Policy, politics, and health trends around the world
The rapid growth in the healthcare industry has led to changes in policies, laws, and regulations to ensure the delivery of quality healthcare. Today, issues in healthcare policy fall into the broad categories of increasing healthcare coverage and issues related to costs. The primary purpose of these healthcare policies is to ensure people get easy access to healthcare services at lower costs (Leichliter et al., 2016). Although different health problems are addressed in these policies, adolescent health is among the critical areas of concern. Because adolescent health is shaped by the environmental contexts they live in, healthcare policies for the youths should cover the family, home, school, and community contexts. Additionally, these policies should aim at promoting positive behavior because adolescent health is influenced by behavioral components. This discussion proposes a local policy change in addressing adolescent health focusing on sexually transmitted infections (STIs).
Public Policy Issue
Healthcare is a major issue in American politics, with major debates related to healthcare coverage and access. The public policy issue of concern in this discussion is adolescent health in the area of sexually transmitted infections. Adolescents remain highly vulnerable to sexually transmitted infections in the community and there is a lack of enough policy support on this issue. The rate of sexually transmitted infections among adolescents aged 18 to 24 years is high in the US with reports indicating lack of enough education and awareness are the leading causes of this problem. For example, the 2013 compendium of state statutes shows that most policies available focus on mandatory testing, treatment, and provision of partner therapy. There is little known about the availability of policies supporting education and awareness of STIs in the country.
Access to confidential STI services among adolescents is a challenge in today’s healthcare delivery system. Research demonstrates that many youths may prefer to keep their sexual life confidential including delay in seeking healthcare services. While the healthcare industry tries to ensure the safe delivery of adolescent sexual health services, legal issues related to access to STI services limit the service providers. An example is a law that allows minors to consent to access STI services. To ensure an effective approach to STI prevention among the youths, supporting evidence recommends the use of education approaches especially to college and university students. A mandatory STI education program for the adolescents in these institutions can greatly serve to address sexually transmitted infections for adolescents aged 18 to 24 years.
Although adolescence is a time of positive physical, cognitive and social growth, it is also a time that tremendous changes with lifelong consequences occur. These individuals face challenges such as violence, mental health, sexual health, alcohol, and drug-related issues. Healthy sexuality is an important part of adolescent development and the development of policies to guide sexual health is key to improving their health. I selected this issue because there has been an alarming rate of STIs increase in the US of late. A recent report by researchers estimated 67.6 Million prevalent and 26.2 million incident STIs in 2018. About 45% of these cases were observed to be adolescents aged 15 years to 24 years. The common infections affecting adolescents were identified to be chlamydia, trichomoniasis, genital herpes, and human papillomavirus. Despite the increase in these cases, there is a lack of an evidence-based education program to ensure the youths have adequate knowledge on these infections. There is an urgent need to reverse the trend of increasing STIs among the youths and the use of policies stressing educational approaches can greatly influence sexual behavior changes among the youths.
Apart from being serious diseases, STIs fuel the transmission of other diseases like HIV. Addressing the control of STIs among the youths is a measure to ensure that the adolescents stay a healthy quality of life. STIs can have serious complications especially in women of reproductive age. Research demonstrates that untreated STIs can cause infertility, cervical cancer, pelvic inflammatory disease, and fetal complications (Leichliter et al., 2016). For example, congenital syphilis is an important cause of infant mortality and morbidity worldwide and it can also have serious consequences to the health of affected adults. It is crucial to establish policies guiding the provision of education to adolescents on their sexual life. The goal is to provide adolescents with increased self-sufficiency in practicing STIs prevention and risk reduction. Additionally, the policy issue will help in reducing the financial costs related to STI treatment in the country. In 2013, it was estimated that $16.7 billion was spent to manage STIs in the US and the cost has risen even further in recent years (World Health Organization (WHO), 2019). A policy change in this issue will ensure a reduction in healthcare costs and improved quality of life for adolescents.
