American+Health+Care+as+a+Sustainability+Problem

=American Health Care as a Sustainability Problem= Chris Aram

The overarching American cultural problem stems from our ideology to procrastinate and deal with problems later. This is a reactionary approach, where no action is taken until the need is expressed or a problem has exacerbated to the point of necessity. This contrasts to the more sustainable approach of having a proactive mindset. However, the current situation as it stands, American health care creates two sustainability problems, one of human sustainability and another of environmental sustainability.

We have a health care human sustainability problem. Primary care is considered to be one of the elements of proactive medical care, creating a path for sustainable healthcare. There is a problem however; primary care is on the decline. Physicians are overworked; underappreciated and new medical students wish to become specialists instead of primary care physicians. (Garibaldi, Popkave, and Bylsma). What does primary care have to offer? Patient history is one of the biggest assets that primary care has in regards to health care. The construction of patient history over a period of time accounts for an evaluative and systematic environment of risk assessment. This results in an overall improvement in health care as symptoms and ailments can be briskly treated before they turn into larger issues.

The Commonwealth Fund indicated that there is an increased need for medical homes (or primary care). Medical homes help to reduce incidents of errors, and often increase the effectiveness of coordination between different facilitators of health care. Statistically speaking, 54% of Americans would have experienced a lapse in the coordination of their medical care over the span of two years. This figure was reduced to 33% with the addition of a medical home. Better coordination results in less tests and reduced errors, thus less cost to the patient. Cost is a barrier to health care within the United States. A whopping 42% of Adults in the United States abstained from medical care in the past year due to the cost. This can be compared to the cost in the UK (11%) and Switzerland (18%). All this waste incurred through increased cost prevents primary care from functioning as it should, as evident with the increase in many chronic illnesses, such as diabetes, heart disease and obesity. (Schoen, Osborn, Squires, Doty, Pierson, and Applebaum).

The Capital District Physicians (CDPHP) founded in 1984, serves the New York Capital Region area. They embraced the idea of Enhanced Primary Care, by offering greater compensation to treat patients better, and not subject them to more care. The results are significant. (CDPHP)

//“ Total hospital admissions were 24 percent lower than otherwise expected among the population served by the practices participating in the pilot.” // (CDPHP)

// “A 9% reduction in the rate of overall medical cost increases—a savings of $32 per member, per month—as compared to other area physician practices.” // (CDPHP)

This should incentivize insurance companies to embrace the medical home as an option to lower overall costs of medical coverage. This would have a profound effect on the population, providing more access to medical care, and reducing instances of preventable illness. The system is self-feeding, which can work in both directions, either going cyclically up or down. Until these problems are addressed, health care will spiral out of control.

Environmental sustainability is another facet to the American Health Care problem. We have become our own doctors, experts at our own health. We’re convinced that we must have a problem which must be cured. The pharmaceutical industry and associated marketing play into this fear by producing targeted products. They even create and foster the fear to develop a market and ecosystem around it. Another facet to the environmental sustainability problem is the treatment of medical waste. This waste creates a problem for the environment depending on how it is destroyed and disposed.

How is pharmaceutical waste generated? This waste is generated due to overprescribing, self-diagnosis, and marketing. The drugs are required to be within packaging, this packaging produces waste once the usefulness of the packaging has been fully spent. When the drugs are not ingested, and pass expiration, they are thrown out into various waste streams such as municipal waste and the sewer system.

// “In March of 2002, the United States Geological Society released the results of the first nationwide reconnaissance of the occurrence of pharmaceuticals, hormones and other organic wastewater contaminants (OWCs) in surface waters. 4 USGS surveyed 139 streams across the country, including // // three in Wisconsin, looking for 95 different OWCs. One or more contaminants was found in 80% of the samples, and What Pharmacists Should Know18 Nov/Dec 2002 Journal of the Pharmacy Society of Wisconsin included common pharmaceuticals.” // (Smith)

The majority of the samples had some amount of pharmaceutical product. This creates an environmental problem as these substances can affect the surrounding habitats, even eventually us as well as the water moves upstream to our tap. Many water treatment plants are unable to treat and remove organic molecules. (Smith)

Primary care can be tied in here. With a further importance placed on good health care rather than the quantity of care, less waste will be produced. Fewer tests ordered, fewer mistakes made and less medical waste generated is part of a function of having a healthier population. (Root) Physicians learn new strategies and techniques to lower their environmental footprint through the manifestation of medical record systems, which help to reduce paper consumption. The system feeds itself, thus relying on a higher, stressed importance on primary care.

Solutions would include higher importance and stress on primary care. The ideology that quality care is better than more care results in less consumption, waste and errors. Tighter regulations on medical waste would ensure that the less of an impact would be put on the environment through the consumption of pharmaceuticals and use of medical equipment.

Works Cited CDPHP® MEDICAL HOME PILOT RESULTS IN QUALITY IMPROVEMENTS AND COST SAVINGS." Press Release. Albany, NY, Albany. 2011. Reading.

Finds That Care Is Often Poorly Coordinated." // Health Affairs // . (2011): n. page. Web. 15 Nov. 2011. .

Garibaldi, Richard, Carol Popkave, and Wayne Bylsma. "The disturbing decline of primary care." // PNHP-Physicians for a National Health Program //. PNHP, May 2005. Web. .

Macinko, James, Barbara Starfield, and Leiyu Shi. "QUANTIFYING THE HEALTH BENEFITS OF PRIMARY CARE PHYSICIAN SUPPLY IN THE UNITED STATES." // International Journal of Health Services //. 37.01 (2007): 111-26. Print. . Root, Jessica. "Sustainability and Health Care: What's the Green Connection?." // planet green //. Discovery Communications, 05 Aug 2009. Web. 8 Nov 2011. .

Schoen, Cathy, Robin Osborn, David Squires, Michelle Doty, Roz Pierson, and Sandra Applebaum. "New 2011 Survey Of Patients With Complex Care Needs In Eleven Countries

Smith, Charlotte. "MANAGING PHARMACEUTICAL WASTE." // Journal of the Pharmacy Society of Wisconsin //. (2002): n. page. Web. 14 Nov. 2011. < http://premierinc.com/informatics/tools-services/safety/topics/epp/downloads/PSW_article.pdf>.

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