Hey all.
Here's an interesting article from BBC, talking about a study performed at Berkeley that tested the brain function of kids from both low and high socio-economic backgrounds. Turns out that kids from low SE families did not process information in their brains as well as those from higher SE backgrounds.
"This is a wake-up call - it's not just that these kids are poor and more likely to have health problems, but they might actually not be getting full brain development from the stressful and relatively impoverished environment associated with low socioeconomic status."
http://news.bbc.co.uk/2/hi/health/7762492.stm
Researchers think this lower performance may be because these children were not spoken to as much by adults as they developed.
Monday, December 8, 2008
Sunday, December 7, 2008
NY Time Article
Yes, this is a bit late....
I came across this article in the Times: Finding a Voice to Match the Pressing Medical Needs of Hispanics.
It is an interesting story about a Latino community that rallied together and compelled their governor to give fully fund a program which institutes interpreters in medical facilities.
Certainly a step in the right direction--Yay :)
Friday, December 5, 2008
Impoverished HIV Patients in California
Hey Everyone,
This just came out today in the LA Times about California's health care system for poor patients with HIV:
http://www.latimes.com/features/health/la-me-hiv5-2008dec05,0,6358115.story
In 2002, Governor Gray Davis signed a bill into law that would make Medi-cal more accessible to low-income HIV patients.
Unfortunately, California's Department of Health Care Services failed to take the mandated steps to put the law into action.
Now, a LA County Superior Judge has decreed that Governor Schwarzenegger's administration has not fulfilled it's obligation to enact the law.
The intent of the law was to cut the costs of AIDS care by switching patients from expensive fee-for-service systems into managed care. The savings would then be used to extend Medi-cal coverage to more poor HIV patients.
A spokesperson for the Department claims that the increased cost of care could not be resolved by the proposed changes. However, instead of looking at other strategies for making the changes successful, it seems that the program was just abandoned.
It is disappointing to see our Department of Health Care Services giving up so easily on a project that could pave the way for more universal coverage. It's hard to say how much analysis or effort they put into the situation from reading just one article, but it would be nice to see some inspiring dedication and creative efforts put into something that is this important. If anyone has any insight on what went on behind the scenes, I'd love to know!
Nicole
This just came out today in the LA Times about California's health care system for poor patients with HIV:
http://www.latimes.com/features/health/la-me-hiv5-2008dec05,0,6358115.story
In 2002, Governor Gray Davis signed a bill into law that would make Medi-cal more accessible to low-income HIV patients.
Unfortunately, California's Department of Health Care Services failed to take the mandated steps to put the law into action.
Now, a LA County Superior Judge has decreed that Governor Schwarzenegger's administration has not fulfilled it's obligation to enact the law.
The intent of the law was to cut the costs of AIDS care by switching patients from expensive fee-for-service systems into managed care. The savings would then be used to extend Medi-cal coverage to more poor HIV patients.
A spokesperson for the Department claims that the increased cost of care could not be resolved by the proposed changes. However, instead of looking at other strategies for making the changes successful, it seems that the program was just abandoned.
It is disappointing to see our Department of Health Care Services giving up so easily on a project that could pave the way for more universal coverage. It's hard to say how much analysis or effort they put into the situation from reading just one article, but it would be nice to see some inspiring dedication and creative efforts put into something that is this important. If anyone has any insight on what went on behind the scenes, I'd love to know!
Nicole
Quick update: Obama & changes to U.S. healthcare!
Quick summary of Obama's recently announced plan here: I can't get the URL to work, so just go to news.google.com and type in "FACTBOX: Obama's ambitious healthcare plan"
My favorite points of the plan are:
-- Stop insurers from denying coverage based on pre-existing conditions.
My favorite points of the plan are:
-- Stop insurers from denying coverage based on pre-existing conditions.
-- Obama says he can reduce healthcare spending by 8 percent and save each taxpayer $2,500.
-- The Lewin Group, a consulting firm, forecasts the Obama proposal would raise federal spending by $1.17 trillion from 2010 through 2019. (From wikipedia: "In 2007 the U.S. spent $2.26 trillion on health care")
(Quick side note: The Lewin Group conducted a study on the single payer CA Bill SB840 showing that a single payer system would SAVE (versus increasing spending) $8 billion in the first year. Savings are because you decrease the insurance companies' 25% administrative overhead to the 4% Medicare admin overhead. Check it out here: http://www.healthcareforall.org/studies.html)
-- A National Health Insurance Exchange to help people buy private insurance, act as a watchdog and create standards
-- Tax employers who do not provide coverage.
-- Small business tax credit to help pay for employee health insurance
-- Require healthcare for all children, expanding Medicaid & SCHIP to cover poor children
Thursday, December 4, 2008
Health Care Reform Reveals Doctor Shortage
Hi everyone,
It seems that every time time I read the news I encounter a new article about the need for universal health care. Just today, I was reading about former Senator Tom Daschle, Obama's nominee for Secretary of Health and Human Services, who has plans to hold holiday-season house parties to brainstorm over how best to overhaul the U.S. health-care system.
One subtle aspect that is not being openly discussed is the fact that health insurance does not necessarily guarantee health care access. To prove this point, I just saw an article in the New York Times that relates a new crisis facing Massachusetts universal health care reform: the lack of primary care physicians to provide care for all the newly insured. The article stresses that what has happened in Massachusetts has put " a spotlight on the workforce shortages that don't get meaningfully talked about in just about any other other state." The main point is that Massachusetts is the first to encounter a problem that will confront other states as more people are able to afford/receive health insurance. People will have insurance, but who will accept them as patients? Unfortunately, this is a problem that promises to particularly affect poor and underserved communities.
Why the decreased interest in primary care? Why are so many existing primary care physicians disenchanted? Among the issues highlighted in the articles are high student-loan debt and poor compensation/reimbursements by insurance companies, Medicaid and Medicare for primary care visits--no one pays for the time it takes to fill out enormous amounts of paperwork, take on the insurance companies on behalf of patients or to write sick notes to employers.
What to do to change this situation? As one article states, "the solution is ultimately political, since it requires making sure that our enormous public investment in medical care goes where it will do the most good."
You can take a look at the following articles I just referenced at:
http://www.nytimes.com/2008/04/05/us/05doctors.html?pagewanted=1&sq=primary%20care%20physician%20shortage
http://seattletimes.nwsource.com/html/opinion/2002895859_rosenblatt29.html
http://www.npr.org/templates/story/story.php?storyId=97620520
All the best,
Rosa
It seems that every time time I read the news I encounter a new article about the need for universal health care. Just today, I was reading about former Senator Tom Daschle, Obama's nominee for Secretary of Health and Human Services, who has plans to hold holiday-season house parties to brainstorm over how best to overhaul the U.S. health-care system.
One subtle aspect that is not being openly discussed is the fact that health insurance does not necessarily guarantee health care access. To prove this point, I just saw an article in the New York Times that relates a new crisis facing Massachusetts universal health care reform: the lack of primary care physicians to provide care for all the newly insured. The article stresses that what has happened in Massachusetts has put " a spotlight on the workforce shortages that don't get meaningfully talked about in just about any other other state." The main point is that Massachusetts is the first to encounter a problem that will confront other states as more people are able to afford/receive health insurance. People will have insurance, but who will accept them as patients? Unfortunately, this is a problem that promises to particularly affect poor and underserved communities.
Why the decreased interest in primary care? Why are so many existing primary care physicians disenchanted? Among the issues highlighted in the articles are high student-loan debt and poor compensation/reimbursements by insurance companies, Medicaid and Medicare for primary care visits--no one pays for the time it takes to fill out enormous amounts of paperwork, take on the insurance companies on behalf of patients or to write sick notes to employers.
What to do to change this situation? As one article states, "the solution is ultimately political, since it requires making sure that our enormous public investment in medical care goes where it will do the most good."
You can take a look at the following articles I just referenced at:
http://www.nytimes.com/2008/04/05/us/05doctors.html?pagewanted=1&sq=primary%20care%20physician%20shortage
http://seattletimes.nwsource.com/html/opinion/2002895859_rosenblatt29.html
http://www.npr.org/templates/story/story.php?storyId=97620520
All the best,
Rosa
Interesting article on health care access by undocumented immigrants
Hey everyone,
As I was preparing for our presentation a couple of weeks ago, I came across this comprehensive yet concise article on health care access/use by undocumented immigrants. In the heated immigration debates in California, it's often stated that undocumented immigrants use a disproportionate amount of public services, especially health care. The data presented in the article demonstrates that this population has low rates of health care utilization and that immigrant authorization status remains a significant barrier to health care access.
