Welcome to Week Six – Winding down and taking stock….

As you focus on catching up, and producing a powerful photovoice assignment, take a moment to reflect on the PUBH 209 course objectives outlined in the syllabus. Please review them.

Course Objectives Reflective Prompt – due PW Friday July 28 or LC Sunday July 30
By the LC deadline of next Sunday July 30 at 10pm, post a reflective statement about your progress in consumer health, how meaningful you believe it is for most public health students (or even others) to be able to do the things on the list, and other thoughts about the course objectives, especially as they relate to improving personal and societal health and other outcomes. Use your username and Course Objectives as tags and Reflection as the category. I’ve copied the course objectives here below for your convenience.

Course Objectives: By the end of the course, students will be able to:

  • describe the impact of recent health care legislation on consumers;
  • describe U.S. consumer protection laws, agencies, and strategies;
  • find and use credible information about health-related services & products;‎
  • describe industry influence, fraud, quackery & unscientific claims
  • collect and share qualitative data regarding consumer health
  • outline key historical events that affect people’s choices and outcomes in a given realm of consumer decisions
  • provide and analyze examples of credible, accessible consumer-relevant information and sources, with an emphasis on helping others to distinguish between sources that help and hinder healthy decision making.
  • compare health-related policy and societal decision making in the United States and other locations, as well as across regions of the United States; as a result of comparing these contexts, they will be able to emphasize any apparent links to health behavior, choices, and outcomes.

It is my hope that you find that, through the materials provided to you and the requirements for you to read, think, explore, and write about consumer health-relevant issues and strategies, you can do at least 5 of the listed items very well, at least one other on the list fairly well, and at least one other adequately.

(Keep in mind that at THIS point we still have 1/6 of the class to go, so if there is an item you believe you can not do at all or can only do marginally at best, you still have a week to work on that skill! You may perhaps decide to address that intention in your reflective statement….)

Photovoice Guidelines – pls review ASAP!

Hi all – I was just alerted by one of you that it may not have been obvious when the Photovoice guidelines were posted.

If you have NOT yet seen those, please DO review them here right away. The general gist:

  • Photovoice/digital storytelling helps people use images to discuss societal problems.
  • You decide on an consumer health issue area of interest to you, and take 3 to 5 photos (OR shoot a short video) that help you answer two questions from the following list:
    • How healthy IS it?”
    • “What choice/s do I have?”
    • “Do I really know what I need to to make a healthy choice?”
    • “Why is it so difficult to be healthy/easy to be unhealthy?”
    • “What’s depletion got to do with it?”
    • “TMI but not the right kind or layout to help me make a good decision?”
    • “Who has the upper hand and how?”
    • “Who’s selling me what?”
    • “What’s the typical discourse (what “most people” say?) about this & similar products/services?”
  • By Wednesday (July 19) I would like a brief post (with appropriate tags and category) telling me what direction you’re going in (topic/issue area and your chosen questions)
  • By Friday July 28*, please post a post with
    • 1) your photos or video (either by ppt file or simply as photos inserted in your post) and
    • 2) two brief narratives, each 250 to 500 words, the first
      • discussing how your photos or video help you think about and answer the questions you chose, and the second
      • discussing the experience of taking the photos or video.
  • For more details, again, visit the guidelines, bottom of Guidelines and Deadlines page, here

End of Week Four – Happy Friday, but let’s talk about death and dying a bit….

As you’ll hear if you head over to Canvas and listen to the recording of today’s conference/chat session, today I attended a memorial for the brother of close friends. It made me think about the individual choices we have – and CAN make – as consumers, and how difficult that decisionmaking and choosing IS for many of us.

As I noted in the recording, you have access to a Content Page on Illness and Mortality Matters, but I want to call out a couple of the resources included there.

First, take a look at the FAQ page of the Honoring Choices website. It’s a really good place to start for folks wanting to learn more about this important aspect of life and how best to make sure their own wishes are known and respected. Here comes a challenge….

