An explanation of the health issues and risks that are relevant to the child you selected? Post an explanation of the health issues and risks that are relevant to the child you selected.

/in /by

An explanation of the health issues and risks that are relevant to the child you selected?
Post an explanation of the health issues and risks that are relevant to the child you selected.

Describe additional information you would need in order to further assess his or her weight-related health. Taking into account the parents and caregivers potential sensitivities list at least three specific questions you would ask about the child to gather more information. Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their childs health and weight.

:Culture clearly has strong effects on mental disorders. How does this influence what you think about what is normal or abnormal?

/in /by

:Culture clearly has strong effects on mental disorders. How does this influence what you think about what is normal or abnormal?

Culture clearly has strong effects on mental disorders.

How does this influence what you think about what is normal or abnormal?

The German Philosopher Friedrich Nietzsche thought that society itself might be neurotic, and suggested that our societies set up a “neurosis of health.” What do you think he meant by that?

Do you think that society is unhealthy, and adapting to a sick society makes us depressed, anxious and off balanced?

Article Review of Health Disparities Research

/in /by

ARTICLE ONE (1) REVIEW


Purpose

This paper is a personal subjective review of the article “

Perspective: Challenges to Using a Business Case for Addressing Health Disparities

“,


[1]

further referenced herein as ‘the literature’.


Definition

Health disparity is defined as “

the difference in health among different populations”




[2]


Discussion

In our textbook, McKenzie and Pinger describe differential gaps between individuals as the cause for health disparities. To expand on this, they write


[3]

:

“

recognized that some individuals lead longer and healthier lives than others, and that often these differences are closely associated with social characteristics such as race, ethnicity, gender, location, and socioeconomic status. These gaps between groups have been referred to as health disparities”


Health Disparity Problem

Whereas our textbook briefly discusses health disparity, it doesn’t delve into causes, nor how long it has existed. However, the ‘how long’ answer can be found in a paper by Cindy Lawler in which she writes that the problem was recognized “

As early as 1899, W.E.B Dubois (1899) observed the existence of Racial and ethnic Health Disparities (REHDs)

“, and through

” his social study of Blacks in Philadelphia he interpreted statistical data about their health and drew several conclusions that are similar to today.

” She also touched upon Dubois working with “

flawed health data collection in Philadelphia that sacrificed the accuracy of statistical analysis.”




[4]

80 plus studies, conducted between 1984 and 2004


[5]

, have repeatedly stated similar, if not the same issues and viewpoint – all point to the health disparity issues in the United States, but not enough data to identify a fix for the causation(s).

So, if this is an age-old problem, why are we still facing this systemic problem after a full century of recommendations have been made? I believe the authors attempted to address this by writing the literature; but, it is my belief, they fell short as the literature only touches the tip of the ice berg.


Challenges

As written, the literature appears to be solely focused on the many challenges to using a business case for health care organizations. The common challenges that were identified included:

  • lag-time in ROI, and
  • disconnect between investor and the realized beneficiary.

In discussing ways to tackle the problem, the literature laid out a litany of challenges faced by health care entities through use of a broad view of both business and social cases. Throughout, it outlined what businesses and health care entities must do to achieve a better ROI, while trying to attain equity, with the ultimate goal of achieving a reduction in health care disparity.

The literature also points out that a great many health organizations remain reluctant to help combat the disparity problem. Their reasoning is based on concern for their bottom line–they are unsure about whether they may see a positive ROI return, or not. And, this is not without merit, especially since there is typically a lag between initiation and seeing the ROI.

To emphasis this point the authors state it doesn’t take much to begin the process.

“

a combination of business and quality improvement principles may still be able to guide health care organizations seeking to reduce disparities

.”

As a starting juncture, they suggest use of Pareto charts and application of the 80-20 rule. In doing so, stakeholders could initiate a process to re-focus their efforts, thus allowing them the ability to turn their energies toward redirecting threatened capital items, such as funds, manpower, and equipment more effectively.

To prove their point, the authors referred to an 80/20 rule study which identified a disparity within an unidentified health care setting – specifically, care afforded to African Americans. The study found that “

approximately 80 percent of African Americans were cared for by 20 percent of physicians,”

in an under-resourced setting, thus subjecting the group to a lessor form of quality care.


[6]

The literature goes on to identify another avenue to further increase effort effectiveness, and reap further rewards in doing so, and that is though collaboration with other interested parties within the community. By doing so, they hopefully will begin the process of reducing the disparities, one small step at a time.


Who is at Risk?

Health disparities commonly affect minority, low-income, and rural-based populations. One reason for this, in part, is due to location. Regardless of the setting, in town, low income housing projects, or rural environment, many may have little to no access to a quality care facility, or any type care facility, or provider at all. This forces these groups to travel greater distances, and in tight economic times, such as we are in today, these groups many not be able to afford the travel costs. This creates a socio-economic Access to Care disparity, as well as an inequity issue.

Of course, many races and ethnicities are affected by these factors, and the literature explains that the authors believe this is rooted in racial segregation.


Conclusion

Individual health is the culmination of many factors. However, the most important factors are the social, economic, and environmental conditions in which we are born, live, work, study, and play.

Engaging the social elements of health is a critical component of any comprehensive health equality strategy. Successful engagement could ultimately lead to reduced healthcare costs, and improvement in everyone’s overall health outlook. From a business standpoint, health care entities, stakeholders, and investors need to identify and implement the correct business model, ensure proper policies and procedures in place, and have buy in from everyone (community, workers, senior ‘C’ levels, and ultimately clients) before they can begin to realize a faster, positive ROI.

Furthermore, health care entities and business stake holders, in cooperation with community leaders and governmental agencies (regardless of level), need to realize there is a critical need to identify and improve community health environments and health policies. This can only be achieved though cooperative efforts by all; and, by supporting programs and policies that address the myriad of social and economic determinants of health. In doing so, only then can we ensure the root causes of health disparities, and the associated inequities, are adequately, and effectively addressed and eliminated.