You can take a look at the article at: http://archinte.ama-assn.org/cgi/content/full/167/21/2354
Many regards,
Rosa
As I was preparing for our presentation a couple of weeks ago, I came across this comprehensive yet concise article on health care access/use by undocumented immigrants. In the heated immigration debates in California, it's often stated that undocumented immigrants use a disproportionate amount of public services, especially health care. The data presented in the article demonstrates that this population has low rates of health care utilization and that immigrant authorization status remains a significant barrier to health care access.
You can take a look at the article at: http://archinte.ama-assn.org/cgi/content/full/167/21/2354
Many regards,
Rosa
Homless Hospital Release Solutions
Here's an article that I found from National Coaltion for the Homeless that describes some of the changes that have to occur with physicians when homeless patients are released from hospital, in order to imporove patient outcomes.
http://www.nhchc.org/Network/HealingHands/2008/Oct2008HealingHands.pdf
I found most interesting the program at OHSU with their hospital, which seemed to mirror/alleviate many of the same problems that we have with patients at the Hillcrest hospital. I was also aghast at the crazy practices going on in LA.
http://www.nhchc.org/Network/HealingHands/2008/Oct2008HealingHands.pdf
I found most interesting the program at OHSU with their hospital, which seemed to mirror/alleviate many of the same problems that we have with patients at the Hillcrest hospital. I was also aghast at the crazy practices going on in LA.
Monday, December 1, 2008
A breathtaking aspiration for AIDS
An interesting opinion piece in the IHT about a Lancet research paper that suggests testing and treating everyone who tests positive in Africa. The idea is quite simple: test everyone, suppress viral loads in everyone who is positive, and transmission rates with be dramatically reduced. Whatta ya think?
Today is World AIDS Day, Please Take Action
Hey Everyone,
Today is World AIDS Day and it would be great if you could take a minute to help increase the availability of antiretrovirals and other life saving medicines in the developing world. I started a chapter of Universities Allied for Essential Medicines here at UCSD - it is a national advocacy organization that works to ensure Global Access Licencsing for university-based biotechnologies and drugs. You can ask me more about it if you are interested. Anyways, we are stepping up our campaign to encourage the President of the University of California system (Mark Yudof) to adopt global access licensing for all UC-developed health technologies. Please go to http://www.essentialmedicine.org/uc and sign the letter that will then be emailed to Yudof, and please send it to other friends and professors. Over 100 physical letters were already collected at UCSD alone, and nearly 1,000 at all the UC schools combined, and have been hand delivered to the UC President's office. We need to continue to remind him how important it is that the fruits of university research should be available to all, not just those who are fortunate enough to afford it.
Thanks,
Chris
Today is World AIDS Day and it would be great if you could take a minute to help increase the availability of antiretrovirals and other life saving medicines in the developing world. I started a chapter of Universities Allied for Essential Medicines here at UCSD - it is a national advocacy organization that works to ensure Global Access Licencsing for university-based biotechnologies and drugs. You can ask me more about it if you are interested. Anyways, we are stepping up our campaign to encourage the President of the University of California system (Mark Yudof) to adopt global access licensing for all UC-developed health technologies. Please go to http://www.essentialmedicine.
Thanks,
Chris
Hey all! So, I'm finally sharing some thoughts on the blog. About time . . . Below is a link to a relevant article that was buried deep in the NYTimes over the weekend. It discusses a new report from the European Union which accuses Big Pharma in Europe of intentionally delaying generic production of certain medications, which cost the EU almost $4billion over the last seven years. Drug policy is an interest of mine and I would encourage us all to ask questions about not only access to care but also the cost of helathcare. Lets all encourage the Obama administration to ensure access to low cost medications!
http://www.nytimes.com/2008/11/29/business/worldbusiness/29drugs.html?_r=1&pagewanted=print
Along the same lines, I recently became aware that many corporate pharmacies have a $4 generic drug list. Any drug on the list only cotst $4 to fill a prescription, with or without insurance. So, let's try to make sure our attendings are writing Rx for generics whenever possible, particularly if we know our patient doesn't have insurance!
http://www.nytimes.com/2008/11/29/business/worldbusiness/29drugs.html?_r=1&pagewanted=print
Along the same lines, I recently became aware that many corporate pharmacies have a $4 generic drug list. Any drug on the list only cotst $4 to fill a prescription, with or without insurance. So, let's try to make sure our attendings are writing Rx for generics whenever possible, particularly if we know our patient doesn't have insurance!
Friday, November 21, 2008
Broken Promises
Hi all!
Congratulations on completing our first round of courses in med school =)
When I had originally signed up for the ethnic minorities presentation group, the particular group of interest I had in mind was Native Americans. I know there are many reservations in this area and I do not feel that I have a good grasp on the disparities they face. Before our group decided to focus on the Latino population, I began research on Native Americans and wanted to share with you one of the most informative resources I came across. It is extremely long, but I felt it would be a good resource for all of us because this is a population of patients we WILL be treating in San Diego. (Plus it has a handy table of contents).
The document also provides a history of health policies and decisions involving the Native Americans--attempts at solutions which have ultimately not been accomplished yet. It is incredible what a role the federal government has played in the health care of Native Americans and ultimately how their relationship has lead to health disparities experienced by this population.
I hope you all find this educational and interesting.
And have a wonderful Thanksgiving!
Cassidy
http://www.usccr.gov/pubs/nahealth/nabroken.pdf
Congratulations on completing our first round of courses in med school =)
When I had originally signed up for the ethnic minorities presentation group, the particular group of interest I had in mind was Native Americans. I know there are many reservations in this area and I do not feel that I have a good grasp on the disparities they face. Before our group decided to focus on the Latino population, I began research on Native Americans and wanted to share with you one of the most informative resources I came across. It is extremely long, but I felt it would be a good resource for all of us because this is a population of patients we WILL be treating in San Diego. (Plus it has a handy table of contents).
The document also provides a history of health policies and decisions involving the Native Americans--attempts at solutions which have ultimately not been accomplished yet. It is incredible what a role the federal government has played in the health care of Native Americans and ultimately how their relationship has lead to health disparities experienced by this population.
I hope you all find this educational and interesting.
And have a wonderful Thanksgiving!
Cassidy
http://www.usccr.gov/pubs/nahealth/nabroken.pdf
Tuesday, November 18, 2008
Hepatitis B Virus-Induced Liver Cancer in Asian Americans: A Preventable Disease
Hello!
I recently attended a Hepatitis B conference sponsored by APAMSA and was surprised to learn that about 1 out of 10 Asian Americans have chronic hepatitis B infections, compared to only 1 out of 1,000 white Americans! I think the statistic speaks for itself. Hepatitis B is a serious liver disease that disproportionately affects Asian Americans today.
Why so common among Asian Americans? First of all, 90% of Hepatitis B infections were acquired from other countries, and not in the U.S. Thus, Asian immigrants and their descent often carry the disease. Sadly most are unaware of it. People with chronic HBV often show no symptoms. Blood test is the only way of detecting the infection. Chronic Hepatitis B infection can lead to liver cancer.
Because Hepatitis B is a sexually transmitted disease, talking about Hepatitis B is a social taboo in Asian culture. However, sex is not the only method of transmission. People living in developing countries often acquire the disease from their mother at birth.
One of the main speakers at the conference has Hepatitis B. She acquired Hepatitis B from her mother at birth. She was in her mid-40s when she found out. Consequently, she unknowingly passed Hepatitis B to her husband and her three children - all of whom are now at risk of liver cancer....However there is hope!
Treatment for Hepatitis B is now available! Although it is not a complete cure, studies have shown that the new treatment can reduce a patient's risk of developing liver cancer significantly. Unfortunately, most old Asian healthcare providers are unaware of the new treatment and still follow the old rule: “If your liver looks fine, you are fine.” People who have Hepatitis B need to be tested and treated.
I encourage you to check the following article that was published this year! A lot of Hepatitis B awareness (Jade Ribbon Campaign) in the U.S. just started a couple of years ago and is happening now! http://liver.stanford.edu/
Please join the movement by staying informed!
Hepatitis B Virus-Induced Liver Cancer in Asian Americans: A Preventable Disease
JNCI Journal of the National Cancer Institute 2008 100(8):528-529
http://jnci.oxfordjournals.org/cgi/content/full/100/8/528
I recently attended a Hepatitis B conference sponsored by APAMSA and was surprised to learn that about 1 out of 10 Asian Americans have chronic hepatitis B infections, compared to only 1 out of 1,000 white Americans! I think the statistic speaks for itself. Hepatitis B is a serious liver disease that disproportionately affects Asian Americans today.
