User:Almahern/sandbox

Description
The org that I will be part of for my PE is Health Advocates of Alameda Health System. I have been part of the org since last summer and will continue it this semester, summer and senior year. I will continue being an advocate and we mainly help patients of the Alameda Health System fill out housing applications, public benefits applications and legal referrals for various reasons. The org headquarters is located in Highland Hospital in Oakland. The org is integrated into the Alameda Health System and the org is in the following health care facilities Fairmont Hospital, Eastmont Wellness Center, and Hayward Wellness Center.

Area
Alameda county

I can add a section about homeless or about health care and how the Alameda health system works. Since the main location of the org is in Highland hospital the patients we see are from the surrounding areas.

Alameda health system

The org is incorporated into the Alameda health system and I can probably add a section about the program or expand the page since it does not have much in the page.

Highland hospital

The main org location started in Highland Hospital and we can expand the page since it does not have much information about what the hospital does.

Article evaluation
Health insurance coverage in the United States

After receiving feed back from the professor I looked at the article and I saw that it was a well fleshed out article but I could possible add to certain parts of the articles. I can possible add to causes since that is part of what the organization that I am part of mainly does and we see why many do not have insurance or have access to the benefits we help apply to. Also there seems to be a need to add to the last section of the article that talks about assistance programs that mainly help those people that are uninsured. This would be a good place to add more information and add other sources that can attest to this statement since it was created by only one cited source.

Talk page evaluation
I went to the talk page of the article and saw some people commenting on the article. Most of the comment that some people were trying to come to a conclusion was about the term uninsured vs underinsured and what that meant in the article. They talked about the meaning of the words as well as the important of each and what it meant to the article regarding insurance and what it should be one or the other. Ultimately they came to and agreement and decided to use the word underinsured but not use it in the name of the article. Also the use of articles and updating the numbers to more current content was suggested and accepted but wikipedia. This seems that it might not be to difficult to add to the article and specially in places that can use a different source and more current information.

Article evaluation
Housing First

This article was suggested by the professor and after careful evaluation I saw that it incorporated a lot of parts from the other articles that I had selected and would be a good place to add more information regarding homelessness and affordable housing. I can possible contribute some information but yet do not know were and how much and what parts need to be added to the article to Mae it reflective of possible the Bay Area and what the outcome of the program has been. I would need to flesh out my ideas for what I could possible add and where it would be the best place to add my contribution. I seems that there is a lot of information already and since it is about one single topic it might be hard to add to it and the sources that can be added will be already a lot.

Talk page evaluation
I went to the talk page of the article and found that it was made by another student who was doing work related to housing and overall on the article it states that it part of wikiproject social work and that it is labeled C-class and of high importance. Also it has a lot of work regarding links available for the public and how updated they are. It seems that the best way I can contribute to the article would be looking for updated material and making sure that my resources are reliable and current. I can possible work on this page but do not know much of the topic and so I would do more research and hope to find much more information about what Housing First is.

The waiting room

The wikipedia page is about a past documentary regarding the Emergency room at Highland Hospital and it can be a good place to add about the people we see and the need for more assistance.

homelessness in the San Francisco Bay Area

There is not a huge section about homelessness in Oakland and more specifically Alameda county. We see many people that are looking for housing within the area.

California housing shortage

The page talks about homelessness in Oakland and i can see how it doesn't have a specific place for homelessness. The housing waitlist for affordable housing is long and section 8 applications are closed and it is difficult for people to get in an affordable home. There is also no section in shelters but many people end up going there. We see that many people that can pay for housing are driving up the price of housing in the Bay Area. Also there is not enough housing and especially not enough affordable housing. We have people that their budget for housing ranges from 300-1000 and that range in Oakland is difficult to find.

Poverty and Health Prospective Evidence from the Alameda County Study
Haan, Mary, George A. Kaplan, and Terry Camacho. "Poverty And Health Prospective Evidence From The Alameda County Study." American Journal of Epidemiology125, no. 6 (1987): 989-98. doi:10.1093/oxfordjournals.aje.a114637.

I believe this source would be interesting to use since it discusses about the situation that is happening in Alameda county but also about how such problems would affect the people that live there and what has or hasn't been done to address them. One bad thing is that is is old and since then new things have arose and it has become much harder and different I wouldn't know how too properly use it maybe on history related. They use epidemiological surveys to look at the deprivations that is happening and affecting people's health.

Health advocates
Losonczy, Lia Ilona, Dennis Hsieh, Michael Wang, Christopher Hahn, Tarak Trivedi, Marcela Rodriguez, Jahan Fahimi, and Harrison Alter. "The Highland Health Advocates: A Preliminary Evaluation of a Novel Programme Addressing the Social Needs of Emergency Department Patients." Emergency Medicine Journal34, no. 9 (2017): 599-605. doi:10.1136/emermed-2015-205662.