[1]
Lurie, N., Somers, S. A., Fremont, A., et al., 2008


[2]
McKenzie, James F., Pinger, Robert R. 2015. pg. 25, sidebar


[3]
McKenzie, James F., Pinger, Robert R. 2015, pg. 25, para 5


[4]
Lawler, C. (2011), Introduction, pg. 15


[5]
Lawler, C. (2011), Introduction, pg. 15, para. 3.


[6]

Lurie, N., Somers, S. A., Fremont, A., et al., 2008, para 12.

What are the services provided by mental health courts?

/in /by

What are the services provided by mental health courts?

Deinstitutionalization has led to increased numbers of homeless and has had other unintended consequences. According to the National Alliance on Mental Illness, up to 40 percent of mentally ill people have become involved in the criminal justice system. In an effort to address the traditional lack of sufficient mental healthcare in jails and prisons, mental health courts have been established, leading to decreased jail time and improved provisions of psychiatric services for mentally ill prisoners (National Alliance on Mental Illness, 1993).

You can read more about this at the link below:

Almquist, L., & Dodd, E. (2009). Mental health courts: A guide to research-informed policy and practice. NY, NY: Council of State Governments Justice Center. Retrieved from https://www.bja.gov/Publications/CSG_MHC_Research.pdf
National Alliance on Mental Illness. (1993). A guide to mental illness and the criminal justice system: A systems guide for families and consumers. Retrieved from
http://www.nami.org/Content/ContentGroups/Policy/Issues_Spotlights/Criminalization/Guide_to_Mental_Illness_and_the_Criminal_Justice_System.pdf

Use the Internet to examine the roles that mental health workers play in the provision of services to mentally ill populations in jails and prisons. Find at least two research articles that evaluate the success of mental health service programs for mentally ill populations in prisons. This assignment is a research paper. In paragraph form, please provide a thorough and integrated response to all questions that follow:

What are the services provided by mental health courts?
How do these services benefit the prisoners? How do these compare to the services already available through the existing criminal justice system?
Do the research findings support the establishment of more mental health service programs to imprisoned mentally ill populations? What can be done to improve these services further?
Submit your analysis in Word format. The body of your paper (not including the title page or references page) should be at least 4-5 pages. Format your paper according to current standards of APA style and include an APA-style title page, a running head, and a references page. Apply APA standards to citation of sources.

Advantages and Disadvantages of Conceptualising Addiction as a Disease

/in /by

The question of whether alcoholism or drug addiction can be correctly defined as a disease has been the subject of debate for well in excess of 70 years.

It has, however, been a very fertile debate with many writers, thinkers and researchers contributing arguments on both sides which we will discuss in the course of this paper. Although he was not the first person to propose that alcoholism was a disease, Jellinek (1960) in his landmark book established the debate as we know it today and few writers on the subject can overlook his work and discussion. Jellinek did not use a broad brush to describe all who presented with alcoholism as addicts of the brain disease concept, rather he broke it down into five categories. Of these five categories he suggests that two of the groupings might be described as a disease. Other experts differ in opinion feeling that the disease label (White 2001) should be abandoned, that it fails to provide an adequate framework for prevention and is a term misused.

Since Hogarth’s (1751) depiction of the perils of gin in his famous painting ‘Gin Lane’ there have been many wide ranging and inhumane attempts at addiction treatment. From spiritual crisis to spiritual awakening, taking the pledge or imprisonment the cures and success chronicles of the last 200 years are varied. In this essay I set out some of the advantages and disadvantages of conceptualising addiction as a disease.

In his article (White 2000) suggests the disease concept challenged public health authorities to take responsibility for the treatment of addiction and altered public perception of the alcoholic. In the USA in the late 1970’s and early 1980’s White tells us there was a huge growth of treatment programmes from private rehab facilities and hospitals who implemented and promoted the disease based concept.

One advantage of the 28 day residential model was that treatment could more easily be accessed through private medical insurance. The disease concept was, in part,

intended to remove the moral stigma of a condition previously regarded as self-inflicted. By 2001 White (White 2001) states that the disease concept was accepted by many including people in recovery, Doctors, Psychiatrists, counsellors and other professionals. It also went some way to support disturbed family members by offering acceptance and removing shame and guilt around their relationships with the addict. White argues that the disease concept encourages self-seeking behaviour and relieves guilt, replacing moral censure with unprejudiced access to health care institutions. He also claims the disease concept works as an umbrella to understand the various potential causes of the problem, as well as the evolution and the interventions that are available as treatment options.

Mansell Pattison et al (Mansell 1977) also note that whilst ‘disease’ does not have a written-in-stone definition, just as any deviation for health may be regarded as a disease, any condition that progresses over time may also fall into that category.

Pattinson recognises that E M Jellinek’s book (Jellinek 1960) had been a most important and pervasive influence on the so-called disease model. Its primary intent being to influence both contemporary medical practices with social and political developments. Jellinek alludes to five sub categories of ‘alcoholisms’ though he defines only two, the gamma and the delta varieties of alcoholism as a disease. This model effectively captured the notion that addictive disease was not a one size fits all malaise. Further Jellinek acknowledges that the definition of ‘disease’ as effective for the medical profession is not necessarily the identical definition of disease as held by the general public.

