Despite showing signs of mental illness, Asian immigrant adults (ages 20-60) with disorders like schizophrenia and ADHD living in the United States are often undiagnosed and therefore untreated by doctors.
The intervention I most recommend would be asking community leaders to recommend utilization of mental health services and decrease stigma regarding mental illness within the community.
I would begin implementing this intervention by sending public health officials to various known community leaders, such as pastors and respected elders. I would try to send public health officials of the same race as the specific Asian community that I try to target using this intervention. I believe doing so would help with the next step which is to cultivate a relationship between the public health official and community leaders that will encourage utilization of mental health services and ending cultural stigma. If the public health official is not of the same race as the community leader, I don't think it will be a cultural barrier as long as there is no language barrier. If there is a language barrier, a translator would have to be found but I believe this can easily be done, possibly without cost if a member of the community volunteers to help communication between leaders and public health officials.
Public health officials would first explain the problem to leaders and ask them to encourage their followers to get help and refrain from ostracizing those with mental illnesses. I doubt that any community leaders will refuse to direct their followers to get professional help, but they may refuse for unforseen reasons. Public health officials and community leaders might work together to create an informative talk on mental health or a pamplet with information about mental health. These may cost some money but if the community leaders are willing to help, the community will most likely cover these costs. There are little infrastructure and monetary costs associated with this intervention because ideally, public health officials working with community leaders would utilize the community's existing tools to help spread the message.
The most important stakeholders in this intervention are the community leaders who are easy to identify and contact. I think all that is necessary to "get them on board" is to explain the long and short term benefits of encouraging mental health services and discouraging stigma against mental illness. Asian immigrants with mental illnesses will often turn to their community leaders instead of seeking professional help. Encouraging utilization of mental health services would decrease the burden that community leaders bear in taking care of these mentally ill constituents as well as the burden of conscience that they might feel when they cannot effectively help them. Though this intervention would take some effort on their part, in the end, they would gain more time to help other members of their community as well as a better conscience knowing that ill members are getting the help they need. The next group of stakeholders would be members who suffer from mental illnesses. They would benefit not only from getting medical help they need from professional mental health services, but they would also feel more comfortable in their social circles if stigma could be decreased. To gain these benefits they would have to listen to the community leaders' advice and utilize mental health services and maybe serve as examples that mentally ill people are not "crazy" to decrease stigma.
To evaluate the effectiveness of my intervention, I would have to do both a quantitative and qualitative study. I would need to quantitatively check measures of mental illness diagnoses in Asian immigrants such as whether the rates of utilization of mental health services are at sufficient levels. I would need to qualitatively check if Asian immigrant communities who have been subjected to the intervention feel less stigma regarding mental illnesses. If the measure of mental illness diagnoses are equal or nearing equal to that of comparable races and if studies show that there is less stigma regarding mental illness in Asian immigrant communities, then the intervention can be deemed successful.
Saturday, April 27, 2013
Saturday, April 20, 2013
Assignment 10: Intervention
Despite showing signs of mental illness, Asian American adults (age 20-60) with disorders like schizophrenia and ADHD living in the United States are often undiagnosed and therefore untreated by doctors.
I have found that currently, only one strategies is in place to address this problem. The current strategy is very indirect as it addresses the much larger problem of uninsured Asian Americans, under which this problem would be specified. The indirect strategy is to improve access and affordability of insurance for Asian Americans so that it will be easier to access mental health services, which makes it more likely that they will seek diagnosis and treatment for mental illness. This strategy has been put into place through various policy changes, a fight that continues today at a time when so many still remain uninsured. This first strategy addresses the influence of economic and environmental key determinants by addressing the cost and presence or absence of health insurance. One possible reason why there is only one current strategy could be that the problem I have defined is a relatively small, specific population which has received little individual attention.
For my first intervention, I would recommend working with community leaders of Asian American adults to encourage their followers who sound like they are suffering from symptoms of mental illness to seek professional help. This can be primary, secondary, and tertiary depending on when the community leaders intervene. Ideally it would be primary and the community leaders would advise their followers to seek professional help before they feel symptoms of mental illness. This primary prevention could help eliminate the stigma surrounding seeking it by talking about it, preventing Asian Americans from feeling too stigmatized to get diagnosed. This intervention can be secondary prevention as Asian American adults who suffer from mental illnesses are likely to go to their community leaders like their pastors and priests for help first. Second prevention would happen with this strategy if community leaders directed their followers to mental health services immediately after followers went to them for symptoms. This intervention can be tertiary prevention as Asian American adults who have been suffering from mental illnesses for a long time are likely seeking counselling from community leaders. Tertiary prevention would happen if community leaders directed those followers who have been suffering for a long time already, to mental health services. This would address the key determinant of social and cultural stigma which prevents them from seeking help.
For my second intervention, I would recommend setting up a mental health counseling center within popular and respected Asian American community, such as church organizations. This could be staffed and run entirely by the community as a simple information center about various symptoms of mental illness and what they can mean. This deals with the environmental key determinant of Asian Americans who are so far removed from mental health services that they do not even consider it an option.
For my third intervention, I would recommend a media campaign together with community leaders of Asian Americans that distributes general information like the typical symptoms of most common mental illnesses, where the nearest mental health services are located, and etc. This would address both social/cultural and environmental key determinants. The media can also target stigma regarding mental illnesses.
I have found that currently, only one strategies is in place to address this problem. The current strategy is very indirect as it addresses the much larger problem of uninsured Asian Americans, under which this problem would be specified. The indirect strategy is to improve access and affordability of insurance for Asian Americans so that it will be easier to access mental health services, which makes it more likely that they will seek diagnosis and treatment for mental illness. This strategy has been put into place through various policy changes, a fight that continues today at a time when so many still remain uninsured. This first strategy addresses the influence of economic and environmental key determinants by addressing the cost and presence or absence of health insurance. One possible reason why there is only one current strategy could be that the problem I have defined is a relatively small, specific population which has received little individual attention.
