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Sample Essay Paper on Policy, Politics, and Global Health Trends

Analysis of Health/Nursing Profession Public Policy Issue

Childhood diseases pose serious health challenges not only in the U.S. but around the world. In the recent past, concern over the outbreak of measles and whooping cough among newborns has increased. Vaccination has been used as a remedy to such diseases, although some celebrities have a contrary opinion concerning child vaccination. Particularly, they argue that vaccination is not necessary for newborns.  Based on their opinion, vaccination is harmful and should be abandoned. These celebrities have the potential to sway the minds of ordinary people who follow them blindly and reject childhood vaccination citing the harmful effect of the activity. To some extent, vaccination may be harmful and cause bad reactions, but the danger of not vaccinating a child is worse than the reactions that might be caused by vaccination. Some children depend on "herd immunity" to protect themselves. Such children may not require vaccination, but such children are a fraction of those who require vaccination. A recent study confirms that the number of children who are not vaccinated is on the rise. Infants are also at risk of missing vaccination if their parents fail to present them for vaccination.

Some parents cite cost as a factor that hinders vaccination. However, this is an unsatisfactory excuse since immunization is free just as it was before the introduction of the Affordable Healthcare Act.  The guest editorial published by the America Academy of Family Physicians states that doctors are obliged to initiate child vaccination without discussing the same with parents or obtaining their consent. They are required to inform parents that it is time to administer the vaccination. This perspective has led to a significant increase in the number of children being vaccinated annually. A few states, such as California, have removed the exemption of personal and religious beliefs on vaccination and only maintain the medical exemption. West Virginia and Mississippi are two other states in which vaccination is compulsory. Other states still have a religious and personal exemption from vaccination, but it is important for all states and all nations of the world to remove such exemptions to protect children from preventable childhood diseases.

The ethical value implemented by this policy is the utilitarian ethical value. The policy also implements justice as an ethical value. Justice is served when everyone is given the same standards. There should be no exemption for vaccination except for the medical one. That way, all children would be vaccinated at the same standard. The utilitarian principle considered here is based on the notion that vaccination protects children from childhood diseases and produces the best result for the majority in society.

Reason for Selecting the Public Policy Issue

A policy that provides only medical exemption to vaccination is important because children who grow without being vaccinated are at risk of acquiring diseases such as measles, polio, and whooping cough among others. Vaccination is important to everyone, and the benefit outweighs its potential harm. Indeed, children are the greatest future asset of any nation; hence they should be protected, which vaccination accomplishes. Courts usually play a role in protecting children against their ill-informed parents by upholding medical treatments when children's lives are at risk, especially when parents object to such treatment. 

Policy Relevance to Health and Nursing

The outbreak of measles between 1989 and 1991 led to the development and implementation of the Vaccines for Children Program, which allowed for child vaccination at no cost. According to Whitney, Zhou, Singleton, & Schuchat (2014), out of 78.6 million children born between 1994 and 2013, vaccination has prevented about 732,000 deaths.  It is also estimated that vaccination has prevented illnesses in approximately 322 million children. The core of nursing is disease prevention and management. This policy is thus relevant to health and nursing because it focuses on disease prevention. The policy fights religious exemption to vaccination because although there is religious freedom in the U.S., such freedom does not include subjecting others to risk; hence, in this context, religious freedom is invalid. Similarly, the personal belief exemption to vaccination is invalid because such beliefs are not founded in science.

Financial Impact

Although the estimated cost of child immunization is staggering, it is approximated that about 402 billion dollars are saved annually directly when children are vaccinated (Whitney, Zhou, Singleton, & Schuchat, 2014). It is estimated that 1.5 trillion dollars are saved indirectly.

Values That Impact Position on The Public Policy Issue

Ethical Principles

This policy is founded on the ethical principle of beneficence and justice. The principle of justice is about the moral obligation to act based on fair adjudication between competing claims. In this case, there is a competing claim between religious and medical claims about vaccination. The principle of justice supports vaccination of healthy children to provide herd immunity and protect children at risk of getting illnesses that are preventable. The benefit provided in saving children from illness and possible death outweighs autonomy.

A.    Policy Brief

Decision Maker

At the state level, the policy brief would be sent to New York Governor; Andrew Cuomo, who believes in no-exemption for vaccination. According to a press released on Friday, June 13, 2019, Cuomo signed a bill that ended the exemption of vaccination based on religious beliefs. Therefore, he would also act on exemption based on personal philosophy, as proposed by this policy. New York is the hardest-hit state by the contagious virus due to a low rate of vaccination. Cuomo believes that vaccines are safe, and vaccination is the most effective way to keep children out of danger of illnesses. In 2015, Senator Barbara Boxer introduced a bill that required mandatory vaccination for all head start program children to be vaccinated. However, some states have not implemented mandatory vaccination.