Burnham (1994) determines that the inability to abstain and loss of control in the context of an illness appears to normalize and legitimize the compulsive drinking behaviour. It reduces the sense of isolation, blame, stigma, guilt and shame, and subsequent resistance to seeking help. It provides a healing rationale and justification for self-punishing actions whilst at the same time instilling hope and optimism that recovery is possible. Burnham also suggests that it is probable that treatment promotes identification and connection with others who are similarly afflicted. Burnham concedes that the advantages of the disease concept are far-reaching and can have positive effects for both female and male alcoholics. Placing the inability to abstain and loss of control in the context of an illness, which can be treated, is comforting to the sufferer and family members. It reduces the sense of isolation, blame, stigma, guilt and shame, and subsequent resistance to seeking help. It instils hope that recovery is possible and probable with help, as so many have demonstrated. It also promotes identification and connection with others and provides information as to the causative factors behind the continued consumption.

However, where women alcoholics are concerned, Burnham (1994) discusses the impact of the disease concept and the need for women in particular to engender self- efficacy and feelings of empowerment, several problems with the disease concept emerge. Its emphasis on illness evokes images of a dependent whose wellness is under the control of medical or mental health professionals, contradicting the disease rhetoric of clients taking responsibility for their recovery. Burnham further observes that given women’s socialized patterns of dependency and subordination this additional dependent role reinforces any learned helplessness formulated during early childhood and later years. The obsessive and compulsive lack of control of drinking, a primary symptom of the disease concept, can readily be symbolically generalized to a lack of control of the totality of her life in the woman’s belief system. Instead of believing in herself, in her personal creative abilities and strengths, she focuses on her childlike, immature and needy traits. Underhill and Lester argue that women need to feel empowered with their life situation (Burnham 1994)

In his article (White 2001 Counsellor 3) White argues that the disease concept strips the addict of freedom and responsibility and can be misapplied. He suggests that labelling alcohol/drug problems as incurable diseases could dissuade heavy drinkers from seeking help, and furthermore that by restricting the definition of vulnerability to a small group it has let alcohol and drug industries escape blame for the promotion of their products. White goes on to recommend (White, Apr 2001)

that disease concept critics claim that the majority of people who resolve alcohol-drug related problems do so without seeking recourse to any treatment programme or group. The paper continues to say that addiction is not a disease but rather a choice founded in weakness of character, a habit under the control of the Will that could be broken like any other habit.

Another adverse result was that there was a financial backlash against access to the ‘industry’ managing access to treatment, in particular, the prototype 28-day inpatient programme. Right of entry became more restricted towards the end of the twentieth century unless it could be paid for, insurers did not like the heavy costs. Professional consensus was again resurfacing that some of the addiction problems might be best resolved at a personal, cultural and environmental level. In a later paper (White, Counsellor Apr 2001) proposes that one of the first definitions needed is that of disease. The addiction field must follow the rest of medicine in moving away from the depiction of disease as an entity to an understanding of disease as a metaphor. “Disease” is a word and an idea used to convey substantial, deteriorating changes in the structure and function of the human body and the accompanying deterioration in biopsychosocial functioning.

Burnham (1994) argued that diseases were usually thought of as being inside the body but alcoholism and addictions present through mainly environmental factors.

Lewis (2016) asserts that the disease model is scientifically baseless and sustains stigma. Lewis suggests that we are starting to recognise addiction as a consequence of social ills rather than individual flaws. Furthermore, he observes that medical care only makes sense for medical illnesses.

The enduring debate about whether there are advantages or disadvantages in using the disease concept terminology will rumble on and until we have some definitive wisdom as to the cause of addiction. We know that the disease concept has lent hope and identity to many addicts and their families, we also know that some people recover from drug/alcohol addiction without any treatment intervention at all.

Lewis (2006) argues that the disease model undermines hope, fails to end stigma and doesn’t always get addicts the help they need. Lewis further suggests that the brain changes observed in long term substance abusers are nearly identical with those suffering from obesity, gamblers, porn aficionados, gamblers and internet addicts, pointing to the idea of responding to cues predicting their preferred rewards. Dopamine flows in anticipation of pleasure, (Maté 2012) a response to an outside stimulus rather than a disease which originates within, children are constantly chasing dopamine. Adult children seek to recreate the same. Conceivably the ritual of pouring a drink or assembling drug paraphernalia offers this promise, and this is outside the body and in the environment.

Should we look more closely at lives rather than genetics and addictions as the disease, keeping in mind the human brain is shaped by environment.

Some addicts, in a moment of sudden insight can change course and turn away from addiction, this is undeniably at odds with the disease concept.

Is there an argument to look at what is right about addiction?

Are there undeclared forces at work to encourage the disease model, such as the alcohol industry, advertising and marketing companies, pharmaceutical companies, costly private rehab residential centres and the Inland Revenue. Lewis (2015) argues that the disease label locates the problem of addiction in the individual and therefore it is hard to see how that counteracts stigma. Most addicts eventually recover with or without help and it is therefore confusing for them to be labelled as chronically ill.

An opportunity to explore this model was presented when (Finagrette, 2010) when the Supreme Court considered the issue of whether alcoholism is a disease and whether being alcoholic excuses one from criminal responsibility.Although, when entering this fray, Herb Finagrette’s sense was that alcoholism had been established to be a disease, his examination of the issues thoroughly convinced him otherwise. There was no genetic or other biological explanation for why a person drinks too much either on a particular occasion or habitually, why a person commits violent or criminal acts when drunk, why a person decides that he or she is an alcoholic and that drinking is an excuse for misbehaviour. Instead, Herb saw, drinking was an all-purpose excuse, a special case of self-deception anointed by science but actually steeped in the lore of magical “loss of control”—”I couldn’t help myself”—as though this

description

of irresponsibility was somehow an explanation and an excuse for it.

It remains the case that treatment is not available to the majority who seek it.

Recovery from alcohol dependence bears no necessary relation to abstinence, (Pattinson 1977) although such a concurrence is frequently the case. (Levine 1978) reminds us that there are different conditions facing people in the 20

th

century, particularly giant organisations and the consequent degree of human interdependence, evolving what were once viewed as individual problems into problems of a more social nature.

