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Use all you have learned about health care and public health structures and current structural bias, racism, and social inequities to describe what you see in the future for a particular public health topic. The paper should be at least 1500 words on a topic of your choosing (see below); the total paper grade is 200 points. Outline of your paper:Select one issue in public health you anticipate will change in the future as a consequence of globalization, climate change, and human/animal interactions (e.g., we will have permanent water rationing; our coastline cities will be flooded; we will be challenged by new emerging infectious diseases). Describe the situation and why the change is likely to occur, emphasizing the role of globalization, climate change, and/or human/animal interactions as causal contributors. Discuss why you think this issue is important and cite research evidence to the extent possible.Discuss if this change will increase or decrease issues of health equity. In particular, discuss the group(s) most affected by this change and why you think this, including addressing the contexts of structural bias, social inequities, and racism. Discuss the both the societal and community-level challenges that public health leaders will face in trying to address the public health issue and ensure health equity. Cite research evidence to the extent possible.If the future event is negative, how might we intervene to either keep it from happening or to lessen its impact? If the future event is positive, how might we help bring it about?Overall, whose responsibility is it to either to prevent a negative event or promote a positive event?Please use APA style for references.Below is 2 examples of the paper
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Climate Change
“SUMMERS: So, what has the heat been like in Austin this year for you?”
“BUCHELE: It’s been relentless. You know, it started in the spring, and we started getting triple digits in
May with very little rain. And it’s just basically stayed that way. Here in central Texas, we’re now at
around 45 days of triple-digit heat this year. It stays warm through the night, you know, so you wake up
and it’s hot out first thing in the morning. This is a level of heat that the state’s grid operator said it did
not expect going into this summer. But summers are getting hotter here with climate change, so it’s also
kind of becoming more of the norm” (Buchele, 2022.)
It isn’t just in the U.S, across the world heat related incidents are becoming more common
“Summer heatwaves in France, Germany, Spain, and Britain led to more than 20,000 “excess” deaths, a
report compiling official figures said on Thursday. Temperatures hit nearly 40 degrees Celsius or above
from Paris to London in 2022 and climate scientists from the World Weather Attribution group found
that such high temperatures would have been “virtually impossible” without climate change” (Portala,
2022).
Climate change takes many forms, but in the summer of 2022, throughout Texas, the rest of the
United States and every other part of the world, temperatures continued to break record highs.
“Extreme heat events have long threatened public health in the United States. Many cities, including St.
Louis, Philadelphia, Chicago, and Cincinnati, have suffered dramatic increases in death rates during heat
waves. (CDC, 2022). As climate change continues to change temperatures with milder winters and
longer, hotter summers the public’s health is at risk. Not just from acute heat related accidents but also
from other factors that such as cardiovascular, respiratory, and cerebrovascular disease (CDC, 2022).
“Heat waves are also associated with increased hospital admissions for cardiovascular, kidney, and
respiratory disorders. Extreme summer heat is increasing in the United States, and climate projections
indicate that extreme heat events will be more frequent and intense in coming decades” (CDC, 2022). As
the population of the United States continues to flee the middle of the country for the Southwest and
Southeast this issue will need to be put on the forefront of public health research to mitigate deaths and
disease as much as possible. As the climate continues to change and the world continues to warm it will
cause specific places in the Middle East to become uninhabitable leading to a potential migration crisis
across the world. Educating and informing people on this topic before heatwaves strike will allow them
to be prepared for these potentially life threating situations as they continue to become more frequent.
Climate Change and Health Equity
The threat continues as heatwaves threaten the power grid and force homes to reduce energy
usage during peak times. “The Electric Reliability Council of Texas (ERCOT), which operates the grid that
serves more than 26 million customers, initiated a rarely used emergency program that is triggered
when supplies fall below a critical safety margin. Earlier, ERCOT had urged residents to cut power use
during the hottest hours of the day and warned of a risk for rolling blackouts. Residents were asked to
turn up thermostats, defer the use of high-power appliances and turn off swimming pool pumps”
(Varghese, 2022).
As power grids are stressed and power companies continue to increase prices people with lower
incomes will be affected by heat related death and disease disproportionally. Those who can afford the
higher energy costs will be able to use air conditioning in their homes. Impoverished people, if they even
have access to air conditioning in the first place, will be forced to use it less as costs rise. As we know,
people in poverty are less likely to have access to resources that could help them as temperatures rise.
