Introduction to Radiologic Technology - Prelims Coverage PDF

# Chapter 4: Evolution of Health Care Delivery **Objectives** On completion of this chapter, you should be able to: * List the main contributions to medicine from ancient Egypt, India, China, and Greece. * Describe the medical practice of the ancient Hebrews. * Outline the teachings of Hippocrate...

# Chapter 4: Evolution of Health Care Delivery **Objectives** On completion of this chapter, you should be able to: * List the main contributions to medicine from ancient Egypt, India, China, and Greece. * Describe the medical practice of the ancient Hebrews. * Outline the teachings of Hippocrates. * Describe the effect of Christianity on medicine. * List events during the Renaissance that were significant in the progress of medicine. * Describe important advances in medicine from the eighteenth and nineteenth centuries. * List the significant developments in medicine during the twentieth century. * Indicate trends in medicine for the twenty-first century. * Describe the major issues in medicine at the present time. * Define disease. * List the top 15 causes of death in the United States. * Compare mortality rates among various groups. * List the primary disabling conditions present in U.S. society. * List diseases that have been eradicated or are targeted for elimination. * Explain the significance of emerging infectious diseases. * List key social forces that affect the health care system. * Discuss the dominant ethical issues in medicine today. * Explain the impact of an aging population on health care delivery. * Describe the nation's health care expenditures. * Explain prospective payment. * Correlate defensive medicine, medical malpractice, and health care costs. * Give the top five causes of death, and list the associated risk factors. * Describe a typical wellness program. * Describe the advantages of giving up smoking. * Link poor diet to major causes of death. * Outline dietary guidelines for good health. * Discuss the role of the radiologic technologist in patient education. * List alternate health care practices. * Describe the overall goals of Healthy People 2010. **Outline** * Prehistoric and Ancient Medicine * Ancient Egypt * Ancient India * Ancient China * Ancient Greece * Pre-Hippocratic Medicine * Hippocrates * Christianity * The Renaissance * Eighteenth Century * Nineteenth Century * Twentieth Century * Twenty-First Century * Health and Disease * Mortality * Morbidity * Life Expectancy * Emerging Infectious Diseases * Social Forces that Affect Health Care * Ethical Issues * Economic Forces that Affect Health Care * Need for Health Care Management * Preventive Medicine * Healthy People 2010 * Health Care System * Beginning of Your Challenge **Key Terms** * Defensive Medicine * Diet * Disease * Emerging Infectious Diseases * Epidemic * Health * Health Maintenance Organizations * Healthy People 2010 * Morbidity * Mortality * Pandemic * Prospective Payment System * Smoking # Prehistoric and Ancient Medicine The history of medicine abounds with tales of cooperation and confrontation with nature. Disease was present on earth long before human life, and we can only speculate about the human practice of prehistoric medicine. Fractures were probably common injuries. Egyptian mummies and radiographic images of the ice man show characteristics of arteriosclerosis, pneumonia, urinary infections, stones, parasites, cavities, teeth erosion, abscesses, pyorrhea, arthritis, and tubercular disease of the spine. Prehistoric people probably treated their wounds similarly to the way animals treat themselves: immersing them- selves in cool water and applying mud to irritated areas, sucking stings, licking wounds, and exerting pressure on wounds to stop the bleeding. Until well into the nineteenth century, medical treatment was intertwined with religion and magic (Fig. 4-1). Some cultures treated their sick, elderly, and disabled with kindness. Other cultures, during times of famine, sent the elders out into the unsheltered environment; some even killed and ate disabled tribe members. Disease was thought to be caused by gods and spirits, and magic was used to drive away evil forces. Tribal healers held high political and social positions and were responsible for performing religious ceremonies and protecting the tribe from bad weather, poor harvests, and catastrophes. Along with sucking, cupping, bleeding, fumigating, and steam baths, medicinal herbs were used to treat wounds. Surgery was used to treat bone fractures and to sew up wounds. The Mesopotamians studied hepatoscopy, which is the detailed examination of the liver. They believed the liver was the seat of life and the collecting point of blood. Although gods and magic still played an important role in medicine, rational thought about nature's relationship to health began to increase. The ancient Hebrews still considered disease to be divine punishment and a mark of sin. Plagues and epidemics such as leprosy were often mentioned in the Bible, as were medications such as balsams, gums, spices, oils, and narcotics. Surgery was performed only under ritual circumstances. Hebrew