Running Head: BURDEN OF DISEASE 1 Burden of Disease Cardiovascular diseases refer to many heart and blood vessel-related conditions such as heart diseases like hypertension. Center for Disease Control and Prevention (2018) shows that approximately one hundred and twenty million United States adults have at least one BURDEN OF DISEASE 2 cardiovascular disease-out of this number, forty-eight percent are twenty years and above. The most prevalent cardiovascular disease is hypertension, where the data shows that other components only account for about nine percent. Wayne County tops in the rate of cardiovascular diseases and death in Michigan. One of the three residents of Wayne County has high blood pressure. Wayne County health departments have developed various strategies to curb this fatal condition. Community preventive service task force recommends team-based care to improve blood pressure control. Team-based is cost-effective and effective in increasing the portion of patients with controlled blood pressure as well as reducing and diastolic blood pressure. It is a health systems-level and an organization intervention that depends on multidisciplinary collaboration to enhance the quality, safety, and effectiveness of high blood pressure care to patients and the community at large. It is established by either adding new healthcare professionals or changing roles and responsibilities of current staff in primary care. Team-based care comprises of the patient primary care providers, nurses, pharmacists, community health workers, socials workers, among other healthcare providers. The team members support the process and are responsible for complimenting primary care providers' services in hypertension care. They manage medication, conduct patient follow-up, and promote adherence as well as self-management support. Specifically, the team for hypertension care facilitates communication and coordinates care among its members and enhances the use of evidence-based guidelines in caring for patients. Besides, it establishes regular, systematic, and objective follow-up to oversee patient progress and advice accordingly on visits. Lastly, it promotes active engagement of patients in their hypertension care through empowering them on medication, adherence, and necessary tools that they may need for self-management. BURDEN OF DISEASE 3 The strategy is excellent and has been reported by the task force to reduce the burden of hypertension and improve hypertension care among the affected population. However, as seen, it focuses much on the already affected individuals and pays little attention to the undiagnosed or the community regarded as safe. I believe that the strategy can achieve more if it includes interventions focused on preventing cardiovascular diseases, particularly by educating the community on the risks and significance of seeking care as well as empowering them (Smith, 2016). Its activities should consist of a focus on emerging cardiovascular diseases risks factors as a way to reduce the burden and not entirely to emphasize the already affected population. Similarly, by engaging in preventive intervention, it will increase awareness, which will ultimately reduce the burden of cardiovascular diseases. Its task of engaging patient patients on their hypertensive care should be broad and include engaging community on their hypertension care and prevention to accommodate the whole community and realize shared goals for the community as a whole. Some of the policies that impact health among the residents of Wayne County relate to insurance coverage, resources allocation and preventive taskforce. Wayne County has enacted a policy that requires all children getting into kindergarten through seventh grade to be up to date with all immunizations. This is ensured through its school immunization program that requires all schools to report children vaccine data to its local health department via the Michigan Care Improvement Registry. The program and the policy aim to warrant that children's students are protected from various vaccine-preventable diseases. Additionally, Michigan has expanded its public health care programs and implemented policies that ensure their sustainability. It has also expanded its Medicaid managed care. Currently, Wayne County, apart from the Medicaid that is the primary public health care BURDEN OF DISEASE 4 coverage, has state children's health insurance programs as well as the indigent care programs. The Wayne County also has elder prescription insurance coverage to improve health access and quality among the elderly population. The SCHIP funds enable Michigan to expand Medicaid to children between 16 to 18 year in low-income families according to the federal poverty level and the policy is effective in Wayne County. Also, MICHILD covers children aged 18 years and from families earning an income of below 200 percent of the federal poverty level. These changes in policies came as a result of a change in the economic state of the state and Michigan after terrorist attacks, which left many marginalized communities suffering to access health in various counties including Wayne. Establishing polies that expanded coverage aimed to improve care access, quality, and the general health of persons and has successfully achieve this. Similarly, Wayne