Global Health and USA's expanding role

Public health in the 21st Century will be tasked with protecting us from various diseases or life threatening conditions deriving from: climate change; emerging diseases; bioterrorism; racism; stigma; prejudice; and political dilemmas. Therein lie USA's expanded roles. Therein lies the new foreign policy code. 

Public health practitioners of the 21st Century must look at public health of the globe. They must be in position to understand the complexities of cultural diversity, e.g.,different generational, economic, professional, ethnic, religious, linguistic background, gender, gender identity, sexual orientation, stereotypes, prejudices, physical status, conscious bias, unconscious bias, structural bias, enjoyment of access to resources, access to opportunities, access to options, safety from violence,  affordability of housing, civil rights, access to food, access to jobs, opportunities for job trainings, access to recreation and readiness to be  a compassionate provider.

Tom while in Kenya, 2009.

Many clients and communities face bias and discrimination when they attempt to access health and social services and , as a result, receive fewer services and services of poorer quality (Berthold, T. 2009). In order to provide public health services, government has concrete plans such as enacting laws, enforce laws, provide financial support and oversight to ensure promotion of health, prevention of diseases and instituting a preparedness mechanism.The most important new or expanded roles for public health occupations in the 21st century will include:

1. Strengthening the public health activities framework that is interlinked by a network of federal, state and local public health agencies with emphasis on referral mechanisms and oversight processes.

2. Ensure a reporting mechanism that dovetails into the overarching design where: the contribution of USA to international health-related interventions continues; the legal foundation gives gives primacy for health concerns to states; allows the federal government to promote consistency and minimum standards across the 50 diverse states; and a practical foundation of LHDs serving as the point of contact between communities and the three-tiered government.

3. Shifting mobilization tasks to advocacy entities at community level as a means of having a pulse on changing needs, resource needs and meeting public expectations.

Tom meeting with a Community Health Worker in Kisumu, Kenya circa 2009.

4. Investing in early warning mechanisms for threats from fires to bio-terrorism. There will be need to have a contingency for fire hazards now that the globe is getting warmer. This will mean wildfire-prone geographical zones like Mid-Western and California will have more established fire departments. The quarantine points at border entry points, airports and ports need to be strengthened now that there is more likelihood for bio-terrorisms, hostility and acts of sabotage against the U.S. or any other nation by terrorists and enemies (www.nytimes.com). 

5. Public health practitioners reaching out to the indigent or marginalized. This will rely on the work of local health agencies. These will in turn report to second tier government levels and different organizations that form the backbone through which the power to protect the public’s health is possible.

6. Providing training and promoting competencies for public health professionals in the 21st century mostly in these areas: conducting essential public health services; legislation; regulation; policies; and the ability to negotiate,  justify public funding for many public health initiatives. For public health to be perceived, such essential services as are relevant: monitoring the health status of the population; diagnosing and investigating problems deemed hazardous to the public’s health; educating the population on health issues; mobilizing communities to act on their own health issues; developing policies; enforcing laws and regulations that protect the public; linking people to health services; ensuring a competent healthcare workforce; evaluating the effectiveness, access and quality of health services and researching to continue progress and innovation in healthcare (Turnock, B. J. (2016). Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett).

The Green cover needs all the care we can give it.

7. Use of Technology, which will enable complex research to be translated into action in a faster and flexible way. Technology can be used in many other forms as well. One way is establishing a centralized health management information templates that can be used to report for instance compliances to the Healthy 2020 vision and mission. Events in which equity and equality are addressed can be captured at local, state, regional and federal levels. Racial biases are shown to be a part of the social structure of medical practices at both macro and micro levels (Centre for excellence in health care journalism). Use of web-based platforms to share information can help improve on coverage of what works and who is served. Public health will be a means for America to deal with the hot topics that focus on: race, culture, ethnicity, lifestyle, health status and health care in America. This might be the great quest of technology as well. Through technology it will be possible to level the health care playing field. Socioeconomics, individual racism, and institutional racism that represent the three predominant pathways to differential treatment for diseases will be targeted and redress provided. Reporting mechanisms will provide common indicators used to gauge quality of life for women and men irrespective of their gender, sexuality, race and social status.  Compiling reports into a format that can be disseminated to all concerned is another good use of  print technology and the world-wide web. In this format the media can be relied upon to make information available or the applicability of the information by society in form of case reports/studies or any format that is reliable for dissemination. However, newsprint, radio and TV tend to tap into our anxieties focusing on trivia. “The CDC has had to contend with bogus reports of imported banana carrying flesh-eating bacteria, drug addicts placing HIV-infected needles in pay coin-return boxes, virus soaked sponges arriving with the mail,”(Drexler, M. 2010). 

