This assignment deals with the impact that social and cultural issues have on attitudes towards healthcare using their chosen nation as an example; I should evaluate healthcare policy in one national context and explain the influences on policy formation, including impacts of funding issues. The comparison should be made to other national policies to show how different national policies arise. I should explain the structure of healthcare delivery in their chosen nation including an analysis of the organisations involved in healthcare and showing how this represents the translation of policy into practice. And also I should analyse practical barrier to the provision of healthcare in their chosen national context. All of these are covered in task 1 of this unit. Under task 2; Student should identify national and international public health campaigns and analyse their impact on the demand for healthcare in their chosen nation. Their analysis should look at the promotion of public health issues and how well this is achieved. And one thing more, student should identify current international or national health issues and assess how national policy accommodates these issues and the practical responses to these issues in their chosen national context. These assignments bring us new insight to the healthcare in the international sector as well as national. The example that I can cite is the issue of tuberculosis in national and international context.

Let me give you a bird’s eye view regarding tuberculosis. Tuberculosis remains one of the most devastating diseases in the world, affecting people of all ages across the globe. Despite rumours of its demise, tuberculosis remains one of the most deadly, and disabling, diseases in the developing world. According to the World Health Organization’s Global Burden of Disease project (Mathers 2002), in 2000 it was the eighth highest cause of death, and the tenth highest cause of disability adjusted life years (DALYs).

Tuberculosis (TB) is a common and often deadly infectious disease caused by mycobacteria, usually ”Mycobacterium tuberculosis” in humans. Tuberculosis usually attacks the lungs but can also affect other parts of the body. It is spread through the air, when people who have the disease cough, sneeze, or spit. Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent infections eventually progresses to active disease, which, if left untreated, kills more than half of its victims. Tuberculosis is most prevalent in developing nations and often coincides with malaria prevalence and acquired immune deficiency syndrome, or AIDS, and human immunodeficiency virus, or HIV, infections. As an opportunistic disease, tuberculosis easily seats itself in carriers with weakened immune systems. When tuberculosis is a secondary infection in those with a primary infection that is as dire as AIDS, HIV or malaria, it is often a fatal disease.

Diagnosis relies on radiology which is commonly known as chest X-rays, a tuberculin skin test, blood tests, as well as microscopic examination and microbiological culture of bodily fluids. Treatment is difficult and requires long courses of multiple antibiotics. Contacts are also screened and treated if necessary. Antibiotic resistance is a growing problem in (extensively) multi-drug-resistant tuberculosis. Prevention relies on screening programs and vaccination, usually with Bacillus Calmette-Guérin vaccine. Tuberculosis has been contagious for a long period of time. The signs and symptoms usually dormant or they called it as latent period. It can stay up to 5 years, until you will experience loss of appetite, weight loss, fever, easy fatigability, night sweat and persistent coughing with or without blood. This said bacteria are treatable if caught in an early stage. But also it is deadly if left untreated. Mostly the treatment is provided by the government; the course of treatment is quiet long and has to take religiously.

Task 1

One of the healthcare policies of the World Health Organisation regarding tuberculosis is to reduce the transmission of TB in households, any information, education and communication activity for prevention and management of TB should include behaviour and social change campaigns. Such campaigns should focus on how communities and, in particular, family members of smear-positive TB patients and health service providers can minimize the exposure of non-infected individuals to those who are infectious. This will ultimately translate into healthier behaviour of the entire community in relation to prevention and management of TB.

Healthcare in the UK is mainly provided by the country’s public health provider – the National Health Service (NHS). Established in 1948, the NHS was the first state organisation in the world to provide free healthcare. Today, it is the largest health service in the world providing services such as hospitals, General Practitioners (GPs/doctors), specialists, dentists, chemists, opticians and the ambulance service. The majority of these are free to those who are entitled (see below), but patients pay fixed fees for prescriptions, sight tests, NHS glasses and dental treatment, unless they are exempt for a particular reason.

The state system is supported by private health providers. These offer the opportunity to receive treatment more quickly, always see an expert specialist and be seen in clean and comfortable surroundings. The private health providers are not paid for by the state but through private health insurance or personally.

Those entitled to free or subsidised treatment on the NHS include:

Anyone with the right to live in the UK and who currently resides there (excluding British citizens who are resident abroad)

Anyone who has been resident in the UK for the previous year

EU Nationals

Anyone with a British work permit

Students on courses longer than six months

In addition, nationals from countries with reciprocal health agreements can also get treatment on the NHS, although this is usually limited to emergencies. (A full list of these countries can be found on the NHS website – www.nhs.uk).

The number of patients using the NHS is huge. On average, it deals with one million patients every 36 hours and each GP sees an average of 140 patients a week. The NHS struggles to cope with these numbers and it is not uncommon to have to wait several months to see a specialist. As a result, many people opt to pay for private health insurance (or have it provided by their employer) to avoid long waiting times for appointments and treatments.