medicine was influenced by the Greeks around the fourth century BC with an emphasis placed on anatomy and physiology, diet, massage, and drugs. Disease was considered an imbalance of the four humors of the body: phlegm, blood, yellow bile, and black bile. # Ancient Egypt The deities of ancient Egypt were associated with health, illness, and death. Isis was the healing goddess; Hathor was the mistress of heaven and the protector of women during childbirth; Keket ensured fertility. The embalming practices of the Egyptians have provided much of our knowledge of ancient medicine. The most elaborate embalming practice required that the liver, lungs, stomach, and intestines be preserved in stone jars so that they could function for eternity. Cranial contents were removed with hooks through the nostrils. The skull and abdominal cavities were washed with spices; soaked for 70 days in a solution of clay and salts of carbonate, sulfate, and chloride; and then washed. The corpse was then coated with gums and wrapped in fine linen. The ancient Egyptians linked anatomy and physiology with theology-each body part had a special deity as its protector. They believed that the body was composed of a system of channels, with the heart at the center. They thought air came in through the ears and nose, entered the channels, went to the heart, and was then delivered to the rest of the body. They believed the channels also carried blood, urine, feces, tears, and sperm. Although the main water source, the Nile River, was probably clean in ancient Egypt, public health was also a concern. Egyptian homes were immaculate, and personal hygiene was practiced regularly. The prevalent diseases included intestinal ailments, malaria, trachoma, night blindness, cataracts, arteriosclerosis, and epidemic diseases. Diagnoses were made by probing wounds with fingers, taking the pulse, and studying sputum, urine, and feces. Religious rituals were still part of the healing process, as were drugs administered in the forms of pills, cake suppositories, enemas, ointments, drops, gargles, fumigations, and baths. Drugs were made from vegetable, mineral, and animal substances; and imported materials such as saffron, cinnamon, perfumes, spices, sandalwood, gums, and antimony. # Ancient India The ancient Indians believed (as do many contemporary Indians) that life was an eternal cycle of creation, preservation, and destruction. Their religion allowed secular medicine and sound, rational health care practices, which is remarkable in light of their emphasis on the spiritual over the material. They detected diabetes by the sweetness of the patient's urine and treated snakebites by applying tourniquets. Surgery was a common procedure on the nose, earlobes, hare- lips, and hernias; it was also used to remove bladder stones and to perform amputations. The Indians also performed cesarean sections. # Ancient China In ancient China, harmony was considered to be a delicate balance between yin and yang, and Tao was considered the way. Illness was seen as a result of disregard for Tao or acting contrary to natural laws. Chinese medicine focused on the prevention of disease (Fig. 4-2). Because Confucius forbade any violation of the body, dissections were not performed in China until the eighteenth century. According to Nei Ching, five methods of treatment were available: cure the spirit; nourish the body; give medications; treat the whole body; and use acupuncture and moxibustion, which is a treatment similar to acupuncture in which a powdered plant is burned on the skin. Treatment came in the forms of exercise, physical therapy, massage, and administering medicinal herbs, trees, insects, stones, and grains. By the eleventh century, the Chinese had developed an inoculation against smallpox. # Ancient Greece In the sixth century BC, the Greeks built the healing temples of Asclepios in Thessaly. The temples contained a statue of a god to whom gifts were often given as a sign of worship. Usually, a round building, the tholos, encircled a pool or sacred spring of water for purification. The abaton was a building considered to be an incubation site, where the cure took place. The patient went to sleep there until visited and cured by the god. The temples usually consisted of a theater, a stadium, a gymnasium, inns, and temporary housing. Healing rituals began after sundown and often involved fasting or abstinence from certain foods or wine. ## Pre-Hippocratic Medicine The ancient Greeks began applying scientific thought to medical theory very early. Thales (625 to 547 BC) professed that the basic element in all animal and plant life was water, from which came the earth and air. Anaximander (610 to 547 BC) believed that all living creatures originated in water. Anaximenes, born in 546 BC, believed that air was the element necessary for life. Heraclitus (540 to 480 BC) believed that fire was the principal element of life. By the sixth century BC, earth, air, fire, and water were accepted as the basic components of life on earth. ## Hippocrates During the sixth, fifth, and fourth centuries BC, the Greeks advanced medicine with their