Families and Health
Publication Year: 2014
This interdisciplinary text examines five different components of family health-biology, behavior, social-cultural circumstances, the environment, and health care-and the ways they affect the abilities of family members to perform well in their homes, workplaces, and communities. Special awareness is paid to health disparities among individuals, families, groups, regions, and nations. The author discusses how health of individual families influences our local, national, and global communities. Families and Health argues that family health is not a privilege for the few, but a personal, national, and global right and responsibility.
- Front Matter
- Back Matter
- Subject Index
- Chapter 1: Introduction: Families and Their Health
- Family Health: Definitions and Determinants
- Case 1.1 Tyra: Influences on Family Health
- The Status of American Families' Health
- Overweight and Obese
- Access to Health Care
- Uninsured and Underinsured
- Case 1.2 Trent: Uninsured and Underinsured Young Adults
- Family Health Concept: From Insularism to Interdisciplinary
- Reconnecting Mind-Body-Spirit in Health Care
- The Biopsychosocial Model and beyond
- General Systems and Related Family Health Theories
- Summary and Book Organization
- Critical Thinking Questions
- Chapter 2: Biology and Family Health: Epigenetics and beyond
- Epigenetic Inheritance Research and Family Health
- Multifactorial Inheritance Disorders
- Race, Ethnicity, and Genetics in Health Disparities
- Family Health Histories
- Case 2.1 Victoria and Hope: Breast Cancer in the Family
- Ethical, Legal, and Social Implications (ELSI)
- Families' Adaptations to Chronic Illnesses
- Family Health and Alzheimer's Disease (AD)
- Case 2.2 Hank and Lily: A Time of Loss and Love
- Family Caregivers
- Loss, Dying, and Death—Part of Family Health
- Case 2.3 Tylor and Maria: Gone without Goodbye
- Case 2.4 Josh: Dying Well
- Critical Thinking Questions
- Chapter 3: Behavior Patterns: Families' Health Choices
- Interactive Nature of Family Health Behaviors
- Case 3.1 Alicia: No Vaccinations for My Kids
- Family Health Promotion—“Health Work”
- An Ecological Approach
- Health Behavior Theories and Models
- Intrapersonal Models
- Case 3.2 Simone: Sex and the Heart
- Interpersonal Approaches
- Cigarette Smoking is Addictive, but Stopping Can Be Contagious
- Case 3.3 Julio: Childhood Obesity—Beyond Family Concern
- Community-Based Approaches
- Critical Thinking Questions
- Chapter 4: Social Determinants and Family Health
- Health Disparities among Families
- Case 4.1 The Injustice of Health Inequities
- Infant Mortality
- Cardiovascular Disease (CVD)
- Type 2 Diabetes
- HIV Infection and AIDS
- Mental Illness
- Discrimination, Stigmatization, and Health
- Family Relationships and Mental Health
- Case 4.2 Sarah: What a Depressed Teenager Wished She Could Say
- Health Education: Families, School, and Community Collaborations
- Case 4.3 Mia: The High Price of Ignorance
- Critical Thinking Questions
- Chapter 5: Environmental Exposures and Global Family Health
- The Global Burden of Infectious Disease
- Case 5.1 Aisha: Malaria—A Disease of Poverty
- The HIV/AIDS Pandemic
- Case 5.2 Mandisa: The Youthful, Feminine Face of HIV/AIDS
- HIV/AIDS-Related Stigma and Discrimination
- The Global Reach of Pollution
- Case 5.3 Leon: Uneasy Breaths of Pediatric Asthma
- Internal Environmental Exposures: Imbalances in Biological Flora
- External Environmental Exposures: The Global Tobacco Epidemic
- Deeper Health Impacts: Air Pollution and DNA
- Work Environments and Global Family Health
- Women in the Workplace
- Psychosocial Work Environment
- Case 5.4 Theresa and David: Stress … at Work
- Work-to-Family and Family-to-Work Conflicts
- Smart Workplaces: Just for the Health of it
- Critical Thinking Questions
- Chapter 6: Health Care and Families
- Underinsured Families: Paying too Much and Getting too Little
- Case 6.1 Ed: Medical Tourism and American Health Care
- Dental Health Coverage, Not a Frill
- Globalization of Health Care and Medical Travel
- An Ailing Health System on the Mend?