For my first intervention, I would recommend working with community leaders of Asian American adults to encourage their followers who sound like they are suffering from symptoms of mental illness to seek professional help. This can be primary, secondary, and tertiary depending on when the community leaders intervene. Ideally it would be primary and the community leaders would advise their followers to seek professional help before they feel symptoms of mental illness. This primary prevention could help eliminate the stigma surrounding seeking it by talking about it, preventing Asian Americans from feeling too stigmatized to get diagnosed. This intervention can be secondary prevention as Asian American adults who suffer from mental illnesses are likely to go to their community leaders like their pastors and priests for help first. Second prevention would happen with this strategy if community leaders directed their followers to mental health services immediately after followers went to them for symptoms. This intervention can be tertiary prevention as Asian American adults who have been suffering from mental illnesses for a long time are likely seeking counselling from community leaders. Tertiary prevention would happen if community leaders directed those followers who have been suffering for a long time already, to mental health services. This would address the key determinant of social and cultural stigma which prevents them from seeking help.
For my second intervention, I would recommend setting up a mental health counseling center within popular and respected Asian American community, such as church organizations. This could be staffed and run entirely by the community as a simple information center about various symptoms of mental illness and what they can mean. This deals with the environmental key determinant of Asian Americans who are so far removed from mental health services that they do not even consider it an option.
For my third intervention, I would recommend a media campaign together with community leaders of Asian Americans that distributes general information like the typical symptoms of most common mental illnesses, where the nearest mental health services are located, and etc. This would address both social/cultural and environmental key determinants. The media can also target stigma regarding mental illnesses.
Decision Matrix: (3 – best, 1 – worst)
Options
Decision
Criteria |
Intervention 1:
Talking to Community Leaders
|
Intervention 2:
Setting Up Mental Health Counseling
|
Intervention 3:
Media Campaign
|
Effectiveness
|
3
|
3
|
2
|
Feasibility
|
3
|
1
|
2
|
Sustainability
|
2
|
1
|
3
|
Cost
|
3
|
1
|
3
|
Cost effectiveness
|
3
|
3
|
2
|
Political acceptability
|
2
|
2
|
3
|
Social will
|
2
|
2
|
2
|
Potential for unintended risks
|
1
|
1
|
1
|
Potential for unintended benefits |
3
|
3
|
1
|
Total/conclusion
|
22
|
17
|
19
|
I recommend talking to community leaders. This is the best use of resources and also the most effective way to get through to a population that may otherwise be difficult to get to. There may also be unintended benefits if a relationship is established between public health officials and community leaders. It will not be costly to just send a representative to these communities. It will be very feasible as it is not hard to find Asian American communities and extensive research has been done on the social institutions. Sustainability might be an issue but if both parties are devoted, which they probably will be because both are concerned for the safety of the same population, tools like the internet can help maintain the relationship.
Saturday, April 13, 2013
Assignment 9: Stakeholders
Despite showing signs of mental illness, disorders such as schizophrenia and ADHD in Asian American adults (age 20-60) living in the United States are rarely diagnosed or treated by a doctor.
I would say that because of the specific nature of my problem and the minority it affects, there are relatively few stakeholders compared to perhaps bigger issues. However, there are still stakeholders to consider when considering possible intervention.
There are several possible ways to encourage Asian American adults who show symptoms of mental illness to visit mental health experts. One possible concern I will address before discussing the different ways is the question of whether Asian American adults can identify symptoms of mental illness enough to even think about getting treatment. Though the concern is a valid question and certainly needs more research to verify my opinion, I believe that identifying symptoms is not an issue because mental illnesses have rather distinct symptoms. For example, hallucinations are unlikely to be attributed to a physical illness. Even those who, like many Asian Americans, believe that the mind and body are not separate (Yuasa) will realize that the mind has something to do with the ailment. So I believe I can reasonably conclude that Asian American adults can recognize when they have symptoms of mental illness. The issue is that they are not going to the doctor to get diagnosed and therefore go untreated, not that they do not recognize symptoms of illness.
One suggestion for encouraging them to visit mental health experts is making access to health insurance easier, a much larger problem in and of itself. The stakeholders of this intervention suggestion would be insurance companies who would need to better reach out and communicate to the Asian American community and/or make their insurance more affordable. Many Asian Americans go without insurance because they are small business owners and do not receive it from their jobs nor can afford private insurance. (Carrasquillo) By making health insurance more accessible and affordable, the number of people who utilize mental health services and therefore get diagnosed and treated, will increase. The insurance companies who are the stakeholders would lose the money they gain by refusing to make insurance more accessible and affordable but may gain more money in the future by preventing more costly medical issues caused by untreated mental illness. In this intervention suggestion, my problem becomes part of the bigger, broader problem of lacking health insurance and considers the stakeholders that are part of that larger problem.
A more specific intervention suggestion for encouraging Asian American adults to visit mental health experts is to urge them through valued community leaders. This will address the social stigma that seems to be the main reason why there is underdiagnosis and therefore undertreatment of mental illnesses in Asian American adults. The stakeholders would be the community leaders and environments who would need to agree that mental health services should be utilized and agree to encourage the people they serve to utilize them. An example of this would be for Korean Americans. Many Korean Americans have strong social and cultural connections with their churches, making pastors and other church officials powerful community leaders. (Lee) If pastors agree to encourage their constituents to seek help for mental illness symptoms, it could drastically change the social stigma surrounding mental health services and lead to appropriate diagnosis and treatment of mental illnesses.
Of course, the stakeholders who have the most to gain are Asian American adults themselves. Mental illnesses affect not only the afflicted, but also everyone the afflicted associate with. The symptoms of mental illness are not only privately suffered, but also bear negatively on the emotional wellbeing of others. Solving the problem of underdiagnosis and undertreatment of mental illnesses will improve the lives of many Asian Americans, not only an unlucky few. However, as stakeholders, they too have to make sacrifices. They will need to put the time, effort, and money into getting help and utilizing the services offered. They will need to change their attitude on receiving mental health help as something only for the "crazies".
The most important stakeholders for my problem are the community leaders. They will have the highest impact on a real solution but with a fair amount of sacrifice on their part. I believe my intervention suggest about using the community leaders and organizations to encourage Asian American adults to use mental health services has great promise, especially as the strong ties between community leaders and Asian American adults makes the community leaders invested in their constituents wellbeing.
