I am tired of attending funerals and hearing of the needless deaths of individuals who have died unnecessarily from conditions that could have been cured if treated or prevented in the first place.
This holiday season reminds me of twelve-year old Deamonte Driver, a young African American who died in the shadows of our nation’s capital last February from a toothache that progressed to a brain abscess.
Deamonte’s mother was repeatedly refused dental services for an $80 tooth extraction that could have saved the life of this young boy. He died because he had no insurance and no dentist would pull his rotten tooth without payment up front.
Another tragic death from a treatable cancer occurred with one of my student’s father, a retired El Paso fireman whose retirement left him without insurance. He was too young for Medicare and had “too much” income to qualify for Medicaid. No one would give him the potential life saving chemotherapy he needed without putting money up front.
My father, a sailor in the Pacific front during World War II, survived the sinking of his destroyer by a Japanese submarine, and somehow escaped death or injury in the insuring kamikaze suicide attacks; lived only to be killed 50 years later from an addiction to nicotine that the tobacco industry knew would kill people.
Our current health care system is a “sick care system” with over 70% of the health costs occurring in the last year of life. In 2007, as a country we spent over $2.3 trillion dollars on sick care or over $7,600 for each person living in our nation. What do we get? We have one of the most sophisticated sick care delivery systems in the world, yet we rank 37th when our health outcomes are compared against others such as Cuba at 39th and Costa Rica at 36th.
According to the Paso del Norte Region Health Report of 2007-2008 our local health indicators are some of the worse in the nation. Among USA counties, El Paso has the highest rates of cancer, stroke, and diabetes. Otero County has the highest rates of heart disease, chronic lung disease and injuries. Doña Ana and El Paso counties have the highest rate of death from cancer and heart diseases. Juarez has the highest rates of death from influenza, diabetes, and AIDS.
We have fewer registered nurses, physicians, dentists and other health care workers than in any other part of Texas except for the Lower Rio Grande Valley. Outside of the metropolitan area the rest of the county is considered medically underserved. The number of primary care providers to serve our population is half of the average found in the rest of Texas.
The majority of the causes of death such as diabetes, heart disease, stroke, and cancer are the result of smoking, obesity, and lack of physical activities. In fact depending on where you live your chances of dying is influenced by access to health care, healthy foods, transportation, quality education provided to you and your children, air quality and other environmental hazards.
The proportional importance of factors shaping health is determined 40% on behavior, 20% related to environment, 20 %t on genes, and 10 % on health care.
Where we are in our social structure is the highest predictor of health. Those at the bottom of the social economic ring are unhealthier and die younger. In comparison those at the upper end of the economic spectrum even when they smoke and are obese are healthier and live longer.
According to the Public Broadcast Service series, “Unnatural Causes,” those in the middle class have a 50% higher chance of dying sooner than those on the top. Furthermore, those in the lower economic sector are 400% more likely to die sooner than the upper economic sector.
El Paso ranks as the 7th poorest county in the nation with 26.4% of our population considered poor. We have over 32% of the population without health insurance and in some colonias the rate exceeds 60%. In El Paso 68% of our residents have a high school education and dropout rates in some of our public schools are as high as 50%.
However as a city and county we can take action now to start addressing the other 60% of the other determinates of health. A health population equates to an educated and healthy workforce.
Our schools must be held accountable for their outcomes. New and innovative teaching methods must be implemented to insure that no child, particularly boys, are left behind. A young boy who cannot read by the third grade is at substantial risk to be a high school dropout. Charter schools that are not hampered by bureaucratic restrictions should be financially supported and encouraged to locate in our poor communities. A child with an education insures opportunities for more economic security and the ability to make informed decision about healthy options.
Access to healthy foods for those areas without easy access to grocery stores is critical. Food desserts that exist in many of our poor neighbors must stop. We need to insure, in collaboration with our local government and private sector, local markets are given recognition for being a good neighbor. This recognition would only be awarded when fresh fruits, vegetables, meats, and other products are made available at rates found in more accessible communities. The creation of public garden plots, support for farmer markets, financially supporting local grocery vendors to sell fresh produce, diary products door to door as was once common practice will all assist in making healthy foods available. In other parts of the nation where this approach has been used the health of community members improved as well as the profits of the local vendors who offered the service.
Public transportation must be improved. Our city does not seem to have a transportation plan that encourages the use of public transportation. People without transportation particularly in the rural and in some of our poor areas are left with few options. Our sister city of Juarez has public transportations that serves their entire city. New transportation models must be developed and a long term strategy for transportation must be implemented.
Parks and recreational facilities for our youth must be a high priority. We must demand that physical education is taught in our schools along with curriculums that teach children how to be healthy. Food selections in our schools must include healthy options. Highly addictive food containing high sugar content and Trans fats must be completely eliminated from the school lunch menus. The Women’s Infant and Children program must include access to fresh fruits and vegetables.
A child who is obese will in most cases be an obese adult. We know that obesity kills. In fact the progress made in extending the life expectancy of our citizens may be lost through premature deaths due to health problems associated with obesity. The obesity epidemic will kill our children in their prime of life.
We are surrounded by environmental pollutants that may come from our proximity to smelters, refineries, asphalt plants, auto emissions, pesticides, lead both naturally occurring and as result of paint and other industrial activities, and polluted water. Studies to better understand these environmental hazards and solutions to minimize their impact are urgently needed. The economic impacts to our community from these industries must be balanced with their impact on the health of our citizens.
As a community we must muster the political will to say “enough is enough”. Our communities must be empowered to find solutions. We create through a shared vision solutions to these challenges. We can work with both our elected officials and the private sector to insure we have adequate number of health care providers, more Federally Qualified Health Plans, that our schools take action so they become part of the solution to create a healthier community, that we begin to believe that access to healthy food is a right, that parks and recreational activities means a stronger workforce, that public transportation means more opportunities to create a more educated labor force and enhances access to health services, and that our environment must not be a contributor to poor health no matter how much the economic benefit.
