Environmental Risk Factors & the Medical Care System PDF
Document Details
Uploaded by ProperNewOrleans176
University of Michigan - Ann Arbor
Tags
Summary
This document analyzes the relationship between environmental risk factors and the medical care system. It details how various pollutants, such as radiation, mercury, and lead, impact human health. The role of government regulation and environmental protection agencies is discussed. The document also explores the concept of environmental justice and potential health disparities linked to environmental pollution.
Full Transcript
Environmental RiskFactors and the Medical CareSystem ACleanEnvironment ch20 People areadaptedtotheearth'senvironment EnvironmentalHealthhow thenaturalandbuiltenvironmentaffectshumanhealth taste Eltisther...
Environmental RiskFactors and the Medical CareSystem ACleanEnvironment ch20 People areadaptedtotheearth'senvironment EnvironmentalHealthhow thenaturalandbuiltenvironmentaffectshumanhealth taste Eltistheroleotfhegov'tmostexposuresarebeyondthecontrolofthe individual bystateand gov't localgovtsprovidewaterw requirementstomeetstandardsset federal and systems sewage ofclimatechangeafter 1960s gov't forenvironment hasmoreresponsibility standards Recognition setting newlawsforairwaterandwastedisposal many in60sand70s however standardsset EnvironmentalProtectionAgency for EPA established cleanerhealthierenvironment since slowed progressionhas then accumulation ofgreenhousegasesismajorissue testing toxicity iscostlyandtimeconsuming chemicalsmustberegulatedseparately boutspen In environment many toxicchemicals potentially manufact being RadiationRadon gas lung skincancermelanoma cancer xrays radium poisoning strengtheningandincreasinglimitations FDA damage Mercury neurologic fishcoalburningpowerplantsliquidmetal Lead andkidneys damagesRBCs mostimportant single to environmentalthreat children screenings waterFlintMI inair leadindrinking pollutionpaint ConsumerProduct SafetyCommission CPSCandConsumerProductSafety Act Improvement Arsenic cancer diabetes Asbestos cancermesothelioma RiskBenefitAnalysis liningsionstructionmaterialswalls occupationalsettingsbrake ceilings Absolute safety isanimpossiblegoalavoiding mininginLibby Montana vermiculite health emergency certainriskscan newones t rade bring 911attacksonWorld C enter disease lung overregulationcause does underregulation PesticidesandIndustrialchemicals loosermore achievedstandards easily less controversy i ofriskmustbebalancedagainstothersociety Is Popts prevention Most Americans health wantgov'ttoprotect and Pollutants StockholmConventiononPersistentorganic environmentbut berationalless regulationsmust cumbersomeandmorebalanced OccupationalExposures workers areregularlyexposedtotoxicchemicals FactoryFarms concentratedanimal feedingexposures tons CAFOs produce ofmanuewtoxicgases havegreateconomicandpoliticalpowershouldbe farms these undercleanAirActbut regulated aren't EnvironmentalHealthSciences lecture1112 DiseaseModel Exposure BiologicalandPhysical Chemical stressors radiation soyce Eilena vitiation movement ofpollutants 85000chemicalsinUScommerce 93 missing test 1basic expho he 6 testsnecessaryforminimumunderstandingochemical basic f toxicity Yse 3 developmentalandreproductivetoxicity health Effect 6 environmentalfate 5bitpeopleimpactedbypollutedwaterbodies mil37 127 live Americans inareasthatexceedNAAQS airquality weinhale11k ofairper liters day2kg food22water of diseaseisdue to modifiable factors forchildren environmental nothinEarth includingquality factorsintheenvironment physicalbiologicalchemical oflife determinedby 2 discoverhowtheenvironmentaffectspeopleinordertopromotehealthierlives foodairwaterwastedisposalsustainability Sources in2015 9milprematuredeathscausedbycountries pollution 92occursinlowmiddleincome Most prevalentamong and minorities marginalized Hazard CBorPagentorsetof of conditionscapable causing response biological HumanExposure contactbetween person andhazards overtime space Illicitly of movement Pollutants Dosehowmuch oftheagententersthebodyandisavailabletocauseharm effect Adversehealth anyseverityorlongevity Solutions heirarchy ofcontrols hazard remove physically EEE.fi EEEEIEE.EIi iiii.mn nvironmentalJustice discussion1111 Inflection racismand ofenvironmentalpollutionsystemic activism community Epnmustbetteraddresspollutionaidentionmentaljustice 