Literature Review 1
PUBH 6635/8635 Literature Review PaperOverall Comments: Mary, you’ve composed a good paper. The majority of the information is on target and presented clearly. There were APA formatting errors and a couple of areas that required slightly more detail, lacked clarity and/or could have been communicated more precisely.
Ultimately, a literature review should present a synthesis of research on the topic. This synthesis should include an organized review of what is known and unknown about the topic, as well as provide a display of critical thought on the strengths and weaknesses of the reviewed research. Please keep this in mind when making revisions for the next iteration of this paper.
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Running head: RESEARCH MANUSCRIPT LITERATURE REVIEW[kks1]
Research Manuscript Literature Review
Research Manuscript Literature Review
Introduction[kks2]
The burden of chronic illness and disease has been well-documented in scientific and scholarly studies. Given the amount of human capital, resources and the socioeconomic impact these diseases create within national and global economies, prevention based upon the WHO definition of health has dominated conversations and extended from the 1978 Alma Ata. Yet, few nations have incorporated the elements the Alma Ata or the WHO articulated within its definition of health. Therefore, this literature review will conduct an overview of the barriers that engender chronic illness, limit its prevention and address the required policies, services and societal arrangements.
Accordingly, this review will focus on studies and proposed strategic approaches, healthcare frameworks and the preventive services mandate. Through this literature review it will become evident that numerous levels of prevention must be engaged and inevitably address the precursors of chronic illness, including the availability of mental health and social services, culturally competent and nondiscriminatory care, institutional and employment based wellness education and initiatives and a much more inclusive health and wellness system..
Literature Review
Healthcare and societal roles in perpetuating chronic illness and disease[kks3]
Several factors engender chronic illness including but not limited to lack of access to healthcare and/or quality care, aging, socioeconomic status, mental health and wellness and the availability of such services. Given the diversity in the U.S., however, addressing all these factors is critical to prevention and lessening the burden of disease. Yet, spending alone, diverting funds toward more equitable access is not enough. Rather, as Dr. Besser, Acting Driector of the CDC stated (Majette, 2011, p. 370):
[…] For Americans to truly be healthier, they must not only have access to[kks4] treatment once sick, but they should also receive recommended screenings to detect the risk of disease early; they should have access to evidence-based interventions to prevent disease and injury before they occur; be supported by healthcare systems that minimize the progression of disease once it occurs; and live, work and play in environments that promote healthy choices and behaviors (Besser, as cited by Majette, 2011, p. 370).
Obviously, Dr. Besser has elucidated the tenets of the WHO (2012) definition of health relative to health and healthcare not being related to (WHO, 2012)”[…] merely the absence of disease or infirmity.” Dr. Besser also illuminates the contents of Malouf’s (2011) study of employer based wellness programs and associative strategies directing employees to deal with health problems such as diabetes (p. ).[kks5]Realizing this could become a much bigger issue for the employee, his/her family and even the employer, the company in India (Malouf, 2011), “offers free comprehensive medical checks for employees.” Additionally, too, the company offers discounts on medical services for dependents (p. 15). Other companies in the Philippines regularly conduct surveys relative to happiness, job satisfaction, engagement and sense of empowerment and monitor employee behavior to suggest changes therein (p. 15). After all, any change in productivity or attitude may suggest larger issues are present. Since these aspects are crucial to one’s social and emotional well-being, as articulated by the WHO (2012) definition of health, these strategies fulfill the definition. More importantly, they engender productivity not only within the company but society itself (p. 15).
Given Brown & Bolen’s (2008) findings that “[…] unmet health needs and physical health problems are important barriers to school learning for children and adolescents […] and one in five children in the United States experience symptoms of a diagnosable mental disorder in and given year” schools should be part of the preventative efforts (p. 28). Even though (Brown & Bolen, 2008) approximately 18% of school-age children have one or more chronic condition and approximately 7% of those with chronic conditions suffer additional limitations, schools should coordinate professional efforts among educational personnel, healthcare professionals and mental health providers (Brown & Bolen, 2008, p. 28). Yet, the lack of this effort, the preventative strategies especially relative to at-risk and minority children who disproportionately suffer from any and/or all of the aforementioned conditions merely engender and even increase the prevalence of illness, chronic and mental conditions within society (p. 28, 29).
Accordingly, the previous studies and research efforts demonstrate how society, the healthcare, educational and professional sectors fail to provide the safe environments for persons to work and play within. Instead, they more pointedly show how and where the current system fails to treat persons and views them through a disease oriented lens instead of health and wellness lens, as the WHO (2012) suggests (Brown & Bolen, 2008; Malouf, 2011, p. 15; Majette, 2011, p. 370). Yet, other factors lessen the quality of care, limit access to such care and provide less than optimal outcomes.
