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Introduction
Public health is a societal approach that strives to protect and promote health. In other words, public health aims to enhance the well being of communities. It maintains environmental conditions under which people can live healthier lives, and reduce dangers to health, for instance; ensuring maintenance of steady water supply, children immunization, or performing research on epidemiology. Often, the provision of public health is a preserve of government, rather than private providers (Donaldson, 2003).
The aim of public health is to fulfill the human desire for health by facilitating individual and societal exchange processes. These exchange processes involve acquisition of individual behavior and lifestyle changes and the adoption of social programs to enhance social and economic environment.
This paper describes aspects of public health which includes: the relationship that poverty has with health care; comparisons and contrasts of mental illness and learning difficulties; confidentiality implications of public health matters; why proper care for the elderly is increasingly becoming a problem all over the world; why depression is such a mysterious disease; public health implications of the environment that a person lives; HIV and the modes of transmitting the disease; and whether increase in HIV/AIDS leads to increase in tuberculosis infections in the world.
Relationship that Poverty has with Health
Poverty is one of the socioeconomic factors that cause inequalities in health. The relationship between individuals living in poverty and ill health forms the main focus of public health practitioners. Public health practitioners concentrate on the linkage between environmental, social conditions, and population health and campaign for comprehensive change to improve health. This section explains the relationship that poverty has on health.
First, poverty provides a big challenge to healthcare. In the UK for instance, there has been a marked improvement of in the overall health of the population. Despite of these marked improvements, increasing evidence shows that improvements in health are linked directly to individuals status in society. Good health tends to be associated with wealth, whereas poor health is spread among the poor and the socially deprived disproportionately. For instance, the figures relating to poverty and health in the UK clearly clarify the relationship. Life expectancy standard measurements indicate that UK children born into less privileged social classes are likely to die 8 years earlier than children into privileged social classes (WHO, 2005).
Secondly, poverty makes affected people likely to spend more time at home with poor living conditions. They have limited income, meaning that they are unable to purchase the basics essential for survival, for instance, food. Surviving in such conditions, affects the quality of life and health. People living in poverty experience stress and anxiety, and this affects their physical health directly (Birchenall, 1998).
Thirdly, poverty has visible effects on the provision of healthcare. Severe poverty levels have long term implications and have led to reduced life expectancy for the poor in society. For instance, inequality of growth in health in the United Kingdom in the 1980s led to a fall in life expectancy of men and a reduction in women life expectancy after childhood (WHO, 2001). There had also been a reduction in life expectancy in less than seventeen countries in Africa during the same period. Life expectancy also dropped in two Asian countries, and in one country in the Western Hemisphere (WHO, 2001).
There was also pronounced fall in life expectancy in former States of the Soviet Union. In 1985, life expectancy for men in the Soviet Union was 62.87 years; in 1995, it was 58.27 years in the Russian Federation (WHO, 2001). Life expectancy of men in Belarus reduced from 64.60 in 1989 to 62.87 in 1989 (18). Latvia also witnessed a reduction by 3.4 years of life expectancy among males during 1990 and 1996 (WHO, 2001).
Fourth, there is a relationship that is circular in nature between poverty and health. Aspects of poverty such as: poor living conditions, luck of healthcare, the high cost of drugs and other aspects related to lack of funds makes people vulnerable to disease and illness; and affected people will not be able to work, pay medical insurance premiums, and are forced to pay for expensive drugs and medical attention, thus making them become or remain poor.
Fifth, the economic status of a population strongly relates to health. People living in poverty are likely to live in dangerous environments that are overcrowded and lack proper sanitation. They also undertake jobs that are of high risks, take less nutritious diets, and have numerous stressors, due to lack of enough resources to manage daily life and unexpected problems. According to the US Department of Health and Human Services, there exists the relationship between perceptions of poor health and household income (WHO, 2005).
