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A Model for Advancing Policy in Cultural Competency and Health Disparity

As The US emerges from a long recession, managing the growing cost of healthcare remains an ongoing concern. The Affordable Health Act will eventually assure the availability of healthcare insurance coverage to over 30 million more Americans. This landmark legislation will improve access to a previously uninsured or underinsured group of Americans.Health and Healthcare disparities is broadly defined as worse baseline states of health and relatively worse clinical outcomes associated with certain diseases in certain population groups. The affected groups may be distinguished by race, ethnicity, culture, gender, religion and age. The costs to treat the diseases which result from Health and Healthcare disparities represent one of the recognized areas of unnecessary and arguably avoidable healthcare delivery costs. Specifically, in certain instances both prevention and more cost efficient management of chronic disease states can significantly reduce healthcare costs. A chronic disease is defined as a long lasting or recurrent medical condition.Some common examples include diabetes, hypertension, asthma and cardiovascular disease. Unfortunately, our current healthcare system may be better equipped to manage intermittent and episodic disease occurrences and not the demands of chronic medical conditions In a study published by Weidman et al from The Urban Institute,the authors estimated that in 2009, disparities among African Americans, Hispanics, and non-Hispanic whites will cost the health care system $23.9 billion dollars. Medicare alone will spend an extra $15.6 billion while private insurers will incur $5.1 billion in additional costs due to elevated rates of chronic illness among these groups of Americans. Over the 10-year period from 2009 through 2018, the authors estimated that the total cost of these disparities to be approximately $337 billion, including $220 billion for Medicare.In the same study, the authors estimated the total healthcare costs secondary to racial and ethnic health disparities in chronic disease treatment (diabetes, hypertension, stroke, renal disease, poor general health) in African Americans and Latino Americans residing in the Commonwealth of Pennsylvania to be $700 million. The Urban Institute. A study entitled The Economic Burden of Health inequalities in the United States by LaVeist et almeasured the economic burden of health disparities in the US using three measures: (1) direct medical costs of health inequalities (2) Indirect costs of health inequalities (3) Costs of premature death Their findings revealed:
The combined costs of health inequalities and premature death in the US among African Americans, Hispanics and Asian Americans were $1.24 trillion
Eliminating health disparities for minorities would have reduced direct medical expenditures by $229.4 billion for the years 2003-2006
Between 2003 and 2006, 30.6% of direct medical expenditures for African Americans, Asians, and Hispanics were excess costs due to health inequalities.
Cultural competence (CC) refers to an ability to interact effectively with people of different cultures. CC comprises four components: (a) Awareness of one’s own cultural worldview, (b) Attitude towards cultural differences, (c) Knowledge of different cultural practices and worldviews, and (d) cross-cultural skills. Developing cultural competence results in an ability to understand, communicate with, and effectively interact with people across cultures. CC has been increasingly recognized as an important, overlooked and underappreciated factor in delivering healthcare to an increasingly diverse America. US census estimations project that by 2050, over 50% of Americans will be non-white. Over 50% of children will be nonwhite by 2025. It seems intuitive to that the interface between patient, healthcare system and healthcare provider is a critical point in the delivery of healthcare. To this end, The Office of Minority Health in the Department of Health and Human Services has issued mandates and recommendations to inform, guide and facilitate the creation of cultural and language appropriate services. (CLAS Culturally and Linguistically Appropriate Services). Implementation of these guidelines within systems and agencies and among individuals can enhance CC and ultimately improve clinical outcomes.. The Center for Health Improvement and Economic Development was one of several parties which advocated for statewide guidelines regarding the cultural competency CME (continuing medical education) requirements for initial licensure and relicensing of physicians in the Commonwealth of Pennsylvania. To accomplish this goal, we set forth to educate and inform the various stakeholders regarding the intrinsic value of CC as a critical determinant of improving healthcare outcomes and a direct result of a utilitarian argument of social justice in the United States. The Center also recognized the importance of making a compelling business case in the current economic climate Partnering with the Gateway Medical Society, the Pennsylvania State Legislative Black Caucus (PSLBC) under the leadership of State Representative Ronald G. Waters and the Center for Health Improvement and Economic Development-a townhall format meeting was organized and planned in Pittsburgh. Local legislators including State Representatives Jake Wheatley, Tom Preston and Daniel Frankel