Final Exam Policy
COBRA Costs
Employers may require individuals who elect a continuation of coverage to pay the full cost of coverage, plus a 2% administrative charge. • The required payment for continued coverage is often more expensive than the amount that an active employee is required to pay for group health insurance coverage. • The COBRA payment is ordinarily less expensive than individual health coverage.
History of Government Funded Healthcare
In 1965, the Social Security Act established both Medicare and Medicaid. Medicare was a responsibility of the Social Security Administration (SSA), while Federal assistance to the State Medicaid programs was administered by the Social and Rehabilitation Service (SRS). SSA and SRS were agencies in the Department of Health, Education, and Welfare(HEW). In 1977, the Health Care Financing Administration (HCFA) was created under HEW to effectively coordinate Medicare and Medicaid. In 1980 HEW was divided into the Department of Education and the Department of Health and Human Services (HHS). In 2001, HCFA was renamed the Centers for Medicare & Medicaid Services (CMS). CMS is the federal agency which administers the Medicare Program.
Health Care Reform
In March 2010, President Obama signed the two major health care acts- the Patient Care and Protection Act and the Affordable Care Act. These two acts are combined under the Affordable Care Act (ACA) and commonly referred to as "Obamacare". This health care reform was deemed to be necessary because so many Americans lacked health insurance. premiums doubled over last 5 years population is aging health care costs is fastest growing of federal budget people can be turned down for pre-exisiting conditions lifetime limit on benefits employers can get charged if people are sick phase 1 (2014): insurers limited on how to spend, too much for admin costs, give back in rebates preventative care is free - screenings and vaccinations people on medicare more help with drug costs young people up to age 26 can remain on parents insurance small businesses will get tax breaks to help pay for insurance lifetime limits gone illegal to turn kids down for having pre-existing health condition high risk pool run by the government that covers the sickest uninsured people - pre-existing condition insurance plan phase 2 after 2014 - medicaid expanded to cover all ow income families and individuals in every state depending on what you make, health insurance tax credit exchange - virtual insurance mega mall, based on where you live, compare plans, insurance companies compete fairly under strict rules, competition among insurers competitive can't turn them down or charged more if they are sick people will be required to have insurance or pay a special tax business may be fined if they don't provide insurance government will provide credits expanded programs and new rules by 2019- 32 million who don't heave health insurance will have it undocumentaed immigrants will still be uninsured $938 billion over the next 10 years CB 2% of federal budget and 3% of what we spend on healthcare all over savings come from healthcare providers and insureres on medicare program, fees to hospital won't be able to rise as fast as they have been, insurance companies will be paid less medicare experiments on how they pay doctors, hospitals and other providers to make health care system more efficient and improve quality of care. new federal advisory board will make recommendations taxes going up - higher medicare taxes, insurers and busninesses, companies that make medical devises and drugs, tanning salon CBO - reduce federal deficit $124 billion The rationale for the mandate, which by the way was based on the successful Massachusetts plan, was that in order to lower insurance premium costs, the pool needed to be as large as possible and the healthy younger Americans needed to be part of this pool. This could only be accomplished using commerical insurance products if health insurance was mandated. Needless to say and understandably, many Americans did not want to have a mandate that forces them to participate in the system. Some people preferred to remain uninsured. They challenged the entire Act as unconstitutional. The Supreme Court found that the Act, including the mandates was constitutional- Congress had the authority under its powers to tax.
Historical Foundations of Health Legislation and Policy
In the United States, the government has been involved in efforts to improve or maintain the health of citizens since the late 1700s. over the past two centuries, federal, state, and local initiatives, laws, and organizations have fostered significant improvements in the health and life expectancy of Americans the strength and focus of health policy efforts from the federal level were largely imparted during the latter part of the twentieth century.