Discrimination, Disparate Care and Quality
As evidenced by the Lebrun and Dubay (2012) study of immigrants to the U.S. and Canada and the disparate participation realized between foreign-born and those born in those countries, healthcare inequality and discriminatory healthcare delivery engenders the rise of chronic disease and the burdens thereof (1694). Although discrimination, racial, ethnic and socioeconomic segregation is far more rigid and prevalent in the U.S., the perceptions of care and the differences therein inform participation within public and community health education, promotion and preventative initiatives (James, 2007, p. 22; Lubrin & Dubay, 2012, p. 1712)
Substantiated by the Kaiser Permanente 2007 study (James, 2007), both doctors and patients reported differences in service delivery when the patients were of different races or ethnic backgrounds (p. 22). (James, 2007) When linguistic competence was problematic and patients lacked English speaking ability or fluency, lesser care was delivered in more than 40% of those cases (p. 22). Additionally, doctors treated patients differently based upon their perceptions of whether patients had insurance (p. 22).Patients also confirmed this. (James, 2007) Not surprisingly 70% of doctors verified the latter and 72% of patients also stated this to be true (p. 22). Given these disparities in quality and care, how then might preventative services and/or participation be encouraged?
Whereas Lebrun & Dubay (2012) highlight the differences in participation among immigrant populations in Canada and the U.S and show clear differences in the acceptations of services, Lebrun and Dubay (2012) alternately contend that differences in care quality might be responsible for prevention screening seeking behavior between the two countries (1710). In the U.S. more immigrants were more likely to seek Pap smears as preventative measures (p. 1710). In Canada, the inverse was true. Even when comparing nation of origin, Lebrun and Dubay (2012) failed to explicate why this was so.
However, differences in standard care and its quality might best be explained through the James 2007 study. Using the chronic illness diabetes as the focus, James (2007) explored the likelihood of persons in the U.S. to receive the three types of diabetes tests recommended annually for those with the disease (p. 18, 19). Only 51% of white (non-Hispanics) received the hemoglobin test, a foot exam and the retina exam (James, 2007, p. 18, 19(. Approximately 42% of African-Americans and Hispanics did (p. 18).
Substandard care and lesser prevention
Obviously, the trilogy of annual diabetes screening tests is preventative based. They are also standards of care. Given that half of the target population or less than half received the appropriate screenings, one might wonder how responsible healthcare policies, healthcare delivery services, perceptions about insurance and payers or lack thereof inform this disparity and substandard delivery of care (James, 2007, p. 18). While none of the researchers fully addressed this, Lebrun & Dubay (2012) revealed the differences between Canadian immigrants and those of American immigrants. Suggesting the lower levels of education and income levels among immigrants and racial and ethnic minorities in the United States, Lebrun & Dubay (2012) contend these disparities might explain how and why immigrants and persons of color are less likely to obtain preventative screenings and/or healthcare (p. 1710).
Although Lubrin & Dubay (2012) do not fully detail why this is so, James (2007) demonstrates how the lack of preventative care or the gaps therein exponentially increase the odds of exacerbation of chronic conditions. Given that (James, 2007) less than half of all Hispanic diabetics received the three recommended annual tests for diabetics (p. 18). More than one-third experienced uncontrollable diabetes (p. 19). More than two-thirds experienced short-term and long-term complications that required hospitalization (p. 19). Among African-Americans, the numbers reflected those of Hispanics (p. 19).
If prevention is to be the focus of healthcare policies and frameworks, then many of these factors, the discrimination, delivery of substandard and disparate care must cease (Bodenheimer, Chen & Bennet, 2009). Rather, as Dr. Besser (as cited by Majette, 2011) suggested, health must be the focus of all levels of care (p. 370). It must also include other institutions within society, including employers, schools and communities (Malouf, 2011; Brown & Bolen, 2007). However, the most vulnerable communities are already burdened by disease, as are some sectors of health professionals (Cogan, 2011; Nugent, 2008; Mills, 2003).
Breaking down Healthcare system barriers
(Cogan, 2011) I[kks6]n order to grant access to the more than fifty million uninsured Americans, the Patient Protection and Affordable Care Act (ACA) was passed (Cogan, 2011, (p. 355). Because of the individual mandate it embodies, it requires all Americans to buy health insurance in 2014 or before then (p. 355). While many have contended this still leaves another 50 million Americans uninsured and that the working poor who do not qualify for Medicaid or SCHIP programs will be forced to choose between insurance and food, the ACA has forced healthcare providers and insurers to focus on health and wellness services (p. 355, 359).
Even as the ACA has required healthcare and public health to change its strategies, examine how it could become a proactive, preventative service rather than a disease-based one, it has also necessitated interagency cooperation (Cogan, 2011, p. 356). Insisting these agencies have largely engaged the opposite strategies, worked separately despite mutual dependence, the system has also suffered from knowledge silos, increasing specializations and fragmentation (p. 356, 357; Majette, 2011, p. 367). Therefore, health care and its physicians often featured in media stories doing heroic feats have greatly delimited health and healing and even controlled Public health (Cogan, 2011, p. 357). Since more than 95% of the U.S. health care spending goes toward health care, most of which is disease care, this is understandable (p. 357, 358).
