User:Alex3877/sandbox

PE Organization
My PE organization is called Health Leads which is located inside the West County Health Center in San Pablo California. During my practice experience, I will serve as a health advocate which will meet with clients who are facing various challenges that are affecting their overall health. I will then link the client to resources that would improve their situation and assist them with the application process, completing weekly checkins ensuring that nothing is preventing them from accessing the resource.

Social determinants of health in poverty
This article explains what the social determinants of health are and how they contribute to poverty causing negative consequences on a persons health. I chose this article because my PE organization is focused on addressing health issues related to the social determinants by helping clients gain access to these resources thus improving the clients overall health. Since a majority of the clients I will be working with are low income, choosing this article would provide me the knowledge on understanding how poverty increases the impact of the social determinants. I plan on adding more information to the ethnicity and education sections since the community I will be serving is a majority of people of color with many who are uneducated. I specifically want to focus on the impacts ethnicity and education have on a person within America since that is where I will be working.

Healthcare reform in the United States
This article discusses the evolution of healthcare within the United States from a political perspective. The reason why I chose this article is because it discusses the changes in healthcare caused by the Affordable Care Act which is an improvement in including the social determinants of health within basic healthcare. This is relevant to my PE organization since Health Leads was created to address the social determinants of health thus is important to learn about these issues and their politics, especially currently with President Trump in office who wants to reverse the Affordable Care Affect causing a negative affect on the community I am going to work with.

Article Evaluation
The article I will be evaluating is Social determinants of health in poverty.

Evaluation
This article is overall well written. A majority of the information is relevant with some sections unnecessary and are able to be organized in a better way. One thing I do notice is that in many of the sections, the article simply provides examples to support the topic but does not explain why these examples occur which would be helpful in understanding the information. When dealing with the tone, the article has an encyclopedic tone and explains the information in a neutral way. The article does a well job of citing using relevant and reliable sources. When checking the history, there is a large gap with the article being edited in 2013 and then unedited until 2017. This article was last edited less than 5 months ago maintaining recent information. In the talk page, the comments are very supportive and is mainly contributed by students who are doing this for a class.

Area
The Non-monetary Benefits of Education

This article discusses the numerous positive benefits that come with gaining an education. An important fact is how a person who maintains an education typically has better nutrition, check ups, exercises more frequently, lives in less polluted areas, and has a greater attention to hazards. This is valuable information since a person with higher education is not only more likely to have access to the social determinants of health due to typically earning a higher salary being able to afford them, but are also more knowledgeable and inclined to become and remain healthy. I would want to use this information to explain how an education has positive benefits beyond the monetary benefits which are commonly known. This is relevant or understanding my PE org since it demonstrates how there is a difference between simply giving a person a resource compared to actually educating them on how to use it and why it is important to their health.

Social Inequality at Low-wage Work in Neo-Liberal Economy

This article discusses about racial inequalities and how a person of color faces many more challenges having less life chances than that of a white man. An important fact is how these racial inequalities are able to have an affect on education, employment, income, housing, health status, poverty, and mortality. This is relevant for understanding my PE since a majority of the population my organization serves is people of color. I will be able to use this information to discuss how due to a person’s race, their overall health is affected. I will also be able to explain how certain races are more likely to have access to more social determinants of health than others and why certain races face these challenges while others do not.

Addressing the inequalities in education: parallels with health

This article discusses the different causes for inequalities in education. An important fact that is useful for me is that a person’s family income, housing quality, nutrition, educational resources, parenting practice, and the quality and accessibility of local schools all have an effect on a person’s education. This is relevant for understanding my PE organization since a majority of these factors which can pose negative effects on education are social determinants of health which my PE organization focuses on helping it’s clients receive access to. I would want to use this information to describe how not having access to social determinants of health is able to cause for a circle of events. If a person faces inequalities in education due to the social determinants of health, they have higher chances of working a low wage job which would impose difficulties for being able to provide for themselves and their families which would lead to their children becoming affected by the lack of access to the social determinants continuing the cycle.

