Policies that improve the health of the public. This assessment addresses the following learning objective(s): Advocate for policies that improve the health of the public and the profession of nursing and health care administration.
Healthcare organizations are continually challenged with delivering high-quality care, while simultaneously creating a culture of safety for both patients and healthcare professionals.
Reflect on your experience in healthcare (clinical or administrative). Briefly describe a time when you worked in a culture where safety and quality were effectively-balanced and practiced – OR – describe a time when the opposite occurred. As a clinical or administrative leader, how will YOU ensure safety and quality in your department or facility? Provide specific measures in bullet point format.
Are policies part of these measures? Why or why not? Please be sure to validate your opinions and ideas with citations and references in APA format.
Policies are fundamentally linked to health promotion and disease prevention. They create opportunities for broad and sustainable improvements in population health, and currently, there is a definite need for improvement. The societal burden of preventable chronic disease is staggering. Roughly 80% of deaths in the United States are now caused by chronic diseases such as heart disease, cancer, hypertension, stroke, and diabetes.2
Mortality is not the only concern, because these diseases are also the biggest drivers of healthcare expenditures in the United States, accounting for more than 75% of annual spending on medical care. Costs of lost productivity due to illness add to the economic burden. For example, the total estimated cost of diabetes in the United States for 2012 was $176 billion in direct medical costs and an additional $69 billion in reduced productivity.3
The amount for cardiovascular disease is even greater, with costs reported as $273 billion for direct medical care and $172 in lost productivity.4 These totals are estimated to grow exponentially as costs rise and the population ages.2,3,4 This problem, although dire, is not insurmountable. These diseases are linked to many modifiable lifestyle or behavioral risk factors that can be addressed through interventions that include policy changes. The power of policy is exemplified by the fact that every one of the top 10 public health achievements in the last century was facilitated by some sort of policy action to influence practice and prioritize resources
Historically, policies that focused on prevention greatly affected disease rates, increased life expectancy, and improved quality of life. In 1900, there were approximately 100 cases of typhoid fever for every 100,000 persons living in the United States.6 In 2006, the rate had declined to 0.1 cases for every 100,000 persons (only 353 cases of illness in total) and approximately 75% of these—or 265 cases—occurred among international travelers.7
This dramatic decrease is linked to policies related to improving water quality through disinfection and sanitation, the first of which was implemented in 1908 in Jersey City, New Jersey.7 Many U.S. cities followed suit with similar policies, and this movement resulted in the dramatic decrease of disease. Policies to ensure a safe and reliable water supply continue to emerge. The Clean Water Act, passed in 1972, addressed environmental contaminants and sources of water pollution, such as sewage.8 Policies related to treating water to remove or kill disease-causing contaminants or to monitoring water quality remain a health priority.
Immunization or vaccine policies also improved population health by preventing outbreaks of disease. The late 1770s saw an emerging acceptance of Dr. Edward Jenner’s cowpox inoculation to prevent smallpox. As a result, governments became aware of the potential and widespread impact of preventing this devastating disease.
The science of developing successful vaccinations for infectious diseases advanced and lawmaking agencies realized their value in protecting population health, productivity, and societal security.9 In 1855, Massachusetts passed the first state law requiring vaccinations for school children,10 which was soon followed by many other state, organizational, and school district policies requiring vaccines.
After 1949, there were no endemic cases of smallpox in the United States.11 Vaccination policies have had global impact, too. In the 1960s and 1970s, the World Health Organization (WHO) launched a large-scale smallpox vaccination campaign. This successful effort culminated in the last naturally occurring case of smallpox in Somalia in 1977.12 (See Chapter 10 for more information on policies related to vaccines.)
Another example of a public health issue addressed through past regulation and policy is tobacco control. Laws regulating taxes, access, advertising, and use contributed to the substantial reduction in smoking- and tobacco-related morbidity and mortality.13,14,15 Figure 1.1 depicts a timeline of historical events and policy-related strategies plotted with the per capita use of cigarettes. Policies such as broadcast advertisement bans, increased taxes, and others increasing the availability of nicotine replacement contributed to the declining rates of smoking over time. (See Chapter 6 for more details on policies related to tobacco.)