County has in place policies and legislation that dictate where fruits and vegetables are grown. The county has used its policies and laws as a polices levelers to improve fruits and vegetable intake in the area as a means to improve nutritional status and healthy eating habits of fighting risks for various cardiovascular diseases (Paul, 2019). Some of these policies include increased spending in some healthy or health-related programs and often deregulating its laws that act as barriers to a healthy life. These have significantly impacted the health of residence an improve care access. There major health champions in Wayne County. The public health department liaises with the local, county, and state governments in ensuring that essential resources are available in the community to address their needs. In most instances, the Wayne public health department conducts community assessment to identify the health needs of the community and then collaborate and advocate for the local communities’ needs at all levels (Paul, 2019). BURDEN OF DISEASE 5 Moreover, the Wayne County public health department, through collaboration with the department of health, veterans’ community wellness, created a program known as the vaccine for children, which aims to ensure that all children receive vaccines to prevent vaccine-preventable diseases. Since, then the department of health, veteran, and community wellness has worked with public health community health providers to serve even the uninsured and underinsure children in Wayne County. The target is to ensure that all children are up to date with all immunization to eliminate vaccine-preventable diseases in the county. It has also ensured the training of staff on the same to warrant that they comply with the center for disease control and prevention guidelines on immunization. Detroit Wayne Integrated Health Network is one of the safe health advocates in the county which advocates for access to a full array of health services and ensuring that every individual has a chance to quality lives. Detroit Wayne Integrated Health Network has improved awareness empowerment, particularly in mental health and general health practices that have had a cumulative positive outcome on cardiovascular disease prevalence in Wayne County. It has educated patients on their mental health rights, which are stated in the Michigan Mental health code. Also, the Michigan Quality Improvement Network is another significant champion in promoting health access and quality in the area. The network supports over forty community health centers in an attempt to improve health access and quality. It has members across Wayne County who are well-trained and strive to improve the performance of health sectors in such areas, availing essential resources, and support the communities in living healthy lives. It has also partnered with the public health department to improve immunization to protect children from vaccine-preventable diseases. BURDEN OF DISEASE 6 References BURDEN OF DISEASE 7 Cardiovascular Deaths retrieved from https://www.americashealthrankings.org/explore/annual/measure/CVDDeaths/state/MI?e dition-year=2018 Cardiovascular Disease: Team-Based Care to Improve Blood Pressure Control Immunization Coordination & Vaccines for Children Program retrieved from https://www.waynecounty.com/departments/hhvs/wellness/immunizationcoordination.aspx Paul, B. C. (2019). Impact of Food Insecurity on the Management of Illness in Wayne County, Ohio (Doctoral dissertation, Walden University). Retrieved from https://www.thecommunityguide.org/findings/cardiovascular-disease-teambased-care-improve-blood-pressure-control Rights & Advocacy Rights Is Everybody's Business" retrieved from https://dwihn.org/rights-andadvocacy Smith Jr, G. (2016, November). Health Initiatives: Improving the Health Outcomes in Communities of Color. In APHA 2016 Annual Meeting & Expo (Oct. 29-Nov. 2, 2016). American Public Health Association. Tilly, J. (2002). Recent Changes in Health Policy for Low-Income People in Michigan retrived from https://www.urban.org/sites/default/files/publication/60001/310442-RecentChanges-in-Health-Policy-for-Low-Income-People-in-Michigan.PDF Running Head: NATIONAL HEALTH POLICY VS. STATE POLICY 1 National Health Policy vs. State Policy National Health Policy vs. State Policy The Affordable Care Act (ACA), which also goes by the name Obamacare, got officially signed in 2010 following a debate by policymakers, politicians, and other involved stakeholders. NATIONAL HEALTH POLICY VS. STATE POLICY 2 Its primary purpose was to increase health care independence to US citizens by ensuring that a more significant percentage can afford the services. The biggest change when it comes to ACA was experienced between 2013 and 2016, whereby Michigan alone saw a decline of around 60% of the uninsured people. Counties in the Southwest of Michigan had the drop, with Wayne County alone showing a change from 16.4%- 12.5%. The health policy gives the citizens different benefits at the national and state levels. Focusing on the state of Michigan, ACA was an equivalence of expanding Medicaid, which resulted in the increased funds towards healthcare. Statistics from 2017 show that Michigan alone received $48 million from the State level and $3.6billion from federal inform of