As a research assistant for a Children’s research group at Boston Medical Center I am constantly surrounded by the health care culture. Through my workplace I learn about health care policy, emergency medicine, and interact with physicians, nurses, social workers, etc. As a psychology major and a sociology minor I learn about social determinants and then see them first hand with the families I interview. However, it was not until I took Sociology of Health Care that I realized that I was lacking a basic knowledge of our health care system as well as its history and its provisions throughout the years.
New bills, policies, and methods of intervention are constantly being changed and created. Although it is difficult to keep track of, having a basic understanding should be necessary for any young adult living in the United States. From our coursework, what truly led to my understanding of our country’s health care system was learning about other countries health care institutions. I was unaware of the rise in medical tourism that has been occurring in recent years and the reasons for why this may be occurring. Understanding other systems shed some light on the systemic problems of our own health care system. Additionally, it emphasizes the commercialism/patient consumer role that is growing as a result. Taking this class gave me overall a better understanding and vocabulary to use in order to successfully move forward in the health field (if this is what I choose to do). Personally, I think it should be a requirement at any college to have to take a sociology of health care class. I believe that if more people understood the underlying structure of our health care system, we will then have more voices advocating for better quality of health, lower costs, and equal access.
Prior to Thanksgiving Break Professor Guseva asked us about the tough end of life conversation and whether or not the responsibility fell on us to bring forward this conversation within our families. I personally, felt responsible for this and found that death/dying should not be a dreaded conversation. After everyone had finished eating their Thanksgiving feast this past break I brought up the conversation with my own family. Ultimately, they were very happy I had brought it up and we moved forward with the goal of completing a formal written document to keep track each of our family member’s wishes. Everyone’s personal situation is different and everyone should individually consider what is the best way to bring up the conversation. However, even if you do not feel personally responsible, one should inquire on who the responsibility falls upon. Where does this fear of talking about death stem from? And how do we change the conversation?
Your morals and values, sense of self, anxieties, religious/spiritual views, academic standing, all of this seems minuscule when one fears for their life. Its the not knowing and uncertainty that sends people into a dark abyss of anxiousness. With the recent development of violent events around the world (Paris, Beirut, Nigeria), fear and anxieties of death/dying have been present throughout the country. I was very interested when I found this article, because of a recent conversation hear on campus. The Howard Thurman Center hosts Coffee & Conversation’s every Friday at 3pm and this past Friday over 40 students gathered to talk about these global events. Here, students expressed the fears and anxieties they have for their family, friends, and themselves (at BU and elsewhere).
“Terrorism’s unpredictable nature instills people with anxiety over the lack of control in their fate, Anne Marie Albano, a clinical psychologist and the director of the Columbia University Clinic for Anxiety and Related Disorders, said in an interview.” The article in the New York Times suggests methods of coping with the uncertainty of life. The author also shares a quote that discusses how the unpredictability of death has become normalized and is now “becoming sort of everyday life.” One of the author’s suggestions is to make a plan with your family on how to get in contact with each other if something happens (the author emphasizes that you will likely not need it).
In 2013, many of us here at BU experienced some of these anxieties with the Boston Marathon Bombing; loss of control, uncertainty, and terror was felt throughout the city. Now a similar anxiety seems to have spread around the entire country and world as threatening videos are released and new developments are found. In a tweet the article shares Sapan Verma states “I’m scared of terrorism. Terrified. It’s worse than any natural calamity. Because others humans do it. Of course we should be scared.” How do the anxieties of death through major human threat compare to those of natural illness and calamity, racism, and discrimination? And how is this affecting people’s mental and physical health? The article brought to light what everyone has been thinking but how do we cope with the long-term health consequences that fear of death/dying bring? How does this influence our generation’s health?
Bumrungrad International Hospital shed light onto the possible future of the “modern hospital.” We observe that through medical tourism, healthcare consumers are shopping to find a hospital that meets their needs, but also their expectations. When and through what avenues are people initially exposed to the idea of a hospital? If we take a developmental perspective, one could argue that most people’s first thought is child birth. Traditionally, exposure to hospital’s has been through second-hand family experience; your grandparent is sick, your sister gets hurt playing soccer, etc. If I recall my first experience at a hospital, I think of my younger sister’s birth. However, if I were to ask my now 14 year old sister what her first exposure to a hospital was, chances are she would say something about “Grey’s Anatomy.” The media and advertising are also playing a role in what we expect from a hospital. The patient for the bypass surgery in the video was not aware of Bumrungrad International until he saw the article in Business Weekly. One might expect doctors to be just as handsome and intelligent as Derek Shepard. That nurses will take as good care of you as Bailey does, etc. The media tends to dramatize many aspects of our lives, and the hospital is no exception now thanks to shows like Grey’s Anatomy and Private Practice.