8. Understanding the need for post trauma stress counseling and care arising from the link between terrorism, massacres and resultant traumas. A global nightmare envelopes the world every time wars, genocides and terrorist attacks occur anywhere in the world. The rallying call that brings together nations ready to do rescue activities is to profess solidarity with the suffering nations. Rescue efforts are made by nations. This was seen after September 11, 2001, in UK, in Uganda, in Tanzania, in Kenya and most recently in the 10th district of Paris where the most recent attacks have occurred. The San Francisco editorial has this to say, “France’s loss is our loss. Its grief is our grief. And its fight to counter the forces of inhumanity is our fight”  (San Francisco Chronicle, Editorial, November 14th, 2015). 

9. The effects of political pronouncements such as the recent debate on mass deportations sends trauma shocks to those who are  not documented yet they many have lived in USA all their life and some are employed. These people may end up not attending social services for fear of being hounded and put on hot lists.

 10. Establishing a structure of international partnership to deal with climate change, neglect, poverty and famine  at a global level which in turn make humans and in some cases livestock vulnerable to influenza, Legionnaires’ disease, Lyme disease, toxic shock syndrome, E. Coli 0157:H7, STDs, Ebola virus, AIDS, severe acute respiratory syndrome (SARS), H1N1 influenza (Drexler, M. 2010). 

11. Understanding the increasing relation of chronic low-level inflammation, wide range of common debilitating disorders, stealth infections, deadly sepsis, how to balance use of antibiotics and inflammatory-quashing steroids. Research findings recommend Mediterranean style diet for those suffering from inflammatory disorders (Sachs J.S., 2007).

In the 21st Century, stigma discrimination, bias and prejudice will be the issues that need addressing. This in turn will clear the way for addressing neglect, poverty and famine. In situations where equality, respect and dignity are promoted, proper protection of life and ensuring individual well-being will be achievable.

REFERENCES:

1. Berthold, T. 2009. Foundations For Community Health Workers. San Francisco, MA: Jossey-Bass.

Centre For Excellence in Health Care Journalism. 2006.

2. Drexler M., 2010. Emerging Epidemics: The Menace of New Infections: H1N1 Flu, SARS, Anthrax, E.Coli.Penguin Books.

3. http://www.nytimes.com/2015/11/15/world/europe/strategy-shift-for-isis-inflicting-terror-in-distant-lands.html?emc=edit_th_20151115&nl=todaysheadlines&nlid=60949333&_r=0

4. Sachs, J.S. 2007. Good germs,Bad Germs: Health and Survival in a Bacterial World. New York, NY: Hill and Wang.

5. SFChronicle.com

6. Turnock, B. J. 2016. Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett. 

Of the crystal ball, palm reading, astrology, voodoo, sorcery, witchcraft, weather man and being a Godly infant black man!

                     My heart pumps with excitement, for I am part of the world that treats me or sees me as a human being.  A world where the immediate infrastructure allows me to work hard, read hard, rewards me well and ensures I pursue what is known as shareable happiness. Now, I have to learn to live in this city. I have to be street-wise. I have to socially adjust and speak Spanish and English like they do.

                     I am mostly informed by a christian religion and a western worldview of an African's self actualization. I have been reduced to an un questioning-brainwashed black African who shoulda/coulda/woulda understand that anything African is devilish and evil. Everything Arabic, Judaistic, Indian and everything western is white and therefore Godly.  I am led to understand that my way to heaven is to follow anything Arabic, Jewish or white. I am a subject of a system that ridicules my black skin. I am supposed to remain that way and all who give me praise do so because am staying in line. Their line! Age wise, I am 20, 30, 40, 50... years old. But as a black/negro man, I am an ethno-cultural diaper-loined toddler.

