We will end this week's discussion on health care policy by understanding the problems from the start to see what the solutions are in reversing all this bad health policy. Baltimore was ground zero as usual for these frauds and corruption and that includes the fleecing of our Federal health programs for profit. Reagan era as we see----1987 ----placed the ROBBER BARON period in full swing Schmoke graduated from an initiation at Yale and Harvard comes to being Mayor of Baltimore at the same time Reagan is privatizing all that is public and dismantling all oversight and accountability to set the stage for the series of massive frauds against our government coffers and people's pockets occurred. REAGAN appointed Greenspan as FED----Greenspan created the atmosphere of naked capitalism---DO ANYTHING YOU WANT TO ACCUMULATE EXTREME WEALTH. Reagan was Ayn Rand far-right Libertarian basically the same as we call neo-liberalism. Clinton came next running as a Democrat taking our party to this same far-right neo-liberalism----LYING, CHEATING, STEALING.
THIS WAS WHEN OUR PUBLIC HEALTH STRUCTURES WERE DEFUNDED AND DISMANTLED JUST AS WAS OUR PUBLIC SCHOOLS. THE THOUSANDS OF YEARS OF MEDICAL ETHOS ---DO NO HARM HIPPOCRATIC OATH----WAS DISCARDED FOR PREDATORY PROFIT-DRIVEN HEALTH CARE.
When Clinton was sending US corporations overseas to escape US Constitutional rights and laws---he as Reagan were making sure our US city elections produced mayors and appointed public agency heads willing to dismantle Rule of Law, misappropriate all our Federal, state, and local funds to move all wealth to the top. Here in Baltimore that was SCHMOKE AND O'MALLEY----and every US city had it's health commissioners like BEILENSON-----medical schools began recruiting students tied to gaining wealth rather than worrying about public health and HIPPOCRATIC OATH.
THIS IS WHEN CORPORATION BUSINESS MODELS MADE WELFARE QUEENS OUT OF WHAT WAS THE BEST IN THE WORLD RULE OF LAW BUSINESS STRUCTURE. FORGET BEST PRACTICES AND TAKE WHAT YOU CAN GET.
This was when distribution of our Federal health care funding became PROGRESSIVE POSING---PRETENDING to have policies helping the poor, seniors, disabled while misappropriating all that funding.
On November 3, 1987, Schmoke was elected mayor.
'A year later, Beilenson - who earned his medical degree from Emory University in Atlanta and received public health training at the Johns Hopkins University - was appointed health commissioner by former Mayor Kurt L. Schmoke and is one of a handful of high-ranking city officials to have remained in office under Mayor Martin O'Malley'.
While US city public health became almost exclusively tied to drugs, STD, emergency medicine around violence----our rural communities were seeing all their Federal and state funding for health care defunded---and sent to US cities. That occurred not to give more health care to poor citizens---it happened to centralize all government funding where it could then be systematically fleeced. Black citizens didn't do this, white citizens didn't do this-----the 1% and their 5% across all population groups did this.
FDR A CENTURY AGO BUILT A STRONG PUBLIC HEALTH STRUCTURE THAT ALLOWED ALL AMERICANS TO WALK INTO PUBLIC CLINICS, PUBLIC HOSPITALS, PUBLIC NURSING HOMES AND BUILT OVERSIGHT AND ACCOUNTABILITY TO ASSURE THEY PROTECTED CITIZENS. THIS WAS WHAT REAGAN/CLINTON AND THESE LOCAL OFFICIALS DISMANTLED.
msJAMA | January 2, 2002
Where We Live: Health Care in Rural vs Urban America
FREEJane van Dis
JAMA. 2002;287(1):108. doi:10.1001/jama.287.1.108-The electoral map of 2000—with its coastal blue edges and pointillist urban centers set against great swaths of red—told many political and economic stories. Attitudes toward rural life often reveal a complex mixture of affection and disdain, ideas about neighborliness and isolation, simplicity and provincialism. In his recent essay, "One Nation, Slightly Divisible," David Brooks argues that the differences between rural and urban America may be merely superficial, exemplified in consumer preferences such as Wal-Mart vs Pottery Barn.1 Although I agree with his assertion that the two locales possess unique "sensibilities," there are important differences in rural vs urban health care.
While 20% of Americans live in rural areas, only 9% of the nation's physicians practice there. Poverty—a principal health risk factor in any geographic locale—is more prevalent in rural areas and is often related to increased rates of chronic disease and greater numbers of uninsured citizens.2 Rural residents have fewer physicians and nurses per capita and increased transportation barriers; they visit a physician less often and later in the course of their illness than do urban residents.2 This issue of MSJAMA explores the question of whether there are two US health care delivery systems, one urban and one rural.
Differences between urban and rural health care exist on a continuum defined by many variables. Susan Blumenthal and Jessica Kagen provide an epidemiologic background in which to consider important differences and markers between rural and urban health. Hilda Heady explores some of the monetary inequities embodied in rural vs urban reimbursement policies. Terry Meden and colleagues describe how distance from a tertiary care center may be related to decisions about mastectomy for rural women with stages I and II breast cancer. Although Roe vs Wade made abortion legal in the United States, this right may be moot in many rural settings. Trude Bennett explores some of these barriers to prenatal care, family planning, surgical contraception, and other reproductive health care services in rural areas. To address the chronic geographic maldistribution of physicians, Howard Rabinowitz and Nina Paynter outline the constructs that inform medical students' decision to become generalists or specialists and correlatively to practice in a rural vs an urban setting.
These inequities in rural vs urban health care delivery are based in structural, economic, and cultural differences. Through increased awareness, research, education, and preventive public health measures, congress, and ultimately communities and the health care providers who serve them, may begin to lessen the degrees of difference.
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This was the time that US cities emptied of industry and Wall Street with REAGAN/CLINTON pushed MASTER PLANS for cities that killed policies of rebuilding small business economies in communities devastated by lost jobs---they wanted US cities to die and real estate moved to what was to be the return of global corporations. Public health went from US citizens accessing any health care they needed as in Europe or Canada to being almost exclusively mental health/communicable disease management. This is why citizens across a state were moved to US cities-----centralizing all that government funding for programs where almost none of the funding made it citizens---it was misappropriated to expand institutions like Johns Hopkins into global corporations.
This state of community decay and never-ending unemployment deliberately created the public health crises we have today in Baltimore---and public health became centered on treating disease vectors tied to poverty.
EACH TIME THE 1% KEPT CREATING DATA AND MEDIA TELLING CITIZENS THIS WAS ALL INNOVATIVE----ALL INTELLIGENT AND WE HAD TALENTED PEOPLE ------ELITE AND EXCEPTIONAL----when it simply was taking a strong Rule of Law nation into being a criminal cartel with no business standards.
Former Baltimore Mayor Kurt Schmoke: Ahead of his Time
February 20, 2014 - By Maggie Taylor
Baltimore is a beautiful city, home to the glittering Inner Harbor, mouth-watering crab, and the best ballpark on earth. But if there’s one thing Baltimoreans know, it’s the ravages that drugs can have on families and communities. A staggering 10 percent of Baltimore residents have used an illicit drug in the past year, and nearly a third of all arrests in the city are for drug crimes.
The violence associated with the drug trade is so endemic to the city that HBO’s The Wire is begrudgingly accepted as an accurate portrayal of life for many residents. Meanwhile, the city’s health department has long been at the forefront in treating drug use as public health issues, offering needle exchange, naloxone, and comprehensive health services to Baltimoreans who use drugs. But the city wasn’t always so progressive; it took the bold ideas of Baltimore’s first African-American mayor to transform the way the city – and the nation – look at drug policy.
Kurt Schmoke could have gone anywhere he wanted in life: he was a graduate of Harvard Law, a Rhodes Scholar, and a former advisor to President Jimmy Carter. Schmoke has joked that he is “a man who had a bright future.” But in the early 1980s, he returned to his troubled hometown to seek public office, eventually being elected as the city’s first African-American mayor in 1987.
To call Mayor Schmoke a man ahead of his time is more than an understatement – in the 1980s, he was advancing ideas that remain controversial to this day. At the 1988 U.S. Conference of Mayors, Schmoke shocked the audience by coming out in favor of treating drug use as a health rather than a criminal justice issue, and calling for Congressional hearings to begin a national debate about drug policy. This speech made Mayor Schmoke the first public official in the country to argue in favor of drug decriminalization. His controversial comments gained Mayor Schmoke national attention – not all of it positive. He was famously derided by Rep. Charles Rangel as “the most dangerous man in America” for arguing against drug prohibition.
Mayor Schmoke was inspired to promote the “medicalization” of drug use because he understood that people who struggle with drug addiction are facing an illness, not a moral failing, and should be treated in a medical context. He was also concerned about the spread of HIV/AIDS, which, at the time he was mayor, was a national crisis for public health workers. While it seems common-sense to us now that safe syringes are critical to combatting the spread of infection, at the time his statements were less than palatable. His arguments in favor of heroin maintenance therapy have yet to gain the traction of syringe exchange, but are characteristic of Mayor Schmoke’s dedication to rational, data-driven policy choices.
While Mayor Schmoke is now the Interim Provost and General Counsel of Howard University Law School, he still lives in the Ashburton neighborhood of Baltimore, and he is still best known for his revolutionary stance on drug policy. He continues to promote reform, quietly working to increase Baltimore’s substance abuse treatment capacity and serving on the honorary board of the Drug Policy Alliance.
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This same movement of public health to drugs, STD, and mental health occurred in rural communities as well----it just looked different. So, what was a strong system of public hospitals, public clinics, lots of doctors easy access to all kinds of health care paid for with our Federal, state, and local taxes and PAYROLL taxes now become this network of what for the health industry is CHEAP MEDICINE. It is far more COST EFFECTIVE to send more and more US citizens to treatment programs then to have them accessing REAL PUBLIC HEALTH CARE.
This was Beilenson's job in Baltimore during that REAGAN/CLINTON SCHMOKE/O/MALLEY period we call the ROBBER BARON period. We see the same public health issues today that they were addressing 30 years ago because none of the problems causing these illnesses were addressed---employment, bad housing conditions, bad water, bad soil, bad criminal justice system. Even college grads tasked with what was central to Baltimore's public health ----QUESTIONNAIRES ---have become apathetic as citizen and public health employees knew these policies were schemes.
PUBLIC HEALTH NOW BECOMES MEDICAL RESEARCH. IT WAS EARLIER BUT WAS NOW ALLOWED TO SOAR. IF YOU WANT TO SEE A DOCTOR---JOIN A RESEARCH PROJECT.
Dr. Beilenson as Baltimore Health Commissioner as with those following him had a duty to citizens to keep their environment safe and healthy------to fight to secure health funding for what was legally identified for citizens----to assure citizens medical practice in Baltimore was safe, tested, with pathways to justice when not. That is what a government appointed director has as a mission. Beilenson did the opposite---he embraced the idea there were no public rights or uses for taxes----that taxation was about growing business.
Health care is different in rural areas and urban areas. The same is true for mental health care.
Contact usJames Boulger
Program Director/Director of Alumni Affairs
University of Minnesota Medical School
University of Minnesota Foundation
218-726-7144 | jboulger@d.umn.edu
The Center for Rural Mental Health Studies at the University of Minnesota Medical School, Duluth campus, seeks to better understand the factors that contribute to mental health and disorders in rural areas and the barriers to effective treatment. With that knowledge, we can generate better approaches to prevention, assessment, and treatment that fit in rural settings financially, culturally, and geographically.