understanding of the place of humanity within the cosmos. Pythagoras, Empedocles, and Democritus approached harmony with the universe in an objective, scientific manner. Mathematics, atomic theory, and the basic elements of nature were used to describe health and disease. During this period, Hippocrates established himself as the father of medicine. His approach revolutionized medicine from the ancient past and began turning it into an objective science. Born around 460 BC, Hippocrates believed that people practicing medicine should be pure and holy. He taught that one should (1) observe all, (2) study the patient rather than the disease, (3) evaluate honestly, and (4) assist nature. "He employed few drugs and relied largely upon the healing powers of nature.... The treatment of disease for him was to assist and, above all, not to hinder nature. If succeeding generations had followed his precepts, patients would have been spared countless unnecessary operations and an enormous number of nauseous, disgusting, ineffectual and frequently harmful medicines" (Major, 1954). Hippocrates' writings addressed mental illness, anxiety, and depression. His teachings reached a peak in Alexandria and then eventually penetrated the Roman Empire. ## Christianity The dawn of Christianity changed many attitudes about medicine. Christians sought to bring the healing message of Christ to those in need. The Church dominated medicine during the Dark Ages, and practices involved prayer, exorcism, holy oil, relics of saints, supernaturalism, and superstition. At the same time, medical schools separate from the Church were established and soon became part of major universities. During Jesus' personal ministry and that of his immediate followers, healing was not differentiated into physical, mental, or spiritual categories. The author of one of the Gospels was known as Luke the physician. The content of the Christian faith, with its emphasis on compassion, forgiveness, and concern for the unfortunate and the dispossessed, led the followers of Christianity to provide facilities for the care of the orphaned, elderly, outcast, and poor. The Roman Emperor, Constantine, founded a hospital in the fourth century. Others were established by Christian communities in Caesarea, Edessa, and Bethlehem during the same century. With the Crusades came the distribution of disease. In the twelfth century AD, Europe was inundated with leprosy, typhus, and smallpox. In 1347, bubonic plague spread through Europe and claimed nearly one fourth of its population. # The Renaissance The Renaissance brought new beginnings in medicine. Paracelsus, the father of pharmacology, combined alchemy with the treatment of disease to produce a new science. Jean Fernel professed that physiology, pathology, and therapeutics were the standard disciplines of medicine; he was also the first to suggest that gonorrhea and syphilis were two separate diseases. Ambroise Paré was a forerunner in clinical surgery. An explosion of knowledge of human anatomy was led by Andreas Versalius; his dissections and drawings prompted his designation as the father of anatomy. The seventeenth century was an age of scientific revolution. Latrochemistry, a combination of alchemy, medicine, and chemistry, was practiced by the followers of Paracelsus. Jan Baptista van Helmont made the first measurement of the relative weight of urine by comparing its weight with that of water. Galileo presented the laws of motion in a mathematical manner that could be applied to life on earth; Isaac Newton discovered gravity. William Harvey found that a continuous circulation of blood was present in a contained body system. Christian Huygens developed the centigrade system of measuring temperature; Gabriel Daniel Fahrenheit developed the system named after him for measuring temperature. Marcello Malpighi and Anton van Leeuwenhoek were forerunners in the invention of the microscope (Fig. 4-3). Quinine was discovered as a treatment for malaria. Leonardo da Vinci explored human anatomy through dissection; his anatomic sketches disseminated his findings. # Eighteenth Century Significant discoveries continued into the eighteenth century. Albrecht von Haller did in-depth studies of the nervous system, discovered the relationship of the brain cortex to peripheral nerves, and became the founder of modern physiologic theory. Lazzaro Spallanzani discarded the theory of spontaneous generation and became a pioneer in experimental fertilization. Stephen Hales demonstrated the dynamics of blood circulation, stressed the importance of the capillary system, and became the first person to record blood pressure with a manometer. The father of pathology, Giovanni Battista Morgagni, correlated anatomy with pathology. His research and writings laid the foundation for much of modern pathology. Edward Jenner formulated the smallpox vaccination, which was considered one of the greatest discoveries in medical history. William Hunter, a specialist in obstetrics, founded the Great Windmill Street School of Anatomy, the first medical school in London. His brother, John Hunter, was a giant of the eighteenth century. An