Based on the following question, I need you to help respond to the attached 4 peers’ posts in 150 words each. Question on Public

NR514-NEED RESPONSES

  Maria Houston  - 

· Why did you choose your report? 

· Why is this particular report important to society and how it fits in the Dahlgren-Whitehead model? 

· Using what you have learned through your nursing education, what are your thoughts about how you might affect legislation around this issue at the local level or above?  

The misuse of injectable opioids and heroin creates an elevated risk of contracting infectious diseases from using contaminated syringes such as hepatitis C virus (HCV), hepatitis B virus (HBV), and human immunodeficiency virus (HIV). The report Promoting Health and Cost Control in States: How States Can Improve Community Health and Well-Being (Cabrera, M., & Lustig A., 2019) lists six goals with associated policy recommendations. The report corresponds to the Dahlgren-Whitehead model because it encompasses perspectives of social determinants contributing to health disparities. A recommended policy within the report is to implement syringe safety programs with the goal to employ harm reduction strategies to reduce substance misuse deaths and related diseases. Syringe access laws protect the public and first responders by facilitating the safe disposal of used needles and syringes. Research shows that syringe access laws are safe, effective, and cost-saving, do not increase illegal drug use or crime and play a key role in reducing the transmission of viral hepatitis, HIV, and other infections (Centers for Disease Control, nd).  

Using a sterile syringe for every injection can reduce the risk of acquiring and transmitting diseases, but legal barriers may hinder people from accessing clean needles. Expanding policies that authorize the possession, legal sales, and exchange of sterile syringes can reduce rates of infection. To enact legislation to remove legal barriers to the operation of syringe access programs may be promoted at state and local levels. For example, local government approval not being required prior to operation can improve operability. What additional services must be provided at syringe safety programs (naloxone education, drug abuse treatment referrals, etc. (Policy Surveillance Program, nd). 

· Why did you choose this legislation? 

· What does the legislation provide for?  

I chose the following legislation because it affected the health of large populations within the state my family and I live in: Act 91 (H. 742) of 2020 Vermont's Response to the Coronavirus, is a comprehensive act that provided administrative and health care providers flexibility in responding to the COVID-19 pandemic and was enacted 03/30/2020. It allowed the Agency of Human Services and the regulatory board to waive certain requirements as appropriate to prioritize direct patient care, allow flexible staffing, and preserve provider sustainability. It adopted emergency rules to expand health insurance coverage for and reduce out-of-pocket costs related to COVID-19 diagnosis, treatment, and prevention; modify or suspend deductible requirements for prescription drugs; and expand access to and reimbursement for health care services delivered remotely. It permitted patients to refill their maintenance medications early, allows pharmacists to extend prescriptions for maintenance medications, and allows pharmacists to substitute an equivalent prescription drug if a prescribed medication is unavailable. It allowed recently retired Vermont health care professionals and health care professionals licensed in other states to deliver health care services to Vermonters using telehealth, as part of the staff of a licensed facility, or under a temporary license, and provided the Office of Professional Regulation and Board of Medical Practice flexibility to waive certain requirements during a state of emergency. The act also expanded health insurance coverage for telehealth until January 1, 2026, requiring health insurance plans to reimburse providers the same amount for the same services whether provided in person or through telemedicine. The act also allocated additional funds for the Child Care Financial Assistance Program to help childcare programs at risk of closing due to financial hardship.  The Act enabled many individuals and families to receive necessary care on an emergent basis, strengthened the workforce, rescued families from economic ruin, and saved lives by reducing barriers to health care.

Centers for Disease Control (nd).  https://www.cdc.gov/ssp/index.html  

The Policy Surveillance Program (nd).  https://lawatlas.org/datasets/syringe-services-programs-laws  

Cabrera, M., & Lustig A., (2019). Promoting Health and Cost Control in States: How States Can Improve Community Health & Well-being Through Policy Change, Trust for Americas Health, lawatlas.org/datasets/syringe-services-programs-laws, 2019 PHACCS Report.pdf 

Vermont State Legislature (2020).   https://legislature.vermont.gov/Documents/2020/Docs/ACTS/ACT091/ACT091%20Act%20Summary.pdf  

Aloo Ragwar  - 

1.  The news article that I selected was published in March 2021, and it was entitled Kentucky governor signs bill to cap insulin costs: ‘Health care is a human right.’ I chose this report due to my interest in understanding rising healthcare costs. This report highlights the importance of making healthcare more affordable, especially for those living with chronic diseases. If individuals cannot afford the cost of insulin, a life saving medication, then they are more likely to either underuse it or abandon treatment altogether (Herkert et al., 2019). Therefore, medication nonadherence can be better prevented with health policies that aim to improve insurance coverage and patient’s out-of-pocket expenses.

