Benchmark: Policy Brief and Climate Change
Climate change is considered a critical aspect of public health with communities and individuals experiencing its impacts, especially its effects on the quality of air around the world. In their article, Blumenthal and Seervai (2018) assert that the U.S. health care system is one of the most affected by climate change as the country is one of the largest emitters of greenhouse gases, making it a major contributor to air pollution and global warming. Further, they opine that the environment shapes the health system and recent catastrophes show that climate change has adverse effects on the health care system’s capacity and ability to meet patient needs (Johnson& Lichtveld, 2017). The purpose of this paper is to discuss the effects of climate change on healthcare delivery system, its effects on the population and propose a solution to the issue.
Policy Health Issue
The World Health Organization observes that climate change impacts the social and environmental determinants of health that include clean air, safe drinking water, secure shelter, and adequate food supply to different population. The organization asserts that climate change is a serious global phenomenon that will impact different aspects of health at individual and community level with effects like increased mortality rates from diseases like malaria, diarrhea, heat stress as witnessed by increased heat waves across the country and other parts of the world and malnutrition, especially in developing regions and countries in the world. In their article Chen and Murthy (2019) opine that the human and health effects of climate change are evident in the extreme weather conditions that are leading to disruption of lives by exacerbating chronic health diseases like asthma and expanding the range of infectious diseases and worsening mental health illnesses (Johnson & Lichtveld, 2017). Climate change is also causing growing health effects associated with population displacement and migration and climate-triggered instability and conflicts. Extreme weather events disrupt health infrastructure that include utilities, transportation, and communication systems that are critical to maintenance and access to emergency services and care.
Climate change affects many people since it is a global phenomenon (Hathaway & Maibac
h, 2018). However, individuals with chronic conditions, those living at coasts, and those in poorer communities are the most affected. Those living in regions prone for extreme weather are also hard hit by the issue. Children are also vulnerable and affected by aspects of climate change like air pollution that exacerbates conditions like asthma and respiratory illnesses contributing to heart disease, cancers and lung diseases among others.
Problem Statement
The problem statement on climate change and health stakeholders’ awareness is essential to addressing the issue. A problem statement on the issue begins with who, what, where, why and when of the problem. Climate change affects all people, especially those from lower socioeconomic status and those vulnerable to the effects of extreme weather due to sensitivity or lack of protection. Climate is anthropogenic as it emanates from human actions that necessitate emissions of greenhouse gases like methane and carbon dioxide which trap heat in the atmosphere leading to global warming that result in climate change (Hathaway & Maibach, 2018). Climate change is now happening as evident through increase in temperatures and if the world does nothing, it will worsen and impact all aspects of healthcare delivery and life in general. The problem statement therefore, addresses the need to have policies and suggestions to tackle the issue and reduce its effects on health at individual, community, and even global levels.
Suggestions to Address Climate Change
Early, deliberate and responsible actions from a multi-agency approach can help in safeguarding health and people’s safety from the vulnerabilities and detrimental effects of climate change. Measures should focus on addressing future effects of climate change while tackling the current situations to attain greater benefits for all affected populations. Robust climate-health initiatives and programs help reduce the emission of carbon elements into the atmosphere that trap heat to cause global warming.
The American Public Health Association created the “Climate, Health, and Equity: A Policy Agenda,” aimed at attainment of health energy, enhancing transportation and land use, and advance the use of agriculture system as critical to addressing the adverse effects of climate change (Johnson & Lichtveld, 2017). The policy prioritizes three primary areas aimed at providing a climate action for health, a health action for climate, and funding of the two approaches.
Policies on reduction of emissions of greenhouse gases through transitioning to clean, renewable and sustainable transportation and agricultural systems are key to mitigating the severity of climate change and its effects on healthcare delivery. The health care sector contributes significantly to climate change as it produces close to 10% of total greenhouse gases in the U.S. Hospitals and health systems should address climate change as a public health issue by decreasing their carbon footprint, transitioning to clean, renewable energy and having climate-resilient facilities.
Healthcare providers and professionals have substantial influence on heath delivery systems and can protect their patients from the effects of climate change through development of sustainable, climate-smart facilities and systems. Physicians can advocate for their facilities to be part of the Health Care Climate Challenge and mobilize institutions across the world to protect public health from the adverse effects of climate change (Chen & Murthy, 2019). They can offer participants easy-to-use resources to assist support climate-smart solutions. Evidence suggests that health providers can help their patients and communities participate in climate change initiatives to reduce their carbon footprints and respond immediately to these conditions (Salas et al., 2020). Caregivers need to understand the effects of climate change on disease patterns and population vulnerabilities through awareness creation by physicians and nurses.
