Diana Dinh, Raegan Meyers, Ayush Kaw, Jordan Keuneke, Bryce Poindexter

HEALTHCARE POLICY: A GLOBAL HEALTH ISSUE

Spring 2022

Diana Dinh, BSPS candidate Raegan Meyers, PharmD student Ayush Kaw, PharmD student

Jordan Keuneke, BSPS candidate Bryce Poindexter, BSPS candidate

Background

Healthcare policies are the laws, regulations, and practices that are implemented to protect the well-being of the people. They affect not only individual patients, but also play a role in the function of larger institutions. Here, we examine healthcare policies that arise in the areas of harm reduction, public vs private healthcare, paid leave, alternative medicine, and FDA regulations.

Our research has yielded insight into the limitations of harm reduction services in global pandemics and rural communities, the safety concerns with the FDA fast track program and the policies implemented to address them, as well as, looking at the laws around all types of paid leave in the United States and how we compare to the rest of the world in terms of the amount of time and support given, as well as the advantages and disadvantages of both private and public healthcare.

Harm reduction is an approach used around the world that acknowledges that some people are not ready to or not capable of stopping their substance use. It focuses on limiting the harm associated with substance abuse.1

HARM REDUCTION SERVICES

Syringe access programs & supervised injection sites 1

Community naloxone distribution 1

Opioid treatment programs 2

Distribution of sterile injection equipment Safe disposal of needles and syringes Reduce the risk of contracting HIV, hepatitis C, and other blood-borne infections Access or referral to medical, mental health, legal, and 2 social services

Effective in decreasing deaths due to overdose Training programs for recognizing overdose symptoms

Dispensation and administration of medicationassisted treatment (MAT) medications Substance abuse counseling Individual and group therapy

PROFESSIONAL OPINION

While the implementation of harm reduction services is immensely beneficial to their recipients, there is a clear need for increased funding to improve the accessibility of these programs to rural, lower-income, and/or underrepresented populations. -D. Dinh

GLOBAL PERSPECTIVE & COVID-19

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There is a significant funding gap for harm reduction programs in middle and low-income countries In areas where opioid agonist treatment is available, access is still limited for certain populations (women, transgender, homeless) The COVID-19 pandemic has affected harm reduction services worldwide

Thailand: Limited access to opioid agonist therapy and

HIV-related services due to travel restrictions and quarantine regulations

Bulgaria: Reallocation of resources and funding to COVIDrelated programs diverted support from harm reduction programs

Dominican Republic: Shutting down a needle-service program due to physical distancing restrictions

Harm reduction services have begun to adapt by offering mail-delivery of harm reduction equipment and offering virtual consultations

LIMITATIONS IN RURAL SETTINGS

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Patients who could benefit from harm reduction programs may have to travel long distances to access them in an area that lacks sufficient public transportation Programs designed to help substance abusers in rural areas may have a limited range of services compared to their urban counterparts 82% of rural residents lack access to detoxification services, which are necessary in limiting effects due to substance abuse Rural health providers report a concern about the lack of resources to dedicate to patients with opioid use disorder on top of meeting the demands for non-substance abusers There are currently efforts to integrate or co-locate harm reduction services with primary health services in rural areas

A Global Comparison: Public versus Private Healthcare

Jordan Keuneke (BSPS candidate)

What is Public Healthcare? 2

Public healthcare (also known as Universal healthcare) is designed to meet the cost of healthcare needs and is typically funded by the government. This can be health insurance or a publicly funded hospital system or both. Public healthcare is variable by nation. Some countries' insurance may pay for some or all of a patient's medical expenses. Additionally, publicly funded insurance may have restrictions on where the insured can receive treatment.

What is Private Healthcare?

Private healthcare is healthcare that is paid out of the pockets of the individual. Insurance is purchased from a private healthcare insurance provider. Many countries offer both public healthcare and private healthcare for those who prefer it and can afford it.

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Public Healthcare

Pros: - Equal access to healthcare - Covers basic human right

Cons: - Extended wait times - Increased taxes - Lack of innovation Private Healthcare

Pros: - Choose your own doctor - Improved facilities

Cons: - Expensive - Creates inequality

Countries with Free and Universal healthcare Countries with universal but not free healthcare Countries with free but not universal healthcare Countries with neither free nor universal healthcare Unknown 2019 1

Each form of healthcare offers its advantages and disadvantages. A couple of the advantages of public healthcare include the coverage of medical care for all citizens, boosting economic productivity, and taking the burden off of businesses who pay for most or part of employees' private healthcare insurance. Disadvantages include lowered doctors' earnings, rationing of medical services, and increase in doctor shortage.

