Chapter 11 Review Questions
Who are the AAPIs?
AAPI stands for Asian Americans and Pacific Islanders. Compared to blacks, Hispanics, and Native Americans, AAPIs have relatively small numbers. However, AAPIs constitute one of the fastest growing minorities in the United States. In education, income, and health, AAPIs form a bipolar distribution. Compared to the rest of the population, a greater proportion of AAPIs have at least 4 years of high school education, but this group also has a greater proportion of those with 0 to 4 years of elementary education. Their median family income is higher, but a higher percentage also live in poverty than the total population. While US smoking rates are reported to be lowest among Asian/Pacific Islanders, 92% of Laotians, 71% of Cambodians, and 65% of Vietnamese are smokers. Compared to whites, Korean- American men have a fivefold incidence of stomach cancer and an eightfold incidence of liver cancer. Cultural practices and attitudes may prevent AAPI women from receiving adequate breast cancer screening and prenatal care. Ignorance of this bipolar distribution contributes to the myth of a minority population that is both healthy and economically successful. Such a misunderstanding demonstrates that a need for more in-depth, ethnic-specific health research is essential.
What is the impact of the ACA on vulnerable populations?
ACA is expected to significantly reduce the number of uninsured Americans and results in enhanced insurance coverage for those previously inadequately insured. The removal of preexisting conditions would also allow certain vulnerable groups (e.g., HIV/AIDS patients, those mentally ill) to be more appropriately covered. However, the full benefits of ACA may not be realized unless certain challenges are well-handled such as increase in insurance cost, supply of health care providers, and simplification of administrative procedures to sign up for ACA related insurance exchanges.
Which childhood characteristics have important implications for health system design?
Among the unique characteristics of childhood that have important implications for health system design are children's developmental vulnerability, dependency, and differential patterns of morbidity and mortality. Developmental vulnerability refers to the rapid and cumulative physical and emotional changes that characterize childhood and the potential impact that illness, injury, or untoward family and social circumstances can have on a child's life-course trajectory. Children have complex and changing dependency relationships that influence their development and affect their utilization of health services. Children are dependent on their parents or other caregivers to recognize and respond to their health needs, to organize their care and authorize treatment, and to comply with recommended treatment regimens. Children increasingly are affected by a broad and complex array of conditions termed "new morbidities." The new morbidities include drug and alcohol use, family and neighborhood violence, emotional disorders, and learning problems from which older generations do not suffer. These new morbidities originate in complex family or socioeconomic conditions rather than from exclusively biological etiologies. To sustain positive outcomes, the new morbidities require a continuum of comprehensive services that includes multidisciplinary assessment, treatment, and rehabilitation as well as community-based prevention strategies.
How does AIDS affect different population groups in the United States?
In 1994, the death rate from HIV infection per 100,000 population among persons 25-44 years was almost four times as high for black men as for white men and nine times as high for black women as for white women. In 2004, males and blacks continued to have significantly higher prevalence of AIDS than females and whites. Those increasingly affected by this disease are the poor and disenfranchised in society. There is a growing recognition of the spread of HIV into rural communities. Rural persons with HIV and AIDS are more likely to be young, nonwhite, and female and more likely to have acquired the infection through heterosexual behaviors. Women are a rapidly growing proportion of the population with AIDS and HIV. While the majority of people with AIDS are men, the number of women progressing to AIDS is increasing almost four times as fast as the number of men. Black and Latino women are particularly vulnerable.
How is mental health provided in the United States?
Mental health services are provided through public (primarily for patients without insurance) and private resources (primarily for patients with insurance) in both inpatient and outpatient facilities, including state and county mental hospitals, private psychiatric hospitals, nonfederal general hospital psychiatric services, Department of Veterans Affairs psychiatric services, residential treatment centers, and free-standing psychiatric outpatient clinics. Managed care is becoming increasingly common in mental health. Insurers are now contracting for a limited scope of mental health benefits for enrollees as part of more comprehensive healthcare packages. Psychiatrists and other mental health providers are also contracting with insurers, employers, and managed care plans to provide mental health services for enrolled populations, often based on capitation payments. The ability of managed care plans to provide comprehensive services and to meet the full range of patient needs, given the constraints of these contracts, is an open question at the present time.
Compared with white Americans, what are the health challenges faced by minorities?