Steps to initiate policy changes include identification of the problem with stakeholder gathering relevant information on the effects of climate change on public health and the population (Friel, 2019). They should identify the features, severity, scope and financial implication of the issue. The second encompasses policy analysis through research and identifying options to address the problem. The analysis provides an opportunity to understand issues like morbidity and mortality associated with the issue and other factors affecting it like political and socioeconomic perspectives (Johnson & Lichtveld, 2017). The implementation of the policy leads to effective steps by stakeholders in enactment of the identified interventions like cutting down greenhouse gases emissions through use of clean and sustainable energy solutions, smart-hospitals, and innovative ways to reduce carbon footprints among providers, patients, and health populations.
Impact on Health Care Delivery System
Climate change has negative effects on human health as it restricts people from performing outdoor activities, leads to disruptions in care provision and increases susceptibility to infectious diseases. The implication is that the health care delivery system is impacted due to the disruptions and increased cost burden of emergency room visits due to attacks from chronic diseases like asthma and more hospitalizations because of respiratory and cardiovascular diseases (Wang, 2020). The direct damage to health by climate change is close to $3 billion each year with estimated projected to rise as more regions continue to face unpredictable weather situations.
Conclusion
Climate change affects human health due to its severity and detrimental implications. The healthcare delivery system will continue to shoulder the burden based on increased cost of care, exacerbation of conditions, and need for emergency room visits. Stakeholders must find ways to address the unpredictable nature of climate change through policies like the APHA’s policy on getting resources to address these effects.
References
Blumenthal, D. & Seervai, S. (2018). To Be High Performing, the U.S. Health System Will Need
to Adapt to Climate Change. https://www.commonwealthfund.org/blog/2018/be-high-performing-us-health-system-will-need-adapt-climate-change
Chen, A. & Murthy, V. (2019). How Health Systems Are Meeting the Challenge of Climate
Change. https://hbr.org/2019/09/how-health-systems-are-meeting-the-challenge-of-climate-change
Friel, S. (2019). Climate change, global justice, and health inequities. Climate Change and the
People’s Health, 1-56. https://doi.org/10.1093/oso/9780190492731.003.0001
Hathaway, J., & Maibach, E. W. (2018). Health Implications of Climate Change: A Review of
the Literature About the Perception of the Public and Health Professionals. Current
Environmental Health Reports, 5(1), 197-204. https://doi.org/10.1007/s40572-018-0190-3
Johnson, B. L., & Lichtveld, M. Y. (2017). Steps in environmental health Policymaking.
Environmental Policy and Public Health, 25-50. https://doi.org/10.1201/9781351228473-2
Salas, R. N., Friend, T. H., Bernstein, A., & Jha, A. K. (2020). Adding A Climate Lens To
Health Policy in The United States: Commentary explores how health care policy makers can integrate a climate lens as they develop health system interventions. Health Affairs, 39(12), 2063-2070. https://doi.org/10.1377/hlthaff.2020.01352
Wang, J. (2020). Climate-smart health care: The power of health care action on air pollution and
climate change. European Journal of Public Health, 30(Supplement_5). https://doi.org/10.1093/eurpub/ckaa165.299
World Health Organization (WHO) (2021). Climate change and health.
https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health
Epidemiology is the scientific study of how frequently diseases occur in different groups of people and why. It is based on two fundamental assumptions. Firstly, it assumes the occurrence of the disease is not random because several factors concomitantly influence the likelihood of developing the disease (Stover et al., 2021). Further, it assumes the study of populations facilitates the recognition of the causes and preventive factors analogous with the disease. Communicable diseases refer to infectious diseases caused by different microorganisms such as bacteria, viruses, fungus, and parasites that can be spread directly or indirectly from one individual to another. Many infectious diseases can be transmitted via bites from insects, while others are caused by ingesting contaminated substances such as food or fluids. Although several infectious diseases pose serious health risks to communities, HIV can never be underestimated. The purpose of this paper is to discuss HIV and apply epidemiology and nursing research concepts to this communicable disease.