3 health.mn ingiietiastnma 1 his.ie 2system EYE iiigw ahfdEPA ation 2 challenges ifYmerican current standards communities signifantly to exposed more p ollutants lookatcombined needto from effects health multiplepollutants 3grassYes here a dvocates awareness 3proYmoffiemspollution moniteringlobbying raising impactassessments 4politicaland efforts legislative have measures been by introduced lawmakersbut issues systemic persist Yelets In Etressingdisparities 5needfor reform c omprehensive 5urgencyforchange mwith EnvironmentalJust sittin are ie commercial from the FairTreatmentnogroupshouldbearadisproportionateshareof met yd environmentalconsequencesresulting negative industrigqq.ve both and area a cademic social movement JusticeMovementconcerned Environmental andanendtoinstitutionaldiscrimination protection wsocialjusticeequal 1960519705 peopleof color SixCitiesStudy1993 at ofairpollutionin70sand80s looked effects EJ Current challenges lifeexpectancydecreasedinhighpollutionareasrelated to is exposure airpollutants independently If I Igwater chronic tocardiovascular mortality it sites waste onunderservedcommunities focus legislationThe Clean AirAct S ources Human by ofAirPollution of and products m anufacturing power generation In If itto human protect health w adequatemargin ofsafety chemical from ducts production tithes regionally renren.by P poorair inineally however byproductsofBigagriculture certain.gg nbgimmbliefe that Factors predict overexposure toairpollution CAAdidwork criteria concdroppedsignificantly pollutant from model exposureDisease ofpollutants humanexposure dose adversehealth source movement effect Air affects Pollution health many areasbeyond lungs frequencyduration exposuremagnitude RacialSegregation Health AirPollutionimprovedafterCAAbutsuccessesandburdensnotevenlydistributed Ambient toairpollutionsresultsindiseasedisordersandcancer iiiis Exposure man fallsdispropotionatelyonlowerincomeandminority Burden groups US MedicalCareSystem ch26 alwaysa for need medicine forPH medsystemprovidespreventativecare saveslives necessary gapsinPHsystem lackof ofpoliticalwillemergenceofnewhealththreats resourceslack mediafire.tt n ii Ygortinvolvement careis aPHresponsibility medical Why infect can in initial many Ed.ge of services provision e mergency ii ng veryimportant butqualityeffectivenessranges lawsonacceptingpatientswfinancial varies issues andprisoners veterans uscitizensdonothavearighttomedicalcare except most PHvsMedicalProfession benefit gethealth most i nsurancethrough employee package Health Traditional Insurance paidto premiums regular the insurance company fly mhnts costs medical escalating flat feefixed medicaid ii missies Attempts iiiiiiIII for health national program i medical medicine o pposed socialized profession an Medicarehealthcare for those 65 part yo ofsocialsecurity I I Ii t.ioto9iiitiymetquiresmonthlypremium Eaten It filon plan voluntaryrequiresmonthlypremium drug MedicaidHfdfhinefty.IE'me shared costs byfedandstategovt's Health Children's Insurance ProgramCHIP expanded to coverage in that children families too earn much for toqualify medicaid Ardffhtt.us was plan noguaranteed nationwonationalmedicalcare only to access healthcare of medical required licensure qualified practitioners ensuresquality ofcare the JointCommissionaccreditshealthcareinstitutions tEaiii i iiiiiiiiiiiii.fi infants treating p wbirth ite defects jiii iii us resentment can Inequitiesinhealthcare fans ingetspriority WhytheUS ch27 Medicalsystemneedsreform costs medical risingaccess tocareishardtoobtain qualityofcareispoor aresignificantproportionofUSGDP usspendsmoreoncare costs medical than othercountry per person any to thatAmericansarehealthier evidence most uninsured are people poor ofuninsured asincome very foremployerssmallbusinessestoprovidehealthinsurance expensive lackofinsurance pooreroutcomes Medicare outmorethanitcollectsinpremiums pays costs Growing ofMedicaidputsstrainonstatebudgets Englosts Aging population newmedical and technology tech high procedures costs administrative kithierate obesity financialincentives forproviders of growth specialization thesellerdoctordetermineswhat buyerthe needs patient ihffi i tech Approaching.fi and aeatgilities managed fedproviderorganizationsPPOs camo Ytime maintains Affordablecare Act significantly