were in attendance.The townhall program: Working To Eliminate Healthcare Disparities in the Commonwealth of Pennsylvania was held in Pittsburgh. Attendees and participants included state policy makers, legislators, healthcare providers, healthcare administrators, social activists, business leaders and members of the general public. Robust debate occurred throughout the day and the exchange between audience members, legislators, policy makers and thought leaders underscored the recognized importance of the critical issue of Health Disparity and Cultural Competency. It is important to recognize the backdrop of the day’s events. The meeting took place two days after the initial steps of The Affordable Care Act were initiated with critical new consumer protections in the Patient’s Bill of Rights, including no pre-existing diseases for children, outlawing rescission and creating a path to allow adult children to remain on their parent’s insurance until age 26. The enthusiasm of the day culminated with a pledge from State Representative Ronald G Waters to support a resolution on CC to be submitted to the National Black Caucus of State Legislators- ultimately a path to introducing the legislation to all states and ultimately to the Congressional Black Caucus. The meeting emphasized the necessity and the benefit of identifying stakeholders, recognizing mutual agendas and seeking consensus in the path to generating support for public policy. Addressing CC in the healthcare environment through requirements for healthcare provider continuing education is one small step. Certainly, this requirement should be considered for other healthcare professionals, administrators and ancillary staff members. Greater awareness of the emerging diversity of America and understanding how to manage that diversity will significantly enhance the delivery of healthcare. The Pennsylvania State Legislative Black Caucus, The Center for Health Improvement and Economic Development and The Gateway Medical Society call upon other groups to join in our collaborative model to reduce Health Disparity and enhance healthcare delivery in The Commonwealth of Pennsylvania and beyond.The Legislative Black Caucus of Pennsylvania The PLBC was organized by House Majority Leader K. Leroy Irvis during the 1973-74 legislative session. K. Leroy Irvis saw the need for the caucus because he felt that legislators representing minority districts needed to speak with a united voice regarding the issues and concerns of their constituents. State Representative Ronald G. Waters was first elected to the House of Representatives in a special election in May 1999. He is chairman of the Health and Human Services Subcommittee on Health and serves on the Children and Youth, Health and Human Services, Judiciary, Liquor Control and Professional Licensure committees. He is also a member of the Philadelphia and the Southeast Pennsylvania delegations. Waters is also the chairman of the Pennsylvania Legislative Black Caucus, and chairman of Region 2 (which includes Pennsylvania and New York) of the National Black Caucus of State Legislators. About the Authors: Lee Kirksey MD is co-founder of The Center for Health Improvement and Economic Development, a public policy think tank. The organization is focused on the impact of social determinants on community health utilizing public private partnerships. His current research efforts include cultural competency and it impact on health disparities within surgery. He is author of The Wellness Revolution: Eliminating Disparities and Promoting Prevention…For All. Dr Kirksey is an Assistant Professor of Surgery in the University of Pennsylvania School of Medicine. Michele Jones, MSW, MHA serves as Manager of Partnership Development and Community Relations at Fox Cancer Center in Philadelphia. Having over 15 years management experience in health disparities, health education, public relations and development, Ms. Jones oversees prevention practices and partnership development. Through the years, she has worked in similar capacities at companies covering San Diego, New York as well as Pennsylvania. Through her work, she has become known as an innovator in the areas of health access, prevention and education, acquiring City Citations and Awards for both Community Outreach and Health Education. Jones is the founder of Jones Health Care Management Solutions and is currently a second-year Bioethics Student attending the University of Pennsylvania, School of Medicine.The Gateway Medical Society The Gateway Medical Society is a component of the National Medical Association. The National Medical Association objectives are to promote the science and art of medicine and the betterment of public health. Organized in 1895, the NMA Limits memberships to physicians licensed to practice medicine in any state or territory of the United States and the District of Columbia. Election of Membership may be obtained through Constituent Associations, through affiliation with societies consisting organized women physicians, Haitian physicians, and other minority physicians. The Gateway Medical Society is therefore a component society of its constituent association the Keystone State Medical Society of Pennsylvania.LaVeist TA, Gaskin DJ, Richard P, The Economic Burden of Health In equality in the US. Joint Center for political and Economic Studies.. Accessed Oct 10, 2010National Standards for Culturally and Linguistically Appropriate Services in Health Care Final Report, OMH, 2001