On top of a lack of air conditioning, it will be much harder for them to relocate to a safer living situation
and often, they don’t have motor vehicles which makes it even harder for them to leave their living
situation. This will disproportionally affect people of color in the United States. These people will be less
likely to be able to afford preventative measures before a heat wave takes out the grid like a generator
or stocking up on supplies. These people are often living paycheck to paycheck and that will hurt their
ability to prepare and deal with the catastrophic situations when they start.
Proposed Interventions and Whose Responsible
It will be up to public health officials to bridge these disparities as the warming climate
continues to bring on acute illness and chronic conditions. From a community level standpoint,
preparation is key. As we have seen in the past the federal response to disasters in the United States has
been lackluster. At the community level it is important to know what kind of threat exist and what they
community should be prepared for given the worst-case scenario. Often this will include stocking certain
supplies and having a community center ready to take in people who are suffering from the extreme
weather conditions. This center should be well air-conditioned, be able to hold a large amount of people
for an indefinite amount of time, including sleeping quarters, food, and water. With the lackluster
response to large scale disasters such as hurricane Katrina and the 2003 power outage it will come down
to local communities to be ready for heat related disasters. On top of a community center for the people
who are hit the hardest, other will need assistance as well and having plenty of supplies on hand for the
rest of the community will be important as well. Hospitals and other important health related places,
like senior homes and urgent cares should have backup power and have a surge plan in place for heat
related illnesses. While the community should have these plans, the funding needs to come from the
federal level realistically.
Society and the federal government need to be ready for heat related power outages, illnesses,
and a potential mass migration from the Middle East and Pacific islands as well as the costs, especially
the gulf coast of the United States. “Cities that stretch across the “sun belt” of the southern and southwestern US have in recent years enjoyed population booms, with people lured by the promise of cheap
yet expansive properties, warm winters, and plentiful jobs, with several large corporations shifting their
bases to states with low taxes and cheaper cost of living. But this growth is now clashing with the reality
of the climate emergency, with parts of the sun belt enduring the worst drought in more than 1,000
years, record wildfires and punishing heat that is triggering a range of medical conditions, as well as
excess deaths” (Milman 2022). To address these problems with the greatest health equity we need to
“responsibly manage the problems facing our environment by taking sensible steps toward protecting
human health and safety. Whether measures are meant to reduce future climate change impacts or
address the health impacts of climate change that are happening already, early action provides the
greatest health benefits. It makes sense to invest in creating the strongest climate-health adaptation
and preparedness programs we can (CDC, 2022).
Heat related public health problems stem directly from climate change, so as a society we need
to prioritized mitigating the effects of climate change. On an individual level we can contribute to this by
“Reducing the release of heat-trapping gases like CO2 can help protect our health and wellbeing by
decreasing impacts on our climate system. Activities that reduce the amount of heat-trapping CO2 in the
atmosphere are many of the same things we already know prevent health problems. Active modes of
transport like biking or walking can help reduce traffic-related air pollution and encourage physical
activity, which has public health benefits including reduced rates of obesity, heart disease, and diabetes”
(CDC 2022). But it is important to note that reversing climate change does not fall on the individual
rather large global corporations are the biggest contributors to the warming environment we live in.
“The results showed that nearly two-thirds of the major industrial greenhouse gas emissions (from fossil
fuel use, methane leaks, and cement manufacture) originated in just 90 companies around the world,
which either emitted the carbon themselves or supplied carbon ultimately released by consumers and
industry” (Starr, 2016).
As climate change continues to warm the earth it is important to remember that heat related
illnesses and chronic conditions stemming from them are only part of a much bigger picture. While
these problems will continue to become more prevalent, climate change doesn’t simply warm the globe
as was first thought. Weather patterns across the world are changing and this will also contribute to
future global public health issues. Extreme heat and cold, changing severe weather patterns, and
droughts will change how individuals are able to live their lives. Ultimately, if we are to solve or attempt
to prevent some of these issues it will have to come from global cooperation to reduce greenhouse gas
emissions and change how we consume fossil fuels. The World Health Organization is already
responding to climate change and warming global temperatures but so far, has not made the impact
needed to reduce negative climate change outcomes. Climate change, along with most scientific opinion
today, continues to be challenged by powerful people and corporations that have the money to stop
effective legislation from pushing the U.S. and other countries in the right direction of energy
consumption. The only hope is that we can continue making green energy more affordable and
appealing for consumers and producers. If we can make the right changes, we can avoid global
catastrophe. If we cannot make the right changes, it will be a tough road ahead for public health officials
in the wake of climate change and warming temperatures.