Education and Health: Theoretical Considerations Based on a Qualitative Theory Study

This article discusses the effects an education has on a person's health. An important fact is that if a person does not maintain a high level of education, they may be unable to get a well paying job thus is faced with a financial burden. Due to this burden, a person is unable to set their health as a priority due to having to concentrate on their economic survival. By doing this, it may have an affect on their compliance, the access to their own body, and the perception of their health complaints. This is relevant for understanding my PE organization since the people I will be serving are a majority of lower educated people facing financial difficulties. I will be able to use this information to explain how there are other factors which may shift how a person may view their health or place it at a lower priority than it should thus worsening their condition.

Include a Social Determinants of Health Approach to Reduce Health Inequities

This article discusses why the social determinants of health should not be ignored due to the ability to reduce health inequities. An important fact is that while addressing the social determinants of health is important for any age, it is critically valuable for children. By addressing the social determinants at a young age, children are able to have a positive early development which is able to improve their health throughout their life span. This is relevant for understanding my PE organization since the community I am serving consist of many families with young children. I will be able to use this information in correlation with the effects of an education to explain why it is important to address the social determinants rather than ignoring them.

Race/Ethnicity and Health-Related Quality of Life Among LGBT Older Adults

This article discusses how a person's race/ethnicity may pose implications and challenges in their life which may affect their overall health. In addition to this, the article explains how a person's sexual orientation has similar effects and discusses how if intersected, a person of color who is also a member of the LGBTQ community may face exacerbated effects than if in one category alone. This is relevant for understanding my PE organization since a majority of the community I will be serving is people of color with the possibility of clients also being a member of the LGBTQ community. By knowing this information, I will have a better understanding of the possible reasons why clients are experiencing the situations they are facing which would allow me to better identify resources that would assist them. I will be able to use this information to explain the correlation between health and the intersect between race/ethnicity and a person's sexual orientation.

Levels of Racism: A Theoretic Framework and a Gardener’s Tale

This article discusses the correlation between race and health by explaining the negative effects caused by racism and the different forms it posses. Racism is able to be described in three separate levels, institutionalized racism, personally mediated racism, and internalized racism. Institutionalized racism is when members of a certain race have different access to goods, services, and opportunities in society. This form of racism is normative, legalized, and often manifests as inherited disadvantage. Personally mediated racism is when a person faces prejudice and discrimination. Lastly, internalized racism is when members of the stigmatized races accept the negative messages about their own abilities and intrinsic worth. This is relevant for understanding my PE organization since the community I am serving consist of a majority of people of color which likely experience one or more of the three levels of racism on a daily basis. I will be able to use this information in order to explain the three levels of racism providing details of how each level is able to negatively affect a persons health in a different way.

Sector
How the Trump Administration's Policies May Harm the Public's Health

This article discusses how having Trump as president places health care at risk since he is attempting to reduce the amount of government involvement when dealing with the lives of Americans. A key argument is that if Trump is successful, he would be ruining all the recent progress made on improving health care for Americans. This is relevant for my PE org because if Trump is successful, the current reform pushing for the social determinants of health to be included in basic health care would fail. Along with this, the Affordable Care Act would become the American Health Care Act which would cause many people to become uninsured lowering their overall health. This is important information since my PE org was created to assist people in accessing the current social determinants of health which many in the community my PE org serves lack. Thus if Trump reverses the progress in health care, my organization would have to increase the scope of what we assist our clients with along with serving an even larger amount of clients. I would want to use this information to address what Trump wants to change in current health care and how it would affect health in America. Beyond Health Insurance: Remaining Disparities in US Health Care in the Post-ACA Era

This article discusses that although the Affordable Care Act insured many people who were previously uninsured, there are still many factors which can be improved for better quality care. An important fact is that families who have a lower income and are racial/ethnic minorities typically experience less quality of care and higher cost which may cause barriers to health care that may be needed. This is relevant information since Trump wants to reverse the progress made on health care when we should instead be focused on improving it. This is relevant to my PE org since we deal with many who are low income and are racial/ethnic minorities, thus it is important to know this information to ensure we are linking them to resources where they will receive the quality care they deserve. I would want to use this information to explain how although the Affordable Care Act was a great advancement in Health Care, it is still not perfect with much room for improvement.

