What other resources are needed?
Dr. Daniel Laroche President of the Empire State Medical Association emailed the NHMA President Dr. Elena Rios with the following recommendation:
1. Create and enhance preventive public service announcements and public health education protocols.
Rationale: Educational advertisements regarding diet, exercise, substance use, smoking, sexually transmitted diseases will help prevent premature death from cardiovascular disease, cancer, homicide, HIV and diabetes as the leading causes of death.
Increased numbers and frequency of public service announcements will also help reduce health care expenditures on many preventable
diseases, including tuberculosis and Hepatitis B. Advertisements via radio, television, billboard posters and press conferences are very effective in providing awareness about the latest health alerts, issues and action initiatives.
To increase public education, health information DVDs should be made for all public school 8th graders, Medicaid applicants, and public hospital emergency and waiting room visitors to view.
2. Develop job-training programs for unemployed New York City residents.
Unemployment leads to poverty, substance abuse, and crime.
In NYC, for example, 51% of Black men are unemployed, which also affects the families and children of these men. This should be considered a catastrophe requiring city, state, and federal emergency aid.
3. Ban alcohol and tobacco billboard advertisements in New York City.
Rationale: Alcohol and tobacco are heavily advertised on billboards in Black and Latino communities in New York City. Disproportionate advertising and subsequent use of these substances lead to increased disease and health disparities in Southeast Queens, Central Brooklyn, South Bronx and Harlem. Banning these ads will help reduce the glamorization of these dangerous products.
4. Design and implement policies that include access to nutritionists and comprehensive nutritional reform in all schools and government agencies and communities.
Poor nutrition in many inner city zip codes contributes to obesity rates as high as 70%, leading to increased morbidity, mortality and health care costs.
No number of physicians or amount of money spent on health care treatment can solve the health care crises due to obesity, poor nutrition and lack of exercise without complementary policies, including tax incentives for those with BMI (body mass index) within normal range, that encourage health and reduce health care costs.
Determinants of Health
Health is ultimately influence by many factors than just access to health care. One of these determinants of health is education. Thus, partners in education – especially K-12 – would be best engaged to ensure that all children including Spanish speaking children receive a standardized health education curriculum. These children will then be able to educate their families on the basics of health including the importance of healthy behaviors, prevention, early and appropriate health encounters and a basic medical literacy.
Moreover, we need to be sure to partner with others in the community interested in the overall health of the community. This includes ensuring that public health departments are properly funded and outreach to ensure that issues are addressed at the community level – since every local jurisdiction has unique needs and resources.
Approximately 25% of the uninsured in this country today are eligible for either medicaid or subsidized health insurance via state programs. However, this number of people which is roughly 10 million fail to enroll in these plans.
Currently in Howard County, Maryland, comprehensive healthcare is being offered to its' uninsured residents who make too much for medicaid, at a cost to the subscriber of about $800.00 per patient per year. Only about six per cent of the eligible residents of Howard County have enrolled.
while this does not directly address the ongoing discussion regarding options for all uninsured to obtain healthcare coverage, a large part of the discussion, especially when there is talk of possible penalties for those who don't enroll, is how to effectively reach all people who qualify?
Nelly Maseda M.D.
Bronx, NY
A cost effective system requires the strongest emphasis on prevention. This is the area that must have high priority. Without it, our health care costs will continue to rise astronomically. The fact remains that in a profit driven system prevention is not a priority. It will be the most important element of reform.
And we already have a great infrastructure for the provision of prevention utilizing education and enrollment. Our public school system does a very effective job of making sure that all students are immunized. This same system should be used to educate the public on good nutrition and overall health measures. The school system can be utilized to enroll all students in an insurance program as a requirement for entrance. For Latinos this is extremely helpful and useful as most people will not go out of their way to sign up for any insurance. There is little knowledge of our present programs nor is there interest until an emergency occurs.
Primary care can be extended further by subsidizing school clinics to provide this prevention and enrollment into an insurance program. This infrastructure is already in place and should be utilized. Low income areas can be helped by providing for school providers which they presently do not have. These providers should represent the lingual and cultural aspects of the community.
What other resources are needed?