Disturbing Parallels (Final)

Health care has been a problem around the world for some time now. There are countries that offer little to no healthcare to their poor residents, and the care that is offered is minimal at best. I have had the belief for most of my life that the United States offers great healthcare to the majority of its citizens. This was based off the fact that I have always had very good healthcare. As I got older and was hearing things in the news and then as I began to research health care I realized that our country, while still better than most, is very far from being perfect. In fact after doing some research I believe that the United States is slowly becoming more like the third world countries that most people have a tendency to pity. I am not saying that the quality of health care in the United States is diminishing or that the government is not looking out for the healthcare of its people, just that I have come across some information that has drawn me to some disturbing parallels.

Nicaragua is one of the poorest countries in the world. Its citizens suffer from a variety of ailments that are preventable and most prevalent in their country, such as pneumonia and diarrhea. The fact that many of the citizens are also malnourished leads to several other diseases that could easily be prevented. In addition to these ailments are several that are seen throughout the globe, but are also very prevalent in the United States, such as heart disease, cancer, and diabetes. On top of all this because their health care is so poor maternal care suffers greatly. Currently Nicaragua has the highest infant mortality rate of all the Latin American countries and maternal death is equally high. Breast cancer in women is also on the rise in this very poor country.

So what is my point in bringing up all the ailments of Nicaragua? Despite the few lifestyle diseases the rest could be prevented if proper health care was available. Recently the World Bank had Nicaragua cut funding in certain areas of their spending. One such area was healthcare. This cut left the majority of the population without healthcare. In fact currently over half of Nicaraguans are without proper healthcare due to poverty and lack of health care facilities.

Despite the fact that Nicaragua does not have adequate health care for most, it does not mean that they do not have a health care policy in place, because they do. Ninety percent of the population in Nicaragua is served by public facilities that are understaffed and poorly supplied. These facilities are funded by less than half of the health care budget for the country. The public clinics and hospitals are also located primarily in the cities, very few are found in rural areas which make up the majority of the population. In fact there are in total only 33 public hospitals for the entire nation of Nicaragua and again the majority of these are in larger cities. The ninety percent of the population that are using these facilities are not receiving any aid from the government, they are paying for this healthcare themselves, and many cannot afford it. The cost of just one treatment could mean more that four days wages that would have normally gone to food. This group makes up the third tier in Nicaragua’s three tiered healthcare system.

The middle tier of Nicaragua’s health care system provides health care to those who are working in Nicaraguan government or industry. Their health care is provided through the Nicaraguan Social Security Institute. This system is like insurance with some paid through the employing company, some through the workers wages and the rest through the government. This care covers a large number of conditions, surgeries, medicines and exams, so those fortunate enough to have jobs in government or industry are very well cared for. Where the bottom tier of health care receives less than half of the health care budget the middle tier, serving about only eight percent of the population, receives over half of the health care budget.

The top tier of the Nicaraguan health care system is the private sector which is growing larger due to the cut backs to the governmental health care funding. This sector provides health care to the elite of Nicaragua, the rich. An ad on a travel site for Nicaragua shares how great the health care is and how travelers from the United States are surprised by the quality of care. I believe after learning about the health care in Nicaragua that the advertisement was speaking of the private health care in Nicaragua. In fact the majority of the rich of Nicaragua do not even stay in their country for surgeries or specialized treatments, but instead travel else where.

Now while all of this information on Nicaragua is interesting and very informative, it seemingly does not have anything to do with the United States and its state of health care, or does it? While doing some searching I came across some information about health care in the United State that reminded me very much of Nicaragua.

As insurance cost rise in the United States many people are looking for ways to obtain affordable health care. Several companies feel they have found the solution. As part of their medical policies for their employees, they will send them overseas for any surgery or major care. Some companies have found this to be up to seventy percent cheaper than having their employees stay in the United State for care. One company is so impressed with the saving that they will help pay for the travel expenses as well as provide a bonus to the employee for choosing to go overseas for treatment. There are some hospitals in the United States that are willing to match the prices overseas and this has resulted in traveling from one state to another for care, although this practice is much less popular.

