Take-Home Final Exam MPA-730- Health Disease, an.docx

Take-Home Final Exam
MPA-730- Health Disease, and Medical Care
Chaela Griffin
Professor Dr. Martin

1) According to the textbook, the homeless
population is considered to be amongst the vulnerable and
populations at risk (Shi & Singh, 2017). In relation to this, in
the United States women and children as well as veterans and
the severe mental ill comprise majority of the homeless
population. Furthermore, in correlation to class notes,
vulnerability is determined by the conjunction of three main
characteristics: Predisposing, Enabling, and Need. Predisposing
characteristics can be defined as attributes that lead to
vulnerability that involve demographics—gender, age and race,
social structure—geographic location, where a personal spends
most of their time, and belief systems (Shi & Singh, pg. 270,
2017). Whereas the characteristic of need can be defined as an
individual’s evaluated health status and quality-of-life factors.
For example, a need factor could be if a person has HIV or
chronic disease. Also, the vulnerable population is comprised of
those who are underserved, medically underserved and
disadvantaged, underprivileged, and American underclasses. In
regards to the homeless population having access to health care
is defective, due to the enabling characteristics. For example,
enabling characteristics correlate to socio-economic status,
individual assets—human capital, and mediating factors such as
access to health care. In addition to this, due to the
vulnerability and enabling factors the homeless population lack
minimum requirements for health insurance (Shi & Singh,

2017). Thus, they are unable to obtain any treatment for their
medical needs. Furthermore, this population lacks financial
barriers, transportation to travel to and from the medical centers
if required, a lack of address and primary care physicians,
cannot pick up medication, unsanitary, and unable to be a
productive member of society (Shi & Singh, pg. 272, 2017).
In relation to the chart in 11.2, certain populations are
at risk for poor physical, psychological, and social health more
than others. Some major factors that resonated with me most
were: African Americans have 665% higher homicide rates in
comparison to non-Hispanic whites, AIDS and Homicide are the
two leading causes of death in Hispanics, as well as alcohol use
is 43% in Hispanics (Shi & Singh, pg. 273, 2017). The fact
presented about African Americans having a 665% homicide
rate is eye opening because this is more than a majority so it is
more likely some of color will die due to murder. In reference
to AIDS and homicide being two leading causes of death was
something I did not know prior to reading this textbook, and
alcoholism was not much of a surprise but it was unbeknownst
to me that 43% of this population is expected to drink (Shi &
Singh, pg. 273, 2017). Moreover, Korean Americans have a
fivefold incidence of having stomach cancer and an eightfold
incidence of having liver cancer, is something that stood out
because there is a preconceived stigma that Asian Americans
are considered to be the healthiest population (Shi & Singh, pg.
273, 2017). Amongst the Native American population, it was
reported that poverty is associated with high injury relating to
high mortality rates in children, and the rate of death due to
alcohol is 7 times greater and the suicide rate is 3.5 times
greater than the national averages. This population is considered
to be the most at-risk population due to poverty and choices of
living this directly affects their offspring, thus, the high
mortality rates in children due to injury is a result of potential
abuse from unhappy parents. Also, alcoholism and suicide
amongst this group could be a direct correlation to ancestral
PTSD from genocide and exile.

2) In reference to class discussions and the text book,
the four main determinants of health consist of:
Predisposition— a person’s genetics or heredity make up, an
individual’s behavior and how they live their life-lifestyle, a
person’s access to medical care, and an individual’s social and
environmental factors such as income inequality or geographic
location (Shi & Singh, 2017). The government plays an active
role in trying to eliminate health disparities or address leading
health concerns within the population. For example, the Healthy
People initiative was established in 1980 to address the nation’s
health objectives within a 10-year increment plan (Shi & Singh,
pg. 41, 2017). Moreover, the initiative of the program includes
a combination of preventative services, medical care, promotion
of health, education and increase incentives to access. In order
to address the main determinants of health, Healthy People
projected a plan for the year 2020 with the goals to: make it
easily accessible to attain high-quality, longer lives with the
elimination of preventative disease—premature deaths, achieve
health equity—eliminating disparities, creating social and
physical environments that promote good health; promoting
quality of life—health behaviors and health developments (Shi
& Singh, pg.41, 2017).
The United States has both market and social
justice aspects in health care because the theoretical principle
of market justice and social is to distribute medical services
based on individual’s willingness and ability to pay; the
promotion of fair distribution of health care to make it equitable
for all. Lastly, there are four main strategies for social and
medical points of intervention which are: Social or public
policy interventions- such as OSHA which is an illness and
injury prevention program, Community-based intervention
which could be an “exchange needle” program in place to
promote health and eliminate risky behavior, health care
interventions— electronic medical records, and individual level
interventions- such as reducing the use of alcoholic or smoking