experimental surgeon, John Hunter developed a method of closing off aneurysms, thus eliminating many unnecessary amputations. Hunter turned surgery into a respected science and became a pioneer in comparative anatomy. The eighteenth century also saw dramatic changes in the care and treatment of mentally ill patients, with Phillippe Pinel demanding that a more humane regimen be instilled at Asylum de Bicêtre near Paris. # Nineteenth Century Autopsies were the major focus of medicine during the nineteenth century. Carl Rokitansky was the most outstanding morphologic pathologist of his time. Rudolf Virchow professed that "all cells come from other cells" and revolutionized the understanding of cells. Claude Bernard was the founder of experimental physiology and discovered the principle of homeostasis, clarified the multiple functions of the liver, studied the digestive activities of the pancreas, and was the first to link the pancreas with diabetes. He pioneered and established the specialty of internal medicine. René-Théophile Hyacinthe Laennec contributed to the pathologic and clinical understanding of chest diseases including emphysema, bronchiectasis, and tuberculosis. He was also a pioneer in the invention and use of the stethoscope. Surgery advanced in Paris during the French Revolution and Napoleonic wars. Ephraim McDowell performed the first successful abdominal operation to remove a huge cyst from an ovary. J. Marion Sims laid the foundation for gynecology and founded the Women's Hospital of the State of New York, the first institution of its kind. He also invented the Sims position and later the speculum and catheter. By 1831, ether, nitrous oxide gas, and chloroform had been discovered but not yet applied to medical practice. After Joseph Priestley had discovered nitrous oxide gas, Humphry Davy suggested that it be used in surgery, but he was ignored. Although Crawford W. Long used sulfuric ether during surgery in 1842, he did not publicize its use. When anesthesia finally entered the world of surgery, surgical procedures multiplied in number and complexity. Joseph Lister discovered that bacteria were often the origin of disease and infection; thus safe surgical procedures were introduced to minimize the risks of surgery. Louis Pasteur discovered that the decay of food could be forestalled by heating the food and destroying harmful bacteria; he formulated the germ theory of disease and explained the effectiveness of asepsis and antisepsis. Robert Koch performed extensive research into microorganisms and founded bacteriology. Psychiatry gained considerable respect from the work of Benjamin Rush, the first American psychiatrist. Based on his involved clinical studies of the human gastrointestinal tract, William Beaumont became the first prominent American physiologist. The foundation of modern genetics was laid by Gregor Mendel in 1886 with his experiments involving the heredity of plants. November 8, 1895, is a date that forever changed the course of diagnoses of disease and injury. As will be explained more fully in Chapter 5, Wilhelm Roentgen discovered and described x-ray films. Within months, the significance of these new kinds of rays in medicine was realized. Pierre and Marie Curie discovered radium 3 years later and provided the foundation for the use of radioactivity in the treatment of diseases. # Twentieth Century Remarkable developments continued as the century turned. Major Walter Reed led a U.S. Army board in discovering the cause of yellow fever, and this led to its eradication. Paul Ehrlich became the father of chemotherapy, which would have ramifications throughout the century. Pavlov conducted extensive research not only about the conditioned response but also about the process of digestion. In 1913, Abel, Rowntree, and Turner invented the first artificial kidney, and this led to kidney dialysis. World War I provided the opportunity to explore wound infection in detail and advanced the prevention of surgical infections. Willem Einthoven made the first electrocardiogram, and Hans Burger used similar technology to invent the electroencephalogram. Lind, Eijkman, Hopkins, Szent-Gyorgyi, and Funk defined and isolated vitamins and described their role in the life process. This development would have a profound effect on diet and, late in the century, on the possible prevention and treatment of chronic diseases. Surgical techniques were refined, and diagnostic procedures became more accurate. The invention of the electron microscope in 1930 (Fig. 4-4) made possible the study of viruses and advances in the fields of biochemistry, biophysics, physical chemistry, and immunology. The Salk vaccine virtually eliminated the scourge of poliomyelitis (polio). Watson and Crick won a Nobel Prize in 1962 for accurately describing the deoxyribonucleic acid (DNA) molecule as a double helix and identifying its components. In 1967, Christiaan Barnard performed the first successful human heart transplant. In the ensuing years, other organs were successfully transplanted, adding another valuable tool to improving and saving lives. Microminiaturization, which was invented for space