CHALLENGE: After reviewing Honoring Choices information, have a conversation with someone you love (OR have an imaginary conversation with that person). How do you start the conversation? What do they say? What does it feel like to take this step as a consumer?

Post your reply by PW deadline of NEXT Friday July 21, or LC deadline of Sunday July 23. Use your username and Challenge as tags, and choose the Challenge category!

NOTE: If thinking about death and dying is hard for you, I understand. It’s hard for all of us, and in my family we tend NOT to discuss it (or our options) at all. It’s simply TOO difficult for some of my family members. I really wish it wasn’t that way, because I know there’s going to be a time when I will simply have to deal with the dying and deaths of my parents. And I know that would be just a little easier if we’d shared our thinking and wishes in advance. Btw, I intend to take myself up on this challenge. I think I’ll be doing the imaginary version. But that will help prepare me to push again to hold a REAL conversation and become an active, healthy consumer in this area of life….

 

Glossary Building posts clarification!

Just had a good question: “Our own words or copy and paste?”

Short answer – Either is fine. You will of course also want to cite (and list) your sources either way.

Longer answer – Make your post meaningful by sharing some context; tell us why you find the terms important, where you ran across them, and where you looked to find a useful definition.

Looking forward to more good thinking in consumer health!  –DrP

The Monday July 3 Summary/Digest. Read here!

Hello and happy odd holiday weekend, right?

Rather than posting two separate posts leading you to responsibilities and opportunities, here’s a single post with information you should have right now.

First, if you have NOT yet been using the slides, please start. Although I haven’t specifically required you to include info from them as part of your posts, you’ll learn a great deal from them about consumer health as an area of public health. AND – bonus! – there’s a “Challenge” in one of them. Scavenger hunt!!!!! You know you want to…..

You’ll also find a third “Thinking and Discourse Prompt” up, and it specifically does invite you to make use of slides information. I look forward to seeing some of you posting to that prompt. Visit it here!

Glossary Building Posts – here’s how!

A total of five* Glossary Building posts are due by the end of the quarter. Try to post GBs every week, when new terms are hitting you, rather than rushing to post all five and having to search for terms to include. (*Note: Because I’m just getting the guidelines to you and there are only four weeks left officially, you may opt to replace one with a “challenge” or other “extra learning” post.)

Click here to see the GB guidelines at the Guidelines and Deadlines page, or keep reading.

A glossary is a specialized list of terms and definitions. You may find regular words, just like in a dictionary, but with an additional meaning or a “twist” for the context. You may find some acronyms or even concocted terms or phrases very specific to a given field, industry, or organization.

Each of your GB posts should include at least three terms that you believe are important for a glossary in consumer health, particularly if consumer health content is a chance to empower others to make the healthiest choices they want to make.

Posting on time, with attention to detail, correct citing of sources, and a readable, user-friendly approach – AND using your username as a tag and glossary as the category – will earn you the possibility of a High Pass (5/A) for your GB post.

PhotoVoice Plan

For my Photovoice Project I’d like to tackle the issue of Crohns Disease. I’ve essentially ignored the fact that I have it, making very few dietary changes over the last few years. In order to make myself address this problem directly, I’ll research some of the problem areas in my diet and how others handle it. My mother has made multiple serious diet changes herself over the years, and I’d like to learn about those more as well.

Glossary Building: Post Four

Recidivism

According to the article National Institute of Justice (2014) “Recidivism is one of the most fundamental concepts in criminal justice. It refers to a person’s relapse into criminal behavior, often after the person receives sanctions or undergoes intervention for a previous crime. Recidivism is measured by criminal acts that resulted in re-arrest, reconviction or return to prison with or without a new sentence during a three-year period following the prisoner’s release” (National Institute of Justice, 2014, para. 1). I chose this word because it is important to understand what it means and what it entails when dealing with criminal activity. Research has been done throughout the years to calculate and assess why recidivism is so high.

Cognitive Behavioral Therapy

According to Senson (2016) “CBT is a psychotherapeutic treatment administered by a therapist trained in mental health disorders and specifically in CBT. Patients typically attend a limited number of sessions that focus on a specific problem, helping the patient identify, recognize and change disturbing thought patterns and feelings that are leading to negative or destructive beliefs and behaviors” (Senson, 2016, para. 6).

