Behavior can be modified through educational programs and incentives directed at specific high-
risk populations. For example, in the case of cigarette smoking, health promotion is aimed at
3. Discuss the definitions of health presented in this chapter in terms of their implications
for the health delivery system.
Within the framework of the medical model, health has been viewed as the absence of illness
or disease. Alleviation of symptoms is often the goal of medical interventions. The implication is
that the health delivery system emphasizes diagnosis and treatment rather than prevention of
4. What are the main objectives of public health?
5. Discuss the significance of an individual’s quality of life from the health delivery
perspective.
Quality of life is an important factor both during a patient’s institutionalization and after the
6. What “preparedness” related measures have been taken to cope with potential natural
and man-made disasters, since the tragic events of “9/11”? Assess their effectiveness.
• The Public Health Security and Bioterrorism Response Act of 2002
• Training for workers in medical care, public health, emergency care, and civil defense
agencies at the federal, state, and local levels.
• National initiatives to develop counter measures, such as new vaccines, a robust public health
7. The Blum model points to four key determinants of health. Discuss their implications for
healthcare delivery.
The Blum model points to four key determinants of health: environment, lifestyles or individual
behaviors, a person’s genetic makeup or heredity, and medical care. These four elements are
8. What has been the main cause of the dichotomy in the way physical and mental health
issues have traditionally been addressed by the health delivery system?
Diagnosis and categorization of mental distress have not always been as clear-cut as biomedical
problems. Difficulties in identifying certain behaviors as indicative of mental disorders at least
9. Discuss the main cultural beliefs and values in American society that have influenced
healthcare delivery, and how they have shaped the healthcare delivery system.
The US healthcare delivery system has been shaped by two main beliefs and values. First, belief
in science led to the application of the scientific method to medicine. The medical model of
healthcare delivery is founded on advances in science and technology. In turn, the medical model
where, and in what quantity, and who will have access to those services. Thus, we find a clear
distinction in the types of services between poor and affluent communities, and between rural
and urban locations. The value and belief system also governs the training and general
orientation of healthcare providers, type of health delivery settings, financing, and access.
Healthcare personnel have been trained to concentrate on physical symptoms. Medical practice
10. Briefly describe the concepts of market justice and social justice. In what way do the two
principles complement each other and in what way do they conflict in the US system of
healthcare delivery?
Market justice views health care as an economic good delivered under free-market conditions. It
assumes that markets are more efficient in allocating health resources equitably. The distribution
of medical care services and access to them are determined by people’s ability to pay.
Social justice views health care as a social resource. It requires active government involvement
11. Describe how health care is rationed in the market justice and social justice systems.
In the market justice system, healthcare services are rationed through prices and the ability to
pay. The uninsured and those who lack sufficient income to pay privately cannot obtain the
quantity and type of healthcare services they need when they want them. This is referred to as
“rationing by ability to pay,” demand-side rationing, or price-rationing.
Under social justice, the government makes deliberate attempts, often referred to as “health
12. To what extent do you think the objectives set forth in the Healthy People initiatives can
achieve the vision of an integrated approach to healthcare delivery in the United States?
The Healthy People initiatives have been founded on the integration of medical care with
preventive services, health promotion, and education; integration of personal and community
health care; and increased access to integrated services. The lofty goals to be achieved in health
13. What are the major differences of Healthy People 2020 from the previous Healthy
People initiatives?
Healthy People 2020 is differentiated from previous Healthy People initiatives by including
multiple new topic areas to its objective list, such as adolescent health, genomics, global health,
health communication and health information technology, and social determinants of health.
14. How can healthcare administrators and policymakers use the various measures of health
status and service utilization? Please illustrate your answer.
When health problems are clearly identified, managers and policymakers can plan efforts and
apply resources where they will produce the greatest benefit. For example, high incidence rates
of an infectious disease may indicate an impending epidemic for which public health officials
15. Using the data given below:
a. Compute crude birth rates for 2005 and 2010.
b. Compute crude death rates for 2005 and 2010.
Crude death rate, 2005: = 1,294/248,710 = 0.00520 × 10,000 = 52 deaths per 10,000 population,
or 520 deaths per 100,000 population
c. Compute cancer mortality rates for 2005 and 2010.
Cancer mortality rate, 2005: = 336/248,710 = 0.00135 × 100,000 = 135 deaths per 100,000
d. Did the infant death rates improve between 2005 and 2010?
Infant death rate, 2005: = 39/4,250 = 0.00918 × 1,000 = 9.2 infant deaths per thousand births
e. What conclusions can you draw about the demographic change in this population?
To answer this question, we should look at the change in birth rates, death rates, and life
expectancy between the two periods. The birth rate declined by 14.6% [see results in 16 (a):
f. Have efforts to prevent death from heart disease been successful in this population?