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Eight Americas: Investigating Mortality disparities across races, counties, and race-counties in the United States

Introduction

In the report there is an examination of the US population which is divided into eight distinct groups. The eight Americas addresses critical issues such as life expectancy, existent health disparities, and ultimately offers a platform for better understanding health intervention policies and programs. There are three principal questions that will be addressed. These including examining probable factors predictive of life expectancy, the role of environment as a predictive factor, and the employment of environmental interventions. The Centers for Disease Control and Prevention and the State health department utilize an annual cross-sectional telephone survey called the (BRFSS) Behavioral Risk Factor Surveillance System. The BRFSS questionnaire aptly identifies personal risk behaviors and exposures, health plan coverage data, and care utilization (Murray et al., 2006).

What factors did the authors consider as possibly being predictive of life expectancy for the "8 Americas" sub-populations?

The authors considers factors such as health care access and utilization, age, gender, and associated disease patterns. For example, the report indicates that health care access and utilization differs between various subgroups. In other words, there is an identified correlation between socioeconomic inequalities and health inequalities. As such the authors suggest increasing financial access to health care by ensuring more Americans have health plan coverage (Murray et al., 2006).

Additional proposed interventions include, eliminating any existent physical, behavioral, or cultural barriers. Further, healthcare utilization must also include specific strategies such as redesigning neighborhoods for increased physical activity. Healthcare organizations should educate patients and provide community outreach events. Such early intervention strategies will reduce (i.e. obesity, blood pressure, and cholesterol levels) ensuring enhanced quality of care (Murray et al., 2006).

An examination of Figure 6A reveals that of the eight Americas, Native Americans in the West (America 5) and low-income rural southern blacks (America 7) have the lowest levels of health coverage. The highest coverage areas include northland white low-income rural population (America 2), Middle America (America 3) and Asians (America 1) (Murray et al., 2006). According to the authors there was an approximate gap of 15.4 years (morality rate) between Asian males compared to low-income rural black males in the South (Murray et al., 2006).

There was a similar gap between Asian females and low-income southern rural blacks of approximately 12.8 years. This pattern is mostly unchanged between the years of 1987-2001. Disease patterns also played a significant role. Between the late 1980’s-1990’s there was a significant gap between Americas 1 and 8 for males primarily associated with increased HIV and homicide rates. One macro observation is that Americans identified by socio-demographic characteristics and residence, have similar life expectancy to low income developing countries (Murray et al., 2006).

How would environmental factors be related to the predictive factors?

It seems that environmental factors combined with other socio-economic factors play a significant role. For example Americas 8 is the category for high-risk urban blacks with a population of greater than 150,000 persons. This population has a cumulative probability of homicide death between 15 and 74 years of greater than 1 percent (Murray et al., 2006). Also noteworthy is that the median annual income is approximately $14,800. Therefore it can be deducted that median income, population size, and other socio-economic factors created an undesirable environment. This caused some individuals within the community to lose hope and ultimately end their lives.

How might environmental intervention be employed?

According to the authors effective interventions must be multi-faceted, cost effective, and target specific. This requires the implementation of a systematic epidemiological or economic analysis to determine cost-effective strategies. For example population-wide measures could include tobacco taxation, drinking and driving countermeasures, and interventions to minimize public and domestic alcohol induced violence. In other words by the government implementing increased taxes on products like tobacco and alcohol, some individuals may decrease the frequency of purchase. There also needs to be classes/workshops on the correlation between abuse and alcohol. Personal interventions include pharmacological for blood pressure and cholesterol (Murray et al., 2006).

Additionally, here needs to be a restructuring of the health policy agenda in the United States. For example the authors purport that increasing coverage for approximately 44 million Americans (15% of the population) is only part of the solution. This is partly due to the fact that health plan coverages will vary based on the area and policy. Therefore, there also needs to be an effective methodology for gathering data and measuring emergent outcomes. This will help to overcome any disparities especially among young and middle-aged adults (Murray et al., 2006).

Final article analysis (Pro or Con)

This article is best viewed as an entry or staring point. While it aptly identifies relevant health disparities among dissimilar groups it is not comprehensive. This division of America into eight groups could easily be clustered in numerous ways. For example when looking at specific health strategies they will differ based on the socio-economic characteristics of a group. In Americas 1 there are Asians with a median income of $21, 566. The population size is approximately 10.4 million with 80% of residents completing high-school. This is in stark contrast to Americas 2, which is Northerland low-income rural white. In Americas 2 the population is only 3.6 million and the Average Income per Capita is $17, 758. Approximately 83% of residents have completed high-school (Murray et al., 2006).

Given the fact that Americas 1 and 2 have similar high-school completion rates, the assumption is literacy rates may be similar. So the development of health-related educational material would need to be written for easy comprehension at the high-school level. There is an approximate difference of $3, 808 in terms of Average Income per Capita. This means that health insurance premium rates may be slightly different (between Americas 1 & 2) to ensure that the majority of residents have coverage.

However, the biggest difference between Americas 1 and 2 is the population size. There are approximately 6.8 million more individuals in Americas 1 versus Americas 2. This means that consideration must be given to providing healthcare services relative to population size. In Americas 1 there will likely be more healthcare facilities. This means that the Government will likely spend more money on building infrastructure. That money will need to come from greater taxation on residents.

Although habits and behaviors will affect health status other factors are relevant. Air quality is a factor that often determines health. Eating habits (i.e. cultural) and available foods will also impact health. Therefore educating individuals on healthy eating alternatives while simultaneously respecting cultural values is key.

Reference

Murray, C. J., Kulkarni, S. C., Michaud, C., Tomijima, N., Bulzacchelli, M. T., Iandiorio, T. J., & Ezzati, M. (2006, September). Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States. Plos Medicine, 3(9), e260.

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