to improve the quality of life.
3) According to the textbook, the significance of the
gatekeeping role in primary care in order to reduce costs is
implied to be, the permission needed (a referral) for a patient to
be seen by a specialists or allowed to be admitted to a hospital
(Shi & Singh, 2017. This is a tactic to prevent patients
undergoing unnecessary treatment. Summarily a gatekeeper is in
charge of who/what enters or leaves the gate-permission must
be granted upon entry.
The textbook states, community health centers were
established since the 1960’s to reach and serve the medically
under severed or disadvantaged regardless of insurance or
compensation (Shi & Singh, 2017). In relation, CHC’s play a
primary role in healthcare for the underserved because they
offer services easily attainable that is funded through the
government. The CHC’s are assessed by the quality,
accessibility, and cost-effectiveness. A major challenge CHC’s
face is funding. Although the Affordable Care Act made strides
to provide funding for the CHC’s it is stated that Medicaid
reimbursement has declined due to an increase in patients on
Medicaid.
4) In most recent studies in relation to access and utilization of
healthcare it is found that the elderly population spends
majority of their time in hospitals in comparison to the younger
population (Shi & Singh, 2017). Moreover, it is found that even
after the preparation for bearing a child, women are admitted to
the hospital more likely than men however men have longer
stays. Also, the black community utilizes hospital services more
frequently than whites or Caucasians and those who are
considered poor or underserved spend more time than non-poor
individuals (Shi & Singh, 2017). However, there are multiple
factors that contribute to health outcomes such as education and
behaviors of these various groups which in turn, result in
differences in utilization and access. For example, someone who

is elderly has to stay on top of their health because they are at
much higher risk for chronic diseases in comparison to someone
who is much younger (Shi & Singh, pg. 199, 2017). The
vulnerable population are at high risk to acquire more medical
attention than someone who is not amongst this group and
women have a longer life expectancy than men so it is
imperative women stay abrupt on their health (Shi & Singh,
2017). Also, due to the increase of population there is a greater
demand for services and majority of patients seen utilize the
governments primary insurers Medicare and Medicaid (Shi &
Singh, pg. 199, 2017).
There is a total of eight hospitals that differ in services
provided and the demographics that is served. The difference in
hospitals consist of: Community, Public, Private Non-for-
Profit hospitals, Private for-profit, Specialty, Psychiatric,
Rehabilitation, and Teaching hospitals. Community hospitals
are non-federal and primarily short stay facilities that offer
services to the general public, operated by the government on a
state and local level (Shi & Singh, pg. 199, 2017). An example
of a community hospital would be a federal hospital or prison
hospital like Bellevue. Public hospitals are government owned
and offer services on a state and local level. The individuals
served primarily by public hospitals are veterans and native
Americans as well as military personnel. Private non-for-profit
hospitals are also loosely referenced as voluntary hospitals that
are privately owned by non-government entities, allowing the
facility to make a profit but are not required to pay taxes (Shi &
Singh, pg. 199, 2017). For example, a hospital like St. Jude’s
would be considered as a Private non-for-profit hospital and it
is found that facilities operated by a religious group is deemed
superior. Private for-profit hospitals are also known as investor-
owned hospitals established to operate for financial benefits and
is operated by individuals—corporations. Specialty hospitals
and facilities can include Psychiatric and Rehabilitation
hospitals whereas others can perform services in a particular
area of medicine, such as cancer. Psychiatric hospitals are used

to diagnose and treat mental ill patients, provide social work
and psychological help (Shi & Singh, pg. 199, 2017). The
Psychiatric facilities take on transfer patients from general
hospitals and are government owned. The rehabilitation
hospitals are considered to be specialty facilities where
specialized therapeutic services are offered to restore
functionality in patients with a disability due to crime or
accidents. The government and state share ownership of these
facilities. Lastly, teaching hospitals are meant for medical
students in pursuits to become a health care professional,
offering one or more graduate residence programs and approved
by the American Medical Association. Furthermore, teaching
hospitals are associated with major universities as well as
deliver specialty care to patients.
5) Case: E-Cigarettes
In relation to this case study, the United States cigarette
market is segmented by three groups: Existing cigarette
smokers, former smokers, and non-smokers (Quelch,2014). The
first group which is comprised of existing smokers may benefit
from an electronic cigarette because there is an absence of
actual tobacco, the user can smoke at his or her own leisure
indoors and out, there are multiple flavors, a limitation to smell,
and the consumer can decide the nicotine strength. In tangent to
group one, group two can benefit from e-cigarettes because they
are less toxic, and the taste of menthol can give the illusion of
smoking an actual cigarette. The non-smokers group can use the
benefits an e-cigarette because there is assorted flavors, there is
an absence of second hand smoke, there are no toxins, it
proposes a certain image of being cool, and there is lack of
social stigma in comparison to group one and two
(Quelch,2014).
In response to the rivalry of cigarettes vs. e-cigarettes,
tobacco companies should invest in e-cigarettes due the closely
related businesses. For instance, if the tobacco companies were
to invest into e-cigarettes there would be an increase in