Today I attended the 6th annual Medical-Legal partnership conference at the Federal Reserve Bank of Boston. The theme of the conference was “Going Upstream: How Doctor’s Notes and Medical Certifications Influence Health, Healthcare Quality, and Health Equity.” The conference consisted of a keynote presentation by Attorney General, Maura Healey as well as three panels and two workshops presented by a variety of Medical and Legal professionals. I wish I could have recorded the entire conference to present to everyone instead of a blog post, it truly was amazing to be in a room full of health professionals and legal advocates discussing how they can work together to improve the health of families through a health and racial equity lens.
For lack of better words, everything that was said struck me, but what struck me the most was this idea of a “whole person system;” a logical approach, but one that is not currently a part of our healthcare system. When Medical practitioners see a patient they’re primary focus is their patient’s disease/illness/or complaint, they connect the person to the disease and not the disease to the person. When in fact, social determinants are often the critical building blocks to the disease; one may cure the disease, but does that person have reasonable housing to return to? Do they have the basic needs to assure that they can deal with side effects of medication, or will they relapse because of poor conditions. How and who is in charge of making sure this doesn’t happen to these patients?
Another discussion arose from this one question. We all have this idea (including most of the people in the room that we were in) that Health practitioners, primary care & ED doctors should be the “hub” for these families that need the most help. Often we think doctors should be trained better, medical students should learn a new approach, etc. Subconsciously we have designated this task to the Health professionals, but why? Is there another option for a “hub”?
The take home being that we need to bridge and form meaningful connections with the medical field, the communities they serve, as well as all other advocates who are a part of the “whole person’ analysis.
As woman living in America, and as was demonstrated earlier in class today; most women tend to think that breast cancer is the leading cause of death for women. Just earlier today I saw a facebook thread that was shared by a friend of mine that read the following tweet by “Veroniskellyton Mars”: “A reminder that wearing or buying all things pink this month does not give access to breast cancer screenings, but Planned Parenthood does.” Breast Cancer has received a lot of hype and attention from the media, especially because of Breast Cancer Awareness month. However, I am surprised that I have not heard more about these new screening guidelines announced by the American Cancer Society earlier this week.
Interestingly enough, before taking this class I would have skimmed by this article on the NYT. However, now that I understand how commercialism in healthcare works, I fully understand that this is big news. Before the announcement of the new guidelines the recommendation for women by the American Cancer Society was that women should receive “mammograms and clinical breast exams every year, starting at 40.” The new recommendations are “that women with an average risk of breast cancer start having mammograms at 45 and continue once a year until 54, then every other year for as long as they are healthy and likely to live another 10 years.” It also now does not recommend clinical breast exams at any age if the patient has had no symptoms or abnormalities in the breast area. The American Cancer Society is careful to clarify that it does not believe that women under 54 should be denied the opportunity of an exam.
The organizations main reasons for this new recommendation stems from the evidence that has been found for false positives which result from these tests and that lead to unnecessary procedures afterwards. The article brings up the fact that other influential organizations in the field recommend even earlier screening, which leaves the patient confused at the deviation in suggestions. I found this article very interesting and very telling of the influences that commercialism has had within the healthcare system. Patients are having to question the intentions of the guidelines and doctor recommendations. Which as we have learned in class, is not necessarily a bad thing. Patient-centerdness and choice gives patients more reign over their health, however when there are large disparities in recommendations given to someone, how are we as patients to choose? It is really sad that we must consider the intentions behind guidelines before accepting them, especially when it is a topic so sensitive as health. However, hearing that the American Society is questioning the procedures that not too long ago they recommended makes me hopeful that they have both patients health and pockets in mind.
