National Health Policy versus State Policy Implementation Case Study

National Health Policy versus State Policy Implementation

National health policy sets the tone for the nation on how to implement, strategize, and achieve specific health goals. However, states often times have the option to not fully implement certain health policies based on their state needs. Thus, health policy varies in every state and can lead to varying health outcomes. This week, you will learn the national- and state-level impact of a healthcare policy.

Read the following case study from your textbook:

Don't use plagiarized sources. Get Your Custom Essay on
National Health Policy versus State Policy Implementation Case Study
Just from $13/Page
Order Essay
  • Case 15: The Diethylstilbestrol Story: An Investigation into the Evolving Public Health Policy for Pharmaceutical Products (ATTACHED)
  • Then, visit the Kaiser Family Foundation Web site at

    Kaiser Family Foundation -Health Policy Research, Analysis, Polling, Facts, Data and Journalism

    and research health policy at the national and state levels. Narrow down your focus to the geographic region or location you identified in W1: Assignment 3 (ATTACHED). This would be the same area which you plan to work on for your Course Project.

    Then, respond to the following:

  • Using your chosen geographic region or location, select a particular health policy and then discuss its national- and state-level impact on the population.
  • Consider and discuss how the policy was implemented and if it was effective at achieving the intended outcome.
  • Discuss the themes and barriers that arose as a result of implementation to the policy.
  • Provide support/recommendations for how the policy could be improved upon.
  • CASE 15 The Diethylstilbestrol Story An Investigation into the Evolving Public Health Policy for
    Pharmaceutical Products MARGARET ANN MILLER, EMILY BLECKER, AND MEGHAL PATELi
    Regulatory agencies such as the United States Food and Drug Administration (FDA) play an
    important role in promoting and protecting public health by preventing or limiting exposure to
    unsafe products. Unfortunately, laws and regulations that protect public health are rarely proactive.
    Most current laws, regulations, and policies governing the manufacture and sale of pharmaceutical
    drug products (drugs) were enacted following a public health disaster. Understanding how public
    health disasters have impacted the development of health laws and regulations is critical for
    understanding current public health policy in the United States and for developing a proactive,
    rather than reactive public health framework. This case study describes the tragic story of the
    prescription drug, diethylstilbestrol (DES). It involves numerous players in the public health arena
    including research scientists, regulators, pharmaceutical companies, physicians, lawyers,
    advocates, and of course, patients. INTRODUCTION In 1971, several physicians noted an alarming
    increase in the development of clear cell adenocarcinoma in teenage girls and young women. This
    rare and potentially deadly form of vaginal and cervical cancer had previously occurred mainly in
    women over 50 years of age. The only treatment was major invasive surgery to remove the uterus
    (hysterectomy) or vagina (vaginectomy). This surgery was not only emotionally and physically
    painful but sometimes not a cure. A few physicians began to search for the cause of this rare form
    of cancer, and one physician, Arthur Herbst, described a common link: all of the women developing
    clear cell adenocarcinoma were exposed to DES in utero.1 The implications of this finding were
    terrifying for the American public—millions of children might develop cancer or some other
    reproductive problem after an unknown length of time because their mothers took this prescription
    medication during pregnancy. Today there is still no test for detecting DES exposure and it is
    impossible to know how many people were, or will be, affected by the medication. DES remains one
    of the most significant public health disasters of the 20th century. THE BEGINNING Starting in the
    mid-1920s, scientists understood the action of natural estrogens and their potential utility for
    treating numerous conditions from cancer to wrinkles. The natural estrogens identified at that time
    were not water soluble and showed no activity when given orally. Several research scientists (many
    of whom were supported by pharmaceutical companies) began their search for an orally active
    form of estrogen. In 1938, British physician and chemist Charles Dodds and his team of scientists
    published a paper describing the synthesis of DES, a compound that showed estrogenic activity
    when consumed orally in tablet or pill form. The synthesis of DES was relatively simple and
    inexpensive, and by publishing the formula, Dodds relinquished his patent rights. Although Dodds
    promoted the use of DES for the treatment of menopausal symptoms and encouraged the
    marketing of DES by pharmaceutical companies, he also voiced concerns about the potentially
    harmful effects of the medication.2 THE APPROVAL PROCESS Prior to 1938, there was no federal
    law to prevent the marketing of pharmaceutical drugs—whether safe or hazardous, effective or
    useless.ii Any drug product could be marketed provided it was synthesized according to the
    standard compendia and properly labeled. At the time, drug companies were small manufacturers
    producing patent medicinesiii that were sold over the counter at pharmacies, while most physicians
