality rate is
  down, the infant death rate among
  African-Americans is still more than double that
  of whites.

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• Heart disease death rates are more than 40
  higher for African-Americans than for whites.
• The death rate for all cancers is 30 higher for
  African Americans than for whites.

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• INCOME AND EDUCATION

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• Inequalities in income and education underlie
  many health disparities in the United States.
  
• In general, population groups that suffer the
  worst health status also are those that have the
  highest poverty rates and the least education.

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• Overall, those with higher incomes tend to fare
  better than those with lower incomes.
• Among white men aged 65 years and over, those in
  the highest income families could expect to live
  3 years longer than the lowest income families.

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• For women, the amount of education achieved is a
  key determinant of the welfare and survival of
  their children.

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• GEOGRAPHIC LOCATION

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• Twenty-five percent of Americans live in rural
  areas. Injury-related death rates are 40 percent
  high in rural populations than in urban
  populations. Heart disease, cancer, and diabetes
  rates exceed those for urban areas.
• Timely access to emergency services and specialty
  care are issues to this population.

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• Determinants of Health

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• Biology
• Biology refers to the individuals genetic
  makeup, family history, and the physical and
  mental health problems acquired during life.

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• Behaviors
• Behaviors are individual responses or reactions
  to internal stimuli and external conditions.

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• Social Environment
• Social environment includes interactions with
  family, friends, coworkers, and others in the
  community.

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• Physical Environment
• Physical environment can be thought of as that
  which can be seen, touched, heard, smelled, and
  tasted.

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• Policies and Intervention
• Policies and intervention have a powerful and
  positive effect on the health of individuals and
  the community. Examples include campaigns to
  prevent smoking or mandating child restrains.

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• Health Status
• Health status can be measured by birth and death
  rates, life expectancy, quality of life,
  morbidity from specific diseases, risk factors,
  use of ambulatory care and inpatient care, health
  insurance coverage, and many other factors.

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• State and community health objectives

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• Nearly all States, the District of Columbia and
  Guam have developed their own Healthy People
  Plans

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• Floridas Health Goals

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• Reduce total infant mortality
• Reduce nonwhite infant mortality
• Reduce the rate of teenagers aged 15-19 giving
  birth

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• Reduce the percentage of repeat births to
  teenagers aged 15-19
• Reduce measles case rate
• Reduce Haemophilus influenza type b cases

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• Reduce AIDS cases
• Maintain the rate of primary and secondary
  syphilis cases
• Reduce congenital syphilis cases

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• Maintain the rate of tuberculosis cases
• Reduce potential life lost before 65 due to
  cardiovascular disease
• Reduce life lost before 65 due to preventable
  cancers

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• Reduce the percentage of children entering
  kindergarten who require special education
• Improve the percentage of children with a
  physical impairment who are mainstreamed in
  classroom.

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• Reduce age-adjusted unintentional injury death
  rate
• Reduce enteric illness cases rate

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• Increase dental care for low-income persons
  through publicly-funded programs

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• THE SURGEON GENERAL OF THE UNITED STATES
• PRIORITIES

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• We must move toward establishing a balanced
  community health system.

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• Every child should have an opportunity for a
  healthy start in life
• Our system must promote healthy lifestyles
• We must improve the mental health system

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• We must maintain a global approach to public
  health

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• We must eliminate disparities in health

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• KIDS COUNT, CHILD HEALTH INDICATORS FLORIDA VS.
  UNITED STATES

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• Social and Economic Characteristics Florida US
• of 2-year olds who were immunized 1996
  78 78
• of 4th grade students who scored be
  45 38
• basic math level 1996
• of 8th grade students who scored 49 40
• below basic science level 1996
• Median income of families with 33,500 38,100
• children 1995
• of female-headed families receiving
  31 33
• support or alimony 1995
• of children in extreme poverty 12 9

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• End of lecture for September 24, 2007
• 6th Period
• Questions?
• Discussion?