There has never been a more important time in the relatively short history of this country for leadership in health and health care. Health care reform, in the form of the Affordable Care Act, has been altered within the new Tax Bill (removing the individual mandate) and may continue to be revised either piecemeal or in its entirety in the coming years. In addition, the personal and corporate tax cuts in the new tax bill are likely to drive up the national debt; lawmakers are already looking at cutting safety net programs like Medicare and Medicaid to offset the deficit. Clearly, as a society, we are still determining whether health care is a right or privilege. According to the Centers for Disease Control and Prevention, life expectancy in this country has decreased for the second straight year. In other words, without intervention, children may be living shorter lives than their parents. Furthermore, little progress is being made in reducing racial and ethnic health disparities related to infant mortality, chronic diseases, and violence, and climate change is affecting everything, including heat-related morbidity and mortality, asthma rates, food security, housing, and infectious disease spread. Four months after Hurricane Maria, one third of all people in Puerto Rico still do not have power. The delivery and financing of health care continues to evolve. As is well documented, we spend far more per person on health care than any other nation in the world, yet we rank poorly in many key indicators, such as infant mortality and life expectancy, among developed countries. To reduce costs, health care leaders and policy makers have tried countless incremental fixes-attacking fraud, reducing errors, enforcing practice guidelines, making patients better "consumers," implementing electronic medical records-but none has proven either sufficient or satisfactory. Value-based care is also emerging as a solution to address rising health care costs, clinical inefficiency, and duplication of services, and to make it easier for people to get the care they need. It is believed that paying health care providers to keep people healthy is more efficient and effective than paying feefor-services rendered after people become ill. I am personally hopeful that value-based care can improve health at reduced cost. However, this process needs to be monitored so that any
The implications of climate change on health are increasingly more apparent. From hotter temperatures to more extreme weather events, climate change is a serious threat to the health of our patients and communities. As a founding partner of the Nursing Collaborative on Climate Change and Health, the National Association of Hispanic Nurses is committed to promoting health protective solutions and healthy environments in the communities we serve. With the summer months soon approaching and the fear of wildfires, hurricanes, extreme summer temperatures, and others on the horizon, I reference here a selfauthored white paper recently released. The following is an excerpt from Anabell's whitepaper inspired by her speech at ecoAmerica 2017-Health Mantle Panel. Scientific observation and climate model results indicate the earth's atmosphere is warming due to human activities. The result is changes in weather patterns-more frequent and severe heat waves, hurricanes, flooding, drought, and wildfires. In addition, smog and air pollution are worsening due to increasing temperatures. Climate change threatens life support systems and sustainability: Humans cannot live without clean air, water, food, and shelter. People or communities can have greater or lesser vulnerability to climate-related health risks depending on social and economic factors known as the social determinants of health. Individuals with good jobs, stable housing, and transportation access are generally at lower risk to the effects of climate change. On the other hand, groups with higher poverty rates such as Latinos have less choices about occupation, location of residence (on a flood plain or in an area of poor air quality, for instance), and access to medical care. As described below, these and other social and economic characteristics place Latinos at greater risk for health problems related to the changing climate. Medical and behavioral health care access. Compared with other groups, Latinos are less likely to have health insurance coverage. Access to medical care is critical as heat-related conditions increasingly affect Latino populations. In addition, access to behavioral health services is importantly related to the changing climate as rates of depression, anxiety disorders, posttraumatic stress disorders, substance abuse, and suicides are expected to rise as the effects of displacement from climate change worsen. Housing. Compared with other groups, Latinos are more likely to live in poverty and substandard housing, often in ª The Author(s) 2018 Article reuse guidelines: sagepub.com/journals-permissions
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