    prescribed pills and potions formulated from their own recipes. Beginning in the early 1930s,
    Congress considered strengthening the 1906 Pure Food and Drug Act, but support for legislation
    was inadequate until 1937, when a drug company introduced an untested formulation of
    sulfanilamide with a solvent that caused the death of over 100 people, many of them children.3
    Starting in 1938, drug companies had to submit evidence of a drug’s safety for its intended use to
    the FDA before it could go on the market. The FDA had 2 months to approve, reject, or request
    additional data from the firm, and failure to act on the application would lead to automatic approval
    of the drug. This mandate for premarket evidence of a drug’s safety represented the birth of the
    new drug application (NDA).iv,3 Despite the lack of product exclusivity that would have been
    provided by a patent, several drug companies, including Eli Lilly & Company, took an interest in
    producing and marketing DES. In 1940, 13 drug companies filed NDAs for DES. In anticipation of
    this event, a number of scientists published studies showing that estrogens induced cancer in
    animals, and wrote editorials urging a thorough review of DES by the FDA. FDA informed the drug
    companies that it did not believe the current data supported a determination of safety for DES and
    that it would turn down the applications. The companies withdrew their applications but committed
    to work together to develop the clinical safety information needed for DES to obtain FDA approval.
    The following year, the drug companies again filed NDAs for DES. This regulatory submission
    focused on the safety of DES in human clinical studies—evidence that discounted the disturbing
    findings from several animal studies. In 1941, DES was officially approved by the FDA for four
    indications: treatment of gonorrheal vaginitis, menopausal symptoms, senile vaginitis, and
    prevention of lactation in women who had given birth. The product label listed a number of side
    effects for estrogen treatment v as well as precautions and contraindications of use:
    “Diethylstilbestrol is contraindicated in patients with personal or familial history of breast or genital
    cancer (except in the treatment of cancer). Prolonged, continuous administration can lead to
    endometrial hyperplasia and to ‘breakthrough’ bleeding…”4(para 3),vi In 1943, two Harvard Medical
    School physicians, George and Olive Smith, began evaluating the use of DES to prevent and treat
    complications of pregnancy. Animal research suggested DES could stimulate the production of
    progesterone, and the Smiths hypothesized that increasing progesterone production would prevent
    many complications of pregnancy. In their study of approximately 600 pregnancies, DES was
    effective in preventing miscarriage, late pregnancy toxemia, intrauterine death, and premature
    delivery.5 The Smiths advocated for the prophylactic use of DES in all pregnant women to prevent
    complications of pregnancy (also termed accident of pregnancy) associated with progesterone
    deficiency. In 1947, DES was approved by the FDA for use in preventing accidents of pregnancy.6
    THE MAGIC BULLET The FDA does not regulate the practice of medicine. Once DES was approved,
    physicians were legally allowed to use it for any purpose. The scientific and medical communities
    viewed orally active estrogen as a magic bullet that could be used to treat many medical conditions
    and improve the quality of life. In addition to the FDA-approved indications, DES was used by
    physicians for the treatment of acne, osteoporosis, heavy menstrual bleeding, female infertility, and
    prostate cancer, as an oral contraceptive, and as a morning-after pill. DES was given to teenage
    girls who were too tall in an attempt to stunt their growth and to male transsexuals to help prepare
    them for a sex change. DES was eventually used to treat over 100 conditions and was prescribed
    across the United States and throughout the world. DES was even given to livestock to promote
    rapid weight gain.2 Following World War II, Americans experienced a period of great social
    optimism. New suburban complexes were being developed, science and technology seemed to
    have no limits, and physicians were viewed as kings. As soldiers returned home from war, they
    were eager to get married and start families. The era known as the baby boom began.vii Despite a
    surge in pregnancies during this era, many women desperate to have children were struggling with
    miscarriages. These women were eager for suggestions from their physicians about any
    medications that would help them prevent miscarriages. FDA’s approval of DES for accidents of
    pregnancy in 1947 led to a surge in DES use among pregnant women. Herbst et al. estimated that
    between 1946 and 1951, DES was prescribed for about 1 out of every 20 high-risk, pregnant
    patients at Boston’s Lying-In Hospital.7 Physicians were encouraged by the drug company sales
    representatives to use DES not only in high-risk pregnancies but also as a “vitamin” for all pregnant
    women. Drug company sales representatives offered incentives for physicians and pharmacists to
    prescribe their company’s product—including free samples, medical booklets, and an assortment of
    gifts for their personal and professional use. Pharmacists were offered incentive plans for buying
    DES products, including discounts on larger purchases. At that time, Eli Lilly & Company was one of
