Interdisciplinary Project Example #1

Parts of the project I created, along with three other group members, for my Global Health class are presented here.  Most of what we researched and wrote about eventually was shortened and presented on a poster.  Parts of the final pieces from the poster and parts of the essays that went into created the final pieces are included.





access to healthcare

First-trimester prenatal care is crucial for intervention & education about positive infant health outcomes. Around 20% of mothers in Washington state do not receive this care. Access to care is prevented by the fact that the existing public-private healthcare system denies many American mothers insurance.  The current HMO system is more restrictive than other options such as PPO or single-payer healthcare. To maximize profit, HMO health care providers must see as many patients as possible, and keep their referral rate down. This method of delaying treatment eventually leads to more costly care, usually at the expense of another entity.

 

their lack of funds & fear of stigmatization compromises their ability to seek help. 

PREVIOUS EFFORTS

  • The failed 1993 Health Security Act for universal health care coverage was an attempt to achieve universal health care and health care reform to eliminate inequities of health access. Programs to expand health care coverage to expectant mothers and infants have not been enacted.
  • State execution of Medicaid programs have often failed to provide adequate coverage for low income families.
  • Fewer physicians now accept Medicaid due to poor reimbursement.
  • Fear of deportation and belief in refusal of care has caused such services to be underused. 

SUCCESSFUL PROGRAMS

  • Medicaid and SCHIP (State Children’s Health Insurance Program) provide access to prenatal care for eligible mothers and health coverage for infants from low-income families

WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) provides supplemental foods, for low-income pregnant and postpartum women, and to infants who are found to be at nutritional risk.


What is Infant Mortality?
 
congenital malformations
low birth weight
maternal complications
sudden infant death syndrome
 
Who does it effect?  What are the risk factors?
 
  • poor
  • African-Americans
  • younger than age 17
  • have little or no prenatal care
  • uninsured
  • have inadequate diets
  • pregnancy weight gain is less than 20 pounds
  • smoking, drugs, or alcohol during pregnancy
 
Prior Attempts to Address the Problem:
The problemPrevious attemptsExamples of the previous attemptsHow effective was it?

Education

Increased education of mothers has been shown to reduce risks of infant mortality. Mothers with higher education levels have babies with the best health outcomes, but that could also be correlated with socioeconomic advantages. In addition, mothers may not understand risk factors involved with infants, so they do not know how to prevent harmful behaviors. They may also lack knowledge of how to care for infants, without knowlege of breastfeeding, nutritition, and  healthy sleep habits.

  • Distribution of bilingual pamphlets and education material to improve maternal education for maternal and newborn health
  • Breast-feeding classes to promote effective breast feeding to promote adequate infant growth and nutrition.
  • Education to prevent teenage pregnancy (younger mothers often have low birth-weight infants and premature births with higher likelihood of infant death)
  • "Back to Sleep" campaign for Sudden Infant Death Syndrome
  • Folic Acid Campaign to encourage folic acid intake in mothers to reduce risk of neural tube defects
  • Focus in the past 10 years has been on community-based abstinence education to reduce teenage pregnancy.

 

  • Educational materials do increase knowledge of specific causes of infant death have been moderately effective, in reducing specific causes of death, like Sudden Infant Death Syndrome.
  • However, educational materials are often distributed through healthcare providers, which some women may have limited access to
  • The effectiveness of abstinence-based education has not been proven to reduce teenage pregnancy.

Access to Health Care

First-trimester prenatal care is very beneficial for positive infant health outcomes. Around 20% of mothers in Washington state do not receive this care. Early care leads to early education and early risk management and intervention. However access is prevented by factors such as lack of money or insurance and fear of stigmatization.

  • Attempts to achieve universal health care to eliminate inequities of health access
  • Programs to expand health care coverage to expectant mothers and infants
  • 1993 Health Security Act for universal health care coverage
  • Current health care reform plans to expand coverage
  • Medicaid and SCHIP provide access to prenatal care for eligible mothers and health coverage for infants from low-income families
  • WIC provides supplemental foods, for low-income pregnant and postpartum women, and to infants who are found to be at nutritional risk.
  • Attempts at health care reform have thus-far failed.
  • State execution of Medicaid programs have often failed to provide adequate coverage for low income families.
  • Fewer physicians now accept Medicaid due to poor reimbursement.
  • Fear of deportation and belief in refusal of care has caused such services to be underused. 

