End of Free COVID Tests [Barrier: Cost of Care, Access to Care]

In an article in PBS NEWSHOUR from April 11, 2023 entitled Experts worry about costs as free COVID testing comes to end in May discusses how the free tests available for COVID will be not free anymore in May. The article states:

“Since early 2021, the federal government has required all private insurers to cover up to eight COVID-19 tests per month. That requirement will soon go away. Coverage is also scheduled to lapse for tens of millions of seniors in the federal government’s Medicare program, though some members of Congress are pushing to extend the benefit.

While some private insurers may continue to cover all or some home tests, there will be no longer be a nationwide rule. A two-pack of tests typically costs between $20 and $24.”

FDA Commissioner Discusses Misinformation in Health [Barrier: Health Literacy, Cost of Care, Medication Access]

This video from April 11, 2023 entitled FDA commissioner says health misinformation is driving U.S. life expectancy down discusses various issues related to public health care, including prices of medicines, medical research on medication, life expectancy, health misinformation, vaccinations, and regulation of health information and advertising on digital platforms.

Rural Communities Lack Public Health Care Resources [Barrier: Location/Access to Care, Cost of Care, Health Care Inequity]

In this article from April 11, 2023 on PBS News Hour entitled After a rural California hospital closes, farmworkers pay the price the author discusses how rural farmworkers are deeply negatively impacted by their location and lack of access to health care. The article discusses one person’s situation

“Villa is a farmworker in an impoverished area of Tulare County, located in California’s rural San Joaquin Valley, where his eleventh-hour diabetes diagnosis is just one indication of a health crisis within the greater farmworker community. He’s one of hundreds of thousands of low-wage employees in California who grow and harvest the nation’s food, yet are commonly overburdened with chronic disease.”

Also, the article discusses the wider problems:

“According to the Farmworker Health Study, published earlier this year following in-depth interviews with more than 1,200 farmworkers across California, between one-third and one-half of farmworkers surveyed suffer from chronic diseases, including diabetes and hypertension. The vast majority are considered either overweight or obese. 

Many of these conditions are linked to “social determinants of health’ including socio-economic status, lack of access to primary care and health insurance coverage, cultural and linguistic barriers, transportation, affordable housing, legal status, and other factors,” the authors write. Paradoxically, food deserts and low wages also commonly reduce farmworkers’ access to fresh fruits and vegetables.”

Location impacts age of American Deaths [Barrier: Location/Access to Care, Cost of Care, Inequity in Public Health]

In a TIME article from April 12, 2023 entitled Americans Are Dying Younger—But Where You Live Makes a Big Difference, the author discusses the barriers to public health that impact people depending on where they live. What is driving the differences in life expectancy in America? He states “wealth, demographics, and location.” The article discusses the following claims “Wealthier Americans live longer”, “black communities die younger”, and “state policies make a big difference”. Those state policies include: “Expansion of Earned Income Tax Credit and Child Tax Credit”, “Medicaid Expansion”, “Gun Control”, “Drug overdose prevention”, and “Abortion access”.

Uninsured People with Cancer Experience Many Barriers to Public Health [Barriers: Cost of Care, Access to Care]

An article from April 10, 2023 on Kaiser Family Foundation entitled For Uninsured People With Cancer, Securing Care Can Be Like Spinning a Roulette Wheel details the experiences of people who do not have insurance and who are diagnosed with cancer. They face barriers to public health of cost of care and access to care and sometimes have to wait for long periods due to financial constraints in order to get cancer treatment. The article states:

“Adcox had first met with physicians at the academic medical center in late 2020, after a biopsy diagnosed basal cell carcinoma. The operation to remove the cancer would require several physicians, she was told, including a neurosurgeon, because of how close it was to her brain.

But Adcox was uninsured. She had lost her automotive plant job in the early days of the pandemic, and at the time of her diagnosis was equally panicked about the complex surgery and the prospect of a hefty bill. Instead of proceeding with treatment, she attempted to camouflage the expanding cancerous area for more than a year with hats and long bangs.”

People without insurance often forgo treatment due to the cost of care. This can lead to life-threatening illnesses.

