Disparities in Health Outcomes Between India and China
Disparities in Health Outcomes Between India and China
Disparities in Health Outcomes Between India and China
Introduction
There are significant health disparities between India and China as well as within their populations. At the end of World War I, health outcomes of both China and India were almost comparable. However, the health system of China improved more tremendously than that of India roughly thirty years after the war. The health progress in India thirty years ago is surprisingly better than that of China despite the fact that India is still one of the countries of the world whose economy is highly impacted by the problem of food insecurity (Yip and Mahal, 2008). Ideally, India and China have had varied experiences in health outcomes in the last 50 years
Variations in Health Outcomes between China and India
In the last 50 years, China and India have experienced significant differences in life expectancy rates as well as in rates of parasitic and infectious diseases. The most important measure of life expectancy is infant mortality, while the measure of infectious disease burden is adjustments in life years among the population (Bardhan, 2008). Since the early 1970s, India has been experiencing lower life expectancy, as evidenced by higher infant mortality rates, than China (Kanjilal, Mazumdar, Mukherjee and Rahman, 2010).
By the year 2000, the rate of deaths among children aged five years and below was 46 percent in India and only 8 percent in China. These are deaths that resulted from children who are born if they are underweight (Bardhan, 2008). According to Yip and Mahal (2008), the burden of infectious diseases in India is higher than that of China. Considering these variations, the health care systems of both India and China can only perform effectively if appropriate actions are taken to improve health outcomes about life expectancy and burden of parasitic and infectious diseases.
Reasons Behind the Health Outcome Disparities Between India and China
The two leading causes of health outcome disparities between India and China are variations in health literacy and implementation of public health policies. According to Yip and Mahal (2008), India has been experiencing low life expectancy over the years because of limited health literacy among its population. Yip and Mahal (2008) further assert that the health literacy level in India at the moment is far much lower than it was in China more than ten years ago.
Due to limited health literacy among Indian population, families cannot implement basic health promotion strategies such as proper nutrition and home hygiene practices. The overall impact is an increased burden of infectious diseases coupled with high infant mortality rates in the country (Ma and Neeraj, 2008).
Furthermore, the Chinese government is more committed than the Indian government at funding public health projects that are aimed at improving health outcomes of its population. Over the past fifty years, life expectancy in China has been increasing rapidly from approximately 39 percent to about 68 percent (Tang, Meng, Chen, Bekedam, Evana, and Whitehead, 2008). This has occurred due to the effort made by the Chinese government to support the implementation of public health policies.
The most recognizable initiative that was widely supported by the government is the Health China 2020, which was meant to address the problem of social inequality in health care and to improve the Chinese health care (Tang et al., 2008). Conversely, India is suffering from inadequate public health support accompanied by significant disparities in the country’s health care system.
Consequently, poor implementation of public health policies in India is attributed to the higher mortality rates and burden of infectious diseases in India than in China (Mukherjee, Haddad and Narayana, 2011). Despite these differences, health outcomes of both India and China are greatly impacted by social and health care disparities in the two countries (Balarajan, Selvaraj, and Subramanian, 2011; & World Health Organization, 2005).
Comparison of Health Outcomes in Kerala and India
Kerala state is located in India towards the southern regions of the country. Surprisingly, the health outcomes of Kerala state are better than those of other parts of India, and this is evidenced by variations in both health and social indicators. As Mukherjee, Haddad and Narayana, (2011) explain, Kerala has experienced high life expectancy rates as well as reduced burden of infectious diseases in the last half century. Kerala became a “model India State” because of exhibiting a demographic health pattern that matches those of developed countries like the United States.
The main reasons for improved health outcomes in Kerala are educational equality, increased access to primary health care, and effective implementation of public health policies (Mukherjee, Haddad and Narayana, 2011). Educational equality in Kerala state contributes to an increase in health care literacy among the state’s population.
Furthermore, effective implementation of public health policies in the region has greatly improved the quality of care offered by health care organizations, and this translates into high life expectancy rates and reduced burden of infectious diseases (Mukherjee, Haddad and Narayana, 2011).
Conclusion
India and China are among countries of the world that are currently experiencing almost similar rates of economic growth. However, the two nations have experienced different health outcomes in the last fifty years. The main reasons behind variations in health outcomes between China and India are differences in health literacy levels and implementation of health care policy between the two countries. Although Kerala is a state in India, its health outcomes differ considerably from the rest of India.
References
Balarajan, Y., Selvaraj, S. & Subramanian, S. V. (2011). Health care and equity in India. Lancet, 377(9764): 505-515.
Kanjilal, B., Mazumdar, P., Mukherjee, M. & Rahman, M. (2010). Nutritional status of children in India: Household socio-economic condition as the contextual determinant. International Journal for Equity in Health, 9(1): 19-31.
Ma, S. & Neeraj, S. (2008). A comparison of the health systems in China and India. Santa Monice, CA: RAND Corporation.
Mukherjee, S., Haddad, S. & Narayana, D. (2011). Social class related inequalities in household health expenditure and economic burden: Evidence from Kerala, South India. International Journal for Equity in Health, 10(1):1-13.
Tang, S., Meng, Q., Chen, L., Bekedam, H., Evana, T. & Whitehead, M. (2008). Tackling the challenges to health equity in China. Lancet, 372(9648): 1493-1501.
Financial Management: Health Care Workers Compensation
Financial Management
Overview of the Financial Issue
While a reduction in compensation of health care workers may be influenced by organizational constraints, health care organizations may at times be compelled to trim workers’ wages and salaries due to poor financial management (Bai, Gu, Chen, Xiao, Liu, and Tang, 2017). The most recently reported financial management issue is a reduction in nurses’ compensation from 300 to 250 United States per month due to improper allocation of funds, which resulted in purchase of equipment that is not urgently needed by the organization.
RacKol Health Care organization specializes in delivering cancer care to the community. The company has been experiencing a rapid rise in nurse turnover rates over the past two months. This has resulted in an increase in patient mortality rate from an average of 3 people week to 10 people every week. It is anticipated that the number of nurses who are leaving the organization is on the rise due to the recent reduction in their salaries that is majorly attributed to poor financial management (Dong, 2015).
To determine the actual cause of the financial issue, the Chief Finance Officer and the Senior Accountant have been interviewed, and they have been asked to share their opinions concerning a possibility of mismanagement of funds in the organization. The Chief Finance Officer is charged with the responsibility of preparing financial plans for the organization and for keeping records of those plans.
The Senior Accountant is responsible for compiling accounts information of the organization by checking whether there is a balance between assets and liabilities (Johns, 2013). According to the Chief Finance Officer and the Senior Accountant, the recent reduction in nurses’ compensation is solely attributed to improper allocation of funds during budgeting that made the organization to purchase cancer care equipment for pediatrics. The two interviewees have explained that the organization has tried to address the current issue for the past one month.
Finanacial Management: Measures that have Been Taken to Address the Issue
Officials in the finance department have taken two measures to address the financial management issue that is currently faced by RacKol Health Care. One of the measures is a move to align organizational plans with available funds without compromising the performance of health care workers. Initially, the health care organization did not take any actions to evaluate whether it has available funds to help it accomplish future financial plans.
Since they faced the challenge of compensating nurses, the Chief Finance Officer in collaboration with the Senior Accountant has begun to align future financial plans of the organization with available funds at any given time, as this helps the organization to only allocate funds to useful projects (Dong, 2015). The other measure that is currently implemented by the organization to prevent improper allocation of funds is involvement of departmental heads in financial decision-making.
Before the current financial issue, officials in the finance department did not involve heads of other departments in making financial decisions. As supported by Walsh (2016), involving departmental heads in financial decision-making facilitates proper allocation of funds because it prevents the purchase of equipment that is not urgently needed by the organization.
Future Steps that Have Been Planned to Address the Issue
RacKol Health Care is highly committed to ensuring that the current financial issue does not repeat itself in future. For this reason, officials in the finance department have documented a plan of how they will improve financial management in the organization over the coming months. For instance, they have a plan to hire an Information Technology professional with competent knowledge of data analytics.