- Case 6.2 Isabella: Unhealthy Health Care
- Healthy Lives
- Health Care Reform and Redesign
- Affordable and Equitable Access
- Higher Quality and Efficiency in Delivery Performance
- Greater Accountability, Leadership, and Reorganization in Health Care
- Geisinger-Like Health System: Translating Knowledge into Action
- Case 6.3 Kaela: Creating a Patient-Centered Primary Home
- Critical Thinking Questions
Contemporary Family Perspectives[Page ii]
Susan J. Ferguson
Volumes in the Series
Families: A Social Class Perspective
Shirley A. Hill
Making Families Through Adoption
Nancy E. Riley and Krista E. Van Vleet
Meg Wilkes Karraker
Family Policy and the American Safety Net
Janet Zollinger Giele
The Work-Family Interface
Gay and Lesbian Families
Nancy J. Mezey
Copyright © 2014 by SAGE Publications, Inc.
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Series Preface: Contemporary Family Perspectives[Page ix]
The family is one of the most private and pervasive social institutions in U.S. society. At the same time, public discussions and debates about the institution of the family persist. Some scholars and public figures claim that the family is declining or dying, or that the contemporary family is in crisis or morally deficient. Other scholars argue that the family has been caught in the larger culture wars taking place in the United States. The current debates on legalizing same-sex marriage are one example of this larger public discussion about the institution of the family. Regardless of one's perspective that the family is declining or caught in broader political struggles, scholars agree that the institution has undergone dramatic transformations in recent decades. U.S. demographic data reveal that fewer people are married, divorce rates remain high, at almost 50%, and more families are living in poverty. In addition, people are creating new kinds of families via Internet dating, cohabitation, single-parent adoption, committed couples living apart, donor insemination, and polyamorous relationships. The demographic data and ethnographic research on new family forms require that family scholars pay attention to a variety of family structures, processes, ideologies, and social norms. In particular, scholars need to address important questions about the family, such as, what is the future of marriage? Is divorce harmful to individuals, to the institution of the family, and/or to society? Why are rates of family violence so high? Are we living in a post-dating culture? How do poverty and welfare policies [Page x]affect families? How is child rearing changing now that so many parents work outside the home and children spend time with caretakers other than their parents? Finally, how are families socially constructed in various societies and cultures?
Most sociologists and family scholars agree that the family is a dynamic social institution that is continually changing as other social structures and individuals in society change. The family also is a social construction with complex and shifting age, gender, race, and social class meanings. Many excellent studies are currently investigating the changing structures of the institution of the family and the lived experiences and meanings of families. Contemporary Family Perspectives is a series of short texts and research monographs that provides a forum for the best of this burgeoning scholarship. The series aims to recognize the diversity of families that exist in the United States and globally. A second goal is for the series to better inform pedagogy and future family scholarship about this diversity of families. The series also seeks to connect family scholarship to a broader audience beyond the classroom by informing the public and by ensuring that family studies remain central to contemporary policy debates and to social action. Each short text contains the most outstanding current scholarship on the family from a variety of disciplines, including sociology, demography, policy studies, social work, human development, and psychology. Moreover, each short text is authored by a leading family scholar or scholars who bring their unique disciplinary perspective to an understanding of contemporary families.
