The Reality of Re-Entry
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O N E Introduction and Overview he Emerging Importance.docx
O N E
Introduction and Overview
/he Emerging Importance of Prisoner Reentry3
to Crime and Community
ne of the most profound challenges facing American so-0ciety is the reintegration of more than 600,000 adults-
about 1,600 a day-who leave state and federal prisons and return
home each year. As of 2002, the nation’s prison population exceeded
1.4 million, and despite all of the attention given to the death penalty
and life-without-parole sentences, just 7 percent of all prisoners are
serving death or life sentences, and only a fraction of inmates-about
3,000 each year-die in prison. Thus, 93 percent of all prison in-
mates are eventually released.
Moreover, although the average prison term served is now 2.5
years, many prison terms are short enough so that 44 percent of all
those now housed in state prisons are expected to be released within
the year. Although prisons currently take in about 20.000 more pris-
oners than they let out, it is expected that by 2004 the ratio of admis-
sions to releases will he 1:1.
How we plan for inmates’ transition to free living-including how
they spend their time during confinement, the process by which they
are released, and how they are supervised after release-is critical to
public safety. This process is called prisoner reentry and, simply de-
fined, includes all activities and programming conducted to prepare
ex-convicts to return safely to the community and to live as law-
abiding citizens.
Most of those released from prison today have serious social and
medical problems. They remain largely uneducated, unskilled, and
usually without solid family supports-and now they have the
added stigma of a prison record and the distrust and fear that it in-
evitably elicits. About three-quarters of all prisoners have a historv of
substance abuse, and one in six suffers from mental illness. Despite
these needs, fewer than one-third of exiting prisoners receive sub-
stance abuse or mental health treatment while in prison. And while
3
4 WHEN PRISONERS COME HOME
the federal government has provided some states with additional
funding to increase drug treatment in prison, the percentage of state
prisoners participating in such programs has been declining, from 25
percent in 1991 to 10 percent in 1997 (Mumola 1999).
A significant share of the prison population also lives with an in-
fectious disease. At the end of 1999, 2.3 percent of the state prison
population was IIIV-positive or had AIDS, a rate five times higher
than that of the t7.S. population. According to the National Commis-
sion on Correctional Health Care ( Z O O Z ) , about one-quarter of all in-
dividuals living with HIV or AIDS in the United States pass through
a correctional facility (prison or jail) during any given year. Public
health experts believe HIV will continue to escalate within prisons
and eventually affect prevalence rates in the general community, as
we incarcerate and release more drug offende.
21 minutes agoAmy Miller RE Discussion - Week 9COLLAPSE.docx
21 minutes ago
Amy Miller
RE: Discussion - Week 9
COLLAPSE
Top of Form
NURS 6050C: Policy and Advocacy for Improving Population Health
Main Question Post. Lena is in a precarious situation. There are times in the field of nursing one must make ethical decisions in uncharted waters. If Lena resided in the state of Florida, she would have likely undergone a counseling course and would know the patient must be given informed consent prior to the test’s administration, the patient must be administered pre and post test counseling, offered the availability of testing anonymously, and partner notification of testing results is not mandated by law (The Center for HIV Law & Policy, n.d.).
Florida law does, however, permit (not require) a healthcare professional under the auspice of the Department of Health to make known the positive test results to the sexual partner or needle sharing partner of the patient with a positive test result (Florida Department of Health, 2018, p.25). Lena would not face prosecution for violating confidentiality laws under this situation in the state of Florida, provided she had knowledge her sister was sexually intimate with the boyfriend.
Ethically, I personally think Lena should give the patient the option to discuss the diagnosis with the sexual partner first. The American Nurses Association (ANA), provision eight, infers that the individual needs of one person are trumped by the good of the community and or world and the provision is associated with public health nursing (Fowler, & ANA, 2008, p. 106-108). Provision eight also looks at the personal side of nursing as nurses form bonds with the patient (Fowler, & ANA, 20018, p. 108). If Lena is able to maintain professionalism and a nonjudgmental attitude, provision eight could be used to back Lena’s stance.
I would side with Lena in the current situation and research to find additional legal and ethical support allowing for the notification of the positive test results to the sister. Despite the fact people can now live longer periods of time with the Human Immunodeficiency Virus (HIV), there is no cure, and sexual transmission is a definite mode of contraction for the communicable disease – living longer means needing treatment – obtaining treatment requires knowledge. I would want any person having had sexual relations in the previous ten years with the seropositive patient as well as any current sexual partners to be notified. An uninformed person is not making accurate health decisions.
References
American Nurses Association. (2010). Nursing’s social policy statement: The essence of the
Profession. Silver Spring, MD: American Nurses Association.
American Nurses Association. (2010). Nursing: Scope & standards of practice. Silver Spring,
MD: American Nurses Association.
Florida Department of Health. (2018). FDOH the basics of HIV/AIDS counseling, testing,
and linkage cour.
Demystifying Health Insurance
Understanding the vocabulary of health insurance helps in selecting and using coverage effectively. eHealthInsurance commissioned a national study to determine public awareness of select health insurance terminology and the specifics of health insurance coverage. Americans admit to a health insurance vocabulary deficit.
Only a fourth (23%) feel they are very sure of what the terminology used in their health insurance policy actually means.
A third are somewhat sure of what the terminology actually means (32%).
One-fourth are not very sure (13%) or have no idea (10%) what the terminology used in their health insurance policy means.
One-fifth report they don’t have health insurance (21%).
The public demonstrates its lack of familiarity with health insurance terminology by not knowing what some of the key abbreviations stand for.
Only one-third of Americans (36%) can volunteer that HMO stands for health maintenance organization.
Only one-fifth (20%) recall that PPO stands for Preferred Provider Organization.
