Prevention and Healthcare
Today’s healthcare system emphasizes prevention rather than treatment of disease. Healthcare systems vary in different countries. A comparison of system results between Canada and the United States is summarized in Box 6-2. Both countries believe in health promotion and fitness. Efforts that began in the 1980s directed at changing lifestyle behaviors have resulted in improved maternal, neonate, and child healthcare statistics. Education of youth has resulted in fewer adult smoking-related problems. The benefits of preventive education cannot be underestimated.
Healthcare providers, health insurance companies, life insurance companies, and numerous health-focused agencies, such as the American Diabetes Association and the American Dietetic Association, have become heavily involved in the campaign for improved health. These groups encourage healthier lifestyles through information campaigns designed to educate the public.
BOX 6-2.
Summary Findings of Comparison of Canadian and U.S. Healthcare
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Healthcare and healthcare systems in Canada and the United states have been documented and compared in numerous studies. Accumulated information acknowledges that an individual’s health depends on a great variety of factors, many of which are not related to any specific type of healthcare system. Group studies and individual healthcare surveys have difficulty including research variables such as environment, genetics, and personal lifestyle choices such as smoking or substance abuse. |
10. |
The United States is the only wealthy industrialized country that does not have some form of universal health care. |
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11. |
The United States spends more dollars per person and per total tax dollars than any other country in the world. |
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12. |
The United States has more MRIs and CT scanners per capita, which may account for a higher rate of successful detection and treatment of some cancers than in Canada. |
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Summary |
13. |
Waiting times for nonemergency healthcare is higher for Canadians. |
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1. |
Healthcare costs in both countries are rising faster than inflation. |
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14. |
The United States low-income population has an overall record of better health outcomes than Canadians. |
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2. |
Canada uses less of their country’s dollars (about 10%) on healthcare than does the United States (about 16%). |
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15. |
Both the United States and Canada demonstrate healthcare disparities between minorities of nonwhite races and ethnicities. |
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3. |
Healthcare in Canada is funded by a majority (70%) of public-financed dollars, with 30% private funding, and healthcare is available for all citizens. |
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16. |
The United States has a broader range and more numbers of minorities and ethnic groups than does Canada, which may or may not influence local healthcare. |
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4. |
Healthcare in the United States is paid via a system that is mostly a multipayer system often associated with full-time employment, allowing for large segments of uninsured people. |
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17. |
Most citizens in both countries are satisfied with the health services that they do receive. |
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5. |
Canadians have universal coverage, whereas 1 in 5 citizens in the United States, or about 45 million people, go without any healthcare coverage. |
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18. |
Studies have not shown that a publically funded system provides better healthcare than a multipayer system, therefore, one system cannot be proved to be better healthcare provider than the other system. |
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6. |
The overall health of its citizens remains about the same for both countries. |
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7. |
Life expectancy is somewhat longer in Canada than in the United States. |
19. |
Both countries have comparable good levels of health for specific age groups, such as the adolescent, the adult, or the elderly. |
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8. |
Infant mortality is somewhat lower in Canada than in the United States. |
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20. |
Both countries compare about the same when referring to overall health. |
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9. |
The rate of mortality is higher in the United States from accidents, homicides, and heart disease. |
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Prevention services, also called primary healthcare services, have had significant positive effects on healthcare issues, such as prenatal care for mothers and infants, antismoking campaigns, and mammography for women. Secondary healthcare services provide individuals with specific medical or surgical therapies, generally in acute care settings. Rehabilitation or tertiary services have greatly enhanced the level of the health of clients with chronic illness or disability.
NCHS and CDC statistics clearly show that disparities in healthcare and preventive healthcare exist in the United States and Canada. The United States has both larger numbers of individuals and more cultural minorities than does Canada. Disparities are most evident in African American, Asian, Pan-Asian, and Hispanic communities, but the minority differences have somewhat decreased from numbers in previous decades. Certain segments of the population, including low-income families, individuals with chronic illnesses, unemployed and the part-time employed, and those facing physical disability and mental illness, encounter more difficulty in obtaining healthcare than do others in many areas of the United States.
The Canadian system provides healthcare for everyone, also known as universal healthcare, which is beneficial for all cultures. What has become noted globally is that not only the United States but all countries must continue to focus on extending the benefits of healthcare to all populations. Table 6-1 provides an overview of some statistics.
