Health Status Determinants in Relation to Federal Health Policy

By Elwood, Thomas W. DrPH | Journal of Allied Health, Spring 2009 | Go to article overview

Health Status Determinants in Relation to Federal Health Policy


Elwood, Thomas W. DrPH, Journal of Allied Health


THE PRESIDENTIAL ELECTION of November 4, 2008, produced quite dramatic results. President-elect Barack Obama will he only the third Democrat in 40 years to occupy the Oval Office. He will be joined in governing the United States by a majority presence in Congress of fellow Democrats, whose numbers underwent an increase in both chambers. Expectations among the electorate appear unusually high in eager anticipation of what might occur come January 2009.

Until now, a Democrat has occupied the White House for only 12 years of the past four decades, and William Clinton's term of office accounted for 8 of those 12 years. He too began serving with Democratic majorities in Kuh chambers, but only 2 years after becoming the chief executive, Democrats were soundly defeated and he had to deal with hostile Republicans who took over Capitol Hill. His efforts at the start of his Administration to achieve massive health care reform resulted in a political backlash.

Currently, the United States is in a parlous economic state. Unemployment is rising, companies are going out of business, and investment portfolios set aside for retirement are diminishing in value almost on a daily basis. Health care costs continue to rise while employers reduce health benefits for their employees and the number of Americans lacking any insurance whatsoever continues to rise.

During the campaign, Kith President-elect Obama and his opponent, Senator John McCain, enthusiastically raised the electorate's hopes that meaningful health care reform would he a top priority upon assuming office. Meanwhile, since June 2008, staff members working for three essential Senate committees - Budget; Finance; and Health, Education, Labor, and Pensions - have been discussing steps that could be taken in 2009 to address issues such as expanding insurance coverage and devising ways of paying for it.

Senate Finance Committee Chairman Max Bauens (D-MT) is positioning himself as the leading proponent for health reform in 2009. Shortly after the election, on November 12 he unveiled "Call to Action: Health Reform 2009," a new "white paper" containing specific goals and policy options regarding: universal coverage, tax incentives to boost health coverage, insurance market reform, improvement of the health care delivery system, a greater focus on disease prevention, and an increase in health information technology.

Thus far, little acknowledgment has been paid to the role of health personnel. Many allied health professions, such as clinical laboratory science, along with nursing, are plagued by practitioner shortages and an inadequate supply of faculty to produce the next generation of needed workers. The overall population of the U.S. is growing, with the most rapid growth taking place among the oldest segments. If access to health care is increased, there is a risk of further strains being added to a workforce that is in need of assistance by the federal government.

Determinants of Health Status

The health status of individuals and of society as a whole is a complex affair. Distributing insurance cards to those who lack them will be a necessary, but not a sufficient, means of improving health at Kith the personal and societal levels. The equation of "health care = improved health status" is much ton simplistic, in addition to lacking several key elements such as personal health beliefs and behavior.

One way of envisioning the various determinants of health status is to consider a five-layer chessboard arrangement. Each individual chessboard is independent of the other four, and within each hoard, dynamic interactions occur among the constituent component parts. In addition, although they differ markedly from one another, all five layers are related in essential ways. They are:

* Health care services

* Individual behavior

* Social environment

* Physical environment

* Genetics

HEALTH CARE SERVICES

This set of variables can be affected directly by governmental intervention in many significant ways. …

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