This article is about the organization that I will be working with and this might help since I am thinking that for my area I can talk about the Alameda health alliance insurance and with this it would showing other options or program that are assisting the needs of the patients. In addition it compares how different places look at the social determinants of health and how they are approaching it. Shows how many people have been helped and to what kind of resources have been given.

Homelessness and health
Reid, Kristen W., Eric Vittinghoff, and Margot B. Kushel. "Association between the Level of Housing Instability, Economic Standing and Health Care Access: A Meta-Regression." Journal of Health Care for the Poor and Underserved19, no. 4 (2008): 1212-228. doi:10.1353/hpu.0.0068.

The article was discussing the correlation that homelessness or housing instability had with regards to health care access. it is a research paper but I can use the background were it talks about the correlation about housing and healthcare access. this information and some of the articles parts can be added to the homelessness in the San Francisco Bay Area since the research was done in SF by UCSF and it will have more effect there than in places like housing storage. since the org that I am part of it wrks with people that are homeless and we apply to housing since we see that it affects the health of people it would be a good article to use and it is fairly recent article.

housing and public health
Shaw, Mary. "Housing and Public Health." Annual Review of Public Health25, no. 1 (2004): 397-418. doi:10.1146/annurev.publhealth.25.101802.123036.

This article goes back to the basics and origins as o how the housing situation un the US came to be so it is a really good article about housing in general and then it goes on to describe homelessness and health correlations. in addition it compartmentalized the housing into direct and indirect importance/influence with health and how it has changed over time. it can be added to california housing shortage because it can be a connection with now the increase demand of housing due to gentrification, globalization and tech companies in the Bay Area.

Beginning Bibliography
II. Area

Reid, Kristen W., Eric Vetting, and Margot B. Kushel. "Association between the Level of Housing Instability, Economic Standing and Health Care Access: A Meta-Regression." Journal of Health Care for the Poor and Underserved 19, no. 4 (2008): 1212-228. doi:10.1353/hpu.0.0068.

The article was written to inform the scholarship experts about the health impacts from housing instability. In addition, they look at multiple factors that cause housing instability and health problems rooted from housing problems. They state that housing instability causes people to not prioritize their health by not having a continues provider, no health insurance, delaying medical attention and medications for the need to pay for housing. They also found that people that are housing insecure will have a higher rate of visits to the emergency department or have bad health in the long run because they did not seek health care. They compared the factors for bad health and did so with meta regression that correlated how much each factor had to do with poor health. This article is useful in my research because it shows how housing impacts the health of people and need for more attention to people's housing when addressing the diagnosis part of health care. I also found this article useful for my research because this is something that is seen often in my PE org with peoples housing need.

Shaw,Mary. "Housing and Public Health." Annual Review of Public Health 25, no. 1 (2004): 397-418. doi:10.1146/annurev.publhealth.25.101802.123036.

This article articulates how the United Nations have come to state that housing is a basic right and not just any shelter but appropriate housing. In addition, it gives a brief history of what housing means and how It came to be a social determinant of health. The history of housing overcrowding and especially for poor Individuals came as a great health concern. the article also states that when an individual does not have “adequate housing” they are more prone to getting sick and it is because of they are living in poverty and in poor conditions. They address the large population in cities and how that makes for more crowded cities and poor-quality housing for people on to have an impact on people's health. This article is beneficial to my research because it explains how housing has become recognized as a social determinant of health and it impact on people's life. This article helps with the understanding of why my PE org works alongside with the legal system to address housing problems like mold of tenants right because all these issues are affecting their health and our org tries to address the social factors of health.

Krieger,James, and Donna L. Higgins. "Housing and Health: Time Again for Public Health Action." American Journal of Public Health 92, no. 5 (2002): 758-68. doi:10.2105/ajph.92.5.758.

This article tries to inform the public and future health researchers on why housing is an important factor when discussing social determinants of health. The main focus of the article is affordable housing and how that has become very scarce for many. They also address how people of color are the most affected for the lack of affordable housing because they also tend to be more economically disadvantaged. The poor will oftentimes be living in bad quality housing and overcrowding is very problematic that affects people's health. This article is important because it states how housing quality is important and the need for affordable housing will help many people in both securing housing and in their health that has been affected because they have been housing insecure. My PE org has been trying to address this situation because we try to fill applications for affordable housing and refer people to legal resources if they need help with their housing issues.

Varady, David P., and Carole C. Walker. "Using Housing Vouchers to Move to the Suburbs: How Do Families Fare?" Housing Policy Debate 14, no. 3 (2003): 347-82. doi:10.1080/10511482.2003.9521480.

This article was written on alameda county exposing how section 8 vouchers impact the lives of people and inform on future housing programs. This article is on how section 8 was developed to address housing needs in the Bay Area and how the housing and urban development department has been shifting its focus on addressing the housing issue. The article mainly focuses on ways that housing shortage in the Bay Area has been addressed and how people that go through this system fairs in the long run impacting their heath. This article is useful because it specifically addresses the area my PE org is in and how people in the Bay Area are doing because of housing shortages that exist. My PE org which is located in Oakland which has a high amount of homelessness and housing shortage it is a good article to see how section 8 came to be and how now the waitlist is saturated and the program is no longer accepting applications because they cannot place people in housing due to shortages in the Bay Area.