I chose cognitive behavioral therapy as a glossary word because it is also an important part of consumer health in some aspects. People behave in certain ways because of their different personalities and many suffer from personality disorders. CBT is among one of those treatment methods that can help individuals with cognitive and behavioral problems.

Offender

a person who commits an illegal act.

synonyms: wrongdoer, criminal, lawbreaker, miscreant, malefactor, felon, delinquent, culprit, guilty party, outlaw, sinner, transgressor; malfeasant

a person or thing that offends, does something wrong, or causes problems.

Offender in many cases has been found to mean something other than a wrongdoer and a criminal. People often relate the word offender to a sex offender. I find this word interesting because the Washington State Department of Corrections has recently moved away from using the words offenders, inmates, convicts, and similar words. Currently the State of Washington wants the population of incarcerated individuals to be addressed as students or patients.

References

Offender. (n.d.). Retrieved July 24, 2017, from http://www.thefreedictionary.com/offender

Recidivism. (2014, June 17). Retrieved July 24, 2017, from https://www.nij.gov/topics/corrections/recidivism/Pages/welcome.aspx

Senson, A. (2016, January 06). Virtual Reality Therapy: Treating The Global Mental Health Crisis. Retrieved July 24, 2017, from https://techcrunch.com/2016/01/06/virtual-reality-therapy-treating-the-global-mental-health-crisis/

Glossary Post 5

Tax

What is ‘Taxes’

Taxes are generally an involuntary fee levied on individuals or corporations that is enforced by a government entity, whether local, regional or national in order to finance government activities. In economics, taxes fall on whomever pays the burden of the tax, whether this is the entity being taxed, like a business, or the end consumers of the business’s goods.

BREAKING DOWN ‘Taxes’

Taxes are levied by states upon their citizens and corporations to fund public works and services. Payment of taxes at rates levied by the state is compulsory, and tax evasion, the deliberate failure to pay one’s full tax liabilities, is punishable by law. Most governments utilize an agency or department to collect taxes; in the United States, this function is performed by the Internal Revenue Service.

There are several very common types of taxes:

  • Income Tax (a percentage of individual or corporate earnings filed to the federal government)
  • Sales Tax (taxes levied on certain goods and services)
  • Property Tax (based on the value of land and property assets)
  • Tariff (taxes on imported goods imposed in the aim of strengthening internal businesses).

However, tax systems vary widely among nations, and it is important for individuals and corporations to carefully study a new locale’s tax laws before earning income or doing business there.

Advertiser Disclosure

Like many developed nations, the United States has a progressive tax system by which a higher percentage of tax revenues are collected from high-income individuals or corporations rather than from low-income individual earners. Taxes are imposed at federal, state and local levels. Generally speaking, the federal government levies income, corporate and payroll taxes, the state levies sales taxes, and municipalities or other local governments levy property taxes. Tax revenues are used for public services and the operation of the government, as well as the Social Security and Medicare programs. As baby boomer populations have aged, Social Security and Medicare have claimed increasingly high proportions of the total federal expenditure of tax revenue. Throughout United States history, tax policy has been a consistent source of political debate.

Capital gains taxes are of particular relevance for investors. Levied and enforced at the federal level, these are taxes on income that results from the sale of assets in which the sale price was higher than the purchasing price. These are taxed at both short-term and long-term rates. Short-term capital gains (on assets sold less than a year after they were acquired) are taxed at the owner’s normal income rate, but long-term gains on assets held for more than a year are taxed at a lower rate, on the rationale that lower taxes will encourage high levels of capital investment.

IRS

What is the ‘Internal Revenue Service – IRS’

The Internal Revenue Service (IRS) is a U.S. government agency responsible for the collection of taxes and enforcement of tax laws. Established in 1862 by President Abraham Lincoln, the agency operates under the authority of the United States Department of the Treasury, and its primary purpose includes the collection of individual income taxes and employment taxes. The IRS also handles corporate, gift, excise and estate taxes. People colloquially refer to the IRS as the “tax man.”