The trend of flying overseas for medical care has been given the name medical tourism, and it is becoming much more popular. While medical tourism has in the past been associated with members of lesser developed countries traveling to the United State and Europe for health care lately more members of the United States are traveling to other countries often less developed countries for medical care. This care includes dental services along with basic medical and surgical services. For some going overseas for healthcare is a choice they would prefer, but for others it is a choice based on affordability. In fact the majority of people going overseas for health care in the United States are those in the middle class. In this way health care is shifting along with the rest of our consumer society. In 2007 it was estimated that over 750,000 American would go overseas for health care.

With the trend of Americans going overseas for health care came some changes. There are agencies that one can go through to find the best destination for your health care needs. They serve much like travel agencies. Along with this some insurance companies, such as Blue Cross and Blue Shield, are now offering more affordable policies that encourage and support traveling overseas for medical care.

Many of the physicians in the destination countries have been educated and practiced for a time in well developed countries before returning home to practice. Countries in South and Latin America as well as some in Europe and Asia are very popular destination.

While I can see the benefits of traveling for health care I also am seeing some disturbing parallels between this new trend and Nicaragua. Traveling for health care reminds me greatly of the state of health care that Nicaragua is in. Their upper class of Nicaragua travels out of the country for health care much in the same way a number of Americans are traveling for their health care.

Insurance in the United States is becoming more and more expensive. More and more people in the United States cannot afford health care and are doing with out. An article from 2007 stated that over 40 million people living within the United States were going without health care. I can only see this number raising. With the rising cost of both insurance and medicine many more people will choose to go without. With so many people in the United States barely making it from day to day, not to mention the immigrants to our country, both legal and illegal, that cannot afford medical cost it is not surprising that so many are going without.

With the way things are going I foresee the United State becoming like Nicaragua in its health care system. I see three tiers. I see a tier of medical care that is in the private sector, with people traveling overseas for health care, becoming “medical tourists.” Next I see a tier of public health care provided through insurance, for those who can afford it. I see insurance being offered to those in government jobs and services deemed “needed” much the same way that it is offered in Nicaragua. Last I see a third tier serving the largest population public care paid for by the individual, which many will not be able to afford. This will end up being much like the third tier in Nicaragua leaving many people without health care.

If this tiered system were to come about I think that many preventable diseases will start showing back up in our society, simply because many people will be going without health care.

I in no way want this to happen. But through my research and the parallels that were obviously present the conclusions of what could happen became more and more realistic.

Sources:

http://www.jhc-cdca.org/health.html

http://countrystudies.us/nicaragua/27.htm

http://www.access2insulin.org/html/nicaragua_s_health_system.html

http://www.tortillaconsal.com/health_nicaragua.html

http://www.mapsofworld.com/nicaragua/healthcare/

http://www.cnbc.com/id/33384775/33384775?slide=1

http://www.reuters.com/article/idUSN0343703420071203

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2234298/

http://www.caribpro.com/Caribbean_Property_Magazine/index.php?pageid=360

What Can Be Done

It is obvious that many people around the world are lacking adequate health care and are dying as a result. Understanding the health care problems that others face, both overseas and in our own country, can leave a person with a feeling of helplessness, they wish they could help but how. I know that as I began to research, and when I witnessed first hand in South America, the crises the people without adequate healthcare face I was left with this feeling. I wanted to know what was being done for those who aren’t as fortunate as I am to have good insurance or even a well stocked, technologically advanced health care center. There are several organizations that have made it their goal to provide healthcare to those who need it. Some of these organizations, like Doctors Without Borders, I had heard of, and others I had no idea existed.

One organization that I found interesting and had never heard of before is HealthRight International, they used to be called Doctors of the World. This organization was founded in 1990 and has been working since to make a difference. What I found interesting about HealthRight International was that their main focus was toward helping those that had been hurt by human right violations. When I was reading through the types of situations they are helping with I found that we had talked about them in class, so essentially this organization was aiding those who are victims of globalization. HealthRight International supports those who have been thorough human trafficking and gender and domestic violence.

The way HealthRight International goes about their assistance is beneficial for all involved. They don’t just go in provide aid and then leave; leaving those they have helped to then fend for themselves again. HealthRight International works with communities, physicians, and leaders of an area to set up a system so health care is continued to be provided when they leave. They train members of the community and any physicians in the area. When HealthRight International goes into an area they take into consideration the culture and local practices of the area and then set up a program that will provide tools and protocols that are needed. In this way they can leave a lasting change.