The organization anticipates that with an expert in data analytics, it will be able to understand the specific financial needs of various departments and allocate funds based on the urgency of these requirements. In this manner, it will be able to avoid using funds to make purchases that are not urgently needed by the organization (Walsh, 2016).
Moreover, RacKol Health Care is planning to create a feedback loop that will allow free reporting between executives and the management. With a properly implemented feedback loop, executives on the finance department will be able to understand and strive to address concerns of various departments as far as quick financial allocation is concerned (Dong, 2015).
Potential Blocks in Resolving the Issue
The Chief Finance Officer and senior accountant, however, foresee some problems that may prevent the organization from successfully addressing the financial issue that it is currently facing. One of the problems is the lack of motivation by departmental heads, which may make them to be reluctant to take part in financial decision-making and the creation of the feedback loop.
Moreover, these officials feel that heads of various departments in the organization may lack sufficient training on important issues related to financial management (Bai et al., 2017). Again, managers may lack knowledge and skills to apply in financial management due to unavailability of sufficient financial, managerial tools for use as a reference.
To mitigate these challenges, RacKol Health Care should train all heads of department on basic issues related to financial management. This will enable them to utilize the acquired knowledge and skills to prevent the occurrence of similar financial issues in future (Bai et al., 2017). Personal perception on the current financial issue is similar to the perception of those who are working on finances in the organization.
References
Bai, Y., Gu, C., Chen, Q., Xiao, J., Liu, D. & Tang, S. (2017). The challenges that head nurses confront on financial management today: A qualitative study. International Journal of Nursing Sciences, 4(2): 122-127. https://doi.org/10.1016/j.ijnss.2017.03.007
Dong, G. N. (2015). Performing well in financial management and quality of care: Evidence from hospital process measures for treatment of cardiovascular disease. BMC Health Services Research, 15: 45. doi: 10.1186/s12913-015-0690-x
Johns, M. (2013). Breaking the glass ceiling: Structural, cultural, and organizational barriers preventing women from achieving senior and executive positions. Perspectives in Health Information Management, 10(Winter): 1e.
Walsh, K. (2016). Managing a budget in healthcare professional education. Annals of Medical & Health Sciences Research, 6(2): 71-73. doi: 10.4103/2141-9248.181841
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Gerontological Nursing: Identification and Description of the Interviewed Individual
The interviewee is a male individual aged 80 years, and who currently stays with his wife and their son in the city. This client is a retired accountant who has been out of work for the past five years. Also, he is married with three children; two sons aged 25 and 36, and one daughter aged 40. Furthermore, the patient participates in three major health promotion activities including walking regularly, limiting consumption of salt and sugary foods, and participation in community’s social support groups.
The interviewee believes that increased consumption of fruits and foods rich in sorghum and millet help people to live long. Being 80 years old, the interviewee is considered to be the oldest family member who has ever reached such age. Furthermore, the interviewee is on insulin medication to help with management of diabetes clinical problem. He visits the doctor at least twice a week for a general medical check-up and to obtain clinical guidance on how to effectively manage diabetes symptoms.
Gerontological Nursing: Identification and Description of the Cultural Implications for the Individual
Personal values and beliefs about old age and health have a great implication to the care of the interviewee. For instance, the interviewee’s philosophy on living a long life may make it difficult for him to appreciate the fact that aging is a normal process. He believes that living long is God’s blessings while deaths that occur when people are still young are associated with curses.
Also, the interviewee has unique thoughts about people who are considered to be of old age. He feels that for a person to qualify to be of old age, lack the capacity to perform daily physical activities, be unable to maintain an upright posture, and must put on glasses to assist with vision. These cultural beliefs may impact negatively on the care of this client because the clinician will find it difficult to change the interviewee’s perceptions and replace them with new ones that can promote positive health outcomes (Shrack et al., 2016).
Additional cultural implication related to the interviewed person include; his or her beliefs regarding health and illness and his values about health status and treatment of older adults. The most appropriate way of eliminating the impact of the person’s cultural values and beliefs is through maintenance of cultural competence throughout the interview and when giving interventions.
To establish what the interviewee can accomplish as well as those that he cannot do properly at his age, a comprehensive functional assessment has been performed using four tools namely; Tinetti Balance and Gait Evaluation, Katz Index of Activities of Daily Living, Assessment of Home Safety, and The Barthel Index. The person’s movement ability has been assessed using the Tinetti Balance and Gait Evaluation.
The client’s ability to perform various activities independently has been evaluated using the Katz Index of Activities of Daily Living. The most appropriate tool that has been used to measure the safety of the patient’s environment is the Assessment of Home Safety, while that which has been used to examine whether the identified individual can accomplish some daily tasks independently is The Barthel Index.
A duly filled Tinetti Balance and Gait Evaluation, Katz Index of Activities of Daily Living, Assessment of Home Safety, and The Barthel Index tools used during the interview have been provided in the Appendix section of this paper.
Gerontological Nursing: Comparison of Age-Related Changes
There are similarities and differences between the expected age-related changes and those observed in the interviewee. Older adults are expected to present with some physiological, physical, pathological, sensory, and motor changes, which significantly affect their ability to perform their activities of daily living and to make various physiological controls. According to Shrack et al. (2016), older adults aged 65 years and above have problems with maintaining gait and balance.
Similarly, the interviewee experiences problems with maintaining gait and balance, both while he is seated and whenever he is standing. Also, Tkatch, Musich, MacLeod, Alsgaard, Hawkins, and Yeh, (2016) point out that older adults often need assistance with various activities of daily living such as dressing, cooking, washing, and toileting. Although the interviewee is 80 years old, he needs assistance only in certain activities of daily living such as rising from a chair.
However, he is still strong enough to feed alone once the food is made available for him. Older adults are at high risk of falls, and there is therefore great need to keep their home environment free from objects that may increase the possibility of falling (Phelan, Mahoney, Voit, and Stevens, 2015). Similarly, the interviewee is at a high risk of falling considering the fact he has a problem controlling balance and gait.
For this reason, his home environment is often kept free from equipment that may increase the risk of falling. Again, as it happens in older adults, the interviewee occasionally finds it difficult to control his bladder and bowel and therefore may always want people to stay around to assist.
Gerontological Nursing: Preliminary Issues Assessed from the Interview
Four major preliminary issues have been assessed from the interview. The four issues include; age-related changes that are taking place or that have taken place in the interviewee, health promotion activities that the interviewee is currently involved, the interviewee’s cultural values over old age and living longer, as well as actions that have been taken to promote safety at the interviewee’s home environment.
As Tkatch et al. (2016) explain, nurses who are providing care to older adults must be able to understand the impacts that their age-related changes have on their abilities to perform daily activities. Using this information, these nurses must recommend relevant health promotion activities for their clients, including how they can keep their home environment safe for living. The nature of care given as well as the nature of health promotion strategies recommended will depend on the client’s cultural values and beliefs over old age and long life (Tkatch et al., 2016).
From the current assessment, the interviewer has discovered that the interviewee has undergone various physiological, physical, pathological, sensory and motor-related changes as a result of old age that greatly affect his ability to perform daily activities. Furthermore, the interviewer has found that the client engages in a few health promotion activities such as frequently walking to keep fit and consuming fruits.
Through current assessment, it has also been established that some actions have been taken to keep the interviewee’s home environment safe by eliminating objects that may increase the risk of falls. Most importantly, the interviewer has found out that the interviewee believes that God helps people to survive through old age, that the society is less concerned about assisting the aging population, and that God promotes healing and recovery.
Based on results obtained from this assessment, the interviewer understands health problems that majorly occur in older adult as well as factors that must be taken into consideration when establishing the most appropriate health promotion strategies of the elderly (Shrack et al., 2016).