Hood, Ernie."Dwelling Disparities: How Poor Housing Leads to Poor Health." Environmental Health Perspectives 113, no. 5 (2005). doi:10.1289/ehp.113-a310.

This short article exposes the need to address the living conditions minorities live in and how that impacts the health making it a social determinant of health. This article goes more in depth on how housing is more than just the structure and how the environment is also part of housing issue because it causes greater problems for people in their health and that is not necessarily addresses. Many minorities tend to live in bad conditions, and this is because little availability for adequate housing or they do not have the proper financial means to improve their living conditions that can lead to homelessness. This article is useful in my research because it shows how housing conditions can lead to chronic diseases. My PE org tries to address housing situation by applying for adequate housing and referring people to legal resources so they can know about their tenant rights that will help them fix the housing issue they face so it does not affect their health furthermore.

Williams, D. R. "Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health." Public Health Reports 116, no. 5 (2001): 404-16. doi:10.1093/phr/116.5.404.

This article was written to continue the talk on segregation which still exists with regards to housing for people of color. This article shows how housing for African Americans is highly segregated and causes more morbidity and mortality in communities that face this causing a public health concern. In addition, the article states that due to segregation of housing people face more health concerns that those that do not. The article correlates housing, race and health to show disparities in communities. This article is useful for my research because it helps show how some people are more prone to living in worse housing conditions causing more health problems. My PE org sees the impact of housing segregation when we fill in application for people.

Rauh, Virginia A.,Philip J. Landrigan, and Luz Claudio. "Housing and Health." Annals of the New York Academy of Sciences 1136, no. 1 (2008): 276-88. doi:10.1196/annals.1425.032.

This article looks at various components that constitutes housing to show the impact they have on health. This article is on housing meaning more than just a physical structure but also the social components like the physical, chemical and environmental aspect of housing. They state that some of those include location, overcrowding, ventilation, toxic chemical exposure and weather exposure. They also define housing instability and how the family living, neighborhood and social structure impacts the health of the residents. This article is useful for my research because it shows how housing is very multidimensional and has various aspects that affect people's health. This is related to my PE because it explains why housing that is affordable is hard to find since often times it is not necessarily adequate and why there is a need for legal attention to people's housing situation when the landlords are not meeting the basic needs of people.

II. Sector

Nitin Mehta, Jian Ni, Kannan Srinivasan, Baohong Sun (2017) A Dynamic Model of Health Insurance Choices and Healthcare Consumption Decisions. Marketing Science 36(3):338-360. https://doi.org/10.1287/mksc.2016.1021

The article tries to explain the importance of insurance and how many people do not seek medical care because insurance doesn't cover the costs, or they do not know what gets covered or does not. One of the biggest health issues that insurance is used for is chronic diseases because they are constantly using medical attention but are not always covered by insurance. There is insurance literacy that many people lack and that it causes problems in people choosing proper health plans for such chronic diseases. The lack of knowledge in health plans contributes to the poor insurance coverage that people get and increases the health issues people face because they do not have proper economic coverage. This article helps my research because it gives reasons for why health insurance is a social determinant of health. My PE works with medical and its coverage is part of the public benefits we help with applying for calling to see why it has been discontinued.

Ku, Leighton, and Sheetal Matani. "Left Out: Immigrants’ Access to Health Care and Insurance." Health Affairs 20, no. 1 (2001): 247-56. doi:10.1377/hlthaff.20.1.247.

This article was to inform how certain groups, Latinos, are excluded from the health care system in the US. the amount of uninsured people increased after the 1996 federal welfare reform law passed restricting eligibility for medical for non-citizens. This then causes for uninsured rates to increase and especially with U.S. born children of immigrants for fear of deportation of other fears. This later led to the development of the state children's health insurance program to increase the number of uninsured children to alleviate the increase of health issue Latino immigrants face. This article is useful for my research because it informs me how insurance affects children and how many people that do not qualify for insurance are prone to having more health issues. My PE works with medical very closely by applying or only working with people that have medical physicians in the hospital only.

Lillie-Blanton, Marsha, and Catherine Hoffman. "The Role of Health Insurance Coverage in Reducing Racial/Ethnic Disparities in Health Care." Health Affairs 24, no. 2 (2005): 398-408. doi:10.1377/hlthaff.24.2.398.

This article was written to inform about the health disparities that people of color face in health insurance. The article states that of the 34% people of color 52% are uninsured and that the main people that lack insurance are African Americans and Hispanics. The lack of health insurance by these two groups show that they are not covered by employer-based insurance like many white people. The increases health disparities they face and with more health coverage only 1/3th of the disparities would be addressing for the two groups. The article is useful for my research because it shows how people based on race are more likely to be uninsured cause in more health disparities and making health insurance a social determinant of health. My PE works with many minorities and with insurance that many times they do not necessarily get covered for such reasons.

