Test 3 Flashcards
What is health promotion?
The process of enabling people to increase control over, and to improve, their health.
Moves beyond a focus on individual behavior towards a wide range of social and environmental interventions
What is disease prevention? How is it different from health promotion?
goal is to delay disability and death and maximize illness free years of life
What are the two components of health promotion? Describe them.
educational and ecological supports for actions and condition of living conducive to health
Educational: any combination of learning and experiences
Ecological: social, political, economic, organizational, policy, regulatory, and
other environmental circumstances
Describe US Public Health in the 1900’s
sanitary inspections, communicable disease control
Expanded to fill in gaps in medical system through child immunizations, care of mothers and infants, school screenings, family planning
Fed. Gov. grants supported substance abuse, mental health, community prevention
What are the roles of public health departments
assessment
policy development
assurance
What are the 2 components/types of prevention? Describe them
Primary - goal is to prevent first occurrence
Ex: vaccines
Secondary - Early detection of a disease and intervening to prevent the condition from
progressing
Ex: mammograms
What are the 5 parts of the health impact pyramid?
- Socioeconomic factors
- Changing the context to make individuals default decision healthy
- Long-lasting protective interventions
- Clinical interventions
- Counseling and Education
List determinants of health
● Income and social status
● Social support networks
● Education
● Employment/working conditions
● Social environments
● Physical environments
● Personal health practices and coping skills
● Healthy child development
● Biology and genetic endowment
● Health services
● Gender
● Culture
top 4 causes of death in 2022 (US)
- Heart disease
- Cancer
- Unintentional injury
- COVID-19
List health promotion interventions that need to occur
- excise taxes
- clean indoor air ordinance
- elimination of nicotine in tobacco
- warning labels on tobacco products
- counter-marketing
- ban. on tobacco advertising
- protect kids from advertising
- FDA regulations
Who is most likely to smoke cigarrettes?
People with a GED
What is Strong4Life?
Campaign for Obesity in Georgia
What does the medical model of chronic disease prevention assume?
individuals have a primary role in causing illnesses through poor health behaviors (diet, smoking, alcohol)
Prevention focuses on changing individual health behavior
What does the public health model of chronic disease prevention assume?
Assumes that society creates the conditions leading to disease
Ex: Easy access to alcohol
○ Large tobacco industry
○ Availability of high fat/salt foods
○ Dependence on automobile that decreases exercise
○ Unequal distribution of wealth
What are 3 illness prevention / health promotion strategies?
- Address the basic social determinants of illness
- Increase public health spending
- Provide primary and secondary prevention
What are the 4 parts of Guidelines for Disease Prevention and Health Promotion
- take a long term view
- demonstrate how behavior change enhances health
- encourage societal common good
- make efforts affordable
Percent of HealthCare dollars spent on prevention ***
2.6%
What are the causes of homelessness? ***
Structural trends: housing and social policy
Personal / familial vulnerability
Household income
Social policy
Job opportunities/ unemployment
Housing availability and cost
How many homeless people in Boston in 2024? How many were unaccompanied youth? ***
Total # in 2024: 29,435
Unaccompanied youth: 1800
What is the McKinney Homeless Assistance Act? ***
Passed in 1987 to provide funding for homeless people
What are 4 health problems Occuring More Frequently due to homelessness? ***
Exposure-related
- Frostnip/bite
- Immersion foot
- Heat stroke
Arthropod infestations
Infections
- TB, respiratory infections, cellulitis, HIV, hepatitis, STIs
Violence and Injury
What are 4 Health Problems Exacerbated by Homelessness? ***
Cognitive impairment/TBI
Substance use disorders
Cardiometabolic syndromes
Dental caries
What are challenged homeless people face in getting healthcare? ***
- Insurance access
- Competing priorities
■ Housing, addiction, etc - Practical challenges
■ Med storage/admin
■ Transportation
Describe transitionally homeless. ***
Often homeless due to a single catastrophic event
Young population
Lowest level of mental health, substance abuse, or other medical problems
Enter shelters for short period of time
Describe episodically homeless. ***
Episodic uses of shelter system
Nonshelter time can be spent in jails or hospitals
Compromise 12% shelter users
Younger population
Complex life histories
Often with mental health, medical, and substance use problems
Describe chronically homeless ***
Middle aged to older
High prevalence mental illness, medical, substance use problems , medical illness, and disabilities
Use shelters long term
Long term unemployment
Socially marginalized and high cost
Define homelessness.
Homelessness occurs when people or households are unable to acquire and/or maintain housing they can afford
Where do 1/2 of all people experience homelessness (4 states)?
CA, NY, FL, and WA
How much more likely are homeless people to be admitted to the hospital?
5x more
What are the top 3 causes of death in homeless (BHCHP)?