                    As a black/negro man I am aware my ancestors believed in productivity; they lived in balance with nature (well, in a way as long as the lion and leopard did not eat their livestock; and had enough space left to dig  shallow pit stops); they engaged in negotiations and tolerance rituals (with a little bit of war here and there); they produced and provided foods and ensured nutrition for all; they lived in harmony with the cosmos; and respected death as a natural stage, a passage into after life. They shared this in conversation and work. They rather talked to a snake trance-wise as they chased it away than kill it. They took time to type poisonous spiders, lizards, frogs and snakes and had antidotes for such poisons. They knew which tree to use frequently and one to avoid (like the poison oaks).

                     I was walking by a long street with beautiful Victorian houses lining the asphalt streets. On one house was the sign "your palm reader at arm's length, 8am to 9pm, Tuesday to Friday only." Before I woke up this morning the weatherman (never mind even if it was a PBS's lady presenter of the weather forecast reading into the weather's future for the next 7 days) said it would be sunny in the morning but downcast later in the afternoon. The forecast looked at the rest of the week and it got me thinking and thanking. God's gift to humanity via intellect, ingenuity and tech advance. I wondered if the rainmaker would be equally accepted were I to tell about it to my friends here.

                  I wondered about the African diviners, soothsayers, voodoo man or voodoo woman. Where have they written and kept their knowledge? Yet, the public library I frequent has tomes and more tomes on skills of stargazing, reading the stars, crystal ball consultation, astrology and palm reading. Courses and seminars are dedicated to this. Voodoo? Nada! Voodoo is evil and devilish. Voodoo is black. I am told by those who have been in heaven that even there, the angels are white and devil is black! As long as I know that, live by that I am considered mature. But, as long as I question that then I am out of line. In that heaven, the lion and sheep will play with each other's paws. The lion will open wide its mouth and the sheep will count the number of the teeth in the mouth. But, the black devil and white God will not reconcile in that heaven!

                   I wish I had the same clarity to type the grass; the trees;  the birds; the worms; the butterflies that flutter and remember the trails in the woods as my black fore-ancestors. It is amazing that the crystal ball, palm reading, astrology and weather man are symbols of western world liberty and a pedigree culture but my yearning for an indigenous African black man's culture that has witchcraft, voodoo, sorcery and other objects get in the way of my becoming more Godly. I am still the draped-in-my-diapers ethno black man!

The sun light's limit

Who makes sure there is light,

Who makes sure I have a sense of balance,

Who collects together the sun beams,

Who gathers waters,

What moves the winds,

What makes the hills rise,

What hardens a rock,
What softens water,
What stops the ground from moving

What amplifies sound,

The one who can number the stars,
The one who makes roots hold firm,
The one who makes dust fly,
The one who marks time,

The one who knows the amount of hair on my head,

The one who tells a hill to bow down,

The one who makes a fire burn.

The Single-Parent Paradox: Problematizing causes of vulnerability to HIV; Informing HIV prevention and Control Policies in Uganda

Background: 

Personal decisions; economic pressures; and lifestyle are responsible for increasing numbers of single-parents. These same issues are also risk factors linked to HIV disease in this category of population group. Personal decisions range from: abstinence following death of a spouse or partner; child-bearing to prove fecundity or as financial security from a more well to do partner; living independently as a self-supporting person. Economic pressures include: working so many miles away from home; situations when a female earns more than male partner; and relying on males with in polygamous relations. Lifestyle issues  include: fashion and trend of single-parenthood popular in urban settings; and pressures of living in urban settings as a single-parent. These characteristics should be linked to prevention and control interventions against HIV. 

Description:

 Anecdotal methods were used to generate responses on characteristics, prevention and control practices among groups of single-parents in Wakiso (20 males:30 females); Kampala (30 males:45 females); Mukono ( 20 males: 32 females); Busia (12 males:15 females); Masaka (10 males: 20 females); Bukomansimbi (50 males: 65 females); and Kyegegwa (10 males: 23 females). Anecdotal and literature review were also used to generate further information on HIV Services and demands made that target single-parents: counseling, sexual-reproductive health, post-test practices, prevention, prophylaxis, staying negative, avoiding transmission and economic empowerment. Stigma and discrimination; pressures of bearing children; daily survival; care for children and  caring for people living with AIDS still remain single-parents related issues also linked to HIV.