Works Cited
I would say that because of the specific nature of my problem and the minority it affects, there are relatively few stakeholders compared to perhaps bigger issues. However, there are still stakeholders to consider when considering possible intervention.
There are several possible ways to encourage Asian American adults who show symptoms of mental illness to visit mental health experts. One possible concern I will address before discussing the different ways is the question of whether Asian American adults can identify symptoms of mental illness enough to even think about getting treatment. Though the concern is a valid question and certainly needs more research to verify my opinion, I believe that identifying symptoms is not an issue because mental illnesses have rather distinct symptoms. For example, hallucinations are unlikely to be attributed to a physical illness. Even those who, like many Asian Americans, believe that the mind and body are not separate (Yuasa) will realize that the mind has something to do with the ailment. So I believe I can reasonably conclude that Asian American adults can recognize when they have symptoms of mental illness. The issue is that they are not going to the doctor to get diagnosed and therefore go untreated, not that they do not recognize symptoms of illness.
One suggestion for encouraging them to visit mental health experts is making access to health insurance easier, a much larger problem in and of itself. The stakeholders of this intervention suggestion would be insurance companies who would need to better reach out and communicate to the Asian American community and/or make their insurance more affordable. Many Asian Americans go without insurance because they are small business owners and do not receive it from their jobs nor can afford private insurance. (Carrasquillo) By making health insurance more accessible and affordable, the number of people who utilize mental health services and therefore get diagnosed and treated, will increase. The insurance companies who are the stakeholders would lose the money they gain by refusing to make insurance more accessible and affordable but may gain more money in the future by preventing more costly medical issues caused by untreated mental illness. In this intervention suggestion, my problem becomes part of the bigger, broader problem of lacking health insurance and considers the stakeholders that are part of that larger problem.
A more specific intervention suggestion for encouraging Asian American adults to visit mental health experts is to urge them through valued community leaders. This will address the social stigma that seems to be the main reason why there is underdiagnosis and therefore undertreatment of mental illnesses in Asian American adults. The stakeholders would be the community leaders and environments who would need to agree that mental health services should be utilized and agree to encourage the people they serve to utilize them. An example of this would be for Korean Americans. Many Korean Americans have strong social and cultural connections with their churches, making pastors and other church officials powerful community leaders. (Lee) If pastors agree to encourage their constituents to seek help for mental illness symptoms, it could drastically change the social stigma surrounding mental health services and lead to appropriate diagnosis and treatment of mental illnesses.
Of course, the stakeholders who have the most to gain are Asian American adults themselves. Mental illnesses affect not only the afflicted, but also everyone the afflicted associate with. The symptoms of mental illness are not only privately suffered, but also bear negatively on the emotional wellbeing of others. Solving the problem of underdiagnosis and undertreatment of mental illnesses will improve the lives of many Asian Americans, not only an unlucky few. However, as stakeholders, they too have to make sacrifices. They will need to put the time, effort, and money into getting help and utilizing the services offered. They will need to change their attitude on receiving mental health help as something only for the "crazies".
The most important stakeholders for my problem are the community leaders. They will have the highest impact on a real solution but with a fair amount of sacrifice on their part. I believe my intervention suggest about using the community leaders and organizations to encourage Asian American adults to use mental health services has great promise, especially as the strong ties between community leaders and Asian American adults makes the community leaders invested in their constituents wellbeing.
Works Cited
Carrasquillo, Olveen, and Steven Shea. "Health Insurance Coverage of Immigrants Living in the United States: Differences by Citizenship Status and Country of Origin." American Journal of Public Health, n.d. Web. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446276/pdf/10846509.pdf>.
Lee, Hochang B., Jennifer A. Hanner, Seong-Jin Cho, Hae-Ra Han, and Miyong T. Kim. "KoreaMed Synapse." Http://dx.doi.org/10.4306/pi.2008.5.1.14. Official Journal of Korean Neuropsychiatric Association, 31 Mar. 2008. Web. 06 Apr. 2013. <http://synapse.koreamed.org/DOIx.php?id=10.4306/pi.2008.5.1.14>.
Sue, Stanley, Derald W. Sue, Leslie Sue, and David T. Takeuchi. "Psychopathology among Asian Americans: A Model Minority?" US: John Wiley & Sons, Inc., n.d. Web. <http://ehis.ebscohost.com/ehost/detail?sid=45d5e36d-ffcf-4896-aa50-64a736eaa8d4%40sessionmgr4&vid=1&hid=6&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=pdh&AN=1999-00182-004>.
Yuasa, Yasuo, and Thomas P. Kasulis. "Editor's Introduction." The Body: Toward an Eastern Mind-body Theory. Albany: State University of New York, 1987. N. pag. Web. 6 Apr. 2013.
Saturday, April 6, 2013
Assignment 8: Key Determinants
Despite showing signs of mental illness, disorders such as schizophrenia and ADHD in Asian American adults (age 20-60) living in the United States are rarely diagnosed or treated by a doctor.
Works Cited
A key determinant for my problem definition is a factor that is the influence or cause of the lack of diagnosis or treatment of mental illnesses in Asian American adults. There are several possible key determinants from various social, environmental, economic, and etc. sources. This post is limited by the relatively small amount of literature available on the subject. However, several determinants can be deduced from the available literature. Though the determinants are categorized into various groups, it is important to note that every problem, including this one, is the influenced or caused by many different determinants, not just one.
There is no biological determinant that could cause the lack of diagnosis and therefore treatment of mental illness in Asian American adults. However, there are biological factors to consider when looking at the credibility of my problem. Some say that the problem I have put forward does not exist, but rather that Asian American adults simply have lower rates of mental illness. Biologically speaking, there are no indications that Asian Americans have physical compositions that have fewer rates of mental illness. (Sue 1) Therefore it is likely that my problem of lack of diagnosis and treatment does indeed exist.