The Obama election may mean that perhaps the “stars” are aligning so that healthcare becomes a right and as a nation we may have finally place significant emphasis on health promotion and disease prevention activities that can improve our health and assure quality health care is available to all individuals living in our country. Maybe such an investment will mean that young people like Deamonte Driver won’t die from a tooth ache.
References
Portions of this article were inspired by a speech given by US Representative Elijah Cummings, (D-ND) Key Note Address on December 18, 2008 at the National Health Institutes, National Center for Minority Health Disparities conference on the Science of Eliminating Health Disparities. Representative Cummings gave a very moving speech about health disparities.
Regional health status data was taken from Paso Del Norte Health Foundation: Strategic Health Intelligence Planning Group Assessment of Determinants of Health in the PdNHF Region: A Review of Select Health Indicators for the counties of El Paso and Hudspeth in Texas; the counties of Doña Ana and Otero in New Mexico; and the city of Ciudad Juárez, Chihuahua, Mexico. Retrieved from Internet on December 19, 2008 from http://www.pdnhf.org/documents/659PdNHFRegionalHealthAssessment5-6-08Revised.pdf
And references from Unnatural causes taken from Unnatural Causes: Is inequality making us sick? Retrieved from Internet on December 19, 2008 from http://www.unnaturalcauses.org
This story first appeared in El Paso News Paper Tree on December 22, 2008.
Tuesday, December 30, 2008
Monday, November 24, 2008
Social Determinates of Health - More than health Care
Positioning El Paso as a major center for medical care is an admirable goal and yet is only part of the solution to create a healthy community. What has not received much attention from our policymakers and funders is a comprehensive plan to address the social limitations of health.
Many health problems can either be eliminated or their impact markedly diminished through addressing the root cause of many of these challenges.
The proportional importance of factors shaping health is determined 40 percent on behavior, 20 percent related to environment, 20 percent on genes, and 10 percent on health care.
Proximity to health care does not mean that our community will have improvement in their health status.
The strongest predictor of health is where we stand as individuals in our social structure. Those at the top have the most power and on average live longer and healthier. Those at the low end of the social pyramid are unhealthier and die younger.
According to the Public Broadcast Service series, “Unnatural Causes,” those in the middle class have a 50 percent higher chance of dying sooner then those on the top. Furthermore, those in the lower economic sector are 400 percent more likely to die sooner than the upper economic sector. This is true despite unhealthy behaviors such as smoking and obesity.
The choices that we make are based on what is available to us. For example, does our zoning regulations require parks, walking paths, playgrounds and grocery stores located within walking distance of residential areas. Or do we see more fast food outlets, liquor stores and lack access to affordable fresh foods? Public transportation that is inconsistent, has limited routes and runs at inconvenient times can mean many are unable to access healthier options.
Are our schools held accountable for educating graduates who can compete in our modern world? Are extracurricular activities, such as after school programs, music, art and gym, made available to all students? If we improve access to preschools, community college and universities, and create jobs that are “green friendly” we can enhance the health of our community.
As “Unnatural Causes” illustrates it is not the CEOs that are dying of stress-induced illnesses, it those with low paying jobs who have limited access for housing, food, health care, inadequate public transportation and unsafe living conditions who are suffering the most.
When we do not have money, a sense of control in our lives and an education to allow access to greater economic security then no health insurance, poor health and premature death are the norm. It is this kind of stress that kills!
Social policies such as minimum wages, improved working conditions, mandatory schooling, civil rights laws and improved housing have contributed to an increase in our life expectancy. But more must be done.
We are paying the price by our lack of commitment to address the social determinates of health. Many of us are obese, have cardiovascular diseases and diabetes. In many cases these conditions can be directly related to the limitation of our social status.
The cost of treating our health problems is the highest in the world and will continue to escalate if we do not address these other factors that contribute to disease.
We must also provide resources to tackle these issues. Continuing to educate more nurses, physicians and other members of the health care team—while urgently needed—must also be done in tandem with developing community-based solutions to address these social determinates. We need to invest now or our health disparities and inequities will continue to grow.
Martin Luther King once said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” This statement is still true 40 years after this death.
Many health problems can either be eliminated or their impact markedly diminished through addressing the root cause of many of these challenges.
The proportional importance of factors shaping health is determined 40 percent on behavior, 20 percent related to environment, 20 percent on genes, and 10 percent on health care.
Proximity to health care does not mean that our community will have improvement in their health status.
The strongest predictor of health is where we stand as individuals in our social structure. Those at the top have the most power and on average live longer and healthier. Those at the low end of the social pyramid are unhealthier and die younger.
According to the Public Broadcast Service series, “Unnatural Causes,” those in the middle class have a 50 percent higher chance of dying sooner then those on the top. Furthermore, those in the lower economic sector are 400 percent more likely to die sooner than the upper economic sector. This is true despite unhealthy behaviors such as smoking and obesity.
The choices that we make are based on what is available to us. For example, does our zoning regulations require parks, walking paths, playgrounds and grocery stores located within walking distance of residential areas. Or do we see more fast food outlets, liquor stores and lack access to affordable fresh foods? Public transportation that is inconsistent, has limited routes and runs at inconvenient times can mean many are unable to access healthier options.
Are our schools held accountable for educating graduates who can compete in our modern world? Are extracurricular activities, such as after school programs, music, art and gym, made available to all students? If we improve access to preschools, community college and universities, and create jobs that are “green friendly” we can enhance the health of our community.
As “Unnatural Causes” illustrates it is not the CEOs that are dying of stress-induced illnesses, it those with low paying jobs who have limited access for housing, food, health care, inadequate public transportation and unsafe living conditions who are suffering the most.
When we do not have money, a sense of control in our lives and an education to allow access to greater economic security then no health insurance, poor health and premature death are the norm. It is this kind of stress that kills!
Social policies such as minimum wages, improved working conditions, mandatory schooling, civil rights laws and improved housing have contributed to an increase in our life expectancy. But more must be done.
We are paying the price by our lack of commitment to address the social determinates of health. Many of us are obese, have cardiovascular diseases and diabetes. In many cases these conditions can be directly related to the limitation of our social status.