It stipulates that as income rises, population is more likely to think that their health is good. Poverty reduces peoples access to healthcare in most cases. In advanced nations of the world, this is more a challenge for people above the poverty line who are not qualified for public support. On the other hand, poverty is correlated with reduced access to health care in developing countries.
Sixth, income and education have some influence on poor health status over individual health risk behaviors. It is vital for health care practitioners to understand that certain populations are vulnerable to poor health not only because of manageable individual behaviors but also because of social and economic circumstances. Women, children, and older adults are more likely to be affected by poverty. Roughly, over 80% of people in poverty are classified in these categories (Birchenall, 1998). They are also vulnerable to poor health outcomes, and adding the stressors related to poverty enhances the effects of vulnerability. Pregnancy among the adolescent is a key contributing factor to cycles of poverty among families.
Adolescents from poor homes are more likely to become pregnant compared to those from wealthy families. Teenagers who decide to keep and up bring their children are likely to remain poor themselves. This interrupts their education, limits job opportunities, incurs them expenses related with child upbringing, and long term economic difficulties that affect both parents and children. Economic difficulties are worsened by numerous health problems related to teenage pregnancy (Donaldson, 2003).
Seventh, single parent families led by women are more likely to live in poverty than two parent families, and children in these families are more likely to be abused. This stems in part from the experiences between a mothers history of abuse, feelings of maternal depression, and anger over everyday stressors. (Donaldson, 2003).
Eight, people living in poverty are less educated. Their access to quality education is limited. Education has a greater impact on the health status. Populations with higher levels of education may have more information in deciding healthy lifestyle choices. Highly educated individuals are likely able to make informed choices concerning health insurance and providers. It may also influence perceptions of stressors and problem situations and provide individuals with more alternatives (Birchenall, 1998).
Ninth, people living in poverty are more exposed to numerous socioeconomic stressors which make them more vulnerable to risks than others endowed with financial resources that are able to cope effectively. For instance, living conditions of people under poverty and the practical problems they face, interact to make them susceptible to problems of health (Birchenall, 1998).
Last but not least, populations living in poverty risk being marginalized with respect to the population as a whole. The problems of these vulnerable populations may be overshadowed by those of a larger populace and may have limited power for the resources they need. Money is the most critical resource, in contemporary American society; lack of means of finance puts individuals in dependent positions and further removes control over choices between options available.
Additionally, insufficient financial resources constraint the extent people participate in making decisions that affect them. Thus, this limits their ability to influence kinds of options available to them. In essence, vulnerable groups have limited control over potential and actual health care requirements. They are more disadvantaged than other groups because typical health planning targets the majority. The emphasis of public health traditionally is based on the utilitarian value of the greatest good for the greatest number . This puts the vulnerable groups at a disadvantage (Birchenall, 1998).
Comparisons and Contrasts of Mental Illness and Learning Difficulties
Mental health represents a state in which an individual is capable of playing an active role in the normal functioning of society. For instance, they are able to interact with other people in society and coping with problems without suffering distress or disturbed behavior. Mental illness and learning disability both exhibit a stigma to those affected from them, and mildly, to those people who provide care to the affected. Both mental illness and learning difficulty victims have special requirements that present challenges to appropriate health care provision (Donaldson, 2003). This section tries to compare and contrast mental illness and learning difficulties.
Several factors suggest that individuals with mental disabilities are more at risk than the general population to develop learning difficulties. The capacity of these factors range from biological, psychological and social, and includes lack of friends, parental rejection, social stigmatization, genetic abnormalities, and others. Research evidence morbidity shows that individuals with learning disabilities experience higher rates for autism and psychoses, and high rates of aggressive behavior, compared with the general population (Thomas, 2003).
There are a number of studies that have attempted to enhance knowledge of mental illness manifestation in individuals with learning disabilities, more so, the detection and diagnosis of such conditions. However, there are factors concerning: validity of psychiatric systems of classification derived for the general population; validity of a diagnosis when an individual has inadequate capacity to be interrogated; and expanse social factors that require to be put into consideration when complex mental health requirements for individuals with learning disabilities are assessed. Recognition of learning disability cases is a vital part of the overall assessment process. More so, undetected cases of learning disabilities cannot be assessed and treated unlike those who suffer from mental illness (Thomas, 2007).