Gerontological Nursing: Alterations in Health
The interviewee has alterations in health in three major functional areas namely; physiological functions, motor functions, and physical functions. Concerning physiological functions, the interviewee is struggling to manage diabetes, which is a common chronic health problem among older adults. Due to old age, the interviewer’s body cannot control blood sugar levels as required, and hence the observed onset of diabetes (Kezerle, Shaley, and Barski, 2014).
As far as motor functions are concerned, the interviewee has a problem with bladder and bowel control, which makes him have short call accidentally and long call at any time. This problem occurs mainly because of reduced motor function, which is greatly influenced by old age (Westra, Savik, Oancea, Choromanski, Holmes, and Bliss, 2011).
Furthermore, the interviewee experiences physical problems related to balance and gait maintenance, which put him at high risk of falls. He has reported that he needs support when rising from a chair and when moving upstairs. This means that his physical movement has been limited by old age. Therefore, the nature of intervention that would be recommended for the interviewee must target physical, physiological, and motor functional areas described in this section (Tkatch et al., 2016).
Gerontological Nursing: Interventions for Identified Problems
Interventions should be implemented based on individual health problems that the interviewee is currently suffering from. The most appropriate interventions for diabetes include nutrition counseling, exercise training, and drug adherence training. The interviewee should be guided on those foods that he should avoid keeping his blood glucose level low. Also, he should be trained on the importance of exercise in managing weight, and his family members should be guided on how to offer the right support.
Again, the interviewee should be reminded of the importance of drug adherence in reducing diabetes symptoms (Kezerle, Shaley, and Barski, 2014; & Tkatch et. al., 2016). Three different interventions can be implemented to help the interviewee to reduce risks of falls. First, the interviewee should be guided on how to perform simple exercises that will help him to improve balance and gait.
Second, his family members should be taught on strategies for reducing hazards in the interviewee’s environment to maximize safety. Third, risks of falls can be eliminated if the patient is trained in safety-related behaviors and skills (Phelan et al., 2015). The best interventions for bowel and urinary incontinence include training the interviewee on how to perform pelvic floor muscle exercise, offering nutritional counseling, and educating him on usage and side effects of anticholinergic for the bladder that is overactive.
Frequent pelvic muscle exercise will help to avoid incontinence actions of the urinary bladder and the bowel. Again, the interviewee should be taught to limit fluid intake and to avoid foods that cause bladder irritation. Furthermore, correct use and adherence to anticholinergic can help the interviewee to effectively manage bladder and bowel incontinences (Westra et al., 2011).
References
Kezerle, L., Shaley, L. & Barski, L. (2014). Treating the elderly diabetic patient: Special considerations. Diabetes, Metabolic Syndrome, and Obesity: Targets and Therapy, 7: 391-400. doi: 10.2147/DMSO.S48898
Phelan, E. A., Mahoney, J., Voit, J. C. & Stevens, J. A. (2015). Assessment and management of fall risk in primary care settings. Medical Clinics of North America, 99(2): 281-293. doi: 10.1016/j.mcna.2014.11.004
Tkatch, R., Musich, S., MacLeod, S., Alsgaard, K., Hawkins, K. & Yeh, C. S. (2016). Population health management for older adults: Review of interventions for promoting successful aging across the health continuum. Gerontology and Geriatric Medicine, 2 (1): DOI: https://doi.org/10.1177/2333721416667877
Westra, B. L., Savik, K., Oancea, C., Choromanski, L., Holmes, J. H. & Bliss, D. (2011). Predicting improvement in urinary and bowel incontinence for home health patients using electronic health record data. Journal of Wound Ostomy & Continence Nursing, 38(1): 77-87.
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Development of a health care policy is one of the ways through which developing nations can be influenced to take actions that promote public health and reduce mortality rates, especially in countries where health inequality is a common problem. The Nature of health policy developed largely depends on specific health care problems that exist in a country at any given time.
Furthermore, one has to consider various social determinants of health in a country before developing and implementing a health policy (Kumar and Preetha, 2012). According to Kumar and Preetha (2012), social factors such as demographic patterns, political and economic changes, cultural issues, and learning environments are believed to influence health situations of many countries around the world.
A health policy that is aimed at reducing health inequality can be effective in promoting public health, and can greatly be supported by a country whose health is negatively impacted by disparities in health care. This paper explores the concept of health policy development and implementation about health inequality while giving special consideration to Malawi.
Health Care Policy: Rationale for Selecting Malawi
Malawi has been chosen for this case study because it is one of the world’s developing countries whose public health is negatively impacted by health inequality and lack of health policy to guide proper health care delivery. According to Daire and Khalil (2015), failure to access primary health care is one of the causes of high death rates among children aged below five years in Malawi.
Daire and Khalil (2015) further assert that health care for socio-economic barriers largely face Children in Malawi that policy makers in the health sector must address to promote positive child health in the country. Children who are born to low-income families in Malawi are highly likely to experience limited access to health care as compared to those who come from wealthy families. The main reason for the high infant mortality rates among low-income families in Malawi is a lack of primary health care policy.
According to Makaula, Bloch, and Muula et al., (2012) and Ustrup, Ngwira, and Fischer, et al., (2014), Malawi continues to experience low life expectancy because it currently lacks a primary health care policy to guide health care access among poor families with children aged below 5 years. Now, Malawi utilizes the Essential Health Package (EHP) program to implement primary health care.
This has impacted negatively on health care access among poor households and a significant reduction in life expectancy in the country. In this regard, Malawi is one of the developing countries that are experiencing high rates of infant deaths due to lack of primary health care policy and would; therefore, attract the attention of health policy makers (Daire and Khalil, 2015).
Social Determinants of Health in Malawi and Why they should be Addressed
There are two major social determinants of health in Malawi that need to be addressed. According to Kumar and Preetha, (2012), social determinants of health refer to factors in the social setting that influence the ability of a country’s population to obtain care at any given time. Examples of social determinants of health include socio-economic factors, family patterns, cultural beliefs and attitudes, learning environments, and demographic patterns.
In Malawi, the two social determinants of health that should concern policy makers are; economic affordability and geographic accessibility of health care facilities. These two social determinants are highly rampant among residents of rural Malawi. Rural populations in Malawi cannot access quality health care due to limited finances and high concentration of health care facilities in urban areas (Ustrup, Ngwira, and Fischer, et al., 2014).
In a study conducted by Ustrup, Ngwira, and Fischer, et al., (2014), the researchers have found that health care facilities are mainly located in urban Malawi, and this makes households based in rural Malawi to travel to the urban areas to seek for care. Ideally, rural Malawi does not only lack adequate health care facilities, but it also has poor roads that make it difficult for occupants to reach urban areas.
The long travel time coupled with high costs of transport prevent children from low-income families from receiving quality care, hence the observed high infant mortality rates in the country (Makaula, Bloch, and Muula, et al., 2012). Furthermore, variation in economic affordability among affluent and low-income families determines the nature of care that these two groups of populations can receive in Malawi.
Families in rural Malawi with either small or lack of basic income are faced with the challenge of obtaining care for their children as opposed to those in wealthy regions with high basic income. For this reason, limited economic affordability among residents of rural Malawi presents significant economic burden which prevents families from obtaining quality care for their children (Ustrup, Ngwira, and Fischer, et al., 2014; & Makaula, Bloch, and Muula, et al., 2012).
There is a great need to address social determinants of health about economic affordability and geographic accessibility of health care facilities to increase access to care for families in rural Malawi. As Daire and Khalil (2015) explain, one of the ways through which health inequality in Malawi can be solved is by addressing those factors that hinder citizens from accessing health care.
It is only by addressing these social determinants of health that Malawi will be able to reduce infant mortality and to achieve the Millennium Development Goals. Health care accessibility in Malawi will greatly be improved if the ability of low-income families to meet health care costs and to access health care facilities is enhanced (Daire and Khalil, 2015).
Potential Public Issues that might be encountered
Two major public issues may be faced in Malawi in an attempt to influence health policy development in the country. The possible general issues that may be encountered are related to the level of cultural awareness and health literacy among the country’s population. Health literacy refers to the ability of individuals to comprehend basic health information and their capacity to utilize it in decision-making.