health insurance funds. These are then divided into different counties, including Wayne, Oakland, Mackianac, Oceana, and many others. They all provide their residents with varying covers for their health to promote an independent state that can cater to its basic needs without creating the risks to individuals. ACA has facilitated the expansion of the previously available Medicaid eligibility at the state levels. A minimum income of $45, 321 is an indication that the citizens of Wayne County require a health insurance policy to cater for their needs. The low-income families make up a large portion of the population, as 21.7% of the people are living under poverty conditions. ACA comes in to promote their dream of having a reliable way to fund for their health. Before ACA, it was difficult for most of these individuals to pay for the necessary services, which meant that the mortality rate for preventable conditions was higher. The insurance cover ensured that all states had a chance to absorb as many people as possible. The ACA provides different deals within state legislation to cater for all individuals. Companies have the responsibility of signing their employees to the appropriate covers NATIONAL HEALTH POLICY VS. STATE POLICY 3 according to their earnings and choices as well. In that case, they are deducted a particular amount for their monthly pay, which differs from state to state. Michigan State ensures that the deductions do not mistreat the workers and are equal in all counties. Wayne is one of the most registered counties when it comes to ACA insurance employment covers (Ayanian et al., 2017). On the other hand, if an individual is on the business field or freelancing, he or she can still be included in the insurance policy. They are also given platforms to pay and pass their concerns about ACA. Unlike those in employment who get their cover amounts deducted directly from the employer, business people must make the payment. Their plans are more flexible, but they should be made on time and full prices as expected (Buck, 2011). The ACA is also beneficial at the national level by providing an extension to purchase private covers by offering an affordable marketplace. Insurance was once a monopolistic environment that was expensive to more than half of the population. The US population experienced reduced health quality as most of the citizens were uninsured (Haselswerdt, 2017). The availability of Medicaid and later on, ACA ensured that individuals would not only get insured but also get better opportunities to access other plans. Private companies had to reduce their prices and offer reliable health insurance as they were facing competition from public policies like ACA. Citizens, therefore, got an opportunity to seek services from these companies and increased their health accessibility. ACA was majorly signed for promoting the access of quality health services to lowincome citizens. The purpose of this health insurance policy was achieved as the number of people who enrolled in the plan increased over the period between 2013 and 2016 (Duggan, Goda & Jackson, 2017). Now people are in a better position of accessing all services in the hospital environment as ACA covers them. The plan to reduce the number of funds required by NATIONAL HEALTH POLICY VS. STATE POLICY 4 private covers worked effectively. Unlike in 2009, when it was almost impossible for low and middle-income citizens to purchase a private insurance cover, it is now possible (Ayanian et al., 2017). These companies offer affordable plans to cater to all citizens, which has increased the certainty in the healthcare provision for most individuals. The dynamics surrounding ACA have, however, changed over the years, with the number of uninsured citizens increasing by almost 500,000 between 2017 and 2018. The cover is now uncertain due to the increased lawsuits concerning ACA (Duggan, Goda & Jackson, 2017). The Trump administration has introduced different policies concerning Obamacare, which results in politics in healthcare. Some reduced reimbursements and subsidies reduced the affordability of the insurance cover. The increase in uninsured individuals can be explained through the changing policies in the trump government and the changes that have changed that the sector has experienced over the years. I feel that the changes might be a significant contribution to the reduced healthcare quality in the US, and hence the need to come up with a solution. The best way to handle these issues is by ensuring that citizens get to trust ACA as they did in 2013. There were fewer politics around healthcare, which explains its success, and now it is failing due to a similar issue. The Trump administration needs to focus on the quality of health that the citizens deserve and not how the different parties benefit from the policies (Kocher, Emanuel & DeParle, 2010) (Haselswerdt, 2017). It would also help when citizens can understand the changes in the economy, which means that they have to pay more for their health insurance. Most of the increased cases of coverage are due to the aspect of the increased amount for the cover, which is normal as every other bill has seen an increase over the years. NATIONAL HEALTH POLICY VS. STATE POLICY 5 References Ayanian, J. Z., Ehrlich, G. M., Grimes, D. R., & Levy, H. (2017). Economic