    the largest pharmaceutical companies in the world; it is estimated that Lilly produced 50 to 75% of
    all the DES products sold in the United States.2 However, because several drug companies
    manufactured DES and because it was widely used, it is difficult to determine exactly how many
    people, including pregnant women and their offspring, were exposed to DES during this time.viii
    FROM MAGIC BULLET TO TIME BOMB Although doctors widely prescribed DES for pregnant
    women, some early clinical studies failed to show an increase in progesterone levels in pregnant
    women treated with DES. In the early 1950s, Dieckmann et al. noted that the Smiths’ studies lacked
    an adequate control group and the benefits reported for DES could simply be due to improved
    medical care given to the study participants. Dieckmann’s research group conducted a randomized,
    double-blind clinical trial (a study design that is still considered the gold standard by the FDA) to
    assess pregnancy outcomes in women who were assigned to receive either DES or a placebo. The
    study definitively showed that DES did not work to prevent miscarriages or any of the other
    indications proposed by the Smiths. In fact, although not statistically significant, there was a clear
    trend for the women taking DES to have more miscarriages, more premature deliveries, and lower
    birth weight babies than women who took the placebo.8 The Smiths provided comment on the
    study stating their belief that the negative findings were due to the heterogeneous sample of
    pregnant women, which masked the effect of DES.9 Despite the lack of efficacy in the double-blind,
    placebo-controlled clinical study and the increasing evidence that DES caused reproductive tumors
    in animal models, DES continued to be widely prescribed to pregnant women throughout the 1950s
    and 1960s. Beginning in the 1950s, some public health professionals suggested that drug product
    safety needed to be considered in light of product effectiveness. A congressional investigation and
    subsequent hearing launched by Senator Estes Kefauver in the late 1950s raised questions about
    drugs, including drug effectiveness. However, once again, Congress was not able to garner support
    for a stronger drug law until another tragedy occurred. This time it was thalidomide.3 Thalidomide
    was developed by a German pharmaceutical company, and was approved and widely used in
    Europe between 1957 and 1961 to treat morning sickness in pregnant women. In the late 1950s
    and early 1960s, more than 10,000 children in 46 countries were born with limb deformities. In
    1961, a German pediatrician demonstrated a link between these birth defects and the use of
    thalidomide during the first trimester of pregnancy. Later that same year, thalidomide was removed
    from the market in Europe.10 In the United States, the impact of thalidomide was minimized
    because the FDA insisted that additional studies were needed to demonstrate safety as mandated
    in the 1938 legislation and refused to approve the drug application. Although thalidomide was
    never approved for sale in the United States, millions of tablets were distributed to physicians as
    part of the investigational clinical testing program.3 In 1962, following on the heels of the
    thalidomide tragedy, the United States Congress amended the drug law to require, among many
    other items, that: (1) manufacturers establish the effectiveness of drugs through adequate and
    well-controlled clinical trials prior to marketing; (2) the FDA exert greater control over
    investigational studies; and (3) manufacturers test for safety during pregnancy before a drug
    received approval for sale in the United States.3 For products such as DES that were approved prior
    to these amendments, the FDA engaged the National Academy of Sciences/National Research
    Council to convene panels of experts to review the published literature to determine if the results
    supported product efficacy for a particular indication. The results of the panel reviews were
    submitted to the FDA, which evaluated the findings and published its approval decisions in the
    Federal Register. If FDA determined that a drug was ineffective for a particular indication, the
    agency had to follow the legal administrative hearing process to withdraw the NDA.11 Following
    the passage of the 1962 amendments to the drug law, drug companies needed to provide the
    National Academy of Sciences/National Research Council review panel with published clinical
    studies to support the clinical efficacy of DES for each of its approved indications. The National
    Academy of Sciences/National Research Council panel concluded DES was effective in the
    treatment of menopause, senile vaginitis, postpartum breast engorgement, functional uterine
    bleeding, and controlling carcinoma of the breast and prostate. With regards to the accidents of
    pregnancy claim, the panel stated that accidents of pregnancy is a very vague term and probably
    includes a whole group of indications, and that the company should be asked to clarify exactly
    what indications it covered. The panel also stated that it “feels that this drug is not harmful in such
    conditions as threatened abortion, but that its effectiveness cannot be documented by literature or
    its own experience.”12(p 2) In 1970, Herbst and Scully published a paper describing
    adenocarcinoma of the vagina in seven adolescent females. This finding was especially concerning
    because these cancers were usually seen in women over 50 years of age.1 Interestingly, two of the