High health literacy is directly related to improved health outcomes while limited health literacy is associated with poor public health. According to Smith-Greenway (2015), high infant mortality rates in Malawi are largely attributed to limited health literacy among low-income families in rural areas. Residents of rural Malawi rarely receive health education, and the public sector has not initiated any programs in those areas to keep citizens informed about health.
Also, the majority of households in rural Malawi can only speak their local language, and they do not understand any information presented to them in pure English (Smith-Greenway, 2015). Lack of public health education and proper communication of public health information are the primary causes of limited health literacy in Malawi. Consequently, limited health literacy may impede successful development and implementation of health policy in Malawi (Ustrup, Ngwira, and Fischer, et al., 2014).
The other public issue that may be encountered during health policy development and implementation in Malawi is the level of cultural awareness among the country’s population. According to Daire and Khalil (2015), cultural knowledge in a country determines the possibility with which a new policy can be developed and implemented. In this regard, it becomes difficult to implement a health policy that goes against the cultural beliefs and values of a country’s population.
As Reiney, Watkins, Ryman, Sandhu, Bo, and Benerjee, (2011) explain, low cultural awareness is a big problem in Malawi because it negatively affects health utilization among the country’s population. Specifically, cultural beliefs and values of the country’s population largely influence the patterns of health utilization in the country in the sense that, health underutilization is common in rural Malawi where occupants do not believe in care that is being offered by health care organizations. Ideally, low cultural awareness among rural populations in Malawi may prevent successful implementation of health policy in the country (Ustrup, Ngwira, and Fischer, et al., 2014).
Relationship Between Health Inequality and Life Expectancy in Malawi
There is an inverse relationship between health inequality and life expectancy in Malawi. In this regard, high disparities in health are associated with low life expectancy while low disparities in health are related to high life expectancy in Malawi. Life expectancy is low when infant mortality rate is high while life expectancy is high when infant mortality rate is low (Deurzen, Oorschot, and Ingen, 2014).
According to the World Health Organization report of 2017, health disparity in Malawi is significantly higher than that of Japan. Furthermore, an infant born in Malawi is highly likely to die at the age of 47 while a child born in Japan will probably die at the age of 87. Therefore, when health inequality is high in Malawi, life expectancy in the country is significantly low, especially among the rural populations (World Health Organization, 2012).
The inverse relationship between health inequality and life expectancy among poor populations is supported by research evidence. In a study conducted by Deurzen, Oorschot and Ingen (2014) the researchers have found that the rate of infant mortality is higher among the poor than among the rich populations. Therefore, a policy that can reduce health inequality will help to reduce infant mortality rate and eventually raise life expectancy (Deurzen, Oorschot, and Ingen, 2014).
Current Efforts in Malawi to Reduce Health Inequalities
The government of Malawi has worked hard to reduce health inequalities in the country with the aim of reducing infant mortality rates that occur among its rural populations. These efforts are geared towards addressing two major social determinants of health: economic affordability and geographic accessibility of health care facilities. As Ustrup, Ngwira, and Fischer, et. al., (2014) explain, governments can increase geographic accessibility of health care facilities by constructing additional organizations in rural areas.
Between 2003 and 2010, the Government of Malawi constructed a total of 39 health centers in the rural areas. This has helped its rural populations to access health care and to save time and money that could have been spent in traveling to the urban areas to seek for health care. Additionally, Malawi has taken appropriate actions to mitigate financial barrier among its rural populations by increasing their ability to meet health care cost.
In the year 2010, the Government of Malawi signed an agreement with facilities that operate under the Christian Health Association of Malawi (CHAM) to allow free health care services for mothers and children. With free access to child and maternal health care services, Malawi has been able to record a decrease in infant mortality rate with a slight increase in life expectancy (Ustrup, Ngwira, and Fischer, et. al., 2014).
Health Policy
The best health policy to address health inequality in Malawi would be that which will get the support of the country’s population, considering the fact that residents of rural Malawi have limited health literacy and do not have trust in the care offered by health care organizations (Makaula, Bloch, and Muula, et al., 2012).
An example of a policy that might be developed to reduce health inequality in Malawi is the creation of a National Development and Social Fund to support programs that facilitate construction of health care facilities in the rural areas, while at the same time meeting the health care costs of mothers and children who reside in rural Malawi.
The Government of Malawi should set aside funds to facilitate implementation of this policy to ensure that both rural and urban populations have equal access to health care. Successful implementation of this policy will result in a reduction in infant mortality rates among the poor populations in Malawi, which will eventually translate into high life expectancy in the country (Ustrup, Ngwira, and Fischer, et. al., 2014; Dairen and Khalil, 2015).
References
Daire, J. & Khalil, D. (2015). Analysis of maternal and child health policies in Malawi: The methodological perspective. Malawi Medical Journal, 27(4): 135-139.
Deurzen, I. V., Oorschot, W. V. & Ingen, E. (2014). The link between inequality and population health in low and middle-income countries: Policy myth or social reality? PLoS ONE, 9(12): e115109. https://doi.org/10.1371/journal.pone.0115109
Kumar, S. & Preetha, G. S. (2012). Health promotion: An effective tool for global health. Indian Journal of Community Medicine, 37(1): 5-12. doi: 10.4103/0970-0218.94009
Makaula, P., Bloch, P…..& Muula, A. S. (2012). Primary health care in rural Malawi: A qualitative assessment exploring the relevance of the community-directed interventions approach. BMC Health Services Research, 12: 328. doi: 10.1186/1472-6963-12-328
Reiney, J. J., Watkins, M., Ryman, T. K., Sandhu, P., Bo, A. & Benerjee, K. (2011). Reasons related to non-vaccination and under-vaccination of children in low and middle-income countries: Findings for a systematic review of the published literature, 1999-2009. Vaccine, 29(46): 8215-8221. doi: 10.1016/j.vaccine.2011.08.096
Smith-Greenway, E. (2015). Are literacy skills associated with young adults’ health in Africa: Evidence from Malawi. Social Science and Medicine, 127: 124-133. doi: 10.1016/j.socscimed.2014.07.036.
Ustrup, M., Ngwira, B…& Fischer, T. (2014). Potential barriers to healthcare in Malawi for under-five children with a cough and fever: A national household survey. Journal of Health Population and Nutrition, 32 (1): 68-78.
Client Address: 49 Featherstone Street, London, United Kingdom
Background This patient care action plan is for William. William currently has liver cancer and he is very much worried about his condition and how his wife Gladys will cope with the situation. When William was growing up, he thought that he would live to reach ninety years old, like his parents, without any serious illness. His dream of living longer has just been shattered after he recently discovered the presence of blood in his stool. On visiting the hospital, William has received a confirmation from Dr. Maxwell that he has liver cancer. William’s immediate carer is his wife, Gladys, who provides assistance with daily living activities as well as with social support. Since William’s kids have their own families and they are mostly committed to work, he has limited access to family support. His living setting is the home environment, and he frequently visits the hospital from where he is cared for by Dr. Maxwell and nurse Linda. Dr. Maxwell has involved other physicians in William’s care. The doctor is working together with other highly qualified healthcare professionals to ensure that William receives the support that he needs for the longest period possible. William’s health condition is not that severe, and his recent health care trajectory indicates that he has a positive progress. His positive health progress is mainly attributed to good communication and a positive relationship with his healthcare providers, including the social worker. At the moment, William largely depends on services obtained from only one GP healthcare resource.