Rather than simply creating an ‘urban’ care system in rural Minnesota, our goal is to create a system of mental health care that fits the rural setting.
Why this mission is important to rural families and clinics
More than 50 percent of visits made to family physicians are for health problems with significant social/behavioral components such as anxiety, depression, addictions, obesity, and pain. Incorporating mental and behavioral health approaches in the treatment of primary health problems results in better treatment success and, ultimately, reduces use of health care services.
The rural setting presents unique challenges to providing quality mental health care.
Bringing mental health services to rural primary health care settings is one of our objectives. In 2003, the center began providing telemental health services in one rural primary medical care clinic in northern Minnesota. We now serve Minnesota communities in Appleton, Bigfork, Cook, Ely, Floodwood, Littlefork, Moose Lake, Mora, Nett Lake, Paynesville, and Vermillion.
Center projects have included:
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Two things from article yesterday----the idea that corporate non-profits replace our public health structure IS FALSE. That is not what public option was framed to be. Second is this idea that a century of all Americans accessing all the health care they needed was CHARITY......HOSPITALS WERE FORCED TO CHARITABLE CARE WHEN ACCEPTING ALL PATIENTS.
When Clinton used EXECUTIVE ORDER to install FEDERALISM ACT-----this was the state's rights over Federal law procedure that was NEVER CONSTITUTIONAL. They cannot simply decide not to enforce any Federal law or our Constitutional rights. That set the stage for states to do with Federal health care money what they wanted. Maryland took that further by seeking exemption from Medicare oversight so citizens in Maryland were denied the same rights as all citizens around the nation. Since FDR and his national public health infrastructure---and LBJs Medicare and Medicaid programs billions of dollars were set aside in a Federal agency tasked with making sure hospitals were reimbursed when a low-income citizen could not pay for needed care. It is this Federal fund's SPECIFICALLY STATED MISSION----to protect hospitals from losses in allowing care for all----THAT WAS ALLOWED TO BE MISAPPROPRIATED ----and now Obama and Congressional Clinton neo-liberals defunded this agency altogether saying those few billions were too costly.
At the same time HUNDREDS OF BILLIONS OF DOLLARS IN HEALTH INDUSTRY FRAUD SOAKED OUR MEDICARE AND MEDICAID TRUSTS.
It was US cities under this Reagan/Schmoke/Clinton/O'Malley reign that opened our national public health to systemic fleecing by fraud. Republican voters convinced these Federal programs were SOCIALISM----now pay twice the taxes for corporate welfare queens like EVERGREEN HEALTH.
'Remember, there is a reason that the nonprofit health insurance cooperatives exist. It is because Congress nixed President Obama’s push for the “public option” to provide effective competition with the big insurers'.
'No matter where they are, all hospitals are obliged under federal law to treat anyone who arrives at the emergency room, regardless of their immigration status'.
Here we see the same cuts now falling on immigrants who under Federal laws OF DO NO HARM AND HIPPOCRATIC OATH......were required to have access to emergency care--- Cuts in Federal funding for what has been thousands of years of DO NO HARM HIPPOCRATIC OATH------of course pushes these costs to states and local governments that everyone knows cannot afford these policies. Florida elected as their governor the former CEO of HCA-----Hospital Corporation of America---known to have grown to a global health corporations by systematic health fraud-----at the same time Johns Hopkins was doing the same locally growing to a global corporation.
Hospitals Fear Cuts in Aid for Care to Illegal Immigrants
By NINA BERNSTEINJULY 26, 2012
President Obama’s health care law is putting new strains on some of the nation’s most hard-pressed hospitals, by cutting aid they use to pay for emergency care for illegal immigrants, which they have long been required to provide.
This Federal agency tasked with meeting FDR/LBJ public health access are still there----they have simply been defunded and laws ignored. So, when a media article calls low-income health access to hospitals CHARITY------THEY ARE LYING. Hospitals around the nations were reimbursed for all care.
Feds Wary Of State's LIP Plan
By News Service of Florida • Jun 1, 2015
The federal Centers for Medicare & Medicaid Services is wary of approving a state proposal for helping fund hospitals without knowing more about Florida's plan for the future, an official said Friday.
The statement came as the two sides try to work out an agreement on how to fund hospitals under a program known as the Low Income Pool, or LIP. Funding for the program will decline to $1 billion in the 2015-16 budget year, which begins July 1.
LIP includes $2.2 billion in the current year. The state has proposed offsetting the loss of funds by using some local money to boost the Medicaid rates paid to providers like hospitals. Local money currently helps bankroll LIP.
"We have not heard from the state on their proposal for 2016-17 when the LIP is reduced further to $600 million in spending authority (roughly $360 million federal funds, $240 million state funds)," the official, communicating on background, wrote in an email.
"Knowing that the state has a viable plan for 2016-17 is critical for CMS before signing off on transitional funding for 2015-16."
The official also indicated that the federal government wasn't sure local sources, such as hospital districts, would continue to provide all the funding they currently give the state without assurances of getting a return on their investment, something that is a key part of LIP.
A spokesman for the U.S. Department of Health and Human Services, which includes CMS, said the agency was still looking at the proposal submitted by the state Agency for Health Care Administration, which answers to Gov. Rick Scott.
"CMS continues to be engaged with Florida regarding the state's LIP proposal and the May 26 letter but has not communicated approval," spokesman Ben Wakana said, referring to a May 26 letter from state Medicaid director Justin Senior.
"CMS is reviewing the proposal and public comments, and working to understand the implications of the letter as well as the viability and sustainability of the proposed funding mechanism."
LIP funding will be a key issue as state lawmakers begin a special session Monday to negotiate a budget for the upcoming fiscal year. Jackie Schutz, a Scott spokeswoman, fired back at federal officials late Friday.
"Without HHS finalizing an agreement in principal on this federal health-care funding for the poor, we will fail to have a budget that keeps Florida's economy growing,'' Schutz said in a prepared statement.
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Any health professional knows this transition from a developed nation public health access for all to what is now a predatory, profit-driven health care for a small percentage of the world's rich as led over these few decades to America having the same clinical care as citizens in developing nations. American health care is modeled on World Health and UN health care for third world nations.
This is why we see all care tied to drugs, STD, infant mortality----IT'S THE SAME MODEL.
When Baltimore media prints stats given by the Baltimore Health Commission saying public health stats are getting better---they are using the pushing out 150,000 of the city's poor taking with them their health problems as the successful way to create better public health. Baltimore and Johns Hopkins School of Public Health DOES NOT CARE THAT THOSE 150,000 PEOPLE LEFT THE CITY STILL IN BAD HEALTH----they only care that they are gone and now younger citizens will be brought in who are healthier. Hopkins again doesn't care that those young citizens are now going to be exposed to these same public/environmental health problems====
IT IS NOT PUBLIC HEALTH IF GOALS ARE SIMPLY TO PUSH THE SICK, ELDERLY, DISABLED OUT OF THE CITY.
When Baltimore says infant mortality or wellness for mothers or care for the disabled or growing education testing scores-----it simply sits by and does nothing while pushing citizens out of the city.
IF WE THE PEOPLE KEEP SITTING AND ALLOWING THESE POLICIES TO CONTINUE BECAUSE IT HASN'T HAPPENED TO OUR FAMILIES----IT SOON WILL TAKE OUR FAMILIES.
Please glance to see what US health care will look like for 99% of Americans if this global health tourism for the rich continues. Americans are falling fast to this third world poverty thanks to CLINTON/BUSH/OBAMA 1% Wall Street global corporate health policies.
'Introduction of “health for all.”
By the mid-1970s international health agencies and experts began to examine alternative approaches to health improvement in developing countries. The impressive health gains in China as a result of its community-based health programs and similar approaches elsewhere stood in contrast to the poor results of disease-focused programs'.
Comprehensive Versus Selective Primary Health Care: Lessons For Global Health Policy
Abstract
Primary health care was declared the model for global health policy at a 1978 meeting of health ministers and experts from around the world. Primary health care requires a change in socioeconomic status, distribution of resources, a focus on health system development, and emphasis on basic health services. Considered too idealistic and expensive, it was replaced with a disease-focused, selective model. After several years of investment in vertical interventions, preventable diseases remain a major challenge for developing countries. The selective model has not responded adequately to the interrelationship between health and socioeconomic development, and a rethinking of global health policy is urgently needed.
Meeting people’s basic health needs requires addressing the underlying social, economic, and political causes of poor health.
The health care systems of many developing countries emerged from colonial medical services that emphasized costly high-technology, urban-based, curative care.
When these countries became independent in the 1950s and 1960s, they inherited health care systems modeled after the systems in industrialized nations.2 Public health programs of international development agencies during this period were also largely targeted at eradicating specific diseases such as smallpox, yaws, and malaria. Each disease eradication program operated autonomously, with its own administration and budget and very little integration into the larger health system.3 There were some successes during this period (for example, eradication of smallpox and a decrease in tuberculosis). However, these short-term interventions were not addressing poor populations’ overall disease burden.4 Analysts realized that although one disease might be controlled or eliminated, recipients of that intervention might die of another disease or its complications.5 The situation worsened into the early 1970s, as populations continued to experience failing health outcomes with rising spending.6
Recognizing that narrow targets were not the only option, countries attempted to implement comprehensive approaches to the provision of basic health services. Examples included the creation of the rural health center, staffed by medical and health assistants and supported by the Bhore Commission in India; the implementation of “community-based health programs” in Nicaragua, Costa Rica, Guatemala, Honduras, Mexico, Bangladesh, and the Philippines; and the barefoot doctor program in China.7 As part of the overall efforts to improve population health, these countries brought a new theme to international health discourse: commitment to social equity in health services. Social equity means that although different socioeconomic levels exist, the gaps between those levels are not insurmountable.8 Examples from these countries contributed to the optimism that inequity could be tackled to improve global health.
Introduction of “health for all.”
By the mid-1970s international health agencies and experts began to examine alternative approaches to health improvement in developing countries. The impressive health gains in China as a result of its community-based health programs and similar approaches elsewhere stood in contrast to the poor results of disease-focused programs. Soon this bottom-up approach that emphasized prevention and managed health problems in their social contexts emerged as an attractive alternative to the top-down, high-tech approach and raised optimism about the feasibility of tackling inequity to improve global health. Thus, “health for all” was introduced to global health planners and practitioners by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) at the International Conference on Primary Health Care in Alma Ata, Kazakhstan, in 1978.9 The declaration was intended to revolutionize and reform previous health policies and plans used in developing countries, and it reaffirmed WHO’s definition of health in 1946: “a state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity.”10 The conference declared that health is a fundamental human right and that attainment of the highest possible level of health was an important worldwide social goal.
To achieve the goal of health for all, global health agencies pledged to work toward meeting people’s basic health needs through a comprehensive approach called primary health care. Primary health care as envisioned at Alma Ata had strong sociopolitical implications. It explicitly outlined a strategy that would respond more equitably, appropriately, and effectively to basic health needs and also address the underlying social, economic, and political causes of poor health.11
It was to be underpinned by universal accessibility and coverage on the basis of need, with emphasis on disease prevention and health promotion, community participation, self-reliance, and intersectoral collaboration.12 It acknowledged that poverty, social unrest and instability, the environment, and lack of basic resources contribute to poor health status. It outlined eight elements that future interventions would use to fulfill the goal of health improvement: education concerning prevailing health problems and methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs.