The cost of treating our health problems is the highest in the world and will continue to escalate if we do not address these other factors that contribute to disease.
We must also provide resources to tackle these issues. Continuing to educate more nurses, physicians and other members of the health care team—while urgently needed—must also be done in tandem with developing community-based solutions to address these social determinates. We need to invest now or our health disparities and inequities will continue to grow.
Martin Luther King once said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” This statement is still true 40 years after this death.
Wednesday, October 29, 2008
PTSD - Growing Problem
Post traumatic stress disorder (PTSD) has recently received a significant amount of attention. Most frequently PTSD is associated with members of the armed forces who have been deployed to Iraq or Afghanistan. A recent report by the RAND Center for Military Health Policy Research shows of the approximately 1.64 million military service members who have been deployed to the war zone as spring 2007, 14% screened positive for PTSD and 14% for major depression.
PTSD is an anxiety disorder that is associated with a dramatic event in which the person experiences the threat of death or serious injury. The most common PTSD exposure in the United States comes from individuals who have been involved in automobile accidents. It is estimated that approximately 20% of those in automobile accidents suffer from PTSD. According to the National Highway Traffic Safety Administration, approximately 2.5 million people are injured in automobile accidents annually. So a significant number of individuals are potentially at risk for PTSD and associated conditions.
PTSD and depression both are biological disorders, which can be manifested from exposure to excessive levels of stress. Basically, the body’s stress response system is overloaded. Symptoms of PTSD include insomnia, nightmares, flashbacks of the traumatic event, startling easily, avoiding a situation that reminds the individual of the traumatic episode, difficulty in concentrating, emotional withdrawal, aggression, and irritability. Depression has similar symptoms including ongoing sadness, hopelessness, difficulty sleeping, and fatigue, feelings of worthlessness or guilt for no specific reason, weight change, and loss of interest in usual daily activities.
According to a recent study done by Joseph Boscarino of the Geisinger Health Systems in Danvile, PA, Vietnam veterans with a history of PTSD had a 50% greater chance of dying from heart disease in their 50s compared to those veterans without PTSD. Many individuals with PTSD delay treatment and thus may manage their symptoms with drugs and/or alcohol.
The highest level of evidence for the treatment of PTSD includes exposure therapy, stress inoculation training, cognitive therapy, eye- movement decentralization and reprocessing, psychopharmacology primarily the use of Zoloft and other selective serotonin re-uptake inhibitors, psychodynamic and group therapy. All of these treatment procedures are considered to have a level A of efficacy. Level A evidence is derived from randomized clinical trials for individuals with PTSD.
The Department of Defense has earmarked over $300 million for research on PTSD and brain injuries. The Veterans Administration also has designated significant resources to the treatment of former service members who may have suffered from these conditions. The key to a more successful outcome is early recognition and treatment. Here in El Paso, the military has treatment programs available for active duty personnel. Dependents and retirees are eligible to receive care under the Tri-Care insurance program. Retirees also can see care at the Veterans Administration facility as well. Given the significant number of automobile accidents that occur annually in our community the civilian population, as previously mentioned is also at risk for PTSD and depression. PTSD should be considered a stress injury and care should be sought as soon as symptoms begin to emerge.
PTSD is an anxiety disorder that is associated with a dramatic event in which the person experiences the threat of death or serious injury. The most common PTSD exposure in the United States comes from individuals who have been involved in automobile accidents. It is estimated that approximately 20% of those in automobile accidents suffer from PTSD. According to the National Highway Traffic Safety Administration, approximately 2.5 million people are injured in automobile accidents annually. So a significant number of individuals are potentially at risk for PTSD and associated conditions.
PTSD and depression both are biological disorders, which can be manifested from exposure to excessive levels of stress. Basically, the body’s stress response system is overloaded. Symptoms of PTSD include insomnia, nightmares, flashbacks of the traumatic event, startling easily, avoiding a situation that reminds the individual of the traumatic episode, difficulty in concentrating, emotional withdrawal, aggression, and irritability. Depression has similar symptoms including ongoing sadness, hopelessness, difficulty sleeping, and fatigue, feelings of worthlessness or guilt for no specific reason, weight change, and loss of interest in usual daily activities.
According to a recent study done by Joseph Boscarino of the Geisinger Health Systems in Danvile, PA, Vietnam veterans with a history of PTSD had a 50% greater chance of dying from heart disease in their 50s compared to those veterans without PTSD. Many individuals with PTSD delay treatment and thus may manage their symptoms with drugs and/or alcohol.
The highest level of evidence for the treatment of PTSD includes exposure therapy, stress inoculation training, cognitive therapy, eye- movement decentralization and reprocessing, psychopharmacology primarily the use of Zoloft and other selective serotonin re-uptake inhibitors, psychodynamic and group therapy. All of these treatment procedures are considered to have a level A of efficacy. Level A evidence is derived from randomized clinical trials for individuals with PTSD.
The Department of Defense has earmarked over $300 million for research on PTSD and brain injuries. The Veterans Administration also has designated significant resources to the treatment of former service members who may have suffered from these conditions. The key to a more successful outcome is early recognition and treatment. Here in El Paso, the military has treatment programs available for active duty personnel. Dependents and retirees are eligible to receive care under the Tri-Care insurance program. Retirees also can see care at the Veterans Administration facility as well. Given the significant number of automobile accidents that occur annually in our community the civilian population, as previously mentioned is also at risk for PTSD and depression. PTSD should be considered a stress injury and care should be sought as soon as symptoms begin to emerge.
Monday, September 1, 2008
Health Interpreters for Spanish Speaking Patients - Quality of Care Issue
What options does a non Spanish speaking healthcare have to insure his/her Spanish speaking patients achieve quality care? Tried methods include the use of bi-lingual children, other relatives, non healthcare employees such as those in housekeeping, maintenance, and dietary who have some English language skills are used and continued to be used to translate conversations between healthcare providers and their Spanish speaking patients. While this might seem to be an appropriate avenue, such an approach should only be used in dire emergencies.