Only one out of nine (11%) recalls that HSA stands for Health Savings Account.
When asked how sure they were with some of the specifics of their health insurance policy, most people said they were very sure of the amount of their co-payment (61%), but half or fewer were very sure they knew the amounts of other basic elements of their coverage:
Half said they were very sure of what they paid for their health insurance premiums (50%).
45% were very sure of their annual deductible.
41% were very sure of the level of their plan’s co-insurance.
35% were very sure of their maximum annual out-of-pocket costs.
For each of these items, one-fifth indicated that the questions were not relevant since they did not have health insurance (21%).
Guiding Lights Presentation 09032011
What is Guiding Lights? Who do we serve? What Do we do? We have served over 1,000 family caregivers since opening in October 2011
the graying of america challenges and controversies spring 20.docx
the graying of america: challenges and controversies spring 2012 17
Can Health Care
Rationing Ever
Be Rational?
David A. Gruenewald
Case Study
Mr. M. was a 77-year-old decisionally incapacitated
long-term nursing home resident with chronic schizo-
phrenia who was admitted to the hospital with a
bacterial pneumonia. His past medical history was
notable for deteriorating functional status over the
past 2-3 years, urinary retention requiring chronic
indwelling bladder catheterization, and two recent
hospitalizations for urinary tract infections leading
to sepsis. He developed respiratory failure soon after
admission and was intubated and placed on mechani-
cal ventilation. Follow-up studies suggested worsen-
ing pneumonia and acute respiratory distress syn-
drome (ARDS), as well as worsening kidney function.
The patient was unable to participate in any decision
making. His guardian requested that cardiopulmo-
nary resuscitation and all other intensive care be pro-
vided if necessary, including dialysis should Mr. M.’s
kidney failure continue to worsen. After five days of
mechanical ventilation, the patient was weaned from
the ventilator and extubated. The palliative care ser-
vice was consulted following the extubation; his criti-
cal care team questioned whether it would be appro-
priate to re-intubate the patient if he again developed
respiratory failure. The palliative care team contacted
Mr. M.’s brother, his only living relative, who felt the
patient’s quality of life was poor and believed the
patient would not want aggressive medical care. The
staff at his nursing home was contacted, as well as
the patient’s mental health case manager, who had all
known Mr. M. for many years. All concurred with his
brother’s assessment. Additionally, the nursing home
staff said that Mr. M. would not be able to return there
if the plan was to continue more intensive medical
management of his worsening health conditions. Hos-
pice care was discussed with these parties, and it was
thought that choosing hospice would best represent
the patient’s wishes under the circumstances. The pal-
liative care team contacted his guardian and explained
the patient’s medical situation and its implications
for his ongoing care (including the need for physical
restraints, loss of stable nursing home placement, and
confinement to the acute care hospital environment
for the duration of his acute illness). Based on this new
David A. Gruenewald, M.D., is an Associate Professor of
Medicine at the University of Washington School of Medi-
cine in Seattle, Washington, and the Associate Director of the
Palliative Medicine Fellowship at the University of Wash-
ington. He is the Medical Director of the Palliative Care and
Hospice Service at VA Puget Sound Health Care System in
Seattle, Washington. He received his Bachelor of Arts (B. A.)
degree from Reed College in Portland, Oregon, and his Medical
Doctor (M.D.) degree from the University of C ...
Recommended
O N E Introduction and Overview he Emerging Importance.docx
O N E
Introduction and Overview
/he Emerging Importance of Prisoner Reentry3
to Crime and Community
ne of the most profound challenges facing American so-0ciety is the reintegration of more than 600,000 adults-
about 1,600 a day-who leave state and federal prisons and return
home each year. As of 2002, the nation’s prison population exceeded
1.4 million, and despite all of the attention given to the death penalty
and life-without-parole sentences, just 7 percent of all prisoners are
serving death or life sentences, and only a fraction of inmates-about
3,000 each year-die in prison. Thus, 93 percent of all prison in-
mates are eventually released.
Moreover, although the average prison term served is now 2.5
years, many prison terms are short enough so that 44 percent of all
those now housed in state prisons are expected to be released within
the year. Although prisons currently take in about 20.000 more pris-
oners than they let out, it is expected that by 2004 the ratio of admis-
sions to releases will he 1:1.
How we plan for inmates’ transition to free living-including how
they spend their time during confinement, the process by which they
are released, and how they are supervised after release-is critical to
public safety. This process is called prisoner reentry and, simply de-
fined, includes all activities and programming conducted to prepare
ex-convicts to return safely to the community and to live as law-
abiding citizens.
Most of those released from prison today have serious social and
medical problems. They remain largely uneducated, unskilled, and
usually without solid family supports-and now they have the
added stigma of a prison record and the distrust and fear that it in-
evitably elicits. About three-quarters of all prisoners have a historv of
substance abuse, and one in six suffers from mental illness. Despite
these needs, fewer than one-third of exiting prisoners receive sub-
stance abuse or mental health treatment while in prison. And while
3
4 WHEN PRISONERS COME HOME
the federal government has provided some states with additional
funding to increase drug treatment in prison, the percentage of state
prisoners participating in such programs has been declining, from 25
percent in 1991 to 10 percent in 1997 (Mumola 1999).
A significant share of the prison population also lives with an in-
fectious disease. At the end of 1999, 2.3 percent of the state prison
population was IIIV-positive or had AIDS, a rate five times higher
than that of the t7.S. population. According to the National Commis-
sion on Correctional Health Care ( Z O O Z ) , about one-quarter of all in-
dividuals living with HIV or AIDS in the United States pass through
a correctional facility (prison or jail) during any given year. Public
health experts believe HIV will continue to escalate within prisons
and eventually affect prevalence rates in the general community, as
we incarcerate and release more drug offende.
