Human Needs: Health
Human Needs: Health
- Toba Schwaber KersonToba Schwaber KersonMary Hale Chase Professor in Social Sciences and Social Work and Social Research, Graduate School of Social Work and Social Research, Bryn Mawr College
Health is a need, a basic requirement for life. Needs can become rights when bodies of people, usually governments or organizations such as the World Health Organization sanction them. While many have declared health as a right, the greatest burden of illness continues to be carried by minority and medically underserved populations. Also, industrialization, urbanization, economic development, and food market globalization have brought with them the poor health habits that place people at risk for cardiovascular and other diseases. Improved health habits and universal health care coverage would help to address the health needs of all.
- Health Care and Illness
- Human Behavior
Updated in this version
Data and references were updated, and differences between needs and rights clarified. Questions were raised related to personal vs. state responsibility for health and preventable threats to health. References were made to the PCA and global health.
Health Status in the United States
Health is a need, a basic requirement for life. Needs become rights only when a body of people, usually a government body, sanctions them. The right to health includes access to adequate health care, and countries are measured by the health and social status of their citizens (Center for Economic and Social Rights, 2012; Wolff, 2012). In this regard, the Universal Declaration of Human Rights, Article 25, states that “everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.” The World Health Organization (WHO) defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Its objective is the attainment by all peoples of the highest possible level of health (WHO, 2012).
In 2010, life expectancy at birth in the United States reached a record high of 78.7 years. Age-adjusted death rates decreased significantly for seven of the fifteen leading causes of death: heart disease; cancer; chronic, lower respiratory diseases; cerebrovascular diseases; unintentional injuries; influenza and pneumonia; and septicemia. Homicide fell from among the leading causes. The age adjusted death rate increased for five leading causes of death: Alzheimer’s disease, some kidney and liver diseases, Parkinson’s disease, and pneumonitis due to solids and liquids (Deaths: Preliminary Data, 2010; Federal Health Information Centers and Clearinghouses, 2012; Health, United States, 2012). The National Institute on Minority Health and Health Disparities reports that “there continues to be an alarming disproportionate burden of illness among minority and medically underserved populations” (National Institute on Minority Health and Health Disparities [NIMHHD], 2012). Members of such groups are more likely to have poor health and die at a young age, with rates for some groups similar to rates in some third world countries. The National Institutes of Health describes these disparities as “large, persistent, and even increasing (NIH, 2012). For example, although members of ethnic and racial minorities comprise 26% of the population, they represent 66% of the adult AIDS cases and 82% of pediatric AIDS cases (National Institute on Minority Health and Health Disparities, 2012).
Noted on the WHO website is the fact that, worldwide, vulnerable and poor people have less access to health care, become sick, and die earlier than those who are more privileged. For example, in the United States, ethnic and racial minorities represent 71% of all reported AIDS cases, 80% of all reported gonorrhea cases, and 82% of tuberculosis cases (Office of Minority Health and Health Disparities, 2012). WHO’s priorities are to enhance global health security, prevent chronic disease, work toward health care for everyone, and achieve the Millennium Health Related Development Goals (MDGs), especially reduce child deaths, improve maternal health, combat HIV/AIDS as well as malaria and other diseases, ensure environmental sustainability, and provide access to affordable, essential drugs.
Some of the most arresting questions in health-related work have to do with public health and social and individual responsibility, that is, how much of one’s health is within and how much is outside one’s individual control? According to WHO’s Global Strategy on Diet, Physical Activity and Health, endorsed in 2004, some largely preventable risk factors account for most of the world’s disease and disability burden. This reflects a change in diet habits and physical activity levels worldwide as a result of industrialization, urbanization, economic development, and increasing food market globalization. The strategy describes how better nutrition and physical activity can help to prevent and control non-communicable diseases (NCDs) and lessen the global burden. Thus, WHO is asking for long-term, sustainable national strategies to help individuals and communities make healthy choices. It describes the role of NCD prevention as altering a range of fiscal, agricultural, and other policies; education and health services; and communication, including marketing, health claims, and nutrition labeling to influence choice of food and activity.
Addressing Health Needs in the United States
Healthy People 2010 provides the nation with a framework for prevention of the most significant preventable threats to health and establishes national goals to reduce these threats, as well as a statement of national health objectives. It focuses on helping diverse populations and groups to develop programs to improve health. It measures health with the 10 leading health indicators: physical activity, overweight and obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury and violence, environmental quality, immunization, and access to health care. These are areas in which it is possible to motivate individuals, groups, communities, and states to act, and measure progress. As in the efforts of WHO, it aims to have entities select from the national objectives, build an agenda that can monitor health results over time, and improve the health of the community. In addition, Congress has specified these health indicators as measures for assessing the progress of several block grants and programs. One example is that the Health Plan Employer Data and Information Set of the National Committee on Quality Assurance have incorporated many Healthy People goals among the measures that should be used in judging the performance of managed care organizations in relation to clinical preventive services such as mammography screening and immunization. Another useful database is the National Institutes of Health’s Health Information, in which one can browse by body location/systems, health and wellness, and conditions/disease.
Another national effort toward addressing health challenges is through the Centers for Disease Control and Prevention (CDC). It points to other challenges such as emerging infectious diseases (SARS, monkey pox, and pandemic influenza), terrorism and environmental threats (hurricanes, wildfires, and toxic chemical spills), the aging population, and lifestyle choices (tobacco use, poor nutrition, and lack of physical fitness) and has its own set of health protection goals. Among these are ensuring that all people, especially those at greater risk of health disparities, will achieve their optimal life span with the best possible quality of health in every stage of life; be environmentally safe and protected; and will live safer, healthier, and longer lives through health promotion, security, and diplomacy (Centers for Disease Control and Prevention, 2012). Now, the CDC is creating the action plans and activities to achieve these goals and will have measurable objectives for each in order to demonstrate the impact of the activities and inform the nation about the state of its health. To follow these activities, access the CDC Action Plans and Activities for Achieving Goals of Healthy People 2010 (DATA 2010).