travel, soon found its way into medicine. Coupled with evolving computer technology, the final four decades of the century vastly extended our abilities to diagnose and treat an entire array of medical conditions. Such electronics are used to monitor heart and brain activity with extreme accuracy. The marriage of computers and imaging equipment has provided digital radiography, computed tomography, and magnetic resonance imaging, and it has enhanced nuclear medicine and medical sonography. Treatment planning for radiation therapy is incredibly precise because of the use of computers. Major organ transplants involving the heart, liver, lungs, and kidneys are performed today. Coronary bypass surgery is commonplace. Arthroscopic surgery works in the joint spaces of the body without major incisions. Laparoscopic surgery became commonplace for incisions into the abdomen for conditions affecting the gallbladder, kidneys, adrenal glands, and female reproductive system. Lithotripsy allows the painless passing of stones from the urinary system by first blasting them with sonic waves. Lasers are used routinely in countless procedures as a clean, painless way of removing growths; their accuracy allows their use in areas of the body where precision is indispensable. Artificial hips and knees are inserted to replace those that are degenerating as a result of age or arthritis or that have been destroyed by injury. Plastic surgery allows the reconstruction of most areas of the body that have been disfigured as a result of disease or injury; it is also used extensively for elective cosmetic procedures. # Twenty-First Century The second millennium AD continues with a rapid expansion of technology and information. The accumulation of knowledge accelerates at an unprecedented pace, doubling every 15 to 18 months. Balancing this technologic explosion in medicine, a trend has emerged toward a more personal aspect of health care. The need for the human touch, caring, and concern has never been more important. More personal aspects of care such as the hospice movement for the terminally ill and the reemergence of family practice as a specialty are but a couple of examples (Fig. 4-5). As you begin your studies in this intriguing profession, keep in mind that the human aspect of patient care and quality service must be ever present in your practice. Research into genetics has greatly expanded our knowledge about heredity. The entire DNA code has now been deciphered, and this has opened a new era in the treatment and prevention of disease. The unfortunate affliction of Alzheimer disease has prompted extensive research; its cause remains elusive, and treatment, though still in its infancy, is progressing. The prevention and treatment of human immunodeficiency viral (HIV) infection and acquired immunodeficiency syndrome (AIDS) have increased in importance as both conditions have become global. Biotechnology has opened frontiers in treatment that were unimagined when this text was first published. Increasing numbers of surgeries and other interventional procedures are being made obsolete by the introduction of biotechnology into mainstream health care. Robotic surgery permits more precise incisions and excisions than ever before possible. Carefully guided by three-dimensional video, the surgeon probes deep into the body with a small computer-assisted hand- Robotic surgery is leading the way to improved patient outcomes when compared with open and even laparoscopic surgery. Advantages of robotic surgery include less blood loss, faster recovery for the patient, and fewer overall complications. It may be used for heart surgery, urinary system procedures, and prostate surgery. The electrical conduction system of the heart has now been mapped. Patients suffering from tachycardia or atrial fibrillation benefit from ablation procedures that use radiofrequency catheters to burn away errant pathways and permanently restore normal heart rate and rhythm. The International Space Station is staffed full time and, as a result, new and ongoing research is taking place in the fields of human physiology and pharmacology that will have extensive applications back here on earth. # Health and Disease Before discussing morbidity and mortality, considering the definitions of health and disease would be wise. The World Health Organization defines health as "a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity." Sheldon defines disease as "the pattern of response of a living organism to some form of injury"; he goes on to explain that disease "should be viewed as disordered function rather than only as altered structure." Because measuring health status is a time-consuming, complicated, and often subjective process, we have continued to rely on data that indicate rates of mortality (death rate) and morbidity (occurrence of disease or conditions). It is apparent that Americans live longer and have fewer acute episodes of illness than ever before, but we also have more chronic conditions than ever. Our population is afflicted with arthritis, chronic respiratory diseases, heart and circulatory problems, cancer, allergies, chronic