21 minutes agoAmy Miller RE Discussion - Week 9COLLAPSE.docx
21 minutes ago
Amy Miller
RE: Discussion - Week 9
COLLAPSE
Top of Form
NURS 6050C: Policy and Advocacy for Improving Population Health
Main Question Post. Lena is in a precarious situation. There are times in the field of nursing one must make ethical decisions in uncharted waters. If Lena resided in the state of Florida, she would have likely undergone a counseling course and would know the patient must be given informed consent prior to the test’s administration, the patient must be administered pre and post test counseling, offered the availability of testing anonymously, and partner notification of testing results is not mandated by law (The Center for HIV Law & Policy, n.d.).
Florida law does, however, permit (not require) a healthcare professional under the auspice of the Department of Health to make known the positive test results to the sexual partner or needle sharing partner of the patient with a positive test result (Florida Department of Health, 2018, p.25). Lena would not face prosecution for violating confidentiality laws under this situation in the state of Florida, provided she had knowledge her sister was sexually intimate with the boyfriend.
Ethically, I personally think Lena should give the patient the option to discuss the diagnosis with the sexual partner first. The American Nurses Association (ANA), provision eight, infers that the individual needs of one person are trumped by the good of the community and or world and the provision is associated with public health nursing (Fowler, & ANA, 2008, p. 106-108). Provision eight also looks at the personal side of nursing as nurses form bonds with the patient (Fowler, & ANA, 20018, p. 108). If Lena is able to maintain professionalism and a nonjudgmental attitude, provision eight could be used to back Lena’s stance.
I would side with Lena in the current situation and research to find additional legal and ethical support allowing for the notification of the positive test results to the sister. Despite the fact people can now live longer periods of time with the Human Immunodeficiency Virus (HIV), there is no cure, and sexual transmission is a definite mode of contraction for the communicable disease – living longer means needing treatment – obtaining treatment requires knowledge. I would want any person having had sexual relations in the previous ten years with the seropositive patient as well as any current sexual partners to be notified. An uninformed person is not making accurate health decisions.
References
American Nurses Association. (2010). Nursing’s social policy statement: The essence of the
Profession. Silver Spring, MD: American Nurses Association.
American Nurses Association. (2010). Nursing: Scope & standards of practice. Silver Spring,
MD: American Nurses Association.
Florida Department of Health. (2018). FDOH the basics of HIV/AIDS counseling, testing,
and linkage cour.
Demystifying Health Insurance
Understanding the vocabulary of health insurance helps in selecting and using coverage effectively. eHealthInsurance commissioned a national study to determine public awareness of select health insurance terminology and the specifics of health insurance coverage. Americans admit to a health insurance vocabulary deficit.
Only a fourth (23%) feel they are very sure of what the terminology used in their health insurance policy actually means.
A third are somewhat sure of what the terminology actually means (32%).
One-fourth are not very sure (13%) or have no idea (10%) what the terminology used in their health insurance policy means.
One-fifth report they don’t have health insurance (21%).
The public demonstrates its lack of familiarity with health insurance terminology by not knowing what some of the key abbreviations stand for.
Only one-third of Americans (36%) can volunteer that HMO stands for health maintenance organization.
Only one-fifth (20%) recall that PPO stands for Preferred Provider Organization.
Only one out of nine (11%) recalls that HSA stands for Health Savings Account.
When asked how sure they were with some of the specifics of their health insurance policy, most people said they were very sure of the amount of their co-payment (61%), but half or fewer were very sure they knew the amounts of other basic elements of their coverage:
Half said they were very sure of what they paid for their health insurance premiums (50%).
45% were very sure of their annual deductible.
41% were very sure of the level of their plan’s co-insurance.
35% were very sure of their maximum annual out-of-pocket costs.
For each of these items, one-fifth indicated that the questions were not relevant since they did not have health insurance (21%).
Guiding Lights Presentation 09032011
What is Guiding Lights? Who do we serve? What Do we do? We have served over 1,000 family caregivers since opening in October 2011
the graying of america challenges and controversies spring 20.docx
the graying of america: challenges and controversies spring 2012 17
Can Health Care
Rationing Ever
Be Rational?
David A. Gruenewald
Case Study
Mr. M. was a 77-year-old decisionally incapacitated
long-term nursing home resident with chronic schizo-
phrenia who was admitted to the hospital with a
bacterial pneumonia. His past medical history was
notable for deteriorating functional status over the
past 2-3 years, urinary retention requiring chronic
indwelling bladder catheterization, and two recent
hospitalizations for urinary tract infections leading
to sepsis. He developed respiratory failure soon after
admission and was intubated and placed on mechani-
cal ventilation. Follow-up studies suggested worsen-
ing pneumonia and acute respiratory distress syn-
drome (ARDS), as well as worsening kidney function.
The patient was unable to participate in any decision
making. His guardian requested that cardiopulmo-
nary resuscitation and all other intensive care be pro-
vided if necessary, including dialysis should Mr. M.’s
kidney failure continue to worsen. After five days of
mechanical ventilation, the patient was weaned from
the ventilator and extubated. The palliative care ser-
vice was consulted following the extubation; his criti-
cal care team questioned whether it would be appro-
priate to re-intubate the patient if he again developed
respiratory failure. The palliative care team contacted
Mr. M.’s brother, his only living relative, who felt the
patient’s quality of life was poor and believed the
patient would not want aggressive medical care. The
staff at his nursing home was contacted, as well as
the patient’s mental health case manager, who had all
known Mr. M. for many years. All concurred with his
brother’s assessment. Additionally, the nursing home
staff said that Mr. M. would not be able to return there
if the plan was to continue more intensive medical
management of his worsening health conditions. Hos-
pice care was discussed with these parties, and it was
thought that choosing hospice would best represent
the patient’s wishes under the circumstances. The pal-
liative care team contacted his guardian and explained
the patient’s medical situation and its implications
for his ongoing care (including the need for physical
restraints, loss of stable nursing home placement, and
confinement to the acute care hospital environment
for the duration of his acute illness). Based on this new
David A. Gruenewald, M.D., is an Associate Professor of
Medicine at the University of Washington School of Medi-
cine in Seattle, Washington, and the Associate Director of the
Palliative Medicine Fellowship at the University of Wash-
ington. He is the Medical Director of the Palliative Care and
Hospice Service at VA Puget Sound Health Care System in
Seattle, Washington. He received his Bachelor of Arts (B. A.)
degree from Reed College in Portland, Oregon, and his Medical
Doctor (M.D.) degree from the University of C ...