Thus, while the life span of Americans is increasing, disparities still exist and we are behind other developed countries. For more detailed information, see the Global Health Observatory (GHO) and interactive graph for Life Expectancy at Birth (Global Health Observatory, 2013). Also, while national spending is up in many areas, millions of Americans are still un- and underinsured and many disparities based on color, class, and community remain.
Some Facts about Health Care Spending
In 2009, total national health expenditures rose to $7,538 per person, and 16% of the gross domestic product (GDP) (Health Insurance Cost, 2010). If spending continues as projected, it will constitute 19.8% of the gross domestic product by 2020. In 1970, 20.4 million people were enrolled in Medicare. By 2010, that number was 46 million, and by 2030, it is projected to be 78 million. Overall Medicare spending grew from $3.3 billion in 1967 to $524 billion in 2010. Medicaid is the third-largest source of health insurance in the United States. The largest source is private health insurance and the second-largest is Medicare (Chartbook on Trends in the Health of Americans, 2010). Medicaid’s expenditures have nearly tripled since 1989 with total spending nearly $400 billion in 2010. In 2005, there were 49.9 million uninsured people in the United States, including 8.3 million children (Chartbook on Trends in the Health of Americans, 2011). It is thought that health care spending will be greatly altered as a result of the Patient Protection and Affordable Care Act (ACA), which is popularly known as Obama Care. The results of the ACA are yet to be seen.
Trends and Challenges
At this moment, in view of outside threats including security threats to data, microbial threats, and carcinogens, both worldwide and national efforts are directed toward having individuals and communities take more personal responsibility for their health through lifestyle changes. Among the many sources for information about prevention, education, treatment, and policies that permit real choices and equal opportunities are: websites for the Centers for Disease Control and Prevention; the Kaiser Foundation; the Prevention Institute (DRA, 2006); U.S. Department of Health and Human Services’ Health Resources and Services Administration; and state, county, and municipal health departments as well as reputable websites devoted to specific diseases, conditions, and lifestyle issues.
The overall challenge in the United States is to obtain universal health care coverage. The Patient Protection and Affordable Care Act is a great step in this direction. To do that, the country needs to stop thinking in terms of particular segments of the population and, instead, think about the health of all people. That is, to meet the needs of all of its populace the United States must shift its priorities from personal health to the health of the public (Almgren, 2007; McDonough, 2011; Reid, 2010; Starr, 2011). Health-related social work incorporates these global and national efforts. Now, more than ever, social work uses an ecological perspective spanning traditional boundaries in order to help clients and communities to attain the highest possible level of health (Kerson, 2006).
- Almgren, G. R. (2007). Health care politics, policy and services: A social justice analysis. New York: Springer.
- Center for Economic and Social Rights. (2012). Retrieved 12 June, 2013, from http://ccsr.org/health.
- DATA 2010. http://wonder.cdc.gov/data2010
- Deaths: Preliminary Data for 2005 (September 2010). http://www.cdc.gov/nchs/proeucts/pubs/pubd//hestats/hestats.htm
- DRA (Disparity Reducing Advantages Project) (2007). The imperative of reducing health disparities through prevention: Challenges, implications, and opportunities. Oakland, CA: Prevention Institute. Retrieved 12, June 2013, from http://www.preventioninstitute.org
- Federal Health Information Centers and Clearinghouses. (2012). Retrieved 12, June 2013 from http://www.health.gov/nhic/Pubs/clearinghouses.htm
- Global Health Observatory (GHO). (2013). Life expectancy at birth. Retrieved 15 October, 2013 from http://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends/en/index.htm
- Health, United States. (2011). National Center for Health Statistics. Retrieved 24 June, 2013, from http://www.cdc.gov.nchs/hus.htm.
- HealthyPeople. (2010). Retrieved 3 May, 2013, from http://www.healthypeople.gov
- Kaiser Foundation. Retrieved 3 June, 2013, from http://www.kff.org
- Kerson, T. S. (2006). Living in harmony: Promoting creative synergy in a stressful world. 5th International Conference on Social Work in Health and Mental Health, 2006, Hong Kong, China. Retrieved 3 June, 2013, from http://www.swh2006.com
- McDonough, J. E. (2011). Inside national health reform. Berkeley: University of California Press.
- National Institutes of Health. (2012). Addressing health disparities: The NIH program of action: What are health disparities? Retrieved 3 June, 2013, from http://healthdisparities.nih.gov/whatare/html
- Reid, T. R. (2010). The healing of America: A global quest for better, cheaper, and fairer health care (with an explanation of the 2010 Health Reform Bill). New York: Penguin Group.
- Universal Declaration of Human Rights. (2007). Office of the High Commissioner for Human Rights. United Nations. Retrieved 5 June, 2013, from http://www.unhdcr.ch/udhr/lang/eng.htm
- U.S. Centers for Disease Control and Prevention (2012). Retrieved 10 June, 2013, from http://www.cdc.gov
- Wolff, J. (2012). The human right to health. New York: W. W. Norton.
- World Health Organization. (2012). Retrieved 12 June, 2013, from http://www.who.int
- Centers for Medicare & Medicaid Services. Retrieved 25 June, 2013, from http://www.cms.hhs.gov
- Health Insurance Cost. (2010). Washington, DC: National Coalition for Health Care. http://www.nchc.org/facts/cost.shtml.
- Kerson, T. S. (2002). Boundary spanning: An ecological reinterpretation of social work practice in health and mental health systems. New York: Columbia University Press.