Description of HIV as Chosen Communicable Disease
HIV is a retrovirus that destroys cells of the human immune system (mainly CD4-positive T-cells and macrophages), which are the cellular immune system’s critical components, and kills or impairs their role. Infection with this virus results from the progressive depletion of the immune system, leading to immunodeficiency (UNAIDS, 2021). The Human Immunodeficiency Virus comprises two strands of RNA, 15 types of viral proteins, and a few proteins from the last host cell it infected, all surrounded by a lipid bilayer membrane. There are two categories of HIV, HIV-1 and HIV-2. HIV-1 can be found worldwide, but HIV-2 is almost exclusively limited to West Africa. HIV-1 is transmitted more easily than HIV-2(UNAIDS, 2021). The advanced level of HIV infection is acquired immunodeficiency syndrome (AIDS). AIDS is determined by developing certain malignancies, conditions, or other acute continuing clinical indications. HIV-1 infection progresses more rapidly to AIDS compared to HIV-2.
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Causes of HIV
A virus causes HIV through sexual contact or blood. In addition, transmission can occur from mother to child during pregnancy, childbirth, or breastfeeding. When the virus enters the blood, it destroys the white cells that provide the body with the ability to fight infections and disease (UNAIDS, 2021).
Symptoms
The symptom of HIV varies and is determined by the phases of infection. Several people infected with HIV may manifest flu-like symptoms a few weeks after the entry of the virus. The likely symptoms at the acute stage may include fever, headache, skin rash, sore throat, and painful mouth sore. Similarly, swollen lymph glands, especially on the neck, muscle aches, joint pains, and diarrhea may manifest. In addition, the person could also manifest coughs, weight loss, and night sweats (UNAIDS, 2021). As the pathogen mutates in the blood and destroys the white cells at the symptomatic stage, the following symptoms may manifest Pneumonia, herpes zoster, thrush or oral yeast infection, fatigue, and fever. Furthermore, when the virus progresses to the stage of AIDS, the mentioned symptoms would manifest to be persistent and severe (UNAIDS, 2021).
Mode of Transmission
The predominant mode of HIV transmission is through unprotected sexual contact with an infected partner. In addition, exposure of broken skin or wound to infected blood or body fluids. Similarly, transfusion with HIV-infected blood is another avenue for transmission (Stover et al., 2021). Moreover, when an individual is injected with contaminated objects like needles and unsterilized syringes or razorblades, the virus is likely to be transmitted. Furthermore, transmission can also occur from mother to child during pregnancy, birth, or breastfeeding (UNAIDS, 2021).
Complications People infected with HIV who do not get proper treatment for HIV/AIDS develop a wasting syndrome accompanied by diarrhea, fever, and chronic weakness. In addition, individuals are likely to develop neurological complications as the virus reduces mental functioning. The difficulty includes kidney disease, such as the inflammation of kidney filters that remove excess fluid and waste from the blood to the urine. Similarly, there is the liver complication (UNAIDS, 2021).The other common infectious complications related to or due to HIV comprise Pneumonia that causes severe illness. The difficulty of thrush or candidiasis causes inflammation on various body parts, i.e., the mouth, tongue, and esophagus. Similarly, the other problematic condition is Tuberculosis, especially in developing countries(Mahy et al., 2021).Treatment HIV has no cure but can be controlled through antiretroviral therapy. The treatment entails taking medicine that lessens the viral load in the blood. The medicine for HIV therapy is called antiretroviral (UNAIDS, 2021).The treatment involves a combination of everyday medications that prevent the virus from multiplying. The treatment aids protect the CD4 cells, keeping the immune system strong enough to combat infection and disease. The ART lowers the viral load and reduces the chance for transmissions from one person to another ((Mahy et al., 2021)Demographic- Prevalence
The global prevalence of HIV, according to UNAIDS (2021), estimates that about thirty-eight million people living with HIV. Women accounted for fifty-three percent of the number, while men accounted for forty-seven percent. Furthermore, two million are children between zero to nineteen years of age. In addition, data indicate that women aged fifteen years up to twenty-four years globally acquire HIV. Furthermore, Sub-Saharan females account for sixty-three percent of the newly acquired HIV infection. Women accounted for fifty –three percent. Similarly, in 2020, 1.5 million people contracted HIV globally (UNAIDS, 2021).
According to the UNAIDS report, the most affected populace with HIV is from developing countries. For instance, in 2020, east and southern African countries had twenty-seven million people infected with HIV, accounting for fifty-five percent of global infection. Moreover, Asia and Pacific regions had six million people infected, accounting for fifteen percent of global infection. In addition, western and central Africa had five million infected, accounting for thirteen percent. Moreover, North America and Central Europe had two million, accounting for six percent of the global infection prevalence (UNAIDS, 2021).