    mothers suspected their DES use during pregnancy had caused the cancer in their daughters.7 In
    early 1971, Herbst et al. published a study in The New England Journal of Medicine titled,
    “Adenocarcinoma of the Vagina: Association of Maternal Stilbestrol Therapy with Tumor
    Appearance in Young Women.” This study described the association between clear cell
    adenocarcinoma of the vagina seen in seven women ages 15 to 22 and in utero exposure to DES.13
    Herbst next obtained the patient records from the Smiths to allow for the study of other mothers
    exposed to DES. In these studies, Herbst determined that the development of vaginal adenosis was
    dose dependent and related to the gestational age of exposure, with exposure prior to 18 weeks
    causing cancer. In addition, Herbst established a patient registry to study the clinical,
    epidemiologic, and pathologic aspects of clear cell adenocarcinoma in young women with and
    without DES exposure. From the registry data, it was determined that adenocarcinomas occurred
    with a cumulative incidence of approximately 1 in 1000 exposures to DES. DES became the first
    example of a chemical known to cause cancer in offspring following in utero exposure.
    Noncancerous alterations of the reproductive tract were an even more common finding, affecting
    75% of the female offspring exposed to DES, which contributed to the overall concern regarding the
    use of any medication during pregnancy.7 The young women facing the health problems as a result
    of DES exposure in utero became known as “DES daughters.” Shortly after the publication of the
    first paper by Herbst in 1971, the FDA sent a bulletin to all U.S. physicians advising them against
    the use of DES in pregnant women. In November, 1971, the FDA published a Federal Register notice
    stating that based on the findings of the National Academy of Sciences/National Research Council
    Drug Efficacy study, it would approve DES for the treatment of osteoporosis, disturbances of the
    menstrual cycle, suppression of lactation, and to lessen blood loss at surgery. However, based on
    concerns about the association between DES use in pregnant women and adenocarcinomas in the
    offspring, the FDA concluded that for pregnant women, the risk of treatment did not outweigh the
    benefits and thus DES was contraindicated for use during pregnancy.14 Following a contentious
    comment period, the FDA withdrew the approval of DES for use in pregnant women in 1975.15 It
    has been estimated that between 5 and 10 million pregnant women and their offspring were
    exposed to DES worldwide from 1938 to 1971. It has now been proven that the DES daughters face
    a statistically small, but nevertheless significant, risk of developing clear cell adenocarcinoma.
    Additionally, they face an even greater risk of having a premature birth or other difficulties
    becoming pregnant due to DES exposure.7 While most of the initial attention given to DES was
    placed on the affected daughters, in the 1980s, attention was broadened to include the problems
    faced by DES sons. Assessing the biological impact of DES exposure on males was more difficult
    than it was for females. Many men rarely go to the urologist, and often they do not admit to having
    genital or reproductive problems. However, many DES-exposed sons experienced reproductive
    problems such as pain during sexual intercourse, a low sperm count, and a smaller than average
    penis. THE EMOTIONAL AND SOCIAL IMPACT Epidemiologic incidence numbers do not begin to
    capture the emotional and social impact of DES exposure. Many DES mothers felt guilty about
    taking a medicine while pregnant, resulting in harm to their children, while others objected to
    having their daughters examined. Cancer and surgical removal of the vagina and uterus had a very
    traumatic effect on the teenagers and young women who developed clear cell adenocarcinoma.
    After these surgeries, numerous young women felt angry about what had happened to them and
    struggled with their body image. Many young women and young men who faced problems due to
    DES exposure developed a fear of sexual relations and social rejection. Some couples were willing
    to discuss their experiences and difficulties in trying to get pregnant but still did not discuss the
    tension that occurred between them. Women often had trouble seeking support from their
    husbands whom they felt could not understand or respond to the emotional distress they were
    feeling. Infertility and other medical problems related to DES put a strain on many marriages and
    sometimes led to divorce.2 DES ADVOCACY Many DES advocacy groups were formed to seek
    compensation from the drug companies responsible for manufacturing DES and to help the victims
    of DES exposure handle the physical and emotional consequences of their health problems. In
    1977, Fran Fishbane became the first president of DES Action, National. The goal of DES Action,
    National was to identify all DES-exposed individuals, to provide referral and follow-up care, to
    develop networks of information, and to offer a newsletter on legal and other information pertaining
    to DES. Fran Fishbane later became the head of the Ralph Nader–funded Public Citizen’s Health
    Research Group. The advocacy community pressured the drug companies and public health
    community to assume responsibility for the problems associated with DES exposure. This led to
    the development of a patient registry of women exposed to DES. Patient registries are