Mental Health and Children
Mental health disorders are a concern for people of all ages, from early childhood through old age. Children and Adolescents Approximately 20% of U.S. children and adolescents are affected by mental health disorders during their lifetime. Often, symptoms of anxiety disorders emerge by age 6, behavior disorders by age 11, mood disorders by age 13, and substance use disorders by age 15.6 15% of high school students have seriously considered suicide, and 7% have attempted to take their own life.7 Mental health disorders among children and adolescents can lead to school failure, alcohol or other drug abuse, family discord, violence, and suicide.8
Determinants of Mental Health
Several factors have been linked to mental health, including race and ethnicity, gender, age, income level, education level, sexual orientation, and geographic location. Other social conditions—such as interpersonal, family, and community dynamics, housing quality, social support, employment opportunities, and work and school conditions—can also influence mental health risk and outcomes, both positively and negatively. For example, safe shared places for people to interact, such as parks and churches, can support positive mental health. A better understanding of these factors, how they interact, and their impact is key to improving and maintaining the mental health of all Americans.
Age Related Determinants
ttp://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No3Sept09/Articles-Previous-Topics/Update-and-Baby-Boomer-Generation.html Those born between 1946 and 1964 will start to reach the age of 65 by 2011; and estimates now suggest that by 2030 the number of adults 65 years of age and over will be 71 million, or, 20% of the United States (U.S.) population Physical fitness includes both health-related fitness and skill-related fitness. The investigations into the hypotheses of cognitive reserve suggest that childhood cognition, educational and IQ levels, professional attainment, occupational complexity, and lifestyle characteristics, such as level of activity and nutrition, all lead to greater cognitive reserve (Richards & Sacker, 2003; Scarmeas & Stern, 2003).
Policy Analysis & Influence
an objective process that identifies the sources and consequences of policy decisions in the context of the factors that influence them. determines those who benefit and those who experience a loss as the result of a policy. These considerations are critical to ensure health policies that are fair to all those affected. policy is based on values and the first step in forming policy is identification of the issue. Therefore, it would seem rational to define "health" as the starting point for any policy annexed to health care issues since concepts of health are widely diverse. Policy analysts can look to the experience of the international community and its recently altered view of health as one such definition.
a. List four or more ways balance of power is acheived in the United States. b. List three entitities that create laws, statutes, or ordinances. c. Define an administrative agency and give an example of an administrative agency regulation. d. List three or more steps of policy formation. e. List the possible actions that can be taken after a bill is introduced to a governing body. f. State the health care policy associated with the following Presidents: 1. Johnson 2. Nixon 3. Clinton 4. Obama
a. States retain powers not delegated to the federal government; states may delegate this right to local government. In the United States, legislative activities of the three levels of government (federal, state, and local) may vary greatly in their expectations, actions, and results. bicameralism - ensures that the power to enact laws is shared between the House of Representatives and the Senate providing another check on power. creating laws b. Laws which can be statutes, regulations, ordinances are created in all three branches and at the federal, state, and local ( municipality) levels. Laws created by the legislature are called statutes Laws created by municipalities are called ordinances. The courts ( a branch of government) create laws when a higher court such as the Supreme Court of the US or a state's highest court ( in New York, this is the Court of Appeals) makes a decision. That decision is called stare decisis and is the law. c. a department of the executive branch with the authority to implement or administer particular legislation. one most dramatic changes in American government since the ratification of the Constitution is the growth of these. Federal administrative agencies have broad power- they exercise all of the powers of government: executive, legislative and judicial. The Federal Drug Administration (FDA) is one example HIPPA is an example of an administrative agency regulation d. begins with most critical step: defining the issue and placing it on the agenda A regulatory schedule for the implementation of the law into program is formulated. Then an evaluation process is designed that satisfies regulatory and legislative remedies should they be needed. e. extensively altered through amendments or even killed at various