Lessons learned:

For the time period January 2014 to December 2015, we reached 382 single-parents. 152 are males: 230 are females; 182 were < 45 years; 200 were > 45 years; 300 were HIV-exposed; 10 were living in discordant relations; 120 had had an STI treated in past 12 months. All 382 had engaged in unprotected sexual intercourse with a partner other than their first debut. All 382 expressed need for economic empowerment as means of looking after themselves and their families. 200 females said they had children as a means of getting support from male partners or relatives as well as a desire to bear a child/children. 75 males responded that they had a child or children with female who are not long-term partners. 100 females had lost a male partner to HIV but they bore children as a way of staying with subsequent male partners or spouses.

Conclusions/Next steps:

Single-parents are persons who have made a conscious decision to remain without formal partners. The need to bear children also means engaging in sex without condoms. Planned pregnancies may also mean unwanted STIs and HIV. HIV prevention and Control should incorporate messaging targeting unique needs of single-parents. The messaging should show merits of long-term relation, monogamous fidelity, integrate economic empowerment, discourage widow-inheritance and provide motivation to forming post-test clubs where single-parents as a cohesive force advocate for safe and healthy outcomes.

A Stimulus to Characterize Social, Political, Anthropological, Clinical and Economical Aspects of Pro HIV-Cure Strategies: Africa’s Mississippi Baby, The French Visconti cohort and Berlin Patient on the Horizons.

Institutionalizing HIV-Cure advocacy, implementation and vigorous longitudinal research in African countries will not only popularize the science and trials uptake by subjects but help reproduce results such as the ‘Berlin Patient.’ Africa needs to use many strategies to bring down the escalating HIV Prevalence.  From South Africa's bold  anti-HIV innovations (http://www.sahivsoc.org/(1) to Uganda's robust treatment and prevention initiatives, Africa has all it takes to act as an HIV-Cure force (http://www.avert.org (2).

HIV persists in spite of potent ART through the establishment of HIV latency, when integrated viral DNA is silenced by host mechanisms and the virus cannot be accessed by current ART or by host clearance mechanisms. The primary cellular target for HIV infection is the CD4+T cell. Most infected cells die rapidly but a small proportion become stably infected with integrated HIV-originated DNA and revert to a long-lived resting phenotype [3]. Additional barriers to HIV cure include the existence of non-T cell reservoirs, such as macrophages, ongoing cycles of HIV replication even in the presence of ART, persistent blood/tissue HIV-RNA and an immune system that is permanently affected by HIV that cannot adequately clear the virus [4]. Eradication of HIV in Africa is still held back by resources and policy. HIV cure to grow in momentum needs the combined effort of scientists, governments, development partners, leaders, policy makers,civil society, traditional healers and health advocates. HIV-cure can be institutionalized by leveraging an enabling environment that will in turn galvanize pro HIV-cure funding, human resource, legislation and an enduring culture of efficacy, documentation, ethics and nurturing (EDEN) of research work. The terminology, biomedical interventions and health informatics need to be understood, applicable and agreed upon by academics, policy-makers, leaders, professionals and African traditional healers in the field. To get there, seven aspects  will make HIV cure robust and these are:

(i) Build on existing HIV Prevention and Control Initiatives as iterate opportunities for Pro HIV-Cure Strategies in Africa

(ii) Character of  Social Aspects of Pro HIV-Cure Strategies in Africa

(iii) Character of  Political Aspects of Pro HIV-Cure Strategies in Africa

(iv) Character of  Anthropological Aspects of Pro HIV-Cure Strategies in Africa

(v) Character of  Clinical Aspects of Pro HIV-Cure Strategies

(vi) Character of Economical Aspects of Pro HIV-Cure Strategies

(vii) Outcomes and reproduction of HIV-Cure Strategies in Africa

CONCLUSION:

Africa has the structures to produce large numbers of post-treatment controllers as well as move towards zero infection (saafrica.org (6). Prioritizing resources and embracing global health trends are two major strategies that will ensure this outcome.