BREAKING DOWN ‘Internal Revenue Service – IRS’

Headquartered in Washington, D.C., the IRS is an expansive organization that services the taxation of all Americans. For fiscal year 2014, the IRS

processed nearly 147.5 million personal income tax returns and more than 2.2 million corporate income tax returns. These types of returns brought the federal government close to $2 trillion of revenue.

E-Filing

Individuals and corporations have the option to file income returns electronically thanks to computer technology, software programs and secure Internet connections. During the 2015 tax filing season, more than 91% of all returns came through this e-file option, which comes to more than 128 million out of 150 million returns from January to October 2015. The number of returns that use e-file has grown steadily since the IRS began that program. By comparison, 40 million out of 131 million returns, or just 31%, used the e-file option in 2001. More than 128 million taxpayers received their returns through direct deposit rather than a traditional paper check in 2015, and the average direct deposited amount was $2,935.

Audits

As part of the enforcement mission of the IRS, the agency audits a select portion of income tax returns every year. For the 2013 tax year, the agency audited approximately 1.4 million income tax returns, or 0.7% of all returns filed. This number breaks down to 0.9% of individual income tax returns and 1.3% of corporate tax returns. Around 71% of IRS audits occur through the mail, while 29% happen in the field.

After rising to a peak in 2010, the number of audits has steadily declined. The amount of funding set aside for tax enforcement declined 5% from 2014 to 2015, which indicates even fewer audits should occur. Reasons for an IRS audit vary, but some factors may increase the odds of an examination. Someone who makes more than $200,000 in one tax year has a 2.71% chance of having an audit. One out of every 13 returns of those earning more than $1 million per year undergo an audit.

Other red flags for an audit include failing to declare the right amount of income, claiming a higher-than-normal amount of deductions, running a small business as self-employed, making large charitable donations compared to income and claiming rental losses. There is no one single factor that determines who does or does not face an IRS audit each year.

References

Staff, I. (2016, June 05). Taxes. Retrieved July 24, 2017, from http://www.investopedia.com/terms/t/taxes.asp

Staff, I. (2003, November 23). Internal Revenue Service – IRS. Retrieved July 24, 2017, from http://www.investopedia.com/terms/i/irs.asp

Glossary Post 4

Giffen Good

What is a ‘Giffen Good’

A Giffen good is a good for which demand increases as the price increases, and falls when the price decreases. A Giffen good has an upward-sloping demand curve, which is contrary to the fundamental law of demand which states that quantity demanded for a product falls as the price increases, resulting in a downward slope for the demand curve. A Giffen good is typically an inferior product that does not have easily available substitutes, as a result of which the income effect dominates the substitution effect. Giffen goods are quite rare, to the extent that there is some debate about their actual existence. The term is named after the economist Robert Giffen.

Laffer Curve

What is the ‘Laffer Curve’

The Laffer Curve is a theory developed by supply-side economist Arthur Laffer to show the relationship between tax rates and the amount of tax revenue collected by governments. The curve is used to illustrate Laffer’s main premise that the more an activity such as production is taxed, the less of it is generated. Likewise, the less an activity is taxed, the more of it is generated.

BREAKING DOWN ‘Laffer Curve’

Laffer Curve

The Laffer Curve suggests that, as taxes increase from low levels, tax revenue collected by the government also increases. It also shows that tax rates increasing after a certain point (T*) would cause people not to work as hard or not at all, thereby reducing tax revenue. Eventually, if tax rates reached 100%, shown as the far right on his curve, all people would choose not to work because everything they earned would go to the government. Governments would like to be at point T*, because it is the point at which the government collects maximum amount of tax revenue while people continue to work hard.