Selective primary health care.
One year after the Alma Alta declaration, Julia Walsh and Kenneth Warren presented “selective primary health care” as an “interim” strategy to begin the process of primary health care implementation.13 They argued that the best way to improve health was to fight disease based on cost-effective medical interventions. Although they acknowledged that the goal set at Alma Ata was “above reproach,” they contended that its scope and resource constraints made it unattainable. They proposed that a selective attack on a region’s most severe public health problems would maximize improvement of health in developing countries. They identified four factors to guide the selection of target diseases for prevention and treatment: prevalence, morbidity, mortality, and feasibility of control (including efficacy and cost). Thus, rather than the envisioned emphasis on development and sustainability of health systems and infrastructures to improve population health, primary health care implementation in developing countries became focused on four vertical programs: growth monitoring, oral rehydration therapy, breastfeeding, and immunization (GOBI). Family planning, female education, and food supplementation (FFF) were added later. These interventions targeted only women of childbearing age (15–45) and children through age five. This narrow selection of specific conditions for these population groups was designed to improve health statistics, but it abandoned Alma Ata’s focus on social equity and health systems development. This transformation from the lofty goals set at Alma Ata to a selective approach sparked more than two decades of exhaustive debate.
Effectiveness Of Comprehensive Primary Health Care
Some global health analysts argue that comprehensive primary health care was an experiment that failed; others contend that it was never truly tested. With only one year between the Alma Ata declaration and the shift toward a selective approach to its implementation, the transformative potential of comprehensive primary health care remained largely unexploited. Nevertheless, there were some important successes, particularly in the 1980s. Mozambique, Cuba, and Nicaragua, for example, expanded their primary health care coverage and greatly improved their population health indices.14 The keys to these accomplishments were the political will to meet all citizens’ basic health needs, active popular participation in the effort to realize this goal, and increased social and economic equity.15
Whereas the progress in Mozambique and Nicaragua was short-lived, Cuba has maintained steady progress even after the collapse of, and loss of support from, the Soviet Union and many years of embargo by the United States.16 Its success has been attributed to its model primary health care system.17 Under the Cuban constitution, health care is a right of citizens and a responsibility of government. In addition, Cuba’s Public Health Law outlines the principles of the National Healthcare System as follows: socialized medicine organized by government; basic services accessible to the whole population and free to all; preventive medicine as the hallmark of the system; public participation in health care; and a comprehensive approach to planned development of the health system. A 1997 report from the American Association for World Health, analyzing the U.S. embargo’s effects on health in Cuba, concluded that a humanitarian catastrophe had been averted because the country maintained a high level of budgetary support for a health care system designed to deliver primary and preventive health care to all of its citizens.18 Cuba’s population health indices are on a par with those of developed countries that have several times its budget: Life expectancy is seventy-seven years, and the infant mortality rate is 7.7 per 1,000 live births, which ranks Cuba among the twenty-five countries in the world with the lowest infant mortality rates. As Cesar Chelala observed, Cuba’s infant mortality rate for 1997 was half that of Washington, D.C.19
Effectiveness Of Selective Primary Health Care
While many factors ultimately affected the implementation of primary health care by national governments and aid agencies, selective primary health care and the resulting programs that were and are supported cannot fulfill the ideals of Alma Ata, including the emphasis on self-reliance, which is essential for communities to promote and sustain their own health.
Shortcomings.
First, the selective approach ignores the broader context of development and the values that are imbued in the equitable development of countries. It does not address health as more than the absence of disease; as a state of well-being, including dignity; and as embodying the ability to be a functioning member of society. In conjunction with the lack of a development context, the selective model does not acknowledge the role of social equity and social justice for the recipients of technologically driven medical interventions. The reality of the model is that vertical programs are centered in urban hospitals and health care facilities. Without the participation of communities, there is no avenue for change.
Second, the donor-driven, technocratic approach to determining priorities for interventions detracts from the grassroots approach that the Alma Ata declaration stated was necessary for health development. Third, the model tends to preserve the status quo of vertical objectives, fighting one disease at a time and not incorporating these efforts into a higher baseline of health status.
Fourth, there is little coordination among these vertical programs, leading to redundancy, overlap, and waste. Finally, the sole emphasis on women and young children, to the neglect of other segments of the population, is an important flaw. The high burden of HIV/AIDS among people ages 20–39 in many developing countries (an indication of infection during adolescence) is not surprising, given the long neglect of this population group in health policy and practice.20
Improvements and deficits in global health.In spite of the above shortcomings, selective primary health care has been lauded as having contributed greatly to improvements in global health. It is said, for example, that eight of every ten children in the world today receive vaccinations against the five major childhood diseases.21 Globally, between 1980 and 1993 infant mortality fell by 25 percent, while overall life expectancy increased by more than four years, to sixty-five years.
However, whereas the number of children under age five who died from vaccine-preventable diseases decreased by 1.3 million between 1985 and 1993, more than twelve million of these children died within this period nevertheless. Of this figure, vaccine-preventable diseases still accounted for 2.4 million deaths. Moreover, childhood diarrhea and malnutrition remain leading causes of impaired child health in developing countries, contributing greatly to the thirteen million deaths that occur annually among children under age five.22
A 2003 United Nations report argues that international assistance aimed at helping poorer countries develop is failing; it calls for a reexamination of current strategies if the world is to meet targets for reducing poverty, hunger, and illness.23 According to the report, fifty-four countries are poorer now than they were in 1990, and life expectancy has regressed in thirty-four countries, mostly in Africa.
Lessons For Future Global Health Policy
Although disease-specific interventions are important, assuring real change will require attention to environmental, political, and social actions that target the root causes of disease as envisaged at Alma Ata. Alma Ata’s comprehensive primary health care was a global recognition of some of the causes of unsatisfactory results in many programs.24 Studies during the 1970s revealed that lack of overall development was inextricably linked to health and that health discussed in a vacuum would never succeed. However, experimentation with comprehensive and selective approaches to global health policy have also revealed that discussion of health in the context of society, economics, politics, and development put many barriers in the way of success as well.
One of the ideological barriers was the concomitant challenge of social equity and social justice. Alma Ata made it the responsibility of governments and agencies to promote equity and ensure that certain citizens were not unduly suffering for the benefits received by others. Comprehensive primary health care combined many complex features into its definition of health and health care.
Various sectors need to work together.
First, because health does not occur in isolation, the various sectors, including those within a national government and among aid agencies, need to work together at every level of practice. The ministry of health is not the sole agency charged with production of health; departments of agriculture, housing, sanitation, and education, along with food distribution, are all involved in achieving health.
Interventions must come from needs of the community.
Second, the Alma Ata declaration requires that interventions come from the needs of the community, expressed and subsequently led by community members. Global health problems cannot be solved by distant policymakers and planners.25 Involvement of individuals and communities mobilizes local resources to deal with health problems.26 Implied in the concept of participation is decentralized physical location; programs need to be founded and researched in the locality in which they will be applied. The Alma Ata declaration also recognizes that the issue of accessibility to health services and resources has historically been a barrier to effective care and that placing emphasis on curative, tertiary care hospitals located in urban centers often precludes access for a mostly rural population.
Fullest potential difficult to achieve without supporting infrastructure.These are some of the underpinning principles behind the Alma Ata declaration; unfortunately, key elements are lacking in the selective approach adopted for its implementation. Some developing countries continue to rely on vertical programs, with less emphasis on people’s involvement and development of systems and infrastructures to sustain those programs. For example, although the current initiative on vaccines and immunization designed to help countries incorporate new vaccines into their national health systems surely has benefits for addressing specific communicable diseases, their fullest potential will be difficult to achieve in the absence of effective health systems and supporting infrastructures. Limited assessment of this initiative undertaken in Mozambique, Ghana, Lesotho, and Tanzania revealed that the infrastructural foundation needed for successful implementation and sustainability is inadequate.27
Maintaining the cost of expensive new vaccines after donor support ceases also poses a serious challenge to sustainability. As with most vertical programs, analysts have expressed concern that raising poor countries’ awareness of new vaccines and immunization programs without support in implementing such programs could end up creating markets for these vaccines while doing little to tackle major health problems.28
Given that disease-focused models continue to be funded and promoted in developing countries, it is apparent that adequate lessons have not been learned from experimentation with selective, vertical approaches; that the notion of self-reliance, community participation, and health systems development proposed at Alma Ata have diminished in importance; and that inadequate consideration is given to the link between health and socioeconomic development. Global health policy for the twenty-first century should recognize that high-tech and expensive models to address diseases of poverty will not be sustainable where infrastructures needed for operationalization and institutionalization of those technologies scarcely exist.
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If we look at this same ONE WORLD International Economic Zone Trans Pacific Trade Pact policy and then look at our local US city public health policy we see the bringing down of our developed nation health care being called TOO EXPENSIVE----to what has been through CLINTON/BUSH/OBAMA this installation of a global health care for all care for the world's poor. Same terms used----same focus---and that is what Obama and Clinton neo-liberals are now trying to make in this tiering of our health structures to extreme wealth vs extreme poverty. Beilenson is simply calling EVERGREEN HEALTH a corporate non-profit modeled for PUBLIC-OPTION----when it will simply be expanded to a global health corporations following these World Health Organization models. Meanwhile, all that was our Federal Health funding and trusts is building this global health tourism for the global 1% and their 2%.
PLEASE STOP ALLOWING RACE AND CLASS BE USED BY WALL STREET TO BREAK DOWN WHAT WAS A STRONG PUBLIC HEALTH SYSTEM BASED ON THOUSANDS OF YEARS OF WESTERN MEDICAL ETHOS.
'The MDGs are eight specific goals that the 191 United Nations (UN) states have committed themselves to achieving by 2015. The MDGs are:
1. to eradicate extreme poverty and hunger;
2. to achieve universal primary education;
3. to promote gender equality and empower women;
4. to reduce child mortality;
5. to improve maternal health;
6. to combat HIV/AIDS, malaria and other diseases;
7. to ensure environmental sustainability; and
8. to develop a global partnership for development[17]'.
We can believe as global NGOs PRETEND to install these policies overseas that the 1% of those nations will fleece those funds leaving global citizens with no health access. The US under WORLD HEALTH ORGANIZATION guidelines for its population of 99% of people in poverty----do we really want to go there?
What are the main functions of the World Health Organization?
Jacqueline Hope, Nov 8 2010, 82666 views
This content was written by a student and assessed as part of a university degree. E-IR publishes student essays & dissertations to allow our readers to broaden their understanding of what is possible when answering similar questions in their own studies.
Conclusion
This paper has looked at two questions. The first concerns the functioning of WHO and the second concerns how well WHO functions in relation to a specific area of its mandate. The specific area of WHO’s mandate this paper has addressed is the area of maternal health, an area often ignored by IR scholars in favour of areas of WHO’s functioning that present traditional, hard security threats, particularly infectious disease. The choice to focus on maternal health came out of an interest in the human security paradigm and the belief that because of the emergence of this paradigm IR scholars need to broaden their interest in WHO beyond the traditional interest in infectious disease.
The first section of this paper examined WHO’s functioning on a general level and discovered that WHO’s mandate is far broader than the control of infectious disease. Put succinctly WHO’s role in the international system is nothing short of ensuring the attainment of the highest level of all forms of health, physical, mental and emotional by all human beings.