REFERENCES:

1. http://www.sahivsoc.org. Retrieved on January 18th 2016.

2. http://www.avert.org/professionals/hiv-around-world/sub-saharan-africa. Retrieved on January 18th 2016.

3. Siliciano JD, Kajdas J, Finzi D et al. Long-term follow-up studies confirm the stability of the latent reservoir for HIV-1 in resting CD4+ T cells. Nat Med 2003; 9: 727–728. 

4. Siliciano RF, Greene WC. HIV latency. Cold Spring Harb Perspect Med 2011; 1: a00709.

5. Buzon MJ, Sun H, Li C et al. HIV-1 persistence in CD4(+) T cells with stem cell-like properties. Nat Med 2014; 20: 139–142.

6. http://saafrica.org. Retrieved on January 18th 2016.

Comparison of USA and Republic of South Africa (RSA) Health Indicators

In Physical health status  is often interpreted  through morbidity ( disease and disability) and mortality (death) rates (Shi & Singh, 2015). The following indicators: population size; total expenditure on health as a % of GDP; infant mortality; and life expectancy are used for this short write up.

The total population (2013) of USA is 320,051,000; Life expectancy at birth m/f (2013) is 76/80; and total expenditure on health as % of GDP (2013) is 17.1 (WHO, 2013). The infant mortality rate per 1,000 live births for 2011 was 6.05 (Child Health USA, 2013).

Food is important as a good and a product.

The Republic of South Africa total expenditure on health as % of GDP (2013) is 8.9; life expectancy at birth m/f (2013) is 57/64; and total population (2013) is 52,776,000 ( WHO, 2013). The infant mortality rate per 1,000 live births (2013) is 32.8 (OECD)

The population size of USA is larger than that of RSA, this is because the United States is a larger country. A larger population engages in a variety of production modes. This brings in income and countries are able to get taxes to use to invest in services such as health.

Both countries, USA and RSA has mechanisms in place that promote good health, good healthy outcomes and migration of people. However, the USA has policies that tie the health of people to enjoyment of life.  A proxy of good health outcomes as far as population goes is longevity. Longevity in turn can be measured through life expectancy. Life expectancy is “prediction of how long a person will live” (Page 56).  The table shows that USA has higher life expectancy figures than RSA. The two common measures are life expectancy at birth and life at age 65. Life expectancy at birth is how long a newborn can expect to live and  life expectancy at age 65 is the expected remaining years of life for someone at age 65.

The number of females in USA are more than those in RSA. This means that the pool from which females aged 15-44 is larger in USA than RSA. Fertility or capacity of a population  to reproduce is higher in USA.

Equitable  distribution of healthcare in USA and RSA can be seen through how their populations live. from the table populations live longer in USA than in RSA.  USA has organized structures that produce health services in relation to all categories of population groups i.e., from prenatal, postnatal, infancy, adolescence, adulthood and seniors. USA produces and it also distributes more health care.

Both countries have mechanisms in place that promote health outcomes. The following can make different countries appear to be doing more; investment in health; population sizes; initiatives to promote health according to various populations that demand for the services; and balancing health vis-a-vis other priorities such as: politics; production of food; establishment of infrastructure; and other goods and services.

REFERENCES:

1. Child Health USA. 2013. http://mchb.hrsa.gov/chusa13/perinatal-health-status-indicators/p/infant-mortality.html. Retrieved on December 27 2015.

2. OECD. 2013. https://data.oecd.org/healthstat/infant-mortality-rates.htm#indicator-chart. retrieved on December 27 2015.

3. Shi, L., & Singh, D. A. (2015). Delivering healthcare in America: A systems approach (6th ed.). Burlington, MA: Jones & Bartlett.

Comparison of the United States of America (USA) and the Republic Of South Africa (RSA) Health Care Delivery Systems

Introduction

The term health care delivery means the major components (characteristics) of the system and processes that enable people to be provided or receive health care or services. In this paper, one will read about two countries and how they have organized their health care delivery; statistics that inform policy and programming; measures to improve on health care; a glimpse into culture of provision and demand;the challenges unique to each country; and summaries unique to the two countries.