Flight and Hotel Package Deals – What You Can Expect With These Kinds of Travel Discount Offers

Whether you want to travel to the next city over or the other side of the globe, you must first pay for airfare and a hotel room. Instead of booking each one individually, why not book them both at the same time and save a bit of money? No matter what your travel plans are like, flight and hotel package deals are always worth looking into.You’ve probably seen it before: the option to “book airfare with hotel” when using a travel search engine. Have you really looked into what is available and compared the value of each offer?Most airlines and hotels participate in this kind of price bundling. It’s not hard at all to find inexpensive packages for popular tourist destinations, like Vegas, San Diego, Orlando, New Orleans, Atlantic City, Memphis, etc. You can even find flight and hotel package deals for international destinations, whether you want to stay in North American and experience an exotic beach like Cancun or the increasingly growing Toronto, or head to Europe, Australia, Africa, Asia, or the Middle East.How many nights can you stay at your destination with a bundled package? They can vary anywhere from flight + 2 nights per person to flight + 5 nights per person. If you don’t already have a specific destination in mind, just take a look at the daily or weekly deals on travel websites.Don’t make the mistake of thinking that only cheap, low-quality hotels are available in discount vacation offers. You’ll be surprised at some of the high-quality accommodation you can get at an affordable price with airfare. In popular locations like Orlando and Vegas, some of the big-name resorts offer the cheapest rooms. Depending on when and where you could go, you could end up staying in a nice, cozy bed and breakfast. If you’re interested in a package deal but haven’t heard of the hotel before, simply read some reviews on it.What to Watch Out for With Flight and Hotel Package DealsIt’s easiest to find cheap vacation deals when you are traveling alone or with one person, as prices tend to be based on double occupancy. If you are traveling with more than one person, look for group or family packages.Also, be sure to read the terms and conditions before considering any flight and hotel package deals to see if anything else, like car rental or hotel/airport shuttle is included. Will you be getting any free meals at the hotel? Or free drinks at the resort? If you find a good deal, it’s best to book it ASAP, as a lot of vacation packages are subject to availability and can be discontinued at any time.Plan your trip online, and apply promo codes to your order. You might be able to save even more with coupons that can be used with flight and hotel package deals. There are a variety of offers available online – so start you search today.

