NURS 8310 Discussion 2: Factors That Impact Population Health

An epidemiologist or public health official in the state of Alabama would have interest in identifying prevalence and incidence of cancer, trends of cancer rates in the general population and subpopulations, and supporting cancer related health policy for population health. The Alabama Department of Public Health (ADPH) publishes a list of “population health services” including, among others, a coalition with the express purpose of providing “an actionable framework that will guide statewide efforts to address cancer in Alabama” (Alabama Comprehensive Cancer Control Coalition, 2016, p. 1). This fluid coalition is comprised of multiple stakeholders across Alabama’s public health agency divisions, as well as with representatives from groups of particular interest such as breast or prostate cancer. Their published Plan aims to “address policy… systems.. and the environment,” which taken comprehensively represents recommendations at the primary, secondary, and tertiary levels of prevention (ACCCC, 2016, p. 1). The primary prevention section of the Plan promotes such activities as weight management, tobacco cessation, and human papillomavirus vaccination to decrease cancers with these known contributing factors. They even have a grant program allowing Alabama public schools to receive money toward adding shade structures on playgrounds to limit sun exposure contributing to skin cancers (Alabama Department of Public Health, n.d.). The secondary prevention portion of the Plan focuses on such measures as “improved access to screening tests” so that cancers can be identified prior to symptom development, ensuring earliest possible treatment (ACCCC, 2016, p. 4). The tertiary prevention part of the Plan supports the expansion of clinical trials for treatment of cancers and also promotes a range of treatment possibilities including palliative and hospice programs.

In general, the population of Alabama is largely rural, with little access to or experience with university-based care or cutting-edge medical advances, with the notable exception of Birmingham, and more recently, the Huntsville area. Cultural factors therefore will play a role in Alabamians’ attitudes toward cancer preven

tion, screening programs, and tertiary cancer treatment. For example, some adults may fear that HPV vaccination for their preteen children may constitute tacit permission for the children to participate in sexual activity. They may view tobacco cessation programs as impinging upon perceived freedoms, screening programs as too expensive, or clinical trials as too risky. Regulatory statutes interact with these programs when it comes to municipalities and large organizations banning smoking within their limits or on their campuses. Health care legislation can promote and support or inhibit and prevent preventive healthcare practices. For example, Alabama’s refusal to offer Medicaid to citizens other than dependent low SES children and pregnant mothers means that adults without jobs which provide healthcare benefits likely can not afford colorectal, breast, or cervical cancer screenings. While the ACCCC appears to have some positive goodwill in the state, it needs further legislative support to truly achieve its goals of preventing more Alabamians from cancer morbidity and mortality.

References

Alabama Comprehensive Cancer Control Coalition. (2016). Alabama Cancer Control Plan 2016-2021. Retrieved from https://www.alabamapublichealth.gov/cancercontrol/assets/state-cancer-plan.pdf

Alabama Department of Public Health. (n.d.) Shade Structure Grant Program. Retrieved from https://www.alabamapublichealth.gov/cancercontrol/assets/shadestructurerfp.pdf

Sample Answer 2 for NURS 8310 Discussion 2: Factors That Impact Population Health

Summary of the Selected Public Health Initiative  

My selected public health initiative is the national action plan (NAP) for combating multidrug-resistant tuberculosis (MDR-TB). The United States (U.S.) initiated the NAP against the MDR-TB to expand global efforts to fight the disease, save lives, and prevent its spread both in the U.S. and worldwide. The NAP to combat the MDR-TB identifies a set of targeted interventions that address the core domestic and global challenges posed by MDR-TB (The United States Agency for International Development [USAID], 2020). The main goals of the NAP include strengthening domestic capacity to combat MDR-TB, improving the international capacity and collaboration against MDR-TB, and accelerating basic and applied research and development to combat MDR-TB (De Vries et al., 2017). For more information about NAP, click:

