Public Health Topic of the Month: Health in All Policies

Greetings readers!

Happy Tuesday! I am in the middle of week 4 now in my nursing program. I must say that time is going, at least for me, in warp speed.

As I had some time to really look into nursing care, the most evident topic that came up with the new presidency, is the repeal of the Affordable Care Act, or what many may know it as — Obamacare.

As heated as the topic is, I want to concentrate on another policy that has been gaining a lot of traction, and it’s this — Health in All Policies. Now, this is a terminology that has been used very liberally, but at the heart of such a term is that — health incorporated into policy.

Now, why would I talk about this in light of such a heated topic? First off, I think the repeat of the ACA is a major setback in our country, and if such is going to happen, politicians in DC and in all states alike must come up with a backup plan, because statistics will show you, that a majority of Americans, if not covered by their employer or via federal/state funding (Medicare/Medicaid), are going to be in a place without health insurance. Without health insurance, you have to essentially pay out of pocket to see a primary care physician, go to the emergency room, preventative services, etc. In this light, as a nursing student as well as a public health professional, I am very concerned about that. Unfortunately, mortality and morbidity statistics also don’t lie — Americans are living shorter lives because they are dying of chronic diseases that lead to cardiovascular disease, diabetes, stroke, and more. That is concerning as a health care professional.

However, I will also say this — the ACA, when written, was great on paper. The implementation of such is quite difficult. If you google Atul Gawande’s “The Cost Conundrum” you will see just how broken the healthcare system is with or without the ACA. In fact, when I was still in my graduate studies, my argument from an economic and practical standpoint is this — those enrolling into the ACA will have the outstanding benefit of healthcare insurance to see the doctor, a right and privilege that they do deserve. Yet, will they then get the quality of care they deserve? That was my argument. Why? You give healthcare insurance at subsidized prices. You increase a demand of people seeking healthcare services (whether primary care, preventative, medical services both specialized and not) in a market with a very limited supply of healthcare practitioners (I’m talking all kinds practicing physicians, NPs, PAs) and others (RNs, dentists, pharmacists, and so many other healthcare providers). Such is also concerning. Having worked in the clinical setting before, this uptick in patients that come through the door is outstanding. So outstanding, that by the end of a single 8 hour shift…the record number of patients that my provider saw, and I their MA was 48. You heard me — 48. Some were less than 5 minute appointments. Some were longer at 10. I triaged so many patients, I lost count by 2PM. What kind of quality care would you get? Are you concerned yet? I haven’t even touched on rural areas of the MidWest let alone that of central California. Again, increased supply and limited demand — any amateur economist would see the detriment of this.

I do applaud the ACA…like any law and policy, the ACA was the US’ first step towards universal healthcare that many industrialized countries have in its efforts to give healthcare to those who can’t afford it. For this — I am a full supporter of the ACA. However, healthcare is just one part of the rather larger issue of health.

You see, research and many health professionals are embracing the realities that healthcare isn’t the only place to “get healthy.” To get well maybe at times, but to be “healthy?” Absolutely not. In fact, health happens often times outside of the patient room or a clinic. It revolves around the area you live in, the food that you eat, where you buy your food, how you get around in your community or to work, commute time and length, allergens inside and outside the home, job security, food security/insecurity, and more. In a previous post, I wrote about corner store conversions and the question of why people were so against the choice to have healthy options at local corner stores where food insecurity is high? This policy — revolves around food distribution centers, grocery store policy, and mobilizing community members in local organizations or nonprofits. Walking and public transportation — policies surrounds local transportation agencies and city planners. School education — local school districs. Commute to work and incentives to take public transportation — work policies need to be reviewed and made known. Do you see where I am going with this? What I am show you, my viewers is this — health isn’t just about going to see your primary care provider (please do though, if you haven’t had your annual!) It revolves on all areas of your life from the moment you wake up at home (and sometimes for some, not even a home, but a tent) to what you do throughout the day. All this, all of it…for health, requires work beyond the ACA. It requires agencies (of all different kinds) to come to the “table” and talk about “health.” Let’s face it, if you’re a young mother with 2 kids, with 2 jobs, no car….buying groceries is hard enough as it is. I know what it’s like to go with my mom and sister when my dad was working a full time job, take public transportation to San Francisco, walk or take a bus to my doctor while I or my sister was sick with a fever as a kid, and by the end of the day, the not sick child is carrying 2-3 bags of vegetables and pastries for breakfast. I carried a box of pastries all the way home, only to find bread in crumbles, because I was too small to carry the box. It’s not easy. Yet, there are people in our own communities who live a life like what I described but instead of going to shop for healthy groceries, the fast food venue down the block or gas station around the corner is their “grocery store” where theyre buying not so healthy options as a source of food. Don’t event get me started about a law that says if a grocery moves out, another grocery can’t come in for decades, because the old grocery story owns that land despite having sold it to another commidity.

Ok…that was a long paragraph. In conclusion, the ACA must have a backup plan. Many Americans beyond the 20 million already on the ACA are in need of health insurance to get medical services whether simple or complex. However, government (local, state, and federal levels) also need to look at another area and begin to meld agencies together to work in solidarity in this idea of a health in all policies approach to helping Americans and others to live healthier lives. Let’s face it, not many Americans are healthy; statistics supports the statement and I’m sure healthcare professionals anecdotally can share this with you as well.

Thus, the topic that I found fitting this month, wasn’t to simply provide critique on my thoughts of current events revolving around the ACA, but rather a forward thinking approach to a much bigger problem than healthcare. It is health in our neighborhoods. That, I must say…is a bigger battle that needs to be looked at more closely and promoted more vigilantly. Otherwise, healthcare will not save the unhealthy not matter if we offer coverage or not.



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