digestive disorders, and alcohol and drug abuse. Before moving on in this chapter, it must be noted that, at best, statistics are but a snapshot of a moment in time. Although all data in this chapter are accurate as of the date of publication, it is up to you, the radiography student, to remain current in your knowledge of health statistics by frequently visiting the web sites listed on this page. # Mortality Early in the twenty-first century, mortality statistics revealed much about life and death in the United States. The Centers for Disease Control and Prevention (CDC) through its National Center for Health Statistics (NCHS) gathers and publishes such data. The mission of the CDC is to promote health and the quality of life by preventing and controlling disease, injury, and disability. The primary sources of health statistics are the following web sites: * CDC: www.cdc.gov * NCHS: www.cdc.gov/nchs The 15 leading causes of death in the United States, including all races, both genders, and all ages, are listed. Because this list changes as treatments improve, as the population ages, and as lifestyles alter, you should visit these web sites for the most current list. 1. Heart disease 2. Cancer 3. Cerebrovascular diseases (stroke) 4. Chronic lower respiratory diseases 5. Accidents (e.g., unintentional injuries, including motor vehicle fatalities) 6. Diabetes mellitus 7. Alzheimer disease 8. Influenza and pneumonia 9. Nephritis (kidney diseases) 10. Septicemia (blood infection) 11. Suicide 12. Chronic liver disease and cirrhosis 13. Hypertension (high blood pressure) 14. Parkinson disease 15. Homicide Causes of death vary by age group, race, gender, and socioeconomic status.' Key points from the NCHS (data from www.cdc.gov/nchs) data include the following: General population: * Ages 1 to 44-Accidents are the leading cause of death. * Ages 45 to 64-Cancer is the leading cause of death. * Ages over 65 years-Heart disease is the leading cause of death. Cancer and heart disease account for more than one half of all deaths in the United States. 'The CDC uses the following terms to describe the three major population groups in the United States: white, black, and Hispanic. The terms Caucasian and African American are not used. Number of deaths has declined from: * Cancer * Heart disease * Stroke * Suicide * Influenza and pneumonia * Chronic liver disease and cirrhosis * Accidents * Firearms * HIV * Alcohol * Drugs Number of deaths has increased from: * Alzheimer disease * Kidney disease * Hypertension * Parkinson disease HIV mortality has declined by more than 70% since 1995. HIV no longer ranks among the top 15 causes of death in the United States. Among all women, the number of deaths from breast cancer exceeds 40,000 annually. Maternal mortality (i.e., death from complications of pregnancy, childbirth, and the postpartum period) is nearly 8 deaths in 100,000 live births. Maternal mortality among black women is four times higher than among white women. Among all men, the number of annual deaths from prostate cancer is over 30,000. Mortality rates are higher for men for each of the 15 leading causes of death. Autopsies are performed after approximately 10% of deaths. Most autopsies are performed for traumatic causes such as homicide, suicide, and accidents. The highest percentages of autopsies performed for nontraumatic causes of death are for infant mortality and chronic liver disease and cirrhosis. ## Blacks: * Have higher death rates from hypertension and homicide. * Have lower death rates from lung disease, suicide, and Alzheimer disease. ## Hispanics: * The leading causes of death are homicide, chronic liver disease, and perinatal conditions. * Have lower death rates from heart disease and cancer. * Have higher death rates from homicide in age groups 15 to 24 years and 45 to 64 years. * Rate of death from HIV infection is higher between the ages of 1 and 64 years. * Rate of death from diabetes mellitus, chronic liver disease, and cirrhosis ranks higher for the population aged 45 years old and older. ## Specific causes of death: * **Firearms:** * 59% are white men. * 25% are black men. * 10% are white women. * 3.5% are black women. * Persons aged 15 to 34 years record the largest number of deaths from firearms. * **Drugs:** * Death rate is approximately 4.3 per 100,000 persons. * Death rate among men is more than twice the rate of women. * Death rate for the black population is nearly twice that of the white population. * **Alcohol:** * Death rate is approximately 6.8 per 100,000 persons. * Death rate among men is 3.5 times higher than the death rate for women. * Death rate for blacks is nearly 2.5 times higher than the death rate for whites. * **Infant mortality:** * Is just below 7 deaths per 1000 live births, the lowest rate ever recorded in the United States. * Increasing order of mortality is Hispanics, whites, blacks (more than twice the rate for whites). * Top five causes of infant deaths are: * Congenital malformations, deformations, and chromosomal abnormalities * Short gestation and low birth weight * Sudden infant death syndrome (SIDS) * Newborns affected by maternal