Sensitive Health Care Services in the Era of Electronic Health Records
Sensitive Health Care Services in the Era of Electronic Health Records Philip R. Lee Institute for Health Policy Studies
Access to confidential care is critical for adolescents and young adults, particularly those seeking sensitive services, including sexual and reproductive health, mental health and substance abuse services. Implementation of the Affordable Care Act (ACA) brings new opportunities and challenges for adolescents and young adults.
Authors: Sara Daniel, MPH, Jan Malvin, PhD, Carolyn B. Jasik, MD, Claire D. Brindis, DrPHTeen Pregnancy A Preventable Epidemic Our natio.docx
Teen Pregnancy: A Preventable Epidemic
Our nation is facing an adolescent reproductive-health crisis, with one in four teenage
girls having a sexually transmitted disease, and one in three becoming pregnant before
the age of 20.1 To address this challenge, teens must be able to obtain confidential and
affordable reproductive-health services. However, anti-choice politicians have stymied
efforts to give teens the tools they need to protect themselves against unintended
pregnancy and sexually transmitted diseases (STDs). We continue to call on lawmakers
– pro-choice and pro-life alike – to work together to achieve real solutions – instead of
divisiveness.
The Facts
In spite of a recent decline, the United States still has the highest rate of teen pregnancy
in the western industrialized world.2 Studies show that the United States’ teen-
pregnancy rate is more than twice that of Canada and Sweden.3
§ Approximately 750,000 young women in the United States become pregnant each
year. Eighty-two percent of teen pregnancies are unplanned 4 and more than a
quarter of those end in abortion.5
§ Teen mothers are less likely to complete school, less likely go to college, more
likely to have large families, and more likely to stay single – increasing the
likelihood that their children will live in poverty.6
§ In addition to other consequences for young women and their children, teen
childbearing costs U.S. taxpayers at least $11 billion annually.7
§ A sexually active teen who does not use contraception has a 90-percent chance of
becoming pregnant within a year.8
Potentially due to factors such as decreased access to health-care services and
information, racial and ethnic disparities persist in the reproductive health of young
Americans.
§ The problem of teen pregnancy is more pronounced in the African-American and
Latino communities, where rates of teen pregnancy are higher than those in
white communities – 15 percent and 14 percent respectively, compared to five
percent.9
2
§ Fifty-three percent of Latina teens and 51 percent of African-American teen girls
will become pregnant at least once before they turn 20. In comparison, only 19
percent of non-Hispanic white teen girls will become pregnant before the age of
20.10
A Failed Approach
Anti-choice lawmakers and advocates seized on this public-health crisis as an
opportunity to enact one of their longtime goals: withhold sex education from young
people in a misguided attempt to discourage them from having sex. Instead, they spent
more than $1 billion in taxpayer funds on “abstinence-only” programs11 – programs that
censor vital health information about contraception and safe sex. The approach has been
a spectacular failure.
§ Research shows that “abstinence-only” programs do not work and that
comprehensive sex-education programs do. In 2007, a report commissioned by
the U.S. Department of H ...
6Accessing Health CareLearning ObjectivesAfter rea.docx
6
Accessing Health Care
Learning Objectives
After reading this chapter, you should be able to:
• Identify where access barriers originate.
• Examine the organizational barriers to accessing health services as experienced by
vulnerable populations.
• Explain the financial barriers to accessing health services as experienced by vulnerable
populations.
• Consider ways to improve access to health care.
• Explain the politico-social forces affecting access to health care.
Courtesy of Beerkoff/Fotolia
bur25613_06_c06_173-194.indd 173 11/26/12 2:49 PM
CHAPTER 6
Self-Check
Answer the following questions to the best of your ability.
1. Which populations face access barriers to health care in both financial and orga-
nizational forms?
a. vulnerable
b. naturalized citizens
c. employed
d. school-age children
Critical Thinking
The text states, “More physicians abandon small private practices in favor of joining large health care
conglomerates.” Do you think that these larger corporations would be more willing to accept Medicaid
patients and thus increase accessibility?
Introduction
Introduction
Though institutionalized racial segregation ended decades ago, many would argue that Americans continue to be segregated by
socioeconomic class. Economic status determines
where people live and attend school, and even
where they go to the doctor. Vulnerable popula-
tions face access barriers to health care in both
financial and organizational forms. For example,
many physicians do not accept patients on Med-
icaid, and many who do limit the number to a
certain percentage of their practices or a certain
number of appointments per week. This creates
an organizational barrier to health care access for
Medicaid recipients. At the same time, many low-
income people struggle to find the money to pay
for services that aren’t covered by Medicaid or the
co-pays on the services covered by their employ-
ers’ insurance, thereby creating a financial barrier
to access. As more physicians abandon small pri-
vate practices in favor of joining large health care
conglomerates where they can improve reim-
bursement rates and lower malpractice insurance
rates, and more people receive Medicaid or Medi-
care, reliable access for the vulnerable becomes
increasingly tenuous.