    observational studies designed to determine the safety of a drug in the real world by tracking the
    health of patients who have taken the medication. Patient registries, also referred to as phase IV
    studies, remain the best way to identify safety signals for marketed drug products and are now a
    common requirement for the approval of drugs used by pregnant women. LEGAL ACTION In civil
    law, an individual or an organization (plaintiff) sues another individual or group (defendant),
    claiming the defendant committed some wrong. Sometimes the plaintiff will join with other
    individuals or organizations that are making the same accusation. A specific branch of civil law is
    the product-liability field. When people claim to be injured by a product, they may sue the
    manufacturer of that product for damages. Thus, numerous lawsuits were filed against
    manufacturers of DES. However, one major problem in many of the lawsuits surrounding DES was
    that DES was never patented, and many different manufacturers produced the drug. Furthermore,
    many women did not know which company synthesized the pill that they or their mother took. In
    one famous DES case, a lawyer named Jason Brent filed a lawsuit in 1976 on behalf of Judith
    Sindell against Abbott Laboratories, E.R. Squibb, and Eli Lilly & Company. The defendants were all
    leading drug companies and known manufacturers of DES. Since it was not known which company
    made the DES Sindell’s mother had taken, the court decided that each defendant would be held
    responsible for a percentage of the total compensation based upon their portion of the total DES
    market. This decision, upheld by the California Supreme Court in 1980, changed the course of legal
    history because the plaintiffs were now able to sue the manufacturers even if they didn’t know
    which company manufactured the exact drug product they were given.2 CONCLUSION DES
    products are no longer on the market in the United States and regulatory standards for FDA
    approval of medicine are now much more stringent than those used when DES was approved.
    However, the fact that so many scientists, physicians, and regulators failed to recognize the
    problem with DES until it was too late begs the question: could a public health disaster similar to
    DES happen again? Understanding laws and regulations and process of drug approval and
    postmarketing surveillance will help public health professionals engage proactively in ensuring the
    safety of pharmaceutical products. About the Authors Margaret Ann Miller, PhD, received her PhD
    in endocrinology-reproductive physiology from the University of Wisconsin-Madison in 1981 and
    was a postdoctoral fellow at the University of Illinois, Champaign-Urbana. In 1985, Dr. Miller
    accepted a posit ion at Monsanto Agricultural Company working on the approval of recombinant
    products. In 1989, Dr. Miller joined the United States Food and Drug Administration (FDA) in the
    Center for Veterinary Medicine. She held several positions within the Center for Veterinary Medicine,
    including deputy director for human food safety. In 1999, Dr. Miller joined the FDA’s Office of
    Women’s Health as the manager of science programs. In this position, she initiated several
    successful research initiatives that promoted the health of women. In 2005, she accepted a 2-year
    detail to the World Health Organization, where she worked on food safety. Dr. Miller is currently the
    associate director of regulatory activities in the Washington office of the National Center for
    Toxicological Research and a professorial lecturer at The George Washington School of Public
    Health and Health Services. Emily Blecker is majoring in sociology with a concentration in health
    and medicine at the University of Pennsylvania. She is interested in having a career in public health
    after she graduates. In 2010, Ms. Blecker received a summer internship from Oak Ridge Research
    Institute and worked at the National Center for Toxicological Research at the Food and Drug
    Administration. Meghal Patel, MPH, is a graduate of Indiana University, where she received a
    bachelor of science degree in biology and a bachelor of arts degree in psychology. In 2010, she
    received her master of public health from The George Washington University School of Public
    Health and Health Services, concentrating in global health. She participated in writing this case
    while working at the National Center for Toxicological Research at the Food and Drug
    Administration under Dr. Margaret Ann Miller. ADDITIONAL RESOURCES Centers for Disease
    Control and Prevention. DES update home. http://www.cdc.gov/des/ National Cancer Institute. DES
    questions and answers. http://www.cancer.gov/cancertopics/factsheet/Risk/DES REFERENCES
    1. Herbst AL, Scully RE. Adenocarcinoma of the vagina in adolescence: a report of 7 cases including
    6 clear-cell carcinomas (so-called mesonephromas). Cancer. 1970;25(4):745–757. 2. Meyers R.
    D.E.S.: The Bitter Pill. New York, NY: Seaview/Putnam; 1983. 3. United States of America. The Food
    and Drug Administration. About FDA: summary of NDA approvals & receipts, 1938 to the
    present.http://www.fda.gov/AboutFDA/WhatWeDo/History/ProductRegulation/SummaryofNDAApprovalsReceipts1938tothepresent/ucm2006085.htm. Updated February 16, 2011. Accessed
    July 9, 2010. 4. United States of America. The Food and Drug Administration. New Drug Application:
    Diethylstilbestrol Tablets, U.S.P. September 16, 1947. 5. Smith OW. Diethylstilbestrol in the
    prevention and treatment of complications of pregnancy. Am J Obstet Gynecol. 1948;56(5):821–