Individuals with learning disabilities are at a disadvantage in terms of psychiatric service provision. This is because of the inherent problems of diagnosing mental health difficulties in individuals with learning difficulties. With respect to people with mental disability, the fundamental limitation of primary health care system relies on the ability of individual to recognize and report symptoms of ill-health. Individuals with difficulties in communication may lack skills to do this, thus, health care practitioners may not have skills required to overcome this limitation. Studies show that there are many individuals with learning difficulties who have mental illness but whose problems remain undetected. For this reason, such individuals have little prospect of getting necessary treatment for their condition (Donaldson, 2003).
Consequently, the diagnosis process for learning disabilities is still fraught with problems in circumstances where individuals mental health difficulties have been determined. Researchers and clinicians assert that people with learning disabilities manifest full range mental health conditions reflected by the general population (Donaldson, 2003).
For instance, surveys by Reis and Eaton reported individuals with learning disability attending community based mental health clinics Chicago, determining that they were subject to a wide range of emotional disturbances, and that the symptoms of specific psychiatric disturbances were essentially similar for people with and without learning disability (Thomas, 2003). There was similar conclusion by Sovner and Hurley that mental illness in a population in this population should not be regarded as fundamentally different from that occurring in normal individuals (Thomas, 2003).
It is difficult to obtain consensus on defining mental illness in individuals with learning difficulties in relation to the uncertain status challenging behaviors. Research has indicated that about 6% of people with learning disability display behaviors that: had at some time caused more than minor harm to the individuals themselves or to others, or had destroyed their immediate living or working environment; happened at least once a week and needed the intervention of one member of staff to control, or placed them at risk, or caused damage which could not be rectified by care staff, or caused more than one hour disruption; or happened at least daily and caused more than a few minutes disruption (Thomas, 2003).
These challenging behaviors are more prevalent among people with severe learning difficulties. It is also common in men, adolescents and young adults, individuals with syndromes related to learning disabilities, individuals with specific difficulties in communication, individuals with specific syndromes associated with learning difficulties, and people with recognized psychiatric disorders (Donaldson, 2003).
In sum, learning disabilities refer to lifelong constraints of intellect that translate later into constraints in learning. Individuals who have learning difficulties are naturally slow, for instance, in class; they experience problems learning material as swiftly or as comprehensively as others; and they also have problems in learning life skills, hence, have difficulties in coping and social adaptation. By contrast, mental illness or disorder refers to a spectrum of psychiatric conditions that interfere with a persons usual or prior level of functioning (Thomas, 2003). Individuals with mental disorders do not necessarily suffer from fundamental limitations of intellect.
They may be equally bright and academically capable just like anyone else, but are usually faced with specific symptoms that are disruptive in their lives. Additionally, while learning disability, as a condition, is constant, mental illnesses change and diminish and may be eradicated all together. There is a possibility for individuals to suffer from both learning disabilities and mental illnesses. However, majority of people with mental illnesses do not suffer from learning disability, just like many of those individuals with learning disabilities do not have mental disorders (Donaldson, 2003).
Confidentiality Implications of Public Health Matters
Public health involves a great deal of data collection activities. One of the fundamental risks that are found in public health activities, especially in data collection is the element of confidentiality. Public health data collections provide important statistics of public health or population trends. The collected data presents information that is individually identifiable and can be located publicly. The variety of data collected is not usually treated as personal or sensitive.
However, all people are entitled to personal privacy. For instance, some important statistics such as causes of death or paternity could be considered as a violation of privacy. Publicly collected data can also reveal information that can be stigmatizing and injurious. This section discusses confidentiality implications of public health matters (Thomas, 2003).