Courtesy of Sheri Armstrong/Fotolia
Though a patient may be covered by
Medicaid, many are unable to take full
advantage of that coverage because of
physician-imposed limits and restrictions.
bur25613_06_c06_173-194.indd 174 11/26/12 2:49 PM
CHAPTER 6Section 6.1 Organizational Barriers
2. Many physicians limit the number of what types of patients to a certain percentage
of their practices or to a certain number of appointments per week?
a. HIV/AIDS
b. elderly
c. those on Medicaid
d. charitable cases
3. Many low-income people struggle to find the money to pay for what services
covered by their employers’ insurance?
a. enrollment fees
b. wag ...
PCG Human Services White Paper - Transitional Aged Youth Need Supports to Ach...
PCG Human Services White Paper - Transitional Aged Youth Need Supports to Ach...Public Consulting Group
Public Health in the Correctional Setting: Challenges & Opportunities
Presented at the Maine Public Health Associations' Annual Meeting - October 5, 2010
More than 1 in 5 Americans are unpaid caregivers
A large, national survey conducted by the CDC in 44 states, D.C., and Puerto Rico finds that more than 20% of Americans are unpaid caregivers. Here's more:
•Overall trends: Between 2015-2017, nearly 21% of people who responded to a phone survey on health risks were classified as unpaid caregivers. An additional 17% said they expected to become caregivers in the two years following the survey.
•Demographics: Nearly 60% of caregivers were women, and nearly 45% of caregivers were aged 45 and younger.
•Regional trends: 14% of those in Puerto Rico reported being caregivers, compared to more than 28% of those in Tennessee. Unpaid caregivers were most common in Tennessee, Alabama, Arkansas, and Louisiana, all with a 25% or higher prevalence.
Mythbusters 2012
Presentation made at the annual conference of the National Association of Workforce Development Professionals (May 2012)
Virginia Law Enforcement Leaders: Cutting Crime and Prison Costs - Extending ...
Virginia Law Enforcement Leaders: Cutting Crime and Prison Costs - Extending ...Natasha O'Dell Archer, J.D.
Fight Crime: Invest in Kids/ Council For A Strong America ReportPew Internet Project, Chronic Disease and Internet Use
U.S. adults living with chronic disease are significantly less likely than healthy adults to have access to the internet (62% vs. 81%). The internet access gap creates an online health information gap. However, lack of internet access, not lack of interest in the topic, is the primary reason for the difference. Once online, having a chronic disease increases the probability that someone will take advantage of social media to share what they know and learn from their peers.
1 Department of Health and Human Performance, College of Ch
1 Department of Health and Human Performance, College of Charleston,
Charleston, SC, USA
2 Department of Health Sciences, James Madison University, Harrisonburg,
VA, USA
3 Department of Health Behavior and Health Systems, University of North
Texas Health Science Center, Fort Worth, TX, USA
4 Department of Anthropology, Rollins College, Winter Park, FL, USA
5 Department of Social and Behavioral Sciences, College of Public Health,
Temple University, Philadelphia, PA, USA
Corresponding Author:
Sarah B. Maness, PhD, College of Charleston, Department of Health and
Human Performance, 24 George St, Charleston, SC 29401, USA.
Email: [email protected] cofc. edu
Commentary
Public Health Reports
2021, Vol. 136(1) 18-22
© 2020, Association of Schools and
Programs of Public Health
All rights reserved.
Article reuse guidelines:
sagepub. com/ journals- permissions
DOI: 10. 1177/ 0033 3549 20969169
journals. sagepub. com/ home/ phr
Social Determinants of Health and
Health Disparities: COVID-19 Exposures
and Mortality Among African American
People in the United States
Sarah B. Maness, PhD1 ; Laura Merrell, PhD2; Erika L. Thompson, PhD3 ;
Stacey B. Griner, PhD3 ; Nolan Kline, PhD4; and Christopher Wheldon, PhD5
The coronavirus disease 2019 (COVID-19) pandemic in the
United States provides yet another example of the enduring
and pernicious effect of social determinants of health (SDH)
on African American communities. SDH, as defined by the
Healthy People 2020 SDH framework, include domains of
economic stability, education, social and community con-
text, health and health care, and neighborhood and built
environment.1 Within each domain, key areas represent ele-
ments of focus for the decade (Box). Compared with non-
Hispanic White people, African American people have
higher rates of COVID-19 cases (2.6 times higher), hospital-
ization (4.7 times higher), and death (2.1 times higher).2-4
Although the pandemic is ongoing, it is not premature to call
attention to the root causes of health inequity in the United
States that have persisted for decades and are being high-
lighted in the current crisis.
The disparities in COVID-19 case fatality rates between
African American and White people have been referred to
as a “perfect storm.”5 Such a comparison obfuscates the
larger social and political circumstances that structure poor
health. Unlike a storm, which is a natural phenomenon that
cannot be prevented, the higher rate of COVID-19 deaths
among African American people was predictable and pre-
ventable because of racial injustice. These deaths were pre-
dictable because of the long history of health inequities in
the United States and preventable through systemic changes
to eliminate systemic racism and improve SDH. The social
and political will needed to correct these injustices histori-
cally has been, and continues to be, lacking. SDH underlie
health disparities that increase the potential for exposure t ...
1 Department of Health and Human Performance, College of Ch
1 Department of Health and Human Performance, College of Charleston,
Charleston, SC, USA
2 Department of Health Sciences, James Madison University, Harrisonburg,
VA, USA
3 Department of Health Behavior and Health Systems, University of North
Texas Health Science Center, Fort Worth, TX, USA
4 Department of Anthropology, Rollins College, Winter Park, FL, USA
5 Department of Social and Behavioral Sciences, College of Public Health,
Temple University, Philadelphia, PA, USA
Corresponding Author:
Sarah B. Maness, PhD, College of Charleston, Department of Health and
Human Performance, 24 George St, Charleston, SC 29401, USA.