stages. In Congress and in the 49 states that have a two-house legislature, a bill must succeed through the two legislative bodies, the House of Representatives, and the Senate. A bill that has moved successfully through the legislative process has one final hurdle, which is the chief executive's approval. The approval may be a clear endorsement, in which case the governor or president signs it. If the executive neither signs nor vetoes it, the bill may become law by default. An explicit veto conclusively kills the bill, which then can be revived only by a substantial vote of the legislature to override the veto. This is another example of the checks and balances of the government process. f. 1. Medicare and Medicaid 2. HMO Act 3. Hillary Care and State Child Health Insurance Plan (SCHIPs) 4. ACA (Affordable Care Act)
Social Determinants Across the Life Stage
From infancy through old age, the conditions in the social and physical environments in which people are born, live, work, and age can have a significant influence on health outcomes. Children Early and middle childhood provide the physical, cognitive, and social-emotional foundation for lifelong health, learning, and well-being. A history of exposure to adverse experiences in childhood, including exposure to violence and maltreatment, is associated with health risk behaviors such as smoking, alcohol and drug use, and risky sexual behavior, as well as health problems such as obesity, diabetes, heart disease, sexually transmitted diseases, and attempted suicide.6 Features of the built environment, such as exposure to lead-based paint hazards and pests, negatively affect the health and development of young children. Adolescents Because they are in developmental transition, adolescents and young adults are particularly sensitive to environmental influences. Environmental factors, including family, peer group, school, neighborhood, policies, and societal cues, can either support or challenge young people's health and well-being. Addressing young people's positive development facilitates their adoption of healthy behaviors and helps to ensure a healthy and productive future adult population. Adolescents who grow up in neighborhoods characterized by poverty are more likely to be victims of violence; use tobacco, alcohol, and other substances; become obese; and engage in risky sexual behavior.7 Adults Access to and availability of healthier foods can help adults follow healthful diets. For example, better access to retail venues that sell healthier options may have a positive impact on a person's diet. These venues may be less available in low-income or rural neighborhoods. Longer hours, compressed work weeks, shift work, reduced job security, and part-time and temporary work are realities of the modern workplace and are increasingly affecting the health and lives of U.S. adults. Research has shown that workers experiencing these stressors are at higher risk of injuries, heart disease, and digestive disorders.8 Older Adults Availability of community-based resources and transportation options for older adults can positively affect health status. Studies have shown that increased levels of social support are associated with a lower risk for physical disease, mental illness, and death.9
Managed care
Managed care organizations (MCOs) represent the most common form of private health insurance in the United States, with approximately 126.4 million enrollees in 2008. The National Library of Medicine defined managed care as "a system of providing health care . . . that is designed to control costs through managed programs in which the physician accepts constraints on the amount charged for medical care and the patient is limited in the choice of a physician." MCOs include health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point of service (POS) plans. To recognize and address the insurance-related concerns of cancer survivors enrolled in managed care and their families, additional research is needed to elucidate the specific nature of the problems and their effects throughout the survivorship trajectory. A health care plan that provides a range of health services through a defined network of physicians and hospitals.
Factors affecting health care costs
Many factors affect the cost of health care. Specifically, we will look at technology, pharmaceuticals and legal influences on the health care costs.
Medicaid
Medicaid- covers low income, including children and the blind, aged and disabled Medicare- covers those over age 65 and individuals who have been found to be disabled through the federal government for more than 24 months ( those receiving SSD and SSI). Subsidized public insurance such as Child Health Plus (CHIP) for children True or False: Medicaid covers everyone who needs long-term care. False Not everyone who needs LTC qualifies for Medicaid. People who need LTC must meet financial and functional needs criteria to be eligible for Medicaid coverage. Financial eligibility criteria vary by state, subject to federal minimum requirements. At state option, people whose income or assets are above the eligibility threshold may "spend down" to qualify for Medicaid coverage.