In the UK life expectancy has been rising and infant mortality has been falling since the NHS was established. Both figures compare favourably with other nations.

On the other hand, in USA they have these kinds of free medical services to those who are less fortunate. Medicaid is a highly specific, means-tested health coverage/insurance program. It covers those who are (primarily financially) unable to acquire health coverage. It covers low-income individuals, including children, pregnant women, parents of eligible children, and people with disabilities. Medicaid was created to help low-income individuals who fall into one of these eligibility categories pay for some or all of their medical bills. Medicaid helps eligible individuals who have little or no medical insurance. And for those who are able to pay their insurance they have Medicare which covers wide scope of individual in Unites States. These Medicaid and Medicare are both run by the government. So the government is the one deciding which one is beneficial to their people but they both get a better treatment in terms of healthcare.

As I have discussed TB as my example in healthcare issues again, tuberculosis is an infectious disease. Mycobacterium tuberculosis is the most common tuberculosis-causing pathogen in humans. Tuberculosis impacts society greatly by hindering economic growth in developing countries. Along with AIDS and malaria, tuberculosis is considered one of the three diseases of poverty. Tuberculosis can be extremely isolating for those infected with the disease. During the beginning stages of being a carrier of the active germs, you are required by medical professionals to stay physically isolated for a two-week period while receiving treatment that results in no longer being contagious. For those who are not treated in a timely manner but are aware that they are infected, this isolation may be extended for an inordinate amount of time. This isolation process has created an impact to the society, they become stereotyped that once you are isolated due to the said TB you are contagious for the whole course of treatment. That is why health education in the community, media information and also by giving leaflets are very helpful way to lessen the emotional burden of the victim or the patient.

In the recent study, in Asia India has the highest percentage incident of TB. In a study conducted by the Department of Community Medicine at Maulana Azad Medical College in New Delhi, India, it was shown that tuberculosis patients rated their quality of life as significantly lower than those test cases of non-infected patients. Women, in particular, felt that the effects of being a carrier of the disease were devastating to their romantic lives as well as their abilities to parent their children due to fears of infecting them.

The social determinates of tuberculosis are very clear. Poverty is one of the biggest problems and housing. The impact on women is quite serious because they are at the bottom of everything whether it comes to health services or economic empowerment and whether it is access to food and nutrition. Women are really in the bottom strata of the society, and, coupled with that is the effect of gender discrimination against women. There is no equal opportunity, so it affects a lot of women. Access to health is a big problem for women.

So, tuberculosis is complicated by all of these things and while, yes, it does affect everyone in the society, women tend to suffer a lot more just because their access to healthcare is so low, and it is so difficult for them. In fact, the health-seeking behaviour of women is very poor in the communities, and part of the empowerment process is to help them put their health first and to make them understand that their own health is important. They must begin to put their own health first rather than putting their family first and neglecting their own health. Since the cultural aspect in India are very strong that woman has to take care of the family while the father is the main bread winner; that is why most women tends to ignore their health problem even they were suffering from the said disease. And also one of their cultures is having extended family. In one small house maybe 2-3 families are living together, so the mode of transmission of TB is very evident and that is why increasing number of incident in the said country.

According to the study of British Thoracic Society; in London the cases of tuberculosis have been increasing since year 2000 – 2008 to 37% – 45% roughly estimated. Over 40% of TB Cases are Indian but not born here in London. 65% of new cases are aged 15-44yrs old. And it is common in male which is 55% and female 45%.

Other issues of service user (TB Patient in London) had been determine and it become barrier to the provision of healthcare namely:

GPs slow to recognise and act on symptoms

Non TB staff lack empathy / understanding

TB clinics a source of emotional and social support as well as health care

Advocacy services lacking

Psychological impact on being “isolation inpatient”

Geographic barriers

rural and inner-city health professional shortage areas

Cultural barriers

health beliefs and behaviors, practitioner beliefs and behaviors

Socioeconomic barriers

lack of health insurance, inability to pay out of pocket, poor education

Organizational barriers lack of interpreters, long appointment wait times, referral between hospital departments is troublesome

Combinations of these barriers may occur at the same time

According to the survey, 43% of BTS (British Thoracic Society) respondents gave the Department of Health in England a rating of poor or very poor in the priority they give to TB. The 2007 BTS survey saw 71% poor or very poor so this is a marked improvement. This reflects the increased priority the Department of Health has given TB, with much service improvement attributable to Department of Health funded projects such as Restructuring TB Services ‐ the multidisciplinary team project undertaken by BTS. Since it has given a priority in the year 2008, the incidents of TB are stable. But across England, the number of cases of the illness appears to be on the increase. According to the Health Protection Agency the number of people infected by the illness per year has gone up from 8,496 to 8,679. People who had been affected by the said disease are not the local once but people coming from outside the country like the migrants from Africa and Asia.