The challenge with this approach is the provider may assume the translator is literate and competent to translated medical terms and related conversations. Given that education is only mandatory up to the 6th grade in Mexico it may be a huge error to assume an immigrant who is asked to translated may have sufficient literacy to serve as a translator. Medical terms are not commonly spoken in Spanish by the general population or for that fact with USA residents who have low educational levels.
Given the privacy of communication between the healthcare provider and the patient the use of non health professionals who lack proper education and credentialing to service as translators is inappropriate. Issues such as HIV status, substance abuse, mental health issues such as child maltreatment and domestic abuse need to be discussed using the highest levels of confidentiality. Thus using a child or other relative to serve as the translator is totally inappropriate, particularly in these situations.
For some time healthcare providers can out source translations to vendors who will provide such services via the telephone. This is certainly a step in the right direction, particularly if the provider is unable to secure such translation services locally. The provider needs to insure the questions being asked of the non English speaking are kept short so the translator can provide an accurate word for word translation and not attempt to summary a lengthy questioning and/or discussion. The same is also true when the patient is asked to respond to the provider question. There is always the danger that the translator may not be able to retain all of the information and accurately summarize the response. The provider should ask the translator to repeat back to the him/her the question to help assure the individual doing the translation did understand the communication. While this is a more time consuming process the accuracy of the translation is improved. The tendency for the non Spanish provider to limit the interaction with the patient due to the language problem is common. This can lead to the patient not fully understanding the communication and may lead to more frequent follow-up visits by the patient to seek answers that were not addressed during the initial interview.
Increasing Health and Human Service Administration requirements for cultural competent care and new standards from the Joint Commission on Healthcare Organizations means that healthcare providers must find more suitable solutions to insure competent translations as well as confidentiality of the communications. Spanish speaking individuals who are appropriated educated in the use of medical terminology and knowledgeable about health privacy issues, and can provide proper word for word translations are urgently needed. These individuals with such training and resulting credentialing should be employed in clinics, emergency rooms, and hospitals. They can potentially make an significant contribution to improving the quality of care provided to our monolingual Spanish speaking patients.
The challenge with this approach is the provider may assume the translator is literate and competent to translated medical terms and related conversations. Given that education is only mandatory up to the 6th grade in Mexico it may be a huge error to assume an immigrant who is asked to translated may have sufficient literacy to serve as a translator. Medical terms are not commonly spoken in Spanish by the general population or for that fact with USA residents who have low educational levels.
Given the privacy of communication between the healthcare provider and the patient the use of non health professionals who lack proper education and credentialing to service as translators is inappropriate. Issues such as HIV status, substance abuse, mental health issues such as child maltreatment and domestic abuse need to be discussed using the highest levels of confidentiality. Thus using a child or other relative to serve as the translator is totally inappropriate, particularly in these situations.
For some time healthcare providers can out source translations to vendors who will provide such services via the telephone. This is certainly a step in the right direction, particularly if the provider is unable to secure such translation services locally. The provider needs to insure the questions being asked of the non English speaking are kept short so the translator can provide an accurate word for word translation and not attempt to summary a lengthy questioning and/or discussion. The same is also true when the patient is asked to respond to the provider question. There is always the danger that the translator may not be able to retain all of the information and accurately summarize the response. The provider should ask the translator to repeat back to the him/her the question to help assure the individual doing the translation did understand the communication. While this is a more time consuming process the accuracy of the translation is improved. The tendency for the non Spanish provider to limit the interaction with the patient due to the language problem is common. This can lead to the patient not fully understanding the communication and may lead to more frequent follow-up visits by the patient to seek answers that were not addressed during the initial interview.
Increasing Health and Human Service Administration requirements for cultural competent care and new standards from the Joint Commission on Healthcare Organizations means that healthcare providers must find more suitable solutions to insure competent translations as well as confidentiality of the communications. Spanish speaking individuals who are appropriated educated in the use of medical terminology and knowledgeable about health privacy issues, and can provide proper word for word translations are urgently needed. These individuals with such training and resulting credentialing should be employed in clinics, emergency rooms, and hospitals. They can potentially make an significant contribution to improving the quality of care provided to our monolingual Spanish speaking patients.
Sunday, August 31, 2008
Access to Healthcare and Health Literacy - Critical Issues for Hispanics
A recent report released by the Pew Foundation and the Robert Wood Johnson Foundation HispanicTips » » Hispanics Need “Health Reform Plus,” with ...indicates that access to health care is only part of the problem facing Hispanics in their search for health care. While a significant number of Hispanics lack health insurance and this is a critical issue related to access, an even greater concern is how many Hispanics access care and what happens in that encounter. Once care is accessed the health care is often not provided in a linguist and culturally appropriate manner, thus the individual may leave the encounter with incomplete understanding of the treatment plan prescribed by the provider.
Given the high percentage of Hispanics with lower paying positions (many of which have insurance) a high percentage are unable to take time off from work to seek health care. For lower income employees who work hourly or are paid based on their production (i.e. how many sack of onions picked) they are simply unable to afford the time for health care. Taking time off from work means loss of income and choices between having enough income to care for their families and seeking treatment for a health problem have to be made. Thus when the health problem is significant enough (in the judgment of the individual) healthcare for most of these individuals must be sought during regular business hours and frequently travel to some distant clinic/hospitals is required.
For immigrants another challenge in seeking health care is a lack of understanding how the USA health care system works. For example, unlike programs in Mexico where the care is free or requires a small co-payment those who seek care at hospital emergency rooms can find themselves saddled with unwieldy medical bills. Even with insurance the co-payment when seeking care at emergency rooms for non emergency treatment can create a substantial co-payment requirement. Unlike Mexico where individuals can purchase many medications at the local pharmacy such options in the USA are not available. Our system requires a prescription for most medication and this means the individual who need medications must first be examined by a healthcare provider. A lack of understanding in how the USA and Mexico healthcare systems differ may lead immigrants to spend more money on healthcare and eventually lead to less access. Hispanics in compared to other minority groups already are reported to spend a higher percentage of their personal income on healthcare than others.