effects of Medicaid expansion in Michigan. Obstetrical & Gynecological Survey, 72(6), 326-328. Buck, J. A. (2011). The looming expansion and transformation of public substance abuse treatment under the Affordable Care Act. Health Affairs, 30(8), 1402-1410. NATIONAL HEALTH POLICY VS. STATE POLICY 6 Duggan, M., Goda, G. S., & Jackson, E. (2017). The effects of the Affordable Care Act on health insurance coverage and labor market outcomes (No. w23607). National Bureau of Economic Research. Haselswerdt, J. (2017). Expanding Medicaid, expanding the electorate: the Affordable Care Act's short-term impact on political participation. Journal of health politics, policy and law, 42(4), 667-695. Kocher, R., Emanuel, E. J., & DeParle, N. A. M. (2010). The Affordable Care Act and the future of clinical medicine: the opportunities and challenges. Annals of internal medicine, 153(8), 536-539. Rudowitz, R. (2020). Medicaid: What to Watch in 2020. Retrieved on 24th January 2020 from, https://www.kff.org/medicaid/issue-brief/medicaidwhat-to-watch-in-2020/ Running Head: SUBSTANCE ABUSE IN WAYNE COUNTY Substance Abuse Disorder Treatment Programs in Wayne County, Michigan The social challenges facing Wayne County in Michigan has resulted in severe health issues that need a solution. The region has experienced a significant share of problems dealing with drug abuse and especially the opioids. Many young people fall victims to these issues, 1 SUBSTANCE ABUSE IN WAYNE COUNTY 2 making it necessary for the state has to come up with programs that deal with this situation in a better way. To make it easier to solve this problem, it is essential to take preventive measures as well as rehabilitation for the already affected individuals. The entire Michigan State has systems put in place to ensure that the cases of drug-related crimes and deaths reduced by the highest percentage. Detroit, which is in Wayne County, Michigan State, is one of the most affected regions with it comes to drug and substance abuse. When talking about opioid drugs, we cannot fail to pay reference to Detroit as it has many of these cases. Among the most abused drugs in the area are alcohol, marijuana and opioids like cocaine and heroin (Arfken, 2014). Due to the diversity in Wayne, individuals from different ethnic backgrounds, ages and gender are victims of drug abuse. The issue does not exclude minors from the equation as drugs are highly accessible, making it easier for these individuals to adapt to this lifestyle. In the last decade, drug-related crimes and deaths have been increasing by at least 2% annually. More and more individuals are getting hooked into drugs due to the accessibility, fewer laws put in place to deal with the activities as well as the influence from those involved (Algren et al., 2013). A lot of young people are disorienting their goals due to the interruptions brought across by drug and substance abuse. The crime rate in Wayne is also at its highest, with many drug addicts unable to work and hence to resolve to crime for natural resources to fund their lives. Early deaths and lifetime diseases related to drugs are also a dangerous part of the society, which touches on the health factor of the County and State at large (Arfken, 2014). Continuous use of drugs has proved to be dangerous to the health of the users as it affects not only the physical being but also emotional and psychological. All these are reasons contributing to the development of centers and programs within Wayne and Michigan to help SUBSTANCE ABUSE IN WAYNE COUNTY deal with the aspect of drug-related disorders (Arfken, 2014). They offer a variety of services including counselling, medical approaches and societal programs that can help reduce the problem. Depending on the kind of issues put in place, the different victims can select an appropriate institute in the event of solving their drug abuse issues and benefit as much as possible. One of the best programs is available at Michigan Institute for Behavioral Health, LCC, whose main aim is to offer the highest quality mental care to patients at affordable rates. It identifies as a rehabilitation center for drug abuse because most of the clients in this center have a connection to this social issue. The management has privatized the services to assure their clients of quality and also provide personalized care to them (Psychology Today, 2020). Detroit Behavioral Institute at Capstone Academy is another center that pays attention to mental health and educating the young people in their teenage years on the importance of abstaining from drugs. People at the age of 10-19 years are the most affected when it comes to influencing their choices. Giving them the knowledge at this young age ensures that they can prevent themselves from the impacts that come with drug abuse and also promote a healthier future generation (Psychology Today, 2020). StoneCrest Center-Developmental Disorders deal with providing medical services to the already affected victims to reduce the mortality rates connected to this issue. They also offer psychiatric services to young people, adults and elderly as a way of promoting mental health awareness across Detroit, Michigan. They provide over 100-bed capacity for their inpatient operations to ensure that more patients receive