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How Can Health Be Improved in the USResearch Paper

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Blums Four Factors of Healthcare, and Their Potential Utilisation to Improve Healthcare Outcomes

In the 1970's Henrik Blum, "The Father of Health Planning," at the University of California at Berkeley, grouped the factors influencing health into four principal forces: environment, heredity, lifestyles, and medical services. Blum found that the force labeled environmental was the most ever-present while behavior and lifestyle were the second most prevailing force. The purpose of this paper is to provide an analysis and explanation of the Blum's Model of Health, examining the major elements of change and how planning can positivity impact on the major influences of health

With increasing knowledge of health and the development of new treatments, it may be expected that the level of health in the U.S. population would have increased. However, incidence rates of many illnesses, including many of the leading causes of death, such as heart disease, cancer, and respiratory diseases, have increased, while other preventable diseases, such as late onset diabetes have shown only marginal decreases over the last decade (CDC, 2014). Notably, many of these diseases may have been preventable (Bauer et al., 2014). This trend indicates that preventative strategies are also needed in order to reduce the manifestation of many preventable diseases, utilising a multidisciplinary approach, including consideration of aspect such as environment and lifestyle (Shi & Singh, 2014; Bauer et al., 2014; Owen et al., 2014). Therefore, the underlying thesis of this paper is that if the United States is to increase the health of its populations, it must restructure its present priorities in healthcare to put more importance on the planning, prevention, and promotion of health.

Many researchers have identified numerous different influences on health outcomes, and both quality of life, as well as financial benefits associated with health care planning that incorporates preventative as well as treatment strategies (Glanz, Rimer, & Viswanth, 2015; Tryon et al., 2014). Therefore, any planning strategy needs to account for the potential various influences in a holistic manner, Blum's (1974) model, shown in appendix 1, provides a foundation for understanding not only the influences on health, but the way on which they may be managed.

Within any healthcare model, one of the major contributors will be the hereditary factors (Glanz et al., 2015; Collins, 2004; Blum, 1974; 1983). Genetics will influence the potential predisposition of an individual and the potential probability of developing certain types of health problems (Collins, 2004; Blum, 1974). For example, certain ethnic populations may have a greater genetic propensity to certain diseases, such as sickle cell anaemia (Claster & Vichinsky, 2003), other genetic predispositions may be passed down through hereditary family traits, as seen with breast and ovarian cancer (Berry et al., 2002). While the genetic predisposition may have limited management opportunities it maybe argued that outcomes may be benefited through the potential utilisation of genetic screening, and early identification of increased risk, as long as the screening is linked to preventative strategies which may reduce the likelihood of the disease manifesting (Glanz et al., 2015). Recent shifts in technology, and the understanding of genetics may also result in increased potential use of gene therapy, with the prospect of identifying conditions at an early stage with knowledge of potential predispositions (Nussbaum et al., 2015). It has even been speculated that in the future, genetic therapy may be utilised in a similar manner to today's immunisation for disease (Nussbaum et al., 2015). The presence of hereditary factors has also led to genetic testing in utero, allowing parents to undertake family planning minimising the potential for negative hereditary factors (Nussbaum et al., 2015). Therefore, while hereditary factors are a significant influence on health outcomes, at the current time, with the exception of potential utilisation of genetic screening, and ability to identify predispositions to illnesses early, the ability to manage this dimension of health influences is relatively limited.

The next consideration in healthcare is the medical care services that are provided (Blum, 1974). Provision of healthcare services will be impacted significantly by external environmental issues such as cultural systems, values, and expected outcomes (Glanz et al., 2015). For example, in highly patriarchal cultural systems quality of healthcare, from childhood, through to old age, is likely to be biased towards the male population, likewise, in capitalist market economies where healthcare is a purchased commodity, there is likely to be increased disparity of access to health care, with poor suffering (Glanz et al., 2015; Borrell et al., 2013). Here, it is possible to see the way in which the external environment will impact on the way medical services are provided, indicating a strong influence with the external environment. However, this category focuses on the medical services themselves that are provided, incorporating all services that help people to be well, diagnosis and treatment, as well as preventative care (Slee, Slee, & Schmidt, 2008).

The increased cost of diagnosis and treatment of illnesses is increasing emphasis being placed on the need for preventative medicine (Glanz et al., 2015). However, in many instances, limited levels of resources delegate preventative medicine to a secondary position, as priorities needed to treat those already suffering from serious conditions (Drummond et al., 2015). With limited resources, especially during times of economic hardship and austerity measures, it is difficult to introduce preventative programs which have an immediate expenditure, without an immediate payback, only seeing long-term savings (Drummond et al., 2015). Many preventative programs already in place, such as immunisation programmes, have demonstrated the value of preventative medicine. Furthermore, it should be noted that one medical care services in the United States tend to focus on treatments, aspects such as education, and health promotion, as seen with many of the strategies to tackle obesity, are delegated to community programmes (CDC, 2009). Notably, all of the four forces identified by Blum (1934), it may be argued that medical services themselves, especially with a focus on treatment, is the weakest of all forces, the strongest element within this force being preventative medicine. However, when examining this, it is already apparent that there is a crossover with many other areas.

Lifestyles incorporates the influences of attitudes and behaviours of the population (Blum, 1974; 1983). Many lifestyle choices of today's population will impact on potential have comes, for example attitudes and behaviours towards smoking, diet, exercise, and even choices whether or not wear a seatbelt, can all impact on health outcomes (Bhattacharya, 2013). This may interact not only with overall outcomes, but can also be considered in context of an individual's hereditary position, potential predisposition to disease, for example a healthy diet and avoidance of obesity reduces the potential incidence of breast cancer, including within a population where there is an existing genetic predisposition (Berry et al., 2002). This knowledge, if held by patients, the impact positively on lifestyle choices, and empower populations to manage their health. Likewise, lifestyle choices may also impact on the way preventative medicine is perceived, and the value associated with it. For example, in recently there has been an increased incidence of measles in the United States, resulting from lifestyle choices of certain parents to refrain from immunising their children against disease (Gumbel, 2015). Importantly, many lifestyle choices may impact not only on the individual, but wider, as seen with the vaccination choice of parents, as well as more common lifestyle behaviour choices, such as smoking which results in passive smoking for non-participants.

The behaviour of individuals often reflects, as is reflective of the general environment, which it may be argued is the most influential of the four health factors (Blum, 1974; 1983). The environment incorporates both the physical, as well as the social cultural macro environment. The physical environment can have a particularly strong impact, as in situations where there are negative influences, such as poor sanitation, air pollution, high levels of population density, violence, it is known there are a higher incidence of health-related issues (Glanz et al., 2015). Environmental conditions may be temporary, resulting from a disaster, such as seen in New Orleans, and the numerous negative health impacts following hurricane Katrina (Rhodes et al., 2010). However, ongoing environmental situations may also have an impact; there will be increased health issues in areas where there is violence as a result of attacks, in areas where there is a high population density there is a great potential for disease to spread, and where sanitation is poor there is a greater potential for the spread of bacteria and viruses (Glanz et al., 2015; Rhodes et al., 2010). Therefore, where there are poor environmental conditions, there is a great deal of potential for improved healthcare outcomes through the management of that environment, and improvements to factors such as relevant infrastructure.

The sociocultural aspect of the environment may be more difficult to change, it is made up of the views and values of a community, which are often reinforced through mutual agreement (Glanz et al., 2015). Changes to the sociocultural environment take longer, but can also result in significant health outcomes. Recent examples include increased attention to diet, with… [END OF PREVIEW]

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