The Constitution and the Public's Health: The Consequences of the US Supreme Court's Medicaid Decision in NFIB v Sebelius

This article discusses the Supreme Court trial between NFIB v Sebelius. This is an important case because it discusses the push for a medicaid expansion and explains the decision and reasoning why this expansion got denied. An important fact is that a court majority struck down the medicaid expansion due to unconstitutional exercise of Congress’s spending clause power. This is important since it demonstrates how healthcare is still not viewed as a basic necessity in America with congress being unable to tax in order to increase the health of Americans. This is relevant to my PE org because this information has updated me on what is occuring in politics in regards to health care and why the expansion has been denied. This is important so I am aware of who is eligible for medicaid while assisting the clients which may be uninsured. I would want to use this information to explain how health care is attempting to improve and the barriers it is currently facing.

Estimated Impacts of the Proposed Public Charge Rule on Immigrants and Medicaid

This article discusses the proposed changes President Trump wants to make on "public charge" and the affects these changes will have on immigrants in the United States. If Trump is successful, then these changes will make it more difficult for legal permanent residents to eventually gain citizenship status by including health, nutrition, and housing programs which were previously excluded as negative factors causing a person to be considered a public charge and denied citizenship.

Medicaid's Next Metamorphosis

This article discusses how medicaid evolved to its current state, the Affordable Care Act, and the various forms it may take in the future. An important fact is that if the Medicaid expansion is successful, medicaid would be a fully Federal program due to establishment of new federal eligibility standards. By shifting more responsibility to the federal government, this would relieve states of the financial burden if they are unable to manage, reduce state variations in coverage, and reduce cutbacks during economic downturns due to the ability of the federal government not required to balance it's budget. This is important to know the positive outcomes if the medicaid expansion succeeds since this issue is currently up for debate. This is relevant to my PE org because a large amount of the community I will be serving uses medicaid. I would want to use this information when discussing the Affordable Care Act in order to explain some of the additional reasons why the medicaid expansion is important and the positive benefits it will bring to not only individuals but also to the States.

Racial and Ethnic Disparities in Health Care Access and Utilization Under the Affordable Care Act

This article discusses a research study conducted collecting data from the National Health Interview Survey focusing on US adults during the time period between 2011-2014 in order to examine the racial/ethnic disparities faced in health care access before and after the Affordable Care Act (ACA) was fully implemented. After conducting the study, the results displayed that racial and ethnic minorities had greater improvements under the ACA compared to whites with uninsured rates lowering among people of color allowing many to now be able to access medical care improving the health of numerous citizens. This is relevant to my PE org because many of the clients I will be serving have insurance due to the ACA. Thus, it is important for me to obtain knowledge of how impactful the ACA was due to the current debate for a medicaid expansion along with President Trump pushing to change the ACA into the American Health Care Act which would reverse much of the progress towards improving the social determinants of health. I would be able to use this information to discuss how the ACA has altered health-care since its implementation.

Defining Medical Necessity Under the Patient Protection and Affordable Care Act

This article discusses various health related topics that are becoming apparent in society and which ones politics define as medically necessary that are covered under the ACA. From this article, I will be focusing specifically on the mental health and substance abuse disorders due to this being the most common health related topic that I will encounter in my PE org. An important fact is that with the implementation of the ACA, insurance plans are now mandated to include coverage for those with mental health and substance abuse disorders as well with the inability to deny a person who has preexisting conditions. I would want to use this information to explain the differences before and after the implementation of the ACA.