Wooksoo Kim & Robert H. Keefe PhD and ACSW (2010) Barriers to Healthcare Among Asian Americans, Social Work in Public Health, 25:3-4, 286-295, DOI: 10.1080/19371910903240704

The article is to inform about the stereotype of Asian American that they are better off financially and do better but in reality, they lack proper health care as do many other minorities. One of the biggest challenge Asian Americans face is language and culture health literacy that perpetuates health disparities. The article also explains how health insurance is a factor that places obstacles for Asian Americans in receiving health care because only 6%/26% employer-based insurance is received by Asian Americans. In addition, it also explains the loophole that many Asian Americans are self-employed and do not qualify for government insurance because they earn more than the minimum but can also not afford private insurance. This article is useful for my research because it shows that health insurance is very impactful for everyone in receiving the proper health care that they receive and it's a social determinant of health. In my PE org there are people that do not qualify for medical or Cal fresh because they earn a bit more than the minimum, yet it is not enough that it impacts their health.

Tiffany D. Joseph & Helen B. Marrow (2017) Health care, immigrants, and minorities: lessons from the affordable care act in the U.S., Journal of Ethnic and Migration Studies, 43:12, 1965-1984, DOI: 10.1080/1369183X.2017.1323446

The article is written to explain the impacts that the affordable healthcare act had on many people that previously did not qualify and how health disparities have yet to be eliminated by health insurance. In 2010 the patient protection and affordable care act (aca) was passed by president Obama to reduce the high rates of uninsured and high costing health care insurance. The ACA provided a much better health insured rate for previously uninsured people however it still does not cover immigrants and people that cannot afford insurance lack proper health care. This article is useful because it provides additional information on what is being done to provide better and more health insurance used by more people. Health insurance in m PE is often limited and screening people for qualification is done on a regular basis and many times they do not qualify so we cannot help them.

Institute of Medicine (US) Committee on Health Care for Homeless People. Homelessness, Health, and Human Needs. Washington (DC): National Academies Press (US); 1988. 3, Health Problems of Homeless People. Available from: https://www.ncbi.nlm.nih.gov/books/NBK218236/

The book was written years ago when homelessness was first becoming a health issue and now it can be still used to expand the research needed to be done on health for homeless individuals. This book defines homelessness as an individual that does not have a fixed, regular and adequate residence at night. This book also focuses on what health problems lead to homelessness as well as how homelessness contributes to more health issues that could have been prevented if proper care was taken. This book serves as a bases for my research and gives a lot of the historical perspective on what homelessness is and how health issues are rarely discussed in full discourse when addressing homelessness. My PE serves the homeless population in helping them apply for housing and looking for shelters, but we also see how many times their condition contributes to their health issue like mental health and hygiene that adds to the diseases that they develop.

Moulin, Aimee et al. “Substance Use, Homelessness, Mental Illness and Medicaid Coverage: A Set-up for High Emergency Department Utilization.” The western journal of emergency medicine vol. 19,6 (2018): 902-906. doi:10.5811/westjem.2018.9.38954

The article is on various factors that cause people to use the emergency department and why such factors should be addressed in trying to address healthcare expenditures. Mental health is a contributing factor for homelessness as discussed by the article and how many times the emergency department is the one that sees these patients with few to do for them. Also, the article also explains how intervention for homelessness such as supportive housing has become problematic for healthcare institutions. This article is useful because it shows that emergency rooms are safety needs for many like the homeless because they do not have proper health care. My org sees many people that are living in temporary shelters and are often on the streets and come to us to apply for housing or look for shelters.

Doran, Kelly M.,Nathan M. Kunstler, Tod Manovich, Samantha W. Lang, Ada Rubin, Paul A. Testa, and Donna Shelley. "Homelessness and Other Social Determinants of Health among Emergency Department Patients." Journal of Social Distress and the Homeless 25, no. 2 (2016): 71-77. doi:10.1080/10530789.2016.1237699.

This article was written to inform on the impact of homelessness on the healthcare system especially the ED which is seen as the “safety net” of the system. This article does not necessarily focus on homelessness but does not that they impact the healthcare system and how there has been attempts to address them, but little has been done. The study states that around 15.5% of the ED patients are homeless landing in the emergency department. This article is useful because it adds to the need for healthcare for homeless people because the emergency departments are being highly impacted. In my PE the hospital is has an emergency department and many times the social workers refer the patients that end up there to us to assist them in their needs.

Henwood, Benjamin F.,Leopoldo J. Cabassa, Catherine M. Craig, and Deborah K. Padgett. "Permanent Supportive Housing: Addressing Homelessness and Health Disparities?" American Journal of Public Health 103, no. S2 (2013). doi:10.2105/ajph.2013.301490.