    833. 6. D.E.S. timeline.http://www.douglasandlondon.com/docs/DES-Timeline.pdf. Accessed July
    15, 2010. 7. Herbst AL. Diethylstilbestrol and adenocarcinoma of the vagina. Am J Obstet Gynecol.
    1999;181(4):1576–1578. 8. Dieckmann WJ, Davis ME, Rynkiewicz LM, Pottinger RE. Does the
    administration of diethylstilbestrol during pregnancy have therapeutic value? Am J Obstet Gynecol.
    1953;66(5):1062–1081. 9. Smith, GvS. as quoted Dieckmann WJ, Davis ME, Rynkiewicz LM,
    Pottinger RE. Does the administration of diethylstilbestrol during pregnancy have therapeutic
    value? Am J Obstet Gynecol. 1953;66(5):1075–1076. 10. Miller MT, Stomland K. Teratogen update:
    thalidomide; a review, with a focus on ocular findings and new potential uses. Teratology.
    1999;60:306–321. 11. Karst KR. Marketed unapproved drugs—past, present and future. RA Focus.
    February 2007:37–42. 12. National Academy of Science/National Research Council. Drug efficacy
    studies for diethylstilbestrol. Available at www.pharmapendium.com. Published 1969. Accessed
    July 20, 2010. 13. Herbst AL. Adenocarcinoma of the vagina: association of maternal stilbestrol
    therapy with tumor appearance in young women. N Engl J Med. 1971;282(16):878–881. 14. Food
    and Drug Administration. Certain estrogens for oral or parenteral use: drugs for human use; drug
    efficacy study implementation. Fed Regist. 1971;36(217):21537–21538. 15. Food and Drug
    Administration. Certain estrogens for oral use: notice of withdrawal of approval of new drug
    application. Fed Regist. 1975;40(25):5384. i The views expressed in this publication are those of the
    authors and do not necessarily represent of those of the United States Food and Drug
    Administration. ii In 1906, Congress passed the Pure Food and Drug Act, which prohibited the sale
    of misbranded or adulterated food, drinks, and drugs. iii Patent medicines are medicines, usually of
    low potency, protected by patent and available without a prescription. iv To administer a n
    unapproved new drug to humans, the manufacturer requested an investigational new drug
    application exemption from the FDA. v Side effects include nausea, vomiting, fullness and
    congestion of the breasts, edema, uterine bleeding (either during or upon cessation of
    administration), and, rarely, various forms of abdominal distress or pain, anorexia, diarrhea,
    lassitude, vertigo, headache, anxiety, insomnia, thirst, scotomata, cutaneous rashes, purpura, and
    jaundice. Gynecomastia and loss of libido may occur in men. vi Product labels are available online
    at www.pharmapendium.com. vii The U.S. Census Bureau defined the increased births between
    1946 and 1964 as the baby boom. viii Major manufacturers of approved DES products include:
    Abbott Laboratories, Ayerst, McKenna & Company, George A. Breon & Company, Charles E. Frost &
    Company, Eli Lilly & Company, Merck, Inc., William S. Merrell Company, Sharp & Dohme Inc., E.R.
    Squibb & Sons, Inc., The Upjohn Company, Winthrop Chemical, and Wyeth Laboratories.
    COMMUNITY HEALTH CENTERS
    Community Health Centers
    1
    COMMUNITY HEALTH CENTERS
    2
    Community Health Centers: Wayne County, Michigan
    Wayne County Demographics
    Wayne County, Michigan, as of 2018, had a total population of 1.75 million people with a
    median age of 38 and an average household income of $46,390. The population grew by around
    0.01% from the previous year, with the average household income increasing by 2.78%. The
    population consists of 6.5% persons under the age of 5, 23.6% under the age of 18, 15.4% of the
    population consists of persons who are 65 years old or over, and 51.8% females, with the rest being
    male. 54.6% of the population consist of whites only, Black or African Americans alone are 38.8%,
    Native Americans alone 0.5%, and Asians alone 3.5%. People who belong to two or more races
    are represented by 2.6% of the population, while Hispanics or Latinos are represented by 6.1% of
    the entire population (United States Census Bureau, 2018).
    Of the 1.75 million people living in the community, 85.9% are high school graduates or
    higher, with 23.3% of the population having a Bachelor’s degree or higher. 12.1% of the population
    under the age of 65 years live with disabilities, while the persons under the age of 65 years without
    healthcare insurance represented by 6.8% of the population. The median household income is
    $45,321, with per capita income in the last 12 months being $25,976. 21.7% of the population in
    Wayne County live in poverty (United States Census Bureau, 2018). These demographics,
    therefore, reveal that community health centers in Wayne County are greatly needed by the
    population because a significant percentage of the community is not financially well off. Since the
    services offered by community health centers are less expensive compared to care provided by
    hospitals and outpatient clinics, they come in handy by offering the community affordable care
    and more extensive programs that are greatly needed by the patients.
    COMMUNITY HEALTH CENTERS
    3
    Health-Related Services Delivered
    Community health centers in Wayne County provide a wide range of health-related
    services. The services they provide go beyond what other healthcare providers like out-patient
    clinics and hospitals offer to patients. Community health centers in Wayne county provide not only
    primary healthcare services, but also specialty care, including cardiac, orthopedic and podiatric