The biggest determinants of my problem are social and cultural. To understand the direct social and cultural influences that have caused the low rates of diagnosis and treatment, first requires an understanding of the difference in cultural views between Asians and the rest of the American population. In many Asian cultures, the mind and the body are not seen as separate as it is in Western culture. Illnesses of the mind are traditionally, and to some extent even today, treated by treatment of the body. (Yuasa 1) My problem definition specifies my focus as on Asian Americans, so the possible argument could be made that Asian Americans do not share this belief that the mind and body are one entity. However, many studies show that most Asian Americans retain close ties with their ethnic values, which would include this idea. (Carrasquillo 1) The idea that the mind and body are one itself contributes directly to the lack of diagnosis and treatment for mental illnesses in Asian American adults. They may not seek mental health doctors or disregard suggested treatment because they believe that mental illnesses must be treated completely or at least partially with physical, external treatment. This cultural difference also contributes indirectly to the problem. This ancient, long-standing belief in the unity of mind and body combined with negative media portrayals of those deemed mentally ill has caused serious stigma against receiving mental health help. (Lee 1) It is seen as treatment only for the true "psychos" who are completely deranged both mentally and physically. In Asian cultures where honor and how one is perceived by others is very important, this cultural stigma is probably the leading cause of the lack of diagnosis and treatment of mental illness in Asian Americans. When others in the Asian American community learn that a member is receiving mental health treatment, the stigma affects not only the affected member, but also his/her family and friends.
Another determinant might be the environmental affect of living in an area with few mental health resources. Asian Americans are less likely to use mental health resources, especially considering the other determinants, if the resources are far and hard to access.
One major economic determinant to consider is the generally low rate of health insurance in Asian Americans. Many Asian Americans own small independent businesses and cannot get health insurance from their workplace. And because private health insurance is expensive, many choose to live uninsured. (Carrasquillo 1) With low rates of insurance, Asian Americans are unlikely to utilize health resources in general, let alone mental health resources.
There are no political determinants that might cause low rates of diagnosis or treatment in Asian American adults.
Works Cited
Carrasquillo, Olveen, and Steven Shea. "Health Insurance Coverage of Immigrants Living in the United States: Differences by Citizenship Status and Country of Origin." American Journal of Public Health, n.d. Web. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446276/pdf/10846509.pdf>.
Lee, Hochang B., Jennifer A. Hanner, Seong-Jin Cho, Hae-Ra Han, and Miyong T. Kim. "KoreaMed Synapse." Http://dx.doi.org/10.4306/pi.2008.5.1.14. Official Journal of Korean Neuropsychiatric Association, 31 Mar. 2008. Web. 06 Apr. 2013. <http://synapse.koreamed.org/DOIx.php?id=10.4306/pi.2008.5.1.14>.
Sue, Stanley, Derald W. Sue, Leslie Sue, and David T. Takeuchi. "Psychopathology among Asian Americans: A Model Minority?" US: John Wiley & Sons, Inc., n.d. Web. <http://ehis.ebscohost.com/ehost/detail?sid=45d5e36d-ffcf-4896-aa50-64a736eaa8d4%40sessionmgr4&vid=1&hid=6&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=pdh&AN=1999-00182-004>.
Yuasa, Yasuo, and Thomas P. Kasulis. "Editor's Introduction." The Body: Toward an Eastern Mind-body Theory. Albany: State University of New York, 1987. N. pag. Web. 6 Apr. 2013.
Saturday, March 30, 2013
Assignment 7: Final Paper
Despite showing signs of mental illness, disorders such as schizophrenia and ADHD in Asian American adults (age 20-60) living in the United States are rarely diagnosed or treated by a doctor.
Passive surveillance from records of the prevalence of mental illnesses in adults of various ethnicities show higher or equal levels of mental illness in Asian Americans compared to the other ethnic groups. Active surveillance show lower levels of Asian Americans utilizing mental health services. Both types of surveillance help us identify that there Asian Americans are not utilizing mental health services despite having the same or higher levels of mental illnesses as other groups.
There is admittedly still few direct statistics regarding the underutilization of mental health services by Asian Americans, as the few studies that have been done have been mostly qualitative observational studies. The National Co-morbidity Survey Replication Study, one of a few that measured the utilization of mental health-related services, suggested that Asian Americans have lower rates of use when compared with the general population. Only 8.6% of Asian Americans sought help from any services versus 17.9% of the general population. However, even these statistics may not be accurate as they were taken from a study that was survey-based and the respondents may have under or over reported their use of mental health services. Most studies discussing the issue of underutilization of mental health services by Asian Americans emphasize the need for more statistics, both from survey based studies and more concrete studies, that would be direct indicators of the phenomenon.
Comparatively, there are many indirect indicators that are mentioned in studies that explore the underutilization of mental health services by Asian Americans. The two main ones that are referred to are the levels of general insurance coverage and levels of "foreign born" Asian Americans. General insurance coverage is important as those with insurance coverage are more likely to be informed about mental health facilities and have access to them. If they know about them and have more access to them, they are likely to utilize them. The levels of general insurance coverage among Asian Americans varies widely but statistics indicate that the less time Asian Americans have spent in the United States, the more likely they are to be uninsured. Though the low level of insurance coverage may be in part due to the immigrant status of Asian Americans, statistics show that even among fellow immigrants from other countries of origin, Asians have a low rate of insurance. This is another issue with several reasons that can be discussed further, but for our purposes, this indicates that Asians are less likely to utilize mental health services because they lack access or information about them. The second indirect indicator of underutilization of mental health services by Asian Americans would be the levels of "foreign born" Asian Americans which indicates the number of Asian Americans who maintain a strong tie with their ethnic cultures. This measure matters because Asian cultures may influence the Asian Americans to decide to underutilize mental health services due to stigma against mental illnesses within the culture. Though the levels of "foreign born" Asian Americans also vary widely, most are well tied to their culture's attitudes toward mental illness either themselves or through parents and other influential family members. For example, among Korean Americans, approximately two-thirds of Korean Americans are foreign born and first generation members according to a study done by the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins School of Medicine.
Sources:
http://dx.doi.org/10.4306/pi.2008.5.1.14
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446276/pdf/10846509.pdf
http://synapse.koreamed.org/search.php?where=aview&id=10.4306/pi.2008.5.1.14&code=0162PI&vmode=FULL
http://ehis.ebscohost.com/ehost/detail?sid=a167a6d9-08de-44a4-b6b3-7cc922c868aa%40sessionmgr198&vid=1&hid=109&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=pdh&AN=1999-00182-004
Passive surveillance from records of the prevalence of mental illnesses in adults of various ethnicities show higher or equal levels of mental illness in Asian Americans compared to the other ethnic groups. Active surveillance show lower levels of Asian Americans utilizing mental health services. Both types of surveillance help us identify that there Asian Americans are not utilizing mental health services despite having the same or higher levels of mental illnesses as other groups.