The article was written to inform about the permanent support housing(psh) advocacy that is been trying to pass to support homeless people. The PSH was developed as a response to the need for health access and care. The PSH would build healthy communities and support homeless people transition and not fall back into the streets when they need health care attention. The CDC and US department of housing and urban develop have taken the PSH as a possible solution. This is helpful to know because it shows that homelessness is also a health issue that needs attention and ideas are been thought of. My PE only helps with shelters, but it can do more in trying to assist homeless people find places that truly help them in their health needs.

Cheryl Teruya PhD, Douglas Longshore PhD, Ronald M. Andersen PhD, Lisa Arangua MPP, Adeline Nyamathi ANP and PhD and FAAN, Barbara Leake PhD & Lillian Gelberg MD and MSPH (2010) Health and Health Care Disparities Among Homeless Women, Women & Health, 50:8, 719-736, DOI:10.1080/03630242.2010.532754

This article was to inform the need for more attention to the issues of women that are homeless especially their need for health care. Homeless women suffer more health disparities like mortality, victimization and poor birth outcomes than other population. This article suggest that white homeless women suffer more health disparities than any subgroup because of regular health care. These articles are useful because it brings on a topic that is different on homelessness by discussing women and who suffer more and what they come across. In my PE we see more male homeless bust do see women homeless and have come across women that have suffered such incidents the article mentions among other.

Summarizing and Synthesizing
The article I will be selecting to do more research and use it to add more information about the topic are based on housing insecurity and how they relate to health. The area aspect that I will be addressing will be housing in Alameda county and how that affects the health of the residents. I will also be using the social determinants for my sector part in which I will be adding a section on insurance and especially focused insurance within counties. In addition I will add to the wikipedia page on homelessness in the san Francisco Bay Area on housing and its impacts on health for my sector.

Area
Social determinants of health in poverty

The article is about the social determents of health and how that impacts the health and lives of the population. The top social determents that get discussed in the article are proximal and structural determents and their influence on people's health. The article has different sections and different parts of social life that are said to influence the health out comes of people.

The articles that I have fund also explore the influence of social factors that affect the health of people and mainly my focus is on housing insecurity and how that affects people. Many of the articles attribute poor health to housing insecurity and the affect thats a lack of housing has on people with different health problems. The connection that is made between housing, health and economic is something a lot of the articles discuss and how their correlation has many affects on individuals and society. There is many literature that correlates housing and health determents as being connected even though tho the WHO does not yet see it as being a huge risk factor for peoples health based on the article social determents of health in poverty.

Sector
Social determinants of health in poverty

For the sector part I will be doing to how in places the do not have much aces to medical care insurance is pivotal to the healthy lifestyle and survival of individuals. Insurance especially in places were that does not mean universals health care is something that people have to struggle with and advocate for their own health and it can be expensive for primary care. Insurance is a luxury for many people that suffer from health problems and choosing one that can help alleviate the cost and the problems that come with not having insurance can be a difficult task and many people just do not have the choice of having insurance. In the social determents of health I believe that there should be a section for health coverage because it can be a structural determination in many areas that do not have access affordable healthcare. in some of the article that I found it states that having a choice can sometimes be overwhelming for many and also if not properly informed it can be devastating for their health and their economics. There has also been a change in how insurance operates since the affordable health care was started and how that affects insurance and protect for individuals. I will be analyzing how the insurances impact health outcome and especially insures provide by the county and how impactful they have been towards seeing the community that they have. In Alameda county there is Alameda alliance and in san Francis they also hav their own insurance that covers their population.

Homelessness in the San Francisco Bay Area

In this article I will be adding a section on how homelessness is part of the housing crisis in the Bay Area and how that attributes to poor health. there has been some literature on how the in the Bay Area there is a record amount of homeless individuals and how that has affected their health. The article on wikipedia does not dive into health aspects of being homeless so there is a need for a section discussing that aspect. based on the research for housing been a health determinant I can also use it to show that in the wiki article and explain how housing is impacting health. there has been some studies and literature that focuses on the Bay Area and how there is a connection between poor health and lacking housing. there are two article that I had previously looked at and they are under area but will be used in this section to address health and how that is affected by homelessness and housing insecurity.

Drafting
Area

Article (scholarly)
For example, work on the Boyd Orr cohort, a group of children originally studied between 1937 and 1939, has considered childhood housing conditions and subsequent adult mortality(16). Dedman et al. (16) chose to look at housing conditions as an indicator of early-life exposure to pollutants (such as combustion products), allergens, and risk of infection (such as helicobacter pylori); participants were followed up for mortality to 1998. Those who lived in better-quality housing in childhood had better health and lower overall mortality rates, after controlling for socioeconomic conditions in both childhood and adulthood, although effects were weak and may be explained by residual confounding. Another recent study, however, confirms that this avenue may be worthy of more investigation.

Paraphrase
A study that looked at people from their childhood to adult hood they found out how housing environment contributed to death among adults. The main cause of death in this study was from pollutants found in the housing they resided in despite controlling for socioeconomic factors.

Insertion (wiki article)
the place for my addition to add in the article would best be suited to be in the age part of the article social determinants of health in poverty in the AGE part of the article.