the assistance they need (Psychology Today, 2020). The Wayne State University Psychology Clinic is also involved in the provision of services across the region, to ensure that drug victims have a better way of dealing with their 3 SUBSTANCE ABUSE IN WAYNE COUNTY 4 situations. In all these State institutes and programs, psychological health seems to be a big deal as they offer more services on this line (Psychology Today, 2020). Although all of them still ensure that the individuals are physically well, it is their mental health that matters the most. The future of Wayne state is dependent on the younger generation as they provide better ideas to improve all sectors of the economy. However, with the drug abuse challenge that is affecting this age gap the most, it might be not very easy to achieve this goal, which will end up inconveniencing the future of the region. These programs are therefore put in place to ensure that Wayne County and the entire of Michigan get better ways of dealing with the drug problem challenge (Algren et al., 2013). They offer psychological help to solve the problem in the long run, as that determines how the future generation will manage their activities. Physical action is a short term solution that caters for the needs of the individuals at the moment but does not assure them of any changes in the future. If for example an individual is injured due to excessive drug use, the wound will be nursed and heal in due time but their behavior is unlikely to change without any counselling. Conclusively, drug abuse might be in the category of social issues, but it automatically joins the health department when it affects how people function. Most of the users, especially those connected to opioids, end up depressed with psychological problems and unable to live their lives as expected. The State and County offer a platform to enable individuals to solve their challenges through counselling services as well as preventative means. If the government can reduce the number by 50% in the next two years, it will be possible to transform a lot of departments, including the economy and wellbeing of the people. SUBSTANCE ABUSE IN WAYNE COUNTY References 5 SUBSTANCE ABUSE IN WAYNE COUNTY Algren, D. A., Monteilh, C. P., Punja, M., Schier, J. G., Belson, M., Hepler, B. R., ... & Straetemans, M. (2013). Fentanyl-associated fatalities among illicit drug users in Wayne County, Michigan (July 2005–May 2006). Journal of medical toxicology, 9(1), 106-115. Arfken, C. (2014). Drug Abuse Patterns and Trends in Detroit, Wayne County, and Michigan— Update: January 2014 Psychology Today (2020). Treatment Centers in Wayne County, MI. Retrieved on February 3, 2020 from, https://www.psychologytoday.com/us/treatment-rehab/mi/wayne-county 6 COMMUNITY HEALTH CENTERS Community Health Centers 1 COMMUNITY HEALTH CENTERS 2 Community Health Centers: Wayne County, Michigan Wayne County Demographics Wayne County, Michigan, as of 2018, had a total population of 1.75 million people with a median age of 38 and an average household income of $46,390. The population grew by around 0.01% from the previous year, with the average household income increasing by 2.78%. The population consists of 6.5% persons under the age of 5, 23.6% under the age of 18, 15.4% of the population consists of persons who are 65 years old or over, and 51.8% females, with the rest being male. 54.6% of the population consist of whites only, Black or African Americans alone are 38.8%, Native Americans alone 0.5%, and Asians alone 3.5%. People who belong to two or more races are represented by 2.6% of the population, while Hispanics or Latinos are represented by 6.1% of the entire population (United States Census Bureau, 2018). Of the 1.75 million people living in the community, 85.9% are high school graduates or higher, with 23.3% of the population having a Bachelor's degree or higher. 12.1% of the population under the age of 65 years live with disabilities, while the persons under the age of 65 years without healthcare insurance represented by 6.8% of the population. The median household income is $45,321, with per capita income in the last 12 months being $25,976. 21.7% of the population in Wayne County live in poverty (United States Census Bureau, 2018). These demographics, therefore, reveal that community health centers in Wayne County are greatly needed by the population because a significant percentage of the community is not financially well off. Since the services offered by community health centers are less expensive compared to care provided by hospitals and outpatient clinics, they come in handy by offering the community affordable care and more extensive programs that are greatly needed by the patients. COMMUNITY HEALTH CENTERS 3 Health-Related Services Delivered Community health centers in Wayne County provide a wide range of health-related services. The services they provide go beyond what other healthcare providers like out-patient clinics and hospitals offer to patients. Community health centers in Wayne county provide not only primary healthcare services, but also specialty care, including cardiac, orthopedic and podiatric care, mental health and dental services, care coordination, transportation to and from healthcare facilities, and outreach activities which are driven towards