reduced of number uninsuredAmericans obamacare iriEiiiiiiiiisaan Rational aidlimitedservices IPor thfoh.siIiIise taxessothatchildrencouldbe toprovideeffectivecare couldafford publichospitals providedw medicalinsurance andqualityofmedicalcare costs talk beetle TheUSHealthCareSystem lecture1114 forprovidingmedicalcarewhen needed Whoisresponsible thereisoverlapbetweenPHandmedicalservices whoshould forneededmedialcave pay UShealthcareisamarketbasedsystem Ismedicalcarearightorcommodity 4goalsofhealthcaresystem 4problemsofhealthcaresystem 6elementsofqualitycare olfife 3 optimumquality Everage andcare 2 systemperformancequalitygst centered imaaansi ii tiinimttii'anties iii.li ae both and capita per an 3 costofcareisthecurrentbiggestissued4.5tvil total 2 accesstocoveragecareisdifficultforworkingclassandvulnerablepops pplareputtingoff and care treatment needed 3 qualityandaccountabilityare and inconsistent measured poorly 4racialandeconomicdisparitiesareincreasingasare of have adults pupsolder number vulnerable tocare betteraccess erdierenttypesoeare Iggy.fi homamaresmmDieg i.es gg mitiiiiiiii amsinanciano ii.in ii iiijiiimii i pie miiinsmanceisriaconteationimanagementareatontea mostamericanscovered plans56 payer private through 10 areuninsured rates EiTE iiiÉfiiiidmgF higher erymet 6 majorgovtprogramsthat targetparticularpops amongminorit healthcaremarketfailedtoworkdue.to where Einservices careneedsandlowSES highhealth Medicare oftheUS healthcare system YH.ISedisienisteiiIre 119 challenges 115 IndianHealthservices 1 high costspoor outcomes rateof 2increasing elderly 3growthofgov't programsisnot funded sustainable 4manyAmericansareuninsured 5shortageofprimary care p hysicians 6 pervasivehealthand h ealthcare disparities TheAffordableCareAct101 readingfor119 highuninsurancerates unaffordabilityandpreexisting addressed conditionexclusions medicaidandemployersponsoredinsurance changestomedicare regulatedMarketplaces whatdid ACAchange Expandedcoverageexpandedmedicaidcutoff poverty forindividualsandsmallbusinesses levelexchangemarketswsubsidies rate uninsured reduced lifetime conditionsannual of coveragelimits excessiveout pocket costs consumer.IEhigEeh1fdhYIs ferpreexisting allowed young tostayonfamily adults plans 26 until variationsto limitsonpremium location family sizetobaccouse age drugsfree Medicare prescription benefitsslowed p reventative cost growth Medicaidadded health essential benefitspreventative in services homecommunitybasedcare ACA marketplacesexchangeshelps p eople andsmallbusinessesshopforinsuranceplans cover0 standard essentialhealthbenefitsminimum they stateshave benchmarkplansw requirements most have servicesEXCEPTpreventativeservices cost sharing FinancialAssistance b premium taxcreditsreducepremiums outofpocketcosts 2costsharingreductionsCSRlowerdeductablesand Medicaidexpansion forstates hasbecomeoptional her ispremium growthin in enrollment ACA Big have increased premiums haveincreased deductibles insurer hasbeenstrongoverall participation dipped TrumpAdministration during costs federal high very enhanced subsidies willexpiresoon dis some enrollmentinMedicaid rate uninsured rise may TheAffordableCareActObamacare lecture1119 Goalwastoincreaseinsurancecoverageandaccesstocare ACAthese Before faced groups toinsurancecoverage barriers at fromfamily excluded Adults age which Young planwas 19 wPreexisting People be conditionscould denied insurance childlessAdults notevereligibleforMedicaid SickIndividualslimitsonannualorlifetime Very coverage ACAreformedhealth industryleft insurance fundamental in structure place mandate forallAmericans care emath 1 employermandatesinsuranceindustryreformsindividual subsidi insurance Aversial yafgepn.gr can dependants stayonfamilyplanuntil26 yo and 111improvingquality of efficiency healthcare penaltiesoncompanieswho didn'tprovide insurance IV of and disease prevention chronic PH improving go.iniiuance ITgiIiiiiiii PH v workforce healthcare vi transparencyandengram integrity VIIimprovingaccesstoinnovativemedical therapies villcommunitylivingassistance and services supports to selection designed avoidadverse Engine im accordane care iii ae iaiei iiniiii iii iii iiiiiia individuals small and employee groups can insurance purchaseprivate plans throughinsurance exchanges ACAwascontroversialand political 3typesofmarketplaces Individualmandate