Family affluence directly affects food security, which correlates with adolescent nutrition and health. Family affluence also influences participation in regular physical activity. While nutrition and physical activity promote physical well-being, both promote psychological health as well. Thus family affluence is correlated with reduced psychological stress during adolescence. Family affluence also affects access to healthcare services; however, in countries with universal healthcare systems, youth belonging to less-affluent households still display poorer health than adolescents from wealthier families. '''A study that looked at people from their childhood to adult hood they found out how housing environment contributed to death among adults. The main cause of death in this study was from pollutants found in the housing they resided in despite controlling for socioeconomic factors.'''

Article
Krieger, James, and Donna L. Higgins. "Housing and Health: Time Again for Public Health Action." American Journal of Public Health 92, no. 5 (2002): 758-68. doi:10.2105/ajph.92.5.758.

The notion of housing as a public health issue is not new. In the middle of the 19th century, pathologist Rudolf Virchow advised city leaders that poorly maintained, crowded housing was associated with higher rates of infectious disease transmission. Engels, in his study of the working class in England, noted that “There is ample proof that the dwellings of the workers who live in the slums, combined with other adverse factors, give rise to many illnesses.” “Slum clearance” and improving the quality of housing and sanitation were important components of 19th- and early-20th-century campaigns to control typhus, tuberculosis, and other infectious diseases.

Paraphrase
In the 19th and 20th century with the developments slums there was an increase in poor maintains of the city. The crowding, poor sanitation and poor dwellings in the city brought infectious disease and illnesses thus becoming a public health concern.

Insertion
Between first and second sentence.

The location where people live affects their health and life outcomes, which means impoverished people's health outcomes are especially determined by whether they live in a metropolitan area or rural area. '''In the 19th and 20th century with the developments slums there was an increase in poor maintains of the city. The crowding, poor sanitation and poor dwellings in the city brought infectious disease and illnesses thus becoming a public health concern'''. With the prevalence of inner city ghettos and slums around the globe in cities, with approximately 1 billion people living in slums globally, living situation is an especially strong determinant of health in poverty. Urban areas present health risks through poor living conditions, limited food resources, traffic accidents, and pollution.

Article
Reid, Kristen W., Eric Vittinghoff, and Margot B. Kushel. "Association between the Level of Housing Instability, Economic Standing and Health Care Access: A Meta-Regression." Journal of Health Care for the Poor and  Underserved 19, no. 4 (2008): 1212-228. doi:10.1353/hpu.0.0068.

Domiciled people with housing instability may be more likely to have been homeless in the past or to become homeless in the future than the general population. People with housing instability have poorer access to health care and higher rates of acute health care utilization than the general or poverty populations with stable housing.

Paraphrase
Housing instability constitutes that people have been or will be homeless in the future and the instability in their lives contributes to less health care access and acute health care than other populations.

Insertion
I would add it at the end of the section because this area is other from the household section of the article.


 * Other: In the United States, HIV is more prevalent in cities along the east coast, with prevalence among African-American women in cities 5 to 15 times higher than for women in all areas of that state. "Inner-city women are the most likely of all in the United States to birth dead or extremely sick babies, partially because the massive erosion of prenatal care availability in their area.Slums, made up exclusively of extremely poor populations, provide a particularly strong threat for poor health. Child mortality in the slums of Nairobi, which 60% of the population inhabits, is 2.5 times greater than in other areas of the city. In the slums of Manila, 39% of children have TB, which is twice the national average. Housing instability constitutes that people have been or will be homeless in the future and the instability in their lives contributes to less health care access and acute health care than other populations.

Article
Varady, David P., and Carole C. Walker. "Using Housing Vouchers to Move to the Suburbs: How Do Families Fare?" Housing Policy Debate14, no. 3 (2003): 347-82. doi:10.1080/10511482.2003.9521480.

Released from constraints on the rents they could charge, landlords increasingly rented to families that could afford to pay more. Section 8 families, limited in the rent they can pay by the program, sought housing elsewhere. Cost pressures in both cities were motivating some Section 8 families to move to the suburbs—not necessarily to improve their living conditions, but because they were looking for affordable housing.

Paraphrase
As cities became more populated and increased rent those that receive section 8 had to move away from areas that they could afford not for commodity.

Insertion
I would add it at the end of the section because this area is other from the household section of the article.


 * Other: In the United States, HIV is more prevalent in cities along the east coast, with prevalence among African-American women in cities 5 to 15 times higher than for women in all areas of that state. "Inner-city women are the most likely of all in the United States to birth dead or extremely sick babies, partially because the massive erosion of prenatal care availability in their area.Slums, made up exclusively of extremely poor populations, provide a particularly strong threat for poor health. Child mortality in the slums of Nairobi, which 60% of the population inhabits, is 2.5 times greater than in other areas of the city. In the slums of Manila, 39% of children have TB, which is twice the national average. Housing instability constitutes that people have been or will be homeless in the future and the instability in their lives contributes to less health care access and acute health care than other populations. As cities became more populated and increased rent those that receive section 8 had to move away from areas that they could afford not for commodity.