References

Picardo, C. E. (2015, July 24). Giffen Good. Retrieved July 24, 2017, from http://www.investopedia.com/terms/g/giffen-good.asp

Staff, I. (2015, September 11). Laffer Curve. Retrieved July 24, 2017, from http://www.investopedia.com/terms/l/laffercurve.asp

Pharmaceutical Prompt One

Honestly I don’t see any problem with DTC advertising directly, but there are some problems which could be handled. Bringing treatment options to the attention of consumers is good in my opinion.

The WHO article from the 9th slide said that the advertising led to higher prices for the consumer or tax payer. Tax dollars shouldn’t be subsidizing advertisements, but I’m not sure how the ads can effect the prices consumer pay. The 2015-2016 Congress failed to pass a bill removing this tax break by leaving it untouched in the Finance Committee.

In that article, the former director Ethics, Trade, Human Rights and Health Law at WHO said that it increased focus on pharma company profits. I find it odd that consumers hate the concept of profits, that focus is what drives growth, innovation, and lower prices. After taking some economics courses, this is much clearer to me.

Consumers would be better off if they were informed better about the negative side effects, according to this FDA study.  Atlhough doctors said they felt “that DTC ads made their patients more involved in their health care,” but they also thought “the ads did not convey information about risks and benefits equally well.” Many DTC ads include a short ending with very fast side effect announcements, I think this is almost a sort of disingenuous advertising.

 

Illness and Mortality Challenge Post

A few years ago, my great-grandfather’s health was deteriorating rapidly. He had been admitted to the hospital, given a two-month prognosis, and had been settled into his living room by hospice all within a week. The day after I arrived home from college to spend time with my grandpa, my  uncle started a conversation with my mother, grandmother, and I about the game plan for my great-grandfather’s long-term care.

He laid out the basic logistics of what was currently going on with his care. He was being cared for by my family during the day with intermittent visits from nurses affiliated with our local hospital’s hospice. During the night, after the night nurse visited, my great-grandmother would try to sleep while my uncle stayed awake in case Grandpa needed anything. This would only work for the next couple of days, as my uncle had to go back home. We basically had three options: we could hire a night nurse to take care of grandpa, my mother and grandmother could take turns staying the night, or a combination of the two. Neither option was ideal, as a night nurse would cost my great-grandparents a considerable amount of money and my mother and grandmother had other engagements to balance. After about 15 minutes of discussing these logistics, we decided to revisit the conversation later to come to a conclusion. Unfortunately, a final decision was never come to because my great-grandfather died that night; surrounded by his child, grandchildren, and wife.

As a consumer, taking on logistics and costs is a difficult thing to do. Costs are high and emotions are strong. The stress of losing a loved one is high, and adding the subject of money onto that stress can be difficult for pretty much anyone. As consumers, it is important to know your options and rights, in order to navigate the decisions the way that serves you and your family best. My uncle did the research on what our options were, and he relayed them to the family. If you are a consumer that is considering starting a conversation about this, I would advise doing your research first. Being clear on all of the relevant information can make this difficult conversations less difficult.

A good place to start would be this website, that outlines the rights of the dead and dying.

Glossary Post 3

ex·ces·sive
ikˈsesiv/
adjective
adjective: excessive
  1. more than is necessary, normal, or desirable; immoderate.
    “he was drinking excessive amounts of brand
mod·er·a·tion
ˌmädəˈrāSH(ə)n/
noun
noun: moderation
  1. 1.
    the avoidance of excess or extremes, especially in one’s behavior or political opinions.
    “he urged the police to show moderation
binge drink·ing
ˈbin(d)ZH ˌdriNGkiNG/
noun
noun: binge drinking; plural noun: binge drinkings
  1. the consumption of an excessive amount of alcohol in a short period of time.
    “teenagers as young as 16 admit to binge drinking”

Since, I’m doing my photovoice on millennial alcohol consumption, I thought these terms would be relevant, though already recognizable. The issue is distinguishing between the first two; excess, and moderation. For women the line is between 1 drink and 2. The CDC recommends no more than one a day for women, and 2 for men. Is it okay though for me to have none one day, and two the next? Or is that binge drinking since it’s in excess of one? Or is that heavy drinking if it adds up to eight a week for a woman?