    care, mental health and dental services, care coordination, transportation to and from healthcare
    facilities, and outreach activities which are driven towards finding patients in need of the services
    mentioned. Community health centers also deliver care that is culturally appropriate since they are
    offered in languages that the members of the community understand and in ways that respect their
    cultures and values (Schumann, 2019).
    The services that are offered in Community Health Centers in Wayne County are tailored
    towards meeting the needs of the members of the community in this specific area. This is evidenced
    by the 91 percent of health centers that offer translational/interpretation services, 80 percent that
    provide programs of weight reduction, case management services in 89 percent of the health
    centers, and 90 percent of them offer on-site services to assist patients in identifying additional
    programs which can be beneficial to them. The extent of care that community health centers offer
    the members of the Wayne County community improve overall patient outcomes.
    Patients who receive care in these community health centers develop better relationships
    with their health care providers, such as nurses and other physicians. The care provided in these
    centers is less expensive compared to patient care provided in other healthcare facilities such as
    hospitals and outpatient clinics (Schumann, 2019). This is mainly because care providers in these
    health centers are more centered on the provision of additional services and comprehensive
    COMMUNITY HEALTH CENTERS
    4
    primary care. The provision of health care in community health centers saves the County
    government a significant amount of money on an annual basis by eliminating unnecessary visits
    to the emergency department and other healthcare facilities like clinics and hospitals.
    Available Social Services
    Some of the social services available for the people of Wayne County that are aimed at
    improving their overall health include behavioral health and community services, senior/volunteer
    services, and child welfare services. The behavioral health and community services category focus
    on substance use programs and Worthy, Able and Ready (WAR) programs which are aimed at
    counselling, supporting and managing people with substance abuse issues, and enable people who
    have been incarcerated to transition into the community. Others, such as child welfare services and
    senior volunteer services, ensure that the health of children and seniors are considered a priority
    for the betterment of the overall community or population (“Community Social Services of Wayne
    County,” 2020).
    Barriers to Access to Healthcare
    There are several barriers to access to healthcare within the Wayne County community,
    with the main one being poverty or low income. The high cost of healthcare coverage, another
    slightly different barrier that is closely related to poverty or low incomes, does not resolve the
    conundrum that this community faces. Economic troubles in the Michigan state have significantly
    raised the rates of unemployment forcing several members of the community to lose their health
    coverage through their employers (Rigg, 2018). These employers cannot afford to cover the health
    insurance of their employees, especially due to the rising costs of healthcare. Of all the counties in
    Michigan, Wayne County has the worst health ranking. This is partly due to another barrier to
    COMMUNITY HEALTH CENTERS
    5
    healthcare access, which is the education levels of the community. Moreover, the lack of adequate
    community resources in the entire Michigan state is another barrier that hinders members of the
    community from gaining access to quality healthcare, which may result in poor quality or
    unsatisfactory patient outcomes.
    How Healthcare Providers Can Improve Access to Quality Care
    Healthcare providers in Wayne County or the entire Michigan state can improve access to
    quality care within the community through the use of several strategies. First, they should reduce
    or work towards eliminating the barriers to healthcare access that affect low income, uninsured,
    and underinsured members of the community. Healthcare providers can also support safety net
    capacity in the service area to enhance the population’s access to primary care. They should also
    increase people’s awareness of available health resources. The community health centers in Wayne
    County will be imperative in ensuring that the community receives all the types of primary health
    care that a significant percentage of the population needs (Martinez, King, & Cauchi, 2016).
    COMMUNITY HEALTH CENTERS
    6
    References
    Community Social Services of Wayne County. (2020). Retrieved from
    http://www.csswayne.org/
    Martinez, J. C., King, M. P., & Cauchi, R. (2016). Improving the Health Care System: Seven
    State Strategies. Retrieved from
    https://www.ncsl.org/Portals/1/Documents/Health/ImprovingHealthSystemsBrief16.pdf
    Rigg, S. (2018, October 1). Michigan’s homeless face major barriers to healthcare. Here’s how
    providers are trying to help. Retrieved from
    https://www.modeldmedia.com/features/homelesshealthcare092718.aspx
    Schumann, S. H. (2019). Community Health Centers (CHCS). Encyclopedia of Health Services
    Research. doi:10.4135/9781412971942.n79
    United States Census Bureau. (2018). U.S. Census Bureau Quick Facts: Wayne County,
    Michigan. Retrieved from https://www.census.gov/quickfacts/waynecountymichigan