(Vaillant 1995) reminds us that alcoholism produces enormous suffering and to deny treatment to alcoholics is inhumane. Virtually all follow-up studies show alcoholics better off for several months after clinic treatment than they were just before treatment. The disease model of treatment facilitates the understanding of facts rather than illusions about the addiction which, in turn, serves to assist the natural healing process.

Summing up the advantages and disadvantages of conceptualising addiction as a disease we must look at how the addict might benefit from either point of view.

Drug treatment programmes (Coomber et al 2013) discuss ideologies that vary considerably in terms of treatment, some programmes are abstinence based whereby drug use is not tolerated. This might include the AA 12 step programme or a disease model rehab programme. The alternative philosophy draws on the principles of harm reduction without using a closed environment.

The addict will have their own views on which treatment offers them the better opportunity of success. It is important not to discount the degree of self efficacy the addict may possess or the goals he/she may be determined to attain in order to enable recovery. There may be a situation of natural ‘maturing out’ and reaching a stage where other things replace the drug of choice such as a relationship, children or a job. (Coomber 2013) advocate that successful outcomes depend, in part, on the appropriate match between an individual’s needs and a particular drug treatment modality. Abstinence from drugs must always be placed second to the health of users, so it goes without saying that a person suffering from alcohol addiction should not undertake a detox without medical supervision.

The disease model 28dday recovery programmes offer enlightenment and understanding of some of the reasons that may have led to addiction. This may prompt further self-seeking discoveries, whether a relapse occurs or not, seeds will have been planted during therapy sessions that can be revisited. The security of knowing that there are others in the group who are trying to move out of addiction may offer the feeling that it is not a lone journey and a sense of being able to help each other.

AA’s Twelve Step Program not only provides accessible group support but also a clear ideology regarding addiction. The programme addresses the individuals’ need for identity, integrity, an inner life and interdependence within a larger social and moral, or spiritual context. The ideology largely encompasses a disease-like point of view promoting total abstinence and surrender to a higher power. Not all attendees feel the need to embrace all AA conventions but may draw on the collective wisdom and companionship of the group as they feel appropriate.

Where the addict can move out of depression and engage in a more meaningful life it can follow that he/she will be less interested in mind numbing substances. The Rat Park experiment (Alexander 2018) showed that where a group of rats lived together in a park offering lots of interesting stimulation and food they avoided taking her heroin that was offered. Medicating with mind altering substances is usually driven by not feeling complete emotionally.

Though there are strong arguments on both sides regarding the advantages and disadvantages of conceptualising addiction as a disease, the outcome I feel is that a non-disease concept is marginally more favourable.


Reference list

  • Alexander, B., 2018.

    Addiction: The View from Rat Park (2010)

    . [online] Brucekalexander.com. Available from: http://brucekalexander.com/articles-speeches/rat-park/148-addiction-the-view-from-rat-park [Accessed 20 Oct. 2018].
  • Coomber, R., McElrath, K., Measham, F., & Moore, K. (2013).

    Key concepts in drugs and society

    . Sage. P125-128
  • Finagrette, H., 2010. Is Addiction Really a Disease?.

    Alcoholism Treatment Quarterly

    , 28(2), pp.239-242.
  • Jellinek, E. M., 1960. The disease concept of alcoholism.
  • Hogarth’s, W., 1751. Gin lane.
  • Levine, H. G., 1978. The discovery of addiction. Changing conceptions of habitual drunkenness in America.

    Journal of studies on alcohol

    ,

    39

    (1), 143-174.
  • Lewis, M., 2015.

    The biology of desire: why addiction is not a disease

    . Hachette UK.
  • Maté, G., 2012. Addiction: Childhood trauma, stress and the biology of addiction.

    Journal of Restorative Medicine

    ,

    1

    (1), 56-63.
  • Pattison, E. M., Sobell, M. B., & Sobell, L. C. (1977).

    Emerging concepts of alcohol

  • dependence

    . Springer Publishing Company.
  • White, W. L., 2000. Addiction as a disease: The birth of a concept.

    Addiction

    ,

    51

    , 73.
  • White, W.L, 2001 Addiction Disease Concept: Advocates and Critics.” Counselor 2 (1), 42-46
  • White, W. L., Boyle, M., & Loveland, D. (2002). Alcoholism/addiction as a chronic disease: From rhetoric to clinical reality.

    Alcoholism Treatment Quarterly

    ,

    20

    (3-4), 107-129.
  • Alexander, B., 2018.

    Addiction: The View from Rat Park (2010)

    . [online] Brucekalexander.com. Available from: http://brucekalexander.com/articles-speeches/rat-park/148-addiction-the-view-from-rat-park [Accessed 20 Oct. 2018].
  • Vaillant, G. E., 2009.

    The natural history of alcoholism revisited

    . Harvard University Press.

Select a current health problem (ABORTION) that is being debated at the national and/or state level

/in /by

Select a current health problem (ABORTION) that is being debated at the national and/or state level

 

 

This assignment will provide you with the opportunity to practice influencing policy by communicating with a legislator about a current health problem. The letter should be in block format for a business letter. You do need to support with evidence.PLEASE INCLUDE THESE AREAS IN THE LETTER,1.Select a current health problem (ABORTION) that is being debated at the national and/or state level2.Identify a legislator (state or federal) and state why that person is the appropriate one to contact, you will show why this is right person to contact based on the supporting data you provided in your letter3.Draft a letter to the legislator in business block format including the proper salutation. (CHOOSE A STATE OR LOCAL SENATOR, INCLUDE HIS/HER BUILDING ADDRESS )4.Introduce yourself and your reason for writing5.State concisely what you understand to be the current socioeconomic, political, and ethical issues surrounding the problem. You must have supporting data (include citations).6.Discuss the implications of the problem for your community, nursing or nursing practice7. Make a clear request for action. You must have supporting data (include citations). Request for response8. INCLUDE A REFERENCE PAGE, USE 3 SCHOLARLY REFERENCES THAT ARE 5 YEARS AND UNDER PLEASE.PLEASE ATTACHED EXAMPLE

Criminology Assignment. Word Count: 1000 Plagiarism free and Harvard Referencing

/in /by

Criminology Assignment.