Why so common among Asian Americans? First of all, 90% of Hepatitis B infections were acquired from other countries, and not in the U.S. Thus, Asian immigrants and their descent often carry the disease. Sadly most are unaware of it. People with chronic HBV often show no symptoms. Blood test is the only way of detecting the infection. Chronic Hepatitis B infection can lead to liver cancer.
Because Hepatitis B is a sexually transmitted disease, talking about Hepatitis B is a social taboo in Asian culture. However, sex is not the only method of transmission. People living in developing countries often acquire the disease from their mother at birth.
One of the main speakers at the conference has Hepatitis B. She acquired Hepatitis B from her mother at birth. She was in her mid-40s when she found out. Consequently, she unknowingly passed Hepatitis B to her husband and her three children - all of whom are now at risk of liver cancer....However there is hope!
Treatment for Hepatitis B is now available! Although it is not a complete cure, studies have shown that the new treatment can reduce a patient's risk of developing liver cancer significantly. Unfortunately, most old Asian healthcare providers are unaware of the new treatment and still follow the old rule: “If your liver looks fine, you are fine.” People who have Hepatitis B need to be tested and treated.
I encourage you to check the following article that was published this year! A lot of Hepatitis B awareness (Jade Ribbon Campaign) in the U.S. just started a couple of years ago and is happening now! http://liver.stanford.edu/
Please join the movement by staying informed!
Hepatitis B Virus-Induced Liver Cancer in Asian Americans: A Preventable Disease
JNCI Journal of the National Cancer Institute 2008 100(8):528-529
http://jnci.oxfordjournals.org/cgi/content/full/100/8/528
Thursday, November 13, 2008
UCSD SOM Kiva Loan Community
I have created a community on Kiva.org for the UCSD SOM. Its an open community and anybody can join. It would be awesome if some of you would like to join it and loan as little as $25! To join the community you simply go to kiva.org Then click on Communities. If you search for UCSD it should come up with the UCSD SOM community. Just click to join. You'll first have to create an account on Kiva and then you can join the community. As a member of the team you still actually do the loans individually. So that means you can choose anyone on kiva to loan to yourself. However if you don't want to take the time just let me know and I'll make a couple of suggestions.
The more people that join the bigger impact we can make so please join up! Its only $25 and like 98% you'll get your money back! I'll keep people updated with emails on how its going after you join as well. Some of the people receiving money send out little updates and things. Thanks!!
The more people that join the bigger impact we can make so please join up! Its only $25 and like 98% you'll get your money back! I'll keep people updated with emails on how its going after you join as well. Some of the people receiving money send out little updates and things. Thanks!!
Culture and Health Literacy
Hey guys,
I came across this interesting article while doing research for my project. It discusses the role of culture in health literacy and provides some guidance into breaking the cultural divides. I know we have talked a lot about this, but it never hurts to see what is actually being published about the subject. Enjoy!
http://springerlink.metapress.com/content/x03720m20857mm86/fulltext.pdf
-Daniel
DENTAL DISPARITY in Minority Children
Hey everyone - Today we will talking about a few child disparities but there was ONE that was very shocking to our group that we don't have time to talk about today.
The article is linked below but the main point is that minority children have extremely high cavity rates compared to white children. Apparently cavities can be almost completely eliminated if water is fluoridated:
"Water fluoridation is the most effective measure in preventing caries, but only 62% of water supplies are fluoridated, and lack of fluoridation may disproportionately affect poor and minority children."
It was shocking to our group that 62% of water supplies are NOT fluoridated - that is a simple and relatively cheap solution to the problem. This is a solution that even us as medical students could help initiate and could save millions of dollars of dental care later.
Full Article:
http://jama.ama-assn.org/cgi/content/full/284/20/2625
Brush your teeth!!
The article is linked below but the main point is that minority children have extremely high cavity rates compared to white children. Apparently cavities can be almost completely eliminated if water is fluoridated:
"Water fluoridation is the most effective measure in preventing caries, but only 62% of water supplies are fluoridated, and lack of fluoridation may disproportionately affect poor and minority children."
It was shocking to our group that 62% of water supplies are NOT fluoridated - that is a simple and relatively cheap solution to the problem. This is a solution that even us as medical students could help initiate and could save millions of dollars of dental care later.
Full Article:
http://jama.ama-assn.org/cgi/content/full/284/20/2625
Brush your teeth!!
Wednesday, November 12, 2008
The Current State of Primary Care
This is an extremely relevant video that is a must watch for us PRIME kids, especially because we're all "going to be in Primary Care, right?" (David Ding)
Anyway, the video is a roundtable discussion of a bunch of doctors and one M.D.,M.P.H. Their collective intellect is nice to be around.
They first spend some time citing the problems and their roots,
Then they go into new ways of viewing Primary Care and delivering it,
After which they discuss the importance of using different sectors of medicine in building a "Primary Care Team",
And finally, the group tries to tackle the age-old dragon: Payment Reform.
Enjoy with a ice-cold beverage and bare feet. It's a fun one.
http://www.nejm.org/perspective/primary-care-video/
Anyway, the video is a roundtable discussion of a bunch of doctors and one M.D.,M.P.H. Their collective intellect is nice to be around.
They first spend some time citing the problems and their roots,
Then they go into new ways of viewing Primary Care and delivering it,
After which they discuss the importance of using different sectors of medicine in building a "Primary Care Team",
And finally, the group tries to tackle the age-old dragon: Payment Reform.
Enjoy with a ice-cold beverage and bare feet. It's a fun one.
http://www.nejm.org/perspective/primary-care-video/
articles related to "greening" our cities
Hey guys,
I was just browsing through bbc news and came across an article that relates to Dr. Sidelinger's talk on how urban planning and green spaces affect health.
This first article talks about a study done by a couple of scottish scientists on how greener neighborhoods relate to reducing the "health gap" between rich and poor. They studied the relation between the death of 36600 people between 2001 and 2005 and how "green" their local neighborhoods were. I don't believe all of the evidence but its interesting.
http://news.bbc.co.uk/2/hi/health/7714950.stm
The next one done by researchers at Colombia University is an older one discussing the links between green neighborhoods and a reduction in asthma. They even go so far as to say that "asthma rates among children aged four and five fell by 25% for every extra 343 trees per square kilometre." It also discusses some of the stuff we learned about during the asthma clinical correlate about how exposure to more microbes as a child reduces the risk of asthma. They, however, link greener neighborhoods with playing outside more often. This therefore leads to more exposure to microbes thus lowers asthma risk. I'd like to see some more convincing evidence, but its a start.
http://news.bbc.co.uk/2/hi/health/7374078.stm
-Daniel
Tuesday, November 11, 2008
Hey everybody,
This is an article that I've always thought was interesting. The reported findings are alarming, yet very relevant to what we're trying to train ourselves to do. I've written a quick snippet just to whet your appetites, so that you may go on to the link to read it for yourself: http://jama.ama-assn.org/cgi/content/full/294/9/1058?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=residents%27+preparedness&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
Chao!
hubert
This is an article that I've always thought was interesting. The reported findings are alarming, yet very relevant to what we're trying to train ourselves to do. I've written a quick snippet just to whet your appetites, so that you may go on to the link to read it for yourself: http://jama.ama-assn.org/cgi/content/full/294/9/1058?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=residents%27+preparedness&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
Without a question, current residents are required to face difficulties arising from cross-cultural differences. JAMA reports in a survey taken of residents that 96% do acknowledge that it was very important to address cultural components when giving care, while only 8% answered that they were not prepared to care for diverse cultures. Interestingly, when asked about addressing specific aspects of cross-cultural care, the following results arose: 25% reported that they were not ready to care for someone who firmly believed in something other than Western Medicine, 25% reported that they were not ready to care for new immigrants, and 20% were not ready to care for patients with strong religious beliefs. The discrepancy between these two sets of numbers (8% and 25%) points towards the simple fact that some residents are not even able to pinpoint exactly what entails “cross-cultural care”. This gap in the type of knowledge required in these specific settings may arise from a plethora of situations, ranging from a lack of focused cultural component in the medical school curriculum, to a lack of a mentor who possesses a strong understanding of such issues, to even the failure of the school or hospital administration to believe in the importance of said issues.
Chao!
hubert
The State of SB 840
As many of you know, SB 840 is the senate bill that aims to create a single-payer universal health care system here in California. It is a bill that relies on the fundamental idea that health care is a universal human right, an idea, that even amongst health care professionals, is not universally accepted.
Here are some of the benefits of SB 840 (copied directly from the website:http://www.onecarenow.org/sb840.htm which represents supporter of SB 840)
1) Security - All California residents are covered for life.
2) Choice - Everyone has the freedom to choose their doctor or integrated health system such as Kaiser. Delivery of care will continue as now to be private and public.