Email: [email protected] cofc. edu
Commentary
Public Health Reports
2021, Vol. 136(1) 18-22
© 2020, Association of Schools and
Programs of Public Health
All rights reserved.
Article reuse guidelines:
sagepub. com/ journals- permissions
DOI: 10. 1177/ 0033 3549 20969169
journals. sagepub. com/ home/ phr
Social Determinants of Health and
Health Disparities: COVID-19 Exposures
and Mortality Among African American
People in the United States
Sarah B. Maness, PhD1 ; Laura Merrell, PhD2; Erika L. Thompson, PhD3 ;
Stacey B. Griner, PhD3 ; Nolan Kline, PhD4; and Christopher Wheldon, PhD5
The coronavirus disease 2019 (COVID-19) pandemic in the
United States provides yet another example of the enduring
and pernicious effect of social determinants of health (SDH)
on African American communities. SDH, as defined by the
Healthy People 2020 SDH framework, include domains of
economic stability, education, social and community con-
text, health and health care, and neighborhood and built
environment.1 Within each domain, key areas represent ele-
ments of focus for the decade (Box). Compared with non-
Hispanic White people, African American people have
higher rates of COVID-19 cases (2.6 times higher), hospital-
ization (4.7 times higher), and death (2.1 times higher).2-4
Although the pandemic is ongoing, it is not premature to call
attention to the root causes of health inequity in the United
States that have persisted for decades and are being high-
lighted in the current crisis.
The disparities in COVID-19 case fatality rates between
African American and White people have been referred to
as a “perfect storm.”5 Such a comparison obfuscates the
larger social and political circumstances that structure poor
health. Unlike a storm, which is a natural phenomenon that
cannot be prevented, the higher rate of COVID-19 deaths
among African American people was predictable and pre-
ventable because of racial injustice. These deaths were pre-
dictable because of the long history of health inequities in
the United States and preventable through systemic changes
to eliminate systemic racism and improve SDH. The social
and political will needed to correct these injustices histori-
cally has been, and continues to be, lacking. SDH underlie
health disparities that increase the potential for exposure t ...
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Sensitive Health Care Services in the Era of Electronic Health Records
Sensitive Health Care Services in the Era of Electronic Health Records Philip R. Lee Institute for Health Policy Studies
Access to confidential care is critical for adolescents and young adults, particularly those seeking sensitive services, including sexual and reproductive health, mental health and substance abuse services. Implementation of the Affordable Care Act (ACA) brings new opportunities and challenges for adolescents and young adults.
Authors: Sara Daniel, MPH, Jan Malvin, PhD, Carolyn B. Jasik, MD, Claire D. Brindis, DrPHTeen Pregnancy A Preventable Epidemic Our natio.docx
Teen Pregnancy: A Preventable Epidemic
Our nation is facing an adolescent reproductive-health crisis, with one in four teenage
girls having a sexually transmitted disease, and one in three becoming pregnant before
the age of 20.1 To address this challenge, teens must be able to obtain confidential and
affordable reproductive-health services. However, anti-choice politicians have stymied
efforts to give teens the tools they need to protect themselves against unintended
pregnancy and sexually transmitted diseases (STDs). We continue to call on lawmakers
– pro-choice and pro-life alike – to work together to achieve real solutions – instead of
divisiveness.
The Facts
In spite of a recent decline, the United States still has the highest rate of teen pregnancy
in the western industrialized world.2 Studies show that the United States’ teen-
pregnancy rate is more than twice that of Canada and Sweden.3
§ Approximately 750,000 young women in the United States become pregnant each
year. Eighty-two percent of teen pregnancies are unplanned 4 and more than a
quarter of those end in abortion.5
§ Teen mothers are less likely to complete school, less likely go to college, more
likely to have large families, and more likely to stay single – increasing the
likelihood that their children will live in poverty.6
§ In addition to other consequences for young women and their children, teen
childbearing costs U.S. taxpayers at least $11 billion annually.7
§ A sexually active teen who does not use contraception has a 90-percent chance of
becoming pregnant within a year.8
Potentially due to factors such as decreased access to health-care services and
information, racial and ethnic disparities persist in the reproductive health of young
Americans.
§ The problem of teen pregnancy is more pronounced in the African-American and
Latino communities, where rates of teen pregnancy are higher than those in
white communities – 15 percent and 14 percent respectively, compared to five
percent.9
2
§ Fifty-three percent of Latina teens and 51 percent of African-American teen girls
will become pregnant at least once before they turn 20. In comparison, only 19
percent of non-Hispanic white teen girls will become pregnant before the age of
20.10
A Failed Approach
Anti-choice lawmakers and advocates seized on this public-health crisis as an
opportunity to enact one of their longtime goals: withhold sex education from young
people in a misguided attempt to discourage them from having sex. Instead, they spent
more than $1 billion in taxpayer funds on “abstinence-only” programs11 – programs that
censor vital health information about contraception and safe sex. The approach has been
a spectacular failure.
§ Research shows that “abstinence-only” programs do not work and that
comprehensive sex-education programs do. In 2007, a report commissioned by
the U.S. Department of H ...
6Accessing Health CareLearning ObjectivesAfter rea.docx
6
Accessing Health Care
Learning Objectives
After reading this chapter, you should be able to:
• Identify where access barriers originate.
• Examine the organizational barriers to accessing health services as experienced by
vulnerable populations.
• Explain the financial barriers to accessing health services as experienced by vulnerable
populations.
• Consider ways to improve access to health care.
• Explain the politico-social forces affecting access to health care.