Needs Assessment From the PCC4U Needs Assessment, it is evident that some of Williams needs have been met while there are others, which have not been effectively addressed. Needs that are currently met The positive progress that is being observed in the patient is attributed to primary health care services that he is now receiving from the doctors and nurse Linda (Llobera, Sanso, and Leiva, 2017). Through support obtained from the doctors, William has learned and can apply various health promotion options that are available to him. Also, William has been informed about the right people he should approach in case his health condition gets worse. Immediate needs that should be met It is important to prioritize patients’ unmet needs to plan effectively on how to help them manage their health conditions (Khosla, Patel, and Sharma, 2012). There are two major immediate needs that William should be assisted to meet. During his interaction with nurse Linda, William explains that he is in a bit of pain and that he still has a lousy appetite. These conditions are common among older people with terminal illnesses (Goodman, Dening, and Zubair, et al., 2016). In this regard, William should be taught how he can solve his appetite problems and how he can effectively manage pain. Potential needs that might arise William’s healthcare providers should be prepared to address potential needs that might arise in the course of care. It is important to identify possible emotional and physical health problems that may arise to formulate strategies that can be used to prevent them early (Clarke, Bourn, Skoufalos, Beck, and Castillo, 2017). To meet William’s physical and emotional needs, the healthcare providers should engage specialists in palliative medicine and palliative nursing, as well as family members, to provide necessary care as early as possible (Llobera, Sanso, and Leiva, 2017).
Local Resources and Services Scan
Service name and brief description
Address/contact details and website URL (if available)
Opening hours/contact hours
How to access (e.g. is a referral required?)
What needs can this service help to meet?
Healthcare team member responsible for referral/action
Open Monday to Friday from 8.00 am to 6.00 pm, Saturday 11.00 am to 6.00 pm, and Closed on Sunday
No referrals are necessary
Offers emotional and social support for patients with terminal illness and their families.
Lead nurse Angel and Marilyn can assist patients with making appointments and follow-up.
William can get necessary emotional and social support from this facility.
Hospice UK
34-44 Britannia St, Kings Cross, London WC1X 9JG +44 20 7520 8200 http://www.hospiceuk.org/
Open Monday to Friday from 9.00 am to 5.00 pm, Closed on Saturday and Sunday
No referrals are necessary
Provides all types of home-based care needed by patients with serious illness.
Carol Warlford is the Chief Clinical Officer in charge of all forms of palliative care in the facility.
This facility is appropriate for meeting William’s physical, social, physiological, and emotional needs both now and in future.
St. Christopher’s Personal Care
Sydenham, UK +44 20 8768 4500 http://www.stcpersonalcare.org.uk/
Open every day from 9.00 am to 5.00 pm.
No referrals are required
Offers support with all forms of care including medication, nutrition, activities of daily living, social support, and emotional support.
Denise, Maxine, Tony, and Sandra are highly trained to offer palliative care to all patients with various needs.
The facility is a useful back up for William’s palliative care needs.
Action Plan
Medication: The nurse should plan a visit to the physician to provide the right prescription for William to enable him to manage pain effectively (Ramanayake, Dilanka, and Premasiri, 2016; & Al-Mahrezi, and Al-Mandhari, 2016). This arrangement should be made as soon as possible.
Nutrition: The nurse should contact a nutritionist to help with the development of a feeding plan for William and his wife. Since appetite is one of William’s problems that should be solved urgently, this action should be started as soon as possible (Forbat, Haraldsdottir, Lewis, and Hepburn, 2016; & Caccaialanza, Pedrazzoli, and Zagonel, et al., 2016).
Physical Activity: William’s wife should contact a trainer to help William with physical exercise (Lowe, Tan, Faily, Watanabe, and Courneya, 2016; & Chandrasekar, Tribett, and Ramchandran, 2016). This arrangement should be made before William’s next meeting with the GP.
Counselling: The nurse should plan a visit to a professional psychologist to plan counselling sessions for William and his family (Pino, Parry, Land, Faull, Feathers, and Seymour, 2016). This plan should be ready before William’s next meeting with the GP.
Referral to Hospice: The nurse should contact a social worker to provide William and his wife with detailed legal information related to the procedures he should follow when he will be required to relocate from home-based care to the hospice (Hui and Bruera, 2016). This arrangement should be made when William will no longer be in a position to make decisions by himself.
Reference List
Al-Mahrezi, A. & Al-Mandhari, Z. (2016). Palliative care: Time for action. Oman Medical Journal, 31(3): 161-163. doi: 10.5001/omj.2016.32
Caccaialanza, R., Pedrazzoli, P…& Zagonel, V. (2016). Nutritional support in cancer patients: A position paper from the Italian Society of Medical Oncology (AIOM) and the Italian Society of Artificial Nutrition and Metabolism (SINPE). Journal of Cancer, 7(2): 131-135. doi: 10.7150/jca.13818
Chandrasekar, D., Tribett, E. & Ramchandran, K. (2016). Integrated palliative care and oncologic care in non-small-cell lung cancer. Current Treatment Options in Oncology, 17: 23. doi: 10.1007/s11864-016-0397-1
Clarke, J., Bourn, S., Skoufalos, A., Beck, E. & Castillo, D. J. (2017). An innovative approach to health care delivery for patients with chronic conditions. Population Health Management, 20(1): 23-30. doi: 10.1089/pop.2016.0076
Forbat, L., Haraldsdottir, E., Lewis, M. & Hepburn, K. (2016). Supporting the provision of palliative care in the home environment: A proof-of-concept single-arm trial of a palliative carers education package (PrECEPt). BMJ Open, 6(10): e012681. doi: 10.1136/bmjopen-2016-012681
Goodman, C., Dening, T…& Zubair, M. (2016). Effective health care for older people living and dying in care homes: A realist review. BMC Health Services Research, 16: 269. doi: 10.1186/s12913-016-1493-4
Hui, D. & Bruera, E. (2016). Integrating palliative care into the trajectory of cancer care. Nature Reviews Clinical Oncology, 13(3): 158-171. doi: 10.1038/nrclinonc.2015.201
Khosla, D., Patel, F. D. & Sharma, S. C. (2012). Palliative care in India: Current progress and future needs. Indian Journal of Palliative Care, 18(3): 149-154. doi: 10.4103/0973-1075.105683
Llobera, J., Sanso, N….& Leiva, A. (2017). Strengthening primary health care teams with palliative care leaders: Protocol for a cluster randomized clinical trial. BMC Palliative Care, 17: 4. doi: 10.1186/s12904-017-0217-9
Lowe, S., Tan, M., Faily, J., Watanabe, S. & Courneya, K. (2016). Physical activity in advanced cancer patients: A systematic review protocol. Systematic Reviews, 5: 43. doi: 10.1186/s13643-016-0220-x
Pino, M., Parry, R., Land, V., Faull, C., Feathers, L., & Seymour, J. (2016). Engaging terminally ill patients in end of life talk: How experienced palliative medicine doctors navigate the dilemma of promoting discussions about dying. PLoS ONE 11(5): e0156174. https://doi.org/10.1371/journal.pone.0156174
Ramanayake, R., Dilanka, G. & Premasiri, L. (2016). Palliative care: Role of family physicians.Journal of Family Medicine and Primary Care, 5(2): 234-237. doi: 10.4103/2249-4863.192356
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Types of prescriptions, roles of intra and interprofessional teams, and medicine storage and disposal
This error management reflection covers what I have learnt from the hospital placement by considering Borton’s model. Specifically, I have explored the error reporting process in the hospital and how it has helped me to understand the principles of clinical governance. Furthermore, this error management reflection describes the difference in error reporting processes in community pharmacy compared to hospital pharmacy.
During my placement, I have discovered that the main types of prescriptions in the pharmacy are outpatient prescriptions, cleansing preparation prescriptions, and ward order prescriptions. The pharmacy rarely uses hospital charts and it does not use TPN requests at all. Furthermore, I have learnt that the pharmacy team members perform roles, which are complementary to one another.
For instance, the pharmacist checks medicine history, the technician reviews medicine history and dispenses drugs, and ATO checks stock of drugs and delivers medicines to the wards. Again the pharmacy has well documented standard operating procedures related to storage and disposal of medicines. In the pharmacy, drugs are stored in shelves and they are categorized based on their functions. Moreover, medicines must be checked and reviewed before they are disposed.
Error management: How error reporting improves clinical governance
Error reporting plays a significant role in improving clinical governance. According to Freedman (2006), NHS institutions rely on clinical governance to deliver quality care to patients by allowing parents to get involved in their treatment process. Since the patient is the first priority in clinical governance, there is always great need for hospitals to ensure that their error reporting systems are working well in order to improve clinical governance.
