Process of identification & definition
Review the World Health Organization’s (WHO) definition of health in Chapter 7 of your textbook. Then, write a research paper fulfilling the following requirements.
- Why is the definition of health important to health policy?
- Define the term “target population” as it relates to health policy.
- How do societal influences impact the identification and definition process of policy?
- Research a healthcare organization and highlight how their policies align or misalign with the WHO’s definition of health.
- Must be four to six double-spaced pages in length (not including title and reference pages) and formatted according to APA style as outlined in the Ashford Writing Center.
- Must include a separate title page with the following:
- Title of paper
- Student’s name
- Course name and number
- Instructor’s name
- Date submitted
- Must use at least four scholarly sources in addition to the course text.
- Must document all sources in APA style as outlined in the Ashford Writing Center.
- Must include a separate reference page that is formatted according to APA style as outlined in the Ashford Writing Center.
Table 7-1 presents the view of health and health care espoused in the constitution of the World Health Organization. Although the UnitedStates is a U.N. member state, one would be hard put to find consensus in the United States on a number of the points that it cites as basicprinciples.
Asking people in the United States if health is more than the absence of illness or infirmity could produce a host of different responses. Somerespondents might come down on the side of physical and mental well-being but have a problem with trying to address social well-beingunder the heading of health. Indeed, the fact that we have millions of uninsured and do not provide mental health care to a large proportion ofthe population would seem to indicate a lack of commitment to physical and mental well-being.
Those analyzing or deciding on a policy need to understand the differences in the operational definitions of health that are representedaround the table. In the best of all possible worlds, those seated at the table would agree on thatdefinition and move on, but sometimes theart of politics depends, in part, on knowing when to try to agree on principles, or on actions, or on both, and whether to use limited politicalcapital to try to bring them into alignment publicly.
Table 7-1 Excerpts from the Preamble of the Constitution of the World Health Organization
… the following principles are basic …
• Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
• The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction ofrace, religion, political belief, or economic or social condition.
• The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest cooperation of individualsand States.
• The achievement of any state in the promotion and protection of health is of value to all.
• Unequal development in different countries in the promotion of health and control of disease, especially communicable disease, is acommon danger.
• Healthy development of the child is of basic importance, and the ability to live harmoniously in a changing total environment is essential tosuch development.
• The extension to all peoples of the benefits of medical, psychological, and related knowledge is essential to the fullest attainment of health.
• Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of thepeople.
• Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and socialmeasures.
Source: Reproduced from: Constitution of the WHO, Basic Documents, 45th Ed. Supplied 2006, October at www.who.int/governance/eb/who_constitution_en.pdf
Defining the Target Population
Just what population are we talking about? The history of community mental health centers illustrates how difficult—and critical—it can beto answer this question. A system designed to help the developmentally disabled and severely and persistently mentally ill morphed into ageneral mental health treatment system in which many practitioners avoided the original target group and concentrated on the morerewarding (professionally and financially) cases (Torrey, 1997). As more and more states now focus more intently on the original targetpopulation, many of those previously served must rely more on private payment or insurance or go without.
An analyst in charge of developing a maternal health program policy who wanted to determine the health status of the target populationmight start by looking at the health of all females of childbearing age. But what constitutes childbearing age when 8-year-old girls and womenin their 50s can give birth? An analyst would have to put both an upper and a lower limit on the age range in order to get a count of the targetpopulation.
Identifying the Health Status of the Target Population
The next step after defining the target population is to assess its health status. Many data sources are available for this task, but sometimesthey do not match up exactly with the target population that has been identified. The CDC demonstrated the complex connection betweendefining the target population and assessing its health status using available data in 2000 when it reported on changes in serum foliate levelsin noninstitutionalized women ages 15–44 who participated in the National Health and Nutrition Examination Surveys from 1991 to 1994and in 1999 (CDC, 2000). It did not conduct a special study of pregnant women or women of childbearing age, the recommended targetgroup. Instead, it segmented the data in the existing surveys and analyzed that. There certainly are women bearing children after age 44,before age 15, and in institutions; however, the age range covered most of the potential recipients, and the differences in outcomes were sogreat that the analysts did not feel the need for further refinements.
Looking at the health status of the target population in the aggregate can often obscure differences between subgroups. One frequently hearsabout the millions of people in the United States who lack health insurance. Does their health status suffer because they lack insurance?Sometimes and sometimes not. Historically, many of the uninsured have been young people who have made a calculated trade-off betweenthe cost of health insurance and the fact that they are young and healthy (a group sometimes referred to as “the young immortals”). Yes, theyare more likely to have severe auto accidents than an older population, but until one happens they are not part of the 20% of the populationthat accounts for 80% of health care costs. They are transferring the risk of low-probability events to the public at large because they wouldprobably receive care anyway. Others may want insurance and need it, but are simply unable to afford it. The point is that there is plenty ofroom to talk at each other rather than solve problems. One can talk about the issue by discussing the uninsured as a bloc or about the needsof specific segments. The important thing is that analysts define clearly whom they are talking about.
Identifying the Factors Determining the Health Status of Concern Within That Population
Causation is the bane of the policy world. Politicians and polemicists would have us think that the right policy is certainly this or definitelythat. If it were that simple, however, there would be little need for analysis. The conclusions of studies seeking causation are seldom as clearas obvious results of taking the handle off the local water pump and watching the cholera epidemic stop. Most policy problems support thecharacterization by the Danish mathematician and poet Piet Hein, who wrote, “Problems worthy of attack prove their worth by hitting back.”Inference is one thing, and causation is another.
If we return to our historical population of uninsured individuals as a target (it will take years to understand the full impact of the ACA), wefind that they have poorer health than the average population, and data show that they are more likely to postpone care and not fill aprescription because of cost and have an avoidable hospitalization. One might counter that some lack coverage because they are in poorhealth and cannot find employment. Also, when one deals with a policy issue of uninsured populations, one probably needs to address issuesof the underinsured as well. Problems ofdefinition and causation are also thornier because so many studies and analyses rely on informationentered into the claims data bank, which does not include information on the underinsured because they do not generate claims.
Identifying Methods Realistically Available to Change Health Status
With all the alternative solutions being offered for health policy changes, the analyst needs to identify the few that are most realisticeconomically and politically. By politically realistic, we mean acceptable to those who are likely to fund and use the analysis and implement itsfindings. Many potential actors may express a preference for specific alternatives a priori. The analyst must respect these preferences and stillkeep the process simple enough that decision makers are not likely to ignore the work or be confused by it.
Defining the Methods Operationally and Optimally
In an industry with a recognized high degree of waste like health care, one has to add the step of defining the alternatives operationally byanswering the following questions:
1. Has the alternative been in use?
a. If so, determine how it could be improved prior to applying it in this context.
b. If not, define it in more detail to establish operational feasibility.
2. For the more promising, feasible, and relevant alternatives, determine optimal methods and procedures for delivery.
3. Use these optimal processes to determine costs and effectiveness where relevant.