The United States of America, commonly referred to as the United States or America, is a federal republic composed of 50 states, a federal district, five major territories and various possessions. At 3.8 million square miles and with over 320 million people, the country is the world's third or fourth-largest by total area and the third most populous. It is one of the world's most ethnically diverse and multicultural nations, the product of large-scale immigration from many countries. South Africa, officially the Republic of South Africa, is the southernmost country in Africa. It is the 25th-largest country in the world by land area occupying 470,693 square miles and with close to 53 million people, is the world's 24th-most populous nation (bing.com). USA is almost 9 times the size of  Republic of South Africa (RSA).

Dr. Aaron Motsoaledi (in black suit) during World AIDS Day Event in South Africa. Photo courtesy of National Health Department of RSA.

Both the Republic of South Africa and United States of America value their populations. Healthy populations are an asset to any given country; vast and complex networks of government, private institutions, non-governmental organizations (NGO’s) and community initiatives create structures through which healthy outcomes are achieved; public health is structured according to existing social-political-cultural structures; the authority granted to health professionals; funding provided for social services and programmatic emphasis; and manipulating factors that influence health and illness play an important role on delivery and accessibility of health services. The information garnered can be used to assess population and community health status and develop effective health interventions and public policy (Turnock, 2015). The relevance of these factors “resides in their focus on causes or influence of particular health outcomes” (Page 22).  Data on mortality, morbidity, medical records and population assessments are utilized as measures to gauge health outcomes. Information on health status of a population can be collected and compared to study differences between one country and another. This can offer valuable information about the comparative state of health of a population or about disease trends (American Medical Association, 1989). Crude mortality rates count deaths within the entire populations; age-adjusted mortality rates show age-related factors that influence health (e.g., stroke, heart disease, HIV infections, infant deaths, tuberculosis, influenza, pneumonia, malaria, URTIs, UTIs, syphilis, cancer);  age-specific mortality rates relate the number of deaths to the number of persons in a specific age group ( e.g., infant-mortality rate describes number of deaths of live-born infants occurring in the first year of life per 1,000 live births and maternal-mortality describes number of death by mothers during or after delivery); age-adjusted rates are calculated by applying age-specific rates to a standard population ( the year 2000 is used in USA). “This adjustment permits more meaningful comparisons of mortality experience between populations with different age distribution patterns” (Page 26); Life expectancy, is a computation of the number of years between any given age (e.g., birth or age 75) and the average age of death for that population; and Years of Potential Life Lost (YPLL) is a mortality-based indicator that places greater weight on deaths that occur at younger ages. An arbitrary or given age is used as a threshold e.g., 65. Together  with infant mortality rates, life expectancies are commonly used in comparisons of health  status among nations. These two mortality-based indicators are often considered to be general indicators of the overall health status of a population.  Comparisons between the two different countries for causes of death for say, cancer, heart disease, unintentional injuries, suicide, homicide, cerebrovascular diseases, chronic obstructive lung disease, diabetes mellitus, HIV infections and chronic liver disease and cirrhosis, offer insight into magnitude and impact of problems. This in turn will inform policy, investments and interventions needed. But before one collects the information, it would do to understand the  characteristics or structures that influence particular health outcomes.

Integrated Care for Mothers and Children is an important health approach. Photo courtesy of World Bank.

Characteristics of US Health Care System: 

