Academic journal article Journal of Allied Health

Affordable Care Act: A Pyramidal Success or Failure?

Academic journal article Journal of Allied Health

Affordable Care Act: A Pyramidal Success or Failure?

Article excerpt

THIS ESSAY was prepared nearly four-and-one-half years after the Patient Protection and Affordable Care Act (ACA) became law. Prior to its enactment and just about every day since then, this major health reform initiative has been marked by bitter controversy and staunch opposition by Republicans in federal and state government. The law possesses the hallmarks of a quenchless feud that shows no signs of being abated.

Although the ACA has vital characteristics that will have a sub- stantial impact on individual and community health status, it is important to realize that health reform in and of itself also has important limitations in the con- text of the larger picture of life in the U.S. Apart from what accom- plishment or deficiencies are associ- ated with the ACA, the following societal determinants will exert highly significant effects in the health domain:

* Prominent among population health concerns are events which transpire in periods of economic decline. Loss of employment and difficulties expe- rienced in paying bills are among the many stressful consequences of a weak economy that can lead to the onset of health problems. The U.S. Great Recession (December 2008 through 2011) was associated with increases in a range of health con- cerns that potentially are indicative of worsening population health (e.g., arrhythmia, back pain, cancer, chest pain, gastric pain, headaches, and ulcers).1 The economic recovery from the recession has been the weakest of the post-World War II era. The nation's potential growth rate (the speed at which the economy can expand while keeping unemploy- ment and inflation steady) has plum- meted because two key determi- nants, the supply of workers and their productivity, have fallen short. The labor force has not grown and output per hour worked has fallen. A less than robust economy means that living standards will rise more slowly, tax revenues will be lower, and the burden of paying current debts will be heavier.2

* Stress experienced early in life exerts a powerful, lasting influence on human development. Converging empirical findings show that stressful experiences become deeply embed- ded in a child's neurobiology, with an astonishing range of long-term effects on cognition, emotion, and behavior. Already during gestation, maternal stress is transmitted to the fetus via stress-related hormones, such as glucocorticoids and cate- cholamines. Later on, the developing child faces many potential sources of stress, ranging from physical danger and material deprivation to psy- chosocial stressors, such as family conflict, harsh or neglectful parent- ing, and peer rejection or hostility.3

* Characteristics of unmarried par- ents can influence children's devel- opment. Most parental relationships do not last, and as a result many children experience high levels of instability. Relationship changes influence parental resources and contributions. Unmarried parents are much more disadvantaged than married parents. Compared to mothers married at birth, unmarried mothers engage in fewer literacy activities with their children, are more likely to use harsh discipline (yelling and spanking), and less likely to have a stable home routine (such as a regular bedtime).4

* Despite significant improvements in survival of various diseases over the past few decades, racial/ethnic and socioeconomic disparities persist. The quality of a neighborhood may influence survival through features of the physical (e.g., goods, services, pollutants) and social (e.g., cohesion, collective efficacy, support, stress, coping) environment.5 Level of edu- cation, availability of jobs, and amount of income all have a bearing on the kinds of neighborhoods that can be chosen in which to reside.

* Mental health problems do not always receive the amount of atten- tion they deserve. Outpatient follow- up after hospitalization for mental health reasons is an important indi- cator of quality of health systems. …

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