Population and Disparity Defined



Health Care Disparities and Health Care Policy PaperNicholas KurekFerris State UniversityAbstractWithin the confines of this paper, the reader will discover the health care disparities that people who suffer from brain injury face. People who suffer a brain injury are a vulnerable population that faces health disparities. Brain injury affects every social determinant. Brain injury and some policies that affect those with brain injury are discussed. The interdependent roles economics, social policies, and politics play in social determinants are also explored.Health Care Disparities and Health Care Policy PaperBrain injury and the resultant sequella are serious issues. The Texas Health and Human Services Commission (2012) states brain injury is one of the nation’s major public health issues and is the leading cause of death and disability in people under 45. The large number of soldiers returning from the recent wars in Iraq and Afghanistan who have or may have experienced a brain injury has helped bring the issue to light in the general public and media. In 2007 the United States Government established the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury [DCoE] to integrate knowledge and identify, evaluate and disseminate evidence-based practices and standards for the treatment of psychological health and traumatic brain injury within the Defense Department (DCoE, 2012). Continued research is necessary.Population and Disparity DefinedPeople who have suffered a brain injury are a vulnerable population. Maurer & Smith (2012) define a vulnerable population as a group or groups that are more likely to develop health-related problems, have more difficulty accessing health care to address those health problems, and are more likely to experience a poor outcome or a shorter life span because of those health conditions (p.533). Vulnerable populations frequently face health disparities. Harkness & DeMarco (2012) inform us that health disparities are gaps in care experienced by one population compared with another (p.4). Those who have suffered a brain injury often experience health disparities. Brain injury can result from a variety of things including, but not limited to trauma, cerebral bleed, tumor, aneurysm, anoxic event, and/or seizures. The Center for Head Injury Services (2012) states:There are 2 million Traumatic Brain Injuries each year (One every 15 seconds). Every 5 minutes someone becomes permanently disabled due a head injury. 70,000 - 90,000 of those who survive will have lifelong disabilities. 2,000 more will live in a persistent vegetative state. The cost of Traumatic Brain Injuries in the U.S. is over $48 Billion each year! Review of Social DeterminantsThe social conditions in which people live, their income, social status, education, literacy, home and work environment, support networks, gender, culture, and availability of health services are the social determinants of health (Harkness & DeMarco, 2012, p.4). Brain injury affects every one of the social determinants. Stancin et al (2002) found that adolescents who sustained a severe traumatic brain injury had a lower health related quality of life related to overall psychosocial functioning as well as decreased communication skills, daily living skills and general adaptive functioning. It is often difficult to deal with those who have had brain injuries. The Texas Health and Human Services Commission (2012) state brain injuries may be mild, moderate or severe and may result in memory loss, change in personality, behavior dysfunction, difficulty managing anger, impaired judgment, loss of impulse control, communication impairment, mobility limitations, alcohol and substance abuse and other challenges. Brain injury can go undiagnosed. The Brain Injury Association of Michigan (2012) informs us that many veterans are living with the effects of undiagnosed brain injuries. Policies Contributing to DisparitiesPolicies directly affect disparities. While a lot has been done to prevent brain injury, there is still a lot that can be done. The enactment of helmet laws and school athletic regulations regarding concussions help illustrate this. The Insurance Institute for Highway Safety (2011) states the National Highway Traffic Safety Administration estimates that motorcycle helmets reduce the likelihood of crash fatality by 37 percent; however, only 27 states have a law requiring some motorcyclists to wear a helmet. Safe Kids Worldwide (2011) states only 32 States and the District of Columbia have enacted youth sport concussion-related laws as of October 25, 2011. Pollack (2011) informs us that the National Collegiate Athletic Association has adopted new guidelines which state that any player who has sustained a concussion should be removed from play; however, determining whether a player has sustained a concussion is challenging as the symptoms and assessment are subjective. Policy is a work in progress.Contributing FactorsEconomics, social policies, and politics are intricately related and frequently interdependent. The World Health Organization (2012) states the social determinants of health are shaped by economics, social policies, and politics. Health is dependent on education, prevention, and treatment – all of which are reliant on money. The money allocated is determined by social policies which are made by those in power and are directly influenced by politics which are in turn are driven by public opinion. Our elected officials need to stay in favor with their constituents to stay in office. While some believe in the inherent altruistic nature of people, the reality is that most folks care for themselves first.The Affordable Health Care Act is a fine example of social policy and politics influenced by public opinion. Health care and access to it directly effects all disparity populations and social determinants. Yet while Universal Health Care is arguably ideal for all people, there is controversy. A lot of special interest groups stand to lose a lot of money. Interestingly, it is usually those without disparity who determine the policy that affects those with. We need to ensure continued funding for research. Money is needed to fund research which enables us to understand the many facets and sequella of brain injury. We are just now beginning to understand shearing/axonal injury. Lee & Alcantra (n.d.) inform us that with shearing injuries initial CT scans are often normal and delayed scans may be required for detection. It is through continued research that we will be able to understand, potentially prevent, learn to screen for, and diagnose early. The National Institute of Neurological Disorders and Stroke (2012) informs us research will allow scientists to develop strategies and interventions to limit the primary and secondary brain damage that occurs within days of a head trauma, and to devise therapies to treat brain injury and improve long-term recovery of function. ReferencesBrain Injury Association of Michigan. (2012). Veterans Programs.Retrieved from: for Head Injury Services. (2012). Brain Injury Statistics.Retrieved from: Centers of Excellence for Psychological Health and Traumatic Brain Injury. (2012). What we do.Retrieved from: , G. A., & DeMarco, R. F. (2012). Community and public health nursing. Philidelphia, PA: Wolters Kluwer Health /? Lippincott Williams & Wilkins. Insurance Institute for Highway Safety. (2011). Highway safety research and communications.Retrieved from: , S. & Alcantra, A.L. (n.d.) Neuroradiology teaching file: Shearing injuries.Retrieved from: , F. A., & Smith, C. M. (2009). Community/public health nursing practice: Health for families and populations (4th ed.). St. Louis, MO.: Saunders Elsevier.National Institute of Neurological Disorders and Stroke. (2012). NINDS Traumatic Brain Injury Information Page.Retrieved from: , P. (2011). Ringing the bell on concussion management. Retrieved from: Kids Worldwide. (2011). State concussion laws overview., T., Drotar, D., Taylor, H.G., Yeates, K.O., Wade, S.L., & Minich, N.M. (2002). Health-related quality of life of children and adolescents after traumatic brain injury. Retrieved from: Health and Human Services Commission. (2012). Office of acquired brain injury.Retrieved from: Health Organization. (2012). Social determinants of health: Key concepts.Retrieved from: ................
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