Word Count: 1000

Plagiarism free and Harvard Referencing

Health Issues in Singapore and Strategies to Tackle Them

/in /by

“A good health system delivers quality services to all people, when and where they need them. The exact configuration of services varies from country to country, but in all cases, requires a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; well-maintained facilities and logistics to deliver quality medicines and technologies.” (1)

EXECUTIVE SUMMARY –

The following report discusses the major health issues in urban Singapore and the process to tackle them. The major health difficulties faced by the urban population of Singapore are non-communicable diseases and ageing, which are associated to a change in lifestyle due to 100% urbanisation. Ageing is linked with non-communicable diseases. This report describes UN-habitat as a healthy setting approach which can help in healthy ageing thereby reducing the occurrences of non-communicable disease. Recommendations based on the principles of UN-habitat are provided to tackle these health issues faced in Singapore.

INTRODUCTION –

Singapore is a comparatively small country consisting of small islands in the most south east part of the Asian continent. Singapore is one of the most urban nations on the planet. Having 100% urbanisation, all the population lives in an urbanised area with no possible rural life. (2) The total population is around 5.7 million with an average life expectancy around 83 years of age, higher than compared to any other nations in the south east. (2) The average male to female life expectancy is 80 to 86 years of age respectively. In the year 2013-14, Singapore had a second rank in the world health ratings for an efficient and durable health care system making it a healthy nation. Due to this there was an increase in the cost of health care by 13%. (2) The main health issue which is currently damaging the health system of Singapore is rising the number of non-communicable diseases as well as the population which is affected. When a healthy health care system faces a major health issue it is a challenge for the health system to tackle it in the future. (2) The burden of non- communicable diseases will have a huge impact on the 100% urban health system of Singapore. (2) The purpose of the following report is to understand the key health issue and its impact on the urban community with the help of data collected by the health system about the issue and measures taken to tackle the burden of non-communicable diseases. The data collected by the health system will be beneficial to understand the necessity of tackling this issue for the present and in the future. Based on the limitations and advantages of the measures by the health system, recommendations will be provided to improvise the measures which have been already taken towards the issue.

HEALTH ISSUES –


Non-communicable Diseases –

The urban community of Singapore faces a burden of non-communicable diseases (NCDs) faced by many other developed countries in the world. (3) Rapid increase of the effects and impacts of NCDs on the health and the health system are seen in the urban community of Singapore. (3) More than 5 of the major NCDs are observed affecting the urban population, they are –

  • Ischaemic heart disease, (3)
  • Lower respiratory disorders, (3)
  • Stroke, (3)
  • Cancer – which is related to all important organs, (3)
  • Chronic obstructive pulmonary disorder (3) and
  • Kidney diseases. (3)

Picture number one shown below explains the top 10 causes of death (all NCDs) on the left side showing an increase in deaths caused by kidney diseases, liver cancer and breast cancer; with a slight decrease in the deaths caused by stomach cancer and chronic obstructive pulmonary disorder. (4) The table shows there is no change in the number of deaths between 2000 to 2012 in deaths caused due to ischaemic heart disease, stroke, lower respiratory disorder, lung and related organ cancers along with colon and rectal cancer. (4) The graphs on the right side explains the disability-adjusted life years which are caused by the above mentioned NCDs. (4)

  1. Picture 1 – (4)

There is a rise seen in the mortality rates and the morbidity from the major NCDs in Singapore and it has a possibility of increasing in the future. In the picture number two shown below, there are two graphs. (4) The graph on the left side shows the death rates have decreased over the period of 12 years in males and females affected from NCDs. The pie-diagram on the right side shows the mortality in percentage taking into consideration deaths due to all kinds of diseases and injuries. (4) Only 24% of deaths in the overall population is resulting from communicable diseases and injuries. Rest 76% of total deaths are accounted for NCDs. Statistics state that there is going to be 21% rise in the next decade due to NCDs. (4)

  1. Picture 2 – (4)

Globalisation, poverty and unplanned urbanisation are the three major determinants for the rise of NCDs. Associated to the NCDs there are some risk factors. (3) These risk factors are extremely established in Singapore and are on the rise. The origins of NCDs in the society are due to environmental, social, economic and cultural conditions simultaneously having the risk factors as well. (3) The risk factors associated to NCDs are as follows –

  • Use of tobacco, (3)
  • Harmful use of alcohol, (3)
  • Physical inactivity (3) and
  • Unhealthy diet. (3)

Exposure and vulnerability of the population towards NCDs and health outcomes is influenced by the socio-economic determinants. Immense amount of economic consequences of NCDs are faced in Singapore. (3) Financial support has been decreased for essentials like education and food due to an increase in the demand for nonessential and unhealthy factors like tobacco and alcohol. (3) These consequences affect the health care expenditure of the families lead by an unfortunate rise in use of nonessential and unhealthy factors. (3) Picture three below explains the causes of death by different parameters. The table on the right side explain the age specific risks of mortality throughout life. (4) It shows that probability of deaths occurring in between the ages of 30 to 70 years in both males and females, is because of NCDs. The graph on the left compares the deaths occurred in both males and females. (4) It shows that there is a rise in the number of deaths caused by NCDs in both males and females over the period of 12 years from 2000 to 2012. (4)