Minorities are more likely to be economically disadvantaged than whites. They fall behind in health status despite progress made during the past few decades. Blacks in particular, compared to whites, have shorter life expectancies; higher age-adjusted death rates for leading causes of death; higher age-adjusted maternal mortality rates; and higher infant, neonatal, and postneonatal mortality rates. Blacks are more likely to report fair or poor health status than whites. In terms of behavioral risks, black males are more likely to smoke cigarettes than white males, and blacks have higher serum cholesterol levels than whites.
Which health services are currently available for children?
Personal medical and preventive health services— These services are generally delivered in private and public medical offices, hospitals, and laboratories. Population-based community health services—These provide services such as immunization delivery and monitoring programs, lead screening and abatement programs, child abuse and neglect prevention, case management and referral programs for children with chronic diseases and those requiring early interventions, and monitoring programs for infants at risk for developmental disabilities. Health-related support services—Examples of healthrelated support services include nutrition education, early intervention, rehabilitation, and family support programs. Services in this sector also include parent education and skill building in families with infants at risk for developmental delay due to physiological or social conditions (such as low birth weight or very low income), and education and psychotherapy for children with HIV.
What is the Indian Health Service?
The Indian Health Service is a federal agency responsible for the health of Native Americans since 1955. It operates hospitals and outpatient facilities and negotiates contracts with independent healthcare providers. Nationally, the Indian Health Service is divided into 12 area offices responsible for program operations in a particular geographic area. Actual delivery of health services is the responsibility of the service units operating at the local level. Over the years, the IHS system has evolved to include not only primary care services but preventive strategies such as environmental and sanitation services. Programs have expanded to include mental health, substance abuse, and dental services.
What are the roles of the Office on Women's Health?
The Public Health Service's Office on Women's Health (OWH) is dedicated to the achievement of a series of specific goals that span the spectrum of disease and disability. These goals range across the life cycle and address cultural and ethnic differences among women. The OWH stimulates, coordinates, and implements a comprehensive women's health agenda on research, service delivery, and education across the agencies of the Public Health Service, including the National Institute of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Health Resources and Services Administration (HRSA), the Agency for Health Research and Quality (AHRQ), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Indian Health Service (IHS). The OWH also serves as a link across the country's PHS regions and with other government agencies, including the Department of Defense, Department of Veterans Affairs, Central Intelligence Agency, Environmental Protection Agency, and National Aeronautic and Space Administration. The OWH is responsible for implementing the National Action Plan on Breast Cancer (NAPBC), a major public/private partnership dedicated to improving the diagnosis, treatment, and prevention of breast cancer through research, service delivery, and education. It places particular emphasis on prevention of physical and sexual abuse of women and works to implement important protections for women against violence and abuse.
What are the challenges faced in rural health?
The challenges faced in rural health include poverty or poor economic conditions, lack of healthcare professionals in rural settings, and low population density, which makes it difficult for communities to attract physicians and managed care. As a result, rural populations face greater barriers in access to care than urban populations.
What are the racial/ethnic minority categories in the United States?
The four racial/ethnic minority categories are Black Americans, Hispanic Americans, Native Americans, and Asian Americans. Hispanic Americans include Mexicans, Puerto Ricans, Central or South Americans, Cubans, and persons from other Spanish cultures or origins. Native Americans include American Indians and Alaska Natives. Asian Americans include persons whose origin is the Far East, Southeast Asia, or the Pacific Islands.
What are the health concerns of children?
The health concerns of children include lack of insurance, vaccinations, delayed access to medical care, and unavailability of sick child care or lack of leave benefits for working parents.
What are the characteristics and health concerns of the homeless population?
The homeless population consists of single men (43%) and single women (17%), and families with children (39%). About 40 percent of all homeless men are war veterans. The economic picture of homeless persons is dismal. Almost half have not graduated from high school, and on average they have been unemployed for 4 years. Only 26% have health insurance. The shortage of adequate low-income housing is the major precipitating factor for homelessness. Unemployment, personal or family life crises, increases in rent out of proportion to inflation, and reduction in public benefits can also directly result in the loss of a home. The homeless, both adults and children, have a very high prevalence of untreated acute and chronic medical, mental health, and substance abuse problems. The state of being homeless produces risk factors that would otherwise not be incurred, including excessive use of alcohol, illegal drugs, and cigarettes; sleeping in an upright position, which results in venous stasis and its consequences; extensive walking in poorly fitting shoes; and grossly inadequate nutrition. Homeless persons are also at a greater risk of assault and victimization. The homeless are also exposed to illness due to overcrowding in shelters and overexposure to extreme heat and cold.