References
Buchele, M. (2022, July 26). It’s Texas’ hottest summer ever. can the electric grid handle people
turning up AC? NPR. https://www.npr.org/2022/07/26/1113816003/its-texas-hottestsummer-ever-can-the-electric-grid-handle-people-turning-up-ac
Centers for Disease Control and Prevention (n.d.). Extreme heat can impact our health in many
ways. https://www.cdc.gov/climateandhealth/pubs/extreme-heat-final_508.pdf
Milman, O. (2022, July 20). Alarm as fastest growing US cities risk becoming unlivable from
climate crisis. The Guardian. https://www.theguardian.com/us-news/2022/jul/20/usfastest-growing-cities-risk-becoming-unlivable-climate-crisis
Portala, J. (2022, November 24). Europe’s heatwave may have caused more than 20,000 ‘excess’
deaths. Reuters. https://www.reuters.com/business/cop/europes-heatwave-may-havecaused-more-than-20000-excess-deaths-2022-1124/#:~:text=Europe’s%20heatwave%20may%20have%20caused%20more%20than%2020
%2C000%20’excess’%20deaths,By%20Juliette%20Portala&text=Nov%2024%20(Reuters)%20%2D%20Summer,official%
20figures%20said%20on%20Thursday.
Starr, D. (n.d.). Just 90 companies are to blame for most climate change, this ‘carbon …
https://www.science.org/content/article/just-90-companies-are-blame-most-climatechange-carbon-accountant-says
Varghese, A. (2022, July 13). Texas grid takes emergency actions to avoid blackouts amid
heatwave. Reuters. https://www.reuters.com/world/us/texas-power-use-breaks-record-heatwave-again-with-no-blackouts-2022-07-13/
601 Assignment 2
There is agreement amongst the scientific community that human activity is causing global
warming and this increase in oceanic and atmospheric temperatures is giving rise to global
humanitarian and health crises (Ghazali et al., 2018, p.1). Namely, in this century climate
change has brought about natural disasters (such as tornadoes, tsunamis, hurricanes and
tropical storms), escalation of extreme weather (such as extreme heat, wildfires, flooding), and
rising sea levels with consequences for air, water, and food access and quality as well as the
spread of vector-borne disease (Sorensen et al., 2020, p.168). These phenomena will cause
negative health repercussion for populations which will drive more citizens to seek care through
emergency medicine, and hospitals’ emergency rooms will bear the brunt of this load (Sorensen
et al., 2020, p.168).
As climate change continues to progress, the risks to the health care system are profound,
especially those serving vulnerable populations and those already at social risk. Emergency
medicine is already at the forefront of acute care, when compared with other providers of
healthcare, this branch of the system is serving a larger population of those at risk. For
example, emergency departments (EDs) percent of population served includes 34.8 percent
from low socioeconomic status and 48.3 percent with comorbidities (Sorensen et al., 2020,
p.172). EDs can anticipate the increase in frequency of these climate change risks–whether
natural disasters, infectious disease, or extreme weather–will result in increased injury,
sickness, population displacement, exacerbation of disease, and mental health crisis (Sorensen
et al., 2020, p.171). In order to protect these more vulnerable populations and ensure that
emergency medicine is able to be the primary point of access for these affected populations,
advanced planning of disaster response situations must include health care system access and
readiness, clinical quality of care, and protective public health measures.
It’s important to note that in general EDs serve more vulnerable populations, but all hospitals
and the populations they serve are not equal in the provision of care to those at social risk.
Embedded in our society are the structural biases that create different hubs or areas that are
intrinsically more affected by the impact of climate change and therefore there will be greater
pressure on the specific EDs serving those populations. Take for example inner-city Baltimore
versus suburban Potomac hospitals, Baltimore has a higher likelihood of having urban heat
islands, highly polluted environments, and areas that are prone to flood or have poorly
maintained infrastructure (Sorensen et al., 2020, p.172). They will likely experience a larger
percentage of those with chronic medical conditions, those more likely to face homelessness
post climate crisis, and are at higher risk of needing emergency care when exposed to climate
stressors (Sorensen et al., 2020, p.172).