Medication errors are avoidable mistakes that are made by health care practitioners during prescription, dispensation, and administration of drugs. Such errors negatively impact on patient safety and outcomes. As MRA (2014) explains, error reporting is one of the ways through which health care practitioners learn their mistakes and it therefore plays a big role in improving patient safety.
During my placement, I have discovered that the main source of medication errors in the facility is incorrect drug labelling, and that error reporting greatly improves clinical governance. Specifically, I have discovered that the hospital has a stable system for detecting and reporting medication errors. In addition, I have learnt that, since it is possible to detect medication errors, the facility should have a plan of how such errors can be prevented.
According to Polnariev (2016), through error reporting, healthcare organizations can easily identify and mitigate risks early enough. Therefore, the facility should employ appropriate measures to prevent recurrence of medication errors in future in order to improve clinical governance.
Difference in error reporting in community and hospital pharmacies
Error reporting in community pharmacy differs significantly from that of a hospital. During my placement, I have been able to identify two major differences in error reporting between a community pharmacy and a hospital pharmacy during my placement. First, while delegated authorities are charged with the responsibility of overseeing medication errors in the hospital, the board of directors is directly involved in error reporting process in the community pharmacy (Brunsveld-Reinders, Arbous, Vos, and Jonge, 2016).
Second, community pharmacy mainly relies on voluntary reporting while hospital pharmacy utilizes voluntary, confidential, non-confidential, and mandatory reporting processes. Voluntary reporting process that is mainly used by community pharmacy is not very effective because it leaves some errors unreported. However, mandatory reporting by hospitals ensures maximum error reporting and it helps healthcare practitioners to avoid lawsuit.
In this regard, community pharmacies should use mandatory reporting instead of voluntary reporting in order to improve error reporting (Brunsveld-Reinders et al., 2016).
In conclusion, the most enjoyable parts of my placement were getting to learn the role played by error reporting in clinical governance, and the difference between error reporting process in a community pharmacy and a hospital pharmacy. Through error reporting, hospitals can greatly maximize patient safety and improve their health outcomes.
Unfortunately, effective identification of errors cannot be achieved because some errors go unreported. In order to prevent recurrence of medication errors in future, health care organizations should introduce strict measures of reporting such incidents. However, the least enjoyable part of my placement was retrieving information related to medication errors and error reporting process from employees at the pharmacy.
In order to facilitate easy interaction between the student and the hospital’s workers in future, learners should be allowed to choose facilities which they feel would be comfortable for them to undertake the placement.
Reference List
Brunsveld-Reinders, A. H., Arbous, M. S., Vos, R. V. & Jonge, E. D. (2016). Incident and error reporting systems in intensive care: a systematic review of the literature. International Journal for Quality in Health Care, 28(1), 2-13. https://doi.org/10.1093/intqhc/mzv100
Freedman, D. B. (2006). Involvement of patients in clinical governance. Clinical Chemistry and Laboratory Medicine, 44(6): 699-703.
MHRA. (2014). Patient Safety Alert. Retrieved from https://www.england.nhs.uk/wp-content/uploads/2014/03/psa-sup-info-med-error.pdf
Polnariev, A. (2016). Using the medication error prioritization system to improve patient safety. Pharmacy and Therapeutics, 41(1): 54-59.
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Gonorrhea is a sexually transmitted infection (STI) ,caused by Neisseria gonorrhoeae a bacteria which infects the mucous membranes. The bacteria is often transmitted from one individual to another during sexual contact, including anal, oral or vaginal intercourse. However, babies can also be infected with this condition during childbirth if the mother is infected. In babies, the disease affects their eyes. Hethcote &Yorke (2014) report that some of the factors that may increase the risk of one getting the infection include age, new sex partner, history of gonorrhea infection, multiple sex partners, and co-infection with other sexually transmitted diseases.
The bacteria cannot survive outside human body for long therefore it cannot be transmitted by sharing baths and towel, cups, toilets and seats, kissing or hugging.
Once infected, one presents with urethral discharge while urinating. The infection is treatable therefore one should seek medical attention early after noticing the symptoms.
Presentation of Gonorrhea
Usually, the infection causes no symptoms. However, when they appear it affects multiple body parts, but it appears commonly in the genital tract. Men who have been diagnosed with gonorrhea pus-like discharge from the tip of the penis, painful urination, and swelling and pain in one testicle. In women, the infection causes increased vaginal discharge, dysuria, dyspanuria, pelvic or abdominal pain, and vaginal bleeding between periods such as after vaginal intercourse.
The infection can also infect other body parts such as the rectum where it causes anal itching, discharge of the pus-like substance from the rectum, strains during bowel movements, and bleeding. When it infects the eyes, it may cause light sensitivity, eye pain, and pus-like discharge from one or both eyes. Patients may also develop a sore throat or swollen lymph nodes in the neck if the infection spreads to the throat. It can also disseminate to the various joints causing septic arthritis whereby the affected joints become red, warm, swollen, and extremely painful during movements.
Treatment of Gonorrhea
Adults who have been diagnosed with gonorrhea are prescribed with antibiotics. The Centers for Disease Control and Prevention (CDC) has recommended that patients with uncomplicated gonorrhea should be given a ceftriaxone injection in combination two oral antibiotics, that is, either doxycycline or azithromycin. This is advisable because the drugs provide a wide range of activity which is required due to the emergence of strains of drug-resistant Neisseria gonorrhoeae(Kerani et al. 2015).
Babies who are infected during childbirth are given two eye drops of erythromycin to prevent the spread of the infection. To avoid reinfection with gonorrhea, the patients are advised to abstain from unprotected sex for seven days after he/she has completed the treatment regimen and the symptoms have resolved.
The infection can cause some complications if it is untreated. For instance, it can cause infertility in women by spreading to the oviduct and the uterus cause Pelvic Inflammatory Disease (PID) which causes scarring of the fallopian tubes, increase in pregnancy complications as well as infertility. Infertility can also occur in men if the infection affects the epididymis. Most importantly, the gonorrhea infection predisposes a person to the risk of being infected with STIs such as the Human Immunodeficiency Virus (HIV).
The following steps should be taken to reduce the risk of gonorrhea infection. First, sexually active women should be encouraged to visit health centers annually for gonorrhea screening (Jackson, McNair & Coleman, 2015). Condoms should also be used if a person is having sex with a new sex partner. For those who have been diagnosed with the disease, they should encourage their partners to also go to a hospital for testing.
Prognosis
Gonorrhea has a good prognosis especially if antibiotic therapy is administered early enough. Usually, the infection clears within 2 to 4 weeks if the Neisseria gonorrhoeaeis susceptible to the antibiotics that have been administered. For individuals who have are immune-compromised such as patients with HIV, the infection may last for months and become more severe.
References
Hethcote, H. W., & Yorke, J. (2014). Gonorrhea transmission dynamics and control (Vol. 56). Springer.
Kerani, R. P., Stenger, M. R., Weinstock, H., Bernstein, K. T., Reed, M., Schumacher, C., … & Golden, M. (2015). Gonorrhea treatment practices in the STD Surveillance Network, 2010–2012. Sexually transmitted diseases, 42(1), 6-12.
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Children and Teens Obesity
Recently, the idea of taking body mass index (BMI) measurements within the school premise for surveillance purposes has gained much attention from school officials, researchers, the media, and legislators. While a considerable number of children across the United States are underweight, a huge number of them are overweight or obese.
According to a survey done by the Center for Disease Prevention and Control, there were about 13.7 million children between 2 and 19 years suffering from obesity in the US (Sliwa, Brener, Lundeen, & Lee, 2019). While some policy makers support the idea of school-based BMI measurement, others do not.
One of the biggest reasons for supporting school-based BMI measurement is because many children are suffering from chronic diseases such as diabetes and cardiovascular disease due to overweight and obesity. According to Nihiser et al. (2017), the implementation of school-based BMI measurement will help policy makers to identify the number of children that are underweight, healthy, overweigh, and obese in various schools and apply the necessary measures.