There is admittedly still few direct statistics regarding the underutilization of mental health services by Asian Americans, as the few studies that have been done have been mostly qualitative observational studies. The National Co-morbidity Survey Replication Study, one of a few that measured the utilization of mental health-related services, suggested that Asian Americans have lower rates of use when compared with the general population. Only 8.6% of Asian Americans sought help from any services versus 17.9% of the general population. However, even these statistics may not be accurate as they were taken from a study that was survey-based and the respondents may have under or over reported their use of mental health services. Most studies discussing the issue of underutilization of mental health services by Asian Americans emphasize the need for more statistics, both from survey based studies and more concrete studies, that would be direct indicators of the phenomenon.
Comparatively, there are many indirect indicators that are mentioned in studies that explore the underutilization of mental health services by Asian Americans. The two main ones that are referred to are the levels of general insurance coverage and levels of "foreign born" Asian Americans. General insurance coverage is important as those with insurance coverage are more likely to be informed about mental health facilities and have access to them. If they know about them and have more access to them, they are likely to utilize them. The levels of general insurance coverage among Asian Americans varies widely but statistics indicate that the less time Asian Americans have spent in the United States, the more likely they are to be uninsured. Though the low level of insurance coverage may be in part due to the immigrant status of Asian Americans, statistics show that even among fellow immigrants from other countries of origin, Asians have a low rate of insurance. This is another issue with several reasons that can be discussed further, but for our purposes, this indicates that Asians are less likely to utilize mental health services because they lack access or information about them. The second indirect indicator of underutilization of mental health services by Asian Americans would be the levels of "foreign born" Asian Americans which indicates the number of Asian Americans who maintain a strong tie with their ethnic cultures. This measure matters because Asian cultures may influence the Asian Americans to decide to underutilize mental health services due to stigma against mental illnesses within the culture. Though the levels of "foreign born" Asian Americans also vary widely, most are well tied to their culture's attitudes toward mental illness either themselves or through parents and other influential family members. For example, among Korean Americans, approximately two-thirds of Korean Americans are foreign born and first generation members according to a study done by the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins School of Medicine.
Sources:
http://dx.doi.org/10.4306/pi.2008.5.1.14
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446276/pdf/10846509.pdf
http://synapse.koreamed.org/search.php?where=aview&id=10.4306/pi.2008.5.1.14&code=0162PI&vmode=FULL
http://ehis.ebscohost.com/ehost/detail?sid=a167a6d9-08de-44a4-b6b3-7cc922c868aa%40sessionmgr198&vid=1&hid=109&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=pdh&AN=1999-00182-004
Friday, March 8, 2013
Assignment 6: Public Health Topic (Obesity in Children)
For this assignment, please write in your blog, a description of the public health topic that you think you would like to address in your final paper. (Don't worry you can still refine/change your topic.) Please include the problem definition, a discussion of the relevance and importance of the topic, and why you find this an interesting or important topic to investigate. You may include a discussion of why it is a social relevant problem.
I would like to address the rise of obesity (BMI > 30) in American children (ages 0-12). The problem I would focus on is why pediatricians lack time and knowledge to effectively treat obesity in children. Obesity in children is rising and more important than obesity rates in other age groups because children who are obese are likely to stay obese, leading to more health problems and costs in the future. I find this interesting because though I've heard much about the rise of obesity in general, I haven't heard much about the rise of obesity in children. If the rates of obesity in children are rising, than the fact that I haven't heard of the issue specifically may be indicative of low awareness about the issue. If pediatricians lack time and knowledge to effectively treat obese children, then public awareness about the issue may also be low because of the same reason. With health care costs so high and the general health of America so low, public health officials should focus on early problems like childhood obesity that will affect people later on in life. Decreasing childhood obesity would not only result in healthier children but also prevent many costly and severe weight-related diseases later on.
Saturday, March 2, 2013
Assignment 5: Contagion
1. Give a brief (No more than 5 sentences) summary of the plot of the movie and discuss your reaction to it from your new public health perspective. If you have seen the movie before, do you see anything differently now that you are taking this class?
Contagion is a film that explores what would happen if a fatal, highly contagious disease were to begin in the world's population. It follows the various days after the outbreak, starting with the infection of patient zero, a character named Beth. I have seen the movie before and the same thing that scared me then about the film scares me now, even with my new public health perspective: the realism. All the events in the film all seem more than possible in today's world. However I would say I feel safer with my public health perspective because I understand the steps the characters take or should have taken to contain the outbreak. Though the movie is obviously meant for everyone regardless of public health knowledge, I see the steps it took to accurately portray what the public response to an actual outbreak would be. For example, Mears and Orante's roles and purpose are more clear and relevant to the issue.
2. Briefly explain the concepts; outbreak, outbreak investigation, isolation, and quarantine and how are they relevant to the movie?
An outbreak is a sudden increase in the incidence of a disease which was the premise of the film. Outbreak investigation includes verifying the diagnosis (the actual disease), making sure the number of people infected actually is an outbreak, mapping the spread of it, developing and implementing control systems, and studying how to stop it. A number of different characters did these various steps which seems accurate as an outbreak investigation would entail the work of many people. For example, Mears sets up containment camps, Orantes studies the origin of the disease, and Hextall researches for a vaccine. The outbreak investigation is the multi-factor response to an outbreak. Isolation and quarantine both separates people from the general public. But people are isolated when they are already sick in order to protect the general population from getting sick from them. People are quarantined when they have been exposed to the disease but are not ill who are separated because they may still be infectious. Both examples of isolation and quarantine occur in the film. Mears is isolated when she becomes sick and Mitch is quarantined because of his contact with Beth.