As a Hispanic woman, the video that we watched in class on Tuesday really motivated me to look internally into my culture and upbringing to analyze the possibilities of why my culture seems to have the healthiest families when compared to other race/ethnicities. Latinos main value in life is family, culturally we are known to have larger families which means more bonds and relationships with others. If unfortunately, one of our family members needs help, there are many people whom they can reach out to for help. There is a mutual understanding that we are a minority in a different country and any help that we can provide for family will be given no matter what. However, this is not to say that Latinos do not have our own issues to deal with within our culture. For example, among some of the issues are huge problems of “machismo,” homophobia, mental health, etc.
I think in order to understand gender, we also have to understand it in a cultural context. As a country that is becoming a country of immigrants, I have first hand experience researching populations with health disparities. Most families that come into the BMC emergency room are minorities, and they are the ones that often need the most help socially, emotionally, and medically. However, as a medical professional in our current system it is difficult to know everything and anything about every cultures view on medical and social aspects of life. For example, depression in hispanic culture is still generally viewed as weakness and may go undiagnosed because of it. There is also the issue that there is currently no medical screener that is specifically for depression found in men. When in fact depression in men has been found to have impacts on children’s health and development. Especially since the chance of depression in men almost doubles if their partner also has depression. How do we implement a system that accounts for all of these factors successfully?
The focus of Phelan and Link’s article on “Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implication” is to introduce their theory of fundamental causes in order to better understand the current health disparities in out society. Their theory reminds me of an Interactive Feedback Loop model which I have used in the past to better understand what causes race related health disparities such as premature births in African American women.
By acknowledging and providing specific evidence for the four essential features to their theory they have brought the problem to life. Health policy makers need to understand the impacts that their policies have on low income families who for example receive public assistance through federal government programs. Unfortunately, Healthcare in the U.S comes with a price tag and it is a big factor for families who may or may not have to trade off other aspects of their life (food, phone bills, rent, utilities) in order to make ends meet. Something that Phelan and Link emphasize is the fact that it is often the treatment not the prevention that is the most expensive. However, hand in hand with this idea is that of flexible resources, such as the example of cancer screeners that Phelan and Link use. These mechanisms are linking SES to health, which means that even now screeners are becoming accessible only to those that have the resources and capital to afford it, let alone know about the new mechanism.
This is why research on how public assistance policies and changes in the economy are affecting young children and their families is so important. If we can provide evidence of these disparities then we may help influence policy makers on the types of policy changes they are making. Every part of life, whether it is social, economic, mental, medical, all feeds back into the health outcomes of a family.
My reactions are very similar to those of my classmates. I always knew there were problems with our Health Care system and that other countries had different systems in place. However, learning about the technicalities and the history of our Health Care system has only made me more and more pessimistic. It seems to me that our system is too far gone, socially and politically. It is too late to even try to scrap the entire system and start from the beginning (although that is what should be done). The reforms being passed are made to try to help our system but then we see how much of a struggle it is to do even that. For me, it all stems back to the idea that we need to see Health Care as a human right and not something that should have so many regulations for. It is not something in which different “stakeholders” should fight to control and it is definitely not a system that should leave people without any form of Health Care.
For me, the hardest part has to be sitting in the class and learning about all these issues and sitting there feeling helpless in this fight for health care. Yes, although it may be true that in order to try and change a system you have to know the in’s and out’s but I wonder this. If we were to vote in our class how many people believe the U.S. should have a National Health Care system, what would be the outcome? Maybe, I am just optimistic but I believe that over half of the class would raise their hand to support this kind of system. This makes me wonder, is it a generational issue? Because to me the solution is pretty obvious, and the fact that our countries don’t see this or cannot do anything about it (through state level restrictions, congress, etc.) blows my mind.
This article by the New York Times critically highlights the challenges that millions still face, even after the AFA. Health Care has been brought to 2.9% percent of people in the 2014 year, according to the U.S Census Bureau’s 2014 Health insurance Coverage Data. This is a tremendous achievement for the United States but one that should not take away from the improvements and changes that still need to be made to our Healthcare system. In 2014, Hispanics had the lowest rate of health insurance coverage (2014 U.S. Census Bureau). As the articles states, Black people are greatly being affected as well. It is obvious that although the gaps in health insurance rates among communities of color have been reduced, pervasive disparities in health care and health still persist based on race and ethnicity. We must also question what healthcare trade offs are being made among those that do have insurance but still find it difficult to pay out of pocket costs? These challenges, among others still remain and must continue to be a topic of debate in the upcoming elections.