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

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.

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.