Area
Some major takeaways I have recently learned is how these social inequalities are able to be seen throughout history having a lasting affect which is still able to be seen to this day. Due to these social inequalities, it causes a cycle to form what is known as the poverty trap preventing a person within the cycle to leave. Education and ethnicity, although two very different things, overlap and have an affect on one another. Depending on a person’s ethnicity, it will determine if they are faced with negative inequalities and the amount of life chances available to them. When dealing with education, those who are a person of color are likely to face more challenges which is able to affect the quality of education received or if they receive any at all. If uneducated, a person is likely to work a low wage job and have higher chances of poverty. This thus not only has a negative affect on their life but also on their families life which impacts the future generation continuing the cycle. My future research plans include looking for additional information about these social inequalities and their affects in America along with ways they are able to be improved. I would also like to find more information about how much of an inequality a person of color has compared to that of a white person.

Sector
Some major takeaways I have learned is about the Affordable Care Act and what it did for Americans allowing for many to become insured. Even though this was a vast improvement for healthcare, there are still many issues which need to be addressed in the health system. Despite the improvement towards equity of healthcare, President Trump wants to reverse these improvements by allowing insurance and healthcare to return to being a product in the market. In addition to this, I learned about "public charge" and the vast amount of negative impacts it will have for immigrants if Trump is successful. I want to continue to research how Trump's proposed health plan, the American Health Care Act, would affect the health of many American’s along with who would be mainly affected. In addition to this, I would want to further research if there is any recent progress on the medicare expansion and on "public charge".

Drafting
Bold = From Wikipedia Articles

Unbold = My Drafting

Area:
Ethnicity:

Ethnicity plays '''a large part in determining health outcomes for impoverished minorities. Poverty can overpower race, but within poverty, race highly contributes to health outcomes.[27]''' In the United States, it is common for a person of color to face unequal treatment compared to that of a white person impacting the amount of life chances present which can pose negative affects on education, employment, income, housing, health status, poverty and mortality. The reason for this inequality is due to racism and its three various levels which are consistently present in the United States. The three levels of racism include institutionalized racism where members belonging to a certain race have different access to goods, services, and opportunities present in society. This level of racism is normative, often manifests as inherited disadvantage, and is legalized at times. Another level of racism is personally mediated racism which is where a person faces prejudice and discrimination in their daily life. The last level of racism is internalized racism which is where members of the stigmatized race accept negative messages present about their own abilities and intrinsic worth.

'''Farmer says the growing mortality differentials between whites and blacks must be attributed to class differentials-[27] which includes recognizing race within impoverished populations. Recognition of race as a determining factor for poor health without recognizing poverty has misled individuals to believe race is the only factor.[14] A 2001 study showed that even with health care insurance, many African Americans and Hispanics lacked a health care provider; the numbers doubled for those without insurance (uninsured: White 12.9%, Black 21.0%, Hispanics 34.3%). With both race and insurance status as obstacles, their health care access and their health suffered.[30]'''

Health differentials amongst races can also serve as determining factors for other facets of life, including income and marital status.[14] AIDS-affected Hispanic women hold smaller salaries than average women, are part of poorer families, and are more likely to head households.[14] According to one study, black teenage women living in dysfunctional homes were more likely to have serious health issues for themselves or children.[14]

'''African Americans, even in some of the wealthiest cities in the United States, have lower life expectancy at birth than people in much poorer countries like China or India.[27] In the United States, specifically for African American women, as of 2013 for every 100,000 births 43.5 black women would not survive compared to the 12.7 of white women[28] According to studies, black individuals in South Africa suffer worse morbidity and mortality rates due to the limited access to social resources.[27] Poverty is the chief cause of the endemic amounts of disease and hunger and malnutrition among this population.[27] A disproportionate number of cases of the AIDS epidemic in North America are from American minorities, with 72% of women's AIDS cases among Hispanic or African-American women.[14] Among those American minorities, African Americans comprise 12% of the American population yet, made up 45% of new HIV diagnoses. Blacks in America account for the highest proportion of those living with HIV and AIDS in America.[29]'''