Article
Mehta, Nitin, Jian Ni, Kannan Srinivasan, and Baohong Sun. "A Dynamic Model of Health Insurance Choices and Healthcare Consumption Decisions." Marketing Science36, no. 3 (2017): 338-60. Accessed March 30, 2019. doi:10.1287/mksc.2016.1021.

This increase is relevant from both the consumer’s and the insurance firm’s standpoint. It is relevant for consumers because the increase in healthcare costs has resulted in insurance firms passing on the costs to consumers in terms of increased premiums. This imposes a huge burden on the consumer’s wallet and has led to a dramatic increase in the number of people who cannot pay the high premiums. It is relevant for insurance firms because a part of the increase could be due to the inefficient design of insurance plans, which results in consumers choosing plans and treatment options that are not cost effective.

Paraphrase
The continuous increase in healthcare costs decreased the passion of costs in regards to increased premiums, thus imposing burden on the consumers and not benefitting them at all.

Insertion
Added within 1st and 2nd sentence of original article.

According to US HHS, "In 2009, children 6–17 years of age were more likely to be uninsured than younger children, and children with a family income below 200% of the poverty level were more likely to be uninsured than children in higher-income families." The continuous increase in healthcare costs decreased the passion of costs in regards to increased premiums, thus imposing burden on the consumers and not benefitting them at all. In elderly populations, individuals below 400% of the poverty line were between 3 and 5 times more likely to lack insurance. Children below 200% of the poverty line were also less likely to have insurance than wealthier families. Also, in 2009 in the US, 20% of adults (ages 18–64) below 200% of the poverty line did not receive their necessary drugs because of cost, compared to only 4% of those above 400% of the poverty line.

Article
Ku, Leighton, and Sheetal Matani. "Left Out: Immigrants’ Access to Health Care and Insurance." Health Affairs20, no. 1 (2001): 247-56. doi:10.1377/hlthaff.20.1.247.

Noncitizens and their children also were less likely to have a usual source of health care. Given the low level of insurance coverage, it is not surprising that noncitizen families were relatively less likely to use private doctors or health maintenance organizations (HMOs). Community clinics and hospital outpatient departments are the most common sources of ambulatory care for immigrants. Very few said that the emergency room was their usual source.

Paraphrase
The social structure of being a noncitizen provides very little medical insurance and health care in which many noncitizen are forced to seek care form clinics and outpatient departments.

Insertion
These social structures seem so normal in our understanding of the world that they are almost invisible, but inequality in resource access, political power, education, healthcare, and legal standing are all possible perpetrators of structural violence. The social structure of being a noncitizen provides very little medical insurance and health care in which many noncitizen are forced to seek care form clinics and outpatient departments. Structural violence occurs "whenever persons are harmed, maimed, or killed by poverty and unjust social, political, and economic institutions, systems, or structures" Structural violence can contribute to worse health outcomes through either harming or killing victims, just like armed violence can have these effects.

Article
Lillie-Blanton, Marsha, and Catherine Hoffman. "The Role of Health Insurance Coverage in Reducing Racial/Ethnic Disparities in Health Care." Health Affairs 24, no. 2 (2005): 398-408. doi:10.1377/hlthaff.24.2.398.

Several studies provide evidence that uninsured African Americans and Hispanics fare worse than uninsured whites in obtaining access to care. For example, a nationally representative survey of adults in 2001 found that African Americans and Hispanics were more likely than whites to lack a regular provider, regardless of insurance status; however, the racial/ethnic gap between the uninsured was twice the size of the gap between those with insurance. Since these findings were not adjusted for other factors that might explain the disparity, they are useful in determining that an access gap existed but not whether factors other than insurance status might explain it. Nonetheless, they suggest that people of color, when uninsured, are doubly disadvantaged in the health system by their race and insurance status and that racial/ethnic disparities in health care could become worse if current levels of coverage among minority Americans decline.

Paraphrase
It is not just race but also lack of insurance that fares worse for African Americans and Hispanics this was shown in a 2001 study that found that they lacked a provider regardless insurance however without insurance the amount of people without a provider doubled. when people have twice the amount obstacles against them like race and insurance status it can worse the the care and their health they can attain.

Insertion
Farmer says the growing mortality differentials between whites and blacks must be attributed to class differentials- 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.'''It is not just race but also lack of insurance that fares worse for African Americans and Hispanics this was shown in a 2001 study that found that they lacked a provider regardless insurance however without insurance the amount of people without a provider doubled. when people have twice the amount obstacles against them like race and insurance status it can worsen the the care and their health they can attain'''.