How Social Networking Helps You to Make Money

I like Social Network sites because they are very fun. Getting paid for things I do on the Internet is the best thing about Social Networking.Reason why I Like NetworkingFirst of all I have been into Social Networking for a while now and no matter what one I am a member in, I receive many contacts. Another words, I get the chance to meet a lot of people, in Marketing free affiliate programs that is a plus for those in the Marketing area. Now there is networking sites that pay you to do things you already do on the internet, so that is another big plus for me.Get to know your contactsWhen you join as a member in a social network site, you will probably start getting people who will want to add you as a friend, so the best thing is to go ahead and start adding them. The reason for this is so you can get to know them, see what it is that they are into. You do not want to throw at them your program that you are marketing because that will just turn them away. Get to know them first and see what it is that they are doing, then in return they are going to want to know what you are doing, then you give them just a little taste of what you are doing. By giving them a taste is just giving them a little information about it, something that will make them want to know more about what you are doing. This is what getting to know your contacts is all about. You will find that this is the way to go to make any program work.Free GamesThere is a way to draw many people to your social networking site. A networking site that has free games will draw attention to many and that is because I found that many who are into networking are also gamers. People who like games that are free to play, will love a social network site that has free games to play. There are a few networking sites that have free games to play but I only found one that will pay you to play free games. So make sure that if you want to draw attention then make sure your social site has free games.Research I foundBe careful, there are also scams in some of the networking sites. Some tell you things that they can do for you and you will end up getting let down because of false information, so be careful on what sites you get involved in. Do some research on it first before you get involved. When you are consistent with your efforts in networking it can go a long way to driving traffic to your website or program that you are promoting. Set yourself apart from others who simply want to sell, instead build up relationships first. Social networking is made easier when you have a personal blog of your own. This is because you are allowed to bookmark your blog article to various social network directories. Some sites have an area where you can create a blog right there on their site. When you get to know your contacts, listen to what they have to say and understand their needs and goals, then you can figure out how to help them.What the site should haveTo me the ideal networking site is to have everything there that you can do online right from the site. Like checking your email, working with your affiliate or marketing programs, connecting to your other social sites like Facebook and MySpace and other social sites, play games, and doing searches. To me that is the ideal social networking site, so far I only found one. I am a member in that one for sure. It makes your online work much easier.My final thoughtsWell as you can see, I found that Networking has worked very well in just about everything I do on the internet. Works best for Traffic, affiliate programs, marketing and the best part, meeting new friends. Have fun Networking and hope to see you there.

The Environmental Benefits of Working From Home

Before we jump into the benefits of working from home, let’s just take a quick look at global warming and its biggest contributors. If our current rate of CO2 emissions worldwide does not slow down significantly within the next decade or so, we as the human race stands to lose life as we know it, due to the greenhouse effect (excess CO2 in the earth’s atmosphere is causing average global temperatures to raise over time) that is causing the icecaps to melt and as a result raising the ocean levels, this can have an unimaginable negative effect on our lovely planet and life as we know it within the next 50 to 100 years.Biggest Contributors to Global WarmingEnergy Supply – Burning of coal, natural gas and oil for electricity and heat is responsible for about 26% of global greenhouse gas emissions.Industry – This primarily involves fossil fuels burned on-site at facilities for energy, this includes but is not limited to chemical, metallurgical and mineral transformation processes that is not included in the energy supply and it is responsible for about 19% of global greenhouse gas emissions.Land Use, Land-Use Change and Forestry – includes carbon dioxide emissions from deforestation, land clearing for agriculture and fires or decay of peat soils and is responsible for about 17% of global greenhouse gas emissions.Agriculture – The biggest sources of greenhouse gas emissions in this industry comes from the management of agricultural soils, livestock, rice production and biomass burning and is responsible for about 14% of global greenhouse gas emissions.Transportation – The main contributors here are fossil fuels burned for road, air, and marine transportation. About 95% of the world’s transportation energy comes from petroleum based fuels petrol and diesel and is responsible for about 13% of global greenhouse gas emissions.Commercial and Residential Buildings – Greenhouse gas emissions in this sector is mainly from on-site energy generation for heat in buildings or cooking in homes and is responsible for about 8% of global greenhouse gas emissions.Waste and Waste Water is responsible for about 3% of global greenhouse gas emissions.By raising awareness of global warming and its negative consequences we can begin to reverse the current trend and save our lovely planet for future generations. As the industrial age takes its final dying breaths and we move deeper into the information age, we are becoming better at communication that requires very little to no energy to sustain it. With the advent of the internet and search engines like Google, the world have become an interconnected market place that allows the little guy to compete with the corporates.The Environmental benefits of working from home

You travel less, meaning that your carbon footprint is significantly lower (you don’t burn as much fuel and your car needs less maintenance).

If you communicate electronically you save on paper, meaning that less trees are destroyed to make paper.

You have more time to get involved with environmental initiatives like planting trees or conserving endangered species.