In regards to the Dahlgren-Whitehead model, high medication costs place a heavy burden on an individual’s sense of wellbeing, community resources, and healthcare allocations. Robeznieks (2019) discussed how healthcare providers must be mindful of the cost of healthcare when planning and discussing treatment with patients. It is important for clinical team members to involve patients in their care, so that they do not feel defeated by high costs. As healthcare professionals, we are obligated to ensure patients can afford and adhere to their prescribed medication regimen before discharging from the hospital.. By sharing patients’ experiences surrounding this issue, it can help my fellow colleagues and our healthcare facility with future care planning, so that our patients are more likely to experience treatment success. When patients with chronic disease are properly managed, it helps decrease overall healthcare costs, such as hospital admissions and prolonged length of stays, and it contributes to a healthier community.

2.  After visiting the National Conference of State Legislatures website, I chose a piece of legislation that was enacted in the state of New Hampshire entitled 2021 NH S 155. As a student attending a school located in Vermont, I wanted to look at legislation from our neighboring state to see how their response to COVID-19 compared to our own. This senate bill included many provisions in response to the pandemic, including expansion of outdoor dining, authorization of emergency medical provider licensing, and authorization for pharmacy technicians to administer COVID-19 tests and vaccines. One interesting piece of this legislation was that it established a position for a “temporary health partner,” which essentially allows individuals to work in long-term care facilities after completing training consisting of at least 8 hours.

Temporary health partners are allowed to assist with activities of daily living, such as bathing, toileting, ambulation, and even routine ostomy care. Essentially, they work alongside a licensed nursing assistant. With many healthcare facilities in desperate need of healthcare workers, especially long-term care facilities, I found this very interesting; however, it is somewhat concerning that these positions have very little training.

References

Herkert, D., Vijayakumar, P., Luo, J., Schwartz, J. I., Rabin, T. L., DeFilippo, E., & Lipska, K. J. (2019). Cost-related insulin underuse among patients with diabetes. JAMA Internal Medicine, 179(1), 112–114.  https://doi.org/10.1001/jamainternmed.2018.5008

Robeznieks, A. (2019, May 9). AMA to congress: Patients pay painful price for high drug costs. American Medical Association.  https://www.ama-assn.org/delivering-care/public-health/ama-congress-patients-pay-painful-price-high-drug-costs

2021 NH S 155 (enacted).  https://custom.statenet.com/public/resources.cgi?id=ID:bill:NH2021000S155&ciq=ncsl&client_md= a9f3d3995f3fcfd44fd12920fbdb254a&mode=current_text

Whittington, J. (2021, March 22). Kentucky governor signs bill to cap insulin costs: ‘Health care is a human right.’ Fox 17 news.  https://fox17.com/news/local/kentucky-governor-signs-bill-to-cap-insulin-costs-health-care-is-a-human-right

  Cyron Dalida - 

New York governor declares racism a ‘public health emergency’ amid new anti-discrimination legislation (Alfonseca, 2021).

Why did you choose report?

Since early 2020, the NYC Commission on Human Rights has received a seven-fold increase in anti-Asian harassment, discrimination, and violence (nyc.gov). On December 23, 2021, New York Governor Kathy Hochul signed a package of legislation addressing the racial injustices and discrimination amid the recent spike in harassment and violence against Asian communities during the Covid-19 pandemic. The harassment and hostility directed at Chinese and other Asian communities are related to COVID-19 stigma and misinformation (nyc.gov). 

Since the beginning of the pandemic, I have read reports and news about unprovoked attacks on the elderly Asian population and Asian women. As an Asian American, I share the same concern from my friends and family regarding fear of being attacked because of misinformation and stigma brought upon by the COVID-19 pandemic. The violence against the Asian community reminds me of the rise of Islamophobia after September 11. I chose this report because the legislation protects the communities being targeted through the collection of demographic data of perpetrators and victims.   

Why is this particular report important to society, and how it fits in the Dahlgren-Whitehead model?

The legislation will ensure inclusivity in healthcare by including screenings for conditions found in newborns from the Middle East, Africa, and Southeast Asia declare racism as a public health crisis and provide services to a marginalized population by updating websites and services with translations for translations non-English speakers. This legislation addresses the social factors that contribute to health inequalities in society as mapped out in the Dahlgren-Whitehead rainbow model.

Using what you have learned through your nursing education, what are your thoughts about how you might affect legislation around this issue at the local level or above?

As a nurse in the New York metropolitan area, I encounter patients of diverse ethnic backgrounds and non-English speakers while working in the emergency department. I have seen how difficult it can be for families who are non-English speakers to make their needs known while receiving medical care. As a nurse, I can provide some of the resources firsthand or informational through the passing of this legislation. 