Moulin, Aimee et al. “Substance Use, Homelessness, Mental Illness and Medicaid Coverage: A Set-up for High Emergency Department Utilization.” The western journal of emergency medicine vol. 19,6 (2018): 902-906. doi:10.5811/westjem.2018.9.38954

'''In study of ED usage results showed that people with MediCal(20.4%) and medicare(31.5%) are the highest people seen for mental illness compared to private insurance (12.4%). Medicaid beneficiaries are more susceptible to psychiatric disorders only driving healthcare cost up compared to private insurance even in California where Medi-Cal eligibility has already been extended to its fullest. '''

Tiffany D. Joseph & Helen B. Marrow (2017) Health care, immigrants, and minorities: lessons from the affordable care act in the U.S., Journal of Ethnic and Migration Studies, 43:12, 1965-1984, DOI: 10.1080/1369183X.2017.1323446

'''In 2010, president obama introduces patient protection and affordable care act (aca) in which expanded the health reform to many that lacked coverage when the US being an industrialized nation had the highest rate of uninsured and healthcare cost among many nations. This new reform helped 20 million americans get coverage and decrease rates of uninsured people from 16% in 2010 to 8.6% in 2016. The ACA brought coverage to people that had suffered from downgrade in employee insurance by providing a health insurance exchange marketplace in which they can purchase private plans when they can not afford private insurance.'''

Article
Doran, Kelly M., Nathan M. Kunzler, Tod Mijanovich, Samantha W. Lang, Ada Rubin, Paul A. Testa, and Donna Shelley. "Homelessness and Other Social Determinants of Health among Emergency Department Patients." Journal of Social Distress and the Homeless25, no. 2 (2016): 71-77. doi:10.1080/10530789.2016.1237699.

ED patients frequently reported homelessness and housing instability. Nearly one-fifth of study participants reported that they had lacked stable housing in the past 2 months, and 13.8% were cur- rently living in a homeless shelter or on the streets. Over the past 12 months, 15.5% of ED patients had spent at least one night in a homeless shelter. Nearly one-third (30.5%) reported a history of homelessness at some point in their lifetime. ED patients also appeared to be at high risk for future homelessness, with 25.4% overall reporting a concern about having stable housing in the next 2 months. Further, 9.1% had been evicted from their home in the past year.

Paraphrase
The patients approximately 1/5th, that end up in the ED are often times homeless and housing insecure in the past 2 months and 13.8% were living in homeless shelters or on the streets. the ED patients reported that in the past 12 months, 15.5% had spend a night in a shelter and 30.5% had previously been homeless with 25.4% of the patients were at risk of becoming homeless in the next 2 months and 9.1% had been previously evicted in the past year.

Insertion
Add a new section called healthcare

'''The patients approximately 1/5th, that end up in the ED are often times homeless and housing insecure in the past 2 months and 13.8% were living in homeless shelters or on the streets. the ED patients reported that in the past 12 months, 15.5% had spend a night in a shelter and 30.5% had previously been homeless with 25.4% of the patients were at risk of becoming homeless in the next 2 months and 9.1% had been previously evicted in the past year'''.

Institute of Medicine (US) Committee on Health Care for Homeless People. Homelessness, Health, and Human Needs. Washington (DC): National Academies Press (US); 1988. 3, Health Problems of Homeless People. Available from: https://www.ncbi.nlm.nih.gov/books/NBK218236/

'''Health issues especially mental illnesses worsens many people's ability to cope with their surroundings and can be a precursor to homelessness. As they become homeless because of their health issues there is a decrease in therputec assistance or housing assistance that only worsens their mental health and contributes to the stereotyping of homeless people as crazy. Many shelters have tried to address mental health issues however due to limited prepared staff they can only do little to support homeless people that are suffering from such illness or many are resistant to intervention from clinicians due to previous bad encounters.'''

'''When people are homeless, treatable diseases can turn to serious illness that is rarely treated only exacerbating health issues in the population. Some of the most common health issues homeless people face are malnutrition, skin disorders, dental disease, parasitic infections, venereal disease, and hepatitis due to drug usage. The treatment of these issues are very difficult when proper care is limited due to their housing situation and only worsens the aid they receive due obstacles in the social system.'''

Moulin, Aimee et al. “Substance Use, Homelessness, Mental Illness and Medicaid Coverage: A Set-up for High Emergency Department Utilization.” The western journal of emergency medicine vol. 19,6 (2018): 902-906. doi:10.5811/westjem.2018.9.38954

Homeless people are prone to a much higher rate usage of the ED due to mental health issues and reported various other obstacles in treating mental health impacting the healthcare system.

Responding to Peer Review
I appreciate all the feed back that they have suggested. I understand that my writing tends to be vague or not very straight to the point. I believe that if I take in their suggestions and discuss it with people and listen to opinion I will take the best and incorporate it to my writing.

I think Julia's suggestion on making my addition more visible or more clear is something I will be taking from her suggestion for further understanding for anyone. I see why I would need to paraphrase and condense my thoughts/paraphrase.

Taking Lorraine's advice is something I hope to do by elaborating or consolidating the 2 sections she suggested and maybe adding a new bullet point in a more comprehensive way. Also expand on what ED is and also specify where I will be placing my thoughts.