The paper then turned its attention to maternal health, examining what maternal health is and what WHO’s role in ensuring the improvement of maternal health is. It was discovered that maternal health is an important indicator of overall development. More importantly however it was discovered that maternal health is an incredibly multifaceted idea, taking in physical, mental and emotional health and complicated by a great many issues linked into larger questions of development. It was also shown that WHO’s operations are complex. WHO functions not only at the international level but at regional and national levels as well.
The final section of the paper examined two alternative critiques of WHO’s functioning in relation to maternal health. One was focused on WHO’s functioning in relation to the MDGs. By this account WHO had made little progress in the area of maternal health and by some measures had gone backwards. This account is important because so much of WHO’s energy over the course of the last decade has been placed into achieving the MDGs. However the other account which focused on WHO’s functions as defined by the Eleventh General Programme of Work 2006-2015 presented a brighter prognosis. It argued that instead of focusing on the achievement of the MDGs WHO should place its energy into becoming a catalyst for long-term improvement in the field of maternal health by acting as a setter of norms for international health and international health policy.
One of the questions this paper set out to answer is whether or not it is possible to assess the functioning of an international body with a mandate as broad as the one WHO is required to fulfil by focusing on only a small area of its functioning. After only a brief assessment of WHO’s functioning in the relatively narrow area of maternal health the only conclusion that can be drawn is that it is not possible. In assessing WHO’s functioning in the area of maternal health this paper came to two entirely different conclusions regarding WHO’s effectiveness. Considering this it could be strongly argued that it is impossible to objectively and fairly assess the functioning of WHO as a whole. It may in fact be impossible to assess WHO’s functioning in individual policy areas in a manner that is objective, fair and just.
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We want to remember why these social Democratic policies were put into place. FDR was responding to the Great Depression caused by the same massive Wall Street fraud as is occurring today. As this video shows----when the economic crash hit a century ago it left unemployment sky high with families unable to care for their seniors, disabled, and maternal care. This was the motivation for our US public health system. Well, we are heading towards that century-ago economic crash and great depression/recession that is designed to do the same only this time around CLINTON/BUSH/OBAMA-----SCHMOKE, O'MALLEY, BEILENSON made sure there will be no safety net.
Look at life expectancy back in FDR-----61 for white citizens 48 for black citizens ----that is to where it will fall again as they raise Social Security retirement age. Social Security Trust will be taken out by this bond market fraud and junk bonding of our US Treasury.
FDA’s Huge Conflicts of Interest with Big Pharma50
By anh-usa on March 13, 2012 UncategorizedTragically, the drug they endorsed is killing the women who take it. Why is FDA doing this?
The birth control pills Yaz and Yasmin, which were endorsed by an FDA advisory committee last December, contain a drug called drospirenone. Women who take it are nearly seven times more likely to develop thromboembolism (obstruction of a blood vessel by a blood clot, which can cause deep vein thrombosis, pulmonary embolism, stroke, heart attack, and death) compared to women who do not take any contraceptive pill, and twice the risk of women who take a contraceptive pill containing levonorgestrel. Thousands of women have filed a lawsuit against Bayer, saying they were injured by Yaz or Yasmin.
Why would the FDA approve such a dangerous drug? An investigation by the Washington Monthly and the British medical journal BMJ found that at least four members of the advisory committee have either done work for the drugs’ manufacturers or licensees or received research funding from them. The members reported their industry ties to FDA, but FDA decided it didn’t matter and didn’t make the disclosures public.
REAGAN tripled payroll taxes saying he was protecting these social programs and then sent them to our US Treasury to fleece as he dismantled and defunded them. Bush's Medicare Advantage and Part D prescription was the first stage of privatization with more and more of our health care funding going to PHARMA----and Obama with Affordable Care Act privatized the entire system away. ACA's gutted of funding MEDICAID FOR ALL is simply installing World Health and UN global HEALTH CARE FOR ALL preventative care here in the US. This is the goal of Baltimore's MARYLAND HEALTH CARE FOR ALL by Johns Hopkins. Johns Hopkins' Maryland Health Care for All was founded by Beilenson. We can see that timeline when Clinton deregulated Wall Street and sent all US corporations overseas to when Bloomberg was tied to Baltimore's public health system. Hopkins is now only in name as he is now major shareholder. BLOOMBERG UNIVERSITY........
'The school was renamed the Johns Hopkins Bloomberg School of Public Health on April 20, 2001 in honor of Michael Bloomberg (founder of the eponymous media company) for his financial support and commitment to the school and Johns Hopkins University. Bloomberg has donated a total of $1.1 billion to Johns Hopkins University over a period of several decades'.
Public Health 1929-1941
Introduction
The October 1929 stock market crash and following Great Depression brought massive unemployment over the next decade, particularly the next several years. By 1933 25 percent of the U.S. work-force was out of work, amounting to over 12 million people. In reaction President Franklin Delano Roosevelt (served 1933–1945) introduced the New Deal in early 1933 when he took office. The New Deal consisted of a range of federal social and economic relief and recovery programs addressing a broad span of issues including work relief for the unemployed. The rise in poverty contributed to a decline in sanitation and hygiene in the rural areas and inner cities of the nation. The suicide rate was also on the increase.
During the Great Depression the public health movement of the United States had many successes and some spectacular failures. The New Deal programs played a key role in promoting health, particularly among the most impoverished. Leading up to the Great Depression the leading causes of death in the United States had become degenerative conditions. Heart disease and cancer killed twice as many people as influenza, pneumonia, and tuberculosis. Rates of infectious childhood diseases including measles, scarlet fever, whooping cough, and diphtheria had dropped significantly, and deaths from enteritis, typhoid, and paratyphoid fevers had been drastically reduced. These reductions were due in large part to medical advances and public health successes from the previous decades. Knowledge of how disease spread led to public health efforts to clean up water supplies, suppress epidemics through quarantines, and vaccinate populations threatened with infectious diseases. Research demonstrating that poor diet caused pellagra and scurvy and that unpasteurized milk could carry bovine tuberculosis resulted in education on how to prepare and store healthy foods and legislation that monitored the quality and content of food products. After 1932 public health officials in New Deal programs could point to these successes to prove the need for more health care spending as part of providing relief to those most affected by the economic crisis of the Great Depression.
During the period of the government social and economic recovery programs of the New Deal, the 1930s saw the second great push for national health insurance and the second great fight to defeat it. The battle illustrated the struggle between those who worried that health insurance would inevitably lead to government control of the American medical profession. That fear was already felt by many because of the rapidly growing role of the government under Roosevelt in combating Great Depression economic woes. It also highlighted the fear that public health professionals were overstepping their boundaries and treading on territory best left to private physicians. Public health after all was historically an issue of sanitation and water safety, not medicine. Even though medical economists and health insurance supporters such as Isidore Falk could prove how much money illness cost society, that did not mean that society should pay for its prevention. There was also the belief that the federal government could not adequately respond to local needs as they varied, depending on where you lived. Counties in the rural South were in desperate need of doctors, nurses, and hospitals. Cities in the urban North had better access to medical care but continued to suffer from the effects of overcrowding and poor sanitation. Finally there was the belief that additional funding for public health simply was not necessary. Statistics from the Metropolitan Insurance Company showed that despite slashed health department budgets, widespread unemployment, and the general lack of medical care, the death rate continued to decline. Between 1900 and 1930 the average life expectancy of a Caucasian male had increased by 11 years.
Despite such opposition nearly every piece of New Deal legislation provided funds for public health initiatives. The New Deal was President Roosevelt's plan for new reform and relief policies in the United States. Even the Federal Art Project of the Works Progress Administration (WPA), a New Deal agency, designed posters warning against cancer, and the Federal Writers Project created educational brochures
Chronology:1927:
The Committee on the Costs of Medical Care begins its five-year study of the state of public health in the United States. A joint effort of private philanthropic foundations and government agencies, it examines the economic costs of disease and poor health.
1930:
The Ransdell Act changes the name of the Hygienic Laboratory to the National Institute of Health and gives it authority to provide public funds for medical research.
1932:
The United States Public Health Service begins the Tuskegee Syphilis Study, which withholds medical treatment for syphilis from black American males. The experiment finally ends in 1972.
1935:
Polio vaccine trials are conducted using live polio virus. After nine deaths are reported out of 20,000 inoculations, the vaccine is withdrawn.
August 14, 1935:
President Roosevelt signs the Social Security Act that provides federal funds for state and local health programs.
1937:
In response to the increase of deaths from cancer in the United States, the National Cancer Institute is established with unanimous support from every Senator in Congress.
June 25, 1938:
Roosevelt signs the Federal Food, Drug, and Cosmetic Act replacing the basically ineffectual 1906 Food and Drugs Act.
July 1938:
The National Health Conference gathers public health officials, health care providers, and representatives from labor unions in Washington to discuss the medical needs of the nation.
1938:
The Venereal Disease Act is passed seeking to eradicate venereal disease through education and medical treatment.
1939:
The Wagner Bill, which proposes federal grants to establish state insurance systems, is introduced into the Senate. The bill dies in committee as attention shifts to an increasingly unstable Europe.describing syphilis and tuberculosis. The Social Security Act provided grants to states for the development of public health and the WPA and the Public Works Administration (PWA) built health centers, hospitals, and laboratories, as well as water and sewer systems. Public health functions were scattered among many government agencies. The Public Health Service, the largest agency devoted to health, was part of the Treasury Department. The Children's Bureau, which handled both maternal and child health, was in the Department of Labor, and the Food and Drug Administration was part of the Department of Agriculture. Unfortunately, because there were so many departments providing public health services during the Depression, some efforts inevitably became bogged down in bureaucratic bickering. Even the Interdepartmental Committee to Coordinate Health and Welfare Activities, a committee formed by President Roosevelt in 1936 to organize health efforts nationwide, fell victim to political influence when Martha Eliot, the assistant chief of the Children's bureau, suggested they all work separately on the sections of the program that would affect their particular agencies.
Failures such as these, however, did not detract from the successes of New Deal legislation. By the start of World War II (1939–1945) the Public Health Service had expanded its traditional role of monitoring and preventing infectious disease, protecting water supplies, and insuring the provision of clean milk, to actively providing both emergency and preventative health care. The public health movement was able to provide a safety net for those too indigent to provide one of their own.
1965
Johnson signs Medicare into law
On this day in 1965, President Lyndon B. Johnson signs Medicare, a health insurance program for elderly Americans, into law. At the bill-signing ceremony, which took place at the Truman Library in Independence, Missouri, former President Harry S. Truman was enrolled as Medicare’s first beneficiary and received the first Medicare card. Johnson wanted to recognize Truman, who, in 1945,had becomethe first president to propose national health insurance, an initiative that was opposed at the time by Congress.
The Medicare program, providing hospital and medical insurance for Americans age 65 or older, was signed into law as an amendment to the Social Security Act of 1935. Some 19 million people enrolled in Medicare when it went into effect in 1966. In 1972, eligibility for the program was extended to Americans under 65 with certain disabilities and people of all ages with permanent kidney disease requiring dialysis or transplant. In December 2003, President George W. Bush signed into law the Medicare Modernization Act (MMA), which added outpatient prescription drug benefits to Medicare.
Medicare is funded entirely by the federal government and paid for in part through payroll taxes. Medicare is currently a source of controversy due to the enormous strain it puts on the federal budget. Throughout its history, the program also has been plagued by fraud–committed by patients, doctors and hospitals–that has cost taxpayers billions of dollars.