3. Since 9/11, Public Health preparedness has been an important topic and the movie contagion illustrates many of the important reasons for it. Please review Chapter 29 in the textbook and then give one or two examples of situations in the movie where public health agencies ideally would have been better "prepared". Explain. (Hint: Think about risk communication, hospital facilities and staffing, public services, food distribution)
Like during Hurricane Katrina, there was not enough food distributed to the public during the outbreak. This caused looting and probably more infections because people had to venture out to find food. Though the film's setting is rather unclear (all of America seems to have been affected, but not completely destroyed), I would say that the government in the film needed to address food distribution more, if it was possible. Of course, if all of the country was affected, getting more food could be near impossible or completely dependent on the generosity of other countries. But better food distribution definitely is necessary to minimize infections and other damages that exacerbate the outbreak. Another issue I found was with the CDC's treatment of Dr. Sussman who eventually found the vaccine cure for the disease. Instead of ordering him to shut down his insecure lab and essentially just stop all his work, he should have been transported to Cheever's lab as he clearly had valuable knowledge to help with the development of a vaccine. It seemed rather inefficient and unfair to shut down his lab and not give him any other options.
Friday, February 22, 2013
Assignment 4: U.S. Health Care
1. Briefly describe the Dartmouth Atlas Project. What did they find?
The Dartmouth Atlas Project was a national study to assess the health care system in relation to the cost of care across the United States. The study found that some areas were able to provide great quality of care and much lower costs than similar health care programs that cost more but provided the same quality of care. It showed that more spending does not automatically mean higher quality of care.
The Dartmouth Atlas Project was a national study to assess the health care system in relation to the cost of care across the United States. The study found that some areas were able to provide great quality of care and much lower costs than similar health care programs that cost more but provided the same quality of care. It showed that more spending does not automatically mean higher quality of care.
2. Do you think that access to health care is a right or a privilege? Explain.
I believe in a country as rich as America, health care is now a right. If this were a third world country that was unable to afford basic health care, the lack of an equal system for all would not be as unsettling. However, we are the richest country in the world and could provide health care of great quality to everyone regardless of income. Health care is not a luxury that would be "nice to have". Without proper and affordable health care, people can suffer serious illnesses that can easily be prevented. The right to health care is similar to the right to education and sanitation. It is a right because it affects people's well-being. To take it away as a right and label it a privilege would be to institutionally enforce the inequality established by income.
I believe in a country as rich as America, health care is now a right. If this were a third world country that was unable to afford basic health care, the lack of an equal system for all would not be as unsettling. However, we are the richest country in the world and could provide health care of great quality to everyone regardless of income. Health care is not a luxury that would be "nice to have". Without proper and affordable health care, people can suffer serious illnesses that can easily be prevented. The right to health care is similar to the right to education and sanitation. It is a right because it affects people's well-being. To take it away as a right and label it a privilege would be to institutionally enforce the inequality established by income.
3. Describe and discuss at least one innovation from each of the medical systems visited on the program that you find important/ interesting.
The first medical system visited was the one in Grand Junction, Colorado. I found it rather self-less and interesting that so many doctors agreed to pool the fees for all procedures, coming up with set fees for each procedure for all payers, regardless of insurance. This truly allowed healthcare for everyone as even the doctor in charge of the program states that a person with only Medicare qualifies for the same procedures as he does. The pooling of resources could be railed against by conservatives as "socialist" health care, but in reality, it is the only way to truly support the less fortunate. The program in Grand Junction is a prime example of the equal access that could happen across America. The program's commitment to all pregnant women regardless of insurance is also admirable and shows how this generous model is truly economical by the thousands of dollars saved from fewer premature babies.
The second system was that of GroupHealth which had the concept of a "patient-centered medical home", an innovative idea that allowed doctors longer and more personal time with patients. I found the use of technology in this system very interesting because it seems like the model that we will see first in the future. Though I question whether a doctor would be able to properly give advice solely over email or phone, I do think that emailing and calling can be valuable additions to normal visits. It helps doctors build relationships with their patients and work with them to improve their health in a personal way. This is important because it will encourage patients to follow their doctors' advice more and therefore cut costs on future illnesses.
The third system was in Everett, Washington where doctors and insurance companies shared data to lower costs on medication. This is important because the cost of medication is a huge part of the total cost of care. If costs can be lowered in any way, they should.
The fourth system was that of the Dartmouth-Hitchcock Medical Center where doctors gave their patients a true say in their treatment instead of the traditional model of expecting the patient to blindly follow. I hadn't thought about the personal aspect of health care before, except in religious contexts where a patient could refuse life-saving surgery due to religious objections. But giving patients a say in their treatment is very important to their satisfaction with the health care system. The system's goal is to increase and maintain the well-being of the patient, mentally and physically. If a patient prefers not to get rid of his or her pain for personal reasons, the health care system should accomodate that because to do otherwise would affect the patient's mental well-being unnecessarily. This prospective emphasizes that health care is not only about keeping everyone's body healthy but that there are many mental and social factors to consider.
The first medical system visited was the one in Grand Junction, Colorado. I found it rather self-less and interesting that so many doctors agreed to pool the fees for all procedures, coming up with set fees for each procedure for all payers, regardless of insurance. This truly allowed healthcare for everyone as even the doctor in charge of the program states that a person with only Medicare qualifies for the same procedures as he does. The pooling of resources could be railed against by conservatives as "socialist" health care, but in reality, it is the only way to truly support the less fortunate. The program in Grand Junction is a prime example of the equal access that could happen across America. The program's commitment to all pregnant women regardless of insurance is also admirable and shows how this generous model is truly economical by the thousands of dollars saved from fewer premature babies.
The second system was that of GroupHealth which had the concept of a "patient-centered medical home", an innovative idea that allowed doctors longer and more personal time with patients. I found the use of technology in this system very interesting because it seems like the model that we will see first in the future. Though I question whether a doctor would be able to properly give advice solely over email or phone, I do think that emailing and calling can be valuable additions to normal visits. It helps doctors build relationships with their patients and work with them to improve their health in a personal way. This is important because it will encourage patients to follow their doctors' advice more and therefore cut costs on future illnesses.
The third system was in Everett, Washington where doctors and insurance companies shared data to lower costs on medication. This is important because the cost of medication is a huge part of the total cost of care. If costs can be lowered in any way, they should.