Some might say that while this is great for other countries what about our own. HealthRight International works within the United States as well. They work with those who are fleeing persecution and torture. While their programs in the United States are focused on those migrating into the U.S. they are providing care to a large number of those in our country who otherwise would not be able to get adequate health care and their support program helps them become financially stable.

There is still a lot to be done. I realize that one organization is not going to solve the world’s health care problems, but with the many more organizations like this one progress is being made. I think that if we could set up more systems of health care aid where community members were trained in caring for others as well as local physicians, both in the United States as well as around the world, health care would be less of a crisis. In addition to this I think that if more individuals knew what was being done to help greater strides could be made, maybe instead of magazines in doctors’ waiting rooms we could have information on world health care and those who are trying to help.

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Resources: If you're interested

The Globalization of Healthcare

This article by CNBC is very interesting. We talk of obtaining products from overseas but rarely do we see "products" as health care. The article talks of how with the raising costs of health care in the United States some companies are sending employees overseas for their health care. This was a new approach to health care globalization I did not think about.

Globalization in health care: is international standardization of quality a step toward outsourcing?

This paper provides more insight to the resource listed above. It speaks on patients going overseas for health care now called "medical tourism" as well as the trend for doctors to go overseas to work in third world countries. What I found very helpful was that it not only presented the information but it discussed the consequences that could result from these trends.

Health Care Around the World

This source contains a lot of information. The part I focused on was the section of health as a human right. It reminded me of the discussion in class on water as a human right and it actually lists good drinking water as a right all should have. It goes on to speak of universal care and how in order for all to receive care the rich have to help the poor. Altogether I think this source ties into our discussions on the poor and on human rights well.

Doctors Without Borders

For any interested Doctors Without Borders is a great organization that is helping those who need health care world wide. At their website you can read about the health care issues facing those around the globe and what this organization is doing to help. In addition this is a way for you to get involved if you are passionate about helping because they accept donations.

World Health Organization

I thought that it was appropriate to add this site. The World Health Organization helps to monitor health trends around the world and set standard. From their site you can get information on many health care topics, including what is happening in Haiti in the aftermath and other raising concerns. This may be a good place to start if you wish to see what the state of health care is in certain areas of the world or get facts and figures.

Medical Tourism: Globalization of the Healthcare Marketplace

Having just become aware of the trend of leaving the United States to receive health care I wanted to know more. This article is a great introduction to medical tourism and its popularity. It makes the point that this has been happening for awhile, with people from other countries coming to the US and Europe. It also talks about what countries are now the popular destinations for health care. The discussion in this article takes into account the responses to medical tourism and how it is changing.

Over 40 million in U.S. can't afford health care: report

Because I have talked about the poor as failed consumers of health care I thought that it would be good to include a source that outlines how many people go without health care in the United States. This article does just that. It includes information on all spectrum's of health care including dental, and eye care. In addition to this it talks about the cost of health care.

Water and Development

Because many diseases and health issues can be linked to bad drinking water I feel that this article relates to health care. It deals with the privatization of water and the lack of clean water for many of the worlds people. It also includes several topics that tie back to our discussion of water in class, such As water as a human right and water as a resource. I found interesting the facts on illnesses caused by bad water and how many people die of preventable illnesses related to dirty drinking water.

Health Care in the Developing world

While this source contains primarily information on AIDS in Africa it brings up some other good points related to the lack of health care in poor countries. It talks of lack of resources as well as the lack of ability for people to reach the clinics there are in place due to poor traveling conditions. In addition it has some good facts on how much of the money governments are paying into health care actually reaches the patients in the form of medicine and care.

Cause of Death : Inequality

This source ties back to my intro post and the class discussion of the poor in America very well. I found the addition of statistics in this article helpful in understanding how the poor are dieing at younger ages when the United States is supposed to have good health care available. The source includes the issue of health insurance and how income and education are related to a persons health.

FACTSHEET: Top killer diseases in the developing world

I don't think that you can talk about health care in the world without knowing what kind of diseases are the major killers in developing countries. This source lists the top ten diseases in these countries, what they are, how they are caused and treatment. What I noticed was that many of the diseases listed we in the United States do not get because we have vaccines for them. This site seems connected to the issue brought up in my last post, about getting health care to those that need it.