Mental Health Impact
Mental health and physical health are inextricably linked. Evidence has shown that mental health disorders—most often depression—are strongly associated with the risk, occurrence, management, progression, and outcome of serious chronic diseases and health conditions, including diabetes, hypertension, stroke, heart disease, and cancer.4, 5 This association appears to be caused by mental health disorders that precede chronic disease; chronic disease can intensify the symptoms of mental health disorders—in effect creating a cycle of poor health.5 This cycle decreases a person's ability to participate in the treatment of and recovery from mental health disorders and chronic disease. Therefore, while efforts are underway to reduce the burden of death and disability caused by chronic disease in the United States, simultaneously improving mental health nationwide is critical to improving the health of all Americans. Adults It is estimated that only about 17% of U.S. adults are considered to be in a state of optimal mental health.1 An estimated 26% of Americans age 18 and older are living with a mental health disorder in any given year, and 46% will have a mental health disorder over the course of their lifetime.1 Almost 15% of women who recently gave birth reported symptoms of postpartum depression.1 Older Adults Alzheimer's disease is among the 10 leading causes of death in the United States. It is the 6th leading cause of death among American adults and the 5th leading cause of death for adults age 65 years and older.9 Among nursing home residents, 18.7% of people age 65 to 74, and 23.5% of people age 85 and older have reported mental illness.1
Hill-Burton Hospital Construction Act
One of the earliest pieces of comprehensive health care legislation was passed during the Truman administration in 1946 . The Hill-Burton Act provided grants to states for the construction of new hospitals, targeting low-income and rural areas. Two decades later, President Johnson's terms in office marked a time of dramatic growth in federal health policy, highlighted by the passage of Medicare and Medicaid in 1965. This landmark legislation strengthened the government's role in the health care system and dramatically shaped its rapid growth.
Medicaid Eligibility for LTC
People with long-term services and supports needs may qualify for Medicaid based solely on their low incomes or they may qualify at slightly higher incomes if they also meet disability-related functional criteria. Eligibility criteria vary by state, subject to certain federal minimum requirements. In addition, at state option, people whose income or assets exceed the threshold may later qualify for Medicaid coverage by depleting financial resources, literally "spending down," to meet the financial eligibility criteria. People seeking Medicaid coverage for nursing facility care must contribute to the cost of care from their monthly income and are subject to an asset transfer review; the transfer of certain assets (such as cash gifts) within the five-year "look back" period may result in a penalty and a period of ineligibility. To address the gaps in private LTSS coverage and support people with disabling conditions who desire to secure employment and live in the community, many states opt to allow workers with disabilities to have higher incomes and "buy in" to Medicaid coverage by paying a monthly premium.
Disparaties and Social Determinants
Race and ethnicity, gender, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual's ability to achieve good health. It is important to recognize the impact that social determinants have on health outcomes of specific populations. Social determinants are often a strong predictor of health disparities. For example: -In 2007 to 2008, the Asian or Pacific Islander population had the highest rate of high school graduation among racial and ethnic groups, with 91.4% of students attending public schools graduating with a diploma 4 years after starting 9th grade compared to rates among non-Hispanic white (81.0%), American Indian or Alaska Native (64.2%), Hispanic (63.5%), and non-Hispanic black (61.5%) populations. -According to the National Assessment of Adult Literacy, African American, Hispanic, and American Indian or Alaska Native adults were significantly more likely to have below basic health literacy compared to their white and Asian or Pacific Islander counterparts. Hispanic adults had the lowest average health literacy score compared to adults in other racial and ethnic groups.10 -In 2007, African Americans and Hispanics were more likely to be unemployed compared to their white counterparts. Further, adults with less than a high school education were 3 times more likely to be unemployed than those with a bachelor's degree.11 -Low socioeconomic status is associated with an increased risk for many diseases, including cardiovascular disease, arthritis, diabetes, chronic respiratory diseases, and cervical cancer as well as for frequent mental distress.11 -Low-income minorities spend more time traveling to work and other daily destinations than do low-income whites because they have fewer private vehicles and use public transit and car pools more frequently.11
Health Impact of Social Determinants
Social and physical determinants affect a wide range of health, functioning, and quality of life outcomes. For example: -Access to parks and safe sidewalks for walking is associated with physical activity in adults.2 -Education is associated with: Longer life expectancy Improved health and quality of life Health-promoting behaviors like getting regular physical activity, not smoking, and going for routine checkups and recommended screenings.3 -Discrimination, stigma, or unfair treatment in the workplace can have a profound impact on health; discrimination can increase blood pressure, heart rate, and stress, as well as undermine self-esteem and self-efficacy.3 -Family and community rejection, including bullying, of lesbian, gay, bisexual, and transgender youth can have serious and long-term health impacts including depression, use of illegal drugs, and suicidal behavior.4 -Places where people live and eat affect their diet. More than 23 million people, including 6.5 million children, live in "food deserts"—neighborhoods that lack access to stores where affordable, healthy food is readily available (such as full-service supermarkets and grocery stores).5
Branches of Government
The legislative branch (Congress at the federal level and the legislature, general assembly, or general court at the state level) enacts the statutory laws that are the basis for governance. The executive branch administers and enforces the laws through regulatory agencies. These agencies define more specific implementation of the statutes through rules and regulations (i.e., regulatory or administrative law). The judiciary body provides protection against oppressive governance and against professional malpractice, fraud, and abuse. Its function, through the courts, both state and federal, is to determine the constitutionality of laws, interpret them, and decide on their legitimacy when they are challenged. Decisions of the United States Supreme Court are binding law for the nation. Decisions of the individual state's highest court are binding law within that state alone. The courts also have jurisdiction over specific infractions of laws and regulations.