Private healthcare offers its own set of advantages and disadvantages. Advantages include quicker access to services, increased privacy, and shorter wait time. Disadvantages include the expense of purchasing, inequality that occurs due to only those who can pay being able to afford it, and paying for part of the service not covered by insurance.

Professional Opinion

I believe that the best option for most countries is to offer both forms of healthcare. Including a public healthcare policy would allow for all citizens to be covered while those who can afford it, can still purchase private healthcare insurance. - J. Keuneke

What is It? 1Complementary Medicine: medical therapies that fall beyond the scope of scientific medicine but may be used in treatment of disease and illness. 3Alternative Medicine: medical therapies that are NOT regarded as orthodox by the medical profession

GLOBAL CONTROVERSEY

1 Some forms of alternative medicine are not considered orthodox as far as western medicinal practice (USA). But many countries practice them regularly and it has shown to work for them.

Complementary medicine like acupuncture does not demonstrate any scientific evidence supporting it but it has dated back to 100 BC in China

An example of Alternative medicine is Ayurveda. Is a natural system of medicine, originated in India more than 3,000 years ago. The term Ayurveda is derived from the Sanskrit words ayur (life) and veda (science or knowledge). This form of medicine is still practiced. In the United states it is considered a pseudoscientific.

Overall, this topic impacts all people globally. Relating it back to health care system policy, we practice western medicine in the United States and many people here believe we are doing it the "right way". Many of these methods do not have studies done in the United States that show consistent results of direct benefits which leads to them not being recommended by medical professionals.

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Pictured above are the Top 20 countries by life expactancy

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Real Life Examples

Acupuncture Chiropractic

PROFESSIONAL OPINION I feel like complementary and alternative medicine have proven themselves worthy of being recommended by health care professionals. Mainly because it has been around for centuries in different cultures and religions and not every country practices western medicine and have made it thus far. The United States does not have the largest percentage of older adults.

- R. Meyers

A y u r v e d a . J o h n s H o p k i n s M e d i c i n e . ( n . d . ) . R e t r i e v e d A p r i l 1 1 , 2 0 2 2 , f r o m h t t p s : / / w w w . h o p k i n s m e d i c i n e . o r g / h e a l t h / w e l l n e s s - a n d p r e v e n t i o n / a y u r v e d a # : ~ : t e x t = A y u r v e d a % 2 C % 2 0 a % 2 0 n a t u r a l % 2 0 s y s t e m % 2 0 o f , t r a n s l a t e s % 2 0 t o % 2 0 k n o w l e d g e % 2 0 o f % 2 0 l i f e .

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T y p e s o f c o m p l e m e n t a r y a n d a l t e r n a t i v e m e d i c i n e . J o h n s H o p k i n s M e d i c i n e . ( n . d . ) . R e t r i e v e d A p r i l 1 1 , 2 0 2 2 , f r o m h t t p s : / / w w w . h o p k i n s m e d i c i n e . o r g / h e a l t h / w e l l n e s s - a n d p r e v e n t i o n / t y p e s - o f - c o m p l e m e n t a r y - a n d - a l t e r n a t i v e - m e d i c i n e

Paid family and medical leave typically provides a set number of weeks or months to be used for a worker’s own serious, longer-term health condition, to care for a family member with a serious health condition, or to care for or bond with a new

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child, and for reasons related to a family’s member’s military service. On average, it provides six to twelve weeks of fully or partially paid leave per year, without the need for accrual. Paid family and medical leave may be insured and is often funded by contributions from the employer and/or the worker. With it depending entirely on an employers given amount here in the U.S while the global average hovers around at least a month of guaranteed paid leave.

Maternity and Paternity Leave Around the World

The U.S. is one of six countries without national paid maternity leave. With legislature in the works to provide up to four weeks of federal mandated leave. When looking at other countries, there is evidence of what people need and what’s feasible. 12 weeks is a modest amount, and anything less is grossly inadequate. The rest of the world, including low-income countries, have found a way to do this, with global averages around 29 weeks for new mothers and 16 weeks for new fathers

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The U.S. is one of six countries without any national paid leave

Professional opinion: The United States is one of the richest countries in the world — and yet one of only a few countries not to offer some form of paid family leave for new parents. Paid family and medical leave and sick leave can help workers meet their personal and family health care needs, while also fulfilling work responsibilities. Access to paid leave is a particularly salient concern for women, who comprise nearly half of the nation’s 4 workforce and who are often the primary caretaker for children and aging parents. Yet, many U.S. workers do not have access to paid leave time and it’s something that needs to change so we can take better care of our work force. - A. Kaw

Sick Leave

Paid sick leave can be used to recover from a short-term injury or illness such as a cold. It is often provided on an accrual basis up to a set number of hours or days per year. On average private sector workers are given seven days

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