3) Comprehensive Benefits - Coverage includes all care prescribed by a patient's health care provider that meets accepted standards of care and practice. Coverage includes hospital, medical, surgical, mental health; dental and vision care; prescription drugs and medical equipments, diagnostic testing, hospice care and more.
4) High Quality - The bill utilizes proven financial incentives that support the delivery of high quality care, including bonuses for providers working in rural or under-served areas. The plan invests in needed health care infrastructure such as electronic claims and reimbursement systems and statewide medical databases that improve health care quality.
5) Efficient Administration - Consolidating the hundreds of insurance plans, both private and public, into one comprehensive insurance plan saves the state, patients and providers billions of dollars each year.
6) Shared Responsibility - Payment of an affordable premium by employers, employees and individuals supports the health care system we all need at some time.
7) Fair Reimbursement - Providers receive fair and full compensation for all their services.
8) Cost Controls - Health care costs are controlled by efficient administration, bulk purchase of drugs and durable medical equipment, global health care budgets, coordination of capital expenditures, and linkage to growth of the State Gross Domestic Product.
If you went to the event that Anne helped organize a couple weeks ago, you also know that this bill has passed both houses of the CA legislature twice, only to be vetoed by the governor.
The governor has created an alternative proposal which was not approved by the legislature, this link compares and contrasts his proposal to SB 840
http://www.onecarenow.org/healthcarereformplancompare.htm
Please recognize this is from a group lobbying for SB 840, so of course there are some inherent biases, that being said, I still think its worth looking over.
For a definition of single-payer health care - here is a handy wikipedia link:
http://en.wikipedia.org/wiki/Single-payer_health_care
SB 840 will probably be reintroduced in the CA legislature in Feb 2009, where if it passes again (as it likely will), the governor will have another chance to approve it. If you are in support of Universal health care coverage in CA, you may want to consider signing a petition online: http://salsa.democracyinaction.org/o/1308/signUp.jsp?key=1142&t=DefaultTemplate.dwt, or sending a letter to the governor. There is also a lobby day in Sacramento slated for the 11-12 of January (I think).
If you support Universal Health Care nationally, it will likely need to be proven at the state-wide level before it goes national. And what better place than California to break this important ground?!
Here are some of the benefits of SB 840 (copied directly from the website:http://www.onecarenow.org/sb840.htm which represents supporter of SB 840)
1) Security - All California residents are covered for life.
2) Choice - Everyone has the freedom to choose their doctor or integrated health system such as Kaiser. Delivery of care will continue as now to be private and public.
3) Comprehensive Benefits - Coverage includes all care prescribed by a patient's health care provider that meets accepted standards of care and practice. Coverage includes hospital, medical, surgical, mental health; dental and vision care; prescription drugs and medical equipments, diagnostic testing, hospice care and more.
4) High Quality - The bill utilizes proven financial incentives that support the delivery of high quality care, including bonuses for providers working in rural or under-served areas. The plan invests in needed health care infrastructure such as electronic claims and reimbursement systems and statewide medical databases that improve health care quality.
5) Efficient Administration - Consolidating the hundreds of insurance plans, both private and public, into one comprehensive insurance plan saves the state, patients and providers billions of dollars each year.
6) Shared Responsibility - Payment of an affordable premium by employers, employees and individuals supports the health care system we all need at some time.
7) Fair Reimbursement - Providers receive fair and full compensation for all their services.
8) Cost Controls - Health care costs are controlled by efficient administration, bulk purchase of drugs and durable medical equipment, global health care budgets, coordination of capital expenditures, and linkage to growth of the State Gross Domestic Product.
If you went to the event that Anne helped organize a couple weeks ago, you also know that this bill has passed both houses of the CA legislature twice, only to be vetoed by the governor.
The governor has created an alternative proposal which was not approved by the legislature, this link compares and contrasts his proposal to SB 840
http://www.onecarenow.org/healthcarereformplancompare.htm
Please recognize this is from a group lobbying for SB 840, so of course there are some inherent biases, that being said, I still think its worth looking over.
For a definition of single-payer health care - here is a handy wikipedia link:
http://en.wikipedia.org/wiki/Single-payer_health_care
SB 840 will probably be reintroduced in the CA legislature in Feb 2009, where if it passes again (as it likely will), the governor will have another chance to approve it. If you are in support of Universal health care coverage in CA, you may want to consider signing a petition online: http://salsa.democracyinaction.org/o/1308/signUp.jsp?key=1142&t=DefaultTemplate.dwt, or sending a letter to the governor. There is also a lobby day in Sacramento slated for the 11-12 of January (I think).
If you support Universal Health Care nationally, it will likely need to be proven at the state-wide level before it goes national. And what better place than California to break this important ground?!
School-Based Health Centers
Hi guys, this is my first time posting on the PRIME blog, and so I wanted to shift gears and post a little bit about a topic that is near and dear to my heart... (Its a long one - read it when you have time :)
As many of you know, I spent the last five years teaching in the Oakland Public Schools. When I first came to Oakland High School, there were no health services on campus to speak of, and if a child so much as needed a band-aid, they were going to get sent home (unless the teacher had bought some on her own). In the five years I was there, I had the privilege of seeing a transformation in the role of the school as health care provider and educator for under-served youth - we brought on a full time health-educator, and even a first-aid nurse. In the last few years I was in Oakland, I became very involved in a committee whose goal was to implement a school based-health center on campus.
The model of a school-based health center has been around for over 20 years, and in many ways it is part of a greater vision for the 'School as Village', a concept proposed by many, including Hillary Clinton during her time as First Lady. The idea is that schools should be transformed into full-service community centers that provide not only traditional education, but also mental and physical health services, career and college support, leadership development, and training for parents in a variety of areas ranging from healthy eating, and computer skills to education on navigating college applications and FAFSAs with their children. Many of these services currently receives some level of government support, or are delivered by non-profit organizations that rely at least in part on grants from their state, county, and local government. Therefore, the 'School as Community Center' model centralizes the provision a many related government services to high-need populations.
In California, there are currently more than 150 School-based health centers, many of which are at the elementary school level. Their mission is to provide standard primary care, and often times mental health services to children at the school (who opt to use the clinic). At the high school level, reproductive health services are also a major facet of the health clinics. These health clinics are a safety net to some of our most vulnerable patients, low-income children.
In 2006, Governor Schwarzenegger set a goal of expanding the number of school-based health centers to 500. Unfortunately, California is one of only nine states that do not provide direct state funding for school-based health centers. Instead, school based health centers must rely on a hodge-podge of different funding sources including 'government grants, private donations, in-kind support, and third-party reimbursement from public programs such as Medi-Cal, Healthy Families, Family PACT, and Expanded Access to Primary Care to provide services.' This may not always be the case, as in September of this year; the Governor signed Senator Ridley-Thomas’ SB 564, the School Health Centers Expansion Act. This act creates a state-grant program for school-based health centers, and once implemented will be the first-time direct state assistance will be provided to school health centers. Such funding is absolutely imperative, if the Governor is serious about expanding the number of school based health clinics to 500 or more. SB 564 is a follow-up to AB 2560 of 2006, which established a Public School Health Center Support Program to collect data and provide technical assistance to support new and existing school health centers. Unfortunately, the significance of the new bill may remain symbolic for the time being as the Governor himself as admitted that the budget is tight, and there is no money to start awarding these grants at the present time, however, he wanted to create a mechanism and framework for providing school based clinics with assistance when monies became available.
At Oakland High, the vision for our wellness center was born from many other models that already existed in the Bay area, one particularly exemplary model being at nearby Berkeley High, where a single trailer had grown into a full service health center in a permanent structure with a full-time medical staff. Of course, Berkeley had the privilege of a more ample support from their City's own Health and Human Services Department. Our own clinic was to be funded by a more modest grant from the county Department of Public Health. So, while our funds we more limited, our goals were no less lofty. We were inspired by what other schools in similar communities were able to offer, and strove to provide quality primary care that could be accessed by all 2000 of our students.
As of the 2007-2008 school year, a preliminary health center had been opened in a large classroom that had served as an auto shop many years ago. We were offering a significant (though limited) amount of counseling and psychological health services, as well as sex education and reproductive health services. The school nurse and two school psychologists are at the center of this developing institution and the other services are contracted out to local non-profits and clinics who send staff to provide their services on site. In 2008, we also received additional funding to create a new structure for the health clinic, an approved blue prints that included space for a lab, and several exam rooms. The new center, when it finally opens, will integrate health services with a wide range of academic support, college preparation, employment opportunities, and leadership development. Gardening and cooking classes also aim to improve eating habits amongst teenagers. The idea is that by providing kids with productive ways to engage in their community, we will decrease violence, drug and alcohol use, and unsafe sex, which are all major contributors to diminishing health amongst youth. It is an ambitious project, and one that is still in its infancy, but I hope to visit Oakland High and see their progress this spring.