Policy Formation
a course of action to be followed by a government or institution to obtain a desired end. reflects values and encompasses the choices that a society, segment of society, or organization makes regarding goals and priorities and the criteria used to allocate resources involves the application of reason and evidence to problem solving in public and private settings. authorized authoritative bodies (e.g., state health departments, OSHA, the Center for Medicare and Medicaid Services (CMS) ,and a fiscal oversight subcommittee) rationally determine actions to create, amend, implement, or rescind health care policy These groups would decide what is right or best and then develop the political strategies to affect the desired outcomes. The question of whether a particular policy is advocated or adopted would depend on the degree that a group or the society as a whole may benefit without harm or detriment to subgroups group need and group demand should be the strongest determinants that may influence policy formation The premises supporting the goals of health policy should be equitable distribution of services and the assurance that the appropriate care is given to the right people, at the right time, and at a reasonable cost. begins with most critical step: defining the issue and placing it on the agenda A regulatory schedule for the implementation of the law into program is formulated. Then an evaluation process is designed that satisfies regulatory and legislative remedies should they be needed.
Public Insurance a. Medicaid- Who is eligible for Medicaid? State the eligibility requirements in NY b. Medicare- Who is eligible for Medicare? c. CHIP- Who is eligible for CHIP? State the eligibility requirements in NY Private Insurance d. State how most families obtain insurance Define: e. Premium f. Deductible g. Co-pay h. Co-insurance i. HMO j. PPO
a. low-income people, families and children, pregnant women, the elderly, and people with disabilities. the blind NY State: You have high medical bills. You receive Supplemental Security Income (SSI). You meet certain financial requirements. https://www.health.ny.gov/health_care/medicaid/#income https://www.benefits.gov/benefits/benefit-details/1637 Minimum Medicaid Eligibility under Health Reform 133% FPL ($24,353 for a family of 3 in 2010) b. covers those over age 65 and individuals who have been found to be disabled through the federal government for more than 24 months ( those receiving SSD and SSI). c. children. To be eligible for either Children's Medicaid or Child Health Plus, children must be under the age of 19 and be residents of New York State. Children 241% Pregnant Women 185% Working Parents 64% Jobless Parents 37% Childless Adults 0% https://www.health.ny.gov/health_care/child_health_plus/eligibility_and_cost.htm https://www.benefits.gov/benefits/benefit-details/1609 d. through their employer (or through medicaid or public for the poor) e. fixed, prepaid monthly amount paid into/for health insurance f. the amount the enrollee of plan must pay each year out of pocket before the insurance company will pay g. A set dollar amount the patient must pay when they utilize a service or pharmaceutical h. a percentage of the cost of service. i.Health Maintenance Organization • Members must use participating or approved providers for all health services. • Designated health services are covered for a fixed, prepaid premium. • Health services must be approved through an HMO utilization program. • HMOs are considered the most restrictive form of managed care, because they may limit procedures, providers, and benefits. Patient generally required to choose a primary care provider, referrals go through this provider. Most require patient to remain in network j. Preferred Provider Organization • Members can receive health services from participating (in-network) or nonparticipating (out-of-network) providers. • In-network providers offer care at a discount. • Use of out-of-network providers may incur additional fees, copays, or deductibles. • Many PPO plans are POS plans. an insurance plan that lets the patient choose their provider/hospital
Common Types of Managed Care Organizations: a. Health maintenance organization (HMO) b. Point of service (POS) plan c. PPO
a. • Members must use participating or approved providers for all health services. • Designated health services are covered for a fixed, prepaid premium. • Health services must be approved through an HMO utilization program. • HMOs are considered the most restrictive form of managed care, because they may limit procedures, providers, and benefits. b. • Members may receive health services from participating (in-network) or nonparticipating (out-of-network) providers. • Members can choose from HMO, preferred provider organization (PPO), or fee-for service delivery systems at the time of accessing services, rather than at enrollment. • Costs of receiving care in network generally are lower than out of network. • Use of out-of-network providers may incur additional out-of-pocket costs. c. • Members can receive health services from participating (in-network) or nonparticipating (out-of-network) providers. • In-network providers offer care at a discount. • Use of out-of-network providers may incur additional fees, copays, or deductibles. • Many PPO plans are POS plans.
