This informational webinar was taught by Martha Aguello, a woman who currently works in the Physicians for Social Responsibility (PSR), Los Angeles chapter, for integration of physicians into policy reform. She has worked in public health and environmental advocacy campaigns for the past 32 years. PSR is an organization that attempts to form a collaborative effort for physicians to become involved in policy making, taking important environmental factors and approaching policy makers through health education methods.
Martha states that medical students only get about 6 hours of environmental medicine education. Part of the project for PSR is health education starting with environmental issues (global warming, environmental toxins, etc) and applying them to common complaints seen in a clinical setting. Reaching out to physicians with a better kinesthetic feeling of global impacts on their patient’s health has been very successful in getting clinicians to become involved with PSR work.
Martha discussed that various policies have been put into effect through active work of physicians which range from: BPA-free baby bottles and water bottles in Eastern neighborhoods of Los Angeles, replacing mercury equipment in local community clinics, reducing dry cleaning agents from perchloroethylene to more organic, sustainable, and less harmful substances, and community education on BPA, mercury, pthalates, PBDEs, environmental effects on reproduction, to name a few. Future projects aim to look at flame-retardants with a concentration on environmental impacts, as well as current health and future reproductive implications, with the compounds found in these products.
I found this webinar to be particularly interesting, based on my personal interest in public health, and ways that physicians could impact policy making. The webinar presented the obvious benefits to having physicians on board and creating important connections with doctors of various races, political beliefs, and communities to enhance policy change. Yet Martha neither entered the discussion of a physician’s limitations, nor potential tensions that exist between physicians and policy makers, which make policy reform a much more difficult task.
In the past, there have been comments from policy makers towards physicians, regarding a doctor’s salaries being attributed to the problems of the current health care system and the increasing rise in costs of healthcare (Pho). The reality of the matter at hand is that other countries have free medical schooling and healthcare, where the United States can have upwards of $500,000 of school debt from undergraduate and professional graduate study costs (Pho, McClanahan).
In the 2009 Gallup Poll, it was stated that Doctors and Health Care Professionals are believed to be, by the public, the most important leaders to implement health care reform in the United States (Pho). In our age of health care reform, patients and the general public have a general distaste for legislators working on health policy, which emphasizes the importance of physicians to step into a public health role (Fuchs, and Milstein 1985-1987). So what is disconnected for healthcare workers to be on board in policy making?
In an article of the New England Journal of Medicine, “The $640 billion dollar question […]”, discussions of the United States health care system were presented as the most expensive in the world. The problem with healthcare in the United States is that it is not cost effective, and individuals in charge of health care reform are not particularly the physicians, but rather insurance companies, the media, and legislators. The article also discusses the implementation of The Physicians Charter, which is a modernized Hippocratic Oath, ensuring that physicians work towards overall health of their patients as well as the current health care system to provide for all. However, with this charter, the idea of changing insurance companies, the media, and legislators opinions is a monumental task and can only be carried out in numbers. Potential benefits could include reducing healthcare costs and positively impacting future healthcare goals (Fuchs, and Milstein 1985-1987).
Is there a current answer to the dilemma that not enough physicians are involved in policy reform for the future of healthcare in the United States? At the time, policy reform and healthcare is a major work in progress, located on the national level. In the webinar that I listened to, and in Public Health class, discussions were made of lifestyle changes that could impact health and prevent progression of disease, more effectively on a small-scale, local level. The leading chronic diseases in the United States include cardiovascular disease, diabetes, and smoking. Studies on these conditions mentioned have illustrated prevention methods, through lifestyle and dietary modifications, show correlations of decreased incidences of chronic disease progression.
The American Institute of Preventative Medicine (APM) issued an article: “The Health & Economic Implications of Worksite Wellness Programs”, which targets CFO’s, medical professionals, and medical directors to examine increases in insurance costs and studied benefits of wellness programs. These wellness programs are designed to ensure employee work hours, which correlated to a healthier worker and decreased cost in healthcare, and overall employee satisfaction and morale.
I found the APM paper to compliment the webinar that I listened to on impacts of physicians’ role in environmental medicine. The parallels include preventative medicine as a primary approach to decreased health care costs, whether implemented by a physician working in an area, or a company paying for employee health benefits. By taking into account environmental factors that may be negatively influencing health of patients in a particular area, removing appropriate stressors, decreased costs in healthcare can be achieved: rather than treating problems of BPA-induced disease on a patient, healthcare costs can go elsewhere, for example.
The issues of the current healthcare situation is overwhelming at times, although preventative medicine (environmental, naturopathic, osteopathic, nutrition, etc) does seem to have a light at the end of the tunnel. The limitations to preventative medicine include getting physicians on board to implement change and to get legislators attention that preventative interventions could potentially decrease costs in healthcare. Current efforts by the PSR group in LA have already seen positive impacts, through all the hard-working efforts brought forward.
Policy reform is not an immediate gratification, as would be seen in a clinical setting: it is a struggle that can take a long period of time to see change, but once it occurs, it impacts a large number of patient’s lives, locally or nation-wide. The importance of policy reform for the betterment of society is a statement that cannot be emphasized enough. Hopefully more Naturopathic physicians will implement the principles of Docere, in attempts to teach legislators, insurance companies, and the media, about the benefits of preventative medicine, to implement a positive change for our country.
ReferencesFuchs, Victor, and Arnold Milstein. “The $640 Billion Question Why Does Cost-Effective
Care Diffuse So Slowly?.” New England Journal Of Medicine. 364. (2011): 1985-1987.
Web. 20 Feb. 2012. .
McClanahan, Carolyn . “Physician Pay: A Big Driver of Health Care Costs?.” Forbes. 19 01
2012: n. page. Web. 20 Feb. 2012. .
“Medical Professionalism in the New Millennium: A Physician Charter.” Annals of Internal
Medicine, American College of Physicians. (2004): Web. 20 Feb. 2012. .
Pho, Kevin. “The Tension Between Physicians and Health Care Policy Experts.” Accessed
February 19, 2012.
“The Health & Economic Implications of Worksite Wellness Programs.” American Institute of
Preventative Medicine. (2010): Web. 20 Feb. 2012. .