(Cogan, 2011) Yet, given the reality that the U.S. spends the most in the world on health care, more than double the amount 15 developed countries spend, one would expect the U.S. would be the healthiest (p. 359) However, this is not true. Insurance, points of access to the healthcare systems, knowledge silos and power grabs within the healthcare system merely perpetuate and gender sick care and delimit prevention (p. 357-359). To this end (Majette, 2011, the Institute of Medicine (IOM) asserted that evidence-based medicine including traditional and integrative services should be included (Majette, 2011, p. 366-368). Elucidating how spending on high-technology medicine did not always yield results and often failed to prevent illness, the IOM argued that medicine itself had to change p. 367). Arguing that public health (Majette, 20110 was charged with collective action to assure the people health, the IOM set forth its research and inquiry to fulfill this covenant (p. 366, 367). After all, insurance and access would not and will not offer prevention or even disease mitigation if U.S. healthcare remains the same (Cogan, 2011, p.359).
Mental health inclusions
Due to the deficiencies in the U.S. health care system, it’s financing, frameworks and delivery system, Henderson (2007) draws upon the World Health Organization (WHO) 1978 Alma Ata Declaration (p. 77). Known as Health for all, the Alma Ata not only provides guidance relative to fulfilling the WHO (2012) definition of health but alternately helps policy makers; Public health and healthcare agencies revise, develop and implement the appropriate measures to assure their populations the greatest quality of social, emotional and physical health (p. 77). Using a synthesis of the Alma Ata and the 1970s report, A New Perspective in the Health of Canadians, Henderson maintains that mental health strategies are critical components of any nation’s covenant with its people. Moreover, primary healthcare in every nation is (Henderson, 2007, p. 77):
Obviously, this statement elicits points of disagreement among healthcare professionals and practitioners, the community, public health officials and policy makers. However, this statement was set forth by the World Health Organization more than thirty five years ago (Henderson, 2007, p. 77, 78). In order to help break down the barriers in and among agencies responsible for such, the WHO monograph Health promotion articulated (As cited by Henderson, 2007, p. 78) health promotion as directed toward action on the determinants or causes of health, as combinations or diverse, complementary, methods and approaches and aimed toward effective and concrete participation. Additionally, health promotion did not necessarily focus on persons at risk for certain diseases. Rather, (Henderson, 2007) it involved populations as a whole within their daily lives (p. 78). Furthermore (Henderson, 2007), it charged that health professionals had a duty and a role in nurturing and facilitating health promotion(p. 78).
Within the healthcare framework, however, mental healthcare is often overlooked. Yet, mental health (WHO, 2004b, p. 12, as cited by Henderson, 2007, p. 78) “is a state of well-being in which the individual realizes his or her own capabilities, can cope with normal stresses of life, can work productively and fruitfully and is able to contribute to his or her community.” When persons are challenged by disparate healthcare quality, access to insurance or services, or the safe environments required to prevent chronic illness (Brown & Bolen, 2007, p. 28, 29). To this end, Henderson argues that “[…] the Jakarta Declaration on Leading Health Promotion into the 21st Century states that mental health promotion should focus on reducing inequalities and building social capital” (p. 78). Therefore prevention of mental disorders (Brown & Bolen, 2007) like those documented in one in five U.S. children each year, would not only mandate reducing the risk factors and alleviating socioeconomic, racial and ethnic disparities but would also require the enhancement of protective factors, the reduction of symptoms and incidence of such (p. 78).
Since the ACA does not reveal preventative measures relative to such, the school and employer-based strategies and the collaboration between sectors and professionals Brown & Bolen (2007) propose might be the most beneficial. After all, these relationships, the support they yield and their placement within the daily lives of people would fulfill the WHO’s requirements for health promotion. As Malouf (2011) also suggests, attention to performance, satisfaction levels in the workplace or school setting could also lessen the chances of stresses becoming mental health disease (p. 15). Therefore, counseling, happiness and stress assessments should be part of preventative efforts. Unfortunately, many of the socioeconomic mitigations are too often decided through legislative efforts. Yet, collaborative efforts with social welfare and community agencies might enhance the protective factors within an at-risk population (Brown & Bolen, 2007, p. 28; Mills, 2003, p. 21).
Burden of Chronic Disease
If health promotion were to avert or avoid the inclusion of the WHO 1984 monograph, the burden of chronic disease would eventually lead to lesser economic participation among many sectors of the population (Henderson, 2007, p. 21; Nugent, 2008, p. 78). Healthcare professionals already overloaded with chronic disease cases would also deliver less quality care and the exponential effects of the illness itself would not only affect the young persons, the elderly and their family members (Tilly, 2010, p. 20, 21; Mills, 2003; Nugent, 2008). Rather, it would affect the national productivity, its ability to meet its financial obligations and perhaps lead to questions of the government’s legitimacy (Nugent, 2008, p. 78). These are the realities.