  1. Picture 3 – (4)

The causes of death in the age group between 30 to 70 years are because of the effect of 10% of the 4 major NCDs. Premature mortality is experienced by the urban community of Singapore due to the NCDs. (4) Majority of the deaths are caused by cardiovascular diseases and cancers, rest are caused diabetes, chronic respiratory disorders and some of the other NCDs. Picture number four below shows the probability of dying in males and females aged between 30 to 70 years. (4) Both graphs on the picture show a rise in the mortality due to the NCDs over a period of 12 years from 2000 to 2012. There will be a further rise in the mortality rates of NCDs in the urban population of Singapore. (4)

  1. Picture 4 – (4)


Ageing –

Ageing is another major health issue which is on the rise in the entire world. In Singapore, due to the decrease in death rate and fertility rate, ageing population has been an incipient issue. (5) Rapid change in the population in the world is observed in Singapore as well. There are four main causes of ageing in Singapore –

  • Increased life expectancy, (5)
  • Decreased fertility rate, (5)
  • Decreased population growth rate (5) and
  • Increased access to quality of health care services. (5)

In the year 2014, the total health care expenditure of Singapore was 4047 US dollars. (4) In the past 10 years, life expectancy has been increased from 75 years of age to 82 years to the year 2015. (4) The fertility rate has been low to 1.3 which has decreased the population growth rate. Ageing population is directly proportional to the decrease in the population growth rate in Singapore. (4) This has led to the rise in the economic and social economic impacts on the urban communities. There was an increase in the burden of diseases and disability, number of individuals who are dependent on the families along with hampered quality of life and social security for the elderly. (5) Due to decrease in the workforce, higher taxes for the elderly, lower standard of living, reduced economic growth with reduction in the per capita production the urban population face the economic impacts of ageing. (5)

HEALTHY SETTING APPROACH –

Building healthy policies, creating supportive environments, strengthening community action for health, reorienting health services and developing personal skills are five priority areas where the World Health Organisation promotes health with the help of social utilisation, advocacy and education. (6) To tackle the effects of rapid urbanisation, climate change, environmental deprivation, unhealthy lifestyles and widening inequities, reinforced promotion and advocacy are required. (6) To promote and protect health, approaches are required towards the government and the society. Public health urgencies and incorporation of health promotion and protection into a national development strategy is offered in an effective way by the healthy settings approach. (6) To achieve success factors like multisector collaboration, political commitment, citizen participation and community engagement are very crucial. (6)

UN-habitat is a program which has been started by United Nations operates for a better future. (7) This program promotes development of human settlements which are socially and environmentally sustainable. To address the health issues of ageing and non-communicable diseases in Singapore, UN-habitat has some principles. (7) These principles will help tackle and find adequate techniques to improve the effect of health issues. The principles which link Singapore to the health issues are – a city which is regenerative and resilient, a city which is well-planned, walkable and transport friendly and which should be healthy, safe and the city which promotes well-being. (7) These principles will help guide the city for a healthy atmosphere for ageing and tackle the growing issue of non-communicable diseases (NCDs). (8) As Singapore is 100% urbanised the burden of health issues in the rural area and people under the poverty line has been reduced and limited. (8) Due to this economy of the city changed along with the change in lifestyle of the population. This increased health issues of malnutrition and infectious diseases to shift towards the NCDs. (8)

RECOMMENDATIONS –

The principles of UN-habitat help tackle the health issues as they link with the healthy living master plan for Singapore along with the action plan developed by the Singapore government for the future of elder population. The main topics for the healthy living master plan developed by Singapore state that health promoting facilities which motivate healthy living should be easily available and accessible, for behavioural change, family and social support is very essential and all the population should be able to afford and access the options to develop a healthier living. (9) Ageing and NCDs are associated. As per the statistics, by the year 2030, the population of people aged more than 65 years will be tripled. (9) Due to the rise in the older population, the tendency to develop NCDs is quite high. Stroke, heart diseases, chronic respiratory disorders, cancers and mental disorders account to 70% of deaths in Singapore. (9) Number of risk factors affecting the lifestyle and dietary factors which influence the rise in NCDs. Obesity, cigarette smoking, alcohol consumption and high blood cholesterol are the risk factors which are associated with the burden of diseases. A change in lifestyle will help manage the risk factors. (9) To tackle the NCDs health issues as per the UN-habitat principle, a variety of changes should be done in Singapore with the help of the government –

  • Building a healthy and safe workforce which will help by improving the quality of life, prevent injuries and death from accidents and preventing and managing work and lifestyle which can affect the health and will have a risk of developing NCDs. (8)
  • Health promoting facilities in the community should be incorporated. These facilities will motivate the younger and middle aged population for adequate physical activity and a balanced diet. (9) These facilities will also motivate to reduce the habits of cigarette smoking and alcohol consumption. This will benefit against the development of NCDs in the future. (8)
  • Due to lack of physical activity and healthy dietary habits, peer support to encourage healthy habits is required. (9) These activities also involve the communities to promote cessation of smoking as well as consumption of alcohol. Family, friends and colleagues at workplaces or hospitals help in counselling and promotion of the cessation of the habits. (8)
  • Partnership with the private companies so that these companies will benefit he communities with healthier eating options. (8) To battle the obesity problem, delivery of highly nutritional food is essential by the companies to the vulnerable population. (8) Rising sugar intake from sugar drinks in Singapore should be reduced and substituted by beverages containing less or no sugar and water. (9)

Healthy ageing is the right of each person above 65years of age in the population of Singapore. (5) Based on the principles of UN-habitat, Singapore should develop its action plan to secure the future of the elder population. To help tackle the ageing problem, these are some of the recommendations which the government should consider –