Health Policy
exemplifies both conflict and social change theories product of continuous interactive processes in which interested professionals, citizens, institutions, industries, and other groups compete with one another for the attention of various branches of government The most obvious and prominent among these is the legislative branch, although policy is also made through regulatory mechanisms, and court decisions. may also issue from the recommendations of fact-finding commissions established by the legislative or executive branch. rarely created through discrete, momentous determinations in relation to single problems or issues. It often evolves slowly and incrementally as an accumulation of many small decisions. It also changes slowly because changes in the social beliefs and values that underlie established policy develop within the context of actual service delivery. Once a direct health care service is offered, especially an official tax-funded service, it is often difficult to discontinue it. Existing programs create tradition by establishing vested interest and a sense of entitlement on the part of the public. This tradition also exerts political influence in a natural effort for self-preservation. The state legislatures, for the most part, are directly involved in health care, yet the federal government influences health policy, directly and indirectly, through financing of health care for many groups (Medicare), regulation activities ( approval of drugs), and setting of standards (air quality). Health policy refers to public policies that pertain to or influence the pursuit of health, or a course of action to obtain a desired health outcome for an individual, family, group, community, or society. Nursing policy can be viewed independently or as a subset within the larger health policy arena. health care policy in general - as of Jan 2017 Congress has taken steps towards dismantling the ACA, tremendous changes and discussion regarding health care access and policy in US this year
Medicaid: What it costs, who it covers
https://sbsn.blackboard.com/bbcswebdav/pid-5708-dt-content-rid-8990_1/courses/1176-HNH-505-SECD93-65285/KaiserSlidesDownload_115121037.pdf You will find that the elderly and disabled account for the most amount of dollars spent on Medicaid. Health Insurance Coverage 29 million children & 15 million adults in low-income families; 15 million elderly and persons with disabilities Assistance to Medicare Beneficiaries 8.9 million aged and disabled — 21% of Medicare beneficiaries Long-Term Care Assistance 1 million nursing home residents; 2.8 million community-based residents Support for Health Care System and Safety-net 16% of national health spending; 40% of long-term care services State Capacity for Health Coverage Federal share can range from 50 - 83%; For FFY 2012, ranges from 50 - 74.2% Medicaid, the nation's major publicly-financed health insurance program, plays an important role in the delivery and financing of long-term care (LTC) services.