Contemporary Family Perspectives provides the most advanced scholarship and up-to-date findings on the family. Each volume contains a brief overview of significant scholarship on that family topic, including critical current debates or areas of scholarly disagreement. In addition to providing an assessment of the latest findings related to their family topic, authors also examine the family utilizing an intersectional framework of race-ethnicity, social class, gender, and sexuality. Much of the research is interdisciplinary with a number of theoretical frameworks and methodological approaches presented. Several of the family scholars also use a historical lens as well to ground their contemporary research. A particular strength of the series is that the short texts appeal to undergraduate students as well as to family scholars, but they also are written in a way that makes them accessible to a larger public.About This Volume
Health issues affect families in numerous ways, from caring for individuals with chronic illnesses or loved ones who are aging, to families trying [Page xi]to figure out how to economically meet the high costs of health care in the United States. This volume on Families and Health, describes the multidimensional nature of health issues and the various ways health issues can affect families and how families can affect the health status of individuals. The author, Janet Grochowski, is a family studies professor who became the Endowed Professor of Education and Department Chair at the College of St. Benedict and St. John's University. In this second edition, Grochowski updates and expands her earlier arguments concerning families and health. Specifically, after defining a number of determinants of family health and examining some current health issues for families in the United States, Grochowski develops an interdisciplinary model for understanding the complex relationships between health and families. In the sections that follow, Grochowski closely examines a number of the variables that affect health, beginning with biological factors such as family health history and genetics. She then turns her attention to family decision making and behavioral patterns that affect health outcomes. Next, Grochowski examines social-economic circumstances, such as poverty, that create family health disparities and inequalities. Grochowski broadens her lens even further to investigate how the environment both locally and globally is affecting family health. She also discusses the need for changes in public policies and services to ensure that more American families get the health care information and coverage that they need.
Topics covered include health care access and coverage in the United States, health behavior theories and models, family caregiving issues, global family health concerns such as HIV/AIDS and childhood asthma, the State Children's Health Insurance Program (SCHIP), and how the Affordable Care Act (Obama's health care plan) and some states are trying to reform health care. Grochowski also looks at current health care debates around childhood vaccinations, obesity, abstinence-only sex education, the stress of the workplace, and concerns related to death and dying. In all the chapters, Grochowski includes three to four cases to illustrate the personal side of health care issues and how they affect individuals and families.
Families and Health is appropriate for use in any class concerned with family issues, medical sociology, social inequality, health care, and government policy. This book is a valuable resource to teachers and students in beginning or advanced courses in sociology, psychology, family studies, public health and other health care classes, women's studies, human development, social work, public policy, and many other disciplines. It also finds an audience among those who work in various human service fields, including human development, social work, education, counseling, health services, and the government.
Author Preface[Page xii]
Contemporary Family Perspectives, edited by Susan J. Ferguson, provides a unique set of lenses for studying families. Families and Health is the sixth book in this family series. Family scholars often agree that family health is multidimensional in nature, vital to family well-being, and requires community support and resources. What may be absent in discussions regarding family health, however, is active interdisciplinary communication and cooperation that promote a biopsychosocial approach. The crucial issue family health challenges families and communities on local, national, and global levels. Using the Family Health Determinants Model, Families and Health aims to provide a concise, accurate, and engaging means to better understand and address the complex nature of family health.
Families and Health begins with an introduction to the Family Health Determinants Model as well as the status of American families' health. This introduction also explains the impacts of the biopsychosocial model, General Systems Theory, and related family health theories on the transition toward a more dynamic family health concept. Using the Family Health Determinants Model as an organizational scheme, Chapters 2 to Chapters 6 explore impacts and issues related to each of the five determinants of family health including: biology/genetics, behavior patterns, social-cultural circumstances and disparities, environmental exposures on a global scale, and health care policies, services, reform, and redesign, which together weave the fabric of family health. Within each chapter are several case studies, based on real families' health experiences, to help illustrate the human condition and a more personal side of the data. The second edition of Families and Health includes extensive updated research and statistics presented with clarity and context. This edition draws on data from national and international organizations as well as [Page xiii]findings from current studies conducted by premiere research organizations. Each chapter incorporates studies from scholarly books, journals, and up-to-the-minute online resources. The second edition includes the unfolding impacts of political battles over the Patient Protection and Affordable Care Act (ACA) in the aftermath of the 2012 Supreme Court ruling and presidential and congressional elections.