- drug overdose
- cancer
- heart disease
Characteristics of those most likely to be uninsured in 2004 prior to Chapter 58 law ***
Male
Young
Low income
Minority
Employed
The five key components of the Chapter 58 law ***
- Medicaid expansions (MassHealth)
- Subsidies for private coverage (Connector Care)
- Online marketplace
- Individual mandate
- Employer Mandate
What was the Dukakis Universal Health Care Law (“Pay or Play”)?
Companies have to provide health insurance or they pay a fund (Fund pays for uninsured workers)
Includes student health insurance mandate
Never implemented!!
Did Chapter 58 improve health outcomes?
yes
What did Ch 58 inspire?
Title I of ACA
What is a single-payer plan?
single government fund within each state to pay hospitals, physicians, and other healthcare providers
What is a government-financed plan?
money is collected through taxes or premiums by a public fund that pays healthcare providers
pros and cons of single-payer plan ***
Supporters:
Insures everyone
Could reduce administrative costs
Relieves employers of providing insurance to employees
Employees could gain more choice in providers and plans
No loss of insurance when change jobs
Opponents:
View it as an invitation to bureaucracy
Fives gov’t too much power over people’s health choices
Shift from private payment to taxes would be unacceptable
pros and cons of a government financed plan ***
Supporters say:
Could reduce administrative costs
Employers would not need to provide health insurance to employees
Consumers would have greater choice of physicians
Opponents say:
Society will not accept taxes needed to run it
Public mistrusts the government
pros and cons of employer mandate plan ***
Supporters say:
Needed to raise enough funds to insure the uninsured without large tax increase
Less disruptive to extend this process
Opponents say:
Unfair to small businesses
pros and cons of Individual mandate ***
Employers freed from providing health insurance
Stable source of health insurance regardless of employment, changing jobs, disability
Opponents say:
Inefficient to have each individual buy their own insurance
Lower income families would still have issue of affordability even with tax credits
Uninsured (especially seniors and sick people) would have higher out-of pocket health costs with tax credits as compared to staying uninsured
Describe Employment Mandate Model of NHI- The first plan-Nixon’s plan ***
Forced employers to provide health insurance
Proposal failed
Describe Individual Mandate Model of NHI- 1989- Sponsored by the Heritage Foundation. ***
Individual insurance mandate
No longer would health insurance be tied to employment, would include tax credits for people unable to purchase insurance or a voucher system.
Describe Massachusetts Individual Mandate plan of 2006 ***
States first individual mandate
Penalty for not having insurance subsidies offered
Some people could not afford it
Describe Pluralistic Reform Model – Affordable Care Act 2010 ***
Individual and employer mandates for private insurance and expansion of Medicaid
Tax penalty removed in 2017
Medicare for All proposed but failed
American rescue act helped during covid
What was the American Association for Labor Legislation Plan?
1915: AALL national health insurance proposal to provide medical care to low paid workers … never passed
What was the Wagner-Murray-Dingell Bill?
1943: Proposal for employer and employee contributions for cover medical care… social insurance proposal… never passed
What was the 1970 Kennedy Bill?
draft to cover entire population through national health insurance program that would replace all public and private insurance plans … never passed
How is the NHS funded? How do doctors and hospitals get paid? ***
Taxes
GPs get paid through capitation
Specialists are salaried and use fee-for-service
The NHS covers almost all costs of healthcare
except ___ ?***
No deductibles or copays except for prescriptions drugs which can be waived for certain groups of people
Who has access to the NHS system? ***
Anyone legally residing in the UK
How does the cost of care and the outcomes compare to the United States? ***
Cost of care is less
Outcomes are better
On average what percentage of income is spent on health insurance in Switzerland?***
16%
What is a weakness of the NHS? ***
Those with private insurance still have to pay into it
Are co-payments higher or lower in Switzerland than the United States? ***
higher
Is health insurance tied to your employment in Switzerland? ***
no
What is Australia’s public health insurance plan called? How is it funded? Who is it available to? ***
Medicare”
Paid for by taxes
Available to all australians and permanent residents
What role does the Swiss government play in insurance? ***
Give subsidies to help pay for insurance
Individual mandate
Why would Australians choose to buy private health insurance? ***
Access to elective care at the time they want it
Better amenities
Who sets prices for prescription drugs and treatments in Australia? ***
the government
What is causing a strain on the health insurance system in Australia? ***
People are dropping their health insurance (typically younger people) → elderly suffer
What type of health care system does Canada have? ***
Universal healthcare system
Explain IDEA ***
Provides for federally funded Early Intervention Programs for Children at risk from birth of 3 years of age
Requires special education services be provided for children with disabilities 3-21, if those disabilities affect the child’s ability to participate in regular education
Section 504 of the Rehabilitation Act ***
Requires that appropriate accommodations be provided to permit children with disabilities to benefit from/participate in regular education.
The child does not need to have special education services to qualify for accommodations.