 

https://www.cdc.gov/alcohol/faqs.htm

Death & Dying Prompt 1

On the morning of December 23, 2010 I went into labor with my first child. I arrived at our local birthing center in more pain than I anticipated for this event. It was a busy night, and I felt neglected by the different nurse mid-wives coming in and out of the room. My daughter was in a funny side-ways position, which was causing ‘back labor’ and the pain I mentioned that I wasn’t anticipating. Early the next morning our daughter’s heartbeat had dropped to 40 bpm, and she had passed her first stool. We rushed to the hospital where I had an emergency c-section. They cut my bladder. I wore a catheter for the first month of motherhood. I was filled with anger toward every practitioner involved, as well as the shame that my body had failed me. I became depressed.

Later, I was able to see past the anger and realize this was nobody’s fault, not even my own. What occurred was not negligent, rather it was an adverse unintentional outcome of a very difficult birth. “It is important to understand one fundamental concept – there is a difference between adverse events and negligence. An adverse event is an injury occurring during the course of medical management” (Sohn, 2013). The doctors and midwives did everything they could to manage a difficult situation, and to keep my daughter alive. And in that regard, they succeed. Managing post-partum OCD and depression, they did not. “Negligence is the failure to provide a standard level of care or, in other words, the delivery of substandard care”(Sohn, 2013). At this point I would highly encourage anyone who reads this to please read this following link, and consider which of these scenarios are negligent or adverse: https://www.propublica.org/article/lost-mothers-maternal-health-died-childbirth-pregnancy. I think many of these maternal deaths are adverse, some are uniformed on the part of patients themselves, and I believe others are truly negligent.“According to researchers in Georgia, Michigan and other states, mental health disorders have become a leading contributor to maternal deaths among white women in the months after childbirth” (Cillekens, Freitas, Martin, 2017) are therefore, preventable deaths, and negligent on the part of all health care providers involved. When mental health disorders are the leading contributor of death, there is negligence occurring without a doubt. Again, “negligence is the failure to provide a standard level of care…” (Sohn, 2013).

I don’t know if it’s immediately helpful to know how many women suffer pregnancy related health complications, or that I am one of many women who lives with a mental health disorder. I certainly feel less alone, but I also wonder why, why is this all so commonplace? It was, however, helpful to find the definitions and differences between negligence, and adverse. The high occurrences of adverse health effects does lead to more questions. Why aren’t consumers being educated more on the signs and signals of their possible adverse health outcomes due to medical treatments and conditions? I am again (for the second time so far) reminded of something our professor said in the first week, “ in order to have autonomy, you need to have more information, and in order to have more information, you need more consumer regulation.” I think more than anything I would encourage people to look into the adverse health effects of their medical conditions, and treatments. I would encourage them to ask their doctors in detail about the signs and signals of life threatening conditions related to their conditions and treatments.

Martin, N., Cillekens, E., & Frietas, A. (2017, July 17). Lost Mothers. Retrieved July 17, 2017, from https://www.propublica.org/article/lost-mothers-maternal-health-died-childbirth-pregnancy

Sohn, D. (2013, February 15). Negligence, genuine error, and litigation. Retrieved June 23, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576054/

Glossary Building

Given this week’s topic about honoring choices in death, I thought I would take the opportunity to expand our personal glossaries by including a few words surrounding this topic.

ad·vance di·rec·tive
noun
  1. a written statement of a person’s wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor.
pow·er of at·tor·ney
noun

LAW
  1. the authority to act for another person in specified or all legal or financial matters.
    • a legal document giving power of attorney to someone.

     

health care agent:  A health care agent is a person you choose in advance to make health care decisions for you in the event that you become unable to do so. … A health care agent also may be called a health care proxy or surrogate or an attorney-in-fact.

http://www.webmd.com/health-insurance/tc/choosing-a-health-care-agent-topic-overview

When preparing a will or advance directive, I feel it is important to know what exactly they are and what they entail, as well as understanding that there are other people you will have to involve in these decisions. Deciding who you want and what roles you want them to play in your choices are extremely important.