Tackling the health care debate Fair Trade style

The discussion in class lately about Fair Trade got me wondering what kind of health care is available to those who produce the Fair Trade products. This source helps to answer that question. Looking at Peru we find in this source that there are a few options for the people, but a few still require payment. The source also mentions that health care can be hard to get for those who do not live near urban areas. This source is more worthwhile for the understanding of the health care system in Peru than its connection to Fair Trade, but it is helpful.

Parasitism: Why is it Common in Third World Countries?

I like this source because it connects living conditions to poor health. It also addresses and sums up all the causes of death related to poor health care in developing countries, such as availability of services and medicine and education. One point I found interesting was that the doctors in developing countries are going to more affluent areas and countries where they can live better lives or get better schooling.

Physicians for Peace

This website is for an organization similar to Doctors Without Borders. This organization sends doctors to developing countries to help train those in the medical profession there. They feel that education is a way to help provide better health care to poor countries. This is one way that we may be able to help health care in third world countries, by donating to organizations such as this or just learning about them.

International Health Care Service Organizations

I added this source because it provides information on many organizations that are trying to help with health care in third world countries. Knowing that health care is a problem in developing countries and knowing the causes of the problem can often leave behind a feeling of "what am I suppose to do" or "what is being done?" I wanted to include information on organizations that are helping get health care to those who need it to help answer those questions.

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Pathogens and Poor

For class we recently read a chapter in Paul Farmer’s Pathologies of Power that I feel fits into my topic of health care in globalization very well. I especially liked this chapter as well because it brought in some of the information that I am learning in my Microbiology classes.

Farmer made a point that all over the world the poor are sicker than the nonpoor. He brought up the fact that this is because they have more contact with pathogens and because they do not have the means to obtain the help that they need to stay healthy. As presented in my previous post on Nicaragua this is very true, but I believe that there are some other factors that play in as well, based on information I have obtained from other classes. I learned in my Microbiology class that there are various reasons why we get and stay sick. One is poor nutrition. If we are not receiving the right fuel for our bodies or enough of it the body starts to shut down certain systems. When you are malnourished your immune system is the first to go. Your body has to make the choice of running the organs you need to stay alive or the immune system, and that is why we need to eat a good balanced diet. For poor who do not have access to the types of food that your body needs to run effectively or even to food at all you can see the problem. They essentially have no immune system to keep them from getting sick and when they do get sick they aren’t receiving the nourishment they need to fight off the illness. Now some may say that all this may be true, but look at the United States. Many nonpoor eat poorly and you don’t see them dying prematurely to diseases. To them I say yes many nonpoor eat poorly but, these people have access to healthcare, which the poor do not, as Farmer points out. In addition to that many nonpoor are dying prematurely of diseases due to poor nutrition, but that is another topic.

Farmer states that poor come in contact with more disease. This I believe is very true. In my trips to South and Central America I have witnessed large families and sometimes more than one family sharing a single small living space. This is a perfect way for disease to spread. Many viruses and bacteria can be spread when a person coughs or sneezes releasing minute droplets of saliva that are carrying thousands of pathogens and are then inhaled by another individual. How are many people going to avoid getting sick when they are all sharing a single space? Nonpoor may be crowded into a single space and come into contact with pathogens, but again they also have the access to the care and nutrients they need to fight off disease.

Now as Farmer has pointed out in his book some doctors and nurses try and help solve the problem of access to healthcare for the poor by offering their services. One problem is that these endeavors are poorly funded and thus cannot reach as many people. In addition to this, as was the case in the look at Nicaragua, there are not enough of these people in the areas they are needed. Also, just giving poor medicine or a check up and sending them on their way is not going to be enough. Some diseases require months of treatment and you may feel better after a short time, but you are not. If someone is working just to survive and they start feeling better, why should they continue to take the measures they need to fully fight off the disease when they need to work to provide food and other necessities? I like what Farmer has to say for this. He sees health care as a work of social justice. That we need to help people in the situations they are in and work to help make theses situations better. If this means working with a small population at a time instead of solving the problem in one big sweep I think that it is worth it.

Works Cited:

Farmer, Paul. Pathologies of Power: Health, Human Rights, and the New War on the Poor : with a New Preface by the Author. Berkeley: University of California, 2005. Print.