Memoir of Real-Life Barriers to Public Health [Barriers: Cost of Care]

This NPR article from April 10, 2023 entitled A daughter confronts the failures of our health care system in ‘A Living Remedy’ discusses the memoir of a woman who experiences challenges due to the barrier to public health of Cost of Care, among others. The challenges her family faces are many. The article states “Yet, during the time her 60-something-year old father was dying — of diabetes, renal failure and, most certainly, from decades of postponing costly medical check-ups — Chung and her family couldn’t afford to fly more than once a year, maybe, to visit her parents. ”

Life-threatening pregnancy and childbirth varies depending on location [Barrier: Location/Access to Care, Cost of Care, Health Professional Shortage]

An article from April 6, 2023 entitled Life-threatening pregnancy, childbirth risks can vary depending on where you live, study finds on CBS Detroit states

“The risks of severe complications during pregnancy, childbirth or postpartum can vary drastically depending on where the person lives, a new study suggests.

Among people with Medicaid insurance in the United States, rates of severe maternal morbidity — life-threatening complications during pregnancy, delivery or after childbirth — range dramatically from about 80 cases for every 10,000 live births in Utah to more than 200 per 10,000 in the District of Columbia, according to the study published Thursday in the journal Obstetrics & Gynecology.”

The article states “The five states with the lowest rates of severe maternal morbidity, according to the data, were Utah, with a rate of 80.3 per 10,000; Maryland at 81.3; Rhode Island at 84.4; Nebraska at 88; and New Hampshire at 91.1.”

“The jurisdictions with the highest rates were Washington, DC, at 210.4 per 10,000; California at 190.5; Nevada at 187.1; New Jersey at 180.6; and New York at 174.6.”

Diversity in Health Care leads to fewer deaths [Barrier: Health Care Provider Shortage]

In this article from April 6, 2023 entitled Female physicians at California hospital take on medicine’s gender gap, there is a discussion of the lack of female surgeons in the US and in Canada. This study Association of Surgeon-Patient Sex Concordance With Postoperative Outcomes finds that “Women were 32% more likely to die if treated by a male surgeon rather than a female one,” and “men were less likely to die at the hands of female surgeons.”

I would argue that this article highlights the barrier to public health of health care provider shortage as having more diversity in practitioners can improve outcomes.

Free Preventable Health Services [Barrier: Cost of Care]

This article in The Washington Post from March 31, 2023 is entitled Biden administration to appeal ruling against free preventive health services and states “The Biden administration told a Texas federal court Friday that it plans to appeal an order by a judge that invalidates the Affordable Care Act’s promise of free preventive health services to every American with private health insurance.”

Reasons Doctors and Nurses are Quitting [Barrier: Health Care Professional Burnout]

In this article on Time from March 31, 2023 entitled The Unspoken Reason Why Many Doctors and Nurses Are Quitting discusses various barriers to public health, including Health Care Professional Burnout.

“What has been published so far is very true: We are burned out and overwhelmed. Violence against healthcare workers is a regular occurrence. We are worn down by the daily roadblocks set up by intransigent health insurers, error-promoting electronic health records, and C-suite executives with little understanding of the boots-on-the-ground perspective.”

Poverty and Racism accelerate aging and disease [Barrier: Inequity in Health Care, Cost of Care, Access to Care]

An article in NPR from March 28, 2023 entitled How poverty and racism ‘weather’ the body, accelerating aging and disease states:

“Public health researcher Arline Geronimus from the University of Michigan says the traditional belief that the disparities are due to genetics, diet and exercise don’t explain data that’s accumulated over the years. Instead, she makes the case that marginalized people suffer nearly constant stress from living with poverty and discrimination, which damages their bodies at the cellular level and leads to increasingly serious health problems over time.

Geronimuscoined a term for this chronic stress — she calls it”weathering,” which, she says, “literally wears down your heart, your arteries, your neuroendocrine systems, … all your body systems so that in effect, you become chronologically old at a young age.” She writes about the phenomenon in her new book, Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society.“

Barriers to public health are related to social determinants as discussed in this post. This NPR article highlights research that points to the affect of social determinants on public health.

“[Our health is] an indicator of … the context that we live in, of a society that is racist, oppressive, class conscious. … We won’t solve health inequalities between Blacks and whites or Latinx and whites or other groups simply by getting people more education or higher incomes. This chronic stress arousal is more likely in those kinds of unsupportive environments than … the more supportive environments, if you stick with your own group. Weathering is not against social mobility, it’s not for segregation, it’s for non-erasure. It’s for seeing and recognizing what is really happening, and what it does to you biologically, and realizing if we want to eliminate health disparities or promote health equity, we have to attend to what’s happening in these different settings.”