Public Health is an emerging field that has goals to improve the the access of  healthcare to all individuals. Some believe that equal health care is not attainable for all. Some believe that there should be a bare minimum for all people and they are entitled to this right. However, is it really possible to create a bare minimum of health care for all? There are those that realize this concept, and strive to work against the negative effects of social determinants in our societies. Sreenivasan states that, “Social determinants of health, roughly speaking, are those social factor outside the traditional health care system that have an effect either positive or negative, on the health status of individuals in a given population”. There is obviously a relationship between access and quality of health care to the wealth of an individual. However, it is important to note that health care is not the sole control social factor that significantly impacts one’s health. The article makes very realistic points about how we should view the social gradient. If we were to achieve this idea of “equal opportunity”, every one would “more or less” have the same access and quality health care.This article does not stress that there is a right to health care for all. However, there are organizations that strive for this goal, and have had great successes in reaching this goal. For example, PIH and BRAC have both made great strides toward better health care regardless of the amount of wealth a person accumulates. Sreenivasan more or less states that there is always going to be someone that doesn’t have health care, and doesn’t believe that everyone has a right to health care. However, Buchanan’s article is a very good contrast to the points made in Sreenivasans article.

Buchanan’s article seems to hold a perspective that may be better applied to the outlook of how health should be viewed. Buchanan states, “The main difficulty is that assuring any significant level of health for all is simply not within the domain of social control.” The article discusses how the idea of equal opportunity, but is it truly realistic. Also, it is noted that there is a strong difference between a decent minimum of healthcare and access to health care. Which one should be implemented? There may or may not be a better choice depending on finances and other factors, but which one seems to be more realistic in our world today? Can we provide a decent minimum for all? An important point to note is that people require different levels of health care. People have different cases and diseases that all require differing levels of money to treat. There will always be someone that doesn’t quite receive the adequate amount of healthcare that they should receive, and the reality of it is harsh. However, as a society we can try our best to treat the ones that are affected negatively by these social determinants. There may be wiggle room for the bar to be set as to where to begin treating everyone, but how do we establish a set bar? Each case can have a different level of severity and urgency, so can we really make a bare minimum in the field of public health.

References

Sreenivasan, Gopal. “Health Care and Equality of Opportunity”. The Hastings Center Report (2007). p. 21-31.

A. Buchanan, “The Right to a Decent Minimum of Health Care”. Philosophy and Public Affairs (1984). p.55-78

How should we make decisions in public health and who should be held responsible? Is it the individual or the society who is responsible for own their health? A person is responsible for their health to a certain extent. The doctor can only tell you so much and supply you with resources to aid you in the process. For example, if someone has a smoking habit, and they’re health is in cardiovascular danger. If the doctor has given them sources to help them, but they are not receptive to the treatment then they should be held responsible. Our society is made up of individuals, some who take care of their health and some who don’t. Public health focuses on the society as a whole.

One of the main issues in public health is that they are trying to fix issues quickly and directly. Sometimes in our society we wait on things to get bad, and then we want to fix it instead of increasing primary prevention. For example, “How can you expect me to be healthy if I can’t afford it?”. According to the Brody and Englehardt article, some third world countries are misguided in that they allot more financial aid for improving health as opposed to allocating money to the accumulation of the capitol. In my opinion, when money is given to the health fund, it is a more direct approach, but sometimes a different strategy is needed. As stated in the article, setting money aside for the capitol will help people get jobs and more money, which will increase health. This is a more indirect approach and may take a longer time to be effective, but I feel as though in the long run this may be the most impactful approach.

However, one can never be too sure on which approach to take, because some situations call for different approaches. Although, when one approach fails, the government should try to switch to an alternate method. The best method should be to attack the issues before they even fully develop into major problems. This method may seem unrealistic for issues that are unforeseeable and may contribute unforeseeable consequences. However, even if an issue is just beginning something can still be done to prevent the particular issue getting worse. For example in the article by Brody and Englehardt, it is stated that we would rather spend $100,000 on rescuing people from a trapped mine as opposed to investing in mine safety. Instead of letting a mine get to the point where it collapses, we should set money aside to help the damages in the mine before it gets out of hand.