In the meanwhile, here are some of the important questions and concerns that both proponents and opponents of school based health centers have raised:
How do we determine which schools are best suited for a school-based health center?
How do we optimize the size and nature of the clinic?
(A large full service clinic in some schools, as opposed to a small one-stop shop with more limited services in another)
How do we engage the support and guidance of the community in developing such clinics?
In the case of elementary and junior high students (and to a lesser degree high school students), how do we reconcile issues of patient confidenitality with the right of the parent to be involved in their minor's health care decision-making?
For more info on school-based health clinic in Cali and around the country:
http://www.chcf.org/topics/view.cfm?itemid=133488
(the linked pdf on this page is an excellent, though extensive report)
gov.ca.gov/images/page/health/SchoolBasedHealthCenters.pdf
http://www.schoolbasedhealthcare.org
http://www.schoolhealthcenters.org/
Happy Studying!
Arthi
As many of you know, I spent the last five years teaching in the Oakland Public Schools. When I first came to Oakland High School, there were no health services on campus to speak of, and if a child so much as needed a band-aid, they were going to get sent home (unless the teacher had bought some on her own). In the five years I was there, I had the privilege of seeing a transformation in the role of the school as health care provider and educator for under-served youth - we brought on a full time health-educator, and even a first-aid nurse. In the last few years I was in Oakland, I became very involved in a committee whose goal was to implement a school based-health center on campus.
The model of a school-based health center has been around for over 20 years, and in many ways it is part of a greater vision for the 'School as Village', a concept proposed by many, including Hillary Clinton during her time as First Lady. The idea is that schools should be transformed into full-service community centers that provide not only traditional education, but also mental and physical health services, career and college support, leadership development, and training for parents in a variety of areas ranging from healthy eating, and computer skills to education on navigating college applications and FAFSAs with their children. Many of these services currently receives some level of government support, or are delivered by non-profit organizations that rely at least in part on grants from their state, county, and local government. Therefore, the 'School as Community Center' model centralizes the provision a many related government services to high-need populations.
In California, there are currently more than 150 School-based health centers, many of which are at the elementary school level. Their mission is to provide standard primary care, and often times mental health services to children at the school (who opt to use the clinic). At the high school level, reproductive health services are also a major facet of the health clinics. These health clinics are a safety net to some of our most vulnerable patients, low-income children.
In 2006, Governor Schwarzenegger set a goal of expanding the number of school-based health centers to 500. Unfortunately, California is one of only nine states that do not provide direct state funding for school-based health centers. Instead, school based health centers must rely on a hodge-podge of different funding sources including 'government grants, private donations, in-kind support, and third-party reimbursement from public programs such as Medi-Cal, Healthy Families, Family PACT, and Expanded Access to Primary Care to provide services.' This may not always be the case, as in September of this year; the Governor signed Senator Ridley-Thomas’ SB 564, the School Health Centers Expansion Act. This act creates a state-grant program for school-based health centers, and once implemented will be the first-time direct state assistance will be provided to school health centers. Such funding is absolutely imperative, if the Governor is serious about expanding the number of school based health clinics to 500 or more. SB 564 is a follow-up to AB 2560 of 2006, which established a Public School Health Center Support Program to collect data and provide technical assistance to support new and existing school health centers. Unfortunately, the significance of the new bill may remain symbolic for the time being as the Governor himself as admitted that the budget is tight, and there is no money to start awarding these grants at the present time, however, he wanted to create a mechanism and framework for providing school based clinics with assistance when monies became available.
At Oakland High, the vision for our wellness center was born from many other models that already existed in the Bay area, one particularly exemplary model being at nearby Berkeley High, where a single trailer had grown into a full service health center in a permanent structure with a full-time medical staff. Of course, Berkeley had the privilege of a more ample support from their City's own Health and Human Services Department. Our own clinic was to be funded by a more modest grant from the county Department of Public Health. So, while our funds we more limited, our goals were no less lofty. We were inspired by what other schools in similar communities were able to offer, and strove to provide quality primary care that could be accessed by all 2000 of our students.
As of the 2007-2008 school year, a preliminary health center had been opened in a large classroom that had served as an auto shop many years ago. We were offering a significant (though limited) amount of counseling and psychological health services, as well as sex education and reproductive health services. The school nurse and two school psychologists are at the center of this developing institution and the other services are contracted out to local non-profits and clinics who send staff to provide their services on site. In 2008, we also received additional funding to create a new structure for the health clinic, an approved blue prints that included space for a lab, and several exam rooms. The new center, when it finally opens, will integrate health services with a wide range of academic support, college preparation, employment opportunities, and leadership development. Gardening and cooking classes also aim to improve eating habits amongst teenagers. The idea is that by providing kids with productive ways to engage in their community, we will decrease violence, drug and alcohol use, and unsafe sex, which are all major contributors to diminishing health amongst youth. It is an ambitious project, and one that is still in its infancy, but I hope to visit Oakland High and see their progress this spring.
In the meanwhile, here are some of the important questions and concerns that both proponents and opponents of school based health centers have raised:
How do we determine which schools are best suited for a school-based health center?
How do we optimize the size and nature of the clinic?
(A large full service clinic in some schools, as opposed to a small one-stop shop with more limited services in another)
How do we engage the support and guidance of the community in developing such clinics?
In the case of elementary and junior high students (and to a lesser degree high school students), how do we reconcile issues of patient confidenitality with the right of the parent to be involved in their minor's health care decision-making?
For more info on school-based health clinic in Cali and around the country:
http://www.chcf.org/topics/view.cfm?itemid=133488
(the linked pdf on this page is an excellent, though extensive report)
gov.ca.gov/images/page/health/SchoolBasedHealthCenters.pdf
http://www.schoolbasedhealthcare.org
http://www.schoolhealthcenters.org/
Happy Studying!
Arthi
Monday, November 10, 2008
A Model to Eliminate Health Disparities
Hey guys,
Since I am working on the presentation this coming Thursday, I may as well post these two essays from PLoS Medicine as my share for the blog. Up to this point we have (I hope) acknowledged the fact that there are health inequity and/or disparities in our society. In fact those data, movie clips, and statistic presented by Dr. Daley, Dr. Broyles, and Dr. Sidelinger really opened my eyes as I have learn a lot from this class. However as a thought process, when we think about what goes wrong, we should also think how to fix it and prevent future problems. That is what addressed in these two essays which, I think, is really helpful to read. A solution for health inequity is not simple, but what can we do beside hoping for a better & fairer health policy system?
The first essay (2006) is the suggestion from a former Assistant Secretary for Health of the United State.
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030405
The second one, which is newer (2008), talks about the possibly of a reformation for our health care system.
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0050208&ct=1
Chuong
Since I am working on the presentation this coming Thursday, I may as well post these two essays from PLoS Medicine as my share for the blog. Up to this point we have (I hope) acknowledged the fact that there are health inequity and/or disparities in our society. In fact those data, movie clips, and statistic presented by Dr. Daley, Dr. Broyles, and Dr. Sidelinger really opened my eyes as I have learn a lot from this class. However as a thought process, when we think about what goes wrong, we should also think how to fix it and prevent future problems. That is what addressed in these two essays which, I think, is really helpful to read. A solution for health inequity is not simple, but what can we do beside hoping for a better & fairer health policy system?
The first essay (2006) is the suggestion from a former Assistant Secretary for Health of the United State.
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030405
The second one, which is newer (2008), talks about the possibly of a reformation for our health care system.
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0050208&ct=1
Chuong
Sunday, November 9, 2008
Biotech: Health Equity vs. Economy
Hey PRIME-mates,
This is an article from the San Francisco Chronicle about potential changes in the pharmaceutical market now that Obama has been elected. Obama's proposed changes to the industry include more widespread use of generic drugs, import of lower cost drugs from other countries, and a pharmaceutical price break negotiated for Medicare.
The Biotech Industry Organization is analyzing the financial impact of these types of changes. They've already started to cite our country's economic troubles as a legitimate reason to keep drug prices high. Is revitalizing the economy really more important than treating the sick people who these drugs were developed for (often with publicly funded money from the NIH)?? Check it out:
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/11/08/BU9H13UVDA.DTL&type=politics
Ok, back to biochem....
-Nicole
This is an article from the San Francisco Chronicle about potential changes in the pharmaceutical market now that Obama has been elected. Obama's proposed changes to the industry include more widespread use of generic drugs, import of lower cost drugs from other countries, and a pharmaceutical price break negotiated for Medicare.