manufacturing and revenue (Quelch,2014). In addition to this,
tobacco companies can lower the prices and tax on cigarettes to
potentially increase sales, push for regulations on e-cigarettes
by lobbying, or buy acquisition over e-cigarette companies.
Although e-cigarettes pose to be similar to actual cigarettes,
they have the potential to also pose some public benefits. For
example, the elimination of the harsh smell from actual
cigarettes can be a public benefit because it prevents second
hand smoke (Quelch,2014). Also, a public benefit from e-
cigarettes could be the prevention of contributing to global
warming by the release of harmful chemicals. However, e-
cigarettes can adversely increase the chances of cardiovascular
risk, promote convenience smoking, cause dependency amongst
youth, the vaper can be considered a pollutant and e-cigarette
companies can make misleading product claims (Quelch,2014).
Young adults and Children have a higher risk of becoming
addicted to cigarettes due to peer pressure, the stigma that
smoking is “cool,” or by predisposing factors (Quelch,2014).
Although, e-cigarettes are considered to be an alternative for
smoking real cigarettes, they are not regulated. The government
should put regulations on e-cigarettes by promoting limitation
ads, increasing taxes, posing an age limitation, regulate the
vapor or synthetic chemicals used, and study long-term effects
of e-cigarettes.
6) Case: Life, Death, Poverty Rights
South Africa is located at the most southern part of Africa
stretching from the South Atlantic to the Indian Ocean
(Spar,2005). The neighboring countries are Zimbabwe,
Botswana, and Namibia. Furthermore, South Africa has 9
provinces and 11 languages that is spoken (Spar,2005). The
population of South Africa is comprised of 55 million people
with the life expectancy of 60 years of age, 64 years of age for
women and 57 years of age for males. The former president was
Zuma and the current president is Ramapo’s (Spar,2005).
According to the article, South Africa has the highest

prevalence of HIV in the world; there is a lack of healthcare and
limitation to access of medication as well as government
interventions (Spar,2005). Moreover, this leads to the problem
of the AIDS epidemic; Individuals are not receiving adequate
care due to the lack of education, lack of access, expensive
medication, practice of safe and healthy lifestyles, government
implementation, and scarce resources of pharmaceuticals.
The blame of the AIDS crisis can fluctuate between the
government, the victim(s) as well as the Pharmaceutical
companies. The Pharmaceutical companies could be the blame
for individuals not receiving proper medication due to
unaffordable prices, lack of providing information on the drugs
distributed, and most importantly lack of educating individuals
on the risk the medication poses. The government is at fault for
not addressing and providing education on the epidemic,
providing information on health risk, establishing interventions
that could potentially save lives, and promote save sex.
Although the government is primarily at fault, the consideration
of an individual’s behavior plays a substantial role as well. In
relation to this, a person needs to take ownership in their risky
behaviors they partake in. The practice of safe sex should be
emphasized and promoted instead of the promotion of discretion
amongst those who have HIV/AIDS. Also, individuals should
take ownership of their lives and take preventative measures by
getting tested, using condoms, continue annual/semi-annual
screenings, and practice monogamy. Moreover, if I were to be
an employee of Doctors without Borders I would propose an
incentive initiative plan that would pay for the schooling of
children and young adults, in exchange for their commitment to
practice healthy lifestyles. This proposal will offer full-time
tuition for boys and girls that are active members in
participating in annual and semi-annual screenings, promotion
of practicing safe sex, and education programs implemented to
teach them about the disease, how it is acquired, and ways to
prevent contracting it. Also, if I worked for the South African
Ministry of Health, I would propose a youth outreach