Medicaid, a state and federally funded program that offers health coverage to certain low-income people, was also signed into law by President Johnson on July 30, 1965, as an amendment to the Social Security Act.
THIS WAS WHEN OUR PUBLIC HEALTH STRUCTURES WERE DEFUNDED AND DISMANTLED JUST AS WAS OUR PUBLIC SCHOOLS. THE THOUSANDS OF YEARS OF MEDICAL ETHOS ---DO NO HARM HIPPOCRATIC OATH----WAS DISCARDED FOR PREDATORY PROFIT-DRIVEN HEALTH CARE.
When Clinton was sending US corporations overseas to escape US Constitutional rights and laws---he as Reagan were making sure our US city elections produced mayors and appointed public agency heads willing to dismantle Rule of Law, misappropriate all our Federal, state, and local funds to move all wealth to the top. Here in Baltimore that was SCHMOKE AND O'MALLEY----and every US city had it's health commissioners like BEILENSON-----medical schools began recruiting students tied to gaining wealth rather than worrying about public health and HIPPOCRATIC OATH.
THIS IS WHEN CORPORATION BUSINESS MODELS MADE WELFARE QUEENS OUT OF WHAT WAS THE BEST IN THE WORLD RULE OF LAW BUSINESS STRUCTURE. FORGET BEST PRACTICES AND TAKE WHAT YOU CAN GET.
This was when distribution of our Federal health care funding became PROGRESSIVE POSING---PRETENDING to have policies helping the poor, seniors, disabled while misappropriating all that funding.
On November 3, 1987, Schmoke was elected mayor.
'A year later, Beilenson - who earned his medical degree from Emory University in Atlanta and received public health training at the Johns Hopkins University - was appointed health commissioner by former Mayor Kurt L. Schmoke and is one of a handful of high-ranking city officials to have remained in office under Mayor Martin O'Malley'.
While US city public health became almost exclusively tied to drugs, STD, emergency medicine around violence----our rural communities were seeing all their Federal and state funding for health care defunded---and sent to US cities. That occurred not to give more health care to poor citizens---it happened to centralize all government funding where it could then be systematically fleeced. Black citizens didn't do this, white citizens didn't do this-----the 1% and their 5% across all population groups did this.
FDR A CENTURY AGO BUILT A STRONG PUBLIC HEALTH STRUCTURE THAT ALLOWED ALL AMERICANS TO WALK INTO PUBLIC CLINICS, PUBLIC HOSPITALS, PUBLIC NURSING HOMES AND BUILT OVERSIGHT AND ACCOUNTABILITY TO ASSURE THEY PROTECTED CITIZENS. THIS WAS WHAT REAGAN/CLINTON AND THESE LOCAL OFFICIALS DISMANTLED.
msJAMA | January 2, 2002
Where We Live: Health Care in Rural vs Urban America
FREEJane van Dis
JAMA. 2002;287(1):108. doi:10.1001/jama.287.1.108-The electoral map of 2000—with its coastal blue edges and pointillist urban centers set against great swaths of red—told many political and economic stories. Attitudes toward rural life often reveal a complex mixture of affection and disdain, ideas about neighborliness and isolation, simplicity and provincialism. In his recent essay, "One Nation, Slightly Divisible," David Brooks argues that the differences between rural and urban America may be merely superficial, exemplified in consumer preferences such as Wal-Mart vs Pottery Barn.1 Although I agree with his assertion that the two locales possess unique "sensibilities," there are important differences in rural vs urban health care.
While 20% of Americans live in rural areas, only 9% of the nation's physicians practice there. Poverty—a principal health risk factor in any geographic locale—is more prevalent in rural areas and is often related to increased rates of chronic disease and greater numbers of uninsured citizens.2 Rural residents have fewer physicians and nurses per capita and increased transportation barriers; they visit a physician less often and later in the course of their illness than do urban residents.2 This issue of MSJAMA explores the question of whether there are two US health care delivery systems, one urban and one rural.
Differences between urban and rural health care exist on a continuum defined by many variables. Susan Blumenthal and Jessica Kagen provide an epidemiologic background in which to consider important differences and markers between rural and urban health. Hilda Heady explores some of the monetary inequities embodied in rural vs urban reimbursement policies. Terry Meden and colleagues describe how distance from a tertiary care center may be related to decisions about mastectomy for rural women with stages I and II breast cancer. Although Roe vs Wade made abortion legal in the United States, this right may be moot in many rural settings. Trude Bennett explores some of these barriers to prenatal care, family planning, surgical contraception, and other reproductive health care services in rural areas. To address the chronic geographic maldistribution of physicians, Howard Rabinowitz and Nina Paynter outline the constructs that inform medical students' decision to become generalists or specialists and correlatively to practice in a rural vs an urban setting.
These inequities in rural vs urban health care delivery are based in structural, economic, and cultural differences. Through increased awareness, research, education, and preventive public health measures, congress, and ultimately communities and the health care providers who serve them, may begin to lessen the degrees of difference.
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This was the time that US cities emptied of industry and Wall Street with REAGAN/CLINTON pushed MASTER PLANS for cities that killed policies of rebuilding small business economies in communities devastated by lost jobs---they wanted US cities to die and real estate moved to what was to be the return of global corporations. Public health went from US citizens accessing any health care they needed as in Europe or Canada to being almost exclusively mental health/communicable disease management. This is why citizens across a state were moved to US cities-----centralizing all that government funding for programs where almost none of the funding made it citizens---it was misappropriated to expand institutions like Johns Hopkins into global corporations.
This state of community decay and never-ending unemployment deliberately created the public health crises we have today in Baltimore---and public health became centered on treating disease vectors tied to poverty.
EACH TIME THE 1% KEPT CREATING DATA AND MEDIA TELLING CITIZENS THIS WAS ALL INNOVATIVE----ALL INTELLIGENT AND WE HAD TALENTED PEOPLE ------ELITE AND EXCEPTIONAL----when it simply was taking a strong Rule of Law nation into being a criminal cartel with no business standards.
Former Baltimore Mayor Kurt Schmoke: Ahead of his Time
February 20, 2014 - By Maggie Taylor
Baltimore is a beautiful city, home to the glittering Inner Harbor, mouth-watering crab, and the best ballpark on earth. But if there’s one thing Baltimoreans know, it’s the ravages that drugs can have on families and communities. A staggering 10 percent of Baltimore residents have used an illicit drug in the past year, and nearly a third of all arrests in the city are for drug crimes.
The violence associated with the drug trade is so endemic to the city that HBO’s The Wire is begrudgingly accepted as an accurate portrayal of life for many residents. Meanwhile, the city’s health department has long been at the forefront in treating drug use as public health issues, offering needle exchange, naloxone, and comprehensive health services to Baltimoreans who use drugs. But the city wasn’t always so progressive; it took the bold ideas of Baltimore’s first African-American mayor to transform the way the city – and the nation – look at drug policy.
Kurt Schmoke could have gone anywhere he wanted in life: he was a graduate of Harvard Law, a Rhodes Scholar, and a former advisor to President Jimmy Carter. Schmoke has joked that he is “a man who had a bright future.” But in the early 1980s, he returned to his troubled hometown to seek public office, eventually being elected as the city’s first African-American mayor in 1987.
To call Mayor Schmoke a man ahead of his time is more than an understatement – in the 1980s, he was advancing ideas that remain controversial to this day. At the 1988 U.S. Conference of Mayors, Schmoke shocked the audience by coming out in favor of treating drug use as a health rather than a criminal justice issue, and calling for Congressional hearings to begin a national debate about drug policy. This speech made Mayor Schmoke the first public official in the country to argue in favor of drug decriminalization. His controversial comments gained Mayor Schmoke national attention – not all of it positive. He was famously derided by Rep. Charles Rangel as “the most dangerous man in America” for arguing against drug prohibition.
Mayor Schmoke was inspired to promote the “medicalization” of drug use because he understood that people who struggle with drug addiction are facing an illness, not a moral failing, and should be treated in a medical context. He was also concerned about the spread of HIV/AIDS, which, at the time he was mayor, was a national crisis for public health workers. While it seems common-sense to us now that safe syringes are critical to combatting the spread of infection, at the time his statements were less than palatable. His arguments in favor of heroin maintenance therapy have yet to gain the traction of syringe exchange, but are characteristic of Mayor Schmoke’s dedication to rational, data-driven policy choices.
While Mayor Schmoke is now the Interim Provost and General Counsel of Howard University Law School, he still lives in the Ashburton neighborhood of Baltimore, and he is still best known for his revolutionary stance on drug policy. He continues to promote reform, quietly working to increase Baltimore’s substance abuse treatment capacity and serving on the honorary board of the Drug Policy Alliance.
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This same movement of public health to drugs, STD, and mental health occurred in rural communities as well----it just looked different. So, what was a strong system of public hospitals, public clinics, lots of doctors easy access to all kinds of health care paid for with our Federal, state, and local taxes and PAYROLL taxes now become this network of what for the health industry is CHEAP MEDICINE. It is far more COST EFFECTIVE to send more and more US citizens to treatment programs then to have them accessing REAL PUBLIC HEALTH CARE.
This was Beilenson's job in Baltimore during that REAGAN/CLINTON SCHMOKE/O/MALLEY period we call the ROBBER BARON period. We see the same public health issues today that they were addressing 30 years ago because none of the problems causing these illnesses were addressed---employment, bad housing conditions, bad water, bad soil, bad criminal justice system. Even college grads tasked with what was central to Baltimore's public health ----QUESTIONNAIRES ---have become apathetic as citizen and public health employees knew these policies were schemes.
PUBLIC HEALTH NOW BECOMES MEDICAL RESEARCH. IT WAS EARLIER BUT WAS NOW ALLOWED TO SOAR. IF YOU WANT TO SEE A DOCTOR---JOIN A RESEARCH PROJECT.
Dr. Beilenson as Baltimore Health Commissioner as with those following him had a duty to citizens to keep their environment safe and healthy------to fight to secure health funding for what was legally identified for citizens----to assure citizens medical practice in Baltimore was safe, tested, with pathways to justice when not. That is what a government appointed director has as a mission. Beilenson did the opposite---he embraced the idea there were no public rights or uses for taxes----that taxation was about growing business.
Health care is different in rural areas and urban areas. The same is true for mental health care.
Contact usJames Boulger
Program Director/Director of Alumni Affairs
University of Minnesota Medical School
University of Minnesota Foundation
218-726-7144 | jboulger@d.umn.edu
The Center for Rural Mental Health Studies at the University of Minnesota Medical School, Duluth campus, seeks to better understand the factors that contribute to mental health and disorders in rural areas and the barriers to effective treatment. With that knowledge, we can generate better approaches to prevention, assessment, and treatment that fit in rural settings financially, culturally, and geographically.
Rather than simply creating an ‘urban’ care system in rural Minnesota, our goal is to create a system of mental health care that fits the rural setting.
Why this mission is important to rural families and clinics
More than 50 percent of visits made to family physicians are for health problems with significant social/behavioral components such as anxiety, depression, addictions, obesity, and pain. Incorporating mental and behavioral health approaches in the treatment of primary health problems results in better treatment success and, ultimately, reduces use of health care services.
The rural setting presents unique challenges to providing quality mental health care.