Sexually transmitted infections Have a huge financial burden on the affected individuals and the community. Healthy people 2020 establishes that over 20 million new cases are reported in the US and this accounts for over 16 billion annual spendings on STI management (Healthypeople.gov, 2020). Additionally, over 24, 000 women in the US become infertile as a result of untreated STIs yearly. The proposed policy change will ensure that adolescents are equipped with knowledge on the prevention of the diseases which will reduce healthcare costs. The policy change will also mean that more funding will be required to run the educational programs in schools. Redesigning the university education program to incorporate STI education will also require capital.
Personal values represent the moral compass that defines what to say, how to behave, and choices to make in life. My support for the new sexual education policy change is based on the values of professional competency and respect for human dignity. As a nurse practitioner, I believe I have the role to advocate for the health of populations through the use of evidence-based practices and supporting policy change initiatives. The new policy will improve the health of populations and save lives, just like I do professionally. Secondly, I believe every human being has the right to receive adequate attention and safe healthcare. There is a cry for help from the adolescents regarding their sexual health and my support for the new policy will ensure their health concerns are addressed.
Ethical Principle or Theory
The ethical principle behind my support for the proposed policy change is the principle of justice. Justice speaks to equity and fairness in treating individuals and when addressing population health concerns. Distributive justice practice ensures that healthcare services are distributed equitably in society. The new policy change will ensure that adolescents across all regions get access to health education that will positively promote their sexual health. The new policy will ensure the delivery of justice to the youths according to their needs and health concerns.
The proposed policy will be addressed to the Director of the Michigan Department of Health and Human Services, Ms. Elizabeth Hertel.
Public health has long recognized the importance of healthcare laws in promoting positive health behavior. The issue of sexually transmitted infections requires the attention of policymakers to formulate policies that could reduce the diseases among adolescents. The first reason why policymakers should consider this proposal is because the existing policies have failed to reduce the rate of STIs in the country. For example, expedited partner therapy (EPT) is a policy that allows the treatment of sexual partners when diagnosed with STIs. This policy provides coverage for many people across all age groups but it does not seem to help the adolescents (Leichliter et al., 2016). Many adolescents choose to keep their sexual life private making it difficult to provide treatment. Other available policies are those guiding the screening of STIs including programs for pregnant women. These policies can provide great improvement in the STI status in the county only if the youths are aware of the importance of STI screening and safe sexual practices.
The second reason for addressing the proposed change to the policymaker is the increasing rate of STIs in the county and the whole nation. In the United States, about 20 million new STI cases are diagnosed yearly and the majority of the affected individuals are between 15 years to 24 years. The reason for addressing this policy issue to Michigan county is because chlamydia infections and other STIs have increased since 2014. Recent data shows that 456.2 individuals out of 100,000 people are diagnosed with STIs yearly, a value that is far above the national average (Michigan Department of Health & Human Services, 2020). Evidence-based practice research indicates that an educational approach can be effective in increasing awareness of STIs among adolescents including HIV. The education programs ensure that the youths understand the importance of safe sex, increases the urgency for screening, and promote the use of condoms and other protective mechanisms against STIs (Mason‐Jones et al., 2016).
Various challenges can be observed to affect the passing of STI prevention policies including financial requirements, political involvement, and lack of enough support from the leaders. The new policy change requires the establishment of an evidence-based education program in universities and colleges to minimize STIs in the community. This new policy will require coordination between the healthcare and the education sector. It also means that schools must redesign the curriculum to incorporate sexual health including the employment of new staff to teach the students. Financial costs related to these changes will be high making it a challenge for the county state and national government. Another observed challenge is the lack of strong healthcare leadership to help in moving bills across the state and county governments. Several other policies are lying dormant because of political interests making it difficult to formulate other healthcare policies. The new policy change will require a lot of support from nursing and other medical fields to ensure a solid foundation is laid.