Statement of issue: Non-exemption of vaccination for children in the head start program in New York and the nation at large. According to the Center for Disease Control and Prevention (CDC), the cases of whooping cough have been on the rise in the U.S. with the highest rise recorded in 2014. Between 2000 and 2012, approximately 255 people died of whooping cough. Out of these, 221 were children. In 2004, 37 cases of measles were reported in the U.S., but in 2014, the reported cases of measles were 668 (CDC, 2015a). New York has been hard hit by cases of measles outbreak because between 2017 and 2018, 26,217 students in public and private schools, including those in kindergarten, had a religious exemption from vaccination (Allyn, 2019). As a result, the measles outbreak continues to be a menace in New York and the U.S. at large.  According to the CDC (2015b), globally, approximately 146,000 of the 20 million persons infected with measles die every year. If children continue to be exempted from vaccination on religious and personal grounds, the number of deaths caused by measles and whooping cough would definitely continue to rise. Thus, the issue of vaccination in New York requires the attention of Governor Cuomo, who has the power to implement the policy and address the rising cases of measles in the state.

Possible Challenges

The primary challenge to the implementation of this policy comes from politicians and citizens opposed to mandatory vaccination. Those who oppose the policy argue that vaccination is ineffective and unsafe. Religious groups that are against vaccination argue that abolishing religious exemption for vaccination is against their religious belief and, by extension, a violation of religious freedom enshrined in the US constitution.

Options and Interventions

This policy makes child vaccination mandatory. The only option parents may have is to school their children at home, but it is not feasible due to the added cost incurred. A few interventions that can improve access to vaccination exist. One of the interventions is to bring vaccination closer to children in schools. Vaccinations can also be made available at community events, such as blood sugar testing and blood pressure screening. Generally, parents who are opposed to vaccination may consider homeschooling, an option that does not add any cost to the federal government. Currently, free vaccinations are available in different states and different nations of the world. What is needed is intense lobbying to get politicians and parents that are opposed to vaccination to get on board.

Course of Action

Over time, unvaccinated children have been isolated from schools during the potential outbreak, but this has not solved the problem of the spread of the disease due to prolonged incubation times. In some instances, children have been denied education due to the potential opportunity to infect others. To this effect, it would be important to make school nurses available for potential vaccination at least once a week, if there is a need. It is also important to use the internet and articles as the source of information for the need for vaccination. Internet messages are cost-effective. Furthermore, lobbying would be important in getting the majority of legislators to vote for compulsory vaccination.

Evaluation

Once the policy has been enacted, it will be the responsibility of the state department of health to enforce it. Withholding resources will be an incentive for non-compliance with policy directives, and implementation at the county level would be done in schools and public health institutions. Vaccination at public health institutions is already ongoing. School boards will be responsible for ensuring that schools comply with mandatory vaccination. Every school will be required to report back compliance with the district. The reports would be sent to the county, which would then send the same to the state. The state will compile the report and send it to the federal government. Generally, evaluation of the policy implementation would be a straight forward activity. The aim is to ensure that there is a 100% vaccination of children in the state and nation at large.

B.    Plan for Community-Based Participation

Organization Expressing Interest

The organization that will assist in the policy implementation would be the County Health Officials of New York (NYSACHO). This organization brings together patients, providers, parents, and campaign partners to raise awareness of vaccines and the importance of immunization at all ages. The plan for community-based participation would encompass educating physicians. Educating physicians would be initiated through collaboration with the New York State Medical Society. A list of health departments within the state that provide vaccination will be provided to make it easy for physician referrals for vaccination. School nurses would be able to pick up vaccines from the state health offices for immunization at the community and school level. County health nurses would be present at school registration to direct parents to various county health departments.

Summary of Evidence

NYSACHO supports vaccinations the same way Governor Cuomo supports it. NYSACHO provides up-to-date information concerning childhood vaccination. The goal of NYSACHO is to increase the rate of vaccination throughout the state of New York. Additionally, NYSACHO has published positive immunization messages on the state website, and this makes such messages available to the public and various partners (NYSACHO, 2020).

Community-Based Participatory Research Principles (CBPR) To Be Used

The CBPR is a partnership approach to research that involves various players in all research aspects and processes and in which all partners contribute their expertise (Israel, Schulz, Parker, & Becker, 2000). The CBPRP that would be used to affect the change are as follows:

1.     CBPR for health puts more focus on problems of relevance to the local community through the use of an ecological approach that attends to several health determinants.

2.     CBPR balances action and research for the mutual benefit for all partners

3.     CBPR disseminates the result and the knowledge gained to the wider community and involves everyone in the dissemination process. 