  • Employability – every citizen has the right to work small jobs as a source of income after retirement from professional life. Workplaces need to hire people not based on their age. Aged population should have the availability of lifelong working. They should be able to work on their own will. (5)
  • Lifelong learning – they should be able to learn through school for elders. (5)
  • Senior volunteering – aged population should be able to volunteer for health programs in the community and help in fulfilling lives. (5)
  • Health and wellness – healthy senior population means happy senior population. Recreational facilities should be built especially for the elderly to have a healthy environment. (5) (9)
  • Aged care services – aged care services should be increased in number for helping elderly to remain independent and healthy. (5) (8) (9)
  • Transport and housing – travel experience for the elderly should be re-defined which will benefit them from travelling to short as well as longer distances. Housing for the elderly should be supported with any changing needs. (5) (9)
  • Public spaces should be constructed by making our urban infrastructure more senior friendly and safe. (5) (8) (9)
  • More amount of research is needed for understanding the needs of the elderly as well as new innovations which will be beneficial for them should be encouraged. (5)

CONCLUSION –

The above given recommendations are based on the principles of UN-habitat. To tackle the ageing problems which are directly linked with the NCDs these principles are necessary. The planning of the city provides a major role towards making it healthy and safe. A well-planned city with the benefits for elderly like walkability, easy access to public transport, recreational areas for recreational activities which would also help in reducing the effects of NCDs on ageing. A regenerative and resilient city helps the population to adopt and sustain healthy lifestyles by making healthy living accessible, effortless and natural. UN-habitat has worked for Singapore to develop transport and mobility, sustainable environment and the development of parks and other recreational activities. Considering the limitations of UN-habitat which are generally aiming for long-term global change, immediate results cannot be obtained. The government should follow and apply the principles of UN-habitat to achieve a healthy and safe environment for the urban population ultimately by reducing the health issues like ageing and non-communicable diseases in the future.

REFERENCS –

  1. World Health Organisation. Health systems [Internet]. World Health Organisation. 2017 [cited 24 September 2017]. Available from:

    http://www.who.int/topics/health_systems/en/
  2. World Health Organisation. Singapore [Internet]. World Health Organisation. 2017 [cited 25 September 2017]. Available from:

    http://www.who.int/countries/sgp/en
  3. World Health Organisation. Non-communicable diseases in South-East Asia region [Internet]. World Health Organisation. 2011 [cited 25 September 2017]. Available from:

    http://www.searo.who.int/nepal/mediacentre/2011_non_communicable_diseases_in_the_south_east_asia_region.pdf
  4. World Health Organisation. Non-communicable diseases (NCDs) [Internet]. Who.int. 2014 [cited 27 September 2017]. Available from:

    http://www.who.int/nmh/countries/sgp_en.pdf?ua=1
  5. The Ministry of Health. I Feel Young in My Singapore [Internet]. Ministry of Health Singapore. 2016 [cited 27 September 2017]. Available from:

    https://www.moh.gov.sg/content/dam/moh_web/SuccessfulAgeing/action-plan.pdf
  6. World Health Organisation. Non-communicable diseases [Internet]. World Health Organisation. 2012 [cited 25 September 2017]. Available from:

    http://www.wpro.who.int/regional_director/regional_directors_report/2012/media/03_DHP_03_NHP.pdf
  7. UN-Habitat. The City We Need – Towards a New Urban Paradigm [Internet]. UN-Habitat. 2016 [cited 24 September 2017]. Available from:

    http://www.worldurbancampaign.org/sites/default/files/documents/tcwn2en.pdf
  8. Healthy City Support Organisation. Making Singapore a Healthy Urban City [Internet]. Healthy Cities, Healthy Partners. 2016 [cited 27 September 2017]. Available from:

    https://www.healthy-partners.net/2017/02/23/making-singapore-a-healthy-urban-city/
  9. Ministry of Health Singapore. Healthy Living Master Plan [Internet]. Ministry of Health and Health Promotion Board. 2014 [cited 25 September 2017]. Available from:

    https://www.moh.gov.sg/content/dam/moh_web/Publications/Reports/2014/HLMP/MOH_Healthy%20Living%20Master%20Plan_Inside%20Page_8d.pdf

Discuss why the implementation of an ERP system might require business process reengineering for Colony Nursery and Landscaping

/in /by

Discuss why the implementation of an ERP system might require business process reengineering for Colony Nursery and Landscaping

A company called Colony Nursery and Landscaping opened a new store located a few hundred miles away from its original location. The company wants to implement an award system that awards their customers with points whenever customers make a purchase, but the two stores are not able to share information. Colony Nursery and Landscaping will need to implement an enterprise resource planning (ERP) system that will solve the information silo problem by collecting and making this user data available. Colony Nursery and Landscaping is hoping that by providing customers with this award system, they will be able to maintain competitive advantage. Colony Nursery and Landscaping cannot afford to purchase, develop, or maintain this system on-site, so they are investigating cloud solutions.

In addition, for many organizations, Colony Nursery and Landscaping included, information silos make it difficult to tap into needed information. Discuss whether or not the problem of information silos can be solved by using the cloud. Some organizations do not have the resources to construct or maintain their computer infrastructure, so they utilize cloud services instead to reduce costs and improve scalability. In this assignment, you will discuss whether or not the cloud offers solutions for Colony Nursery and Landscaping and identify an application that the ERP system could provide. Compose an essay that includes the elements listed below.

Factors for Implementing Person Centered Care

/in /by

Person Centered Care

The Person-Centered Care (PCC) model provides the highest quality of life in how medical care and personal care services are provided to the people who reside in long-term care facilities. This model focuses on the patient’s needs, values and expectations for caregiving and decision making (Nikumb-Haval, 2015). Decision making is shared with the patient.  The system is set up to service the needs of the patients.  It ensures that patients are informed and remain in control of their health delivery as a participant whenever possible.