Courtesy of Beerkoff/Fotolia
bur25613_06_c06_173-194.indd 173 11/26/12 2:49 PM
CHAPTER 6
Self-Check
Answer the following questions to the best of your ability.
1. Which populations face access barriers to health care in both financial and orga-
nizational forms?
a. vulnerable
b. naturalized citizens
c. employed
d. school-age children
Critical Thinking
The text states, “More physicians abandon small private practices in favor of joining large health care
conglomerates.” Do you think that these larger corporations would be more willing to accept Medicaid
patients and thus increase accessibility?
Introduction
Introduction
Though institutionalized racial segregation ended decades ago, many would argue that Americans continue to be segregated by
socioeconomic class. Economic status determines
where people live and attend school, and even
where they go to the doctor. Vulnerable popula-
tions face access barriers to health care in both
financial and organizational forms. For example,
many physicians do not accept patients on Med-
icaid, and many who do limit the number to a
certain percentage of their practices or a certain
number of appointments per week. This creates
an organizational barrier to health care access for
Medicaid recipients. At the same time, many low-
income people struggle to find the money to pay
for services that aren’t covered by Medicaid or the
co-pays on the services covered by their employ-
ers’ insurance, thereby creating a financial barrier
to access. As more physicians abandon small pri-
vate practices in favor of joining large health care
conglomerates where they can improve reim-
bursement rates and lower malpractice insurance
rates, and more people receive Medicaid or Medi-
care, reliable access for the vulnerable becomes
increasingly tenuous.
Courtesy of Sheri Armstrong/Fotolia
Though a patient may be covered by
Medicaid, many are unable to take full
advantage of that coverage because of
physician-imposed limits and restrictions.
bur25613_06_c06_173-194.indd 174 11/26/12 2:49 PM
CHAPTER 6Section 6.1 Organizational Barriers
2. Many physicians limit the number of what types of patients to a certain percentage
of their practices or to a certain number of appointments per week?
a. HIV/AIDS
b. elderly
c. those on Medicaid
d. charitable cases
3. Many low-income people struggle to find the money to pay for what services
covered by their employers’ insurance?
a. enrollment fees
b. wag ...
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More than 1 in 5 Americans are unpaid caregivers
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•Overall trends: Between 2015-2017, nearly 21% of people who responded to a phone survey on health risks were classified as unpaid caregivers. An additional 17% said they expected to become caregivers in the two years following the survey.
•Demographics: Nearly 60% of caregivers were women, and nearly 45% of caregivers were aged 45 and younger.
•Regional trends: 14% of those in Puerto Rico reported being caregivers, compared to more than 28% of those in Tennessee. Unpaid caregivers were most common in Tennessee, Alabama, Arkansas, and Louisiana, all with a 25% or higher prevalence.
Mythbusters 2012
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U.S. adults living with chronic disease are significantly less likely than healthy adults to have access to the internet (62% vs. 81%). The internet access gap creates an online health information gap. However, lack of internet access, not lack of interest in the topic, is the primary reason for the difference. Once online, having a chronic disease increases the probability that someone will take advantage of social media to share what they know and learn from their peers.
1 Department of Health and Human Performance, College of Ch
1 Department of Health and Human Performance, College of Charleston,
Charleston, SC, USA
2 Department of Health Sciences, James Madison University, Harrisonburg,
VA, USA
3 Department of Health Behavior and Health Systems, University of North
Texas Health Science Center, Fort Worth, TX, USA
4 Department of Anthropology, Rollins College, Winter Park, FL, USA
5 Department of Social and Behavioral Sciences, College of Public Health,
Temple University, Philadelphia, PA, USA
Corresponding Author:
Sarah B. Maness, PhD, College of Charleston, Department of Health and
Human Performance, 24 George St, Charleston, SC 29401, USA.
Email: [email protected] cofc. edu
Commentary
Public Health Reports
2021, Vol. 136(1) 18-22
© 2020, Association of Schools and
Programs of Public Health
All rights reserved.
Article reuse guidelines:
sagepub. com/ journals- permissions
DOI: 10. 1177/ 0033 3549 20969169
journals. sagepub. com/ home/ phr
Social Determinants of Health and
Health Disparities: COVID-19 Exposures
and Mortality Among African American
People in the United States
Sarah B. Maness, PhD1 ; Laura Merrell, PhD2; Erika L. Thompson, PhD3 ;
Stacey B. Griner, PhD3 ; Nolan Kline, PhD4; and Christopher Wheldon, PhD5
The coronavirus disease 2019 (COVID-19) pandemic in the
United States provides yet another example of the enduring
and pernicious effect of social determinants of health (SDH)
on African American communities. SDH, as defined by the
Healthy People 2020 SDH framework, include domains of
economic stability, education, social and community con-
text, health and health care, and neighborhood and built
environment.1 Within each domain, key areas represent ele-
ments of focus for the decade (Box). Compared with non-
Hispanic White people, African American people have
higher rates of COVID-19 cases (2.6 times higher), hospital-
ization (4.7 times higher), and death (2.1 times higher).2-4
Although the pandemic is ongoing, it is not premature to call
attention to the root causes of health inequity in the United
States that have persisted for decades and are being high-
lighted in the current crisis.
The disparities in COVID-19 case fatality rates between
African American and White people have been referred to
as a “perfect storm.”5 Such a comparison obfuscates the
larger social and political circumstances that structure poor
health. Unlike a storm, which is a natural phenomenon that
cannot be prevented, the higher rate of COVID-19 deaths
among African American people was predictable and pre-
ventable because of racial injustice. These deaths were pre-
dictable because of the long history of health inequities in
the United States and preventable through systemic changes
to eliminate systemic racism and improve SDH. The social
and political will needed to correct these injustices histori-
cally has been, and continues to be, lacking. SDH underlie
health disparities that increase the potential for exposure t ...