The fourth system was that of the Dartmouth-Hitchcock Medical Center where doctors gave their patients a true say in their treatment instead of the traditional model of expecting the patient to blindly follow. I hadn't thought about the personal aspect of health care before, except in religious contexts where a patient could refuse life-saving surgery due to religious objections. But giving patients a say in their treatment is very important to their satisfaction with the health care system. The system's goal is to increase and maintain the well-being of the patient, mentally and physically. If a patient prefers not to get rid of his or her pain for personal reasons, the health care system should accomodate that because to do otherwise would affect the patient's mental well-being unnecessarily. This prospective emphasizes that health care is not only about keeping everyone's body healthy but that there are many mental and social factors to consider.
4. Do you think the way medical care is delivered in the places visited in the program can be duplicated in the area you are from ? Why do you think it hasn't occurred already?
I'm from Fullerton in the suburbs of Southern California and I think it's certainly possible to duplicate the health care systems visited in the program there. The video lists and focuses on three changes that need to happen: doctors and insurance companies need to work together to lower costs, they must be willing to adapt new technology so doctors can spend more time with patients, and doctors must be willing to give their patients a real voice in their treatment. Though some doctors and insurance may be willing to lower costs out of self-less concern for their communities, others may not. Lowering costs may make the cost of care cheaper, but doctors may loose money and therefore may not be willing to do so. Regarding new technology, many hospitals and clinics have changed to electronic records but some, for selfish reasons, may try to take on more patients instead of using the extra time to focus on the patients they already have. The third change is trickier to implement. Even if the doctor is willing to be selfless, he or she may not want to leave medical decisions like whether or not to have surgery up to the patient, out of concern that he or she does not have the medical understanding to make a right decision. So really, for many of the changes needed for health care to be improved like the systems featured in the program, doctors and other figures of the medical field need to set aside their selfishness out of concern for their communities. Whether these medical leaders in Fullerton will choose to act, truly depends on their sense of duty to their communities. I think these changes will be easier to implement in smaller towns like Grand Junction, Colorado and my hometown of Fullerton, California, where the doctors in the town probably all know each other and have a greater sense of community. I don't think it hasn't occurred already in my hometown because the median income is rather high and most people can afford the current system of health care, so there has been no rally for change. In areas different from Fullerton, where there is an immediate need for change, they may not have occurred because doctors are not willing to give up some of their pay for the community.
I'm from Fullerton in the suburbs of Southern California and I think it's certainly possible to duplicate the health care systems visited in the program there. The video lists and focuses on three changes that need to happen: doctors and insurance companies need to work together to lower costs, they must be willing to adapt new technology so doctors can spend more time with patients, and doctors must be willing to give their patients a real voice in their treatment. Though some doctors and insurance may be willing to lower costs out of self-less concern for their communities, others may not. Lowering costs may make the cost of care cheaper, but doctors may loose money and therefore may not be willing to do so. Regarding new technology, many hospitals and clinics have changed to electronic records but some, for selfish reasons, may try to take on more patients instead of using the extra time to focus on the patients they already have. The third change is trickier to implement. Even if the doctor is willing to be selfless, he or she may not want to leave medical decisions like whether or not to have surgery up to the patient, out of concern that he or she does not have the medical understanding to make a right decision. So really, for many of the changes needed for health care to be improved like the systems featured in the program, doctors and other figures of the medical field need to set aside their selfishness out of concern for their communities. Whether these medical leaders in Fullerton will choose to act, truly depends on their sense of duty to their communities. I think these changes will be easier to implement in smaller towns like Grand Junction, Colorado and my hometown of Fullerton, California, where the doctors in the town probably all know each other and have a greater sense of community. I don't think it hasn't occurred already in my hometown because the median income is rather high and most people can afford the current system of health care, so there has been no rally for change. In areas different from Fullerton, where there is an immediate need for change, they may not have occurred because doctors are not willing to give up some of their pay for the community.
Saturday, February 16, 2013
Assignment 3: Vaccine Wars
Summary: The video discussed the controversy surrounding vaccinations, particularly the MMR vaccination. There are pockets of anti-vaccination areas where many parents are choosing not to vaccinate their children out of fear of vaccine-related mental disabilities or allergies and because many feel that they are unnecessary. In particular, the debate really began with claims of parents that the MMR vaccine which is federally required was causing children to develop autism. Critics claimed that the mercury preservative caused the intestines to secrete harmful bacteria that in turn caused autism. They claim that vaccines definitely carry a significant risk of mental disorders and should not be required or even recommended until they are made safe. Scientific research has shown these claims to be false in regards to the MMR causing autism but are unsure whether there is truly a link or not. The ethics of non-vaccination is between vaccination for the greater good (herd immunity) or vaccination as a strictly personal choice.
1. Did the video influence the way you think about vaccinations? Why?
The video made me more of an advocate for vaccines because it explained the public health position of vaccinations as the parent's social duty for the society as a whole instead of vaccinations as a strictly personal choice. I consider vaccinations as both duty to securing the safety of my child but also the safety of the children in my community now. However, I am more aware of the possible risks after seeing the large number of parents who claim that their child's mental disorder was caused by vaccines. I don't think researchers have yet disproved that and thus the risk of a vaccinated child developing mental disorders, despite how miniscule it is, should still be taken into account.
2. What is herd immunity? Define the term and explain how it relates to the public health importance of vaccinations.
Herd immunity is the protection a child in a community of vaccinated people receives from diseases not from direct immunization but from everyone else being immunized already. Herd immunities underlines how vaccinations carry a different set of bioethics. Vaccinations cannot be personal decisions because those personal decisions effect everyone in the community. They therefore need to be treated with more importance and sense of obligation than other personal medical decisions.
3. In what ways is vaccination different from other types of personal health decisions? Who should be involved in deciding whether children receive a specific vaccine?
As said in the previous question, vaccinations are different because the personal decision of choosing to vaccinate or not vaccinate does not just affect one's child but instead the child and other people in the community. Ideally in an ethical world, the community that is affected, which would include the parent, would be involved in deciding whether children are immunized. But that is not a practical policy. Practically speaking, I think it's quite appropriate for the government to require parents to make the choice to vaccinate their children because it isn't fair to others to be exposed to diseases because of the choice of one person.