Another challenge for Hispanics particularly those with limited health literacy and who lack English language skills, they are unable to communicate effectively with their healthcare provider. Even those of us who have the ability to read, write, and speak English fluently our encounter with a physician may leave us with a lack of understanding regarding what transpired in the office visit including the treatment plan prescribed. This lack of health literacy is even more critical when the patient is unable to speak English and when the health encounter is conducted in English. This lack of understanding can lead to errors in taking prescribed medications, uncertainty about follow-up treatment recommendations, and lack of knowledge regarding the diagnosis.
Insuring that healthcare is provided both in an appropriate linguist and culturally relevant manner is critical if we are going to make inroads to eliminating the gaps in health disparities in Hispanics compared to Anglos.
At UTEP, School of Nursing we are committed to insuring our graduates are able to provide such care to this growing segment of our population. We offer courses in Spanish for healthcare providers and are actively integrating the Health and Human Resources Administration recommendations regarding cultural competency and work force diversity into both our undergraduate and graduate curriculum. The need to address these access and quality of care issues impacting Hispanic is urgent.
Given the high percentage of Hispanics with lower paying positions (many of which have insurance) a high percentage are unable to take time off from work to seek health care. For lower income employees who work hourly or are paid based on their production (i.e. how many sack of onions picked) they are simply unable to afford the time for health care. Taking time off from work means loss of income and choices between having enough income to care for their families and seeking treatment for a health problem have to be made. Thus when the health problem is significant enough (in the judgment of the individual) healthcare for most of these individuals must be sought during regular business hours and frequently travel to some distant clinic/hospitals is required.
For immigrants another challenge in seeking health care is a lack of understanding how the USA health care system works. For example, unlike programs in Mexico where the care is free or requires a small co-payment those who seek care at hospital emergency rooms can find themselves saddled with unwieldy medical bills. Even with insurance the co-payment when seeking care at emergency rooms for non emergency treatment can create a substantial co-payment requirement. Unlike Mexico where individuals can purchase many medications at the local pharmacy such options in the USA are not available. Our system requires a prescription for most medication and this means the individual who need medications must first be examined by a healthcare provider. A lack of understanding in how the USA and Mexico healthcare systems differ may lead immigrants to spend more money on healthcare and eventually lead to less access. Hispanics in compared to other minority groups already are reported to spend a higher percentage of their personal income on healthcare than others.
Another challenge for Hispanics particularly those with limited health literacy and who lack English language skills, they are unable to communicate effectively with their healthcare provider. Even those of us who have the ability to read, write, and speak English fluently our encounter with a physician may leave us with a lack of understanding regarding what transpired in the office visit including the treatment plan prescribed. This lack of health literacy is even more critical when the patient is unable to speak English and when the health encounter is conducted in English. This lack of understanding can lead to errors in taking prescribed medications, uncertainty about follow-up treatment recommendations, and lack of knowledge regarding the diagnosis.
Insuring that healthcare is provided both in an appropriate linguist and culturally relevant manner is critical if we are going to make inroads to eliminating the gaps in health disparities in Hispanics compared to Anglos.
At UTEP, School of Nursing we are committed to insuring our graduates are able to provide such care to this growing segment of our population. We offer courses in Spanish for healthcare providers and are actively integrating the Health and Human Resources Administration recommendations regarding cultural competency and work force diversity into both our undergraduate and graduate curriculum. The need to address these access and quality of care issues impacting Hispanic is urgent.
Salmonella Outbreak is now Over – But for How Long?
According to the Center for Disease Control (CDC) the most current salmonella outbreak is now over. The bacteria were found primarily in Jalapeño peppers, secondarily in Serrano peppers, and possibility early in the outbreak in tomatoes. Over a 1000 cases of individuals with confirmed cases of salmonella infections were reported.
University of Texas at El Paso students enrolled in an international health research course while conducting a health survey of farm worker harvesting Jalapeño peppers in the Mexico state of Chihuahua during the summer of 2008 reported a variety of environmental issues. While the students were not specifically researching salmonella, however in the process of interviewing the farm workers they noted the unsanitary working conditions. The workers had no fresh water supply, there were no toilets, and no way for them to wash their hands. Shortly after this field visit officials of the Department of Health in the State of Chihuahua notified the public that Jalapeño peppers from their area were found to be contaminated with salmonella.
The crops may have contaminated by unclean water, from unsanitary harvesting procedures, and possible contamination during the transportation and processing of the peppers at the variety of way points as the pepper found their way into the USA.
The CDC and the US Department of Agriculture (USDA) really lack the resources to provide the necessary timely testing of imports to insure fruits and vegetables are safe. The use of irradiation has been approved by the USDA but costs associated with using this technology and consumer acceptance create a significant barrier to its widespread adoption. Do not look for this technology at least in the next few years to be available to help protect our food supply.
Standards for the production of agricultural products do exist and with enforcement in both USA and other international settings particularly in Mexico and Chile the safety of our fresh fruits and vegetables have a greater chance of being safe for consumers. Food preparation is still the first line of defense. Suppliers should be held accountable to insure that the food products being sold are safe. A simply field visits to the peppers fields such as that conducted by our UTEP students are needed.
Growers and middle men should be required to adhere to standards that will insure our fruits and vegetable are safe. The costs of having hand washing facilities, providing clean drinking water to the farm workers, providing proper toileting facilities, insuring a clean processing plant and transportation that is free from contamination, and using non polluted water to irrigate the crops are costs effective and should be enforced.
Illnesses that can result from eating unsafe food products should not be underestimated. Children, the elderly, and those with impaired immunities are at particular risk. Some of us in the USA may have taken for granted the safety of our food products. The most recent outbreak reminds us that we must also take responsibility for food safety. All fresh produce and fruits should be washed thoroughly with running tap water prior to being used. Additional safeguards are cooking, using only canned items or peeling the product.