- Mental health providers are in short supply
- Existing mental health clinics are located a considerable distance from residents
- Seeking care from a mental health provider may carry a greater stigma
- Financial barriers exist due to inadequacies in health insurance coverage and large numbers of rural residents with incomes below the poverty level
Bringing mental health services to rural primary health care settings is one of our objectives. In 2003, the center began providing telemental health services in one rural primary medical care clinic in northern Minnesota. We now serve Minnesota communities in Appleton, Bigfork, Cook, Ely, Floodwood, Littlefork, Moose Lake, Mora, Nett Lake, Paynesville, and Vermillion.
Center projects have included:
- Outcome study involving the provision of mental health services provided via televideo
- Evaluation of five telehealth projects
- Evaluation of a maternal-mental health pilot project
- Involvement in a project evaluating the psychobiological mechanisms of stress and smoking relapse
- Interactive video delivery of mental health services in primary care clinics
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Two things from article yesterday----the idea that corporate non-profits replace our public health structure IS FALSE. That is not what public option was framed to be. Second is this idea that a century of all Americans accessing all the health care they needed was CHARITY......HOSPITALS WERE FORCED TO CHARITABLE CARE WHEN ACCEPTING ALL PATIENTS.
When Clinton used EXECUTIVE ORDER to install FEDERALISM ACT-----this was the state's rights over Federal law procedure that was NEVER CONSTITUTIONAL. They cannot simply decide not to enforce any Federal law or our Constitutional rights. That set the stage for states to do with Federal health care money what they wanted. Maryland took that further by seeking exemption from Medicare oversight so citizens in Maryland were denied the same rights as all citizens around the nation. Since FDR and his national public health infrastructure---and LBJs Medicare and Medicaid programs billions of dollars were set aside in a Federal agency tasked with making sure hospitals were reimbursed when a low-income citizen could not pay for needed care. It is this Federal fund's SPECIFICALLY STATED MISSION----to protect hospitals from losses in allowing care for all----THAT WAS ALLOWED TO BE MISAPPROPRIATED ----and now Obama and Congressional Clinton neo-liberals defunded this agency altogether saying those few billions were too costly.
At the same time HUNDREDS OF BILLIONS OF DOLLARS IN HEALTH INDUSTRY FRAUD SOAKED OUR MEDICARE AND MEDICAID TRUSTS.
It was US cities under this Reagan/Schmoke/Clinton/O'Malley reign that opened our national public health to systemic fleecing by fraud. Republican voters convinced these Federal programs were SOCIALISM----now pay twice the taxes for corporate welfare queens like EVERGREEN HEALTH.
'Remember, there is a reason that the nonprofit health insurance cooperatives exist. It is because Congress nixed President Obama’s push for the “public option” to provide effective competition with the big insurers'.
'No matter where they are, all hospitals are obliged under federal law to treat anyone who arrives at the emergency room, regardless of their immigration status'.
Here we see the same cuts now falling on immigrants who under Federal laws OF DO NO HARM AND HIPPOCRATIC OATH......were required to have access to emergency care--- Cuts in Federal funding for what has been thousands of years of DO NO HARM HIPPOCRATIC OATH------of course pushes these costs to states and local governments that everyone knows cannot afford these policies. Florida elected as their governor the former CEO of HCA-----Hospital Corporation of America---known to have grown to a global health corporations by systematic health fraud-----at the same time Johns Hopkins was doing the same locally growing to a global corporation.
Hospitals Fear Cuts in Aid for Care to Illegal Immigrants
By NINA BERNSTEINJULY 26, 2012
President Obama’s health care law is putting new strains on some of the nation’s most hard-pressed hospitals, by cutting aid they use to pay for emergency care for illegal immigrants, which they have long been required to provide.
This Federal agency tasked with meeting FDR/LBJ public health access are still there----they have simply been defunded and laws ignored. So, when a media article calls low-income health access to hospitals CHARITY------THEY ARE LYING. Hospitals around the nations were reimbursed for all care.
Feds Wary Of State's LIP Plan
By News Service of Florida • Jun 1, 2015
The federal Centers for Medicare & Medicaid Services is wary of approving a state proposal for helping fund hospitals without knowing more about Florida's plan for the future, an official said Friday.
The statement came as the two sides try to work out an agreement on how to fund hospitals under a program known as the Low Income Pool, or LIP. Funding for the program will decline to $1 billion in the 2015-16 budget year, which begins July 1.
LIP includes $2.2 billion in the current year. The state has proposed offsetting the loss of funds by using some local money to boost the Medicaid rates paid to providers like hospitals. Local money currently helps bankroll LIP.
"We have not heard from the state on their proposal for 2016-17 when the LIP is reduced further to $600 million in spending authority (roughly $360 million federal funds, $240 million state funds)," the official, communicating on background, wrote in an email.
"Knowing that the state has a viable plan for 2016-17 is critical for CMS before signing off on transitional funding for 2015-16."
The official also indicated that the federal government wasn't sure local sources, such as hospital districts, would continue to provide all the funding they currently give the state without assurances of getting a return on their investment, something that is a key part of LIP.
A spokesman for the U.S. Department of Health and Human Services, which includes CMS, said the agency was still looking at the proposal submitted by the state Agency for Health Care Administration, which answers to Gov. Rick Scott.
"CMS continues to be engaged with Florida regarding the state's LIP proposal and the May 26 letter but has not communicated approval," spokesman Ben Wakana said, referring to a May 26 letter from state Medicaid director Justin Senior.
"CMS is reviewing the proposal and public comments, and working to understand the implications of the letter as well as the viability and sustainability of the proposed funding mechanism."
LIP funding will be a key issue as state lawmakers begin a special session Monday to negotiate a budget for the upcoming fiscal year. Jackie Schutz, a Scott spokeswoman, fired back at federal officials late Friday.
"Without HHS finalizing an agreement in principal on this federal health-care funding for the poor, we will fail to have a budget that keeps Florida's economy growing,'' Schutz said in a prepared statement.
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Any health professional knows this transition from a developed nation public health access for all to what is now a predatory, profit-driven health care for a small percentage of the world's rich as led over these few decades to America having the same clinical care as citizens in developing nations. American health care is modeled on World Health and UN health care for third world nations.
This is why we see all care tied to drugs, STD, infant mortality----IT'S THE SAME MODEL.
When Baltimore media prints stats given by the Baltimore Health Commission saying public health stats are getting better---they are using the pushing out 150,000 of the city's poor taking with them their health problems as the successful way to create better public health. Baltimore and Johns Hopkins School of Public Health DOES NOT CARE THAT THOSE 150,000 PEOPLE LEFT THE CITY STILL IN BAD HEALTH----they only care that they are gone and now younger citizens will be brought in who are healthier. Hopkins again doesn't care that those young citizens are now going to be exposed to these same public/environmental health problems====
IT IS NOT PUBLIC HEALTH IF GOALS ARE SIMPLY TO PUSH THE SICK, ELDERLY, DISABLED OUT OF THE CITY.
When Baltimore says infant mortality or wellness for mothers or care for the disabled or growing education testing scores-----it simply sits by and does nothing while pushing citizens out of the city.
IF WE THE PEOPLE KEEP SITTING AND ALLOWING THESE POLICIES TO CONTINUE BECAUSE IT HASN'T HAPPENED TO OUR FAMILIES----IT SOON WILL TAKE OUR FAMILIES.
Please glance to see what US health care will look like for 99% of Americans if this global health tourism for the rich continues. Americans are falling fast to this third world poverty thanks to CLINTON/BUSH/OBAMA 1% Wall Street global corporate health policies.
'Introduction of “health for all.”
By the mid-1970s international health agencies and experts began to examine alternative approaches to health improvement in developing countries. The impressive health gains in China as a result of its community-based health programs and similar approaches elsewhere stood in contrast to the poor results of disease-focused programs'.
Comprehensive Versus Selective Primary Health Care: Lessons For Global Health Policy
Abstract
Primary health care was declared the model for global health policy at a 1978 meeting of health ministers and experts from around the world. Primary health care requires a change in socioeconomic status, distribution of resources, a focus on health system development, and emphasis on basic health services. Considered too idealistic and expensive, it was replaced with a disease-focused, selective model. After several years of investment in vertical interventions, preventable diseases remain a major challenge for developing countries. The selective model has not responded adequately to the interrelationship between health and socioeconomic development, and a rethinking of global health policy is urgently needed.
Meeting people’s basic health needs requires addressing the underlying social, economic, and political causes of poor health.
The health care systems of many developing countries emerged from colonial medical services that emphasized costly high-technology, urban-based, curative care.
When these countries became independent in the 1950s and 1960s, they inherited health care systems modeled after the systems in industrialized nations.2 Public health programs of international development agencies during this period were also largely targeted at eradicating specific diseases such as smallpox, yaws, and malaria. Each disease eradication program operated autonomously, with its own administration and budget and very little integration into the larger health system.3 There were some successes during this period (for example, eradication of smallpox and a decrease in tuberculosis). However, these short-term interventions were not addressing poor populations’ overall disease burden.4 Analysts realized that although one disease might be controlled or eliminated, recipients of that intervention might die of another disease or its complications.5 The situation worsened into the early 1970s, as populations continued to experience failing health outcomes with rising spending.6
Recognizing that narrow targets were not the only option, countries attempted to implement comprehensive approaches to the provision of basic health services. Examples included the creation of the rural health center, staffed by medical and health assistants and supported by the Bhore Commission in India; the implementation of “community-based health programs” in Nicaragua, Costa Rica, Guatemala, Honduras, Mexico, Bangladesh, and the Philippines; and the barefoot doctor program in China.7 As part of the overall efforts to improve population health, these countries brought a new theme to international health discourse: commitment to social equity in health services. Social equity means that although different socioeconomic levels exist, the gaps between those levels are not insurmountable.8 Examples from these countries contributed to the optimism that inequity could be tackled to improve global health.
Introduction of “health for all.”
By the mid-1970s international health agencies and experts began to examine alternative approaches to health improvement in developing countries. The impressive health gains in China as a result of its community-based health programs and similar approaches elsewhere stood in contrast to the poor results of disease-focused programs. Soon this bottom-up approach that emphasized prevention and managed health problems in their social contexts emerged as an attractive alternative to the top-down, high-tech approach and raised optimism about the feasibility of tackling inequity to improve global health. Thus, “health for all” was introduced to global health planners and practitioners by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) at the International Conference on Primary Health Care in Alma Ata, Kazakhstan, in 1978.9 The declaration was intended to revolutionize and reform previous health policies and plans used in developing countries, and it reaffirmed WHO’s definition of health in 1946: “a state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity.”10 The conference declared that health is a fundamental human right and that attainment of the highest possible level of health was an important worldwide social goal.
To achieve the goal of health for all, global health agencies pledged to work toward meeting people’s basic health needs through a comprehensive approach called primary health care. Primary health care as envisioned at Alma Ata had strong sociopolitical implications. It explicitly outlined a strategy that would respond more equitably, appropriately, and effectively to basic health needs and also address the underlying social, economic, and political causes of poor health.11
It was to be underpinned by universal accessibility and coverage on the basis of need, with emphasis on disease prevention and health promotion, community participation, self-reliance, and intersectoral collaboration.12 It acknowledged that poverty, social unrest and instability, the environment, and lack of basic resources contribute to poor health status. It outlined eight elements that future interventions would use to fulfill the goal of health improvement: education concerning prevailing health problems and methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs.
Selective primary health care.
