Anonymous Interview; Region X (7/11/16)
1.
Identification:
-What
is your name? Anonymous
-Where
were you born? West Virginia
-Where
did you grow up? Eastern Tennessee (Rural Tennessee)
-Profession
currently: Gerontology; Run a charitable foundation that works with old folks; primarily rural communities
-Region
working in right now: We work near Appalachia Mountains; comprised of 7 states: Kentucky and West Virginia, Oregon and Central America (Nicaragua)
-State
living in right now: Oregon
2.
Why
are you interested in public health and how did you get into the field of
public health?
Chronic disease is a public
health issue, and I face this all the time when dealing with older adults. We
explore the management of chronic disease. Not only is chronic disease genetic,
but it is also related to socio economic factors which are now called social
determinants of health. And since we deal with older adults, we would be
interested in those factors while speculating on what does that mean going
forward?
We have made a lot of strides
within public health but not a lot of strides within chronic disease issues.
Yes, we have worked a lot on younger health but not chronic disease. So the
bigger question now is how we can support them later in life? On a last note, pre-mature aging
represents a significant public health issue as the global population grows. Including
right now- we are facing it right now in the US but we will face it globally
within the next decade.
3.
What
is health equity to you?
Adequate
access to health and social services for populations in all areas. For example,
in the rural areas they do not have health equity. Because they do not have
access. Particularly those who are not mobile. Means access and a provider
system that understands the health related issues of the population. So if you
have a focus on particular disease, that excludes other subgroups then that is
not equity. If one cannot get to services, that is not equity. Access and knowledge system for the specific sub populations (characteristics: age, race, ethnicity)
is important. Equity: ability to address and provide to all populations.
4.
What
are some challenges (that still persist) within the field of health equity in
public health?
Access in rural
areas because either people cannot get to provider or there is no provider. Haven’t
really developed virtual medicine to the extent that we need to. Have not
thought through how to increase access in comparison to where they are at. Populations
in rural areas are isolated. Another challenge is health education. Therefore, 2
specific problems that still persist in our system today is the lack of health
education and rural health access. We simply have fundamental access issues
that we have not really resolved.
5.
Why
do you think those challenges still persist?
There are 3 reasons why these
challenges still persist:
a) Money
b) Based
upon your political orientation. What is the role of the government both local,
state and federal? A lot of opinions on that.
c) I
don’t think we have fully embraced how to use technology to increase access.
Ex: older people are wary of using nurse
practitioners and physician assistants when probably in many cases for the management
of chronic disease these people are the best people to do it. Also, licensing
laws are not embracing how to increase access (specifically physicians). We are
not doing a lot with technology and bringing awareness to the education people
can receive virtually through virtual visits with physicians. Another issue is
not sharing medical records readily either. All of these issues affect health
care. We probably are not doing a lot of preventative care either. The system
is still biased. In terms of treatment; active treatment versus active
prevention.
6.
What
models within your workforce have worked to encourage health equity?
I am a big believer in community
health (ex: Promotora work). I feel that we can re-examine and look at the underlying
issues with Promotora model, but I don’t think we have taken fully advantage of
this model- particularly in areas where resources are scare.
We simply need to have:
-Aggressive exploration of
using technology for health care
-Extension of Promotora
program within communities
-Full embrace of professional system that
uses all community health workers in the health system (ex: utilizing NP, PA,
nurses, etc.)
7.
At
the beginning of your career, what were some root causes for health inequities
and health disparities? How has those changed (or not at all) following the end
of your career?
There has been improved
access from when I began 40 years ago. Definitely improved access through Medicare
and Medicaid. These programs were just being implemented when I was starting in
the field. Another change that happened is that there is a grow in realization
that decreasing length of stay in hospitals is ideal (not good place to stay
when sick because probability of infection). There has been improved techniques
and specialization within health care and hospitals as well. We are routinely
replacing joints, cataracts surgery in the same day and so on. Technical
deliveries are phenomenal. We are starting to understand how to treat chronic
disease. But some issues
that have risen over the years is that we don’t know how to manage pain anymore. Patients over-utilize pain medication. There is also an over-dependence on testing. We don’t support primary care physicians anymore. These physicians
should be the case manager for the patients (particularly in chronic disease)
but that is not the case. We have probably over-specialized and or over-glamourized
specializations. People simply don’t have the same doctor for many years
anymore. A piece of paper does not understand the depth of knowledge that a physician
can know if they are consistently our doctor for many years (versus that one
piece of health documentation).