tax ferited pier plans it whittenthanaYetsubsidiesallowed partnership andtaxcreditstooffsetcosts subsidies Statescould fortheexpansionmoststatesdid choose 11medicaidIHS won'tcover communityHealthCenterswon'tcover ACA was successful rateof inreducing uninsured whoisstilluninsured 133 coverseveryoneunder medicaid ofFPLincludingchildlessadults incomeinnon low states expansion benefits health essential package 10categoriesofservices thoseunable toaffordmarketplacecoverage onannualoutofpocketspending limit undocumented immigrants mustcoverpreventativeservices documented lowincomeimmigrantsinUS25years traittried datapromotion andatcouncil weakenedACA Trump eliminatedindividualmandate ITei iiin eiii affiliation MostAmericanssupportACAregardlessofpolitical ACAReadings Notes discussion1121 achievements 2 KeyACAachievements KeyACA 1 marketplaceenrollment 1 expandedcoverage 2 costsavings 3hE expansion 3 preventionandPH 4 outreachsuccess 5 healthequity 4 addressingdisparities 6 impactofACAinnovations 5 economichealthbenefits 7 recordcoveragerates of ACAaddressedgoal insurance andaccesstocare coverage ACA was inexpandingcoveragehow successful M childlessadults more andpayingthe enrolled people better gegap in 1 insurancemarketreforms expandedmedicaid to133of states theFPL up a guaranteedissue b dependentcoverageexpansion increased by13mil.in2017 insured 2medicaid expansion 3subsidizedmarketplaceplans 4employermandate anttoinsurethosejustaboveMedicaidincomecutoff 5individualmandate laterrepeated mail.nameace cancomparepurchasemarketplace consumers plansthroughHealthcare.gov RulingNFIBv SupremeCourt Sebelius increased 2mil.in201 Individualmandateisataxand insured.by hasauthority Congress notvalidexerciseofCongress'sspendingpower Medicaidexpansion thisexpansionoptional41states made optedin MarianneUdowPhilips lecture1121 ofMedicaidexpansion HealthyMichiganPlan Michigan'sversion tochoosefrom moreplans of healthinsuranceturmoil 2017 premiumsraised taxcreditasincentiveforindividualstomaintaincoverage Histff ofgov'tversusprivateaction AmericanMedicalAssociation AMA opposesgov't involvement whywedon'thaveuniversalhealthcare to wantgov't controlmedicalpractices don't 19001960there onlyinsurancefor accidents funerals was 1930sdepressionpeoplecouldn'taffordmedical care of Principle Insurance sickatsometimebutwedon'tallgetsickatthesametimeSharethecostsandspreadtherisk weallget ofBlueCrossearly1930s onlycoveredhospitalserviceslatercoveredphysigpyet.in Birth dictated prices ofBlueShield 1939 Birth controls1940s WWIIwageprice ofemployerbasedhealthcoverage introduction HowardAdministration 1950s health insurance insurancegrowinghealth to taxable individualsandemployers becamenon unemployed elderly inguding leftoutofcoverage cameat Medicare Medicaid time same to gov't introduce 1960spressureon AmericanCulturepushesindividualresponsibility mostpoliticalactive Medicaresatisfied talk universalcoverageuntil1990s group seniors solittle of mid1990s Businesscommunitiesdidn't wanttopayhealthinsuranceparticularlycarcompanies inhealthinsuranceinterferesw powerofgov't involvement socialism gov't wantgov'tinvolvement didn't Businesses wantsuniversalhealthcoverage Everyone but betaxedormandated theydon'twantto Globalization internationalcompaniesdon't insurance provide sotheircarsarecheaperandUScompanieslosingbusiness ClintonAdministrationfailed content interestsfoundedon American's misread of concept managed of carenetwork providers taken choice would've govt away smart Processhired to people writelegislationdidn't involve opr ublicnointerestgroups congress In1990sRepublicansproposedindividualresponsibility Democrats opposed 2009Democratsusedindividualresponsibityto 2008 gainRepublicanBipartisonsupport gotNorepublicansupport ACA Congresswrote billandgotsupportfromeveryinterestgroup of Mistake Obamacaredidn't the promote billpoorcommunicationtokeepcostslow gaveopponentopportunitytospreadmisinformation Failures Successes ofACA of rate uninsured lowest ThfT.EE ftity fa Ffundingifdidn'texpandmedicaidbut this wasrepealed of Threat repeal ofACA Trumpadministration Second first Trumpterm rateofuninsured increased health ifgov'tsubsidiesexpirenextyearandaren'trenewedmanywon'tbeableto afford insurance thoseonmarketplace Block forneedy grants families basedonenrollment Funding Aging ch29 diseases medical higher costs