The first primary option for the policymaker is to accept the policy brief as it is and work to push the proposal until it becomes a law in the state. This option is tangible because an educational approach for STI prevention is well-supported by evidence-based practices. The second option for the policymaker is to accept the new change, but make modifications to suit the political environment while promoting the health of the public. For example, the new policy can be modified to ensure the availability of STI education programs for adolescents only during the first year of their studies. This option is tangible because it will help cut the financial costs associated with redesigning the education curriculum as initially proposed. The third available option for the policymaker is to reject the new proposal and work to streamline the available STI policies to suit the interest of the adolescents. This option will depend on the policy maker’s argument and the strength of the evidence supporting the new change. I believe the policymaker will find it interesting to support the policy brief because it provides an alternative to the available ineffective STI prevention policies in the state.
Course of Action
Many policies in the United States that affect healthcare are made at the state level. Shaping a new policy requires an understanding of the American political process including the aspects of pluralism, incrementalism, federalism, and civil rights. To ensure the success of this policy, the decision-maker must engage the state politicians and other influential people in the political field. There is a need to identify organizations that have the same interest to help in pushing the new policy during the law-making processes. The decision-maker should entirely involve the state health department, who will discuss the policy issue with the governor to ensure adequate support of the bill at the senate. Additionally, there is a need to involve the state education department because the policy change will directly affect the education sector. The decision-maker can contact the Public Instruction Superintendent, Michigan Education Department to discuss the relevance of the new change to university students and the community. Enough support from these powerful and influential stakeholders will ensure the success of the new policy.
The success of Policy Brief
The primary evaluation method of the success of the policy brief is acceptance by the decision-maker and other politicians. Passing the bill at the committee stage of the law-making process will indicate that eventually, it will become state law. The partnership between the decision-maker, the state department of health, and the education department will indicate fighting towards a common goal. The success of the policy will depend on effective collaboration between these teams. Long-term success strategies include reduced rates of STIs among adolescents in the state and sustainability of the STI education program in colleges and universities.
Identified Organization or Community
Children’s Hospital of Philadelphia is a healthcare organization that has demonstrated interest in campaigning for increased awareness of STIs among the youth. Through the ‘IknowUShould2’ campaign, the organization has served to handle STI prevention in Philadelphia for youths aged 13 to 24 years.
Summary of Expressed Interest
The rates of STIs such as syphilis, chlamydia, gonorrhea, and HIV are rising among the youths in the nation. Current recommendations and policies focus on routine screening of the diseases which does not provide a solution to the STI problem in the US. Started in 2012, IknowUShould2 is a media campaign that aims at improving adolescent knowledge on STIs (Children’s Hospital of Philadelphia, 2019). The campaign is spearheaded by the Adolescent Initiative at Children’s Hospital of Philadelphia (CHOP) and uses media to reach the youths. The campaign has expanded to include education on matters related to HIV. This organization can help in supporting the proposed policy of incorporating education approaches in schools for STIs.
To address the policy change, the following CBPR principles will be used
- CBPR promotes collaborative and equitable partnerships in all research phases and involves an empowering and power-sharing process.
- CBPR balances research and action for the mutual benefit of all partners.
- CBPR promotes a long-term process and commitment to sustainability.
Approach and Collaboration
To work with CHOP, I will approach the team through their email and request an appointment with their team leader. During the meeting, I will discuss how the new policy change will serve the interests of the adolescents and how their support will be of importance. Collaborative efforts during the policy change process will include holding meetings with the decision-maker, updating them on the progress through emails, and maintaining open communication through phone calls.
The goal of the policy brief is to prevent STIs among adolescents through the use of an educational approach in colleges and universities. This goal aligns with the selected organization’s goal of improving adolescent knowledge and testing behaviors for Sexually Transmitted Infections (STIs) such as gonorrhea, chlamydia, syphilis, and HIV (CHOP, 2019).
The first step will involve a literature review for evidence-based strategies to reduce STIs among adolescents. Upon literature review, I will identify and contact the decision-maker for the new policy change. I will also contact various organizations that have demonstrated interests in the policy issue like CHOP to see for their support. During the policy-making process, I will maintain open communication with the key stakeholders and hold meetings when necessary with the policymakers. Through the decision maker’s support and guidance, I believe the proposed policy will pass to be a law governing STI education in the state.