Authors often talk about the adventure they experience while writing. I found authoring Families and Health not only a somber journey, but also one that truly encouraged and energized. I was honored to study and write about families' health experiences in hopes their collective stories will strike a collaborative chord with family scholars, practitioners, and governing agencies. This appears to be a point in time when Americans are engaged in discussions and actions that call for support and wise use of medical advances and genomic research; encourage healthful behaviors; eliminate health disparities; engage in leadership to promote healthful (and reduce unhealthy) environmental exposures; and invest in families through affordable, equitable access to higher quality and efficient health care. Family health is fundamental to being able to perform well in our home, work, and community and, therefore, is not a privilege, but a right and responsibility of our global community. It is my intent that Families and Health honors families and encourages readers to engage achieving healthful lives for themselves and all families.
As a young child, I witnessed my mother's death to breast cancer, and ten years later my father's to heart disease. These two events planted the seeds for a lifelong interest and career in health studies and family studies. Books about the interacting determinants of family health that are played out on personal, national, and global stages are needed. I am grateful to have had the opportunity to author such a work. Yet, solo authors are the first to recognize that without support, they often are unable to complete the challenge and opportunity of authorship. I wish to thank Susan J. Ferguson of Grinnell College, General Editor for the series Contemporary Family Perspectives, who provided valuable guidance, suggestions, and endless encouragement. Susan and David Repetto, Publisher of the Sociology list at SAGE, recognized the unique nature of the proposed manuscript that ventured beyond databases by providing an interdisciplinary approach to better understanding the complex experience of family health. I also value the editorial assistance provided by Eric J. Garner, Senior Project Editor, Diane DiMura, Copy Editor, and marketing expertise of Erica DeLuca, Executive Marketing Manager, Kelley McAllister, Senior Marketing Communications Manager, and Jennifer Jones, Marketing Associate.
My years at the University of St. Thomas provided a wealth of experience, and I am thankful for the support I received in terms of research projects and sabbaticals. More recently, the College of Saint Benedict and Saint John's University provided support and encouragement toward my scholarly endeavors. I am also thankful for the countless medical, social, and educational professionals who have broadened my understanding of and interest in the dynamic field of family health. I am especially grateful to the women and men who unselfishly shared their family health stories that served as the foundation and very human side to the case studies.
With the passage of time, I increasingly appreciate the gifts of learning and curiosity instilled by my departed parents, Gladys and Edward Kortens, who fostered my desire to explore our interconnected world.
[Page xv]My immediate family is my most treasured asset and constant source of support and patience. I wish to thank my lifelong partner, Richard, who sparks the adventurer in me to expand my understanding. Finally, I am grateful to our adult children, Eric Grochowski and Emily Grochowski, whose enthusiasm to make a difference and help others reflects the much-needed optimism and hope for our global community. I dedicate this book to them.
While extending my sincere gratitude to all who contributed to transforming this book from an idea to solid form, I take full responsibility for any errors.—
About the Author
Final Summary Comments[Page 215]
The health of families is fundamental to the health and prosperity of national, regional and global communities. The goal of this book is to describe family health in its multiple dimensions (i.e., biopsychosocial model), and primarily explain the interactive influences of its five major determinants (i.e., biology/genetics, behavior patterns, social-cultural circumstances, environmental exposures, and health care policy and services) as presented in Figure 1.1, Family Health Determinants Model. The United States spends more on health care, yet enjoys less access, equity, quality, and efficiency than other developed nations. What is often overlooked during discussions on access to health care, however, is that family health is determined by five interactive determinants. While there is increasing agreement that health care is a necessity and not a luxury, what may be missed is that family health itself is a right and not a privilege. This means that humans have a “social obligation to protect and promote health for all” (Daniels 2008:140). Protecting and promoting family health encompasses all five of the determinants, not just health care. Making family health a right means
- supporting and wisely using medical advances and genomic research;
- creating healthful behavior options and facilities along with incentives to encourage families to choose to live healthier lives;
- actively addressing health disparities that cross race, ethnicity, sex, age, geographic location, socioeconomic, educational, and sexual orientation lines through better research, education, and health care program delivery and design;
- taking authentic leadership in promoting healthy and eliminating unhealthy environmental exposures, that is, investing in safer air, water, land, food, plus living and working spaces;
- investing in families through affordable, equitable access to higher quality and efficient health care.