complications * Newborns affected by complications of placenta, cord, and membranes # Morbidity In addition to death, morbidity takes its toll. Previously defined as the rate of occurrence of diseases or conditions, the following are the primary causes of disablement, medical intervention, health care expenditures, and overall lack of wellness in the United States: * Obesity * Mental and emotional disorders, including alcohol and drug abuse * Diseases of the cardiovascular system * Arthritis * Epilepsy * Cerebral palsy * Multiple sclerosis * Parkinson disease * Muscular dystrophy * Hearing and visual impairments * Mental retardation * Diabetes mellitus * Cancer # Life Expectancy The overall life expectancy in the United States is the highest in its history: 77.7 years. The female-to-male gap has closed to 5.3 years. At birth, the life expectancy (in years) by gender and race is as follows for those born early in the twenty-first century (data from www.cdc.gov/nchs): * White female: 80.6 * Black female: 76.5 * White male: 75.7 * Black male: 69.7 At age 65, life expectancy is as follows: * All Americans: an additional 18.5 years * All men: an additional 16 years * All women: an additional 20 years # Emerging Infectious Diseases Modern medicine has triumphantly eradicated smallpox and is nearing the elimination of polio. Other diseases targeted for worldwide eradication, severe limitation, or elimination by region include guinea worm, onchocerciasis, syphilis, rabies, measles, tuberculosis, and leprosy. However, the threat from emerging and reemerging infectious diseases has become the leading cause of death and disability worldwide. Dramatic changes in society, technology, and the environment, as well as a diminished effectiveness of some approaches to disease control, have allowed this development to occur. The term emerging infectious diseases refers to diseases of infectious origin whose incidence in human beings has either increased within the past 2 decades or threatens to increase in the near future. Such diseases increasingly threaten public health and substantially increase the cost of health care. Infectious diseases account for 25% of all visits to physicians each year, and antimicrobial agents are the second most frequently prescribed class of drugs in the United States. For example, childhood ear infections are the leading cause of visits to pediatricians, and the incidence of visits for such infections has increased by 150%. Direct and indirect costs of infectious diseases exceed $120 billion. Emerging infections are especially serious in people with lowered immunity, such as those who are HIV positive, those receiving immunosuppressive chemotherapy, and those who have received transplanted organs; these are all growing populations. Other large groups affected by this threat are older adults, those cared for in institutions, people with inadequate access to health care, and more than 11 million children in day care centers. Box 4-1 lists examples of emerging infectious diseases. Disease emergence can be related to many factors. Newly emergent infectious diseases may result from changes in or the evolution of existing organisms; known diseases may spread to new geographic areas or human populations; or previously unrecognized infections may appear in people living or working in areas undergoing ecologic changes (e.g., deforestation, reforestation) that increase human exposure to insects, animals, or environmental sources that may harbor new or unusual infectious agents. Furthermore, infectious diseases may reemerge because of either the development of antimicrobial resistance in existing agents (e.g., gonorrhea, malaria, pneumococci) or breakdowns in public health measures for previously controlled infections (e.g., cholera, tuberculosis, pertussis). Such infections can affect people in geographically widespread areas regardless of lifestyle, cultural or ethnic background, or socioeconomic status. It is important for the health care professional to understand two key terms when discussing infectious diseases-epidemic and pandemic. An epidemic is a widespread infectious disease within a given geographic area. A pandemic is an infectious disease of global proportions. Health care leaders and researchers are trying to contain increasing numbers of emerging infectious diseases to prevent pandemics. Surveillance of infectious diseases in the United States depends on voluntary collaboration among the CDC and state and local health departments, which in turn depend on reporting by health care professionals. Such reporting frequently incomplete. The CDC has established the following goals for dealing with the threat of emerging infectious diseases: * **Goal 1:** Detect, promptly investigate, and monitor emerging pathogens, the diseases they cause, and the factors that influence their emergence. * **Goal 2:** Integrate laboratory science and epidemiology to optimize public health practice. * **Goal 3:** Enhance communication of public health information about emerging diseases, and ensure prompt implementation of prevention strategies. * **Goal 4:** Strengthen local, state, and