In the recent issue in Afghanistan, they begun to work on a $30 million hospital for the treatment of tuberculosis[TB], a disease that health officials say kills more than 10,000 Afghans every year,” VOA’s “Breaking News” blog reports. “The Japanese government is paying for the 80-bed center in the Afghan capital, which will also treat malaria and AIDS patients,” the news service writes, noting, “Japan is the second-largest donor to Afghanistan, after the United States.” VOA adds, “During Thursday’s groundbreaking in Kabul, Afghan Health Minister Suraya Dalil said Afghanistan ranks in the top 20 worldwide for the most TB patients,” and she noted the country has 2,000 centers nationwide that can diagnose and treat the disease. So in this, other first world countries like Japan are helping them to lessen or eventually eradicate the incident of TB and other deadly diseases.

According to the World Health Organisation, tuberculosis is a continuing public problem in developed and developing countries. Due to this, the World Health Organisation had come out with the plan of implementing the DOT or the Direct Observe therapy which started in 2006 and the result were remarkable that is why up to the present they are still using the said method of treatment in tuberculosis. One thing more is the implementation of screening test (chest X-ray) to all migrants who will enter to the specific country like in United Kingdom. They have policy that all migrants who will stay in the country for more than 6 months should have chest X-ray done and have valid reading result. They can bring their result from their own country but if they cannot produce the result in the immigration area, chest X-ray should be done before letting them inn in the country.

TASK 2

First let me define what “Public Health” is? It is the approach to medicine that is concerned with the health of the community as a whole. Public health is community health. And it has been said that it is vital to all of us at all times. Public health professionals are the one monitoring and diagnosing the health concerns of entire communities and promote healthy practices and behaviours to assure our populations stay healthy.

I have read an article about the campaign regarding tuberculosis world wide. It was held last March 2012 the 2012 World TB Day campaign will allow people all over the world to make an individual call to stop TB in their lifetimes. The Department of Health strategy for tackling TB is to help the NHS strengthen TB services in order to detect cases of TB early, and ensure completion of treatment. In addition to developing the TB Action Plan for England has: developed a set of resources, the “TB Toolkit”, on what constitutes a good TB service with advice on how to assess local needs and commission appropriate services in line with National Institute for Health and Clinical Excellence (NICE) clinical guideline. The Toolkit has been presented to Primary Care Trust (PCT) commissioners and their local service providers/public health teams via a series of regional workshops. Provided funding for the BTS (British Thoracic Society) to establish a national clinical advice network, with a multi-disciplinary make-up, offering peer support and best practice advice for the management of TB cases; implemented improvements to the current Health Protection Agency (HPA) surveillance system to enable local services to have rapid, timely and accurate information, allowing them to monitor TB cases and outcomes in their locality; funded an evaluation of the use of mobile X-ray screening in London as a tool for active case-finding. Provided funding for a TB ‘Find & Treat’ programme to support TB services in London in following-up suspected cases of TB, and diagnosed cases who have been ‘lost to follow-up’; introduced X-ray screening equipment in a number of key prisons in order to improve detection of cases among prisoners; Commissioned research on awareness of, and knowledge about, TB among certain migrant groups at higher risk of TB, and among primary care professionals. This forms the basis of further work to raise awareness of TB. For example, the DH is funding TB Alert to develop materials to raise awareness among higher risk groups, and work closely with PCTs to target these materials locally; reduced the cost of TB drugs to patients who would normally pay a prescription charge. A small amendment to the medicines charging regulations allows TB drugs to be given via TB clinics or patient group direction without a prescription charge being levied; held an expert meeting to review the TB Action Plan in England in order to identify gaps and priorities for further action.

On the other hand, tuberculosis impacts society greatly by hindering economic growth in developed and developing countries. The WHO estimates that globally tuberculosis causes $12 billion annual economic loss. Mycobacterium tuberculosis contaminates about one-third of the entire Earth’s society. It is also one of the most averaged single death affecting factors in adolescents.

It is about two point five percent of all the diseases in the world combined, there are huge consequences globally because of tuberculosis approximately two billion people in the world are infected. It is the seventh most death causing disease worldwide. About seventy-five percent of people fifteen years old to fifty-four are afflicted with this disease. In places like South East Asia and sub-Saharan Africa the rates of death caused by tuberculosis can range from ninety-five and ninety-nine percent. There are some productive drugs that sparingly helps prevent tuberculosis, for about 50 years there has been a statistics saying that every 15 seconds, one person dies due to tuberculosis. People say that this statistic is supposed to remain until the year 2020. One person with tuberculosis usually contaminates about ten to fifteen people every year.