finding patients in need of the services mentioned. Community health centers also deliver care that is culturally appropriate since they are offered in languages that the members of the community understand and in ways that respect their cultures and values (Schumann, 2019). The services that are offered in Community Health Centers in Wayne County are tailored towards meeting the needs of the members of the community in this specific area. This is evidenced by the 91 percent of health centers that offer translational/interpretation services, 80 percent that provide programs of weight reduction, case management services in 89 percent of the health centers, and 90 percent of them offer on-site services to assist patients in identifying additional programs which can be beneficial to them. The extent of care that community health centers offer the members of the Wayne County community improve overall patient outcomes. Patients who receive care in these community health centers develop better relationships with their health care providers, such as nurses and other physicians. The care provided in these centers is less expensive compared to patient care provided in other healthcare facilities such as hospitals and outpatient clinics (Schumann, 2019). This is mainly because care providers in these health centers are more centered on the provision of additional services and comprehensive COMMUNITY HEALTH CENTERS 4 primary care. The provision of health care in community health centers saves the County government a significant amount of money on an annual basis by eliminating unnecessary visits to the emergency department and other healthcare facilities like clinics and hospitals. Available Social Services Some of the social services available for the people of Wayne County that are aimed at improving their overall health include behavioral health and community services, senior/volunteer services, and child welfare services. The behavioral health and community services category focus on substance use programs and Worthy, Able and Ready (WAR) programs which are aimed at counselling, supporting and managing people with substance abuse issues, and enable people who have been incarcerated to transition into the community. Others, such as child welfare services and senior volunteer services, ensure that the health of children and seniors are considered a priority for the betterment of the overall community or population ("Community Social Services of Wayne County," 2020). Barriers to Access to Healthcare There are several barriers to access to healthcare within the Wayne County community, with the main one being poverty or low income. The high cost of healthcare coverage, another slightly different barrier that is closely related to poverty or low incomes, does not resolve the conundrum that this community faces. Economic troubles in the Michigan state have significantly raised the rates of unemployment forcing several members of the community to lose their health coverage through their employers (Rigg, 2018). These employers cannot afford to cover the health insurance of their employees, especially due to the rising costs of healthcare. Of all the counties in Michigan, Wayne County has the worst health ranking. This is partly due to another barrier to COMMUNITY HEALTH CENTERS 5 healthcare access, which is the education levels of the community. Moreover, the lack of adequate community resources in the entire Michigan state is another barrier that hinders members of the community from gaining access to quality healthcare, which may result in poor quality or unsatisfactory patient outcomes. How Healthcare Providers Can Improve Access to Quality Care Healthcare providers in Wayne County or the entire Michigan state can improve access to quality care within the community through the use of several strategies. First, they should reduce or work towards eliminating the barriers to healthcare access that affect low income, uninsured, and underinsured members of the community. Healthcare providers can also support safety net capacity in the service area to enhance the population's access to primary care. They should also increase people's awareness of available health resources. The community health centers in Wayne County will be imperative in ensuring that the community receives all the types of primary health care that a significant percentage of the population needs (Martinez, King, & Cauchi, 2016). COMMUNITY HEALTH CENTERS 6 References Community Social Services of Wayne County. (2020). Retrieved from http://www.csswayne.org/ Martinez, J. C., King, M. P., & Cauchi, R. (2016). Improving the Health Care System: Seven State Strategies. Retrieved from https://www.ncsl.org/Portals/1/Documents/Health/ImprovingHealthSystemsBrief16.pdf Rigg, S. (2018, October 1). Michigan's homeless face major barriers to healthcare. Here's how providers are trying to help. Retrieved from https://www.modeldmedia.com/features/homelesshealthcare092718.aspx Schumann, S. H. (2019). Community Health Centers (CHCS). Encyclopedia of Health Services Research. doi:10.4135/9781412971942.n79 United States Census Bureau. (2018). U.S. Census Bureau Quick Facts: Wayne County, Michigan. Retrieved from https://www.census.gov/quickfacts/waynecountymichigan
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