IEP Team – who is required to be on the team ***
Required participants:
-Student’s regular classroom teacher(s)
-Representative of the school administration
-Student’s parent or guardian
Other possible participants:
-Special educator
-School psychologist
-Related services providers (OT,PT,SLP)
-School nurse
-Family advocate
-The student
IEP Team - Parental rights ***
To agree or disagree to having the school evaluate their child
To request an outside (independent) evaluation
To accept or reject the findings of the IEP team
To accept or reject the proposed plan, in whole or in part
Due Process: If there is disagreement, to go to mediation with the school, and if issues cannot be resolved in mediation, to have a court hearing.
To have an advocate or lawyer present to represent their needs.
what is FAPE
free and appropriate public education
What is a disability?
“any person who has a physical or mental impairment which substantially limits one or more major life activities”
what is an appropriate education?
Education in regular classes
Education in regular classes with the use of related aids and services
Special education and related services in separate classrooms for all portion of the school day
Special education may include:
- Specially designed instruction in classrooms, at home, or in private or public institutions
- May be accompanied by related services such as speech therapy, occupational and physical therapy, psychological counseling, and medical diagnostic services necessary to the child’s education
what is the peer effect
academic growth is associated with skill level of classmates (or roommates) even when other factors like SES are controlled
explain Robinson and Norton 2019
Children from historically marginalized groups are assigned to “less privileged” disability categories
African American children are under-represented in DLD dx and overrepresented in ED/ID categories
Over-representation in ID categories has led CA to ban the use of IQ measures for African American Children
list IDEA categories
Intellectual Disability
Hearing impairment, including deafness
Speech or language impairment
Visual impairment
Specific learning disabilities
Other health impairments
Serious emotional disturbance
Orthopedic impairment
Autism Spectrum Disorder
Traumatic brain injury
Deaf-blindness/multiple disabilities
Developmental delay (up to age 9)
do children qualify for an IEP if they make adequate progress in the class even if they are disabled?
no
Some Medical Issues that Might Require a 504 plan Without IEP
Food Allergies
Diabetes
Osteogenesis Imperfecta
Juvenile Rheumatoid Arthritis
Seizure Disorder
Hearing Loss
Vision Loss
Attention Deficit Hyperactivity Disorder
Challenges School Service Providers Face:
- Legally obligated to provide whatever the IEP includes –> financial burden
- Clinical providers may make recommendations that do not meet the requirements of IDEA
- Children fall through the cracks
- poorly defined
Essential features of the German health care system ***
- Division of health insurance into statutory (social) and private health insurance
- mandatory
- All insured individuals receive the same benefits
Biggest challenges in financing statutory health insurance in Germany is ***
demographic change
How much Germany spends on health care compared to other EU countries ***
Spends more than other EU countries except Norway
Financing of the SHI through Contributions
Contributions in the SHI are income-dependent for its members.
The general contribution rate in the SHI is 14.6 percent (with 50% covered by the employer)
In-kind principle
Legally insured individuals of the SHI receive medical treatment without having to
pay upfront.
Doctors, hospitals, and pharmacies directly bill the health insurance funds for the
therapies and medications
Reimbursement principle
Private policyholders typically have to pay for medical services upfront, and then get
reimbursed by the insurers
The nurse shortage is a serious problem caused by ___ ***
burnout, poor working conditions, and low pay.
In the second millennial decade ___ ***
the ACA reduced uninsurance but increased underinsurance
Alternatives to fee-for-service care include ACOs and PCMHs
There is renewed interest in primary care
Budget Reconciliation Act- What is it, what reforms it included ***
Provide 24 hour care
Enhance quality of life
Who pays for long term care (LTC)
***
Medicare covers nothing for custodial care
Medicaid covers nursing homes but not 24 hr custodial home care
Private long term care insurance
How can long term care be improved? ***
Develop social insurance
Shift to community based care
Train family members as caregivers
Expand comprehensive acute and LTC organizations on On Lok
Social insurance ***
Small payments when employed that go towards sickness, unemployment, and retirement
On Lok program ***
Now called PACE
Financed by capitations
Able to provide comprehensive cost effective care to people 55 and older who qualify for nursing home care
Minimizes costs through fewer acute care hospitalizations for residents
ACA reforms for LTC ***
Community First Choice Option – assists states with the costs of in home programs for people who would otherwise be institutionalized
Balancing Incentive Program – increases federal matching Medicaid funds in states with less coverage for home and community services
2014: husband and wives are able to keep more of their assets if a spouse must spend down to go onto Medicaid
Overall proposals for LTC ***
Money Follows the Person (MFP): Rebalancing Demonstration Grant
-Assists states in rebalancing their Medicaid long term care systems
Medical homes
What is Premium Assistance
***
Medicare will cover premiums for cost effective private plans
What are the logistics of ESI
***
Health network
Access to care
Comprehensive coverage
