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Health Indicators and Determinants in the US

Studies undertaken by different researchers describe global health as the measure of burden caused by disease across the world. The current globalization and interconnectedness implies that a major threat of disease in any country carries the possibility that the same can be spread globally. Strong public health systems globally can help in stopping the risk of spreading of such diseases across the world. The strong national public health systems work in synergy to improve the global health security. As of 1 January, 2017 there were more than 180 Zika virus cases reported in the US. Mitigating the spread of the virus in the US requires robust strategies and initiatives of communication that are undertaken to promote positive social change when combating its spread.

Some of the health indicators include the expectancy of life span and mortality,specific  causes of mortality and morbidity, selected diseases which are infectious and coverage of health to the population. The metrics that measure life expectancy and mortality include  expectancy of life at birth and age 60, infant and under-five rates of mortality and adult mortality (between 15-60 years). The life expectancy was 79 years at birth and 23 years ay age sixty for the US in 2013 (WHO, 2015). The infant and under-five mortality rates was 5.9 and 6.9 years in the US during the same period (WHO, 2015). WHO (2015) data also shows that the adult mortality rate in the US was 76 years of age in 2013.

The cause specific mortality and morbidity metric used by the WHO are the communicable, conditions which are non-communicable and injuries that cause deaths.. The morbidity measure was based on deaths arising from HIV/AIDS, malaria and tuberculosis. The mortality rate stood at 31 for communicable conditions, 413 for non-communicable conditions and 44 for deaths caused by injuries (WHO, 2015).There was no data from the WHO on morbidity rates for HIV/AIDS and malaria while the tuberculosis rate was at 3.3%. The aggregate for “other diseases” leading to deaths of children below five years stood at 23%.

Several infectious diseases were used by the World Health Organization to measure the selected diseases indicator. These include diphtheria, leprosy, malaria, measles and meningitis. There was no reported case of diphtheria in the year 2013 while there were 188 reported cases of leprosy in the US for the same period (WHO, 2015).  The World Health Organization (WHO) did not have any data available for reported cases of meningitis and malaria for the US during this period. The reported cases of measles stood at 187 during the year 2013 in the US. The Institute of Medicine, US (2013) states that the above figures need to be interpreted using epidemiological patterns and  methods of collecting data within the US in order to arrive at meaningful results.

The Impact of Globalization on Disease

The determinants of health within the parameters of the WHO include the socio-economic environment, the physical environment and individual behaviors of a person (WHO, 2017).  The US government uses the following different metrics as the determinant of health: policy-making, social factors, healthy services, individual behavior/genetics (Healthy People, 2017).  The policies undertaken at the federal, state and local level affect the health status of the population and individuals. Policies such as the National Traffic and Motor Vehicle Safety Act affect entire populations across different states.  This Act resulted in increased safety standards for motor vehicles.

Social factors are affected by determinants such as daily resource needs, social attitudes and norms, poverty, quality of education and residential segregation (Kronenfeld, 2013). These social factors contribute to determining the individual and collective health status of citizens in the US. In addition to the above, physical factors such as levels of exposure to toxic substances and other hazards affect the status of health. Physical barriers also affect persons with disabilities while housing and neighborhoods also affect the status of health. Aesthetic elements such as trees and good lighting ultimately contribute to determining the status of healthy in the US.

Access to Health services and the quality provided affect and determine the status and quality of health at the individual and population levels. Through the Healthy People 2020, several barriers to accessing health services have been identified (Healthy People, 2017).  These include the lack of available health services which leads to delays in receiving appropriate health care. High costs, lack of insurance coverage and the limitations of language use all contribute as barriers to accessing health services. These barriers to health may lead to health needs being unmet, hospitalizations that are unnecessary and inability to get services which are preventative in nature.

Individual behavior plays a crucial role in determining the status of the health of an individual. Focusing on changing individual behaviors through public health interventions leads to improved health status. An example is when an individual quits smoking and which results in reducing their risk of developing heart disease and complications (Healthy People, 2017).  Individual behavior determinants are affected by diet, physical activity, hand hygiene and drug use. The choices made by the individual collectively contribute to determining the health status of the individual. The choices made can reduce the prevalence of occurrence and reoccurrence of chronic diseases that may affect the individual.

There were 185 reported cases of Zika in the US in 2013, of which 184 were from travelers returning from affected areas (CDC, 2017). The response by the US health system is at the federal level where the Center for Disease Control (CDC) is the main agent. The CDC responds to the Zika virus threat by tracking its spread in the US and around the global. The agency is also involved in training Zika disease detectives who can track and detect it (CDC, 2017).  Healthcare providers are also trained in how to identify the virus while also educating the public on how to protect themselves from the virus. The agency also provides laboratories with diagnostic capabilities while also testing samples provided by medical facilities.

The Importance of Public Health Systems in Stopping the Spread of Diseases

Global Health Ethics Policy in the US. One of the key ethical global issues addressed by the US health system is the consideration of global health equity (WHO, 2015). One policy response has been the encouragement for US health institutions to partner with less developed countries in the effort to promote global health equity (Macklin, 2012).  One example is the partnership between the US health partners and Rwanda in 2012 (Adams, Wagner, Nutt & Binagwaho, 2016).  The Human Resources for Health (HRH) was instituted as a long-term comprehensive commitment to build anew the system of medical education in Rwanda. Faculty members from the US are sent to train their Rwandese counterparts in teaching hospitals across Rwanda.

Another area of global health ethics is international research in less developed countries. The policy position taken within the US is based on research that is conducted outside its borders and research done within the US. The policy position revolves around human subjects, research on vertebrate animals and intellectual property (Hall, Streitz & Hall, 2016).  Human trial subjects relate to consents required of individuals and groups. The US is a signatory of some International Conventions and Codes such as the WHO and the Council for International Organization of Medical Sciences (Hall, Streitz & Hall, 2016).  Gomez & Ruger (2015), state that Federal grants are given to do international research on the basis of the recipients being in compliance with the US laws and the foreign country regulations.

