Modern Issues in Health Care

Colonialism and the Spread of Diseases

European colonization contributed to the spread of disease worldwide.

Learning Objectives

Summarize the impact of European colonialism on the spread of infectious disease and beginnings of disease control

Key Takeaways

Key Points

  • Colonialism is the policy or practice of acquiring full or partial political control over another country, occupying it with settlers, and exploiting it economically.
  • Encounters between explorers and populations in the rest of the world often introduced new diseases, which sometimes caused local epidemics of extraordinary virulence.
  • Trade routes and new world conquests devastated indigenous populations, as they were exposed to new pathogens and newly domesticated animals.
  • The leading cause of death in Europe and North America in the nineteenth century was tuberculosis.
  • In the twentieth century, the world saw the biggest increase in its population in human history due to lessening of the mortality rate in many countries due to medical advances.
  • In the 20th century, the world saw the biggest increase in its population in human history due to lessening of the mortality rate in many countries due to medical advances.

Key Terms

  • mortality rate: The number of deaths per given unit of population over a given period of time.
  • tuberculosis: An infectious disease of humans and animals caused by a species of mycobacterium mainly infecting the lungs where it causes tubercles characterized by the expectoration of mucus and sputum, fever, weight loss, and chest pain, and transmitted through inhalation or ingestion of bacteria.
  • pathogen: Any organism or substance, especially a microorganism, capable of causing disease, such as bacteria, viruses, protozoa, or fungi. Microorganisms are not considered to be pathogenic until they have reached a population size that is large enough to cause disease.

Colonialism and Health

Colonialism is the policy or practice of acquiring full or partial political control over another country, occupying it with settlers, and exploiting it economically. Historically, this has often involved killing or subjugating the indigenous population. Encounters between explorers and populations in the rest of the world often introduced new diseases, which sometimes caused local epidemics of extraordinary virulence.

European colonization contributed to the spread of disease worldwide. Trade routes and New World conquests devastated indigenous populations, as they were exposed to new pathogens and newly domesticated animals. Colonization in Africa and parts of Asia was not as simple for Europeans as it was in the Americas, because Europeans were subjected to diseases they had no prior exposure to. In response to becoming infected, European military and government officials living in African and Asian colonies were quarantined to safety in areas away from natives, who were believed to be disease carriers, and, thus, “biologically inferior. ” The leading cause of death in Europe and North America in the nineteenth century was tuberculosis.

The European contribution to global pathogen exposure created a “global homogenization of disease,” where no border was left uncrossed in the spread of infectious diseases. The ill health effects are long lasting, especially because the health of Europeans improved while the health of colonized nations worsened. Following the end of colonization, many countries continued to use and attempted to enhance their “inherited” healthcare systems, which consisted of “inadequate,” and “top-heavy” structures based on Western medical models. These same models continued to benefit elites and addressed the “rural poor” once the “needs of the urban elite were attended to. ” Hospitals in metropolitan areas were first priority, followed by small rural clinics that were underfunded, understaffed, and, thus, less effective.

From the beginning of the twentieth century onwards, the elimination or control of disease in tropical countries became a driving force for all colonial powers. The sleeping sickness epidemic in Africa was arrested due to mobile teams systematically screening millions of people at risk. In the twentieth century, the world saw the biggest increase in its population in human history due to lessening of the mortality rate in many countries due to medical advances. The world population has grown from 1.6 billion in 1900 to over 7 billion today.

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Florentine Codex smallpox: Aztecs dying of smallpox, (“The Florentine Codex,” 1540–85)

Infectious Diseases Today and in the Developing World

Infectious diseases result from the infection, presence and growth of pathogenic biological agents in an individual host organism.

Learning Objectives

Assess the implications of infectious diseases in terms of health care and life expectancy of individuals

Key Takeaways

Key Points

  • Many infectious diseases that killed by the millions were greatly reduced in the 20th century.
  • While the number of deaths due to nearly every disease has decreased, deaths due to HIV/AIDS have increased fourfold.
  • Infectious pathogens include some viruses, bacteria, fungi, protozoa, multicellular parasites, and aberrant proteins known as prions.
  • The top three single agent /disease killers are HIV/AIDS, tuberculosis and malaria.
  • Normally not a problem to North Americans, malaria is the infectious disease most deadly to children worldwide. Malaria infects 500 million people per year, killing just fewer than 3 million.
  • HIV/AIDS is the world’s leading cause of death; it was introduced as an infectious disease during the 20th century.