Community Collaboration

Once the policy has been adopted, the aim would be to enforce it through community education. In particular, a press release would be of significance to let the community knows about the new law. To facilitate further collaboration, nurses from community hospitals would be involved to help in community events. Initiating conversation among stakeholders and players will help in keeping the pace for the changes. 

Goals

The community organization’s goal is to have every child not exempted from vaccination. It is also my goal for the public policy issue. At-risk children can be protected by administering vaccination to healthy children.  A physician approach would be of significance to achieve this goal. People tend to believe whatever they are told by their physicians. They are likely to comply with their physician’s advice.

Action Steps

The following are the proposed action steps:

·       Lobbying for policy change: This can be done at the state and federal level by convincing the congress members that are not for the idea of vaccination to buy-in to the idea.

·       Information sharing: This would involve the free sharing of information with states and organizations that also struggle with the same issue.

·       Conversation: This would involve preparing physicians to initiate a healthy conversation with patients.

Organization Member Responsibilities

The community organization would be responsible for conducting a quarterly survey on compliance with vaccination. The result of the survey would be relayed to the State and federal health departments. Capacity building and problem-solving performed by NYSACHO would be in the area of helping physicians to provide the best services to patients. The other responsibility would be collecting data that would be sent to the state and federal health department, including data on children on the head start program. The problem solving and capacity building in this area would involve helping the physicians and county board of education with equipment for data collection. Another responsibility would be keeping track of children that are homeschooled and those in schools and forward the report concerning their vaccination status. Problem-solving would be implemented by establishing vaccination clinics in schools to allow the state health department to reach as many clients as possible. Capacity building would involve expanding the scope of practice of school nurses to include vaccination.

Key Elements of Developing A Collaborative Evaluation Plan, Using CBPR Principles

The CBPR for health focuses on problems of relevance to the local community (Israel, Schulz, Parker, & Becker, 2000). This would be evaluated by identifying the determinant of the disease such as biomedical, cultural, and physical environment and develop an approach to address the determinants. CBPR balances action and research for the mutual benefit for all partners and would be evaluated by the extent to which the research findings are translated to intervention and policy change to address the community concerns. CBPR disseminates finding and knowledge gained to a wider community. It would be evaluated by assessing the rate of compliance with vaccination.

Evaluation

The key measurement tool that would be used would be the number of children vaccinated. This method of evaluation is fairly straightforward. An additional measurement tool would be the number of physicians taking in the activity. Physicians play a significant role in making the parents change their minds on health issues; hence this bottom-up approach would be of great significance to the success of the project.

C.    Analysis of Strengths and Challenges

Strengths

One of the most important strengths of the top-down approach in achieving policy changes is that it is a law. Any person wishing for public education for his or her child has no alternative but to abide by the law. Any person not ready to abide by the law has no alternative but to home-school his child. On the other hand, the strengths of the bottom-up approach are educating and convincing rather than forcing and dictating. It is an approach that can make vaccination widely available. People tend to get happy with the decision they feel that a given decision was made independently. They dislike the feeling that society is more authoritative. People would tend to trust their physicians, and this can make them allow vaccination. It is easy to create an environment without boundary, especially for those who do not have transportation if vaccinations are made more widely available.

Challenges

The possible challenge of the top-down approach is that it may lead to people’s rejection of an idea because of the feeling that they are forced into it. It is important to get people to agree first. With the bottom-up approach, the primary challenge is keeping the school and physicians engaged. There is a possibility of a delay in reporting the result.

Most Effective Approach

The approach that I would recommend as the most effective to address the above public policy issue is the hybrid approach. I expect the policy to be effective for a date in the future. This would create more time for the implementation of a bottom-up approach. Allowing for enough time would create breathing space for states to organize their financial resources and educate physicians for the successful implementation of the policy. A bottom-up approach would enable people to embrace change.

 

References

Allyn, B. (2019 June). New York Ends Religious Exemptions for Required Vaccines. Retrieved from https://www.npr.org/2019/06/13/732501865/new-york-advances-bill-ending-religious-exemptions-for-vaccines-amid-health-cris

Centers for Disease Control and Prevention. (2015a, July 28). Measles cases and outbreaks. Retrieved from http://www.cdc.gov/measles/cases-outbreaks.html

Centers for Disease Control and Prevention. (2015b, July 1). Measles vaccination. Retrieved from http://www.cdc.gov/measles/vaccination.html

Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (2000). Community-based participatory research: Principles, rationale, and policy recommendations. Successful models of community-based participatory research, 16-29.

NYSACHO. (2020). Vaccine Providers-New York State. Retrieved from https://www.immunyze.org/providers/

Whitney, C. G., Zhou, F., Singleton, J., & Schuchat, A. (2014). Benefits from immunization during the vaccines for children program era—United States, 1994–2013. MMWR. Morbidity and mortality weekly report63(16), 352.

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