Confidentiality refers to the right of the patient to expect that his or her personal health information is not disclosed by health professionals without their permission. The aspect of confidentiality plays several roles in health care that are important. For instance, it enhances human dignity by protecting intimate information, encourages and promotes trust between health care practitioners and patients, and raises the efficacy of public health programs that depend on voluntary cooperation to effect lasting behavioral changes. Confidentiality also encourages the public to voluntarily donate blood to the health needs of a country (.
The scope of confidentiality may be interpreted differently by different cultures. For example, in Africa, disease and death according the dictates of tradition, is carried as a family if community, rather than an individual matter. If a member of the family becomes infected with a disease such as HIV/AIDS, the family head may decide whether, and from whom, to seek treatment. A community may maintain confidentiality if it does not want other people that one of their member is suffering from a chronic illness or genetic defect (Eldeman, 2007).
Confidentiality in public health practice is important and has been recognized since time immemorial. One significant reason for this is that confidentiality promotes the best interest of patients. Assurance of confidentiality to patients makes them more likely to be candid and truthful. Moreover, every individual requires privacy and therefore, it is only fair and just to extend it to others. Additionally, patients own information about themselves and the aspect of confidentiality respects their privacy and rights to control this information. The release of some information about a patient has the potential to cause great injury to through loss of esteem, discrimination, or labeling (Eldeman, 2005).
Confidentiality is vital for the provision of health care and provides an important basis for the relationship trust between the patient and health care providers. Confidentiality means that a patients information should not be disclosed without consent or authorization. Breach of confidentiality may cause patients to experience harm and may not seek required health care. For instance, they may not disclose factional health history if they think that other people will know their health condition. Confidentiality between a patient and a physician is a vital value in the medical profession (Eldeman, 2005).
Why Proper Care for the Elderly Population is increasingly becoming A Problem all over the World
Provision of care to the elderly presents a challenge to particularly developing countries where the population is increasingly ageing. The costs of health care of the elderly will increase proportionally as the ageing proceeds. The provision of health care to the elderly requires appropriate human labor. The health cost and labor cost of elderly care can have macroeconomic effects on household savings. This section explains why proper care for the elderly population is increasing becoming a problem all over the world (Donaldson, 2003).
The number of elderly population in the world is projected to grow twice from half a billion in 1990 to over one billion by 2025 (WHO, 2001). A greater percentage of this development will occur in the developing countries of Africa, Asia, and Latin America. A quarter a billion people in these regions were over the age of 60 and above in 1990; by 2025 this number will grow to over 800 million (WHO, 2001). This will strain the health care systems and government agencies will strain hard to provide for their needs, as some of the traditional social systems that have given care to the elderly are starting to dwindle and the number of needy aged are increasing.
The increase in the number of the elderly has great influence on mental health in a number of ways. The increase in the elderly population leads to inevitable rise in diseases related to age, such the as dementias. Further, changes in social patterns will affect the role of the old and the way they are valued. These changes can result in adverse mental health outcomes, such as depression, suicide, anxiety, and serious constraints on the quality of life among elderly people.
Besides, families will be overburdened by the increased demand for care provision. More so, the burden care lies heavily on women, since they are usually the primary care givers. The majority of these women are poor and do not have enough resources. Furthermore, the elderly with no children, especially widows may depend on relatives for care. Those who give this care may succumb to depression, hopelessness and frustration.
A survey contacted in India of psychiatric disorders among the elderly population established 27% of them suffered from depression, compared to 12% for dementia, 35% for chronic Schizophrenia and 25 % for other non-specified disorders (Desjarlais, 1996). Other problems of mental health which hinder proper care for the elderly population all over the world relate to food scarcity. According to World Bank estimates, some 780 million of people of all age groups world over lack energy. Majority of the elderly, particularly women, are poor and are more likely than the general population to be malnourished. Problems like forgetfulness and confusion result from lack of food (WHO, 2005).