USpopulationisgetting older older ghfj11nic people hqp.gr Iiiii iiiis median inlife increase increase atbirth expectancy age 3groups young oldaged oldest old atslowerrate ofworking age paytosupportelderlyandgrowing people healthmeerth.geMetedtoincreaseamongelderly Older ppl tohavechronicillnessdisabilityanddependancy likely life Longer expectancymore healthy of periods chronic yearsvslonger anddisability illness ofmortalitydeathsincreasinglyconcentratedinarelativelyshortagerangeatbiologicallimitoflifespan compression ofmorbidityratesofchronicdiseaseanddisability compression rates disability have declined steadilyhoweverprevalence ofdiseaseshasincreased diseaseisnow lessdisablingthanitusedtobe mostsignificantly health smokingobesityand physical inactivity impact Idiotithaveunwantedsideeffects causes Osteoporosis iiiiii hearing ofagingpopulation ofenrolledisincreasingandcostper increasing enrollee Medicareisfeelingstrain forelderly SocialSecurity retirementsystem Medicarecoverage hole gap doughnut in Growth healthcare forelderlyisunsustainable costs rationing Ishighspendingonendoflifecarewell spent aretheelderly recievingtoo m uchcare of fixthis would compression m orbidity Aging lecture11 23 IIIiii iiiiiiii.ie an Growth US in elderly and number greater proportion ofolderadults butcontinuedpopgrowth slower from shift popto youthdependant predominantly elderlydependentpop costof careisgreatestinelderly health iiiiiiei.si i i n Elderlyare active politically very SocialSupportSystemsElderly ratio dependency trends Historical of showacompression mortality foracompressionofmorbidity PHaims Challenges ofcare if iia elderly increasing dependency notin ratio 65 labor force total force labor Solutions PossibleMedicare increase ageofeligibility increase premiums for income high copays beneficiariesincrease high EightiesPart D Yale hingesend olife f care outofpockethealthcareexpendituresformedicare beneficiaries 15ofincome can bankrupt forcing many toturnto them medicaid costs home Nursing forces care people topay downtopovertymedicaid covers home n ursing Possiblesocial solutions security increases age 65 inregular ofhighincomerecipientsbenefitssubjecttotax percentage test means ofbenefits receipt increaseor 16 sstax 613 benefits WorkIncomeand inElderly Poverty formostSSislargestsolesourceofincome hurts incomepeople agedisproportionately low increaseinretirement Health P romotion in is Prevention Elderly same asfor young Agingand PHwasasuccess longevityw increased increased functional increased years Overall goal istocompressmorbidity prgygtiygy.tn T.IE iiiiiiEanen Itinthe21ˢᵗCentury AchievementsandChallenges ch31 in andmethodology advanced knowledge is iesafety nfpei.fiEieimdii aI diseaseandstroke itself contraception Ishealth hazard 0799 child 1 98 environmentc leaned better isease understood up frombehavior affects health andcomputer healthrelateddata better to software analyze it life extended expectancy 10PH achievements of challenges diseases infectious and environmental pollution behavior unhealthy gov'tresponsibility decentralizing management byobjectives progress PHgoals towards care managed to controlcosts butunpopular costs medical continuing torise individualeffort in PHsurveillance Advances informationtechnologybetter necessary it iiit.ie i aosffeaiwy antiation iiiIiimm m.FI interventions lasting long p rotective socioeconomicfactors Popyging Thinkingaboutthefuture lecture123 mostpopulation healthmeasuresimproved lifeexpectancyincreased infant rate mortality decreased ratedecreased maternalmortality and diseases infectious gainsinpreventing treating Gleaner water food changes behaviorand in healthcare to in led improvements ChronicDiseaseoutcomes improvements inMVS inoccupationalinjuriesbetterdental healthimprovedairwater quality PHissourceof these not gains medicine PH inpast20years gains reduced around stigma mental and health obesity around awareness more ofdisabled needs painter in coverage can growingawareness sof ocialdeterminants ofhealth renewedcommitment topursuing health equity challenges u npredicted predicted health address d isparities T.EE i EEeaemanneamand environment Pandemic i PhasedPlythesctions todiseaseprevention ftp.iiahi iaes increased funding to onscienceand rely reasoning topromotehealth to combatmisinformationand r estore inPH trust public's leaders