1 Department of Health and Human Performance, College of Ch
1 Department of Health and Human Performance, College of Charleston,
Charleston, SC, USA
2 Department of Health Sciences, James Madison University, Harrisonburg,
VA, USA
3 Department of Health Behavior and Health Systems, University of North
Texas Health Science Center, Fort Worth, TX, USA
4 Department of Anthropology, Rollins College, Winter Park, FL, USA
5 Department of Social and Behavioral Sciences, College of Public Health,
Temple University, Philadelphia, PA, USA
Corresponding Author:
Sarah B. Maness, PhD, College of Charleston, Department of Health and
Human Performance, 24 George St, Charleston, SC 29401, USA.
Email: [email protected] cofc. edu
Commentary
Public Health Reports
2021, Vol. 136(1) 18-22
© 2020, Association of Schools and
Programs of Public Health
All rights reserved.
Article reuse guidelines:
sagepub. com/ journals- permissions
DOI: 10. 1177/ 0033 3549 20969169
journals. sagepub. com/ home/ phr
Social Determinants of Health and
Health Disparities: COVID-19 Exposures
and Mortality Among African American
People in the United States
Sarah B. Maness, PhD1 ; Laura Merrell, PhD2; Erika L. Thompson, PhD3 ;
Stacey B. Griner, PhD3 ; Nolan Kline, PhD4; and Christopher Wheldon, PhD5
The coronavirus disease 2019 (COVID-19) pandemic in the
United States provides yet another example of the enduring
and pernicious effect of social determinants of health (SDH)
on African American communities. SDH, as defined by the
Healthy People 2020 SDH framework, include domains of
economic stability, education, social and community con-
text, health and health care, and neighborhood and built
environment.1 Within each domain, key areas represent ele-
ments of focus for the decade (Box). Compared with non-
Hispanic White people, African American people have
higher rates of COVID-19 cases (2.6 times higher), hospital-
ization (4.7 times higher), and death (2.1 times higher).2-4
Although the pandemic is ongoing, it is not premature to call
attention to the root causes of health inequity in the United
States that have persisted for decades and are being high-
lighted in the current crisis.
The disparities in COVID-19 case fatality rates between
African American and White people have been referred to
as a “perfect storm.”5 Such a comparison obfuscates the
larger social and political circumstances that structure poor
health. Unlike a storm, which is a natural phenomenon that
cannot be prevented, the higher rate of COVID-19 deaths
among African American people was predictable and pre-
ventable because of racial injustice. These deaths were pre-
dictable because of the long history of health inequities in
the United States and preventable through systemic changes
to eliminate systemic racism and improve SDH. The social
and political will needed to correct these injustices histori-
cally has been, and continues to be, lacking. SDH underlie
health disparities that increase the potential for exposure t ...
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1 Department of Health and Human Performance, College of Ch
1 Department of Health and Human Performance, College of Ch
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Introduction
Johnny Depp is an actor known for his chameleon-like ability to transform into a wide range of characters. from the eccentric Captain Jack Sparrow in "Pirates of the Caribbean" to the introspective Edward Scissorhands. His long hair is one constant throughout his evolving roles and public appearances. Johnny Depp long hair is not a style choice but a significant aspect of his identity. contributing to his allure and mystique. This article explores the journey and significance of Johnny Depp long hair. highlighting how it has become integral to his brand.
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1980s: The Rise of a Young Heartthrob
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Edward Scissorhands (1990)
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The Reality of Re-Entry
- 1. The Reality Of Re-Entry Challenges of Prisoner Re-Entry Societal Connections What Reform Has Been Done or Is in the Works? Medical and Behavioral Health Issues Livelihood Family The U.S. confines 25% of the world’s incarcerated population, despite having only 5% of its total population An average of 590,400 inmates have been released from federal and state prisons annually since 1990 More than 95% of today’s prison population will be released at some point The unemployment rate among formerly incarcerated people exceeds 27% Of the more than 50,000 people released from federal prisons in 2010, 33% found no employment over four years post-release A survey found only 12.5% of employers said they would accept an application from an ex-convict 51% of re-entries relied on their families to a much greater extent than expected Formerly incarcerated people see a homelessness or housing insecurity rate of 5,700 per 100,000-plus Individuals who have been incarcerated more than once experience homelessness at a rate 13 times higher than the public Full implementation of the Second Chance Act of 2007, which supports U.S. criminal justice system reform Additional support for research on pre- and post-re-entry services and programming Re-evaluation and further investment for re-entry programming with provisions made for enhanced care coordination and care management Expansion and enforcement of anti-discrimination rules and regulations Funding increase for subsidized employment programs and American Job Centers Due to pre-existing conditions and the negative effect of incarceration, those released from incarceration have a high risk for adverse health outcomes and death 15-20% of incarcerated men suffer from emotional disorders When compared to the general population, suicide risk was 62% higher among previously incarcerated individuals More than half of incarcerated adults are parents of minor children Prisoners have a lower recidivism rate if they maintain consistent contact and connection with their families Programs to improve parenting skills have been found to be effective and beneficial, yet participation has declined in recent years www.brookings.edu/research/a-better-path-forward-for-criminal-justice-changing-prisons-to-help-people-change/ www.brookings.edu/research/a-better-path-forward-for-criminal-justice-prisoner-reentry/ www.deseret.com/utah/2022/1/6/22868683/hatch-foundation-family-centered-reforms-can-reduce-recidivism- intergenerational-incarceration www.healthaffairs.org/do/10.1377/hpb20210928.343531/ prisonerresource.com/prison-consulting-services/prisoner-reentry-programs/ online.simmons.edu/blog/prisoner-reentry/ iop.harvard.edu/sites/default/files/sources/program/IOP_Policy_Program_2019_Reentry_Policy.pdf