The total population (2013) of USA is 320,051,000; Life expectancy at birth m/f (2013) is 76/80; and total expenditure on health as % of GDP (2013) is 17.1 (WHO, 2013). The infant mortality rate per 1,000 live births for 2011 was 6.05 (Child Health USA, 2013). The health system in USA is complex and decentralized, having a combination of national, state and local public health services.  The private sector is responsible for the delivery and production of most care in USA. The department of health and human services is similar to a ministry of health. An individual can gain access to needed services, including specialized care through hospitals and organizations that supply health services, medical equipments, pharmaceuticals, supplies, health insurance and training work force. Healthcare services are paid for through insurance and out-of-pocket. The U.S has a national health system with tax-funded coverage, a health insurance system with a single payer and a health insurance system with multiple insurers. There are different hospitals, health centers, government insurance programs such as Medicare, Medicaid, State Children’s Health Insurance Program (SCHIP) and these provide vulnerable populations with access to health care services. These are benefits that people in this country experience because of the health system’s characteristics. People are guaranteed access to healthcare services. Medicare is one of the largest sources of health insurance in U.S. serving nearly 39 million people who are either 65 years old or older and who are suffering from certain disabilities or are diagnosed with end-stage renal disease. This is managed by Health Care Financing Administration (HCFA). Medicare has four parts (A, B, C & D). Medicaid is the third largest health insurance in U.S. providing coverage for low-income women, children, elderly people and individuals with disabilities covering 12% of U.S. population. The program provides outpatient care and prescription drugs for vulnerable populations. The SCHIP covers children who are uninsured and those in families with low-income. SCHIP pays for child’s physician visit, immunization, hospitalization and emergency room visits. Insured patients receive well-coordinated care under the Managed Care Organization (MCOs) and Accountable Care Organizations (ACOs). Health information is readily available to providers through an integrated technology system. Not only is there a great deal of choice when selecting physicians but there are other providers along the continuum of care chain. Uninsured people face challenges in accessing basic, well-directed, coordinated, continuous and routine health care. This may translate into typically a long wait to see a specialist. It may cause  many people to encounter adverse effects because medical supplies are not readily available. Because of lack of insurance healthcare services can be prohibitively expensive for most people (Shi & Singh 2015). “In the U.S., public health can be affected by disruptions of physical, biological, and ecological systems. The health effects of these disruptions include increased respiratory and cardiovascular disease, injuries and premature deaths related to extreme weather events, changes in the prevalence and geographical distribution of food- and water-borne illnesses and other infectious diseases, and threats to mental health” (National Center for Environmental Health, 2015). Factoring in environmental health, safeguards the health of populations that are particularly vulnerable to certain environmental hazards e.g., children, the elderly, people with disabilities and persons new to places.

Characteristics of South African Health Care System:

The Republic of South Africa total expenditure on health as % of GDP (2013) is 8.9; life expectancy at birth m/f (2013) is 57/64; and total population (2013) is 52,776,000 ( WHO, 2013). The infant mortality rate per 1,000 live births (2013) is 32.8 (OECD). In the Republic Of South Africa, health care has the following characteristics:  a) Pharmaceuticals, consumables and supplies; public health sector; private health sector; curative hospi-centric focus; human resources; fragmented funding pools; out-of-pocket payments and financing systems (South Africa Gazette, 2015). The National Health Insurance (NHI) of the Republic Of South Africa is a centralized health financing system that is designed to pool funds to provide access to quality, affordable personal health services for all South Africans based on their health needs, irrespective of their socioeconomic status. NHI is intended to ensure that the use of health services does not result in financial hardships for individuals and their families (South Africa Gazette, 2015). An individual can gain access to needed services, including specialized care. Healthcare services are paid for by government and out of pocket. Population coverage under NHI ensures that all South Africans have access to comprehensive quality health care services. This means that people will be able to access health care services closest to where they live. The health care services will be accessed at the appropriate level of care and will be delivered through certified and accredited public and private providers using the NHI Card. NHI creates a unified health system by improving equity in financing, reducing fragmentation in funding pools, and by making health care delivery more affordable and accessible for the population. NHI will eliminate out-of-pocket payments when the population needs to access health care services. In the long run, households will also benefit from increased disposable income as a result of a significantly lower mandatory prepayment ( Page 12). Primary Health Care (PHC) is being reengineered through four streams to improve timely access and to promote health and prevent disease. These streams are Municipal Ward-based Primary Health Care Outreach Teams (WBPHCOTs); Integrated School Health Programme (ISHP); District Clinical Specialist Teams (DCSTs); and Contracting of nonspecialist Health Professionals. This system has its benefits such as: Phakisa Ideal Clinic Realization Programme aimed at improving the performance and quality of health services in the PHC facilities. As well as quality public health infrastructure complete with bulk services such as provision of electricity, water supply, sanitation and waste management supported by effective transport and communication systems. South Africa has had a history of improvements that guaranteed access to healthcare services. Several proposals and attempts to implement health financing reforms namely: the 1928 Commission of Old Age Pension and NHI; 1941 Collie’s Committee of Inquiry into NHI; the 1943 African Claims that proposed equal treatment in the scheme of Social Security; the Dr Henry Gluckman National Health Services Commission of 1943 to 1944 that proposed NHI; The Freedom Charter as adopted by the Congress of the People, 1955; the 1994 Ministerial Committee on Health Care Financing; the 1995 Ministerial Committee of Inquiry into NHI (Broomberg and Shisana Report); the 1997 Social Health Insurance Working Group; Professor Taylor’s 2002 Committee of Inquiry into a Comprehensive Social Security System; Ministerial Task Team on Social Health Insurance and the 2009-2014 Ministerial Advisory Committee on NHI (Government Printing Works, 2015). Patients receive well-coordinated care through an established network of clinics e.g., from 2009 to 2013, the number of nurses trained on Nurse Initiated Management of Anti-Retroviral Therapy (NIMART) increased from 250 to 23,000. This increase contributed to the massive roll out of Anti-Retroviral Therapy (ART) “resulting in the largest ART programme in the world” (South Africa Gazette, Page 17).  People make choices of which clinics to go to as well as selecting physicians. The challenges that people in this country encounter include: “high costs in the private health sector due largely to a fee- for-service model” ( South Africa Gazette Page 22 & 23); High HIV prevalence, e.g., for 15-49 year old is 18.9 (World Bank); controls in place to access HIV medication such as PrEP still serve as a hurdle to prevention (MCC, 2015); “the main cost drivers (other than human resources) in the public health sector are: pharmaceuticals; laboratory services; blood and blood products; equipment; and surgical consumables” (South African Gazette, Page 23); the lack of peer review or regulation of traditional healers who make claims for many cures including that for HIV; congestion at health facilities; and impact of weather changes that cause water shortages e.g., at Stanger Hospital in Ilembe, Kwazulu Natal, South Africa (Kaveel Singh, 2015).