These types of hospitals, public hospitals serving populations at greater social risk, are true
safety-nets as they do things no one else will: they treat—not just stabilize—patients regardless
of their ability to pay. They provide access to healthcare to low-income, underinsured patients,
the majority of whom are from racial and ethnic minority groups. Unlike other hospitals serving
more affluent, predominantly white neighborhoods, many people rely on these essential
hospitals for high-risk care that otherwise would be unavailable to them (Kacick, 2021).
In this current era, we are unpacking the issue of systemic racism that essentially has created a
segregated hospital system. Research indicates that most private hospitals serve a patient
population earning $29K above the national average, whereas safety-net hospitals serve those
earning $27K below the national average (Kacick, 2021). Most commercial hospitals seek
paying customers with private insurance, prioritizing revenue over social impact. Safety-net
hospitals count on Medicaid and Medicare reimbursement at below-market value rates and
assume the social risk inherent with the population they serve.
Safety-net hospitals are in the trenches, dealing with the fall-out of the public health crisis of
racism. These hospitals need more support, and to do so we need to understand the factors
that cause racial disparities. The U.S. Department of Health and Human Services (HHS) report
from May 2021 describes social risk as a key contributing factor to worse health outcomes.
Social risk is a bit of a curveball, as it’s a newer distinction separate but related to social
determinants of health and social needs. Specifically, it encompasses social standing; race,
ethnicity and culture; gender; and community context (Zuckerman et al., 2021). When we are
looking at safety-net hospitals and the populations they serve, we are talking about communities
whose health is exacerbated by social risk. Being within a vulnerable population with higher
social risk may be correlated to physiologic, cultural, and socioeconomic factors all which are
exacerbated by disproportionate exposures to climate stressors as well as limited access to
health care and coverage (Sorensen et al., 2020, p.172).
Within our current federal healthcare funding system, there is really no financial reward for these
safety-net hospitals serving populations at greater social risk, they are not acknowledged or
awarded for the bulk of work they do to serve patients regardless of their financial means or
socioeconomic status (Zuckerman et al., 2021). Even if plans for Medicare to develop equity
measures and attempt to fiscally incentivize them were enacted, unfortunately, a
disproportionate share of hospital payments are completely discretionary by state and leave
many regions of the U.S. underfunded. For instance, Maine gives 97% of its Medicaid money to
its public hospitals, while Tennessee gives 0.7%, although on average states give 14% of
Medicaid allotments to safety-nets (“Medicaid: States’ Use and Distribution of Supplemental
Payments to Hospitals,” 2019). As government bodies slowly churn toward change, it would
make sense to offer additional support and funding based on the percentage of patients served
with elevated social risk, and redistribute that funding from hospitals that do not have high social
risk patients, especially as rapid climate change escalates risk for these institutions.
In the same vein, climate change brings about added risk for adverse health outcomes for
populations as well, and certainly within those more vulnerable and marginalized populations
who are disproportionately affected by climate stressors. Some of these adverse health
outcomes are heat-related disease, respiratory disease, cardiovascular and cerebrovascular
disease, waterborne gastrointestinal disease, vector-borne and zoonotic disease, accidental
and non accidental trauma, and mental health emergencies (Sorensen et al., 2020, p.171). In
addition to these demands on ED resources in the short and long term, natural disasters and
extreme weather disasters will take a toll on not only population health but also hospital
infrastructure. To prepare for these eventualities, safety-net hospitals need funding, preparation
and planning so that they can handle increased volume, mitigate longer wait times, increase
medical and mental health staffing and supply needs, and prepare for potential infrastructure
damages (Sorensen et al., 2020, p.172).
Recently we have seen a massive shift in policy and programming to add racial and social
equity as a priority for health systems. The pandemic was central to such a shift, as we
collectively woke up to embedded structural racism and its results—a significantly higher
COVID-19 mortality rate for people of color. There is a concerted effort to rectify the mistakes of
the past and retool the system such that Medicare embeds solutions to the equity divide within
its programming. These efforts are still in the concept phase. The Centers for Medicare and
Medicaid Services (CMS), which regulate financial incentives and deterrents, is beginning to
reevaluate how safety-net hospitals serve communities with higher social risk and is formulating
ways to financially reward those working to reduce racial disparities in health outcomes in
comparison to those hospitals that serve in primarily more affluent, white areas (Tepper, 2021).