While advances in epigenomic-related and inheritance research promise earlier detection, more effective intervention, and prevention, the multifactorial nature of most diseases and illness require comprehensive approaches that recognize the interactions of all health determinants. Twenty-first-century families need to recognize the important role of knowing their family health histories and how to access and protect the confidentiality of their genetic information. The purpose of epigenomic-related and other medical technological advances is to enhance the quality of life while not denying the full cycle of life that includes living and dying well. Hence, families also need to engage in discussing and creating advance-care directives.
Medical technological advances bring benefits and costs. When family members are ill or injured, their families want and expect the best care, but being able to keep a terminally ill person alive may make the inevitable dying process more difficult and prolonged unnecessarily, all at a staggeringly high cost. When between 20 to 30 percent of Medicare payments during the final 2 months of terminally ill patients are reported as not meaningful, families and health care providers need to be aware of and engaged in candid conversations over end-of-life decisions. These conversations begin with family discussing and creating advance-care directives before family members become gravely ill or frail. The purpose of these discussions and advance-care plans are to confirm that terminally ill family members' choices concerning end-of-life care are honored. The emphasis on families knowing their family health histories, therefore, needs to include discussions over end-of-life health care choices.
Families need to be better educated and proactive regarding the promises and cautions surrounding genome-related fields. Naturally, the promise of medical technological advancements and epigenomic-related research will take time, commitment, and an engaged population on family, community, national, and global levels in order to reach the promises of effective and wise use of current and future advances. Since interactions among biology and the other four health determinants shape and define our individual and family health, it is vital that physical and social sciences collaborate in the area of family health. One of the crucial developments emerging from epigenomic-related research is a demand for greater collaboration among disciplines (e.g., medicine, biological sciences, education, family studies, law, sociology, social work, and psychology) in understanding and working with complex processes, such as redesigning of health care delivery systems.[Page 217]Behavioral Patterns
Choosing healthful behavior patterns begins with having accurate and accessible health information, along with guidance, support, and incentives. In order to encourage more healthful behaviors, one has to know the factors driving behaviors, in other words, recognize the impacts of other determinants. For example, more employer-based health insurance programs are moving toward using incentives (e.g., fitness memberships, reduced co-pays) to encourage their employees to engage in more healthful behaviors. Such practices are based on evidence that workers who practice more healthful behaviors are not only less expensive in terms of health care costs, but more productive in terms of adding value to their families, jobs, and communities. This approach of providing opportunities, facilities, and incentives for healthier behavior patterns needs to be applied to families, especially those located in deprived communities.
As seen in the cases relating the complexities of health issues, such as nonvaccination, cardiovascular disease, and obesity, family members' beliefs, attitudes, and perceptions are crucial to their actions and inactions. Effective interventions that enhance healthful behaviors and prevent or reduce the risk of unhealthy behaviors demand inclusion of family members, their social networks, plus the larger community. Community-based programs appear to be more effective and sustained than isolated individual interventions in terms of health behaviors, yet such collaborative interventions cannot by themselves reverse or prevent complex health conditions. The dynamic nature of family health demands that all five interactive influences (i.e., biology, behavior patterns, social-cultural circumstances, environmental exposures, and health care policy and services) are recognized and incorporated into defining, enhancing, and maintaining families' healthful behavior choices.
Encouraging and supporting family engagement in healthful behaviors is fundamental to family health since families serve as primary role models for healthful behaviors for themselves and others. Healthful living programs that are culturally sensitive, scientifically accurate, and socially appealing accelerate health promotion choices.Social-Cultural Circumstances
While genetics and behaviors are well accepted as necessary parts of the family health tapestry, the impacts of social-cultural circumstances are less well understood when attempting to provide better health and health care opportunities. There is no shame in being ill, but denying respect, care, [Page 218]or coverage based on race, ethnicity, sex, age, sexual orientation, socioeconomic status, education, or geographic location is disgraceful. Stigma toward types of disease and illness such as HIV/AIDS and mental illness remain relatively underrecognized and undertreated. Here the illness itself suffers from stigmatization, discrimination, disregard, and disrespect thus penalizing those suffering from these illnesses just for being sick. Health disparities on national and global levels provide formidable obstacles for families striving and at times struggling to healthy and well.