Proper care for the elderly population presents rising health cost for the elderly. The cost of care giving as a proportion of national income is rising rapidly than the proportionate increase in the elderly population. Care giving or nursing requires human care. Therefore, the ageing of the population will need a larger percentage of the labor force to be employed in the elderly care sector. As the ageing progresses, more people will need intensive care.
For example, while only 2.5% of people aged 65 and 69 require nursing either at home, in nursing homes or hospital, the proportion of people who require such care rises rapidly for older age groups (Desjarlais, 1996). That is, it climbs to 4.3% for age group of 70-74, 8% for age group 75-79, 16.8% for age group 80-84, and as high as 35.5% for age group 85 and over (Desjarlais, 1996).
Why Depression is such a Mysterious Disease
Depression is affective mental disorder whose diagnosis involves symptoms and signs such as; loss of interest in normal activities, sleep disturbances, lose of appetite, psychomotor retardation, and others. The seriousness of depression varies from mild to severe. Its episodes may be recurrent and are a major risk factor for social breakdowns and suicides. This section tries to justify why depression is such a mysterious disease (Siegel, 2004).
Depression is one of the most prevalent of medical diseases. For many sufferers, this disease is chronic and recurrent in nature. Epidemiological studies reveal that, 30% of individuals suffering from depression remain depressed after one year, 18% after two years, and 12% remain sick after five years (WHO, 2001). Majority of patients treated for depression continued to have residual and sub-syndrome signs that led to poor results such as; higher relapse and suicide risks, poor psychosocial function, and increased deaths from other medical diseases. Among the sick who manage to recover from depressive attacks, 50% of them when experience a relapse (WHO, 2991).
Since depression disease is recurrent, therefore, it rarely vanishes with distraction. It is a disease that breaks people and some times leads to death. The disease is a mystery where common feeling of the depressed turns to disabling disorder, and where sadness turns to a state of despair (Wulsin, 2007).
Depression is a mysterious illness given its high prevalence and high socioeconomic costs associated with it. For instance, a study carried out in 1990 by World Health Organization (WHO) comparing all medical diseases, revealed that depression was fourth among the leading health related disabilities, and predicted that the disease will rank second to heart disease by the year 2020 in terms of the total burden. Depression as a disease is such a mystery right from its definition, the context of its classification, and its nature as a disease (WHO, 2001).
The definition of depression has undergone a number changes over time, and this is reason enough to justify why depression is such a mysterious disease. The number of changes depression has undergone reflects clinical and research designs, theories that are evolving that concern psychological and biological causations of disease, and the broad social context in which the disease if viewed. The changes in terms of fashions have also influenced how depression is perceived and how the construct is determined (Wulsin, 2007).
The context of classifying depression justifies its mystery as a disease. Originally, the terms stress, distress and disease had similar meaning and implied inadequacy of emotional well being and external precipitants. Depression is used to explain the effects of state of lowered function, and it covers a wider range of experience. This makes it less meaningful and difficult to define. For instance, it definition ranges from scientific to economic to psychological.
In general terms, depression is used to explain the normal human emotion, convey a predicament, symptom, an affect, a disease, or an illness. The mode of classifying depression relating to context further explains the mystery behind depression as a disease. For instance, in clinical settings, diagnosis is associated with clinical goals such as; making a prognosis about expected outcomes, and management planning (Wulsin, 2007).
The nature of the categories of diagnosing depression raises a fundamental question. The question of whether depression definition is dimensional or categorical in establishing how it is conceptualized, that is, whether on a continuum with normal experience or something that is qualitatively different, and how it is measured. For instance, depression can be classified as a mood disorder, as opposed to say, anxiety disorder or thought disorder. The main emphasis of these terms is on a specific symptom. This provides an arbitrary classification convenience more than dominant fact concerning the primary importance of mood, thought or anxiety for any particular disorder (Wulsin, 2007).