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Nicaragua, a health care conundrum

Having visited Nicaragua and spent some time with the locals of the poor class, Nicaragua’s health care system is of interest to me. Looking back I wish I would have asked more questions as to the state of healthcare, especially now that I know a little more about the country.

Nicaragua, as well as most of the world’s poorest countries, went to the World Bank and IMF for assistance. They were advised to strengthen privet sectors by lowering spending in non profit areas. This resulted in a cut to healthcare funding. I understand where the World Bank and IMF were coming from in a way. It makes since, if you want to increase your economy, put money into areas that will produce the goods and encourage the growth of economy. However I don’t think that you should be forced to cut health care funding in order to adhere to the conditions set out by the World Bank and IMF. Adding this cut of healthcare to the already unequal health care system and many people will have to go with out the basic care they need to survive.

Inequality is very prevalent in the Nicaraguan health care system, which has three tiers. The upper class of Nicaragua receives their healthcare privately, and what care they cannot receive in their own country, they will receive in others. The working class, comprising about eight percent of the population and only includes those working for the government and industries, receives their health care through The Nicaraguan Social Security Institute, which they and their employers pay into, and is similar to insurance. This “insurance” is mainly government funded and the majority of the government health care budget. The Nicaraguan Social Security Institute provides for basic medical care including medications and care for the spouse and young children of the family.

The rest of the Nicaraguan population, about ninety percent, the poorest receive public healthcare that is poor and mismanaged at best. There are public clinics for these people to go to, but many of these clinics lack the resources need to be helpful. In addition to the poor quality of these clinics, many of these services are only offered in the larger cities, and the majority in the capital city of Managua. This is leaving the majority of the country without health care services at all, simply because there aren’t any around. If the poor are fortunate enough to receive care, they may not be able to afford it or the medicine. One medical visit could cost several days wages, if they have a job, and several days without food. Is it better to receive medical care than eat?

I have witnessed the dilemma these people are in. While I was in Nicaragua I saw a family whose father was ill but in order for him to receive care he would have to travel to the city, the cost of traveling alone would cost several days pay and they needed that money for food. I also spent a good deal of time with a three year old girl. She had a stomach ailment and her family had taken her to a local clinic, but the resources at this clinic were poor and they could not figure out what was wrong. Her family wanted her to get better but they could afford neither the care nor the cost of traveling it would take to maybe make this little girl better. And so she suffered, this little girl who should have been smiling and happy toddler was sullen and sad.

I see the health care problem in Nicaragua as one with multiple causes. One being that the government cannot fund the care needed for the entire country. Another is that the resources needed for healthcare are not available, this includes the number of doctors and nurses available to serve. Even if these two causes were fixed and there was enough funding and resources I see the last cause as the one that will continue the problem. The people can barely afford food and as long as they are in a state of struggling to nourish themselves, day by day, they will not be able to have the health care they need.

Works Cited:

http://www.jhc-cdca.org/health.html

http://www.access2insulin.org/html/nicaragua_s_health_system.html

http://www.tortillaconsal.com/health_nicaragua.html

http://www.mapsofworld.com/nicaragua/healthcare/

http://countrystudies.us/nicaragua/27.htm

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History of Health Care

Health care today is expensive and insurance is helpful, but may not cover all medical expenses and may itself not be affordable. How did healthcare get to where it is today, both in terms of medicine and insurance?

Medicine has been practiced as far back as Ancient Egypt and farther. However, this medicine we would not recognize as medicine today. The first practices of healing where religious in nature. Priests, medicine men, other religious leaders would perform rituals in order to heal an ailment. At the same time herbal remedies where also used as the first medicines. As time went on people began to understand more about the human body. Egyptians removed growths on skin and learned about the body through dissection during mummification. Greeks introduce the ideas of exercise and healthy eating and the theory that health was related to bodily fluids and these ideas continued well into the Middle Ages. In the beginning of the Renascence science began to take over medicine when dissection of human corpse was no longer illegal. Next came the discovery of bacteria through the work of scientist like Louis Pasture in the nineteenth century, proving that bacteria was the cause of ailments, not bad air (Slonczewski and Foster, p.16). Studies where also being done to pin point causes of disease epidemics, such as the one by John Snow who pinpointed that one well that was contaminated was the cause of the cholera outbreak in London (Slonczewski and Foster, p. 994). In the 20^th century antibiotics such as penicillin where discovered, transplants and blood transfusions where safely completed and new medicines are developed based on ongoing scientific research. Unfortunately advances in medicine also cause more expenses. It takes money to fund research as well as the production of medical equipment and drugs. Some of these costs are carried on the consumer in their medical bills others through taxes.