Who are the major mental health professionals?
The major mental health professionals include psychiatrists, psychologists, social workers, nurses, counselors, and therapists.
How can the framework of vulnerability be used to study vulnerable populations in the United States?
This framework calls for attention to the convergence of vulnerability attributes. People who experience a combination of risk factors are likely more vulnerable and therefore ought to be prioritized by policy and intervention initiatives. The framework also suggests that public policy and program must address several risk factors at the same time rather than treating each risk factor separately and in isolation. The latter practice is still more common in the US, which results in both inefficient use of resources and ineffective assistance to the vulnerable populations.
Which services and policies currently combat AIDS in America?
Through the Medicaid waiver program, states may design packages of services targeted at specific populations, such as the elderly, the disabled, and those who test HIV positive. For HIV-positive people, the waiver is designed to provide alternatives to care in acute care hospitals. The Ryan White CARE Act was passed in 1990 mainly to provide emergency assistance to cities significantly affected by HIV/AIDS. This was intended to allow cities to provide an array of testing, counseling, and other services, including case management, to people with HIV/AIDS. The Act focuses on the development of cost efficient service schemes by funding innovative and existing services. President Clinton established the following goals to alleviate the national AIDS crisis: Through the Medicaid waiver program, states may design packages of services targeted at specific populations, such as the elderly, the disabled, and those who test HIV positive. For HIV-positive people, the waiver is designed to provide alternatives to care in acute care hospitals. The Ryan White CARE Act was passed in 1990 mainly to provide emergency assistance to cities significantly affected by HIV/AIDS. This was intended to allow cities to provide an array of testing, counseling, and other services, including case management, to people with HIV/AIDS. The Act focuses on the development of cost efficient service schemes by funding innovative and existing services. President Clinton established the following goals to alleviate the national AIDS crisis: Through the Medicaid waiver program, states may design packages of services targeted at specific populations, such as the elderly, the disabled, and those who test HIV positive. For HIV-positive people, the waiver is designed to provide alternatives to care in acute care hospitals. The Ryan White CARE Act was passed in 1990 mainly to provide emergency assistance to cities significantly affected by HIV/AIDS. This was intended to allow cities to provide an array of testing, counseling, and other services, including case management, to people with HIV/AIDS. The Act focuses on the development of cost efficient service schemes by funding innovative and existing services. President Clinton established the following goals to alleviate the national AIDS crisis: • To develop more effective treatments, specifically, a preventive vaccine to protect the uninfected and a cure for those currently infected through strong, continuing support for HIV-related research. • To reduce the number of new HIV infections in adults and children in the United States. This reduction shall persist until the rate of new infections reaches zero by providing strong, continuing support for effective HIV prevention efforts. • To ensure that all people living with HIV have access to services. Services should include everything from health care to housing and supportive services that are affordable, of high quality, and responsive to the patients' specific needs. • To ensure that all people living with HIV are not subject to discrimination of any kind. • To provide strong, continuing support for international efforts to address the HIV epidemic. • To ensure that research advances are translated into improved HIV-prevention programs and enhanced care for HIV-positive persons; in other words, to reduce research duplication and promote more effective care.
What measures are taken to improve access to care in rural areas?
Various measures have been taken to improve access to care in rural America, including the promotion of National Health Service Corps, the designation of Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas (MUAs), the development of the Community and Migrant Health Centers (C/MHCs), and the enactment of the Rural Health Clinics Act.
What are the health concerns of women?
Women suffer greater morbidity and poorer health outcomes and have a higher prevalence of certain health problems than men over the course of their lifetimes. Women also develop more acute and chronic illnesses, resulting in a greater number of short- and long-term disabilities than do men of comparable age. Even after reproductive problems are controlled for, women's health problems limit their activities 25% more days per year than do men's. Women are bedridden 35% more days than men each year due to infectious or parasitic diseases, respiratory diseases, digestive system conditions, injuries, and other acute conditions. In all illnesses, differences arise not only in the onset and progression of illnesses but also in the research, prevention, treatment, and education necessary to address these physical and mental disorders in women of all ages and across all racial and ethnic groups.