mentorship program that involves children and young adults
who have HIV/AIDS and educate their community and young
peers about the epidemic, which can also be a conductive way to
create jobs for individuals in the population due to their
economic harsh ties. Furthermore, the role of a Brazil
Pharmaceutical firm, I would propose a huge involvement with
the highest risk which would be prostitutes. Brazil is known for
many things, beautiful sights, great food and of course the
women. Prostitution is legal in Brazil which means the disease
is spreading faster than most parts of the world. An impactful
and solution to lessen the spreading would be to hand out
condoms and informative pamphlets to travelers and guest of
the country and educating the prostitutes on the effects of the
disease and introduce treatments or options for a healthier path.
For the World Health Organization, I would reiterate the basics
of HIV prevention worldwide. I feel that in today’s society
STI’s are common, so common that they are beginning to lose
its importance in preventing. Most people know what the effects
are but lack the knowledge of how its spread, signs of contact
and options on preventing friends or partners from contracting.
For the Pfizer, I would propose revolution of policies, Low cost
on medication and push for more generic brand drugs rather
than name brand.
7) The economic impacts Dr. Vagelos and Merck must consider
the cost of research and medication production, the financing of
long term investments, the funds occurred over time, in pursuits
to find the correct formula, the expiration of the patient, and
poverty and access. The organizational impact that must be
considered is there is a lack of organizational presence in
Africa, which affects the destruction of drugs, also in aligned
within the company’s original goal to serve the people
regardless of cost, this factor must be considered because the
company will lose money instead of receiving profit if thee
meds are administrated. Furthermore, the strategic impact that
must considered is the difference in test animals in comparison

to humans, may cause severe reaction. Also, the image of the
company can be greatly affected because the company is well
known and have to maintain a certain image in completion with
other pharmacy companies. Merck & Co. is a pharmacy
company that is a large non for profit that is driven by research
and science. Although I’m aware of the outcome, Merck & Co.
should not invest in Campbell’s idea due to a lack of sufficient
research proving its effectiveness. Also, Investment in
Campbell’s idea would be bad for Merck & Co because they
wouldn’t benefit financially. For instance, if I would invest in
Campbell’s Idea and scientists came to me with similar pursuits,
I would not invest because I will take great loss. In reference,
though it may be beneficial to the greater good, proving the
services will hurt my company. As a business owner it’s
difficult to make decisions based off good will when it comes
down to the bigger dollar. Without disrespect to any unfortunate
people, would rather focus on my business than lose profits
even if it for a good cause.
The stakes of administering the drugs for free may cause
disturbance in the industry because other scientist and
companies will try to pursue the same thing, being that its
unprofitable it will be a negative for the company. Knowing the
outcome, I believe Merck shouldn’t give the drug away. There
is a lot at stake in taking responsibility to distribute the drug
such as the fall of his business if the drug is unsuccessful or
have negative reactions. If Merck gave the drug away, I
wouldn’t publicize the decision in case of the previous reasons
and by keeping it private it gives his company a thoughtful
integrality and can easily bounce back in case of any flaws in
the drug.
8) Haiti, although beautiful and rich with culture, is a
developing country with a tragic history of natural disasters,
poverty, racial tension and political failures. The most
vulnerable children to be malnourished are the ones located in

rural areas, newborns, children under two and EBF children.
Some underlining causes of malnutrition in kids in Haiti include
but doesn’t exclude food security, socio economic status—low
income families, high prices in food, poor access to health care,
as well as preventative measures vacancy. According to the
article, Haiti was declared to be under the state of an emergency
because majority of the population’s children were moderately
acute malnourished with little to no resources available, for
long periods of time. In relation to the article, NGO’s did not
want to follow Dr. Marhone’s suggestion to address the
malnutrition because her proposal was not evidence based.
Furthermore, there were a lack of resources without a treatment
follow-up, and the proposal was flawed because there were
different protocols with patients who were Moderately acute
malnourished and considered Severe Acute Malnutrition. The
Ministry of Health should consider an educational program that
teaches mothers the benefits of breastfeeding, how to
breastfeed, and educate mothers on ways to access high protein
foods to feed their children. In 2008 the treatment plans for
malnutrition included Akamil nutrition counseling, enriched
milk and breast feeding programs. Malnutrition is not prevalent
on a global scale because it is underreported and they’re
economic and political policies in place to address malnutrition.
References:
Shi, L., Singh, D, A., (2017). Essentials of The U.S. Health
Care System. Burlington, MA: Jones & Bartlett Learning.
-In regards to my responses, I used majority of our power point
slides as well as the overall discussions from the notes in class,
pertaining to the case studies. I did not know how to cite our

power point slides but I did not stray from using the textbook
and class notes along with self-thought. I did, however, in-text
cite or attempt to properly cite the articles used for the case
studies.
Thank you in advance for a great semester.
California State University San Bernardino
Department of Natural Science
Main campus
NSCI 351: Health and Human Ecology
Spring Quarter 2019
Term Paper
Guidelines
1. Identify a Health, Human or Ecological Topic for
Analysis.
2. Describe the topic and how it relates to the Course, Course
Concepts and/or principles.
3. Analyze the Decision-Making Process (Human) or the
Environmental (Ecological) application that is used for your
topic
4. What is the reason for your interest or analysis?
5. What changes or recommendations should be made?

