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Health Policy and Chronic Disease Assignment Help

Case of Obesity and Diabetes in USA

Examine and research 1 chronic disease (e.g., heart disease, stroke, cancer, diabetes, arthritis, obesity) and write a paper that discusses the following: A comparison of 2 health care policies that are in place (either at the state or federal level) that address the disease The impact the disease has had on the U.S. population and health care system as a whole Strategies that are in place to educate and promote prevention of the disease through public health at the federal and state levels Any challenges and progress to date that has been made in preventing and reducing health risks associated with the disease 2–3 strategies that may increase awareness, education, and prevention of that disease.

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INTRODUCTION

Chronic disease prevalence rate has increased substantially in recent time in USA. As per National Centre for Chronic Disease Prevention and Health promotion out of every ten adults six suffers from chronic disease. Similarly, four out of every ten adults have more than one chronic disease. It adds $3.3 trillion towards Health care costs each year. Thus, it implicates the penetration level of chronic disease in USA and how it impacts on USA productivity as a whole. The chronic diseases reported in USA includes cancer, hypertension, diabetes, stroke, heart disease, obesity, respiratory disease, reduced quality of life, disability, and eventually death. Chronic disease are the major contributing factors towards disability and death (Raghupati and Raghupati, 2018).

In the present essay, health policies in two chronic diseases affecting USA population will be discussed in brief. The progress made till date will be discussed in brief and what can be done to improve the awareness, knowledge and prevention as well as health promotion will be discussed in brief. The two chronic disease chosen for the study includes obesity and diabetes.

OBESITY AND HEALTH POLICY

Currently, the healthcare news that has shadowed US healthcare environment includes healthcare managers and acquisitions, tough flu seasons, Affordable Care Act- regulation and legislation. However, the fact that is slowly grasping US population and yet is subtle includes Obesity. The prevalence of obesity is 39.8% and it affects nearly 93.3 million of US population during 2015-2016. Obesity epidemic is a serious public threat issue and the effects are more serious than opioid epidemic. The other health effects of obesity include heart stroke, high blood pressure, hyperlipidaemia, type 2 diabetes, cancer and other cardio-vascular disease. In a 2013 published study, it was reported that nearly 13% of the Americans within age range 40 to 85 succumb to obesity contradicting previous scientific belief of 5 % (Bibiloni, Puns & Tur, 2013). The obesity epidemic may not be comparable to opioid epidemic in context of deaths associated with it, however the effect cannot be neglected. Obesity related cancer causes death in 7 percent of cancer patients or equivalent to 40,000 deaths each year. The cost of obesity is also very high that is 147 billion dollars in year 2008. The cost of treatment for obesity people was $ 1429 higher than the normal people (Yanovski, 2018).

The above fact demonstrates the wide effect of obesity epidemic ranging from physical to economic burden on US healthcare system. It implicates, to study the current policies regarding obesity and analyse its strength towards recognition, prevention and promotion of health. In this section we will discuss two state policies that has been framed to address obesity.

STATE POLICY 1

DEFINED PHYSICAL ACTIVITY

Only nine states have including Washington D.C. has approved policy for physical activity. Those Nine states include Idaho, Colorado, New Mexico, Western Virginia, North Carolina, Georgia, Virginia, District of Columbia, New Jersey, and Vermont. According to this policy, 60 minutes of full exercise per full day and 30 minutes of half day exercise in Early Childhood Education settings (Langford et al., 2015).

Since, obesity is a life style preventable disorder attributed to high caloric intake and reduced physical activity. Most of the research implicates reduced physical activity is associated with obesity epidemic. The study published by Church and Martin reported that since American’s does not have physical activity-oriented job’s, therefore assuming energy intake regulations will match energy expenditure that occurs in high physical activity related job is wrong. The study concluded due to low physical activity-oriented jobs, the energy intake exceeds energy expenditure leading to obesity (Church and Martin, 2018). In his critical appraisal of physical activity and exercise as causal factor of obesity Wiklund (2016) reported, lack of objective data and physiological data that can show reduced energy expenditure or exercise can increase the chances of obesity or standalone factor. However, the author concluded since voluntary exercise is the single most determining factor for energy expenditure, therefore physical activity and exercise are solution towards obesity epidemic. Keeping these recommendations in mind, the policies adopted by the nine states of USA seems justified towards prevention of obesity. Prevention of obesity at childhood stage or taking preventive approach so that energy expenditure balances energy intake is an established approach towards reduction of obesity and health promotion (Grossman et al., 2017).