These measures can include ensuring that children that have unhealthy weight have access to specialized diets and exercise while at school. School administrators can also use the generate information to help parents take care of their through proper diets at home.
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Children and Teens Obesity
According to Madsen et al. (2020) some institutions and policy makers feel that schools may not provide the necessary environment to ensure privacy and confidentiality while taking the measurements. Many students are very sensitive about their bodies due to the increase of bullying cases among overweight and obese children.
Policy makers therefore feel that children with unhealthy weights will be subjected to an unhealthy environment. Most parents also feel that they also have the right to be consulted before their child’ body mass index is measured and they also have the right to decline or accept the initiative.
The available data is not conclusive as to whether school-based BMI measurement is effective or not. However, it is recommendable that every school have a supportive and safe environment for children of all body weights.
Children and Teens Obesity
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Nihiser, A. J., Lee, S. M., Wechsler, H., McKenna, M., Odom, E., Reinold, C., … & Grummer‐Strawn, L. (2017). Body mass index measurement in schools. Journal of School Health, 77(10), 651-671.
Sliwa, S. A., Brener, N. D., Lundeen, E. A., & Lee, S. M. (2019). Do schools that screen for body mass index have recommended safeguards in place?. The Journal of School Nursing, 35(4), 299-308.
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Nutrition and physical activity programs
Background
In the United States, the prevalence of obese and overweight children aged 2–5 years has almost grown three times over the past 3 decades. These increased levels are alarming and a call for action because children who deal with overweight challenged when they are less than 5 years are more likely to be obese later in life, which leads to detrimental health complications (Hesketh et al, 2017). This can be accomplished by implementing nutrition and physical activity programs.Current statistics show that over 13.7 million children and teenagers in the United States are struggling with obesity.
Out of these 13.9 percent is among children aged between 2 and 5 years, 18.4 percent aged 11 and 20.6 percent aged between 12 and 19 years. Most of the families that have been affected include low-income families and those from ethnic/racial minority groups though they are disproportionately affected. During the early years of development physical activity and eating a healthy and balanced diet are crucial for optimum health, development as well as growth (Hesketh et al, 2017).
It is evident that unbalanced diets and the lack of physical exercise increases a child’s risk for obesity and other consequent health conditions such as diabetes and high blood pressure. Sadly however, the physical exercise and the diet patterns among the preschoolers, particularly those living under or slightly above the poverty line as well as those from racial/ethnic minorities, do not often meet the national standard guidelines.
As such, there is an absolute need to implement effective interventions so as to help in improving the preschoolers’ physical activities and food programs as well as cultivate behaviors that minimize the chances of being obese and the development of related conditions.
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Nutrition and physical activity programs
Making intervention plans for children between the ages 0-5 years is a beneficial strategy as it will help to prevent obesity resulting from poor diets, sedentary life, and physical inactivity. In is crucial that the interventions start before a child enters elementary school. Across the United States, about 11 million children aged 5 and below have enrolled in organized care facilities in an effort to minimize the levels of obesity (Elias, 2018).
Research shows that early care and education programs can be very helpful to families and their children struggling with excess body weight and obesity (Kohl, Fulton, & Caspersen, 2011). Strategies that implement practices and policies relating to sedentary behaviours, physical activity, and nutrition have the potential of influencing the health of toddlers, infants, and preschoolers in a positive way through the programs.
Childcare programs create a valuable opportunity were children and parents can learn about the benefits of physical exercise and balanced diet. Currently, over 70 percent of children whose parents are working late hours are enrolled in childcare programs and spend over 40 hours per week exercising which helps them to burn excess calories.
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Nutrition and physical activity programs
Purpose of the study
There is an alarming number of children in the United States who live in homes where consistent availability of a healthy diets is challenging. Most of them access foods that lead to overweight or obesity while others do not have access to the recommended amount of daily foods and physical exercise. The purpose of this study is to assess child/parental nutrition and physical activity programs within healthcare facilities in the United States. The paper discusses the strategies that can assist healthcare facilities to create and implement successful programs that can address the health and wellness needs of the children and their family members.
Research question
What initiatives are healthcare facilities in the United States implementing to facilitate child/parental nutrition and physical activity programs?
Significance of the study
This paper is important because it will help parents to understand the benefits of proper nutrition and physical exercise which will in turn help children to get healthy stay healthy as well as lead healthier lives. The study also informs healthcare facilities about new exercise and diet programs that are beneficial for parents and their children.
This information is very beneficial because it will help to reduce the increasing number of children who battle over overweight and obesity as well as other condition such as diabetes and blood pressure.
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Methodology
This paper is a qualitative paper that uses secondary materials to summarize recommendations about obesity prevention programs based on reviews from expert guidance from secondary sources such as the American Medical Association, the American Academy of Pediatrics, the National Institute for Health and Clinical Excellence, and the Institute of Medicine among others.
Nutrition and physical activity programs
Literature Review
According to Smith et al (2017), healthcare providers as well as organizations should seek to implement more holistic goals in their roles as public health leaders. Specifically, healthcare facilities hold a significant responsibility to the employees, patients and the public as they are expected to be role models as they provide public health and also act as infection control agents and health promotion advocates.
Through the integration of such practices into the health organization’s operations, healthcare institutions and provides can achieve their duties as professional and take advantage of their unique positions to create change in health behaviors. The widespread challenges concerning overweight and obesity have detrimental consequences on mortality and morbidity due to hypertension, diabetes, cardiovascular disease and hypercholesterolemia among other diseases.
The Centers for Disease Control and Prevention (CDC) asserts that across the US, 69.2 percent of adults between the ages of 20 years and above are overweight, 35.9 percent are obese (Rothstein, 2014). More so, 18.0 percent children between the ages of 6 and 11 years and 18.4 percent of teenagers aged 12 to 19 years are obese. The CDC argues that poor diet contributes heavily to obesity and it is very crucial for overweight and obese parents and children to break unhealthy eating habits and to adopt new ones that promote a healthy body.
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Norman, Zeebari, Nyberg, and Elinder (2019) argue that healthcare institutions and providers have the ability and opportunities to play a symbolic and direct role so as to help patients in adopting improved nutrition and better diet by providing healthy food as well as drinks at the institution. Sadly, instead of providing healthy diet options, some healthcare facilities, which include pediatric hospitals, actually allow fast-food restaurants to sell food within their facilities.
For instance, most hospital organizations have restaurants such as McDonald’s, and some facilities have three to four fast-food restaurants. In these restaurants, the chief patrons include workers employed by the healthcare facility and other guests (Rothstein, 2014). It is essential to however provide more tasty and nutritious food to patients and to ensure that the cafeterias are selling healthy food.
A fast-food restaurants symbol in a healthcare facility is vulgar and unmistakable today. With the current alarming levels of obesity, diabetes, hypertension, and cardiac diseases hospitals cannot afford offer silent support to the public and encourage patients to eat at fast-food outlets that do not provide healthy food choices.
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According to Rothstein (2014), one does not have to get the full fast-food menu to realize some of the “comfort value” prices offered by some fast-food restaurants. After the Philadelphia Children’s Hospital closed McDonald’s, it opened a food service that provided milkshakes for its pediatric patients. Nonetheless, it is true to say that healthy food option are often more expensive as compared to fast-food restaurants.
As a result, to establish and maintain a healthy food restaurant within the facility will require the hospital additional income and also the number of employees who are low-income workers, patients, and visitors may be significantly subsidized. Most hospitals therefore allow fast-food restaurants so that the can gain more profit (Rothstein, 2014).
However, optimizing profits should not be a justification for establishing fast-food restaurants within a healthcare facility just as it would be unfathomable to install a cigarette machine in the hospitals’ lobby. Over the years Healthcare organizations have been in the forefront and led campaigns to ban smoking on their facilities. It would be recommendable if they also took control of the types of foods and drink sold to the children and parents who visit the hospitals every day with the same leadership valor they showed in cigarette cessation.