Although race is able to have a large effect on a person's health, if intersected with another factor, the effects on health are magnified. Similar to how a person's race can have a negative impact on health, a person's sexual orientation is able to do the same if a member of the LGBTQ community. When combined, a person of color who is also LGBTQ faces many more health risk factors such as a lower education level, lower socioeconomic status, and discrimination than a white person in the LGBTQ community.

Education:

'''Education plays an especially influential part in the lives of the impoverished. According to Mirowsky and Ross, education determines other factors of livelihood like occupation and income, which determines health outcomes[6] due to its effect on income, employment, and living conditions.[31][32][33][1]''' If a person is unable to receive a large enough income to support themselves and their family, then they are unable to set their health as a priority having to concentrate on their economic stability rather than seeking medical care due to the risk of a loss of income. An education also impacts health in many non-monetary ways increasing life expectancy by influencing better nutrition, frequent doctor visits, increased amounts of exercise, avoidance of drugs and other illegal substances, along with a greater attention to hazards working environments. Social resources, such as education, determine life expectancy and infant mortality, which measures health.[34] Education is a special determinant of health because it enables people toward self-direction, which leads them to seek goals such as health.[1] Education helps the impoverished develop usable skills, abilities, and resources that help individuals reach goals, including bettering health.[6]

Although education is very important to a person's health, a person's family income, housing quality, nutrition, educational resources, parenting practice, and the quality and accessibility of local schools all have an effect on a person’s education level increasing the gap in inequalities in education. By addressing the social determinants at any age is very beneficial for the health of a person, it should not be prospered until a later age. By addressing the social determinants when a person is young, they are able to have a positive early development which would not only improve their health at that current moment but have lasting effects throughout the individuals life and the life of their children. Depending on a parent's education level, this will determine the child's health, survival, and educational attainment (Caldwell, 1986; Cleland & Van Ginneken, 1988).[1] "Children born to more educated mothers are less likely to die in infancy and more likely to have higher birth weights and be immunized.[9] Studies in the United States suggest maternal education results in higher parity, greater use of prenatal care, and lower smoking rates, which positively affects child health.[9] An increase in child schooling in Taiwan during the educational reform of 1968 reduced the infant morality rate by 11%, saving 1 infant per 1000 births.[9]

"Fig. 2.1 shows variation between countries in infant mortality from just over 20/1000 live births in Colombia to just over 120 in Mozambique. It also shows inequities within countries – an infant's chances of survival are closely related to her mother's education. In Bolivia, babies born to women with no education have infant mortality greater than 100 per 1000 live births; the infant mortality rate of babies born to mothers with at least secondary education is under 40/1000. All countries included in Fig. 2.1 show the survival disadvantage of children born to women with no education."[1]

Sector:
Uninsured rate:

With the implementation of the ACA, the level of uninsured rates severely decreased in the U.S. . This is due to the expansion of qualifications for access to medicaid, subsidizing insurance, prevention of insurance companies from underwriting, as well as enforcing the individual mandate which requires citizens to purchase health insurance or pay a fee. In a research study which was conducted comparing the effects of the ACA before and after it was fully implemented in 2014, it was discovered that racial and ethnic minorities benefited more than whites with many gaining insurance coverage which they lacked before allowing for many to seek treatment improving their overall health. In June 2014, Gallup–Healthways Well–Being conducted a survey and found that the uninsured rate is decreasing with 13 percent of U.S. adults uninsured in 2014. compared to '''17 percent in January 2014 and translates to roughly 10 million to 11 million individuals who gained coverage. The survey also looked at the major demographic groups and found each is making progress towards getting health insurance. However, Hispanics, who have the highest uninsured rate of any racial or ethnic group, are lagging in their progress. Under the new health care reform, Latinos were expected to be major beneficiaries of the new health care law. Gallup found that the biggest drop in the uninsured rate (3 percentage points) was among households making less than $36,000 a year.[37][38][39]'''