The Biotech Industry Organization is analyzing the financial impact of these types of changes. They've already started to cite our country's economic troubles as a legitimate reason to keep drug prices high. Is revitalizing the economy really more important than treating the sick people who these drugs were developed for (often with publicly funded money from the NIH)?? Check it out:
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/11/08/BU9H13UVDA.DTL&type=politics
Ok, back to biochem....
-Nicole
Saturday, November 8, 2008
Intersting NYT article on the treatment of Legal and Illegal Immigrants in Hospitals Across the Country
Hey PRIMErs,
I found this article on the New York Times homepage today (11/8/08) and thought it would be a great read for those (I should say all) of you that are following the blog. Good luck studying! :-).
http://www.nytimes.com/2008/11/09/us/09deport.html?hp
- Hershey
P.S. The article is long, but each anecdotal example is less than a page, so it would be worth it to take a glance at at least a few of the patient examples.
I found this article on the New York Times homepage today (11/8/08) and thought it would be a great read for those (I should say all) of you that are following the blog. Good luck studying! :-).
http://www.nytimes.com/2008/11/09/us/09deport.html?hp
- Hershey
P.S. The article is long, but each anecdotal example is less than a page, so it would be worth it to take a glance at at least a few of the patient examples.
Friday, November 7, 2008
Hi guys,
I found an article on education concerning obesity in African American children. I feel this is extremely important since this is the population that is most effected yet gets the least amount of support. I think educating both the family and children will be great, but I feel availability of healthy foods in these communities still needs to be addressed, without access it makes it very difficult to implement.
http://www.nih.gov/news/health/oct2008/nichd-31.htm
I found an article on education concerning obesity in African American children. I feel this is extremely important since this is the population that is most effected yet gets the least amount of support. I think educating both the family and children will be great, but I feel availability of healthy foods in these communities still needs to be addressed, without access it makes it very difficult to implement.
http://www.nih.gov/news/health/oct2008/nichd-31.htm
Hospitals See Drop in Paying Patients
http://www.nytimes.com/2008/11/07/business/07hospital.html
Here's an article about the current economy's effect (unemployment at a 14 year high!) on hospitals, procedures, and patient enrollment. It's true there's a "bottom-line" that needs to be met, but I still thought it was interesting that the way they present procedures and patients in the article is by dollar signs-- the money-making procedures vs. uninsured or Medicare/Medicaid patients. Anyway, this article also makes it seem apparent to me that the current system isn't working well-- how does hospitals elimating jobs and/or procedures affect patient care? It'll be interesting to see how healthcare reform might play out in our current economy.
Here's an article about the current economy's effect (unemployment at a 14 year high!) on hospitals, procedures, and patient enrollment. It's true there's a "bottom-line" that needs to be met, but I still thought it was interesting that the way they present procedures and patients in the article is by dollar signs-- the money-making procedures vs. uninsured or Medicare/Medicaid patients. Anyway, this article also makes it seem apparent to me that the current system isn't working well-- how does hospitals elimating jobs and/or procedures affect patient care? It'll be interesting to see how healthcare reform might play out in our current economy.
Wednesday, November 5, 2008
Kiva Loan Program
I know this program has gotten a little publicity recently, so perhaps many of you have heard about it already. In case you haven't, I would really recommend checking out kiva.org Its a really cool company that links people around the world to provide personal loans to people in developing countries. The loans are usually for seeds, or supplies for a general store, or other things along those lines. They go directly to the entrepreneur and are repaid relatively quickly usually. I know we are all poor college students, but you can literally give as little as $25 AND you get paid back so you can loan out that money again. And lets be honest, we can probably all spare $25. Its a really cool site and you can look around for regions, and business you are personally passionate about helping. I know this isn't directly linked to health care, but I thought it might be something people in PRIME would be interested in as well. Anyways, check it out!
www.kiva.org
www.kiva.org
Link to previous post
http://www.nytimes.com/2008/11/04/washington/04medicare.html?_r=1&em&oref=slogin
here is the link to the article...I am not very good at this BLOG thing. Sorry =)
here is the link to the article...I am not very good at this BLOG thing. Sorry =)
Tuesday, November 4, 2008
Court Blocks White House Push on Medicare Expenses
Hi everyone,
I thought you might be interested to see this article that popped up on my homepage yesterday regarding another reason most of us are happy to see the Bush Administration leave =). I feel that it is important to be knowledgeable about healthcare policies (such as Medicare), especially in the line of work most of us want to be involved in. I was thankful to see that in this particular case the federal court opposed the administrations effort to have Medicare only pay for the least expensive treatments for particular conditions. As the last paragraph states, this would limit low-income and minority patient's access to more expensive treatments that may be more necessary for proper care. I am interested in learning more about current healthcare policy (because I feel my knowledge is limited) so please post any other articles or relevant findings.
Hope studying is going well for everyone!
Thursday, October 30, 2008
The History of Institutional Review Boards
Along the lines of our discussion regarding research ethics, Dr. William Schneider (Professor of History, Indiana University) provides an overview of the events and developments that led to the establishment of federal rules and regulations concerning research, including the Institutional Review Boards. This article addresses the Nuremberg Code, the Thalidomide Tragedy, the Declaration of Helsinki, the Henry Beecher article in the NEJM, the USPHS memo on review boards, and the Tuskegee Syphilis Study.
http://www.iupui.edu/~histwhs/G504.dir/irbhist.html
http://www.iupui.edu/~histwhs/G504.dir/irbhist.html
Wednesday, October 29, 2008
dialysis for illegal immigrants
Interesting article published today in the L.A. Times about dialysis treatment for illegal immigrants in California and other states:
http://www.latimes.com/news/la-me-dialysis29-2008oct29,0,5272809,full.story
If Mexico can only provide Toribio treatment if she is able to provide enough cash, should U.S. hospitals treat her? Deporting her to Mexico may likely result in renal failure and death from the lack of viable treatment, but treating her here will create a "burden" for tax paying Californians. The article mentions that the United States can't treat the world, especially for dialysis, which can be costly. But is the U.S. treating the world, or simply helping a marginalized group fleeing economic and social struggle?
I am of the opinion that it is the moral obligation of our country to provide treatment for illegal immigrants, though seemingly costly. And for those who have "embraced their inner capitalist" dialysis treatment outside of the ER is cheaper, so really everybody wins...but not quite.
Of course, the argument remains that we ought to instead deport illegal immigrants-after all they are NOT Americans and DO NOT have the birthrights which come with being born on American soil. I do not think that this perspective is without merit. It solves the problem, in a sense. The economic burden is lifted off taxpayer’s shoulders, and hospitals don't have to worry about long term costly treatment, just enough treatment to get the patient back to their home country-that patch of soil on which they were born. Yet in reality, the problem isn't solved, because the problem is human suffering. Toribio would not be magically cured upon flying into Mexican airspace. It is in the interest of all humanity, perhaps physicians most of all, to prevent suffering which can be avoided.
Many who feel inwardly perturbed by the prospect of treating illegal immigrants with tax dollars understand something very important: the healthcare system isn't working properly. Treating Toribio and other illegal immigrants isn't right because the system is wrong: we need a means of absorbing marginalized individuals like Toribio for the long term, in a manner that will not create an unsustainable burden. But for now, how can we send a patient to preventable death?
http://www.latimes.com/news/la-me-dialysis29-2008oct29,0,5272809,full.story
If Mexico can only provide Toribio treatment if she is able to provide enough cash, should U.S. hospitals treat her? Deporting her to Mexico may likely result in renal failure and death from the lack of viable treatment, but treating her here will create a "burden" for tax paying Californians. The article mentions that the United States can't treat the world, especially for dialysis, which can be costly. But is the U.S. treating the world, or simply helping a marginalized group fleeing economic and social struggle?
I am of the opinion that it is the moral obligation of our country to provide treatment for illegal immigrants, though seemingly costly. And for those who have "embraced their inner capitalist" dialysis treatment outside of the ER is cheaper, so really everybody wins...but not quite.
Of course, the argument remains that we ought to instead deport illegal immigrants-after all they are NOT Americans and DO NOT have the birthrights which come with being born on American soil. I do not think that this perspective is without merit. It solves the problem, in a sense. The economic burden is lifted off taxpayer’s shoulders, and hospitals don't have to worry about long term costly treatment, just enough treatment to get the patient back to their home country-that patch of soil on which they were born. Yet in reality, the problem isn't solved, because the problem is human suffering. Toribio would not be magically cured upon flying into Mexican airspace. It is in the interest of all humanity, perhaps physicians most of all, to prevent suffering which can be avoided.