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Another leading factor that had contributed to obesity, particularly among children, is the lack of physical exercise. Physical exercise refers to any form of activity that is structured, planned, as well as repetitive. The main aim for exercise is improving as well as maintaining a healthy weight and the components of physical fitness. Exercise can include activities such as body composition, anaerobic and aerobic capacity, strength, muscular endurance, and power, balance, and flexibility all of will in turn help to reduce excessive weight and obesity.
Some of the structured activities that a person can engage in may include conditioning programs to improve muscular strength, running programs to enhance aerobic capacity and lose fat, or stretching programs with an aim of increasing joint flexibility. Exercise activities are divided into resistance exercises that involve the musculoskeletal system and cardiorespiratory exercise that involves the respiratory and cardiovascular system.
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The main purpose for resistance exercises is developing neurological, physiological, and biochemical components in the skeletal muscles while cardiorespiratory exercises take into consideration the dynamics of the whole body particularly in exercises that involve large skeletal muscle mass. According to Floriani and Kennedy (2008), the intensity of resistance and cardiorespiratory exercises are expressed in either relative or absolute terms.
Absolute exercise intensity is expressed in terms of kilocalories or kilojoules and is determined by the total energy expenditure. The decimal system that is internationally agreed upon is 1 calorie=4.18 kilojoules. In essence, a kilojoule refers to a unit of energy that is equivalent to 1000 joules. 1 joule refers to the total amount of energy needed to accelerate a kilogram of mass at the rate of 1m/sec. Kilocalories are a unit of measurement equivalent to 1000 calories.
A calorie refers to the total amount of energy needed to raise the temperature of a gram of water by 1 degree Celsius. Relative exercise intensity can be defined as activities that are relative to a person’s maximum capacity to undertake a certain exercise.
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Most healthcare organizations and facilities receive hundreds of clients, patients, visitors, and staff members on a daily basis. Instead of installing video games and television on the hospital walls, the facility can have playground areas as well as gymnasiums that these individuals, particularly employees and their children can use (Rothstein, 2014). Where establishing such a facility is not possible, the hospital can provide opportunities for minimal exercises such as walking grounds and climbing stairs.
In most healthcare institutions across the United States, the only way of reaching various destinations is by using a lift. In some facilities located within multipurpose complexes, it is almost impossible for employees and others to find their way across buildings because the pavements are badly constructed, the lighting is insufficient, or there are structural obstructions (Rothstein, 2014).
Given that healthcare institutions act as employers of millions of healthcare workers across different occupations, they have a responsibility to offer maximum quality and efficient wellness programs that offer weight management programs, smoking cessation, food education programs and other services concerting physical wellness. Healthcare organizations ought to make exercise facilities as well as the workout equipment readily available for all its stakeholders.
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Hospitals such as Jersey City Medical Center, an RWJBarnabas Health facility, support their healthcare practitioners to achieve healthy lifestyle goals. One of these initiatives included noting the healthy foods and calories that the medical center sells at the hospital cafeteria. According to Bopp (2016), employers should partner with other health organizations to offer Healthy Wellness Programs. It is recommended that these programs should be fun, interactive, engaging, and also accessible online through mobile phones.
The employees should choose activities based on their personal goals and as per recommendations and earn rewards for making positive, healthy choices. The employees should also be encouraged to involve their families in the program, as there is a probability that families focused on health will be more successful. Hospitals and all healthcare centers should emulate the above named hospitals to maintain their employees fit and happy.
In accomplishing this, they should employ several useful initiatives, which may include programs on opium use, exercise programs, and tobacco addiction counseling programs aimed at lowering the risk of cancer, obesity, heart and mental diseases (Tu, O’Connor, Baranowski, & Mâsse, 2017).
They should also offer healthy food options to their employees as well as providing discounted rates at gyms and fitness centers to ensure that their employees do exercises regularly. For healthcare organizations that do not have enough space, particularly in older organizations, the management can make arrangements and partner with other wellness facilities to allow cost-free, convenient, or subsidized-cost access to off-site activities.
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Hospitals also have a responsibility of educating their patients on how to access and make use of various online exercise programs and diet programs found on different websites. In the Internet Age, healthcare facilities should integrate patient education with technological advancements that can help the patients as well as employees to benefit substantially from the information offered online (Daniels, & Hassink, 2015). Given that not all websites are genuine, the healthcare facilities should help the stakeholders to assess the credibility of the evidence provided.
Some of the means that the healthcare facility can use include investigating the credibility of the author and publication of the evidence and assessing whether author is expert in the nutrition and exercise field. Sometimes, individuals with great interest in nutrition and exercise can write articles or open YouTube channels though they do not have any educational background in nutrition or exercise.
These websites may seem very attractive as they promise exponential changes but disappoint exercisers in the long run as they are not based on scientific evidence. The healthcare providers can therefore assist patients dealing with diabetes, obesity, blood pressure, and overweight to examine the evidence provided to support the nutrition choices as the best choices demands one to have some background knowledge about exercise and nutrition.
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It is impossible to blush off the impacts that healthcare practitioners as well as health plans have on the choices that parents make for themselves and their love ones including children. In the present information-loaded world, where individuals bombard daily with health nutritional and exercise messages, it is hard to differentiate credible information from the misleading ones. As such, credible, useful, and evidence-based information is lost in the static and 24-hour news cycle of websites. Educating patients and employees on how to use various exercise and nutritional websites such as BodyFit,
Calorie King, FitnessBlender, Fit Men Cook, and Ace Fitness database will help nurses and other practitioners to provide patient education. The workout plans as well as the nutrition information offered by such websites help with training, fat loss, and cardio training among others. The instructional videos provided in workout website covers over 3,000 exercise activities and help an exerciser to avoid injuries.
The how-to-images provided in the website provides the exerciser with thousands of workout pictures that show them how to do a certain activity with precision even before they begin exercising. The website also provided step-by-step instructions that help an exerciser to do the right thing every time.
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A website such as Calorie King for instance can be used to find nutrition facts on foods from different food chains and supermarkets (Borushek, 2013). This can be helpful for tracking macros and calories. This database incorporates nutritional data from credible brands in the United States, Australia, and United Kingdom. The website provides nutritional information and effects regarding breakfast bars and cereals, alcoholic drinks, beverages, breads and cookies, and baked goods.
It also provides information about chocolates and other supplements, cheeses, creams, and yogurts, desserts, and animal protein products. Lastly, there is information about vegetables and fruits, fast foods, fats and sauces, packaged and frozen foods, grain foods, snacks, sugars and syrups (Borushek, 2013). Apart from foods, the website also provides information regarding body mass index (BMI) and how to calculate it.
According to calorie King Website, when the BMI is 25 and above, a person is either overweight or obese and risks conditions such as type-2 diabetes, cardiovascular diseases, some cancer forms, and high blood pressure. This site however cautions against the use of BMI because it does not differentiate between muscle and body fat. For instance, in athletes, the BMI can overestimate the body fat due to the muscular build or underestimate body fats in older people who have lost their muscles.
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Nutrition and physical activity programs
Conclusion and recommendation
Conclusively, health organizations that do not offer well-being programs expose their employees and patients to high risks obesity, diabetes, addiction problems, and mental problems among others. Organizations that provided one to two wellbeing programs experience very low rates of employee turnover as compared to companies that implement a minimum of five programs.
When healthcare facilities provide such programs for employees, patients, and other stakeholders, the offer them a channel to relieve stress as well as receive beneficial information regarding how they can take care of themselves as well as their family members. In the 21st century, healthcare workers are expected to learn about new technologies all the time, be innovative and creative, adhere to new policies and regulations, as well as provide patient-centered services.
As a result, these employees become very tired and unavailable emotionally to the point where they lack of empathy for their patients and medical mistakes increase. To overcome these challenges, medial organizations are encouraged to offer wellness programs such as fitness facilities, counseling, educational programs, workshops, and health food programs to ensure that employees reach their intrinsic goals.
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