Quality of Care:

There is significant debate regarding the quality of the U.S. healthcare system relative to those of other countries. Although there are advancements in the quality of care in America due to the acknowledgement of various health related topics such as how insurance plans are now mandated to include coverage for those with mental health and substance abuse disorders as well with the inability to deny a person who has preexisting conditions through the ACA, there is still much that needs to be improved. Within the U.S., those who are a racial/ethnic minority along with those who poses a lower income have higher chances of experiencing a lower quality of care at higher cost. Despite the advancements with the ACA, this may discourage a person from seeking medical treatment. Physicians for a National Health Program, a pro-universalsingle-payer system of health care advocacy group, has claimed this is due to a free market solution to health care creating a lower quality of care, with higher mortality rates, than publicly funded systems.[43] The quality of health maintenance organizations and managed care have also been criticized by this same group.[44]

According to a 2000 study of the World Health Organization, publicly funded systems of industrial nations spend less on health care, both as a percentage of their GDP and per capita, and enjoy superior population-based health care outcomes.[45] However, conservative commentator David Gratzer and the Cato Institute, a libertarian think tank, have both criticized the WHO's comparison method for being biased; the WHO study marked down countries for having private or fee-paying health treatment and rated countries by comparison to their expected health care performance, rather than objectively comparing quality of care.[46][47]

'''Some medical researchers say that patient satisfaction surveys are a poor way to evaluate medical care. Researchers at the RAND Corporation and the Department of Veterans Affairs asked 236 elderly patients in two different managed care plans to rate their care, then examined care in medical records, as reported in Annals of Internal Medicine. There was no correlation. "Patient ratings of health care are easy to obtain and report, but do not accurately measure the technical quality of medical care," said John T. Chang, UCLA, lead author.[48][49][50]'''

Centers for Medicare and Medicaid Innovation:

With the ACA improving the health of many by increasing the amount of people who are insured, this is not the final stage for the ACA due to the push for a medicaid expansion reform. With the Democrats supporting the expansion and the Republicans against it, it was denied in the SupremeCourt in the trial of NFIB vs Sebelius due to the fact that implementing taxes in order to pay for health insurance of every citizen was deemed as an unconstitutional exercise of Congress’s spending clause power. If the expansion eventually succeeds, medicaid would become a fully Federal program due to the establishment of new federal eligibility standards. This would relieve financial burden from states due to the federal government maintaining a larger amount of responsibility and the ability to not balance their budget.

In addition to the reform for the medicaid expansion, there are additional reforms focused on addressing social determinants in the healthcare system through various programs and initiatives in order to reduce healthcare expenditures and improve health outcomes.

Trump Administration Efforts:

Donald Trump was elected President on a platform that included a pledge to "repeal and replace" the Patient Protection and Affordable Care Act (commonly called the Affordable Care Act or Obamacare). Rather than making adjustments to the Affordable Care Act, President Trump is proposing the American Health Care Act (AHCA), which was developed by the House of Representatives. If passed, this new Heath Care Act would cause insurance and healthcare to return to the market potentially causing for 18 million Americans to become uninsured. In addition to this, President Trump is pushing for a change in policies regarding "public charge" which would cause the public benefits such as health, nutrition, and housing programs that were previously excluded to count towards considering a person a public charge. By doing this, immigrants who use these resources would have their ability to obtain legal permanent resident status affected increasing their chance of being denied citizenship. '''The administration has suggested that the AHCA is only part of its reform efforts. Other proposals include allowing interstate competition in the health insurance market.[citation needed]'''

Incentivizing health reimbursement arrangements is another goal.[97]