When trying to fix the issues we also must think about who’s in power to fix these issues. The government has most of the power of where to distribute funds. They are the ones that decide which type of approach should be taken.  According to the WHO website, there are 4 steps that need to be done to properly execute the public health approach: 1) Surveillance 2) Identify risk and protective factors 3) Develop and evaluate interventions 4) Implementation. These are good guidelines to follow, but we must be sure to execute each step in a cost effective and timely manner.

 REFERENCES

Brody and Engelhard. “Preventative Medicine,” Bioethics: Readings and Cases

http://www.who.int/violenceprevention/approach/public_health/en/

http://healthyamericans.org/public-health-funding/

Informed consent is general information distributed to each patient. Despite the efforts made by the consent forms to notify the patient of the risks of the procedure, the content of the forms are often disregarded. The questions then rise with how detailed should the content forms be. Should the debriefing of the dangers of the procedure be mainly done by the doctor or should the information be strictly attached to the form. I believe that there should be a combination of both. The patient should be informed about the severity of their surgery through the form, and the doctor should warn the patient about the basic risks of the procedure. Although not as overlooked as Terms and Conditions, the consent forms do serve a pertinent purpose for both the patient and the doctor. The goal here is to communicate to the patient the general risks of the procedure. However, then the question is what exactly should not be shared? Should the doctor discuss the rare cases that may occur with the procedure or not? I believe that the doctor should try to translate medical terms to lamest terms, but they don’t have to go in depth on rare cases unless it is fitting to their condition. I also think that the time information is conveyed should also be a concern. They should be given enough time to contemplate whether they would like to continue with the procedure or not. The patient and doctor should both be held responsible to effectively communicate with each other their concerns with the treatment. If communication is not present then there will be a disconnect with the information given.

When thinking about how the patient is informed, we must also consider the doctor and patient relationship. Some doctors aren’t personable, but establishing a healthy connection between the doctor and patient is pertinent. When this relationship is formed, it builds trust. Also, the doctor becomes more understanding of how the patient feels generally and about the surgery.  As a result, the doctor would have the patients’ best interests at heart. According to Schumann, establishing a patient doctor relationship has therapeutic purposes and is one of the main goals for a doctor during practice.

As stated in the text by Lidz there were four reasons that patients desired information: “Information of Compliance, Courtesy, Veto, and Decision making”. The reasons are understandable, and the patient has a right to this information. Some patients assume that the doctor simply knows what they’re doing, and will do what is best for them. However, Lidz made a great point that out of respect for the person patients want to be informed. The relationship between the doctor and patient would contribute to the degree of courtesy and amount of information that is disclosed. People are unique and respond differently to information when communicated.  However, the patient must also question the doctor about certain issues they have. They also have a duty to ask the doctor about certain things that would affect them that the doctor may not be as informed about. The decision of the procedure should ultimately be a combination of the doctors expertise and how the patient feels. Quite naturally, there will be things that the patient does not understand about the procedure, but it is the doctor’s duty to inform the patient as much as possible with sufficient information prior to the procedure.

References

Charles W. Lidz, Ph.D., Alan Meisel, J.D., Marian Osterweis, Ph.D., Janice L. Holden, R.N., John H. Marx, Ph.D. and Mark R. Munetz, M.D. “Barriers to Informed Consent.” Arguing About Bioethics. Ed. Stephen Holland. London: Routledge, 2012. 93-104. Print.

Kegley, Jacquelyn Ann K. “Challenges to informed consent” EMBO reports, 2004. 832-836.

Suchman, Anthony L. M.D., Matthews, Dale A., “What Makes the Patient-Doctor Relationship Therapeutic? Exploring the Connexional Dimension of Medical Care”.  American College of Physicians. 1988; 108; 125-130.