One year after the Alma Alta declaration, Julia Walsh and Kenneth Warren presented “selective primary health care” as an “interim” strategy to begin the process of primary health care implementation.13 They argued that the best way to improve health was to fight disease based on cost-effective medical interventions. Although they acknowledged that the goal set at Alma Ata was “above reproach,” they contended that its scope and resource constraints made it unattainable. They proposed that a selective attack on a region’s most severe public health problems would maximize improvement of health in developing countries. They identified four factors to guide the selection of target diseases for prevention and treatment: prevalence, morbidity, mortality, and feasibility of control (including efficacy and cost). Thus, rather than the envisioned emphasis on development and sustainability of health systems and infrastructures to improve population health, primary health care implementation in developing countries became focused on four vertical programs: growth monitoring, oral rehydration therapy, breastfeeding, and immunization (GOBI). Family planning, female education, and food supplementation (FFF) were added later. These interventions targeted only women of childbearing age (15–45) and children through age five. This narrow selection of specific conditions for these population groups was designed to improve health statistics, but it abandoned Alma Ata’s focus on social equity and health systems development. This transformation from the lofty goals set at Alma Ata to a selective approach sparked more than two decades of exhaustive debate.
Effectiveness Of Comprehensive Primary Health Care
Some global health analysts argue that comprehensive primary health care was an experiment that failed; others contend that it was never truly tested. With only one year between the Alma Ata declaration and the shift toward a selective approach to its implementation, the transformative potential of comprehensive primary health care remained largely unexploited. Nevertheless, there were some important successes, particularly in the 1980s. Mozambique, Cuba, and Nicaragua, for example, expanded their primary health care coverage and greatly improved their population health indices.14 The keys to these accomplishments were the political will to meet all citizens’ basic health needs, active popular participation in the effort to realize this goal, and increased social and economic equity.15
Whereas the progress in Mozambique and Nicaragua was short-lived, Cuba has maintained steady progress even after the collapse of, and loss of support from, the Soviet Union and many years of embargo by the United States.16 Its success has been attributed to its model primary health care system.17 Under the Cuban constitution, health care is a right of citizens and a responsibility of government. In addition, Cuba’s Public Health Law outlines the principles of the National Healthcare System as follows: socialized medicine organized by government; basic services accessible to the whole population and free to all; preventive medicine as the hallmark of the system; public participation in health care; and a comprehensive approach to planned development of the health system. A 1997 report from the American Association for World Health, analyzing the U.S. embargo’s effects on health in Cuba, concluded that a humanitarian catastrophe had been averted because the country maintained a high level of budgetary support for a health care system designed to deliver primary and preventive health care to all of its citizens.18 Cuba’s population health indices are on a par with those of developed countries that have several times its budget: Life expectancy is seventy-seven years, and the infant mortality rate is 7.7 per 1,000 live births, which ranks Cuba among the twenty-five countries in the world with the lowest infant mortality rates. As Cesar Chelala observed, Cuba’s infant mortality rate for 1997 was half that of Washington, D.C.19
Effectiveness Of Selective Primary Health Care
While many factors ultimately affected the implementation of primary health care by national governments and aid agencies, selective primary health care and the resulting programs that were and are supported cannot fulfill the ideals of Alma Ata, including the emphasis on self-reliance, which is essential for communities to promote and sustain their own health.
Shortcomings.
First, the selective approach ignores the broader context of development and the values that are imbued in the equitable development of countries. It does not address health as more than the absence of disease; as a state of well-being, including dignity; and as embodying the ability to be a functioning member of society. In conjunction with the lack of a development context, the selective model does not acknowledge the role of social equity and social justice for the recipients of technologically driven medical interventions. The reality of the model is that vertical programs are centered in urban hospitals and health care facilities. Without the participation of communities, there is no avenue for change.
Second, the donor-driven, technocratic approach to determining priorities for interventions detracts from the grassroots approach that the Alma Ata declaration stated was necessary for health development. Third, the model tends to preserve the status quo of vertical objectives, fighting one disease at a time and not incorporating these efforts into a higher baseline of health status.
Fourth, there is little coordination among these vertical programs, leading to redundancy, overlap, and waste. Finally, the sole emphasis on women and young children, to the neglect of other segments of the population, is an important flaw. The high burden of HIV/AIDS among people ages 20–39 in many developing countries (an indication of infection during adolescence) is not surprising, given the long neglect of this population group in health policy and practice.20
Improvements and deficits in global health.In spite of the above shortcomings, selective primary health care has been lauded as having contributed greatly to improvements in global health. It is said, for example, that eight of every ten children in the world today receive vaccinations against the five major childhood diseases.21 Globally, between 1980 and 1993 infant mortality fell by 25 percent, while overall life expectancy increased by more than four years, to sixty-five years.
However, whereas the number of children under age five who died from vaccine-preventable diseases decreased by 1.3 million between 1985 and 1993, more than twelve million of these children died within this period nevertheless. Of this figure, vaccine-preventable diseases still accounted for 2.4 million deaths. Moreover, childhood diarrhea and malnutrition remain leading causes of impaired child health in developing countries, contributing greatly to the thirteen million deaths that occur annually among children under age five.22
A 2003 United Nations report argues that international assistance aimed at helping poorer countries develop is failing; it calls for a reexamination of current strategies if the world is to meet targets for reducing poverty, hunger, and illness.23 According to the report, fifty-four countries are poorer now than they were in 1990, and life expectancy has regressed in thirty-four countries, mostly in Africa.
Lessons For Future Global Health Policy
Although disease-specific interventions are important, assuring real change will require attention to environmental, political, and social actions that target the root causes of disease as envisaged at Alma Ata. Alma Ata’s comprehensive primary health care was a global recognition of some of the causes of unsatisfactory results in many programs.24 Studies during the 1970s revealed that lack of overall development was inextricably linked to health and that health discussed in a vacuum would never succeed. However, experimentation with comprehensive and selective approaches to global health policy have also revealed that discussion of health in the context of society, economics, politics, and development put many barriers in the way of success as well.
One of the ideological barriers was the concomitant challenge of social equity and social justice. Alma Ata made it the responsibility of governments and agencies to promote equity and ensure that certain citizens were not unduly suffering for the benefits received by others. Comprehensive primary health care combined many complex features into its definition of health and health care.
Various sectors need to work together.
First, because health does not occur in isolation, the various sectors, including those within a national government and among aid agencies, need to work together at every level of practice. The ministry of health is not the sole agency charged with production of health; departments of agriculture, housing, sanitation, and education, along with food distribution, are all involved in achieving health.
Interventions must come from needs of the community.
Second, the Alma Ata declaration requires that interventions come from the needs of the community, expressed and subsequently led by community members. Global health problems cannot be solved by distant policymakers and planners.25 Involvement of individuals and communities mobilizes local resources to deal with health problems.26 Implied in the concept of participation is decentralized physical location; programs need to be founded and researched in the locality in which they will be applied. The Alma Ata declaration also recognizes that the issue of accessibility to health services and resources has historically been a barrier to effective care and that placing emphasis on curative, tertiary care hospitals located in urban centers often precludes access for a mostly rural population.
Fullest potential difficult to achieve without supporting infrastructure.These are some of the underpinning principles behind the Alma Ata declaration; unfortunately, key elements are lacking in the selective approach adopted for its implementation. Some developing countries continue to rely on vertical programs, with less emphasis on people’s involvement and development of systems and infrastructures to sustain those programs. For example, although the current initiative on vaccines and immunization designed to help countries incorporate new vaccines into their national health systems surely has benefits for addressing specific communicable diseases, their fullest potential will be difficult to achieve in the absence of effective health systems and supporting infrastructures. Limited assessment of this initiative undertaken in Mozambique, Ghana, Lesotho, and Tanzania revealed that the infrastructural foundation needed for successful implementation and sustainability is inadequate.27
Maintaining the cost of expensive new vaccines after donor support ceases also poses a serious challenge to sustainability. As with most vertical programs, analysts have expressed concern that raising poor countries’ awareness of new vaccines and immunization programs without support in implementing such programs could end up creating markets for these vaccines while doing little to tackle major health problems.28
Given that disease-focused models continue to be funded and promoted in developing countries, it is apparent that adequate lessons have not been learned from experimentation with selective, vertical approaches; that the notion of self-reliance, community participation, and health systems development proposed at Alma Ata have diminished in importance; and that inadequate consideration is given to the link between health and socioeconomic development. Global health policy for the twenty-first century should recognize that high-tech and expensive models to address diseases of poverty will not be sustainable where infrastructures needed for operationalization and institutionalization of those technologies scarcely exist.
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If we look at this same ONE WORLD International Economic Zone Trans Pacific Trade Pact policy and then look at our local US city public health policy we see the bringing down of our developed nation health care being called TOO EXPENSIVE----to what has been through CLINTON/BUSH/OBAMA this installation of a global health care for all care for the world's poor. Same terms used----same focus---and that is what Obama and Clinton neo-liberals are now trying to make in this tiering of our health structures to extreme wealth vs extreme poverty. Beilenson is simply calling EVERGREEN HEALTH a corporate non-profit modeled for PUBLIC-OPTION----when it will simply be expanded to a global health corporations following these World Health Organization models. Meanwhile, all that was our Federal Health funding and trusts is building this global health tourism for the global 1% and their 2%.
PLEASE STOP ALLOWING RACE AND CLASS BE USED BY WALL STREET TO BREAK DOWN WHAT WAS A STRONG PUBLIC HEALTH SYSTEM BASED ON THOUSANDS OF YEARS OF WESTERN MEDICAL ETHOS.
'The MDGs are eight specific goals that the 191 United Nations (UN) states have committed themselves to achieving by 2015. The MDGs are:
1. to eradicate extreme poverty and hunger;
2. to achieve universal primary education;
3. to promote gender equality and empower women;
4. to reduce child mortality;
5. to improve maternal health;
6. to combat HIV/AIDS, malaria and other diseases;
7. to ensure environmental sustainability; and
8. to develop a global partnership for development[17]'.
We can believe as global NGOs PRETEND to install these policies overseas that the 1% of those nations will fleece those funds leaving global citizens with no health access. The US under WORLD HEALTH ORGANIZATION guidelines for its population of 99% of people in poverty----do we really want to go there?
What are the main functions of the World Health Organization?
Jacqueline Hope, Nov 8 2010, 82666 views
This content was written by a student and assessed as part of a university degree. E-IR publishes student essays & dissertations to allow our readers to broaden their understanding of what is possible when answering similar questions in their own studies.
Conclusion
This paper has looked at two questions. The first concerns the functioning of WHO and the second concerns how well WHO functions in relation to a specific area of its mandate. The specific area of WHO’s mandate this paper has addressed is the area of maternal health, an area often ignored by IR scholars in favour of areas of WHO’s functioning that present traditional, hard security threats, particularly infectious disease. The choice to focus on maternal health came out of an interest in the human security paradigm and the belief that because of the emergence of this paradigm IR scholars need to broaden their interest in WHO beyond the traditional interest in infectious disease.
The first section of this paper examined WHO’s functioning on a general level and discovered that WHO’s mandate is far broader than the control of infectious disease. Put succinctly WHO’s role in the international system is nothing short of ensuring the attainment of the highest level of all forms of health, physical, mental and emotional by all human beings.
The paper then turned its attention to maternal health, examining what maternal health is and what WHO’s role in ensuring the improvement of maternal health is. It was discovered that maternal health is an important indicator of overall development. More importantly however it was discovered that maternal health is an incredibly multifaceted idea, taking in physical, mental and emotional health and complicated by a great many issues linked into larger questions of development. It was also shown that WHO’s operations are complex. WHO functions not only at the international level but at regional and national levels as well.
