PPACA and public health: creating a framework to focus on prevention and wellness and improve the public's health.
ABSTRACT PPACA epitomizes comprehensive health care reform legislation. Public health, disease prevention, and wellness were integral considerations in its development. This article reveals the author's personal experiences while working on the framework for health care reform in the United States Senate and reviews activity in the United States House of Representatives. This insider's perspective delineates PPACA's positive effect on public health by examining the infrastructure Congress designed to focus on prevention, wellness, and public health, with a particular focus on the National Prevention, Health Promotion and Public Health Council; the National Prevention, Health Promotion, Public Health, and Integrative Health Care Strategy; and the Prevention and Public Health Fund. The Council, strategy, and fund are especially important because they reflect compliance with some of the Institute of Medicine's recommendations to improve public health in the United States, as well as international health and human rights norms that protect the right to health.
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ABSTRACT: The political acceptance and policy implementation of the right to health long remained uncertain in the United States, leaving it until recently as the only developed nation without policies to realise universal health coverage. By reengaging longstanding debates on government obligations to secure the health of every American, the 2010 Patient Protection and Affordable Care Act (Affordable Care Act or ACA) draws on an internationally recognised conception of a human right to health, seeking to progressively realise the ‘highest attainable standard of physical and mental health’ through policies that ensure the availability, accessibility, acceptability, and quality of health care. With the US Supreme Court upholding the constitutionality of most key aspects of the Affordable Care Act, this precedent-setting decision has created an imperative for health care reform in the United States and a model for realising universal health coverage pursuant to the right to health. This article examines the evolution, implementation, and implications of US efforts to realise health-related rights through health care policy. In the evolution of norms for health, Part 2 examines the intertwined history of US development of a right to health in international law and implementation through national health care reforms. Culminating in the promulgation of the 2010 Affordable Care Act, Part 3 analyses how this national policy effort corresponds with the principles of the international right to health – even as it neglects any explicit recognition of the right to health. With the Affordable Care Act immediately challenged as a violation of the US Constitution, Part 4 looks to the first major challenges to the Affordable Care Act, analysing the Supreme Court’s decision on these challenges. As the Supreme Court has now largely upheld the government’s constitutional authority for health care reform, Part 5 considers the continuing challenges to the Affordable Care Act and the precedential impact of this decision on rights-based health reforms throughout the world. This article concludes with a hopeful assessment of the role of the United States as it moves progressively toward universal health coverage and frames an agenda for renewed American participation in global efforts to realise the highest attainable standard of health.Human Rights Law Review 01/2013; DOI:10.1093/hrlr/ngs036
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ABSTRACT: More research is needed to identify factors that explain why minority cancer survivors ages 18 to 64 are more likely to delay or forgo care when compared with whites. Data were merged from the 2000-2011 National Health Interview Survey to identify 12 125 adult survivors who delayed medical care. The Fairlie decomposition technique was applied to explore contributing factors that explain the differences. Compared with whites, Hispanics were more likely to delay care because of organizational barriers (odds ratio = 1.38; P < .05), and African Americans were more likely to delay medical care or treatment because of transportation barriers (odds ratio = 1.54; P < .001). The predicted probability of not receiving timely care because of each barrier was lowest among minorities. Age, insurance, perceived health, comorbidity, nativity, and year were significant factors that contributed to the disparities. Although expanded insurance coverage through the Affordable Care Act is expected to increase access, organizational factors and transportation play a major role.American Journal of Medical Quality 06/2014; DOI:10.1177/1062860614537676 · 1.78 Impact Factor