Public Health Implications of Environments that a Person Lives
The basic function of public health is to promote the health of people. It is responsible in preventing environmental risk factors that cause chronic disease, epidemics and infectious illnesses that threaten public health. As an institution that belongs to society, public health faces threatening environmental challenges in terms of changes in national economies, political environment, health care delivery procedures, public opinions concerning public health, government, and the community (Siegel, 2004). This section tries to explain public health implications of environment that a person lives.
Public health has diverse implications of the environment that individuals live. Effective public health policies strive to provide good environmental management, necessary in guiding the public towards avoiding preventable illnesses. According to World Health Organization report (2005), 25% of all preventable diseases resulting from environmental factors directly, can be avoided by excellent management of the environment.
Public health is influenced by environment in a number of ways: through exposures to risk factors such as; physical, chemical, biological and social transformations in behavior in reaction to these risk factors. 13 million people die every year due to controllable environmental causes (WHO, 2005). Further, 4 million children from third world countries in particular could be saved through proper environmental risk prevention strategies (WHO, 2005).
Sound public health policies are able to mitigate the environmental risk factors, and thus improve the health of the population. It is important to note that, the critical strategy for public health to achieve meaningful health reform for the population is through the commitment of society to change. Disease and illness prevention requires changing the circumstances or conditions in which people live, enhancing environmental quality and public policy reform (Siegel, 2004). Quite often, social and political issues affect the standards of living of a population, and are major determinants of health and disease. Most public health programs are aimed at preventing infectious diseases and change individual behavior. It also aims at changing the physical environment and alleviates poverty to reduce disease (Donaldson, 2003).
The changes in causes of deaths from infectious to chronic diseases have same implications for improved public health. Chronic diseases are related to individual and societal behavior, social policy, and social conditions (Siegel, 2004). Therefore, it is inherent that public health must be committed to social change. The achievement of efficient human health is attained only through public health, as it is a societal institution whose aim is to promote social change (Donaldson, 2003).
In sum, public health shifts the focus of health from an issue of individual lifestyles and choice to a wide matter of the community. Public health informs that health is created in places where population lives, love, play, or work. Communities create health by interacting with one another and with their physical environments. Therefore, public health policy set-ups should start with every days life set up in which health is created and strengthen the health capability of these settings. This requires identification of patterns that form health and creating strategies that strengthen such patterns throughout the process of human development (Siegel, 2004).
HIV/AIDS Disease and its Mode of Transmission
Human immunodeficiency virus (HIV) is a virus that causes Acquired immunodeficiency syndrome (AIDS). This disease weakens and destroys the immune system of the body of infected individuals. The world has registered unprecedented rapid spread of HIV/AIDS in the last two decades, resulting to human death and suffering, particularly in third world countries. Not only is HIV and AIDS a serious issue in third world countries, but also a serious catastrophe in terms of development that dismantles social and economic gains of the past half century (UNAIDS, 1999). This section explains what HIV/AIDS is about and the mode of transmitting the disease.
HIV and AIDS is a terminal, sexually transmitted infection. Once an individual gets HIV and AIDS, he or she is infected for life. In all but a small fraction of cases, HIV and AIDS completely destroy the immune systems of infected individuals.
The time frame between one becoming HIV positive varies with the onset of AIDS. The average time between infection with HIV and the emergence of the symptoms is about 10 years in developed countries and five years short in the poorest countries of the world. These poor nations go without access to proper care. Once an individuals immune system is destroyed severely, the body becomes vulnerable to opportunistic ailments that are life-threatening such as; tuberculosis and pneumonia. The individual is then diagnosed as having AIDS. Infected individuals succumb to these opportunistic infections after the onset of AIDS within about two years (UNAIDS, 1999).
Statistics worldwide indicate that, almost half of all those infected with HIV get the infection before the age of 25, and it is estimated that they die before they turn 35 years. Therefore, AIDS poses a threat to both young people who are at risk of getting infected and the children who lose their parents through HIV/AIDS. UNAIDS report states that, cumulative total of about 12 million children had been orphaned by AIDS epidemic by the end of1999 (UNAIDS, 1999).
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