Future trends in health and health care: implications for social work practice in an aging society.

Major economic, political, demographic, social, and operational system factors are prompting evolutionary changes in health care delivery. Of particular significance, the "graying of America" promises new challenges and opportunities for health care social work. At the same time, the Patient Protection and Affordable Care Act of 2010, evolution of Accountable Care Organizations, and an emphasis on integrated, transdisciplinary, person-centered care represent fundamental shifts in service delivery with implications for social work practice and education. This article identifies the aging shift in American demography, its impact on health policy legislation, factors influencing fundamentally new service delivery paradigms, and opportunities of the profession to address the health disparities and care needs of an aging population. It underscores the importance of social work inclusion in integrated health care delivery and offers recommendations for practice education.

Do Indigenous Australians age prematurely? The implications of life expectancy and health conditions of older Indigenous people for health and aged care policy.

OBJECTIVE: To assess whether Indigenous Australians age prematurely compared with other Australians, as implied by Australian Government aged care policy, which uses age 50 years and over for population-based planning for Indigenous people compared with 70 years for non-indigenous people. METHODS: Cross-sectional analysis of aged care assessment, hospital and health survey data comparing Indigenous and non-indigenous age-specific prevalence of health conditions. Analysis of life tables for Indigenous and non-indigenous populations comparing life expectancy at different ages. RESULTS: At age 63 for women and age 65 for men, Indigenous people had the same life expectancy as non-indigenous people at age 70. There is no consistent pattern of a 20-year lead in age-specific prevalence of age-associated conditions for Indigenous compared with other Australians. There is high prevalence from middle-age onwards of some conditions, particularly diabetes (type unspecified), but there is little or no lead for others. CONCLUSION: The idea that Indigenous people age prematurely is not well supported by this study of a series of discrete conditions. The current focus and type of services provided by the aged care sector may not be the best way to respond to the excessive burden of chronic disease and disability of middle-aged Indigenous people.

The quest for equity in Latin America: a comparative analysis of the health care reforms in Brazil and Colombia.

INTRODUCTION: Brazil and Colombia have pursued extensive reforms of their health care systems in the last couple of decades. The purported goals of such reforms were to improve access, increase efficiency and reduce health inequities. Notwithstanding their common goals, each country sought a very different pathway to achieve them. While Brazil attempted to reestablish a greater level of State control through a public national health system, Colombia embraced market competition under an employer-based social insurance scheme. This work thus aims to shed some light onto why they pursued divergent strategies and what that has meant in terms of health outcomes. METHODS: A critical review of the literature concerning equity frameworks, as well as the health care reforms in Brazil and Colombia was conducted. Then, the shortfall inequality values of crude mortality rate, infant mortality rate, under-five mortality rate, and life expectancy for the period 1960-2005 were calculated for both countries. Subsequently, bivariate and multivariate linear regression analyses were performed and controlled for possibly confounding factors. RESULTS: When controlling for the underlying historical time trend, both countries appear to have experienced a deceleration of the pace of improvements in the years following the reforms, for all the variables analyzed. In the case of Colombia, some of the previous gains in under-five mortality rate and crude mortality rate were, in fact, reversed. CONCLUSIONS: Neither reform seems to have had a decisive positive impact on the health outcomes analyzed for the defined time period of this research. This, in turn, may be a consequence of both internal characteristics of the respective reforms and external factors beyond the direct control of health reformers. Among the internal characteristics: underfunding, unbridled decentralization and inequitable access to care seem to have been the main constraints. Conversely, international economic adversities, high levels of rural and urban violence, along with entrenched income inequalities seem to have accounted for the highest burden among external factors.

Alternative medicine utilization by African Americans and improving life expectancy: is there a correlation?

The life expectancy of African Americans and Caucasians has been increasing in the United States and in many other countries around the world since the late 1800s. However, as long as statistics have been accrued on race and ethnicity, the life expectancy of African Americans and Blacks in general has been significantly lower than that of Caucasians. Basic public health and medical preventive education is needed because higher cardiovascular disease (CVD) rates is one of the primary reasons for the differences between life expectancy between African Americans and Caucasians. It is also of an apparent separate but perhaps related interest that several recent preliminary studies suggest that African Americans, more than any other race, may have some of the lowest uses of alternative medicine due to skepticism, as well as educational efforts and trust in their health care professional. Despite a common belief that African Americans harbor profound distrust of specific areas of the medical profession, it is of interest that this finding has not held validity in the area of alternative medicine. Therefore, since lifestyle changes are considered alternatives in most of these studies, this would suggest that a greater educational emphasis on behavioral modification could establish a foundation or a model of preventive medical education that can be utilized for underserved populations around the world.

Living the health transition among the Chamorros of Guam.

Health transition in the Pacific islands reflects the richness of diversity created by varied socio-cultural, ecological, and politico-economic systems and, therefore, requires the inclusion of the local cultural context in health assessment, planning, and program development. This paper focuses on the health transition of the Chamorros of Guam, blending assessment of health trends with the cultural contexts associated with them. The review of health trends reveals that the Chamorros are experiencing a mixed transition, including a combination of infectious and chronic diseases, in addition to the increasing impact of health risk behaviors, which have led to increasing rates of injury-related mortality. The cultural review presents Chamorro perceptions and values in their extended, multigenerational family system, in traditions of caring and sharing within their communities, and in the continued use of their traditional healers. By paying attention to the Chamorro's cultural perspectives and concerns, a "window" is provided to understand the interaction of changing population trends with their actual lives as well as an opportunity to integrate culture and health in our understanding of the health transition.