    Achiever Essays
    Calculate your paper price
    Pages (550 words)
    Approximate price: -

    Why Work with Us

    Top Quality and Well-Researched Papers

    We always make sure that writers follow all your instructions precisely. You can choose your academic level: high school, college/university or professional, and we will assign a writer who has a respective degree.

    Professional and Experienced Academic Writers

    We have a team of professional writers with experience in academic and business writing. Many are native speakers and able to perform any task for which you need help.

    Free Unlimited Revisions

    If you think we missed something, send your order for a free revision. You have 10 days to submit the order for review after you have received the final document. You can do this yourself after logging into your personal account or by contacting our support.

    Prompt Delivery and 100% Money-Back-Guarantee

    All papers are always delivered on time. In case we need more time to master your paper, we may contact you regarding the deadline extension. In case you cannot provide us with more time, a 100% refund is guaranteed.

    Original & Confidential

    We use several writing tools checks to ensure that all documents you receive are free from plagiarism. Our editors carefully review all quotations in the text. We also promise maximum confidentiality in all of our services.

    24/7 Customer Support

    Our support agents are available 24 hours a day 7 days a week and committed to providing you with the best customer experience. Get in touch whenever you need any assistance.

    Try it now!

    Calculate the price of your order

    Total price:
    $0.00

    How it works?

    Follow these simple steps to get your paper done

    Place your order

    Fill in the order form and provide all details of your assignment.

    Proceed with the payment

    Choose the payment system that suits you most.

    Receive the final file

    Once your paper is ready, we will email it to you.

    Our Services

    No need to work on your paper at night. Sleep tight, we will cover your back. We offer all kinds of writing services.

    Essays

    Essay Writing Service

    No matter what kind of academic paper you need and how urgent you need it, you are welcome to choose your academic level and the type of your paper at an affordable price. We take care of all your paper needs and give a 24/7 customer care support system.

    Admissions

    Admission Essays & Business Writing Help

    An admission essay is an essay or other written statement by a candidate, often a potential student enrolling in a college, university, or graduate school. You can be rest assurred that through our service we will write the best admission essay for you.

    Reviews

    Editing Support

    Our academic writers and editors make the necessary changes to your paper so that it is polished. We also format your document by correctly quoting the sources and creating reference lists in the formats APA, Harvard, MLA, Chicago / Turabian.

    Reviews

    Revision Support

    If you think your paper could be improved, you can request a review. In this case, your paper will be checked by the writer or assigned to an editor. You can use this option as many times as you see fit. This is free because we want you to be completely satisfied with the service offered.

    Live Chat+1(978) 822-0999EmailWhatsApp

    Order your essay today and save 20% with the discount code RESEARCH

    slot online