The New York Assembly Bill A10344

Why did you choose this legislation?

I chose this legislation because it affects health care workers who are constantly exposed to COVID-19 while on the job. Until recent weeks, COVID-19 was still a primary reason why nurses in the emergency department were calling out sick. My emergency department has seen increased sick calls during the Omicron variant surge. This legislation will provide benefits to employees whose employers might not accommodate these benefits. The case now sits on the assembly committee.

What does the legislation provide for?

The New York Assembly Bill A10344 allows employees to be eligible to take paid family leave benefits if not otherwise paid by an employer while in mandatory or precautionary quarantine or isolation due to COVID-19.

References:

Alfonseca, K. (2021, December 30). New York governor declares racism ‘public health emergency’ amid new anti-discrimination legislation. ABC News.  https://abcnews.go.com/US/york-governor-declares-racism-public-health-emergency-amid/story?id=82002884

New York State, the official website of New York State (2021, December 23). Governor Hochul signs package of legislation to address discrimination and racial injustice.  https://www.governor.ny.gov/news/governor-hochul-signs-package-legislation-address-discrimination-and-racial-injustice

NYC, the official website of the city of New York (n.d.). Stop Asian hate: A toolkit for addressing anti-Asian bias, discrimination, and hate. The office of human rights.  https://www1.nyc.gov/site/cchr/community/stop-asian-hate.page

The New York State Senate (n.d.). Assembly bill A10344: Relates to requirements for sick leave when such employee is subject to a mandatory or precautionary order of quarantine or isolation.  https://www.nysenate.gov/legislation/bills/2019/A10344?intent=support

Louann Robinson  - 

The report chosen to focus on is how online food retailers are not required to display nutritional information to customers the same way as other stores.

According to Pomeranz et al. (2022), online food retailers do not display food nutrition information consistently, and laws requiring this action are slow. Pomeranz et al. (2022) provide clear insight into the growing economic influence online grocery shopping has in our society and how it influences poor choices. According to Pomeranz et al. (2022), “online grocery sales in the U.S. tripled from 3.4% to 10.2% of total grocery sales, and are projected to reach 21.5% of total sales by 2025” (par. 3). 

Using the Dhalgren-Whitehead rainbow model (2022) (see Appendix), health literacy and understanding food labels influence our food choices. Cultural, social normative ethics and behaviors influence the food we eat. The Waianae community is predominantly lower socioeconomic Native Hawaiian and Pacific Islanders (NHPIs) with a diet high in processed food such as SPAM, white rice, and fast food.

In conjunction with Federally Qualified Health Center (FQHC)(2022) facilities, health care professionals in Hawaii can advocate for increased spending on health literacy programs in communities like Waianae. Improved efforts emphasizing food literacy could positively affect families and normative cultural behaviors.

Hawaii Legislation

 According to the National Conference of State Legislatures. (NCLS)(2022). Hawaii SB 3139 (2022), signed into law by Governor Ige, appropriates $43 million from the general revenues to the emergency and budget reserve fund. SB 3139 makes deposits into the emergency and budget reserve fund by replacing general fund appropriations with general obligation bond proceeds and transferring savings from the Supplemental Appropriations Act of 2020. It also transfers excess funds from other sources into the emergency fund. In general, SB 3139 allows money to be in reserve for quick emergency response, which is helpful in the case of a sudden increase in COVID-19 cases.

 References

Economic and Social Research Council. (2022). The Dahlgren-Whitehead rainbow – Economic and Social Research Council. Esrc.Ukri.Org. Retrieved March 13, 2022, from  https://esrc.ukri.org/about-us/50-years-of-esrc/50-achievements/the-dahlgren-whitehead-rainbow/

Hawaii State Legislature. (2022). Hawaii State Legislature. Capitol.Hawaii.Gov. Retrieved March 13, 2022, from  https://www.capitol.hawaii.gov/Archives/measure_indiv_Archives.aspx?billtype=SB&billnumber=3139&year=2020

National Conference of State Legislatures. (2022). State Fiscal Responses to Coronavirus (COVID-19). Ncls.Org. Retrieved March 13, 2022, from  https://www.ncsl.org/research/fiscal-policy/state-fiscal-responses-to-covid-19.aspx

Pomeranz, J. L., Cash, S. B., Springer, M., del Giudice, I. M., & Mozaffarian, D. (2022). Opportunities to address the failure of online food retailers to ensure access to required food labeling information in the USA. Public Health Nutrition, 1–9.  https://doi.org/10.1017/s1368980021004638

State of Hawaii Department of Health. (2022). Federally Qualified Health Centers. Health.Hawaii.Gov. Retrieved March 13, 2022, from  https://health.hawaii.gov/opcrh/home/federally-qualified-health-centers/

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