University of Texas at El Paso students enrolled in an international health research course while conducting a health survey of farm worker harvesting Jalapeño peppers in the Mexico state of Chihuahua during the summer of 2008 reported a variety of environmental issues. While the students were not specifically researching salmonella, however in the process of interviewing the farm workers they noted the unsanitary working conditions. The workers had no fresh water supply, there were no toilets, and no way for them to wash their hands. Shortly after this field visit officials of the Department of Health in the State of Chihuahua notified the public that Jalapeño peppers from their area were found to be contaminated with salmonella.
The crops may have contaminated by unclean water, from unsanitary harvesting procedures, and possible contamination during the transportation and processing of the peppers at the variety of way points as the pepper found their way into the USA.
The CDC and the US Department of Agriculture (USDA) really lack the resources to provide the necessary timely testing of imports to insure fruits and vegetables are safe. The use of irradiation has been approved by the USDA but costs associated with using this technology and consumer acceptance create a significant barrier to its widespread adoption. Do not look for this technology at least in the next few years to be available to help protect our food supply.
Standards for the production of agricultural products do exist and with enforcement in both USA and other international settings particularly in Mexico and Chile the safety of our fresh fruits and vegetables have a greater chance of being safe for consumers. Food preparation is still the first line of defense. Suppliers should be held accountable to insure that the food products being sold are safe. A simply field visits to the peppers fields such as that conducted by our UTEP students are needed.
Growers and middle men should be required to adhere to standards that will insure our fruits and vegetable are safe. The costs of having hand washing facilities, providing clean drinking water to the farm workers, providing proper toileting facilities, insuring a clean processing plant and transportation that is free from contamination, and using non polluted water to irrigate the crops are costs effective and should be enforced.
Illnesses that can result from eating unsafe food products should not be underestimated. Children, the elderly, and those with impaired immunities are at particular risk. Some of us in the USA may have taken for granted the safety of our food products. The most recent outbreak reminds us that we must also take responsibility for food safety. All fresh produce and fruits should be washed thoroughly with running tap water prior to being used. Additional safeguards are cooking, using only canned items or peeling the product.
Tuesday, April 1, 2008
April is Minority Health Month
April is Minority Health Month and is a cause to reflect on such particularly here in our border community in which nearly 80% of our residents are Hispanics of Mexican origin. According to a recently released report by the Agency for Healthcare Research and Quality a Health and Human Resources Administration of the USA government the majority of minorities EXCEPT Hispanics when compared to non Hispanic white are not making significant progress towards the elimination of health disparities. The rate of HIV/AIDS among Hispanics is now more than three times higher than their comparison group. The rate of obesity is significantly higher among Hispanics and it’s now known that such can lead to cardiac disease and diabetes. Obesity is now becoming the primary cause of cancer. A number of studies have linked obesity to breast and colon cancer and also to cancer of rectum, kidney, pancreas, and esophagus. Obesity is approaching epidemic proportions and with Hispanics the rate of obesity is higher than in other minority groups. Diabetes is the third leading cause of death in the border and the number one cause of death on the Mexico side of the U.S.-Mexico border. A tuberculosis infection along the border is 8.96 per 100,000 compared to 4.6 per 100,000 in the rest of the USA.
In El Paso County the uninsured rate is 40% and in studies conducted by the School of Nursing at The University of Texas at El Paso shows the rate exceeds 60% in some colonias. Those uninsured remain in many cases our most vulnerable: women and children. Further more a serious shortage of health care providers along the border and in some cases restrictive practice acts limit the access of residents to health care. The numbers of nurse practitioners who can provide high quality care is significantly below the ratio in metropolitan areas 22.3 compared to 14.2 per 100,000 in the metropolitan border areas. The number of registered nurses is 468.9 in metropolitan border areas compared to non border metropolitan areas of 715.3 per 100,000.
The School of Nursing at UTEP is meeting this challenge, which is to provide more nurse practitioners and registered nurses through substantial increases in its enrollment and this academic year will have one of the largest groups of nurses graduating in the history of the School. Faculty shortages, limited clinical sites, and salary pressure have created challenges. However innovations in curriculum, state of the art teaching methodologies and committed faculty are assisting UTEP in meeting these challenges. It takes a health care team involved in education, patients care, and research to eliminate health disparities in our Hispanic population.
In El Paso County the uninsured rate is 40% and in studies conducted by the School of Nursing at The University of Texas at El Paso shows the rate exceeds 60% in some colonias. Those uninsured remain in many cases our most vulnerable: women and children. Further more a serious shortage of health care providers along the border and in some cases restrictive practice acts limit the access of residents to health care. The numbers of nurse practitioners who can provide high quality care is significantly below the ratio in metropolitan areas 22.3 compared to 14.2 per 100,000 in the metropolitan border areas. The number of registered nurses is 468.9 in metropolitan border areas compared to non border metropolitan areas of 715.3 per 100,000.
The School of Nursing at UTEP is meeting this challenge, which is to provide more nurse practitioners and registered nurses through substantial increases in its enrollment and this academic year will have one of the largest groups of nurses graduating in the history of the School. Faculty shortages, limited clinical sites, and salary pressure have created challenges. However innovations in curriculum, state of the art teaching methodologies and committed faculty are assisting UTEP in meeting these challenges. It takes a health care team involved in education, patients care, and research to eliminate health disparities in our Hispanic population.
Saturday, March 8, 2008
Tips in How to Get Admitted to a Bachelor of Science Nursing Program
Given the demand for admissions to Schools of Nursing across the country many qualified applicants are being turned away due t0 lack of capacity to enrolled everyone. Those who are admitted to the top Schools such as the UTEP program, where in general, we receive twice as many applications as we have openings, the applicants have science GPA of at least a 3.0 and in most cases higher. The scores on the Nurse Entrance Test (NET) for reading and math are at least at the high school level and frequently higher. Overall GPA vary from 4.0 to 2.9 or higher. The exact GPA scores does vary with applicant pool.
Students interested in nursing should start taking pre college course work while in high school. A number of school districts have health academies and these programs provide individualized counseling and adcademic guidance to insure students complete the appropriate courses. This preparation in high school is extremely important as it assist the student in being ready to begin the pre-nursing currculum once admitted to a univeristy or community college.