The goals of the Healthy People 2020 initiative include: (1) Attain health quality, longer lives free of preventable disease, disability, injury, and premature death; (2) Achieve health equity, eliminate disparities, and improve health of all groups; (3) Create social and physical environments that promote good health for all; and (4) Promote quality of life, healthy development, and healthy behaviors across all life stages. The disproportionate toll on racial and ethnic minorities, women, the urban and rural poor, and other medically underserved individuals and their families result in poorer health status not only for the afflicted individual, but also for their families, communities, and nations.
Equity of health opportunities demands recognizing that health disparities stem from complex, interrelated factors that need to be corrected in order to improve health and delivery of quality health care. Families are better able to take greater responsibility for their health and choose more healthful behaviors when their social-cultural circumstances and related disparities are fully addressed. Poverty, limited educational background, and disadvantaged geographic locations are examples of social-cultural determinates that significantly impact family health. Promoting health and eliminating health disparities are ethical and economic concerns of all Americans as national and primarily as global citizens.Environmental Exposures
The world population shares a global home—a home in which the air we breathe, water we drink, food we eat, spaces we live, play, and work in are increasingly interconnected. While some of these environmental exposures, such as tsunamis or earthquakes, cannot be controlled, others can. For example, many infectious diseases are preventable and treatable, yet families continue to suffer the ravages of epidemics, such as malaria, and pandemics, such as HIV/AIDS, that devastate our collective youth and future. Human actions (e.g., war, genocide, pollution, destruction of natural resources) and inactions (e.g., inadequate allocation of resources toward those in need, limited access to effective health care) frequently have disastrous ramifications.
[Page 219]Negative actions and inactions lead to complex conditions such as population displacement, urban crowding, poverty, increased spread of disease, or climate change (increased frequency and severity of droughts, floods, storms) with devastating effects on family health and well-being. The human and economic costs of negative human actions and inactions impact our communities and threaten future generations on local, national, and global levels.
A major family health challenge in the twenty-first century is securing and allocating resources to meet the escalating prevalence rates of chronic conditions (e.g., heart disease, diabetes, cancers, asthma), while struggling with epidemic and pandemic infectious diseases (e.g., malaria, antibiotic-resistant tuberculosis, HIV/AIDS) that ravage developing nations, such as sub-Saharan Africa. While creating healthful environments begins in our homes, work sites (e.g., reducing job strains, work-family conflicts), and communities, it also demands national and international attention and effort in addressing the environmental concerns of our global community.Political Impacts on Health Care Policy and Services
Americans spend more and gets less for their health care dollars than any other developed nation. The lack of universal health care in the United States has proven to be not only ethically, but fiscally, irresponsible. The reality is that providing access to affordable, equitable and effective quality health care is a hallmark of a truly progressive nation. The Patient Protection and Affordable Care Act (ACA) of 2010 was the first major health care reform legislation since Medicare and Medicare were signed into law in 1965. Historians may recount the drama and fierce political opposition to the passage of major health care legislation such as Medicare, Medicaid, and ACA, but once enacted most American families embraced these reforms in health care policy and services as necessary parts of family health. Opponents to ACA termed this landmark health care reform act as “Obamacare.” While originally meant to be derogatory in nature, the term Obamacare became a theme of “Obama Cares” in 2012 and throughout the presidential election.