Key Terms

  • pathogen: Any organism or substance, especially a microorganism, capable of causing disease, such as bacteria, viruses, protozoa, or fungi. Microorganisms are not considered to be pathogenic until they have reached a population size that is large enough to cause disease.

Infectious diseases, also known as transmissible diseases or communicable diseases, are clinically evident illnesses resulting from the infection, presence and growth of pathogenic biological agents. Infectious pathogens include some viruses, bacteria, fungi, protozoa, multicellular parasites, and aberrant proteins known as prions. These pathogens are the cause of disease epidemics, in the sense that without the pathogen, no infectious epidemic occurs.

Many infectious diseases that previously killed by the millions were greatly reduced in the 20th century, with the most notable achievement being the eradication of smallpox. Other diseases, such as diphtheria, typhoid fever, tuberculosis and whooping cough were greatly reduced throughout the world due to childhood immunization programs, improved sanitation, and the use of antibiotics. However, some infectious diseases remain a problem today. The top three single agent/disease killers are HIV/AIDS, tuberculosis and malaria.

Malaria

Normally not a problem to North Americans, malaria is the infectious disease most deadly to children worldwide. Said to be one of the world’s oldest diseases, malaria is caused by one of four protozoans within the genus Plasmodium. The blood pulled from the bite of an Anopheles mosquito carries this disease, which infects the human or animal host and resides in red blood cells in order to reproduce. Malaria infects 500 million people per year, killing just fewer than 3 million. It is the second leading cause of death in Africa, after HIV/AIDS, and is the fifth leading cause of death from infectious diseases worldwide.

HIV/AIDS

HIV/AIDS was introduced as an infectious disease during the 20th century and deaths due to HIV have increased fourfold since. The first cases were diagnosed in the United States in the early 1980s. This misunderstood illness was originally thought to only exist among four risk groups, better known as the 4Hs: Homosexuals, Haitians, Hemophiliacs and Heroin users. However, as HIV/AIDS has become a pandemic, it is better understood and is known to not just be isoloated to certain groups of people. There are various modes of HIV transmission which include: male to male sexual contact, injection drug use, and heterosexual contact. In some developing countries where antiretroviral drugs are not affordable or readily accessible, mother-to-child transmission still poses a possible risk of infection.

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Concentrations of malaria transmission worldwide.: Normally not a problem to North Americans, malaria is the infectious disease most deadly to children worldwide. Said to be one of the world’s oldest diseases, malaria is caused by one of four protozoans within the genus Plasmodium.

HIV and AIDS

HIV/AIDS is a major health problem in many parts of the world.

Learning Objectives

Describe the problems associated with HIV/AIDS for many societies, particularly poor countries and ethnic minorities

Key Takeaways

Key Points

  • Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). The virus and disease are often referred to together as HIV/AIDS.
  • The three main transmission routes of HIV are sexual contact, exposure to infected body fluids or tissues, and from mother to fetus during the perinatal period.
  • The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems.
  • There is currently no publicly available HIV vaccine or cure for HIV or AIDS. The only known methods are based on avoiding exposure to the virus.

Key Terms

  • transmission: HIV is transmitted by three main routes: sexual contact, exposure to infected body fluids or tissues and from mother to child during pregnancy, delivery or breastfeeding.
  • vaccine: A substance given to stimulate the body’s production of antibodies providing immunity against a disease, prepared from the agent that causes the disease, or a synthetic substitute.
  • perinatal period: Of or pertaining to the time around birth.

HIV and AIDS in Health Care

Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). The illness interferes with the immune system, making people with it much more likely to get infections that do not affect people with working immune systems. This susceptibility gets worse as the disease continues. HIV is transmitted through sexual intercourse, contaminated blood transfusions and hypodermic needles. It can also be transmitted between mother and baby during pregnancy, childbirth and breastfeeding. It can be transmitted by any contact of a mucous membrane or the bloodstream with a bodily fluid that has the virus in it, including blood, semen, vaginal fluid, preseminal fluid, or breast milk.