Healthy People 2010 is a report for the 21st century with the documented national goals for the United States. This report represents a strategy for significantly improving the health of citizens by preventing major chronic illnesses, injuries, and diseases. Personal responsibility is considered a key to good health. The individual, the community, and healthcare professionals are challenged to take specific steps to ensure good health and long life. Box 6-3 summarizes areas of health promotion for some specific topics. Clients may need to individualize these suggestions related to their individual healthcare needs, and they should be advised to consult with their healthcare providers. Age, sex, genetics,
TABLE 6-1. Cancer Comparisons in Canada and the United States
Below are the figures for the number of cancers diagnosed per 100,000 persons and number of deaths attributed to cancer per 100,000 persons in 2003. Health status is very much influenced by socioeconomic and demographic characteristics, such as levels of education and personal income, and there are some limiting factors to any absolute conclusions made using these data. Therefore, any statistics cannot be considered a totally complete measurement of the effectiveness of healthcare. Notice the similarity of mortality rates between Canada and the United States. Also notice the higher rates of cancer in males in both countries.
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2003 CANCER |
FEMALES |
MALES |
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CANADIAN MORTALITY RATE |
AMERICAN MORTALITY RATE |
CANADIAN MORTALITY RATE |
AMERICAN MORTALITY RATE |
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Intestinal |
17 |
16 |
27 |
23 |
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Stomach |
4 |
3 |
7 |
6 |
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g n |
35 |
42 |
63 |
72 |
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Non-Hodgkin lymphoma |
6 |
6 |
9 |
9 |
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ALL CANCERS |
148 |
161 |
215 |
234 |
Data for these studies were collected from registries that are members of the North American Association of Central Cancer Registries, an organization dedicated to developing and promoting uniform data standards for cancer registration in North America. Author note about statistics: For the purposes of this topic, the figures have been rounded to nearest whole number and environment often alter or enhance these preventive measures. Visit the CDC’s Website (see Web Resources on Point,’·.) for additional, specific healthcare information. Using the data found in Healthy People 2010, the health in the United States is measured by looking at 10 Leading Health Indicators. These indicators reflect major health concerns and public health issues in the United States. They are designed to motivate action and provide reliable data that will influence changes.
The Leading Health Indicators are:
1. Physical activity
2. Overweight and obesity
3. Tobacco use
4. Substance abuse
5. Responsible sexual behavior
6. Mental health
7. Injury and violence
8. Environmental quality
9. Immunization
10. Access to healthcare
Key Concept Personal responsibility is considered a key to good health.
THE WELLNESS-ILLNESS CONTINUUM
Most people are not totally healthy or totally ill at any given time. An individual’s daily state of health falls somewhere on a continuum from high-level wellness to death. Figure 6-3 illustrates the basic concept of the wellness-illness continuum. The state of wellness or illness fluctuates depending on the individual.
The following components contribute to a state of wellness:
• Good physical self-care
• Prevention of illness/injury
• Using one’s full intellectual potential
• Expressing emotions and managing stress appropriately
• Comfortable and congenial interpersonal relationships
• Concern about one’s environment and conditions throughout the world
Acute illnesses are illnesses that interfere with the wellness-illness continuum for a short period of time. Acute illnesses generally develop suddenly and resolve within a specified period of time. The common cold is an acute illness. You may be ill for a few days and then return to your normal state of health.
Chronic illnesses such as arthritis, asthma, or HIV/AIDS result in a long-term health disturbance. Individuals with chronic illnesses function within the wellness-illness continuum, but often are limited by their disorder.
A person may have an acute illness, a chronic illness, or both. It is very common for an individual with a chronic illness to become acutely ill. For example, a person might become acutely ill from a seasonal virus, or someone with a chronic illness may become unstable from an acute asthma attack. The elderly commonly have both acute and chronic illnesses. Figure 6-4 illustrates the possible fluctuations of acute and chronic illnesses.
FIGURE 6-3 · The wellness-illness continuum. Individuals function on a fluctuating continuum of health and illness.
BOX 6-3.