The Children’s Hospital Philadelphia is the organization I will work with during the policy change process. The role of the organization will be to provide support on the selected policy issue through their expertise in matters of policy and advocacy. The organization’s members together with the decision-maker will be involved in following state debates o the policy issue. On the capacity-building role, CHOP will participate in promoting the engagement of other influential parties and in providing education to the senate on the importance of STIs prevention.
Key Elements of Evaluation Plan
The first CBPR principle focuses on collaborative and equitable partnership in all research phases. The evaluation plan using this principle will involve the demonstration of multidisciplinary approaches to the policy change, effective partnership, and establishment of good communication with team embers. The second CBPR principle focuses on the balance of research and the action of mutual benefit of all partners. Evaluation of this principle will involve an effective presentation of evidence to STI prevention and passing of the proposed change at the committee stage. The third CBPR principle talks about the maintenance of long-term processes and commitment to sustainability. Evaluation of this approach will involve assessing communication channels during the law-making process and the reduction of STI cases among adolescents after education.
The success of the organization’s plan will be evaluated using partnerships during policymaking and the observed results after the policy change. The first strategy will involve successful support of the proposal and availability of members to guide the law-making process. The second strategy will involve the active participation of the members in meetings and the maintenance of clear communication channels by the organization. Lastly, passing the proposed change as a law will demonstrate the success of the organization.
Strengths of Each Approach
The top-down approach in this policy change has been used to identify the policymaker and the course of action for the new change. This approach is effective because it demonstrates control of the policy change process by directly involving the decision-maker. Additionally, the approach makes it easy to evaluate the success of the policy either through acceptance or rejection of the proposal. The bottom-up approach in the policy change is used to identify the organization supporting the project and the action steps to be followed. This approach is advantageous because it provides a clear channel of policymaking and stipulates the roles of each member in the policy-making process.
Challenges of Each Approach
The top-down approach is disadvantageous because decisions are only made from a central point. The acceptance or denial of the proposal will mean the end of every effort. The approach does not factor in the input of other team players. On the other hand, the bottom-up approach is disadvantageous because it wastes time due to the involvement of multiple team players. It s also difficult to evaluate the success of the project because of the multiple steps involved in policy formulation.
Most Effective Approach
To address the issue of STI prevention, I would recommend the use of the top-down approach. This approach will ensure the proposal will reach the decision-maker in time and that supporting evidence will be used to guide decision making. Due to the complex nature of policymaking in the US, the top-down approach will be appropriate in addressing the selected public policy issue.
Children’s Hospital of Philadelphia. (2019) Policylab. Iknowushould2: A campaign to raise awareness about sexually transmitted infections among youth in Philadelphia. https://policylab.chop.edu/project/iknowushould2-campaign-raise-awareness-about-sexually-transmitted-infections-among-youth
Healthypeople.gov. (2020). Sexually transmitted diseases. https://www.healthypeople.gov/2020/topics-objectives/topic/sexually-transmitted-diseases
Leichliter, J. S., Seiler, N., & Wohlfeiler, D. (2016). Sexually transmitted disease prevention policies in the united states: Evidence and opportunities. Sexually Transmitted Diseases, 43(2 Suppl 1), S113–S121. https://doi.org/10.1097/OLQ.0000000000000289
Mason‐Jones, A. J., Sinclair, D., Mathews, C., Kagee, A., Hillman, A., & Lombard, C. (2016). School‐based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents. Cochrane Database of Systematic Reviews, (11). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461872/
Michigan Department of Health & Human Services. (2020). STD trends in Michigan, 2019. Retrieved from https://www.michigan.gov/documents/mdhhs/2010-2019_STD_trends_in_Michigan_tables_summary_697339_7.pdf
World Health Organization. (2019). Sexual and reproductive health: Sexually transmitted infections. https://www.who.int/reproductivehealth/publications/stis-evidence-brief/en/
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