Some school districts have dual enrollment programs. In this program students can enroll and complete college courses while still in high schools. In some cases students can complete a Associate Degree while still in high school. Some health academes have curriculums that will allow the student to complete the requirements for a licensed vocational nurse along with their high school diploma.
Once admitted to the pre-nursing major the student should meet at least once per semester with their academic advisor to insure he/she are on target with their goal to become a nurse. Students should take advantage of tutors provided by their university or community college. The importance of studying and receiving grades of A and B is very critical if he/she is going to have a competitive GPA to be admitted to a BSN program. Achieving excellent grades means that the student must be committed to reaching his/his goals through making wise decision about time managment and dedicating ample time to his/her studies.
While some students find they must work while going to school it is highly recommended that students take full advantage of all financial aid resources available and limit the hours worked. The financial aid may also include the use of low interest loans that are supplemented by the US government. While many students do have to work it is best to limit the number of hours per week and concentrate working during holidays and vacation times. Working too many hours often leads to poor academic performance and thus non admission to a nursing programs. The financial aid office at your university or community college can assist you in finding funds for your education. DO NOT be afraid to consider financing part of your educational investment using loans if necessary. The time you delay your educating while working for $6.00 per hour compared to $30 per hour rate as a registered nurse does not make much economic sense.
Once you have completed all of the required course or will be finished by the end of the semeter, you are ready to apply to the School of Nursing. The fall applicant pool is typically larger and thus more competitive. The Accelerated (Fast Track) program typically has a smaller number of students applying than those seeking admission to the traditional program. So if you have a bachelor degree in some other areas, have at least a 3.0 GPA in your science courses plus have high school or post high school scores on the NET then your chances of being admitted are enhanced.
The bottom line is to study, study, study. As in other health related professions only the top applicants are accepted and eventually graduate. For example the BSN program at UTEP is very challenging. The current retention is around 80% and we are working very hard to achieve our goal of 85%. Students are provided academic coaches at no cost to assist them with their studies. All students have access to their faculty for one on one coaching during the faculty's weekly office hours. Selected courses are digitally recorded and placed on the course web site so students can view via video streaming the lecture and/or download the audio to a mp3 player. They can again listen to the lecture and review the power point slides posted on the course web site. (The majority of all undergraduate nursing courses at UTEP have power point slides of the lectures posted on the course web site).
All nursing students who have academic challenges are required to be a member of a study group and to meet with the retention coach. This coach is a season faculty member who assist students with test taking skills, problem solving, time management, and perhaps most importantly provides encouragement and emotional support. As appropriate students who have special needs are referred to other campus or community resources.
The nursing program at UTEP is tough as our graduates are one of the best in the nation. We expect outstanding academic performance combined with a humanistic and caring concern for our fellow humans. This past year (2006-2007) our passing rate on the NCLEX-RN exam was slightly over 96%, statistically the same as those students graduating from UT Austin. We have more graduates than Austin and 78% of our students are Hispanic. Thus we are living our Vision of Becoming the Premier Hispanic Serving School of Nursing in the Nation.
For more information about the University of Texas at El Paso School of Nursing please visit our web site. www.utep.edu/nursing
Students interested in nursing should start taking pre college course work while in high school. A number of school districts have health academies and these programs provide individualized counseling and adcademic guidance to insure students complete the appropriate courses. This preparation in high school is extremely important as it assist the student in being ready to begin the pre-nursing currculum once admitted to a univeristy or community college.
Some school districts have dual enrollment programs. In this program students can enroll and complete college courses while still in high schools. In some cases students can complete a Associate Degree while still in high school. Some health academes have curriculums that will allow the student to complete the requirements for a licensed vocational nurse along with their high school diploma.
Once admitted to the pre-nursing major the student should meet at least once per semester with their academic advisor to insure he/she are on target with their goal to become a nurse. Students should take advantage of tutors provided by their university or community college. The importance of studying and receiving grades of A and B is very critical if he/she is going to have a competitive GPA to be admitted to a BSN program. Achieving excellent grades means that the student must be committed to reaching his/his goals through making wise decision about time managment and dedicating ample time to his/her studies.
While some students find they must work while going to school it is highly recommended that students take full advantage of all financial aid resources available and limit the hours worked. The financial aid may also include the use of low interest loans that are supplemented by the US government. While many students do have to work it is best to limit the number of hours per week and concentrate working during holidays and vacation times. Working too many hours often leads to poor academic performance and thus non admission to a nursing programs. The financial aid office at your university or community college can assist you in finding funds for your education. DO NOT be afraid to consider financing part of your educational investment using loans if necessary. The time you delay your educating while working for $6.00 per hour compared to $30 per hour rate as a registered nurse does not make much economic sense.
Once you have completed all of the required course or will be finished by the end of the semeter, you are ready to apply to the School of Nursing. The fall applicant pool is typically larger and thus more competitive. The Accelerated (Fast Track) program typically has a smaller number of students applying than those seeking admission to the traditional program. So if you have a bachelor degree in some other areas, have at least a 3.0 GPA in your science courses plus have high school or post high school scores on the NET then your chances of being admitted are enhanced.
The bottom line is to study, study, study. As in other health related professions only the top applicants are accepted and eventually graduate. For example the BSN program at UTEP is very challenging. The current retention is around 80% and we are working very hard to achieve our goal of 85%. Students are provided academic coaches at no cost to assist them with their studies. All students have access to their faculty for one on one coaching during the faculty's weekly office hours. Selected courses are digitally recorded and placed on the course web site so students can view via video streaming the lecture and/or download the audio to a mp3 player. They can again listen to the lecture and review the power point slides posted on the course web site. (The majority of all undergraduate nursing courses at UTEP have power point slides of the lectures posted on the course web site).
All nursing students who have academic challenges are required to be a member of a study group and to meet with the retention coach. This coach is a season faculty member who assist students with test taking skills, problem solving, time management, and perhaps most importantly provides encouragement and emotional support. As appropriate students who have special needs are referred to other campus or community resources.
