Writing Homework Help

Discussion Board 5

This week (Week 5), we summarize the reconstitution of the hospital (Starr, Chapter 4) and introduce the boundaries of public health (Starr, Chapter 5).

In Week 6 (9/28 – 10/4) we prepare for Exam 1; I will post a study guide for the exam on 9/28. Additionally, Exam 1 will be made available to you on 9/28. You must complete Exam 1 by 10/4. This is an open book exam with four essay questions.

Hospitals Today

• Hospitals employ more than 5 million people
• Hospitals are the second largest private sector employer
• Hospitals support one of every 10 jobs in the US
• Hospitals provide 1.9 trillion dollars of economic activity

Hospitals began as…

Almshouse

• General welfare and a place to stay for the poor
• Tax funded
• Became county/city public hospitals

Voluntary Hospital

• Care of the sick
• Funded by donations/charitable contributions
• Became private hospitals (non-profit public benefit)

If you are living in Kern County, here is an example of hospital evolution:

In 1867, a one-room adobe building located in Havilah was turned into Kern County’s first Almshouse.

In 1875, a one-story building was constructed on the corner of G street (where Bakersfield High School now sits) to serve as Kern County’s public hospital.

In 1894, a two-story public hospital was built at 19th and Oak Street (Bakersfield). It had 40 beds, an operating room, and a kitchen.

In 1925, Kern General Hospital opened on Flower Street, modern for its time-some parts made of brick. Some parts of the original hospital are incorporated into the current hospital.

1954, major repairs and renovations to Kern General Hospital due to the 1952 earthquake.

Currently, Kern Medical (638 beds) is a modern teaching hospital and serves as the county’s trauma center.

Here are some other voluntary hospitals that have withstood the test of time:

Established in 1752, Pennsylvania General Hospital (Philadelphia):

Established in 1771, New York Hospital (New York City):

Established in 1821, Massachusetts General Hospital (Boston):

Hospitals have dramatically changed from then to now:

What attracted physicians to start practicing medicine at hospitals?

• Education: Some hospitals were “teaching hospitals”
• Use of expensive equipment: X-ray, laboratory, fracture casting, and isolation/quarantine

• Profit sharing: Some hospitals became proprietary hospitals (profit making)

• Following their patients: Sick care shifted from the home to hospitals

Summary

Hospitals have evolved from charity and public supported housing to state-of-the-art medical institutions that underpin the modern U.S. health care system.

The Public Health System

Public health and medical care have always been different. Unlike most industrialized nations where public health concepts are part of primary care, the public health system and the health care system in the United States are clearly siloed; they coexist under different doctrines and funding streams, and have learned to work together in modern times.

This table summarizes some of the differences between public health and health care:

The point in history when public health services made a discovery that established the importance of public health for all communities is attributed to the work of Dr. John Snow in 1854 (a few years before the American Civil War).

In a community in England (Soho, London), Dr. Snow (a physician in private practice) started collecting data on the frequency and location of victims of Cholera. Dr. Snow started plotting a location on a map of each death attributed to a cholera outbreak.

Cholera is caused by a bacterium that attacks the intestines causing dehydration and severe diarrhea. The expulsion of fluids is so severe it often causes death. The bacteria thrive in water; much like the water supply in a neighborhood or community.

Dr. Snow was perplexed as to why so many of his patients were coming down with cholera compared to his colleagues.

Dr. Snow started “charting” where his patients with cholera lived and died.

Dr. Snow looked at his data and found a relationship between the location of his cholera patients and a communal water well. He ordered the removal of the water pump handle, which stopped the cholera epidemic in Soho (a neighborhood in London). Here is an image of the data collection that Dr. Snow used to discover the source of the cholera epidemic in Soho:

Dr. Snow exemplified the following public health practices that we still use today:

• Epidemiology: The study of incidence, distribution, and causes of disease for a community. Snow’s technique of collecting data for analysis is the basis of epidemiology today.
• Authority of the Local Health Officer: Every county in the U.S. (and some cities) have a physician that specializes in public health. These “health officers” have the authority, through their state constitution, to use “police powers”, which means they can order interventions to protect the health of the public, as well as quarantine groups or individuals to the protect the health of the public. Snow exerted his authority when he ordered the handle of the water well pump be removed to stop the Soho community from drinking the well water with cholera bacteria in it.
• Community Focus: Snow left the paradigm of “individual” healthcare when he theorized that a group of his patients were drinking the tainted water-he then focused on the community of Soho.

Please review this 8-minute YouTube:

John Snow and the 1854 Broad Street cholera outbreak (Links to an external site.)

After the American Civil War, physicians and nurses recognized a need to apply their newfound knowledge related to germ theory, sanitation, and mitigating conditions of squalor (it’s important to know what squalor means-google it). However, there was no money or profit to be made in caring for the public’s health, especially since those in need where mostly of the lower socioeconomic class. Therefore, since “public health” could not survive on the free market system, the government developed and funded local public health departments with regional jurisdictions. Subsequently, our system of state, county, city, and tribal health departments became another American institution.

For public health on the federal level, we have the Centers for Disease Control and Prevention (better known as the CDC), and the United States Public Health Service. Check them out:

CDC: https://www.cdc.gov/ (Links to an external site.)

U.S. Public Health Service: https://www.usphs.gov/ (Links to an external site.)

Here are the ten essential functions of public health service:

1. Monitor health status to identify and solve community health problems

2. Diagnose and investigate health problems and health hazards in the community

3. Inform, educate, and empower people about health issues

4. Mobilize community partnerships and action to identify and solve health problems

5. Develop policies and plans that support individual and community health efforts

6. Enforce laws and regulations that protect health and ensure safety

7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable

8. Assure competent public and personal health care workforce

9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services

1. Research for new insights and innovative solutions to health problems

Public Health “Then”

Another point in U.S. history that helped bring public health services to the forefront of health and healthcare was a long-lasting polio epidemic.

Poliomyelitis (usually called polio) is a viral disease transmitted by contaminated food and water. The disease deteriorates the nerves cells in the spinal column, which causes paralysis of the extremities at first, then moves on to the muscles that control breathing.

In the 1920’s, the world saw a horrific polio epidemic affecting young children. Some children were crippled for life, some children stayed alive by the use of the iron lung (respirator), and a lot of children died. It wasn’t until the 1950’s that an effective vaccine was used to eliminate the disease in industrialized nations. Once again, it was the public health services that developed, tested, and effectively deployed the vaccine to end the polio epidemic. In modern times, it is highly unusual to find a case of polio-it is usually only found in 3rd world countries or areas of squalor.

Public Health “Now”

COVID-19 and the global pandemic has once again emphasized the importance of Public Health. Our last global pandemic was the 1918 Influenza Pandemic due to the H1N1 virus. Here’s a little history of what happened back then:

https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html (Links to an external site.)

Portrayed in the media is a global response to COVID-19 that is fraught with controversy. The balance between individual rights and the greater good is but one example. Another example is how the public health response has been politicized (again, portrayed in the media). Some countries have placed more emphasis on “personal responsibility” and kept their economies going while other countries have enforced strict lockdown policies regardless of the impact on their economies.

Discussion Board Assignment:

Answer one question. Answer the question from the perspective of the “greater good” or in other words, what benefits society over individual rights.

What needs to change in the U.S. public health response to COVID-19 to make it more effective?

Respond to one classmate’s post.

**Please keep an open mind because some responses may challenge your position-all opinions are valid.