Racial and Socioeconomic Disparities

There are enormous racial disparities concerning positive infant health outcomes. For example, the rate of infant mortality per 1000 births is 13.63 among African-Americans, but only 5.76 among Caucasians. Existing health systems

  • Community involvement in healthcare provision.
  • Promotores for Latina Women are community members who integrate information about health and the health care system into the community's culture, language and value system 
  • The Black Infant Health program in California to identify "at-risk" pregnant mothers, providing medical care and family support services.
  • These programs have worked well to improve health outcomes in areas where the programs exist.
  • Program have benefited by providing social support and empowerment for pregnant women
  • Effectiveness of these programs vary by location, but programs have appeared successful in expanding care, education, and targeting higher-risk populations.

System/Structural Barriers

Often forgotten are the structural barriers to receiving care. The uneducated, socioeconomically disadvantaged, and immigrant populations often lack resources to reach the health services they are entitled to. In addition, non-English speaking populations have language barriers that prevent communication between providers and patients, leading to difficulty communicating health problems.

  • Hiring translators
  • Improve public transit to hospitals
  • Locally instituted measures to improve transportation,
  • There are no national requirements for transportation or provision of services in different languages.
 
 
 
 

Who Are The Players?

Creators of the Injustice:

  • The Health Care System: The U.S. health care system is often focused on producing power and profit for the providers (Jonas 9).  As a result, it has generated corporate profits from the provision of healthcare services (Jonas 9). These for-profit aspects of the health system, in addition to high inflation costs of healthcare, have increased health costs for individuals, limiting both mothers’ and children’s access to necessary healthcare. Many other developed countries offer universal health care, such as Great Britain, France, and Japan. Joseph White has coined the term "international standard," which the United States’ often fails to meet.
  • The Government: Policymakers in America and are responsible for the creation of a healthcare infrastructure that is in severe disrepair. The prevailing conservative, neoliberal stance that Americans in the "land of opportunity" are capable and responsible for determining their station in life has stalled both welfare reform and progress in the realm of healthcare.[7]. In addition, "local governments in Paris, Tokyo, and London operate nationally funded programs to identify high-risk mothers and offer them special services." It is clear that the US government has some catching up to do in terms of actively preventing infant mortality.

 

Victims of the Injustice:

  • Economically Disadvantaged Populations: It has been found that Medicaid managed care reduced the quality of prenatal care and increased low birth weight, prematurity, and neonatal death (Aizer 386). Thus disadvantaged populations that qualify for Medicaid programs do not receive adequate care. [1]
  • Educationally Disadvantaged Populations: Preterm deliveries are a major cause of neonatal deaths, and preventable factors such as smoking and poor diet can increase the chances of preterm deliveries when mothers are not adequately educated about such risks. Inadequate education about breastfeeding can also lead to poor infant weight gain, and lack of adequate post-natal checkups can lead to undetected jaundice, infection, and other life-threatening conditions.
  • Specific Minority Groups: Some minorities are treated less fairly than others.  An extreme difference is seen among blacks who have an infant mortality rate twice that of whites and up to four that of other minorities such as Chinese, Japanese, and Cuban whose rates are actually lower than whites ("Evidence of Trends"). Many governmental and non-governmental groups, such as March of Dimes and Health and Humans Services’ Administration for Children and Families, that create programs aimed at helping these disadvantaged minorities end up blaming individual behavior or culture when their programs fail, instead of altering their methods.
Infant Mortality Essay

Infant mortality is a crucial indicator of the health of a society, not only on a physical level, but in the social realm as well. Thus, it is an urgent issue to be discussed and remedied on a biomedical and social level. In America, the current infant mortality rate is 7 infant deaths per 1,000 live births. Even more disturbing is that the rate is 13.63 among African-Americans, but only 5.76 among Caucasians, suggesting a vast difference in both access to health care and in education about prenatal care along racial and socioeconomic lines. [1] A lack of educational funding can be directly linked to socioeconomic stratification and poverty in the US. This leaves a significant proportion of our nation’s mothers uneducated about prenatal care and family planning essential for producing healthy babies.