Comparison of USA Health Care System to RSA:

The US health care system is not centralized, serves a population of  320,051,000; Life expectancy at birth m/f is 76/80; and total expenditure on health as % of GDP (2013) is 17.1. The infant mortality rate per 1,000 live births for 2011 is 6.05. Whereas for Republic of South Africa total expenditure on health as % of GDP is 8.9; life expectancy at birth m/f is 57/64; and total population 52,776,000. The infant mortality rate per 1,000 live births is 32.8.

Potential benefits for people in USA and RSA:

In USA, an individual can gain access to needed services, including specialized care through hospitals and organizations that supply health services, medical equipments, pharmaceuticals, supplies, health insurance and training work force. A national health system with tax-funded coverage and a health insurance system with multiple insurers exists. Access to different hospitals, health centers, government insurance programs such as Medicare, Medicaid, State Children’s Health Insurance Program (SCHIP) provide vulnerable populations with affordability to health care services. These are benefits that people in this country experience because of the health system’s characteristics. People are guaranteed access to healthcare services. 

In RSA, an individual can gain access to needed services, including specialized care. Healthcare services are paid for by government and out of pocket. Population coverage under NHI ensures that all South Africans have access to comprehensive quality health care services. People access health care services closest to where they live through certified and accredited public and private providers using the NHI Card or  pay out-of-Pocket.

Built areas contribute to good health. Photo courtesy of Tom Mukasa

Potential challenges for people in USA and RSA:

In USA, uninsured people face challenges in accessing basic, well-directed, coordinated, continuous and routine health care. Because of lack of insurance healthcare services can be prohibitively expensive for most people. Public health can be affected by disruptions of physical, biological, and ecological systems. The health effects include exposure to elements, increased respiratory and cardiovascular disease, injuries and premature deaths related to extreme weather events, changes in the prevalence and geographical distribution of food- and water-borne illnesses and other infectious diseases, and threats to mental health. 

In RSA, challenges that people encounter include:high costs in the private health sector due largely to a fee- for-service model; High HIV prevalence, e.g., for 15-49 year old it is 18.9; the controls in place to access HIV medication such as PrEP can be a hindrance for prevention; high costs for: pharmaceuticals; laboratory services; blood and blood products; equipment; and surgical consumables; the lack of peer review or regulation of traditional healers who make claims for many cures including that for HIV; congestion at health facilities; and impact of weather changes that cause, say,  water shortages in hospitals.

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