The virus and disease are often referred to together as HIV/AIDS. The disease is a major health problem in many parts of the world, and is considered a pandemic; a disease outbreak that is not only present over a large area but is actively spreading. In 2009, the World Health Organization (WHO) estimated that there are 33.4 million people worldwide with HIV/AIDS; 2.7 million new HIV infections are reported per year along with two million annual deaths due to AIDS. The three main transmission routes of HIV are sexual contact, exposure to infected body fluids or tissues, and from mother to fetus during the perinatal period. It is possible to find HIV in saliva, tears and urine of infected individuals, but there are no recorded cases of infection by these secretions. Anti-retroviral treatment of infected patients also significantly reduces their ability to transmit HIV to others. This treatment reduces the amount of virus in bodily fluids to undetectable levels

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AIDS awareness in Chimoio: AIDS awareness painting on a wall in Chimoio town, Mozambique.

People with AIDS also have an increased risk of developing various cancers like Kaposi’s sarcoma, cervical cancer and cancers of the immune system known as lymphomas. In addition, people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss. The opportunistic infections AIDS patients develop depend in part on the prevalence of these infections in the patient’s geographic area. Symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems. Most of these conditions are opportunistic infections caused by bacteria, viruses, fungi and parasites normally controlled by the elements of the immune system that HIV damages. These infections affect nearly every organ system.

Many people are unaware that they are infected with HIV. Less than 1% of the sexually active urban population in Africa has been tested; this proportion is even lower in rural populations. Furthermore, only 0.5% of pregnant women attending urban health facilities are counseled, tested or receive their test results. Again, this proportion is even lower in rural health facilities. Therefore, donor blood and blood products used in medicine and medical research are screened for HIV.

There is currently no publicly available HIV vaccine or cure for HIV or AIDS. The only known methods are based on avoiding exposure to the virus or, failing that, an antiretroviral treatment given directly after a highly significant exposure. This treatment is called post-exposure prophylaxis (PEP). PEP has a very demanding four-week schedule of dosage. It also has very unpleasant side effects, including diarrhea, malaise, nausea and fatigue.

Health Insurance

Health insurance is insurance against the risk of incurring personal medical expenses.

Learning Objectives

Discuss the use of both private and public health insurance and the implications for society’s overall health

Key Takeaways

Key Points

  • Two types of health insurance have developed in modern society: private health insurance and publicly funded health insurance.
  • A premium is the amount a policy-holder or his sponsor must pay to a health plan in order to purchase health coverage.
  • A deductible is the amount that the insured must pay out-of-pocket before the health insurer pays its share.
  • Co-payment is the amount that an insured person must pay out of pocket before a health insurer pays for a particular visit or service.
  • An explanation of benefits is a document that may be sent by an insurer to a patient. This document explains what was covered for a medical service, and how payment amounts and patient responsibility amounts were determined.
  • The premium is the amount the policy-holder or his sponsor pays to the health plan to purchase health coverage.
  • The deductible is the amount that the insured must pay out-of-pocket before the health insurer pays its share.
  • Co-payment is the amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service.
  • Explanation of benefits is a document that may be sent by an insurer to a patient explaining what was covered for a medical service, and how payment amount and patient responsibility amount were determined.
  • The medical model of medicine science focuses on the eradication of illness through diagnosis and effective treatment.
  • The social model of medicine science focuses on changes that can be made in society and in people’s own lifestyles to make the population healthier.

Key Terms

  • deductible: A deductible is the amount that the insured must pay out-of-pocket before the health insurer pays its share.
  • premium: The premium is the amount a policy-holder or his sponsor must pay to a health plan to purchase health coverage.
  • co-payment: A co-payment is the amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service.

Health insurance is insurance against the risk of incurring personal medical expenses. By estimating the overall risk of health care that a target group will require, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in an insurance agreement. These benefits are administered by a central organization, like a government agency, private business, or non-profit organization.

Types of Health Insurance: Public Vs. Private

Two types of health insurance exist in modern society, private health insurance and publicly funded health insurance. Private insurance, based on free market principles, refers to health insurance provided by a non-governmental organization, usually a privately owned or publicly traded corporation. Among developed nations, the United States is the only country in which private insurance is the primary source of healthcare.

In contrast to this private method, in public insurance, health care is paid wholly or mostly by public funds. This type of health care is the most common and popular in almost every developed and developing nation in the world, except the United States. The majority of developed nations have publicly funded health systems that cover a majority of the population.