Health insurance is a relatively new concept; in fact medical insurance in the United States did not come about until around the 1920’s. Before this time medical expenses were low because medical technology had not fully begun to develop and people where treated in their homes. Cost of medical care was not a chief worry at the time as much as missing work because of sickness, and the loss of pay that went with it, was. So around 1915 a type of insurance called “sickness funds” was put in place to compensate for any lost wages due to illness. About this time railroad, lumber, and mining companies were setting up medical services for their employees or they had contracts with medical groups to provide care for workers. By the 1930’s many employers provided prepaid contracts with health groups for their employees. In the mean time medical cost were raising, and the demand for medical care was increasing. In the 1930’s the depression hit and money was short everywhere. It was then that the first structured insurance was formed by hospitals, Blue Cross and then Blue Shield. After these two companies paved the way, commercial insurance companies began to offer health insurance in the 1940’s. By the 1960’s 75% of Americans had health insurance. In the 1960’s insurance for the elderly and low income through Medicare and Medicaid came about, funded through the government. This was the start of insurance how we know it today.

Today we are facing high costs of medical care and insurance, both of which are expensive. For those who cannot afford the cost one option is to go without. Should those who can afford medicine and doctors be the only ones to receive care? I know that receiving care involves payment to help keep clinics and hospitals running, but healthcare has evolved to fit the consumer society, if you cannot pay or conform to their requirements you do not receive the care. Insurance was created to help now it has become a hindrance to many, some companies refuse to offer coverage because of your medical history and most is expensive. I feel a change needs to take place so that all, not just the young, healthy and those who can afford it, receive health care, however I am not sure what that change should be.

Works Cited:

Slonczewski, Joan L., and John W. Foster. Microbiology An Evolving Science. New York: W.W. Norton, 2009. Print.

http://encyclopedia.farlex.com/doctors,+history+of

http://eh.net/encyclopedia/article/thomasson.insurance.health.us

http://www.lwv.org/Content/ContentGroups/StudyTaskforces/HealthCare/HCET_BP_EvolutionHealthCareUS.pdf

http://www.bmj.com/cgi/content/full/314/7097/1823

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Health Care

This blog will be dedicated to the topic of health care in relation to inequality and globalization. As a student looking into going into the medical field and maybe some day working overseas as well as in the United States, I am interested in my future career in light of globalization and inequality. Health care is a problem world wide as well and in the United States. From the information I have acquired in the past few years from watching the news I know that in the US many people who need health care are going without because they cannot afford insurance and certainly can not afford the medical bills they will be charged. These people are the elderly and the poor in our society. My globalization class talked about the “invisible poor” and how they are living in the worst part of cities and striving to live, some panhandling because they can make more money there than with an “acceptable” job. We discussed how in the world today our society is a consumer society and we strive to earn money to buy more things or the ideas that companies are presenting to us in their ads and that the poor today are “failed consumers.” I think that in much the same way the poor and elderly are “failed consumers” of the medical field. Hospitals are businesses and what they are selling could make lives better but because the poor and elderly can not afforded health care they do without. If these people choose to purchase medicines they need they could be spending money that they need for food or housing. Much is being discussed in the new today and for the past few years about healthcare and the state it is in, in the United States, in fact this is not new as an article from the Washington Post in 2006 demonstrates( http://www.washingtonpost.com/wp-dyn/content/article/2006/12/12/AR2006121201436.html). Through my blogging on this topic I would like to learn more about the health care in the United States and how it relates in the inequality and globalization in relation to the country where I live and also in the state of Washington. I am interested in the relationship of inequality in health care in relation to life expectance as was presented in this blog http://www.willwilkinson.net/flybottle/2009/10/20/inequalities-in-health-care/. I would also like to find out what the state of health care is like in other countries including first and third world countries. How is health care related to globalization in these areas? I would like to come out of this with a clearer picture of the career path I have chosen outside of the world of science. This may even help me be better at what ever job I choose.