Health Promotion and Disease Prevention Measures
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Healthy Pregnancy |
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Start your pregnancy with early prenatal care. |
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Avoid tobacco, alcohol, and secondary smoke during and after pregnancy. |
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Take dietary supplements, such as iron and folic acid. |
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Avoid contact with individuals who have been exposed to measles or chickenpox. |
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Use protective measures during sex to protect from STIs. |
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Use caution with household chemicals. |
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Avoid cleaning cat litter box. |
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Childhood Injuries and Illnesses |
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♦ |
Know National Poison Control Number – 1 800 2221222 Visit the National Poison control Website. They have free stickers and magnets so you can put their number on each phone and in several locations around house and garage. |
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Baby/child-proof house, garage, yard, and vehicles. |
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Encourage parenting classes for first-time and/or high risk parents. |
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Follow immunization programs. |
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Provide instruction in first aid and CPR to caregivers (including babysitters). |
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Use appropriate-sized car seats. |
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Use helmets, elbow pads, knee pads with appropriate toys. |
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Detect and treat parasites early |
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For comprehensive child safety information go to the Website of the MedlinePlus, a service of the U.S. National Library of Medicine (see Web Resources on Point1-.) |
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Dental Health |
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Schedule regular preventive dental care. |
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Teach good dental hygiene at home (e.g., flossing, tooth brushing, use of fluoride toothpaste) as needed in your community |
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Vision Care |
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Encourage preventive measures, such as regular checkups for early detection of visual problems, such as glaucoma and cataracts. |
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Use fastidious handwashing and hygienic care for corrective lenses and contact lenses. |
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Provide adequate lighting. |
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Know the location of eyewash stations at employment or school labs. |
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Heart Health |
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Use preventive measures against cardiovascular disease, such as a low-fat diet and regular exercise. |
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Maintain appropriate body weight. |
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Avoid all tobacco products. |
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Protect yourself and your children from the hazards of second-hand smoke. |
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Monitor stress levels and use productive methods to protect self from unnecessary physical or mental stress. |
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Consult with your healthcare providers regarding the need for laboratory studies, such as cholesterol levels. |
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Be aware of your normal blood pressure and consult healthcare providers when blood pressure is not within your own averages. |
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Smoking |
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Encourage attendance at smoking cessation programs |
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for those who use tobacco products. |
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Encourage utilization of smoke-free environments. |
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Diabetes |
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Encourage early detection of diabetes. |
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Monitor the three critical elements: diet, exercise, and appropriate use of prescription medications. |
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Encourage compliance to diabetic regimen, which can minimize diabetic complications. |
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Hypertension |
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Consult your physician about increased physical activity |
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and be as active as is possible for your situation. |
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Limit alcohol intake. |
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Monitor sodium (salt) intake. |
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Read food labels to determine sodium, sugar; and fat content. |
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Monitor laboratory levels of potassium and eat sufficient natural sources, such as bananas, oranges, potatoes, or watermelon. |
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Take prescribed blood pressure medications as indicated by healthcare providers. |
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Notify healthcare providers of all changes or reactions to medications. |
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Do NOT abruptly stop taking prescribed medications without professional guidance. |
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Have regular healthcare, dental, and vision checkups. |
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Learn to talk to your physician about any physical, emotional, financial, or lifestyle changes. |
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Cholesterol |
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Eat low-fat foods. |
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Read food labels. |
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Increase activity. |
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Include the Website of MyPlate (see Web Resources on Point;·.) in your favorites list for comprehensive information on healthy dietary habits for men, women, children, and families. |
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Cancer |
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Follow a low-fat diet. |
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Have adequate fiber daily. |
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Adhere to screening recommendations for prostate, colon, and breast cancers. |
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Prevent sunburns in children. |
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Protect the skin by wearing hats, scarves, or specifically made sun protective clothing. |
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Use sun screens and reapply according to product directions. |
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Avoid getting sunburns. |
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Refrain from smoking. |
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Reproductive Health |
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Discuss STI protective measures with your partner: |
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Protect yourself from unplanned pregnancies. |
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Use safer sex practices that are appropriate for your personal needs. |
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Be aware that many safer sex practices do not protect from STIs. |
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Get reproductive health checkups, including HIV and STIs. |
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Osteoporosis |
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Eat foods high in calcium and vitamin D. |
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Exercise or include some physical activity. |
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Alcohol and Drugs |
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Educate children and adults on how to detect and treat abuse. |
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Avoid excessive alcohol use. |
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Eating Disorders |
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Be aware of the possibilities of eating disorders for yourself, friends, and family. |
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Research health maintenance programs related to obesity, anorexia nervosa, and bulimia. |
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Mental Health |
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Be aware of the stressors in your life. |
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Include stress reduction activities in your daily life, such as exercise, reading, listening to music. |
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Recognize the symptoms of depression, anxiety, panic disorder, and seasonal affective disorder. |
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Access suicide prevention and abuse hotlines and programs, if necessary. |
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Regular Physical Examinations and Self-Examinations |
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Adhere to screening recommendations for mammograms, breast, intestinal, and testicular cancer, as well as for tuberculosis. |
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Update and maintain immunizations throughout life. |
Healthcare facilities are also known by the terms acute care or long-term care. Acute care hospitals provide short-term care for clients with serious illnesses. Long-term care facilities, such as rehabilitation centers or skilled nursing facilities, are responsible for the care of residents with chronic illness. Occasionally, a resident may become seriously ill and need to be transferred to an acute care facility.
This hierarchy and the responsibilities of the nurse relate to the health-illness continuum. The concepts of Maslow’s fundamental survival needs may often be components of nursing examinations. If clients have survival needs, but other needs are blocked or threatened, clients function at a lower level on the hierarchy and they move toward the illness end of the illness-wellness continuum. When basic needs are satisfied and they move toward self-actualization, the trend is toward the wellness end. High-level wellness is called optimum health.
FIGURE 6-4 · The wellness-illness continuum shows the different levels of health a person experiences over a lifetime.