Long-Term Care

Long-term care involves a variety of services and support designed to meet the health and personal care needs of a person. The level of care depends on the needs of the individual. The services of long-term care help the person live as independently as possible when they can no longer do these tasks on their own. Care includes assistance with basic Activities of Daily Living (ADL), which include everyday personal care tasks such as getting out of bed, bathing, dressing, eating, and toilet use. Other services of support can include instrumental ADL like taking medication, housekeeping, preparing meals, meal cleanup, and shopping (U.S. Department of Health and Human Services, 2019). The current approach to long term care in the United States has slowly evolved.

The era of the nursing home began with the Social Security Act of 1935. It includes the Old Age Assistance program making federal money available to assist with the heath care needs of low-income seniors. Amendments of Medicare and Medicaid were passed as well as payments directly to the institutions. Medicaid was set to provide coverage of LTC in institutions, but not in homes.  Government became the largest payers for LTC by 1965. This was followed by standards, regulations and the new age of home and community-based services (HCBS).     HCBS were now an alternative to institutional nursing homes and covered by Medicaid. The 2010 Affordable Care Act (ACA) came with the Community Living Assistance Services and Supports (CLASS) Act with the intention of offering a voluntary insurance program for long term services and support that is paid by individual premium contributions.  This brings us up to today’s government support for new long-term care infrastructures to support the population of Baby Boomers reaching 65 years old (KFF, 2015). According to Genworth (2018), as soon as a U.S. citizen becomes 65 years old, he/she will have a 70% chance of requiring some type of LTC services and supports in their remaining years.  Currently the majority of LTC is paid for by private individuals unless they qualify for Medicaid or have LTC private insurance (Paul & Schaeffer, 2017).


Models of Care

There are many different models for long term care. The Person-Centered Care (PCC) Model puts people and their families at the center of decisions. The person and family work with professionals to meet individuals’ needs, values, and expectations for caregiving and decision making (Nikumb-Haval, 2015). It ensures that patients are informed and remain in control of their health delivery as a participant whenever possible. PCC is about considering people’s desires, values, family situations, social circumstances and lifestyles; seeing the person as an individual and working together to develop appropriate solutions (Health Innovations Network, 2013). The concepts of compassion, respect and seeing things from the person’s point of view are all necessary for this model to work.  The physician or institution does not make all decisions for the individual.  Person (or patient) centeredness stands in contrast to doctor, hospital, or facility centeredness. In that regard, it represents a shift of power and control from the health care provider or practitioner to the patient (Evans, 2017).

When comparing the current medical model to a PCC model there are quite a few differences. The patient’s role moves from passive to active.  The physician discusses treatment options and the patient is now a partner in the process of his health care.  The care of the patient is centered on quality of life, rather than focused on illness or disease. The health provider listens more to the patient, and the patient is more likely to adhere to the plan due to his involvement (Nikumb-Haval, 2015).


Stakeholders

The stakeholders in long term care are the patients, physicians, organization providers themselves as well as insurance companies and the government. They all want to provide the patient with quality health care as cost effectively as possible. Active participation of the patient as a stakeholder is key in person centered care model and an essential element of patient-centered outcomes research (

Jayadevappa

, 2017). All stakeholders gain from a person-centered care model. Research shows that person centered care can have a huge impact on quality of care in patient outcomes (Source?). The level of customer satisfaction increase, a big impact on the quality of care. It can improve the patients experience, encourage people to lead a healthier lifestyle, impact health outcomes, such as blood pressure, and reduce patients use of services. All of this reduces overall health care costs and gives the provider satisfaction and confidence (Health Innovations Network, 2013).


Cost

There is a gap in available information on PCC cost effectiveness and cost benefit. In order to look at cost effectiveness we can look at care services, which are provided by assisted living facilities and personal care options. According to testimony submitted to the U.S. Senate Special committee on Aging, “person-centered long-term care can be found in assisted living communities” (Black, 2018). The results from Genworth’s 15

th

Annual Cost of Care Survey shows PCC cost is much less than institutional nursing home care (Genworth, 2018).

Source of image?


Implication

For PCC to be effective, it must be supported from the top of the organization to the lowest level.  A review of 12 studies shows when PCC operates at the organizational level, with the full support of organizational leaders, it can increase quality of life in people living with dementia, and it can potentially improve their well-being and reduce neuropsychiatric symptoms (Chenoweth et al., 2019). Research finds the success in implementation of PCC has determinants at three levels: the individual level (personality, skills and attitudes), the organizational level (leadership and training, resources, infrastructure and culture) and the health care system level (regulations and government policies). The organizational level is a mediator between the individual and the system level and combined with the individual level it plays a major role here, since at these levels specific activities for implementing PCC need to be carried out to fulfil patient needs (Hower et al., 2019).  The diagram below defines the steps necessary to successfully implement this model (Santana et al., 2018):


Barriers

The lack of emphasis on PCC in medical education remains a barrier to its implementation, resulting in practices gaps, there is no practical guidance, no strictly defined process, procedures or interviewing styles. Many medical treatment decisions can have multiple paths for treatment. Communication and trust between patient and providers are essential (Santana et al.,2018).  Changing the interaction of patient and physician is a challenge due to the current culture in health care.

Cultural change must shift from task-oriented care to supporting person center care. PCC changes the environment to a home-like setting from an institution setting. The ethical framework in the medical field has always been to work in the best interest of the patient.   A societal shift has taken place with regards to health care, manifest in part by an ethical shift from paternalism to autonomy. Autonomy — the right to self-determination, to do what you want — has come to take precedence over all other guiding ethical principles, particularly “paternalism” and “best interest”  (Evans, 2017).


Future Directions

The future direction in the application of the PCC model is in the development of tools to support organization in the delivery of PCC. All areas of the medical industry are going towards a person-centered delivery system.  It will be essential in assisting in government guidelines in providing quality service to patients in all areas. This can be applied to all industries, which provide care services.

References