STATE POLICY 2

HEALTHY FOOD FINANCE INITIATIVE

Apart from early childhood educational settings, community targeted approaches have recently shown to be an effective method towards chronic disease prevention and health promotion. USA states has policies at three levels, schools, early childhood and communities. In this section, the policy existing at community level will be discussed in brief. The policy is called as healthy food finance initiative (HFFI). Under this policy, many healthy food retailers and grocery stores selling healthy foods are brought down to suburbs and rural areas of America. More than one dozen of states have their own funding initiatives. Let’s have an analysis how access to healthy food influence in reduction of obesity. Hawkes et al (2015) in their extensive review reported policies targeted towards development of healthy food preference by children, and disadvantaged population can lead to better obesity prevention. The policies must be assessed and changed such that the disadvantaged population can overcome the barriers to healthy food choice. However, Dubowitz et al. (2014) in previous year in his quantitative correlational study reported, although policies are targeted towards improved access to healthy food as a promotional approach towards obesity prevention, easy access supermarkets not necessarily has reducing effect on obesity. Similarly, another study in 2018 reported the prevalence of obesity among children and other community member is higher when they have greater access to combination grocery store (Gorski et al., 2018).

Thus, how effective is the policy towards prevention of obesity among suburban areas of America needs an evaluation? However both the policies targeted towards obesity prevention and reduction is right approach in contemporary time period.

DIABETES

The second chronic disease to be discussed is diabetes that has become the global pandemic. According to American Diabetes Association statistics, it is the 7th leading cause of death in USA. The numbers are based on 2015 statistics that revealed 75, 535 numbers of death certificates issued cited diabetes as the underlying cause of death. Similarly, the prevalence of diabetes is very high and as per 2015 statistics, 30.3 million people that equivalents to 9.3% of the population suffers from diabetes. Approximately, 1.25 million of American children had diabetes in 2015. Every year nearly 1.5 million people are diagnosed with diabetes every year. Similarly, the cost of diabetes to USA healthcare system is very high. As per March 2017 data, the total cost of diagnosed diabetes in USA was $ 327 billion. Out of that $ 90 billion accounts for reduced productivity and rest is directly incurred as medical costs (American Diabetes Association, 2018).

Diabetes has become a global pandemic that has led to development of numerous policies at global level. Although, the etiological factors ranges from genetic to abnormal physiology, lifestyle moderating factors and other preventable factors such as exercise, food, obesity act as major risk factors for diabetes (Zimmet and Alberti, 2016). In this context, it is important to study what policies do exist at state or federal level in USA for prevention of diabetes and health promotion.

HEALTH POLICY 1

INSURANCE COVERAGE

Diabetes is primarily a disease that needs more self-management than physician intervention. However, to manage this condition the person requires test strips, meters and insulin. According to healthcare department of USA, affordable health care and health insurance is critical for access to diabetes prevention resources, education, medication and other supplies. In past, people with diabetes faces problems to access these services, however with current policy of including diabetic population under insurance coverage has increased the access. One of the primary goals of Affordable Care Act was include the population in insurance coverage those who are excluded from this. Post launching of this initiative, there was 35% reduction in people who had no insurance coverage (Konchak et al., 2016). Secondly, in order to ensure better coverage they introduced exchange marketplace, where they can buy personal insurance plans irrespective of their employer. One recent studies have found, the states where Medicaid was expanded, 23% of diabetes diagnosis has increased. However the initiative helped in medication treatment for diabetes, but no effect was observed on glycosylated haemoglobin levels (American Diabetes Association, 2018).

HEALTH POLICY 2

SOURCE OF CARE

When the effect of diabetes is so high, and there are gaps in whole system, only having insurance coverage is not enough to address the problem. The source of care need to be strengthened. Research suggest diabetes like chronic disease warrants a strengthened primary care system having multidisciplinary structure and proactive health care teams to address the issue at population level. This was acknowledged by the Affordable Care act of 2010 and federally funding was initiated for federally qualified health care centres and Primary health care centres. The funding has been channelized towards health homes or patient centred medical homes for population level diabetes prevention. Studies showed better diabetes care and prevention through this approach (Brown and McBride, 2015).

AWARENESS AND HEALTH PROMOTION

However, these policies targeted towards reduction in chronic disease like obesity and diabetes seems insufficient. The high prevalence of these conditions, life style preventable factors implicates stress must be given on awareness of candidates or population towards prevention. Community level workshops, regulation policies on grocery stores, fast food stores, timing of opening, perimeter or area of operation need to be tightened in order to prevent diabetes and obesity (Roberto et al., 2015). While educational programs are targeted towards inducing better health behaviours among school children, it is imperative for school management and state governments to initiate programs that will include parents too. In this way, the community and population level awareness can be carried out regarding chronic disease (Freudenberg et al., 2015).

CONCLUSION

Chronic disease like obesity and diabetes have been global pandemic since last decade. Thus, USA’s healthcare system must learn from other countries regarding strategies that led to reduction in prevalence of these disorders, increase awareness and reducing financial burden on the system. At the same time education, better access, regulation on external and environmental factors also plays an important role in controlling these chronic conditions. Thus, it is expected in near future more variant and robust health policies backed by evidence will be launched to curb obesity and diabetes.

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