Analysis of the Selected Public Health Initiative 

The rise in drug-resistant TB and the outbreaks of MDR-TB pose serious underlying problems in the health care infrastructure in the U.S. For instance, there is an increasing proportion of TB in people who were born in other countries or who are homeless, who have a mental illness or substance use, or other socioeconomic or medical problems, such as HIV, that make compliance with treatment difficult (De Vries et al., 2017; Nash et al., 2021). Thus, cultural concepts about illness causation and associated behaviors should be considered priorities to facilitate improvement in the initiative performance. Also, unethical exposure of TB patients to discriminative issues due to prejudice and bias from health care workers may negatively impact the initiative (Nash et al., 2021). Socioeconomic and patient factors such as behavior, demographic characteristics, and attitudes can lead to unfavorable MDR-TB treatment outcomes. Also, cases of unfavorable treatment outcomes may give rise to further transmission of MDR-TB, risking the development of extensive drug resistance (De Vries et al., 2017).

In the U.S., there is already political and regulatory support for the fight against MDR-TB. In collaboration with the world health organization (WHO), there has been a political will to enhance policy community cohesion (Sakamoto et al., 2019). Also, community health workers, including public health nurses, play a crucial role in reducing the MDR-TB burden globally. The contribution of public health workers in disease detection and management through regulation has resulted in a rapid decline in MDR-TB prevalence (Sakamoto et al., 2019; Nash et al., 2021).

Impact of the Current Health Care Legislation on the NAP Initiative

The current health care legislation necessitates the need for TB surveillance, reporting, and vaccination (Global Health Agency, 2021). The U.S. government’s global TB efforts have increased through funding having legal support. In 2021, for instance, the U.S government released 332 million dollars to enhance the global fight against TB. Currently, USAID serves as the lead implementing agency for the U.S. global TB efforts, reaching more than 50 countries worldwide (Global Health Agency, 2021). Additionally, the current health care legislation has enhanced bilateral TB programs in sub-Saharan Africa and South Asia to accelerate detection, treatment, and scale-up prevention of MDR-TB (Global Health Agency, 2021). Thus, such U.S. involvement through regulation can enhance the fight against MDR-TB.

Conclusion

The U.S. government initiated the NAP program in the global effort to fight MDR-TB. Cultural and ethical issues such as patient behaviors and discrimination should be considered for the effective implementation of the NAP initiative. Also, the political and legal support of the MDR-TB initiative has enhanced its implementation through increased funding. Lastly, the current health care legislation on TB surveillance, testing, and vaccination has resulted in the decline of MDR-TB cases worldwide.

References

De Vries, G., Tsolova, S., Anderson, L. F., Gebhard, A. C., Heldal, E., Hollo, V., … & Van der Werf, M. J. (2017). Health system factors influencing the management of multidrug-resistant tuberculosis in four European Union countries-learning from country experiences. Bio-Med Central Public Health, 17(1), 1-12. https://dx.doi.org/10.1186%2Fs12889-017-4216-9

Global Health Agency (2021). The U.S. government and global tuberculosis efforts. https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and-global-tuberculosis-efforts/

Nash, D. B., Skoufalos, A., Fabius, R. J. & Oglesby, W. H.  (2021). Policy and advocacy. In population health: Creating a culture of wellness (3rd ed.). Jones & Bartlett Learning.

Sakamoto, H., Lee, S., Ishizuka, A., Hinoshita, E., Hori, H., Ishibashi, N., … & Shibuya, K. (2019). Challenges and opportunities for eliminating tuberculosis–Leveraging political momentum of the UN high-level meeting on tuberculosis. Bio-Med Central Public Health, 19(1), 1-7. https://doi.org/10.1186/s12889-019-6399-8

The United States Agency for International Development (2020). National action plan for combating multidrug-resistant tuberculosis. https://www.usaid.gov/global-health/health-areas/tuberculosis/national-action-plan-combating-mdr-tb