Many who feel inwardly perturbed by the prospect of treating illegal immigrants with tax dollars understand something very important: the healthcare system isn't working properly. Treating Toribio and other illegal immigrants isn't right because the system is wrong: we need a means of absorbing marginalized individuals like Toribio for the long term, in a manner that will not create an unsustainable burden. But for now, how can we send a patient to preventable death?
Monday, October 27, 2008
Dr. Elioda Tumwesigye at 12pm, TODAY
Physicians for Human Rights is bringing Dr. Elioda Tumwesigye, a member of the Ugandan Parliment and chair of the Ugandan government's HIV/AIDS committee, to UCSD today!
Location: Price Center, Sungod Lounge, Gallery B
Time: 12pm (we'll walk over after lecture)
He will be sharing insights on the strides that the US global AIDS response (PEPFAR) has made in addressing these issues, as well as the need for evidence-based prevention policies that put human rights before ideological politics. In collaboration with the Health Action AIDS Campaign at Physicians for Human Rights, Dr. Tumwesigye will also discuss ways to join a movement fighting AIDS.
Location: Price Center, Sungod Lounge, Gallery B
Time: 12pm (we'll walk over after lecture)
He will be sharing insights on the strides that the US global AIDS response (PEPFAR) has made in addressing these issues, as well as the need for evidence-based prevention policies that put human rights before ideological politics. In collaboration with the Health Action AIDS Campaign at Physicians for Human Rights, Dr. Tumwesigye will also discuss ways to join a movement fighting AIDS.
Wednesday, October 22, 2008
Discussion Prompt 2
The following article provides an historical overview of human-subjects research. In your discussion, please address the implications that the lack of oversight and ethical standards in past human-subjects research has had on the trust of vulnerable populations and how this affects your role as a physician serving these communities. Other topics to address include: the risks and benefits to health associated with human-subjects research, current ethical concerns regarding human-subjects research, and the role legislation should play in regulating human-subjects research.
The historical, ethical, and legal background of human-subjects research.
http://www.rcjournal.com/contents/10.08/10.08.1325.pdfWednesday, October 15, 2008
Discussion Prompt
Thank you to those who have already made posts of important resources and information (Hershey, Amy, Chuong & Jimmy).
To initiate your dialogue, please respond to the posts Amy and Hershey created regarding Propositions 3 & 4 and the presidential candidates, respectively, by discussing the potential health care and health status implications of current and pending legislation, as well as the policies and past voting histories of the two presidential candidates. Other topics to consider are the direct and indirect health implications of the following repealed initiatives: Initiative 08-0004 Bans Human Embryonic Stem Cell Research, and Initiative 08-0009 Marijuana Legalization.
For summaries, visit http://www.sos.ca.gov/elections/elections_j.htm#failed
To initiate your dialogue, please respond to the posts Amy and Hershey created regarding Propositions 3 & 4 and the presidential candidates, respectively, by discussing the potential health care and health status implications of current and pending legislation, as well as the policies and past voting histories of the two presidential candidates. Other topics to consider are the direct and indirect health implications of the following repealed initiatives: Initiative 08-0004 Bans Human Embryonic Stem Cell Research, and Initiative 08-0009 Marijuana Legalization.
For summaries, visit http://www.sos.ca.gov/elections/elections_j.htm#failed
Tuesday, October 14, 2008
WHO 2008 Report
Today the World Health Organization released their 2008 Report. It focused a lot on the disparities of health care from country to country but also citizen to citizen within the same country. The emphasis was on Primary Care, universal care, leadership and an emphasis on preventative measures to cut worldwide health care costs. Though the report is a behemoth, at 148 pages, there is lots in there probably worth reading about. At the very least, I'd recommend reading over the summary of the report. Or take a look at the table of contents for the actual report and read up on the sections that are particularly interesting to you.
The report can be found:
http://www.who.int/whr/2008/whr08_en.pdf
The summary can be found:
http://www.who.int/whr/2008/summary.pdf
There are lots of other interesting links, including a speech by the director of the WHO, and some really cool comparisons of country's GDP per capita vs health care spending per capita (much like the TED videos we watched).
http://www.who.int/whr/2008/en/index.html
For the country comparisons, click on the link under Primary Healthcare in Action.
I'm sure there are millions of reviews of the report out there too (or at least there will be in near future).
The report can be found:
http://www.who.int/whr/2008/whr08_en.pdf
The summary can be found:
http://www.who.int/whr/2008/summary.pdf
There are lots of other interesting links, including a speech by the director of the WHO, and some really cool comparisons of country's GDP per capita vs health care spending per capita (much like the TED videos we watched).
http://www.who.int/whr/2008/en/index.html
For the country comparisons, click on the link under Primary Healthcare in Action.
I'm sure there are millions of reviews of the report out there too (or at least there will be in near future).
Thursday, October 9, 2008
Tracking Legislation
It looks like some of you beat me to it, but to help you track current legislative policies and gather information about past legislation, I have compiled a list of resources to get you started.
Tracking the U.S. Congress
http://www.govtrack.us/congress/subjects.xpd
This is a tool to follow the status of federal legislation. You can subscribe to web feeds or email updates to keep up with the latest activity in Congress. This link provides you with a list of bills in Congress organized by subject and popularity, including immigration, abortion and health insurance.
California Pan-Ethnic Health Network (CPEHN)
http://www.cpehn.org/issues.php
Mission: To improve access to health care and eliminate health disparities by advocating for public policies and sufficient resources to address the health needs of the community. CPEHN's website allows you to track the progress of priority bills for the 2008 legislative session, such as those that are:
Achieving Equity Through Place-Based Solutions
Expanding Access to Health Care
Increasing Access to Nutritious Food
Increasing the Diversity of the Health Care Workforce
Ensuring Cultural and Linguistic Competency
Improving Our School Health Centers
Ballot Measure Update – California Secretary of State
http://www.sos.ca.gov/elections/elections_j.htm#2008General
This site lists ballot measures that have qualified for this year’s general election. In addition, you will find a list of initiatives that are currently circulating for possible placement on the next ballot, failed to qualify, were withdrawn, or are pending at the Attorney General's Office.
California Ballot Initiatives Database
http://holmes.uchastings.edu/cgi-bin/starfinder/0?path=calinits.txt&id=webber&pass=webber&OK=OK
University of California Hastings College of the Law maintains a comprehensive, searchable database of information on California ballot initiatives from 1911 to the present. The database contains the full text of the initiatives, accompanying material relating to their filing & qualification, related legal and legislative history, and digital images of pertinent documents.
California Ballot Propositions Database
http://holmes.uchastings.edu/cgi-bin/starfinder/0?path=calprop.txt&id=webber&pass=webber&OK=OK
University of California Hastings College of the Law also maintains a comprehensive, searchable database of California ballot measures from 1911 to the present. The Hastings site also offers PDF versions of ballot pamphlets from 1911 to the present.
Kaiser Daily Health Policy Report
http://www.kaisernetwork.org/daily_reports/rep_hpolicy.cfm
This site provides a list of daily headlines on health-related issues connected with legislation, including health coverage & access, presidential candidate health care proposals, state policies, report briefs, and opinion pieces. You can also sign up for email alerts to get this information sent to you directly.
Kaiser Health Disparities Report: A Weekly Look at Race, Ethnicity and Health
http://www.kaisernetwork.org/daily_reports/rep_disparities.cfm
This is a great resource to monitor current issues related to health disparities as well as for accessing archives. Categories include: Politics & Policy, Public Health, Culture-Based Care, and Initiatives. You can also sign up for daily or weekly e-mail alerts.
Tracking the U.S. Congress
http://www.govtrack.us/congress/subjects.xpd
This is a tool to follow the status of federal legislation. You can subscribe to web feeds or email updates to keep up with the latest activity in Congress. This link provides you with a list of bills in Congress organized by subject and popularity, including immigration, abortion and health insurance.
California Pan-Ethnic Health Network (CPEHN)
http://www.cpehn.org/issues.php
Mission: To improve access to health care and eliminate health disparities by advocating for public policies and sufficient resources to address the health needs of the community. CPEHN's website allows you to track the progress of priority bills for the 2008 legislative session, such as those that are:
Achieving Equity Through Place-Based Solutions
Expanding Access to Health Care
Increasing Access to Nutritious Food
Increasing the Diversity of the Health Care Workforce
Ensuring Cultural and Linguistic Competency
Improving Our School Health Centers
Ballot Measure Update – California Secretary of State
http://www.sos.ca.gov/elections/elections_j.htm#2008General
This site lists ballot measures that have qualified for this year’s general election. In addition, you will find a list of initiatives that are currently circulating for possible placement on the next ballot, failed to qualify, were withdrawn, or are pending at the Attorney General's Office.