The final section of the paper examined two alternative critiques of WHO’s functioning in relation to maternal health. One was focused on WHO’s functioning in relation to the MDGs. By this account WHO had made little progress in the area of maternal health and by some measures had gone backwards. This account is important because so much of WHO’s energy over the course of the last decade has been placed into achieving the MDGs. However the other account which focused on WHO’s functions as defined by the Eleventh General Programme of Work 2006-2015 presented a brighter prognosis. It argued that instead of focusing on the achievement of the MDGs WHO should place its energy into becoming a catalyst for long-term improvement in the field of maternal health by acting as a setter of norms for international health and international health policy.
One of the questions this paper set out to answer is whether or not it is possible to assess the functioning of an international body with a mandate as broad as the one WHO is required to fulfil by focusing on only a small area of its functioning. After only a brief assessment of WHO’s functioning in the relatively narrow area of maternal health the only conclusion that can be drawn is that it is not possible. In assessing WHO’s functioning in the area of maternal health this paper came to two entirely different conclusions regarding WHO’s effectiveness. Considering this it could be strongly argued that it is impossible to objectively and fairly assess the functioning of WHO as a whole. It may in fact be impossible to assess WHO’s functioning in individual policy areas in a manner that is objective, fair and just.
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We want to remember why these social Democratic policies were put into place. FDR was responding to the Great Depression caused by the same massive Wall Street fraud as is occurring today. As this video shows----when the economic crash hit a century ago it left unemployment sky high with families unable to care for their seniors, disabled, and maternal care. This was the motivation for our US public health system. Well, we are heading towards that century-ago economic crash and great depression/recession that is designed to do the same only this time around CLINTON/BUSH/OBAMA-----SCHMOKE, O'MALLEY, BEILENSON made sure there will be no safety net.
Look at life expectancy back in FDR-----61 for white citizens 48 for black citizens ----that is to where it will fall again as they raise Social Security retirement age. Social Security Trust will be taken out by this bond market fraud and junk bonding of our US Treasury.
FDA’s Huge Conflicts of Interest with Big Pharma50
By anh-usa on March 13, 2012 UncategorizedTragically, the drug they endorsed is killing the women who take it. Why is FDA doing this?
The birth control pills Yaz and Yasmin, which were endorsed by an FDA advisory committee last December, contain a drug called drospirenone. Women who take it are nearly seven times more likely to develop thromboembolism (obstruction of a blood vessel by a blood clot, which can cause deep vein thrombosis, pulmonary embolism, stroke, heart attack, and death) compared to women who do not take any contraceptive pill, and twice the risk of women who take a contraceptive pill containing levonorgestrel. Thousands of women have filed a lawsuit against Bayer, saying they were injured by Yaz or Yasmin.
Why would the FDA approve such a dangerous drug? An investigation by the Washington Monthly and the British medical journal BMJ found that at least four members of the advisory committee have either done work for the drugs’ manufacturers or licensees or received research funding from them. The members reported their industry ties to FDA, but FDA decided it didn’t matter and didn’t make the disclosures public.
REAGAN tripled payroll taxes saying he was protecting these social programs and then sent them to our US Treasury to fleece as he dismantled and defunded them. Bush's Medicare Advantage and Part D prescription was the first stage of privatization with more and more of our health care funding going to PHARMA----and Obama with Affordable Care Act privatized the entire system away. ACA's gutted of funding MEDICAID FOR ALL is simply installing World Health and UN global HEALTH CARE FOR ALL preventative care here in the US. This is the goal of Baltimore's MARYLAND HEALTH CARE FOR ALL by Johns Hopkins. Johns Hopkins' Maryland Health Care for All was founded by Beilenson. We can see that timeline when Clinton deregulated Wall Street and sent all US corporations overseas to when Bloomberg was tied to Baltimore's public health system. Hopkins is now only in name as he is now major shareholder. BLOOMBERG UNIVERSITY........
'The school was renamed the Johns Hopkins Bloomberg School of Public Health on April 20, 2001 in honor of Michael Bloomberg (founder of the eponymous media company) for his financial support and commitment to the school and Johns Hopkins University. Bloomberg has donated a total of $1.1 billion to Johns Hopkins University over a period of several decades'.
Public Health 1929-1941
Introduction
The October 1929 stock market crash and following Great Depression brought massive unemployment over the next decade, particularly the next several years. By 1933 25 percent of the U.S. work-force was out of work, amounting to over 12 million people. In reaction President Franklin Delano Roosevelt (served 1933–1945) introduced the New Deal in early 1933 when he took office. The New Deal consisted of a range of federal social and economic relief and recovery programs addressing a broad span of issues including work relief for the unemployed. The rise in poverty contributed to a decline in sanitation and hygiene in the rural areas and inner cities of the nation. The suicide rate was also on the increase.
During the Great Depression the public health movement of the United States had many successes and some spectacular failures. The New Deal programs played a key role in promoting health, particularly among the most impoverished. Leading up to the Great Depression the leading causes of death in the United States had become degenerative conditions. Heart disease and cancer killed twice as many people as influenza, pneumonia, and tuberculosis. Rates of infectious childhood diseases including measles, scarlet fever, whooping cough, and diphtheria had dropped significantly, and deaths from enteritis, typhoid, and paratyphoid fevers had been drastically reduced. These reductions were due in large part to medical advances and public health successes from the previous decades. Knowledge of how disease spread led to public health efforts to clean up water supplies, suppress epidemics through quarantines, and vaccinate populations threatened with infectious diseases. Research demonstrating that poor diet caused pellagra and scurvy and that unpasteurized milk could carry bovine tuberculosis resulted in education on how to prepare and store healthy foods and legislation that monitored the quality and content of food products. After 1932 public health officials in New Deal programs could point to these successes to prove the need for more health care spending as part of providing relief to those most affected by the economic crisis of the Great Depression.
During the period of the government social and economic recovery programs of the New Deal, the 1930s saw the second great push for national health insurance and the second great fight to defeat it. The battle illustrated the struggle between those who worried that health insurance would inevitably lead to government control of the American medical profession. That fear was already felt by many because of the rapidly growing role of the government under Roosevelt in combating Great Depression economic woes. It also highlighted the fear that public health professionals were overstepping their boundaries and treading on territory best left to private physicians. Public health after all was historically an issue of sanitation and water safety, not medicine. Even though medical economists and health insurance supporters such as Isidore Falk could prove how much money illness cost society, that did not mean that society should pay for its prevention. There was also the belief that the federal government could not adequately respond to local needs as they varied, depending on where you lived. Counties in the rural South were in desperate need of doctors, nurses, and hospitals. Cities in the urban North had better access to medical care but continued to suffer from the effects of overcrowding and poor sanitation. Finally there was the belief that additional funding for public health simply was not necessary. Statistics from the Metropolitan Insurance Company showed that despite slashed health department budgets, widespread unemployment, and the general lack of medical care, the death rate continued to decline. Between 1900 and 1930 the average life expectancy of a Caucasian male had increased by 11 years.
Despite such opposition nearly every piece of New Deal legislation provided funds for public health initiatives. The New Deal was President Roosevelt's plan for new reform and relief policies in the United States. Even the Federal Art Project of the Works Progress Administration (WPA), a New Deal agency, designed posters warning against cancer, and the Federal Writers Project created educational brochures
Chronology:1927:
The Committee on the Costs of Medical Care begins its five-year study of the state of public health in the United States. A joint effort of private philanthropic foundations and government agencies, it examines the economic costs of disease and poor health.
1930:
The Ransdell Act changes the name of the Hygienic Laboratory to the National Institute of Health and gives it authority to provide public funds for medical research.
1932:
The United States Public Health Service begins the Tuskegee Syphilis Study, which withholds medical treatment for syphilis from black American males. The experiment finally ends in 1972.
1935:
Polio vaccine trials are conducted using live polio virus. After nine deaths are reported out of 20,000 inoculations, the vaccine is withdrawn.
August 14, 1935:
President Roosevelt signs the Social Security Act that provides federal funds for state and local health programs.
1937:
In response to the increase of deaths from cancer in the United States, the National Cancer Institute is established with unanimous support from every Senator in Congress.
June 25, 1938:
Roosevelt signs the Federal Food, Drug, and Cosmetic Act replacing the basically ineffectual 1906 Food and Drugs Act.
July 1938:
The National Health Conference gathers public health officials, health care providers, and representatives from labor unions in Washington to discuss the medical needs of the nation.
1938:
The Venereal Disease Act is passed seeking to eradicate venereal disease through education and medical treatment.
1939:
The Wagner Bill, which proposes federal grants to establish state insurance systems, is introduced into the Senate. The bill dies in committee as attention shifts to an increasingly unstable Europe.describing syphilis and tuberculosis. The Social Security Act provided grants to states for the development of public health and the WPA and the Public Works Administration (PWA) built health centers, hospitals, and laboratories, as well as water and sewer systems. Public health functions were scattered among many government agencies. The Public Health Service, the largest agency devoted to health, was part of the Treasury Department. The Children's Bureau, which handled both maternal and child health, was in the Department of Labor, and the Food and Drug Administration was part of the Department of Agriculture. Unfortunately, because there were so many departments providing public health services during the Depression, some efforts inevitably became bogged down in bureaucratic bickering. Even the Interdepartmental Committee to Coordinate Health and Welfare Activities, a committee formed by President Roosevelt in 1936 to organize health efforts nationwide, fell victim to political influence when Martha Eliot, the assistant chief of the Children's bureau, suggested they all work separately on the sections of the program that would affect their particular agencies.
Failures such as these, however, did not detract from the successes of New Deal legislation. By the start of World War II (1939–1945) the Public Health Service had expanded its traditional role of monitoring and preventing infectious disease, protecting water supplies, and insuring the provision of clean milk, to actively providing both emergency and preventative health care. The public health movement was able to provide a safety net for those too indigent to provide one of their own.
1965
Johnson signs Medicare into law
On this day in 1965, President Lyndon B. Johnson signs Medicare, a health insurance program for elderly Americans, into law. At the bill-signing ceremony, which took place at the Truman Library in Independence, Missouri, former President Harry S. Truman was enrolled as Medicare’s first beneficiary and received the first Medicare card. Johnson wanted to recognize Truman, who, in 1945,had becomethe first president to propose national health insurance, an initiative that was opposed at the time by Congress.
The Medicare program, providing hospital and medical insurance for Americans age 65 or older, was signed into law as an amendment to the Social Security Act of 1935. Some 19 million people enrolled in Medicare when it went into effect in 1966. In 1972, eligibility for the program was extended to Americans under 65 with certain disabilities and people of all ages with permanent kidney disease requiring dialysis or transplant. In December 2003, President George W. Bush signed into law the Medicare Modernization Act (MMA), which added outpatient prescription drug benefits to Medicare.
Medicare is funded entirely by the federal government and paid for in part through payroll taxes. Medicare is currently a source of controversy due to the enormous strain it puts on the federal budget. Throughout its history, the program also has been plagued by fraud–committed by patients, doctors and hospitals–that has cost taxpayers billions of dollars.
Medicaid, a state and federally funded program that offers health coverage to certain low-income people, was also signed into law by President Johnson on July 30, 1965, as an amendment to the Social Security Act.
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