federal public health infrastructures to support surveillance and to implement prevention and control programs. Implementation of these goals and their accompanying objectives are relevant to health care delivery and its reform. Relevant issues include prolonged hospitalization as a result of noso-comial (hospital-acquired) infections, increased morbidity and treatment costs resulting from antimicrobial drug resistance, and excessive burdens placed on public and private health care delivery facilities because of community-wide outbreaks of foodborne and waterborne infections. # Social Forces that Affect Health Care As a radiologic technologist, you are part of a larger health care system that, in some way, touches the lives of everyone. The technologic advances alone have been dramatic. These improvements-coupled with a deeper understanding of the human being at the focus of our care-provide the basis for the continual evolution of health care delivery. Economic and social forces not in existence in centuries past deeply affect today's health care system. As a key member of the health care team, you, too, are influenced. The quality of the care you provide is profoundly determined by the environment in which you practice and by your professional self-image. Chapter 1 discusses in detail the values you can add to the services you provide. Such values enhance not only the patient's experience but also your self-image. The challenges are many; consequently, the opportunities for professional growth are plentiful. However, the radiologic technologist must have an understanding of the continually changing health care climate. The aging of the population, increasing health care costs, and an upturn in the birth rate are key forces that are greatly changing health care delivery. Although diagnostic imaging will continue to play a prominent role in health care, its exact shape will continue to evolve. You have chosen a field of study that has a bright future but that will certainly have its peaks and valleys over time. The venues in which radiologic technologists practice continue to change, and the job market fluctuates constantly. However, radiologic technology will continue to be one of the fastest-growing occupations in the coming decades. Within the profession, individual fields will grow even faster than others, such as education and all forms of scanning and digital imaging. Your patients and employers will expect and require the best of your talents and skills. They require a strong command of both the technical aspects of radiologic technology and the high-touch aspects of patient care and service. More work must be done with fewer caregivers when dealing with the realities of health care financing. You will also need a working knowledge of health care delivery issues. # Ethical Issues The advances in research and technology in medicine have prompted disagreement about ethical issues as never before. With all of its hope and ability to enhance the quality of life, health care has also raised questions that society must answer. Professionals and private citizens alike debate issues such as the patient's right to privacy and confidentiality of information. This topic has become particularly sensitive since the outbreak of AIDS. Animal rights advocates decry the use of laboratory animals in medical experiments; other groups question whether new drugs are made available to human beings too soon or not soon enough. Health care-related issues dominate the medical, religious, and political arenas. The elusive question of when life begins has yet to be answered by either science or the courts. At the other end of the life cycle is the debate over when life ends. Accompanying these controversies are the issues of abortion, active euthanasia (assisted suicide), passive euthanasia, and the right to die. In vitro fertilization is a reality, and so is surrogate motherhood. Genetic engineering carries with it the hope for the elimination of inherited diseases, as well as the specter of selecting which offspring to carry to term. Human cloning is a near reality. Ultimately, the most sensitive ethical issue may be the rationing of health care. Concern about long-term care for an aging population becomes greater with each passing year. During the first decade of the twenty-first century, more than 10 million older adults need care, and over 3 million are in institutions with that number growing annually. By the year 2025, one half of all older Americans will be age 75 and older. Even now, more than two thirds of those in nursing homes suffer from some form of cognitive disorder such as Alzheimer disease. Most of the cost of long-term care is paid for by the nursing home residents, their families, or both; depletion of life savings in a very short period is not unusual. Some underwriters offer a form of long-term care insurance coverage, and the government is examining its role in funding such care. Because of the sheer increase in the number of citizens in this age group, home care is on a steady increase. Home health care products cover simple hygiene, as well as complex medical technology. In