Research Paper: Identifying Opportunities to Improve Public Health

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¶ … babies born in the United States enjoy a 50% chance of living to see their 100th birthday and innovations in healthcare technology, Medicaid and Medicare services and community-based participatory research promise to improve these chances even further during the 21st century. A number of public health threats persist, though, including the potential for the outbreak of epidemic, the persistence of tuberculosis, and oral disease, some of which involve the use of tobacco. This paper provides a review of the relevant literature to identity the key characteristics of community-based participatory research and an explanation concerning how these characteristics could enhance community health initiatives, the seven major steps of an outbreak investigation, the components of tuberculosis prevention and control in the United States, and an analysis of the greatest future challenges to efforts to reduce tobacco use and what could be done to reduce these challenges. In addition, an examination of the differences in eligibility criteria between Medicaid and Medicare and an assessment concerning whether these differences are likely to remain throughout the 21st century is followed by a discussion concerning why oral diseases are regarded as a neglected epidemic in the United States and why oral health is important. Finally, a summary of the research and important findings concerning these issues are provided in the conclusion.

Review and Discussion

1.

Identify key characteristics of community-based participatory research, and explain how these characteristics could enhance community health initiatives.

A range of partnership approaches to research within the field of public health have been introduced in recent years including community-based participatory research (Israel & Parker, 2006). Community-based participator research in public health is defined by Israel and Parker (2006) as "a partnership approach to research that equitably involves community members, organizational representatives, and researchers in all aspects of the research process, in which all partners contribute expertise and share decision making and responsibilities" (p. 1463). These characteristics of community-based participatory research serve to (a) increase knowledge and understanding of a given phenomenon and (b) integrate the knowledge gained with interventions and policy change to improve the health and quality of life of community members (Israel & Parker, 2006, p. 1464).

2.

What are the seven major steps of outbreak investigation?

The seven major steps of outbreak investigation are set forth in Table 1 below.

Table 1

The seven steps of an outbreak investigation

Step

Description

Action(s)

1

Preliminary assessment in outbreak investigation

Confirm existence of outbreak

2

Case definition and identification

1. Define 'cases' in terms of time / place/person/symptoms/lab results

2. Define population at risk

3. Case identification

3

Descriptive study

1. Collect data

2. Analyse data

3. Draw epidemic curve

4. Generate hypothesis

4

Analytical study of an outbreak

1. To test hypothesis

2. To attempt to overcome bias

5

Verify hypothesis

Confirm or refute by:

1. Microbiology using food and environmental samples

2. Veterinary investigation

6

Institute control measures

1. Remove source

2. Protect persons at risk

3. Prevent recurrence

7

Communicate

During outbreak:

1. Information to public and professionals

2. After outbreak: report, for those involved and wider audience, also make recommendations for the future

Source: Adapted from Outbreak Investigation (2011) at http://www.healthknowledge.org.uk / public-health-textbook/disease-causation-diagnostic/2g-communicable-disease/outbreak-investigation

3.

What are the components of TB prevention and control in the United States?

The components of the Centers for Disease Control (CDC) tuberculosis prevention and control in the United States include the following:

Contact investigations

Genotyping

Testing and diagnosis

Vaccines and immunizations

Infection control and prevention

Treatment

Control and elimination (CDC tuberculosis guidelines, 2014).

4.

What is the greatest future challenge to efforts to reduce tobacco use and what could be done to reduce these challenges?

First and foremost, tobacco contains nicotine which is a highly addictive substance that makes it uncomfortable and even painful for people to quit. In this regard, Tripathy (2013) emphasizes that, "Quitting smoking is the single most important step a smoker can take to improve the length and quality of his or her life. However, stopping smoking can be tough due to the addictive nature of nicotine" (p. 443). When tobacco dependence reaches a chronic condition, frequent and repeated interventions by healthcare professionals are required (Lenz, 2013). Some of the greatest challenges to providing efficacious interventions for tobacco use cessation include a lack of time to provide frequent and repeated interventions, as well as a lack of knowledge and skills on the part of clinicians concerning tobacco-related diseases and how to best help current users stop using tobacco and how to prevent people from beginning its use (Lenz, 2013).

There remains a paucity of instruction in the general healthcare curricula, though, that is required to help these healthcare professionals provide timely and informed tobacco cessation services (Lenz, 2013). In response, Lenz recommends that, "Future research is needed to address the effectiveness of efforts to transform curricula and faculty resources to address patient tobacco use and cessation. It is important to note that cultural sensitivity to lifestyle choices, including tobacco use, is essential" (p. 179). In addition, a number of evidence based interventions (e.g., behavioral therapies, group and individual counseling, quitlines, pharmacotherapy (all types of NRT, Bupropion, Varenicline), quit-and-win strategies, and text messaging) have been shown to significantly improve cessation rates (Tripathy, 2013).

5.

Why is there a difference in eligibility criteria between Medicaid and Medicare? Are these differences likely to remain throughout the twenty-first century? Why or why not?

The U.S. Department of Health & Human Services (HHS) explains the differences in eligibility criteria between Medicaid and Medicare as follows:

Medicare is an insurance program. Eligible beneficiaries for Medicare include seniors aged 65 years and over, end-stage renal disease patients, and disabled individual that are eligible to receive for Social Security benefits.

Medicaid is an assistance program. Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities in all states; in addition, in some states, Medicaid also covers all low-income adults below a certain income level that varies from state to state (Medicaid and Medicare differences, 2014).

Because people in the United States are living longer and the baby boomer generation has starting retiring in increasing numbers, it is reasonable to suggest that there will be a continuing need for Medicare well into the 21st century, but that the age-related eligibility criteria may be extended to 67, 69 or even 75 years of age by the 22nd century because innovations in healthcare technology will help people live healthier lives in the future as well (Gorin, 2000). It is also reasonable to conclude that there will always be some segment of American society that is disadvantaged compared to the mainstream population, so there will also be an ongoing need for Medicaid but the eligibility criteria for this program may also be changed by increasing the income cut-off to much higher levels, reflecting an overall increase in the national gross domestic product (Gorin, 2000).

6.

Why are oral diseases considered a neglected epidemic in the United States, and why is oral health important?

Oral diseases affect people all income levels, but because they affect more people in lower-income segments of American society, they are regarded as a neglected epidemic in the United States (Peterson & Bourgeois, 2005). According to Peterson and Bourgeois (2005), "Oral diseases such as dental caries, periodontal disease, tooth loss, oral mucosal lesions and oropharyngeal cancers, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV / AIDS)-related oral disease and orodental trauma are major public health problems" (p. 661). Oral health is important because it affects a wide range of quality of life factors. For example, the simple act of trying to eat can become an adventure in pain for people with poor oral health. Moreover, poor oral health is related to a number of chronic diseases such as diabetes (Peterson & Bourgeois, 2005). Finally, oral health is important… [END OF PREVIEW]

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