Reporting of HIV
The primary object for reporting is for public health authorities to know where several diseases are found in a population. The information helps them take steps to mitigate the spread of infectious diseases and safeguard the community’s health. Further, it ensures linkage of care for any newly infected patients or continuation of care for earlier diagnosed patients(Stover et al., 2021). Moreover, timely monitoring presents trends in the epidemic and secures proper funding for local treatment and prevention services.HIV is a reportable condition that medical practitioners and pathology services must notify within five days of diagnosis to the HIV is reported only to the HIV/AIDS Surveillance Program at the Department of Public Health.
Determinants of Health and Explanation of How Determinants Contribute to Disease Development
Social health factors are the conditions in which people are born, grow, live, work and age. The social determinant includes factors like socioeconomic status, education, neighborhood, physical environment, employment, social support networks, and access to health care(Stover et al., 2021) The social factors of health can influence a person’s likelihood of acquiring HIV through influences on improper behavior, limited access to preventive measures, and limited access to healthcare providers or testing sites.
Studies show that abuse drugs such as alcohol, cocaine, marijuana have exacerbated the risk of HIV infection. Similarly, the use of drugs leads to confinement. The individuals under detention are reported to be engaging in unprotected sex leading to a high rate of HIV infection. Further, the social-economic status has contributed to the prevalence of HIV. The economically poor are more likely to get into unwarranted behaviors, e.g., indulging in commercial sex, thus risking and enhancing the infection of the virus (Mahy et al., 2021). Economically vulnerable women experience the scarcity of health-related resources in poor, under-served communities or villages where access to health care and condoms are not readily available(Mahy et al., 2021). These compounding social health determinants extrapolate the prevalence and the risk of acquiring the virus.
The Epidemiologic Triangle
The Epidemiologic Triangle is a tool that researchers employ in addressing the three constituents that contribute to the spread of infections or disease. The triple components comprise an external agent, a susceptible host, and an environment that brings the agent and host together (Mahy et al., 2021).The triangulation of HIV (causative agent) refers to factors and attributes of the virus that concomitantly aids its infection and spread on the host. Firstly, the nature of the subtype of the HIV Virus determines the extent of infection and spread. Studies show that HIV-I is easily transmitted due to its biological and chemical characteristics. To underscore, HIV-1 RT is a heterodimer composed of p66 and p51 subunits, with p66 harboring two functional, active sites: an N-terminal RNA- and DNA-dependent DNA polymerase and a C-terminal RNase H that digests the RNA component of RNA–DNA hybrids (De Almeida et al., 2021). Due to its nature, HIV -1, therefore, binds more efficiently and faster than HIV 2 with the receptor molecule CD4 on the cell surface.; thus having a higher capability to infect and spread rapidly. Similarly, the other exacerbating factors include having a sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhea, and bacterial vaginosis that enhance chances for infection.
The host triangulation characterizes the host (human) factors as those that help enhance infection and spread the virus. The factors include having unprotected sex, having a frequent change of partners or having sexual activity for financial gain, peer pressure, drug and substance abuse (Hershow et al., 2019). These behaviors aid in enhancing HIV infection and spread. Similarly, urban health studies have found that poverty and unemployment, vacant buildings, and high crime rates are concomitant with an increased risk of HIV infection. The Social economic factors such as lack of access to care, discrimination, stigma, homophobia, and poverty enhance higher rates of HIV infection. Studies from cosmopolitan and urban areas indicate that poverty, unemployment, and high crime rates increase the risk of HIV infection and spread (Hershow et al., 2019). In addition, viral load increases in the infected occur for reasons such as not taking antiretroviral medication consistently due to lack of access to ART.
Special Consideration
There are special considerations or notifications for the community regarding the triangulation of HIV. Communities affected by HIV usually do risky behaviors, including sexual activities without protection and sharing paraphernalia that contribute to HIV infection. HIV education can aid learners in schools and the community develop and maintain safer behaviors and reduce stigma and discrimination towards people affected by and living with HIV (Hershow et al., 2019).
Role of the Community Health Nurse and Importance of Demographic Data
Nurses play vital roles in educating patients about HIV, providing support for treatment adherence, and assisting with navigation of care delivery. APRNs, further, are positioned to provide ART directly, consistent with their state practice authority.The community health nurse has professional technical skills and knowledge that the community populace may not have; thus, the nurse has the role in ensuring the quality of community-based care(Stover et al., 2021). They form a significant component in delivering quality HIV services, including counseling, adherence support, development of a referral framework, and dissemination of information. They also have the role of reporting and HIV data collection.