Political opposition to ACA resulted in several states filing a lawsuit with the U.S. Supreme Court against ACA. In June 2012, the U.S. Supreme Court ruled that ACA was constitutional and approved all provisions except requiring that all states expand Medicaid to cover individuals with incomes below 133 percent of the poverty level regardless of preexisting medical conditions. Individual states' decisions to comply or not comply with Medicaid expansion impacts millions of Americans and the overall health of the nation. Failure to expand Medicaid coverage to the additional [Page 220]16 to 17 million uninsured Americans would interfere with a promise of near-universal health care in the United States. It is important to note that over half of the newly eligible Medicaid families under ACA live in the 26 states that challenged ACA. Which states choose to or not to comply with Medicaid expansion will be evident by 2014 when ACA is fully implemented. While governors and state legislatures hold considerable power over how ACA is implemented in terms of expansion of Medicaid and development of health insurance exchanges, the re-election of President Obama in November 2012 confirmed that ACA would remain as landmark health care reform. Just as in the unfolding of Medicare and Medicaid, within a few years all states will comply with the expansion of Medicaid under ACA. The Commonwealth Fund called for a national entity that demands accountable and collaborative leadership among political and private sector parties. While access and equity are vital first steps, these must be accompanied by health care reform and redesign that promotes higher quality and efficiency in delivery of health care services.
Higher-quality health care means raising the level of effectiveness, safety, coordination, patient-centeredness, and timeliness. Overlapping with this drive for higher quality is the need for greater efficiency. Several attributes of a high-quality and efficient health care system include:
- availability of relevant patient information to all providers and universal use of health information technology;
- coordinated patient care among providers and settings through integrated, team-based approaches;
- access to appropriate care when needed to avoid overuse of emergency departments, for care is better provided at the primary care level;
- greater provider accountability within and across settings in pursuit of continuously innovating and learning to improve quality and efficiency of care;
- patient-physician partnerships and incorporation of patient feedback; and
- greater efficiency and streamlining of coverage administration. It is argued that a well-supported, patient-centered medical home is better able to meet higher quality and efficiency demands since it provides the system where health care is less fragmented and more focused on primary care.
Most Americans across the political spectrum agree that health care in the United States costs too much. One of the reasons for spiraling medical costs is end-of-life medical care decisions that may counter terminally ill patients' advance-care choices. The AFA includes an Independent Payment Advisory Board (IPAB) with the authority to recommend proposals to limit Medicare spending growth. There was much confusion and false statements regarding the purpose and authority of the new Board. To clarify, the IPAB “is prohibited from submitting proposals that would ration care, increase taxes, change Medicare benefits or eligibility, increase beneficiary premiums and cost-sharing requirements, or reduce [Page 221]low-income subsidies …” (KFF 2010c:1). The challenge of redesigning and reforming health care includes addressing difficult questions such as those surrounding end-of-life care decisions. Families and health care providers need to actively communicate and create advance-care directives regarding extent of medical care that honor the choices of terminally ill family members. Health care can do much to alleviate pain and suffering and even cure some medical conditions, but families must not lose sight of the reality that dying is part of living. Advance-care directives are an essential part of authentic health care reform, but in the explosive political atmosphere surrounding the 2012 presidential election, this vital area was not addressed. Leadership in health care reform and redesign must come from the collaborative efforts of families, health care providers, and elected officials. This national entity requires not only access to enhanced access to and equity in health care, but also a continued drive to improve the quality and efficiency in health care delivery performance. Health care redesign and reform must be coordinated, comprehensive, and supported by health care providers, families, and those we elect to govern.
Family health is a dynamic process of interacting determinants and fundamental to families and the communities and nations in which they live. As the health of each family member impacts the entire family, so does the health of our local, national, and global communities impact all of us. Just as families need to be more proactive and responsible for their health, governmental agencies and health care providers need to be more attentive in providing accessible, equitable, and more efficient delivery of high quality health care policy and services. The greatness and wisdom of a nation are found in how it cares for its citizens, that is, all of its citizens. As the opening quote to Chapter 1 explains, it has long been recognized that health, family health, is essential to being able to perform well in our home, work, and community settings. Family health, therefore, is not a privilege for the few, but a personal, national, and global right and responsibility of all.[Page 222]
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