It usually takes 1.6 billion US dollars to budget for tuberculosis control for just one severely affected country. Tuberculosis is a huge epidemic in Yemen. The majority of patients in Yemen that are contaminated by tuberculosis between the range of fifteen years old to fifty-four years old, seventy-two percent of that majority of the patients have pulmonary tuberculosis and twenty-eight percent of them have extra-pulmonary. Tuberculosis is transmitted very easily, when a person coughs they discharge a droplet nuclei which holds about ten bacilli. They are then transported by air currents, once they are breathed in they are anchored in the upper respiratory tract. Because the droplets are very small it is easier for them to stay in the air for a long amount of time. The risk of being contaminated with tuberculosis is very high in poor ventilated ares and crowded places.

There are many ways one can be infected by tuberculosis. An exposed victim will have a hundred percent chance of getting tuberculosis if they are in a very small, enclosed place with the infectious person. Poor ventilation can increase the risk because ventilation is used to remove the contagious droplet nuclei. The amount of time that you are exposed is another key factor. If the individual is exposed and is very susceptible that individual will be contaminated. There are many treatments for tuberculosis, one of them is a drug called Isoniazid it is widely used and it is for prevent tuberculosis. Another one is Rifampicin, it is very effective is non toxic. There are many others like Pyrazinamide, Thioacetazone, Streptomycin, and Ethambutol.

In Yemen, there were no studies or research conducted for a treatment for tuberculosis. But there have been many advances around the world in the past one hundred years, like in 1885 Cantan discovers nonpathogenic bacteria that reduce the amount of Mycobacterium tuberculosis. In 1944 the worlds first single anti-tuberculosis drug. Many scientists in Europe have worked hard to find a cure for Tuberculosis and in 1946 they succeeded in creating an acid that resist the bacteria, it is called PAS which stands for para-aminosalycilic acid. Soon after that they started to discover a lot more new drugs to treat tuberculosis; isoniazed was discovered in 1951, in 1954 pyrazinamide was discovered, cycloserine was discovered in 1955, ethambutol in 1962, and rifampicin was discovered in 1963. All of these have helped the spread of tuberculosis significantly lessen.

Even though many anti-tuberculosis drugs exist around the world, tuberculosis is still and epidemic in some countries because of the low economy some of the countries have. Since the countries that have tuberculosis as their epidemic have a low economy, this means that the country could not provide enough money to trade with other countries who have these drugs or the country could not afford money to provide research and studies for prevention of tuberculosis or for a cure. If each country with the anti-tuberculosis drugs would share their information with the other countries maybe tuberculosis can be eliminated from this world, because it affects the society of today’s world.

Conclusion:

Having discussed the issues regarding tuberculosis in national and international aspect; it was an eye opening to the community how to lessen the transmission of disease and at the same time how to get information; give solution to the problem. By identifying the barriers in the issue of tuberculosis such as; GPs slow to recognise and act on symptoms; non TB staff lack empathy / understanding; Psychological impact on being “isolation inpatient”; rural and inner-city health professional shortage areas; long appointment wait times, referral between hospital departments is troublesome. And another thing is the cultural beliefs about healthcare. In these barriers, the NHS is trying their best to intervene and look for a possible and healthy solution.

Further more, the link between tuberculosis and diminished growth suggests that there is a role for health programmes such as DOTS in improving not only the health of those living in the developing world, but also such individual’s wealth. Any policy would need to take into account the problems involved in scaling-up treatments in countries with limited healthcare staff and health infrastructure. Both sets of guidelines appear to support a dedicated programme to treat tuberculosis using community based methods such as those of DOTS, which do not require long periods of hospitalisation or high-level infrastructure.

References:

Future Impact of Tuberculosis | eHow.com http://www.ehow.com/facts_6216508_future-impact-tuberculosis.html#ixzz1vVOEcyBC

TB’s Impact on Women

http://www.livestrong.com/article/202018-impacts-of-tuberculosis/#ixzz1vVNlcgOL

www.news-medical.net/health/What-is-Tuberculosis.aspx

Controlling TB in London, London TB Services and Review

www.ucl.ac.uk/infection-immunity/research/res…/tb…/j_hayward

Barrier to Healthcare

www.amsa.org/programs/barriers/barriers.html

Tuberculosis in UK. What is being done?

www.bma.org.uk/health…ethics/…/Tuberculosiswhatisbeingdone.jsp

The Impact of Tuberculosis on Economic Growth – HEC Montréal

neumann.hec.ca/neudc2004/fp/grimard_franque_aout_27.pdf

Future Impact of Tuberculosis | eHow.com http://www.ehow.com/facts_6216508_future-impact-tuberculosis.html#ixzz28nhrmlUx