In 2021, along with other government healthcare stakeholders, HHS conducted a report that
outlines the next steps to identify and incorporate equity measures to reduce disparities, still
tying in quality measures but adding a next layer measuring improved care and health outcomes
for those with greater social risk (Zuckerman et al., 2021). The comprehensive in-depth report
investigates eleven equity measurement approaches. The report defined health equity
measurement—evaluating the extent to which the quality of healthcare provided by an
organization improves the care and health of those with greater social risk—and emphasized
the importance of monitoring performance to determine if disparities are indeed improving
(Zuckerman et al., 2021). These nascent plans and programs need to take hold such that
funding streams for safety-net hospitals see reform. Programs like Medicare need to allocate
funds based on the volume of work hospitals do to heal social risk by directly serving large
percentages of vulnerable populations, and states must allocate funding not arbitrarily but
proportionate to social risk served.
In addition to proper funding for safety-net hospitals, there are clinical interventions as well as
system wide approaches that are important to implement at the local level within these
safety-net hospitals, those include health care system access and readiness, quality of care,
protective public health measures (Sorensen et al., 2020, p.171). The US Department of Health
and Human Services created the Sustainable and Climate Resilient Health Care Facilities
Toolkit, to assist hospitals in developing a resilience plan in the face of disasters to decrease
infrastructure damage and continue to provide care (Sorensen et al., 2020, p.173). Clinically,
EDs management can implement climate-sensitive protocol that will affect clinical decisions and
behavioral interventions, as well as take into account time-sensitive education about exposures
that can reduce morbidity and mortality (Sorensen et al., 2020, p.173). Additionally, increased
surveillance activities will help identify and address regional climate hot spots, such as New
York Cities system that tracks heat-related EMS dispatches and ED triage logs to help prepare
for heat related health crises and proactively protect those most vulnerable (Sorensen et al.,
2020, p.174). Another strategy, disaster preparedness, requires stress testing to determine if
the system can cope with patient surges due to unparalleled climate events, teams designed to
handle disaster management would create and update surge protocols frequently (Sorensen et
al., 2020, p.173). Again, all of these climate preparedness strategies are dependent upon
proper funding and resources being allocated to these safety-net hospitals. Vulnerable
populations stand to be disproportionately negatively affected by extreme climate events,
therefore the management and staff in hospitals serving these populations need to be prepared
and federal funding needs to support these hospitals for the work they do bearing the brunt of
these disasters.
References
Ghazali, D.A., Guericolas, M., Thys, F., Sarasin, F., Arcos González, P., Casalino, E. (2018,
May 5). Climate Change Impacts on Disaster and Emergency Medicine Focusing on
Mitigation Disruptive Effects: an International Perspective. Int. J. Environ. Res. Public
Health. https://doi.org/10.3390/ijerph15071379
Kacick, A. (2021, May 25). Urban hospitals tend to cater to white patients, analysis finds.
Modern Healthcare.
https://www.modernhealthcare.com/patient-care/urban-hospitals-tend-cater-white-pati
ents-analysis-finds
Medicaid: States’ Use and Distribution of Supplemental Payments to Hospitals. (2019,
July). U.S. Government Accountability Office (U.S. GAO).
https://www.gao.gov/assets/gao-19-603.pdf
Sorensen, C. J., Salas, R. N., Rublee, C., Hill, K., Bartlett, E. S., Charlton, P., Dyamond, C.,
Fockele, C., Harper, R., Barot, S., Calvello-Hynes, E., Hess, J., & Lemery, J. (2020).
Clinical implications of climate change on US emergency medicine: Challenges and
opportunities. Annals of Emergency Medicine, 76(2), 168-178.
https://doi.org/10.1016/j.annemergmed.2020.03.010
Tepper, N. (2021, November 16). How to pay for equitable outcomes. Modern Healthcare.
https://www.modernhealthcare.com/politics-policy/how-pay-equitable-outcomes
Zuckerman, R., Samson, L., Tarazi, W., Aysola, V., & Adetinji, O. (2021, May). Developing
Health Equity Measures. ASPE | Office of the Assistant Secretary for Planning and
Evaluation.
https://aspe.hhs.gov/sites/default/files/migrated_legacy_files//200651/developing-heal
th-equity-measures.pdf
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