Unit 3
Edelman: Ch 3
1. Health disparities
a. a particular type of health difference that is closely linked with social, economic,
and/or environmental disadvantage
b. adversely affect groups of individuals, especially vulnerable populations
c. Medicare and Medicaid were created to aid the poor and older adult populations,
but escalating health costs are still an issue
d. People who experienced greater obstacles to health based on: race/ethnicity,
religion, socioeconomic status, gender, age, mental health,
cognitive/sensory/physical disability, sexual orientation, geographic location, or
other characteristics historically linked to discrimination or exclusion
2. Patient Protection and Affordable Care Act (ACA)
a. Signed into law on March 23, 2010
b. Largest change since Medicare and Medicaid in the 1960s
c. Will be fully enacted by 2018
d. Designed to address issues of affordability, accessibility, and financing of health
care with focus on vulnerable populations
e. Requires changes in public insurance programs, private health insurance market
regulations, and other components
f. If can’t get insurance through job, can go to health insurance exchange
3. Healthy People 2020
a. Goals:
i. Attain high-quality, longer lives free of preventable
disease, disability, injury, and premature death.
ii. Achieve health equity, eliminate disparities, and improve
the health of all groups.
iii. Create social and physical environments that promote
good health for all.
iv. Promote quality of life, healthy development, and healthy
behaviors across all life stages.
4. Health indicators of a nation
, a. Mortality-based indicators reflect general health of nation and are readily
available
b. International Comparisons of Core Health Indicators compares average life
expectancy by gender and infant mortality rates
c. Infant mortality rates are very important because reflect maternal health and
access to health care (US is slightly worse than other industrialized nations
because of the large disparities in health )
d. The higher the education of women, the lower the infant mortality rate (also
White women have much better rates than African or Hispanic)
5. Historical Role of Women in Health Promotion
a. Florence Nightingale
i. Founder of modern nursing
ii. While caring for wounded soldiers in the Crimean War, she fought for
hospital reform by crusading for cleanliness and against overcrowding and
lack of ventilation.
iii. Her careful recordings of care outcomes quantified needed reform in
health promotion
b. Lilian Wald
i. Appalled by the lack of medical care, ignorance, and living conditions of
the poor in 1893, developed a settlement program in New York City that
trained nurses, provided care to families, and developed education
programs for the community
ii. organized public health in the direction of health promotion for families
and communities
6. Institute of Medicine (IOM)
a. Nonprofit
b. Conducts research from systems approach to advise nation in improving health
c. Work environments contribute to nurses’ errors and poor communication
d. Medication errors were common and costly
7. World Health Organization (WHO)
a. Objective is to influence health opportunities and outcomes for all people so that
, they can attain highest possible level of health
b. Recognizes importance of families and health promotion
c. Agenda with 6 goals:
i. Promoting development; fostering health security; strengthening health
systems; harnessing research, info, and evidence; enhancing partnerships;
and improving performance
d. History of Health Care
i. Early influences
1. Earliest views of health were holistic
2. Primitive people understood illness in mystical terms (sickness
linked to cosmic view)
3. Middle ages:
a. infectious diseases were leading cause of death
b. health was absence of disease
ii. industrial influences
1. manufacturing advances during 18th century (flush toilet, sewage
system) made sanitary engineering possible, preventing diseases
(typhoid, paratyphoid, and gastroenteritis)
iii. socioeconomic influences
1. 1834: pauperism
a. Moral failure against poor
b. If worker didn’t earn a subsistence-level income, attitude
toward them was suspicious and punitive
c. People are held directly accountable for state in life, and
health maintenance is responsibility of individual
iv. Public health influences
1. Edwin Chadwick (1800-1890)
a. Father of British and American Public Health
b. Established English Board of Health
c. Emphasized environmental sanitation but excluded
physicians outside times of crisis
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