 

The United States ranks 29th of 37 developed nations in infant mortality, despite spending 15.2% of its GDP on health care; this is twice the spending of most other developed nations. With 46 million Americans living without insurance under the existing health care system, the problem clearly does not lie in a lack of funding, but in the distribution of said funding. From this data, one can see that the tragedy of infant mortality is undeniably and intimately linked with injustice and inequity in the US. The inequality of health care in the United States can be framed with structural violence in both a political and social sense. A grave and unnecessary structural flaw caused by irresponsible policy decisions is complicit in perpetuating this harmful misappropriation of funds. Improving social and political decision-making that has impaired access and education surrounding prenatal care in the United States is the only means of reducing this tragic and preventable loss of valuable life. This requires an essential overhaul of the nation’s health care system. There needs to be a heavy focus on education; partnership between the CDC (Center for Disease Control), healthcare providers and ethnic community centers is the most efficient means of fostering education about nutrition, smoking, drugs, alcohol, etc. for expecting mothers. [2] Prenatal and infant health care must be universalized and supervised by the government, extended to include even the uninsured.

 

The current inequality in health care is partly responsible for the high infant mortality rate in the US, as compared to other industrialized countries with more equitable distributions. Studies have shown that there is a large difference in the use of health services between privately and publicly insured women, but a small difference between publicly insured and uninsured women. This suggests that even with expanded coverage from the public sector, drastic improvements need to be made in order to bring about more equitable coverage between publicly and privately insured women. Inadequate access to health care, either because of lack of insurance or insufficient coverage, can be considered structural violence because government policies dictate who receives public insurance and how much health care is covered. This lack of access results in higher infant mortality rates because uninsured women are less likely to receive prenatal and infant care, resulting in more complications during and after birth. The inequality in infant mortality rates among minority groups reflects the distribution of insurance. 38% of Hispanics, 30% of Native Americans, 23% of African Americans and 20% of Asians are uninsured; only 13% of whites are uninsured. [3] In addition to income gaps, the difference in insurance between minorities and whites can also be attributed to rising public outcry against public insurance for immigrants without citizenship status. In recent years, tax-payer ridicule has resulted in strict rules limiting access to health care. Many non-citizens are hesitant to see a doctor, including pregnant women and new mothers, out of fear of deportation. It is also increasingly common that they are refused treatment because of their citizenship status.

 

In the developing world, infant mortality is an even larger issue. There are four million infants each year that die each year, and most of them are born into poverty. The biggest problem is the lack of qualified health professionals, leaving both infants and mothers to be susceptible to bacterial infection. In addition, conditions of birth asphyxia and sepsis with pneumonia cause nearly 60% of all neonatal deaths worldwide. [4] Although these deaths are preventable, health systems fail to deliver the necessary care to cure the diseases at birth for millions of infants born in underserved areas.

 
Sources:
[1] "Infant Morality and African Americans." Office of Minority Health. <http://www.omhrc.gov/templates/content.aspx?ID=3021>

[2] "Eliminate Disparities in Infant Mortality." Office of Minority Health and Health Disparities. <http://www.cdc.gov/omhd/amh/factsheets/infant.htm>

[3] March of Dimes Senate Testimony – Uninsured Pregnant Women: Impact on Infant and Maternal Mortality. Issues and Priorities. 24 October 2002. March of Dimes. 11 May 2009. <http://www.marchofdimes.com/855_4397.asp>

[4] State of the World's Mothers 2006: Saving the Lives of Mothers and Newborns. Save the Children. May 2006. <http://www.savethechildren.org/publications/mothers/2006/SOWM_2006_final.pdf>

 
"Interventions to address maternal, newborn, and child survival: what difference can integrated primary healthcare strategies make?" The Lancet,
Volume 372, Issue 9642, Pages 972 - 989, 13 September 2008 <http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61407-5/fulltext> (need login, but about interventions for world infant mortality through primary care"
 
"Neonatal Mortality--4 millions reasons for progress." The Lancet,
Volume 371, Issue 9628, Pages 1893 - 1895, 7 June 2008. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60810-7/fulltexthttp://www.thelancet.com/images/clear.gif

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