Health communication strategies in the US. The health communication strategy in the US is based on heath communication strategies, cultural competence, annual observances and campaign resources (CDC, 2017). Health communication involves advertising, media advocacy and media literacy. Cultural competence builds capacity for health providers to embrace values and behaviors that enhance cross-cultural competence in service delivery. Campaign resources include awareness of diseases such as HIV. Annual observances reinforce achievements and milestones achieved in the communication strategy, such as the Cervical Health awareness mo nth. These initiatives collectively form the strategy taken to communicate on health issues.

The communication strategy taken for controlling the Zika virus is posited on four elements: preparation, season where mosquito breeding is prevalent, first cases of  local transmission which are confirmed and cases where  transmission is widespread (Reynolds, 2017). This strategy is prepared for communication in all the states and is effective in addressing the above four interventions. The preparation stage raises awareness for the public on the risks of infection. The communication during mosquito season focuses on travel advisories for travelers. The first confirmed local transmission emphasizes on monitoring local news and releasing appropriate responses. When the transmission is widespread, there is intensified countrywide communication to raise awareness.

Life Expectancy and Mortality Rates in the US

Promoting  positive social changes to address Zika virus threat in the US. Promoting public health communication is the first step that is necessary in promoting positive social change (WHO, 2016, Lammert et al, 2017).  Working with the media, the public can be given relevant information on the virus. This information should be concise, touching on the vector, transmission and populations at risk. This information will change individual behavior such as sexual activity before and during pregnancy that puts persons at risk of infections (Peteresen et al, 2016).  Lammert et al (2017) posits that travelers and pregnant women who are at the highest risk will then make relevant changes in sexual choices made that will reduce the prevalence of Zika virus infections.

The Zika virus is a global disease that requires robust coordination between nations in order to mitigate its spread. The US has scored well in health indicators and determinants as shown in data from the WHO. The US health systems have responded to the Zika virus primarily through the agency of the CDC. The policies instituted on global health ethics focus on areas of research and global health equity. The communication strategies taken in the US health system with regards to the Zika virus are preventive in nature. This communication strategy is also the most important promoter of positive social change in mitigating the spread of the Zika virus.

References

Adams, L, V., Wagner, C. M., Nutt, C, T., Binagwaho, A. (2016). The future of Global Health Education: training for Equity in Global Health. Retrieved from https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-016-0820-0

(2017). 2017 Case Counts in the US. Zika virus. Retrieved from https://www.cdc.gov/zika/reporting/2017-case-counts.html

(2017). Health Communication Strategies. Health Communications. Retrieved from https://npin.cdc.gov/pages/health-communication-strategies

(2017). What CDC is Doing. Zika virus.Retrieved from https://www.cdc.gov/zika/about/whatcdcisdoing.html

Gómez, E. J., & Ruger, J. P. (2015). The Global and Domestic Politics of Health Policy in Emerging Nations. Journal of Health Politics, Policy & Law, 40(1), 3. doi:10.1215/03616878-2854256

Hall, J., Streitz, W., Tom, J. (2016). Conducting International Research: Ethical and Policy Concerns. Retrieved from https://www.ucop.edu/ethics-compliance-audit-services/_files/webinars/1-29-16-conducting-intern

Healthy People. (2017). Determinants of Health. ODPHP. Retrieved from https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health

Institute of Medicine, (. (U.S.). (2013). Toward Quality Measures for Population Health and the Leading Health Indicators. Washington, District of Columbia: National Academies Press.

 Kronenfeld, J. J. (2013). Social Determinants, Health Disparities and Linkages to Health and Health Care. Bingley: Emerald Group Publishing Limited. 85/mmwr.mm6539e1

Lammert, S., Walker, A. T., Erskine, S., Rao, S. R., Esposito, D. H., Ryan, E. T., & ... LaRocque, R. C. (2017). Characteristics of US Travelers to Zika Virus-Affected Countries in the Americas, March 2015-October 2016. Emerging Infectious Diseases, 23(2), 324-327. doi:10.3201/eid2302.161292

Macklin, R. (2012). Ethics in Global Health: Research, Policy and Practice. Oxford: Oxford University Press.

Petersen, E. E., Meaney-Delman, D., Neblett-Fanfair, R., Havers, F., Oduyebo, T., Hills, S. L., & ... Brooks, J. T. (2016). Update: Interim Guidance for Preconception Counseling and Prevention of Sexual Transmission of Zika Virus for Persons with Possible Zika Virus Exposure - United States, September 2016. MMWR: Morbidity & Mortality Weekly Report, 65(39), 1077-1081. doi: 10.155

Reynolds, B. (2017). Zika Communication Planning Guide for States. Retrieved from https://www.cdc.gov/zika/pdfs/zika-communications-planning-guide-for-states.pdf

WHO. (2015). Global Health Ethics: Key Issues. Global Network of WHO Collaborating Centres for Bioethics. Retrieved from https://apps.who.int/iris/bitstream/10665/164576/1/9789240694033_eng.pdf

WHO. (2015). World Health Statistics. Global Health Indicators. Retrieved from https://www.who.int/gho/publications/world_health_statistics/EN_WHS2015_Part2.pdf

WHO. (2016). Zika: Strategic Responses Framework & Joint Operations Plan. Retrieved from https://www.capsca.org/Documentation/Zika/WHO-ZikaResponseFrameworkFeb16.pdf

WHO. (2017). The Determinants of Health. Health Impact Assessment. Retrieved from https://www.who.int/hia/evidence/doh/en/ 

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