4. Describe several reasons why children might not receive the recommended immunizations. Consider reasons that originate from the patient/parent, the physician, and the healthcare system.
One reason would be the parents refuse because they decide that the risk of their child becoming autistic is not worth protecting them from diseases that they likely will not contract. The patient may have illnesses that prevent them from being able to receive the vaccination. The parents may not be financially able to pay for vaccinations. The parents may have religious or other moral reasons for refusing to vaccinate.
5. What should be the public health response to increase vaccination rates? That is, as a public health policymaker, how would you attempt to increase vaccination rates?
As stated in the video, it is rather difficult to dispel harmful and ungrounded ideas that spread from the Internet and by word-of-mouth, especially when people are more willing to believe what they heard from their neighbor than from an established medical institution. I think public health policies should emphasize more of the social duty aspect of vaccinations. For example, they should hold up the baby who contracted whooping cough, Vanessa, as a real and completely plausible consequence of not immunizing one's child. Research journals and other evidence/ experiment based papers should be summarized and easily accessible with visible links to the original papers for parents who want to see proof that there has been no link established with vaccinations and autism.
Saturday, February 9, 2013
Assignment 2: Second-hand Smoking and Lung Cancer: Cause and Effect
1. Briefly summarize the study design and results.
The study followed 91,540 married non-smoking women above the age of 40 for 14 years from 1966-79 in various districts of Japan. It tried to assess how their husbands' smoking habits affected their risk of getting lung cancer. The smoking habits of the studied husbands ranged from non-smoking to more than 20 cigarettes per day. The study considered possible confounding variables such as rural/urban homes, lifestyle habits, and individual health risks. The results for risk ratio was found to be the following: non-smoking household (1.00), ex-smoker household (1.43), and chain smokers (1.90). The study concluded that the number of smokers' wives who had a higher risk of lung cancer than the wives of non-smokers was statistically significant indicating a high correlation. The husband's smoking habits did not affect the risk of the wife developing other types of cancers but did effect her chances of getting emphysema and asthma.
2. What do you find interesting/important about this study?
This study seeks to prove the link between second-hand smoke and lung cancer, an important health hazard. If causation is proved, it changes public policy regarding smokers and also how people view smoke. Ever since studies such as this one have indicated that second-hand smoke raise the risk of lung cancer for non-smokers, many states and countries have made it illegal to smoke in public places. This study is therefore important because it decreases many people's chances of getting lung cancer. From a sociological standpoint, I find the social change caused by this study rather interesting. People now view smokers as not only harming themselves, but as harming those around them, whether it's the general public or the smoker's immediate family and they often are shunned or scolded for their bad habit.
3. What is the advantage of using this type of study design here?
The large number of subjects observed and their varying lifestyles allowed for an accurate measurement of the effects of various confounding variables like rural or urban location, drinking habits, etc. It also allowed for researchers to observe a range of non-smoking, formerly-smoking, and currently smoking husbands as well as the range for smoking from 1-20 cigarettes per day. Possible subjective bias from one spouse to the other was also eliminated by interviewing the couple separately. By having a long term study, researchers were also able to have a more accurate statistical analysis.
3. You read in Schneider (Chapter 6) about proving cause and effect. Discuss why or why not you feel the results of this study support second-hand smoke as a cause of lung cancer.
Though I believe there is definitely a cause and effect relationship between second-hand smoke and lung cancer, I do not believe that this study proves it. Though a strong correlation between second-hand smoke and lung cancer was made, correlation does not necessarily mean causation. For example, it is possible that perhaps breathing in the smoke is not what increases chances of lung cancer, it might be the lingering smell of smoke in the house or on the spouses' clothes that does damage to the lungs. The study also sought from the beginning to prove that second-hand smoke caused lung cancer. It is possible that the statistics of the study were unintentionally skewed in order to support this theory.
Friday, February 1, 2013
Assignment 1: MMWR Binge Drinking Among Women and High School Girls
1. Briefly summarize the article (what are the main findings, where did the data come from).
The article studied binge drinking among women and high school girls. The data for women came from the Behavioral Risk Factor Surveillance System (BRFSS), a randomized telephone survey that assesses various health risk behaviors in U.S. adults aged 18 or older. The data for high school girls came from the Youth Risk Behavior Surveillance System (YRBSS) which essentially was the same study for a younger age group. The study had several useful results. There was a strong correlation between the level of binge drinking in women and high school girls. Women and high school girls who abused alcohol frequently usually also binge drank frequently. Those who binge drank tended to do so frequently and in high amounts.
2. Explain why you think this is an important public health issue.
As a college student female, the problem of binge drinking is one that affects me directly. Though I feel that Hopkins has done a good job of informing students of the dangers of binge drinking and focusing on the issue, many of my friends who attend universities that do not. The general consensus among my friends from universities has been that they focus more on the dangers of any alcohol abuse, without the specific focus on binge drinking. Though I am not suggesting that universities condone alcohol abuse, I think it's smart of a college campus to recognize that it does happen and to focus on preventing binge drinking specifically. Though I can see where some people would see this as a university condoning drinking, just not binge drinking, practically speaking, such an emphasis would probably do more to reduce the negative effects of alcohol abuse than campaigns focusing on drinking in general because students would actually pay attention to it.
3. Are you surprised by the results? Notice that the data source is a survey, might there be some issues with the accuracy of self-report data on alcohol consumption?
I was surprised by the figures showing that women and girls who drink regularly usually also binge drink. I would hope that campaigns focusing on binge drinking would reduce this correlation so that women and girls, especially those in college, who do drink do not also binge drink. I do think that there are some issues with the accuracy of the self-report nature of the survey and that unfortunately, the figures are probably lower than the actual numbers. However, I also think the survey, which I assume was either anonymous or assured participants of privacy, was close to the real figures.
4. How would you try to reduce the prevalence of binge drinking in college or high school age women?
As mentioned in the article, I think the most effective type of campaign against binge drinking would involve the use of figures and statistical evidence demonstrating the high likelihood of suffering the negative consequences of binge drinking.
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