Effects of Childhood Stress Across the Life Span
https://www.cdc.gov/violenceprevention/acestudy/about.html The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study is one of the largest investigations of childhood abuse and neglect and later-life health and well-being. The original ACE Study was conducted at Kaiser Permanente from 1995 to 1997 with two waves of data collection. Over 17,000 Health Maintenance Organization members from Southern California receiving physical exams completed confidential surveys regarding their childhood experiences and current health status and behaviors. The CDC continues ongoing surveillance of ACEs by assessing the medical status of the study participants via periodic updates of morbidity and mortality data. Adverse Childhood Experiences (ACEs) are common. Almost two-thirds of study participants reported at least one ACE, and more than one in five reported three or more ACEs. The ACE score, a total sum of the different categories of ACEs reported by participants, is used to assess cumulative childhood stress. Study findings repeatedly reveal a graded dose-response relationship between ACEs and negative health and well-being outcomes across the life course. As the number of ACEs increases so does the risk for the following*: Dose-response describes the change in an outcome (e.g., alcoholism) associated with differing levels of exposure (or doses) to a stressor (e.g. ACEs). A graded dose-response means that as the dose of the stressor increases the intensity of the outcome also increases. Alcoholism and alcohol abuse Chronic obstructive pulmonary disease Depression Fetal death Health-related quality of life Illicit drug use Ischemic heart disease Liver disease Poor work performance Financial stress Risk for intimate partner violence Multiple sexual partners Sexually transmitted diseases Smoking Suicide attempts Unintended pregnancies Early initiation of smoking Early initiation of sexual activity Adolescent pregnancy Risk for sexual violence Poor academic achievement Adverse Childhood Experiences (ACEs) are categorized into three groups: abuse, neglect, and family/household challenges. Each category is further divided into multiple subcategories. Participant demographic information is available by gender, race, age, and education. The prevalence of ACEs is organized by category. All ACE questions refer to the respondent's first 18 years of life. Abuse Emotional abuse: A parent, stepparent, or adult living in your home swore at you, insulted you, put you down, or acted in a way that made you afraid that you might be physically hurt. Physical abuse: A parent, stepparent, or adult living in your home pushed, grabbed, slapped, threw something at you, or hit you so hard that you had marks or were injured. Sexual abuse: An adult, relative, family friend, or stranger who was at least 5 years older than you ever touched or fondled your body in a sexual way, made you touch his/her body in a sexual way, attempted to have any type of sexual intercourse with you. Household Challenges Mother treated violently: Your mother or stepmother was pushed, grabbed, slapped, had something thrown at her, kicked, bitten, hit with a fist, hit with something hard, repeatedly hit for over at least a few minutes, or ever threatened or hurt by a knife or gun by your father (or stepfather) or mother's boyfriend. Household substance abuse: A household member was a problem drinker or alcoholic or a household member used street drugs. Mental illness in household: A household member was depressed or mentally ill or a household member attempted suicide. Parental separation or divorce: Your parents were ever separated or divorced. Criminal household member: A household member went to prison. Neglect1 Emotional neglect: Someone in your family helped you feel important or special, you felt loved, people in your family looked out for each other and felt close to each other, and your family was a source of strength and support.2 Physical neglect: There was someone to take care of you, protect you, and take you to the doctor if you needed it2, you didn't have enough to eat, your parents were too drunk or too high to take care of you, and you had to wear dirty clothes.
LHI for Mental Health
https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Mental-Health The burden of mental illness in the United States is among the highest of all diseases, and mental disorders are among the most common causes of disability. Recent figures suggest that, in 2004, approximately 1 in 4 adults in the United States had a mental health disorder in the past year—most commonly anxiety or depression—and 1 in 17 had a serious mental illness. Mental health disorders also affect children and adolescents at an increasingly alarming rate; in 2010, 1 in 5 children in the United States had a mental health disorder, most commonly attention deficit hyperactivity disorder (ADHD). It is not unusual for either adults or children to have more than one mental health disorder. Mental health is essential to a person's well-being, healthy family and interpersonal relationships, and the ability to live a full and productive life. People, including children and adolescents, with untreated mental health disorders are at high risk for many unhealthy and unsafe behaviors, including alcohol or drug abuse, violent or self-destructive behavior, and suicide—the 11th leading cause of death in the United States for all age groups and the second leading cause of death among people age 25 to 34. Mental health disorders also have a serious impact on physical health and are associated with the prevalence, progression, and outcome of some of today's most pressing chronic diseases, including diabetes, heart disease, and cancer. Mental health disorders can have harmful and long-lasting effects—including high psychosocial and economic costs—not only for people living with the disorder, but also for their families, schools, workplaces, and communities. Fortunately, a number of mental health disorders can be treated effectively, and prevention of mental health disorders is a growing area of research and practice. Early diagnosis and treatment can decrease the disease burden of mental health disorders as well as associated chronic diseases. Assessing and addressing mental health remains important to ensure that all Americans lead longer, healthier lives. The Leading Health Indicators Are: Suicide (MHMD-1) Adolescents with a major depressive episode in the past 12 months (MHMD-4.1)
Social Determinants
https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Social-Determinants A range of personal, social, economic, and environmental factors contribute to individual and population health. For example, people with a quality education, stable employment, safe homes and neighborhoods, and access to preventive services tend to be healthier throughout their lives.1 Conversely, poor health outcomes are often made worse by the interaction between individuals and their social and physical environment. Social determinants are in part responsible for the unequal and avoidable differences in health status within and between communities. The selection of Social Determinants as a Leading Health Topic recognizes the critical role of home, school, workplace, neighborhood, and community in improving health. The Leading Health Indicators Are: Students graduating from high school 4 years after starting 9th grade (AH-5.1) Although education is the Leading Health Indicator for this topic, many of the Healthy People 2020 objectives address social determinants as a means to improve population health.