California Ballot Initiatives Database
http://holmes.uchastings.edu/cgi-bin/starfinder/0?path=calinits.txt&id=webber&pass=webber&OK=OK
University of California Hastings College of the Law maintains a comprehensive, searchable database of information on California ballot initiatives from 1911 to the present. The database contains the full text of the initiatives, accompanying material relating to their filing & qualification, related legal and legislative history, and digital images of pertinent documents.
California Ballot Propositions Database
http://holmes.uchastings.edu/cgi-bin/starfinder/0?path=calprop.txt&id=webber&pass=webber&OK=OK
University of California Hastings College of the Law also maintains a comprehensive, searchable database of California ballot measures from 1911 to the present. The Hastings site also offers PDF versions of ballot pamphlets from 1911 to the present.
Kaiser Daily Health Policy Report
http://www.kaisernetwork.org/daily_reports/rep_hpolicy.cfm
This site provides a list of daily headlines on health-related issues connected with legislation, including health coverage & access, presidential candidate health care proposals, state policies, report briefs, and opinion pieces. You can also sign up for email alerts to get this information sent to you directly.
Kaiser Health Disparities Report: A Weekly Look at Race, Ethnicity and Health
http://www.kaisernetwork.org/daily_reports/rep_disparities.cfm
This is a great resource to monitor current issues related to health disparities as well as for accessing archives. Categories include: Politics & Policy, Public Health, Culture-Based Care, and Initiatives. You can also sign up for daily or weekly e-mail alerts.
Some more thought-provoking data!
As the heat of the Presidential Debate on last Tuesday and the up coming election, I think Hershey hit the right target to start off with the candidates’ health plans. I totally agree with Amy about evaluating the issue and taking stance on this issue. I already decided who will be my president anyway! However, for those who are still debating on this; especially about the health plans, please keep these facts in mind:
Only 30 of 50 states have a dedicated office of minority health.
Nearly one-third of the states report mortality data using a "white-other," "black-white," or "black-white-other" racial breakdown.
States with the highest proportion of minorities had physician workforces that were the least reflective of their demographic composition.
There are no consistent association between the four performance measures and either state fiscal capacity or percentage of minorities in the state.
Overall that is the reason we are taking this course. These are from an old (2005) paper that I found from the Policy Journal of Health Sphere.
You can read it here: http://content.healthaffairs.org/cgi/content/full/24/2/388
Chuong
California Propositions
Thanks for posting that Hershey. I just received my absentee ballot in the mail, and it's definitely a good time to evaluate and think about our stance on things, if we haven't done so already. I thought I'd also throw in California's health-related propositions. In addition to the waiting period/parental notification proposition (Prop 4) we discussed last week, there is also one about funding for Children's Hospitals (Prop 3). Granted, Prop 4 is the more controversial proposition, and can have a big impact on the adolescent population and the doctors that treat them, but it's also important to think about how this state uses its money.
Here is some info and links for fact sheets/arguments:
Prop. 3: Funding for Children’s Hospital Projects Authorizes $980 million in general obligation bonds for construction, expansion, remodeling, renovation, furnishing, and equipping of eligible children’s hospitals. Fiscal Impact: State cost of about $2 billion over 30 years to pay off both the principal ($980 million) and interest ($933 million) costs of the bonds. Payments of about $64 million per year.
Prop 3 Facts and Analysis
Prop 3 Arguments: for and against
Prop. 4: Waiting Period and Parental Notification Before Termination of a Minor’s Pregnancy Changes the California Constitution to prohibit abortion for an unemancipated minor until 48 hours after a physician notifies the minor’s parent, legal guardian, or, in limited cases, substitute adult relative. Provides an exception for medical emergency or parental waiver. Fiscal Impact: Potential unknown net state costs of several million dollars annually for health and social services programs, court administration, and state health agency administration combined.
Prop 4 Facts and Analysis
Prop 4 Arguments: For and Against
Amy
Here is some info and links for fact sheets/arguments:
Prop. 3: Funding for Children’s Hospital Projects Authorizes $980 million in general obligation bonds for construction, expansion, remodeling, renovation, furnishing, and equipping of eligible children’s hospitals. Fiscal Impact: State cost of about $2 billion over 30 years to pay off both the principal ($980 million) and interest ($933 million) costs of the bonds. Payments of about $64 million per year.
Prop 3 Facts and Analysis
Prop 3 Arguments: for and against
Prop. 4: Waiting Period and Parental Notification Before Termination of a Minor’s Pregnancy Changes the California Constitution to prohibit abortion for an unemancipated minor until 48 hours after a physician notifies the minor’s parent, legal guardian, or, in limited cases, substitute adult relative. Provides an exception for medical emergency or parental waiver. Fiscal Impact: Potential unknown net state costs of several million dollars annually for health and social services programs, court administration, and state health agency administration combined.
Prop 4 Facts and Analysis
Prop 4 Arguments: For and Against
Amy
Wednesday, October 8, 2008
Which Healthcare Plan is better: Obama's or McCain's?
While that is a bit of a loaded question, I figured I would at least send out a link with some information on both candidates plans and what the American Academy of Family Physicians thinks about them. Just like the AMA I am pretty sure the AAFP doesn't endorse any one plan, but I know a lot of classmates in PRIME--and not in PRIME--have been looking for an analysis from physicians' (albeit mostly focused on primary care) points of view. Thanks and I hope this helps or at least provides greater information to make you a more educated voter. :-).
http://www.aafp.org/online/en/home/publications/news/news-now/inside-aafp/20080910campaign-health-plans.html
See you tomorrow,
Hershey
http://www.aafp.org/online/en/home/publications/news/news-now/inside-aafp/20080910campaign-health-plans.html
See you tomorrow,
Hershey
Thursday, September 18, 2008
To get you started....
Here are your first reading assignments to acquaint you with the types of issues that will be discussed in this course:
Aral SO, Adimora AA, Fenton KA. Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans. Lancet. 2008 Jul 26; 372 (9635): 337-40.
Accessible at: http://www.ncbi.nlm.nih.gov/pubmed/18657713
Sanson-Fisher RW, Williams N, Outram S. Health inequities: the need for action by schools of medicine. Med Teach. 2008;30(4):389-94.
Accessible at: http://www.ncbi.nlm.nih.gov/pubmed/18569660
Training Physicians for Public Health Careers (June 2007, Institute of Medicine)
Accessible at: http://www.iom.edu/Object.File/Master/43/416/Training%20physicians%20report%20brief.pdf
Aral SO, Adimora AA, Fenton KA. Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans. Lancet. 2008 Jul 26; 372 (9635): 337-40.
Accessible at: http://www.ncbi.nlm.nih.gov/pubmed/18657713
Sanson-Fisher RW, Williams N, Outram S. Health inequities: the need for action by schools of medicine. Med Teach. 2008;30(4):389-94.
Accessible at: http://www.ncbi.nlm.nih.gov/pubmed/18569660
Training Physicians for Public Health Careers (June 2007, Institute of Medicine)
Accessible at: http://www.iom.edu/Object.File/Master/43/416/Training%20physicians%20report%20brief.pdf
Welcome to the Health Equity Blog!
This blog was set up for use by students and faculty in PRIME-HEq (Program in Medical Education - Health Equity) as a way to talk about ideas and issues affecting health. Health equity is a broad concept - but here we use the term to refer to an aspect of social justice. In general - ways of looking at resources and distributing those resources in a way to best serve a population in order to reduce disparities in health.
It is expected that students and faculty will read the blog on a regular basis. Students will also be expected to post at least two blog entries during the class quarter. These entries will focus on topics of the students’ choosing as well as topics related to health care systems and policies. These systems may include payment systems (Medicare, Medicaid, HMO’s, etc.), government responses to increase access (the Massachusetts model, proposals being debated in California, etc.), or health provision models (the VA, public health approaches, etc.).
Blog entries might be based on an idea, a news story, an item on the web, or something that was overviewed. The entry is a response to something that made you stop and think – and will hopefully do the same for your fellow students.
It is expected that students and faculty will read the blog on a regular basis. Students will also be expected to post at least two blog entries during the class quarter. These entries will focus on topics of the students’ choosing as well as topics related to health care systems and policies. These systems may include payment systems (Medicare, Medicaid, HMO’s, etc.), government responses to increase access (the Massachusetts model, proposals being debated in California, etc.), or health provision models (the VA, public health approaches, etc.).
Blog entries might be based on an idea, a news story, an item on the web, or something that was overviewed. The entry is a response to something that made you stop and think – and will hopefully do the same for your fellow students.
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