Ch 11 - Special Populations

-Created out of the concern that rural areas could not support enough physicians -Permitted PAs, NPs, and CNMs with rural clinic to practice without the direct supervision of a physician -Established rural health clinics to be reimbursed by Medicare/Medicaid to keep them open

3 characteristics of Rural health clinics act

-health professional shortage area -Medically underserved areas -contain High percentage of population below poverty income levels, High percentage of population >65, High Infant mortality rates, Low number of PCPs, Substance abuse problems PCPs are great for rural health because they can take care of 75% of things, but there are still not enough physicians so NPs and PAs (midlevel providers) are growing in rural areas

3 characteristics of rural health Which group of doctors is great for rural health and why?

-mostly Young, ethnic minorities because of lack of education, which limits their job opportunities that provide health insurance -Face poorer health than general population -ACA made progress in reducing the uninsured through expansion of Medicaid

3 characteristics of the Uninsured

-Growing deal in Austin -Complex problem -Caused by shortage of adequate low income housing + barriers to health care (homeless should be going to safety net clinics but since many of them don't go, APBH sent mobile clinics out into the community to see the homeless out in the streets) Novel solution: add more affordable/low income housing = first step to put a roof over people's heads

3 characteristics of the homeless + solution

At a disadvantage in obtaining employer based health insurance + being paid equally to their male counterparts Office on Women's Health = specific goals that span the spectrum of disease and disability

1 characteristic of women Office of Women's health

-Health insurance is a major determinant of access to and utilization of health care --> CHIP -Coverage rates vary across races and ethnicities -Unintentional injuries are leading cause of death, Asthma is a common chronic disease, Depression has an impact on adolescent development -Children's health has certain unique aspects: Developmental vulnerability and dependency Personal medical and preventive services Population based community health services Health related support services

4 characteristics of Children + 3 programs in the US healthcare system that work to improve the health of children

-depends on predisposing, enabling, and need characteristics -caused by SDOH Solution: spend more on SDOH

2 characteristics of Vulnerability + solution

1. Community/migrant health centers 2. Rural health clinics act

2 programs for migrant workers

-Number of AIDS cases reported has fluctuated -Greater infection in rural communities, children, women -Caused by need for research, PBH concerns, discrimination, and provider training -Characterized by a gradual decline in physical, cognitive, and emotional function --> dependence on public entitlements Ryan White CARE Act = federal block grant that gives money to states to address HIV/AIDS

4 characteristics of HIV/AIDS Which act is targeted towards treating this population?

-Barriers to mental health care -Not paying providers enough → loss of money -Community need -Made improvement over men's mental health by viewing mental health as any other common illnesses/physician medical issue

4 characteristics of mental health

-Leading cause of death in the US -Complex and costly due to comorbidities -Result in limitations on daily life activities -Can be mental, physical, or social disability (measured by disability tests) -Goal is to induce a lifestyle that reduces chronic disease incidences through prevention and early intervention

5 characteristics of the chronically ill

1. Racial/ethnic minorities 2. Uninsured children 3. Women 4. Rural residents 5. Homeless 6. Mentally/chronically ill 7. Disabled 8. HIV/AIDS

8 special population groups

organization associated with St. John's Catholic church that provided food to homeless/poor individuals → realized that bringing food to the homeless is good but it is not an answer → Built houses to take people off the streets and move the homeless population to an area where they have a roof over their heads = affordable housing Goal = to try to bring everyone to the table/create a safety net - Transform the residential program by getting people off the streets and into a community bc discovered that lack of safety net caused homelessness Homeless people are put in a house and given tasks/choices to earn money and get to feel like they are giving back to the community and being a part of a community Individuals could be given a home as long as they are off drugs and are not a sex offender (rent equivalent) Community First gave money for addiction resources in exchange for doing chores/jobs (janitorial work, landscaping, creating artwork/gifts) to help them pay their rent

COMMUNITY FIRST HOMELESS SOLUTION Describe what Mobile Loaves and Fishes does and what their goal is How did the Community First Village give the homeless population dignity? Who qualifies to live in the village? Most of the homeless people were getting a check from social security or disability insurance, but this was often used for food, alcohol, and drugs. How did Mobile Loaves and Fishes address this?

Equity Politics

COVID REFLECTIONS ON GOVERNANCE, COMM, AND EQUITY COVID has revealed a gap in ____ The US response to COVID-19 has been plagued with ____ driving PBH and messaging

Equity, special populations, varying Health care services, disparities Greater Insurance

Currently, there are a lot of issues with ____ (gaps between pop groups and the rest of the population), which is a problem since a lot of different people of racial/ethnic descent are ___ ____ that have ____ health statuses/issues Population groups are facing greater challenges and barriers in accessing ___ ___ ____, which results in racial/ethnic ___ in health status Certain groups are at ___ risk of poor physical/psychological/social health We are trying so hard to give people ___ through expansion of Medicaid, but since Medicaid pays doctors so poorly, not many doctors provide care to Medicaid

Cause: not enough providers working in the area Solution: telehealth/telemedicine (broadband access) to allow rural doctors communicate with doctors in the city, Health Professions Educational Assistance Act provided financial incentives to help distribute health professionals, National Health Service Corps provides scholarships to PCPs that work in shortage areas geographic areas, population groups, and medical facilities

Problem + solution to health professional shortage areas What are the 3 ways HPSAs can be classified as?

Texas lost a lot of money from the federal government due to not expanding Medicaid -reduce uncompensated hospital care costs = positive impact on economics -greater health coverage in rural areas -decrease uninsured rate Go to business people to tell them that refusing to expand Medicaid is a bad business decision for Texas → trying to improve quality of life for everyone

TEXAS REFUSAL TO EXPAND MEDICAID Main consequence of Texas refusing to expand Medicaid What 3 things would have happened had Texas expanded Medicaid? What is the new approach to encourage Medicaid expansion?

Individuals covered by Medicaid (insurance) still do not have good healthcare because there are only certain, limited spots they can go to receive care (community clinics) because Medicaid pays doctors poorly Solution: increase the amount of money paid to doctors for seeing medicaid patients Tradeoff: will have to increase taxes to pay doctors more

What does it mean to be medically underserved/disadvantaged/underprivileged/underclass? What is the solution and the tradeoff to this solution?

-Incidence and prevalence of certain diseases in the AI/AN population are prime concern = Higher death rates from alcoholism, TB, diabetes, injuries, suicide, and homicide -Even though we have allocated a lot of federal money to try to improve health status, it is still not solved as it is a complex problem Solution: indian health care improvement act + indian health service

What is the 2 prime concerns regarding the American Indian/Alaska Native population? What is the solution?

Cardiovascular disease Blacks White and black males/females White mothers Black mothers

Which condition is responsible for the highest age adjusted death rate for all persons Which race category experiences the greatest infant, neonatal, and postnatal deaths? Which population face the highest percentage of being overweight? Which race of mothers has the highest education and prenatal care during 1st trimester? Which one has the lowest birth weight?

White males Black women Latinos Asians Highest = white females Lowest = black males + females Decreasing bc of burnout, depressing, chronic disease, lack of prevention Black women bc lack of attention paid to this pop Whites perceive their health more positively compared to blacks Black males bc often in vulnerable/stressful situations

Which population group drinks alcohol the most? Which population group has the highest incidence of maternal mortality? Which population group is most reluctant to get a mammography? Which population is the fastest growing? Which population has the highest/lowest life expectancy? Is the general life expectancy in America increasing or decreasing? Which population has the highest age adjusted maternal mortality and why? How do whites perceive their health compared to blacks via respondent assessed health status? Which population smokes the most and why?