6. Would you try to influence your area of interest?
Why or why not? How?
Note: The 6-8 page paper must be typed (12-14 point font), with
separate reference (scholarly using MLA, APA or Scientific)
and title page.
Thoughts:
1) Term Paper for Health; Water or Air Quality(Indoor),
Asthma, Food Safety, Nutrition , GMO’s vs Organic, Obesity,
Drugs and addictions
2) Term Paper for Human Ecology; Poverty, Housing, Wastes,
Sanitation, Food Security and, Human Hazards (Radiation, and
Pesticides); or School Dropouts, Juvenile delinquency and
Crime
3) Natural Hazards (Fire, Flood, Freezing, Earthquakes), and
Disease epidemiology (Ebola, malaria etc.)
4) Science information/data/research can be used for advocacy
of a special interest group, showing differences of expert s,
contrasting positions and taking-sides or showing the trade-offs.
How are Impacts or hazards measured or assessed? i.e. cost-
benefit analysis, risk assessment, or health/ecological
thresholds/indicators.
What are the time frames for decisions? Emergency, Law
Enforcement procedures, planning process
Is there an environmental health strategy; Health
Education/Promotion, Design with Nature, pollution prevention,
or environmental enhancement.
NSCI 351 Booklist

1. The Worst Hard Time: The Untold Story of Those Who
Survived the Great American Dust Bowl –Timothy Egan
2. A Fine Balance by Rohinton Mistry (India Sterilization-
Chapter 2)
3. The Omnivore’s Dilemma by Micheal Pollan (Meat Industry)
4. In Defense of Food by Micheal Pollan (Corn Syrup)
5. The Blue Zones: Lessons for Living Longer From the People
Who've Lived the Longest by Dan Buettner
6. The Good Gut: Taking Control of Your Weight, Your Mood,
and Your Long-term Health by Drs. Justin Sonnenburg and
Erica Sonnenburg (Health)
7. Grain Brain by Dr. David Perlmutter
8. Twelve Diseases that Changed the World by Irwin Sherman
9. Collapse: How Societies Choose to Fail or Succeed by Jared
Diamond (Civilizations)
10. Guns, Germs, and Steel: The Fates of Human Societies by
Jared Diamond
11. Brain Rules by John Medina (Healthy Brain)
12. The Shallow: What the Internet Is Doing to Our Brains by
Nicholas Carr
(Internet reworking our brains)
13. Climate Change: The Facts by Alan Moran and etc. (Not
man-made)
14. I Eat: Around the World in 80 Diets by Peter Menzel, Faith
D'Aluisio
15. Hungry Planet: What the World Eats by Peter Menzel, Faith
D'Aluisio
16. This Changes Everything: Capitalism vs. The Climate by
Naomi Klein
17. The Glass Castle: A Memoir by Jeannette Walls
(Homelessness)
18. The Ghost Map by Steve Johnson (Cholera in London)
19. How Not to Die by Michael Gregor (Nutritional Foods)
20. A Framework for Understanding Poverty by Ruby Payne
21. Silent Spring by Rachael Carson

22. When Breath becomes Air by Paul Kalanthi
23. FactFulNess by Hans Rosling
NSCI Movie List
1. Temple Grandin (Livestock Industry)
2. City of God (Brazil Favellas/Shanty Towns)
3. Darwin’s Dilemma (Invasive Species-Lake Victoria)
4. Forks Over Knives (Documentary)
5. Cosmos (Documentary-Episode “The Clean Room”- Lead in
Gasoline)
6. Philadelphia (AIDS)
7. The Big Short (Housing)
8. The Soloist (Homelessness)
9. Climate Hustle (Documentary)
10. What the Health(Documentary)-Links between diet and
disease
11. What happened to Monday? (Sci-Fi-Pop Control)
12. Soylent Green, (feed people)
13. “Global Waste-Food Waste”-Netflix
14. “A Plastic Ocean” (Documentary)

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