Demographics are essential since they offer an exhaustive comprehension of a population’s various features. The provided information is particularly vital to government organizations and institutions for making crucial policy decisions concerning the people(Stover et al., 2021). Similarly, demographics data is critical as it gives the health authorities andpopulace information they need to strategies and implements future investments and services; data from sources such as the CDC and the US Census aids in determining where assistance programs need to be directed (UNAIDS, 2021)
National Agency or Organization That Works to Addresses Communicable Disease
The USAID is one of the major federal agencies that implement the PEPFAR core mandate. The USAID’s Office of HIV/AIDS reinforces country-led efforts to combat the complex challenges of HIV in over fifty countries around the globe. The agency avails global leadership in developing projects and plans of actions that amplify impact. Similarly, it reinforces country-led programs and policies while at the same time administering USAID’s elaborate health and development skills and particularized HIV/AIDS technical capability(Stover et al., 2021). Further, the organization applies research, technology, and change to encourage cost-effective, sustainable, and judicious integrated HIV/AIDS interventions.
Global Implication of HIV
Notwithstanding the existence of treatment that can manage and mitigate the progression of HIV viral transmission, the virus remains a major leading cause of death and a health risk to millions globally. HIV is non-endemic; it is widespread globally. Different countries have put various strategies to mitigate the infection surge among their population. Techniques like the use of male and female condoms are encouraged by various governments. Further, voluntary medical male circumcision is agitated across the globe to minimize the chances of infection. (UNAIDS, 2021).Moreover, many countries use antiretroviral drugs to prevent mother-to-child transmission, pre-exposure prophylaxis, post-exposure prophylaxis, and treatment as prevention. Similarly, sex and reproductive health services are used to inform the population on the crucial knowledge that helps reduce infection of the virus (Stover et al., 2021).
Conclusion
HIV is a retrovirus that destroys cells of the human immune system, specifically the CD4-positive T-cells and macrophages. There are two types of HIV, namely HIV-1 and HIV-2. HIV-1 can be found worldwide. In addition, the infection is non-endemic but widely spread. Further, it is caused by a virus that enters the blood and impairs the white cells. Moreover, the primary mode of HIV transmission is through contact with infected blood body fluids. In addition, people infected with HIV who do not get proper medication for HIV/AIDS develop diarrhea, fever, and chronic weakness. In addition, they are likely to develop complications like neurological malfunction, kidney, and liver, among others. UNAIDS 2021 report reveals that about thirty-eight million people live with HIV, of whom women are the majority with infection. Similarly, regionally, the Sub-Saharan countries lead with an infection of about twenty-seven million, accounting for 53% of the world infection as of 2020. Moreover, the condition is modifiable to the health authorities to help mitigate the spread of infectious diseases and safeguard the community’s health.
References
De Almeida, S. M., Rotta, I., Tang, B., Vaida, F., Letendre, S., Ellis, R. J., & HNRC Group. (2021). IgG intrathecal synthesis in HIV-associated neurocognitive disorder (HAND) according to the HIV-1 subtypes and pattern of HIV RNA in CNS and plasma compartments. Journal of Neuroimmunology, 355, 577542. https://doi.org/10.1016/j.jneuroim.2021.577542
Hershow, R. B., Gonzalez, M., Costenbader, E., Zule, W., Golin, C., & Brinkley-Rubinstein, L. (2019). Medical providers and harm reduction view on pre-exposure prophylaxis for HIV prevention among people who inject drugs. AIDS Education and Prevention, 31(4), 363-379. https://doi.org/10.1521/aeap.2019.31.4.363
Mahy, M. I., Sabin, K. M., Feizzadeh, A., & Wanyeki, I. (2021). Progress towards 2020 global HIV impact and treatment targets. Journal of the International AIDS Society, 24, e25779. https://doi.org/10.1002/jia2.25779
Stover, J., Glaubius, R., Kassanjee, R., & Dugdale, C. M. (2021). Updates to the Spectrum/AIM model for the UNAIDS 2020 HIV estimates. Journal of the International AIDS Society, 24, e25778. https://doi.org/10.1002/jia2.25778
UNAIDS (2021) epidemiological estimates.https://aidsinfo.unaids.org