Leading Health Indicators
https://www.healthypeople.gov/2020/leading-health-indicators/Leading-Health-Indicators-Development-and-Framework Leading Health Indicators Development and Selection Process The process of selecting the Leading Health Indicators (LHIs) mirrored the extensive collaborative efforts undertaken to develop Healthy People 2020. The process was led by the Healthy People 2020 Federal Interagency Workgroup, with approximately 50 members from across the U.S. Department of Health and Human Services (HHS) and other Federal departments. Reports by the Institute of Medicine of the National Academy of Sciences and the Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020 provided several recommendations for HHS to consider in developing the final set of LHIs. In addition, consideration was given to other indicator sets, such as the National Prevention Strategy mandated by the Affordable Care Act, as well as to key priorities of the secretary and the assistant secretary for health, to ensure alignment among the various prevention initiatives within HHS and across the Federal government. Leading Health Indicators Framework The Healthy People 2020 LHIs were selected and organized using a Health Determinants and Health Outcomes by Life Stages conceptual framework. This approach is intended to draw attention to both individual and societal determinants that affect the public's health and contribute to health disparities from infancy through old age, thereby highlighting strategic opportunities to promote health and improve quality of life for all Americans. Determinants of Health and Health Disparities Biological, social, economic, and environmental factors—and their interrelationships—influence the ability of individuals and communities to make progress on these indicators. Addressing these determinants is key to improving population health, eliminating health disparities, and meeting the overarching goals of Healthy People 2020. Health Across Life Stages LHIs are being examined using a life stages perspective. This approach recognizes that specific risk factors and determinants of health vary across the life span. Health and disease result from the accumulation (over time) of the effects of risk factors and determinants. Intervening at specific points in the life course can help reduce risk factors and promote health. The life stages perspective addresses 1 of the 4 overarching goals of Healthy People 2020: "Promote quality life, healthy development, and health behaviors across all life stages."
Government
the structure of principles and rules determining how a state or organization is regulated. purposes: regulation of conditions beyond individual control and provision of individual protection through a population-wide focus tasks accomplished through passage and enforcement of laws Requirements of childhood immunizations for school attendance, vector control, and sewage treatment are examples of regulations to protect the health of the population. the sovereign power (the independent and supreme authority of the nation; can also be found in each state) vested in a nation or state The basis of the government's responsibility for health in the United States and the subsequent authority to enact health laws (or any laws) comes from specific sources contained in our historic documents that reflect the values of the country's founders. They give the government the authority to enact laws, but they also limit that power. The earliest of these statements was the Mayflower Compact, through which the Pilgrims committed themselves to making "just and equal laws" for the general good. The Declaration of Independence later established the doctrine of inalienable rights, life, liberty, and the pursuit of happiness. The Constitution separates governmental powers among the branches of government: the executive branch, which includes the President, the Vice President and the administrative agencies; the legislative branch, which includes the Senate and the House of Representatives (Congress); and the judicial branch, which at the federal level includes district courts, circuit courts and the highest court in the land, the Supreme Court. In the United States, legislative activities of the three levels of government (federal, state, and local) may vary greatly in their expectations, actions, and results.