The nursing program at UTEP is tough as our graduates are one of the best in the nation. We expect outstanding academic performance combined with a humanistic and caring concern for our fellow humans. This past year (2006-2007) our passing rate on the NCLEX-RN exam was slightly over 96%, statistically the same as those students graduating from UT Austin. We have more graduates than Austin and 78% of our students are Hispanic. Thus we are living our Vision of Becoming the Premier Hispanic Serving School of Nursing in the Nation.
For more information about the University of Texas at El Paso School of Nursing please visit our web site. www.utep.edu/nursing
Sunday, March 2, 2008
Nursing Shortage
The shortage of registered nurses practically those with baccalaureate and higher degrees continues. The Kaiser edu.org Kaiser citing a study released by the Health Resources and Services Administration within the Department of Health and Human Services reports that by 2020 there will be a shortage of 340,000 nurses with 44 states anticipating shortages.
The aging population and increasing demand for health services contributes in part to the demand for more registered nurses. Kaiser reports that a significant growth in demand for long term care is also contributing to this projected shortage. They report there will be a 66% growth in nurses needed in geriatric related services.
An excellent video on You Tube Amesricanneednurse points out the need for nurses. Another You Tube video series also discusses the nursing shortage and reasons for such. Nursingcrisis
Nursing schools across the country have responded to the demand for increase their enrollments. Innovations in curriculum that includes the use of simulations, accelerated programs for those who have degrees in other areas have been developed, and new partnerships between academia and healthcare service settings have been forged. The ability of schools of nursing to rapidly increase their capacity have been hampered by a shortage of faculty, limited clinical sites, and inadequate budgets to expand enrollments.
Hopefully, this dialogue will start conversations about the shortage and potential solutions.
The aging population and increasing demand for health services contributes in part to the demand for more registered nurses. Kaiser reports that a significant growth in demand for long term care is also contributing to this projected shortage. They report there will be a 66% growth in nurses needed in geriatric related services.
An excellent video on You Tube Amesricanneednurse points out the need for nurses. Another You Tube video series also discusses the nursing shortage and reasons for such. Nursingcrisis
Nursing schools across the country have responded to the demand for increase their enrollments. Innovations in curriculum that includes the use of simulations, accelerated programs for those who have degrees in other areas have been developed, and new partnerships between academia and healthcare service settings have been forged. The ability of schools of nursing to rapidly increase their capacity have been hampered by a shortage of faculty, limited clinical sites, and inadequate budgets to expand enrollments.
Hopefully, this dialogue will start conversations about the shortage and potential solutions.
Healthcare Costs are Soaring and Our Health is Worse
Healthcare costs are expected to soar to $4.3 trillion by 2017 which is estimated to be nearly 20% of the gross domestic product. The increasing demand for health services will continue to drive the costs of care. Read the full story at Healthcare cost.
The increase in cost is driven in part by increasing demand for complex technology, demand for new pharameuticals, increasing number of uninsured, shortage of healthcare professionals, lack of a national health insurance, malpractice claims, restictive practice acts, inconsistent quality of care, medical errors, and aging of the baby boomer who are now seeking more healthcare services.
Unhealthy lifestyles that have contributed to what some see as an epidemic of obesity that can result health problems such as diabetes, heart diseases, and cancer. Most when asked seem aware of the need to have a health lifestyle that includes proper diets, exercise, and management of stress. However, for what ever reasons particularly in the USA achieving these goals for many has been unreachable. For example, the adverse health problems related to smoking are common knowledge. For a number of years the Surgeon General has required that warnings are placed on all tobacco products. Yet in Kentucky 28.5% of the population smokes while Utah has the lowest rate at 9.8%. To see how your state ranks national on smoking as well as on other health issues take a look at the Kaiser State Health Facts. Statehealthfacts.
Clearly the cause of increasing healthcare costs is caused by multiple factors. The United States is the only industrial nation in the world without national health insurance. Over 44 million citizens do not have insurance. Most of these individuals are women and children. In some parts of the country such as along the US Mexico border over 40% are without insurance. Some areas the percentage is nearly 60%. Without health insurance people simple put off obtaining care when the problem is just emerging. Then when the problem becomes acute they are forced to seek expensive emergency room care. The system as depicted extremely well in Michael Moore's the movie Sicko broken and without a political commitment to change the existing piece meal system of insurance and public policies that tend to favor the status quo countless American will die and/or suffer from unnecessary health challenges.
The increase in cost is driven in part by increasing demand for complex technology, demand for new pharameuticals, increasing number of uninsured, shortage of healthcare professionals, lack of a national health insurance, malpractice claims, restictive practice acts, inconsistent quality of care, medical errors, and aging of the baby boomer who are now seeking more healthcare services.
Unhealthy lifestyles that have contributed to what some see as an epidemic of obesity that can result health problems such as diabetes, heart diseases, and cancer. Most when asked seem aware of the need to have a health lifestyle that includes proper diets, exercise, and management of stress. However, for what ever reasons particularly in the USA achieving these goals for many has been unreachable. For example, the adverse health problems related to smoking are common knowledge. For a number of years the Surgeon General has required that warnings are placed on all tobacco products. Yet in Kentucky 28.5% of the population smokes while Utah has the lowest rate at 9.8%. To see how your state ranks national on smoking as well as on other health issues take a look at the Kaiser State Health Facts. Statehealthfacts.
Clearly the cause of increasing healthcare costs is caused by multiple factors. The United States is the only industrial nation in the world without national health insurance. Over 44 million citizens do not have insurance. Most of these individuals are women and children. In some parts of the country such as along the US Mexico border over 40% are without insurance. Some areas the percentage is nearly 60%. Without health insurance people simple put off obtaining care when the problem is just emerging. Then when the problem becomes acute they are forced to seek expensive emergency room care. The system as depicted extremely well in Michael Moore's the movie Sicko broken and without a political commitment to change the existing piece meal system of insurance and public policies that tend to favor the status quo countless American will die and/or suffer from unnecessary health challenges.
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