Understanding Health Insurance Terms

Some of the essential terms associated with health insurance are premiums, deductibles, co-payments, and explanations of benefits. A premium is the amount a policy-holder or his sponsor (e.g. an employer) must pay to a health plan to purchase health coverage. A deductible is the amount that an insured individual must pay out-of-pocket before the health insurer pays its share. For example, policyholders might have to pay a $500 deductible per year, before the health insurer covers any health care costs. A co-payment is the amount that an insured person must pay out of pocket before the health insurer pays for a particular visit or service. For example, an insured person might pay a $45 co-payment for a doctor’s visit, or to obtain a prescription. A co-payment must be made each time a particular service is obtained. Lastly, an explanation of benefits is a document that may be sent by an insurer to a patient. This document explains what the insurer will cover, in terms of medical services. It also explains how payment amounts and patient responsibility amounts have been determined.

Healthcare and Modern Medicine

Healthcare improves as a result of advancements in medical science. Modern medicine approaches health care from two angles. The first, the medical model, focuses on the eradication of illness through diagnosis and effective treatment. The second, the social model, focuses on changes that can be made in society and in people’s lifestyles to make the population healthier. This second method typically focuses on preventative care. Modern, scientific medicine has proven uniquely effective at treating and preventing disease. It is increasingly widespread and more widely accepted than other forms of medicine. Modern medicine is notably secular, and indifferent to ideas of the supernatural or the spiritual. Instead, it concentrates on the body and society to determine the causes and cures of health issues. Modern, scientific medicine is the most effective contributor to the health of humans in the world today.

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In less than 10 Years, AMERICA will Spend $1 of Every $5 Dollars on Health care: Across the country, American workers, their families, and small businesses are struggling with rising health care costs and policies that put quality, affordable care out of reach. A new report by the Centers for Medicare and Medicaid Services (CMS), published in the magazine Health Affairs, estimates that spending on health care grew to 17.3 percent of the U.S. economy – a record and the largest one-year jump since 1960.

Preventing Illness

Preventive medicine, or preventive care, refers to measures taken to prevent diseases, rather than curing them or treating their symptoms.

Learning Objectives

Explain the purpose of preventive medicine and how insurance companies can influence the types of preventive medicine chosen

Key Takeaways

Key Points

  • Preventive care may include examinations and screening tests tailored to an individual’s age, health, and family history.
  • Preventive medicine or preventive care refers to measures taken to prevent diseases rather than curing them or treating their symptoms.
  • Professionals involved in the public health aspect of this practice may be involved in entomology, pest control, and public health inspections.
  • Intrauterine devices (IUD) are highly effective and highly cost effective contraceptives, however where universal health care is not available the initial cost may be a barrier.

Key Terms

  • intrauterine device: A contraceptive device consisting of a spiral or similar shape of plastic or metal inserted through the vagina into the uterus in order to prevent the implantation of a fertilized egg.
  • public health: The science and practice of community hygiene; it includes preventive medicine, health education, sanitation and environmental safety.
  • preventive medicine: Preventive medicine refers to measures taken to prevent diseases rather than curing them or treating their symptoms.

Preventive medicine, or preventive care, refers to measures taken to prevent diseases, rather than curing them or treating their symptoms. The term contrasts in method with curative and palliative medicine, and in scope with public health methods, which work at the level of population health rather than individual health. Simple examples of preventive medicine include hand washing, breastfeeding, and immunizations. Preventive care may include examinations and screening tests tailored to an individual’s age, health, and family history. For example, a person with a family history of certain cancers or other diseases would begin screening at an earlier age and/or more frequently than those with no such family history.

Professionals involved in the public health aspect of this practice may be involved in entomology, pest control, and public health inspections. Public health inspections can include recreational waters, swimming pools, beaches, food preparation and serving, and industrial hygiene inspections and surveys.

Since preventive medicine deals with healthy individuals or populations, the costs and potential harms from interventions need even more careful examination than in treatment. For an intervention to be applied widely it generally needs to be affordable and highly cost effective. For instance, intrauterine devices (IUD) are highly effective and highly cost effective contraceptives, however where universal health care is not available the initial cost may be a barrier. Preventive solutions may be less profitable and therefore less attractive to makers and marketers of pharmaceuticals and medical devices. Birth control pills, which are taken every day and may take in a thousand dollars over ten years, may generate more profits than an IUD, which despite a huge initial markup only generates a few hundred dollars over the same period.

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Leading Preventable Causes of Death in the United States.: This data is outdated and was in fact significantly revised in subsequent reports of the leading causes of deaths, especially for obesity-related diseases.