Boston University Art & Copy Film Movie Questions Writing Assignment Help

Boston University Art & Copy Film Movie Questions Writing Assignment Help. Boston University Art & Copy Film Movie Questions Writing Assignment Help.

Watch the acclaimed film, Art & Copy (1 hour 10 minutes).

Please answer to the following questions

Which campaigns stood out to you and why?

The film hosted a Who’s Who of advertising creatives. Which practitioner’s explanation of advertising most resonated with you and why?

Beyond just celebrating the art of advertising, the film also addressed some of the problems associated with advertising. Which were noteworthy to you and why? Were there any challenges of advertising that you feel should have been addressed that were not.

Is there anything you wished the film addressed that it did not?

Boston University Art & Copy Film Movie Questions Writing Assignment Help[supanova_question]

Florida International University FCA, CPT and DAP Incoterms Discussion Business Finance Assignment Help

Compare and contrast three incoterms. Explain why your choices are superior to your teammates when writing your comments.. PLEASE PROVIDE COMMENTS TO AT LEAST TWO OTHER CLASSMATES CONTRIBUTION AND SHOW LINKS WHERE THEY CAN GO TO GET MORE INFO.

reply 1

by Alannis Pacheco

The first incoterm is EXW, which stands for Ex Works. The term EXW means the buyer is responsible for all risks and costs, starting when the product is picked up from the seller until the products are delivered to their location. The seller is not responsible for loading the goods or clearing them for export.

Next is CIP, which stands for Carriage and Insurance Paid To. This is when the seller clears the goods for exporting and delivers them to the place of shipment. At this point, the risk is transferred to the buyer. The seller is also responsible for transportation costs and any insurance until the goods reach their destination.

Lastly is DPU, or Delivered at Place Unloaded. This is the only term where the seller has the task of unloading the goods. The seller is also expected to clear the goods for exporting and is responsible for any risks and costs associated with delivering and unloading.

https://www.shippingsolutions.com/blog/beginners-introduction-to-incoterms

Reply 2

by Alexia Cohen

The primary purpose of Incoterms is to define the responsibilities and costs between two parties correctly.

CFR: Cost and freight is a legal term used in foreign trade contracts. In a contract specifying that a sale is cost and freight, the seller is required to arrange for the carriage of goods by sea to a port of destination and provide the buyer with the documents necessary to obtain them from the carrier.

DDP: Delivered duty paid is a delivery agreement whereby the seller assumes all of the responsibility, risk, and costs associated with transporting goods until the buyer receives or transfers them at the destination port.

DDU: Delivered Duty Unpaid is an old international trade term indicating that the seller is responsible for the safe delivery of goods to a named destination, paying all transportation expenses and assuming all risks during transport.

More information here:

https://www.shippingsolutions.com/blog/beginners-i…

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Ohio University Social Determinants of Health and Cultural Awareness Outline Health Medical Assignment Help

Overview:

In this assignment, the student will outline the content of the final paper.

Outline:

The more detailed the outline the easier it will be to write the final paper.

Review this sample outline:

Use Roman numerals for the main headings in the outline (I, II, III, IV)

Capital letters are used for the sub-headings (A, B, C, D)

If another set of sub-headings is needed use 1, 2, 3, 4

The next sub-heading would be lowercase letters, e.g. a, b, c, d

Main headings should include on heading titled Introduction and one titled Conclusion. Other main headings will address major concepts in your thinking.

The outline is to provide the logical progression of the ideas and points you will make in the final paper. Items do not need to be in complete sentences.

You will NOT need to include in-text citations in the outline, but you will need to include a reference list on a separate page to credit the information used to the original author.

References MUST be in proper APA 7th edition format

Please include a properly formatted student APA 7th edition title page

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ECH 440 GCU Evaluation Importance Methods in Preschool & Primary Children Discussion Humanities Assignment Help

Use 3-5 scholarly resources and an interview with an early childhood educator in your local school or district to complete this assignment.

Write an essay of 750-1,000 words in which you answer the following questions:

How are formative and summative evaluations used in the classroom?
How are these evaluations different in a Birth-Pre-K versus a K-3 learning environment?
Why is it important to use informal evaluation methods with preschool and primary children?
What are the names of specific types of formative and summative assessments used in Birth to Age 5/Pre-K and K to Age 8/Grade 3 classrooms?
How is diagnostic evaluation used in instructional planning?
What strategies does the early childhood teacher use to assess young students using formative and summative measures?

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

– Explore alternative types of assessment in “40 alternative assessment ideas for learning,” located on TeachHub website. http://www.teachhub.com/40-alternative-assessments-learning

-Read Chapter 3 in Assessment in Early Childhood Education. Pg 70

http://gcumedia.com/digital-resources/pearson/2011/assessment-in-early-childhood-education_ebook_6e.php

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Ohio University Social Determinants of Health and Cultural Awareness Discussion Health Medical Assignment Help

Two (2) references are required for the initial post; one can be the ACOG article. The initial post is to be 250-300 words in length.

Instruction for Discussion Board #4: Introduction of Article Content to a Lay Person (M4-A3)

1. Read the ACOG article (Committee on Health Care for Underserved Women).
2. In the discussion board, provide an explanation to a lay person about the use of social determinants of health and cultural awareness in the delivery of health care (250 – 300 words)

Websites:

Centers for Disease Control and Prevention. (2018). Social determinants of health: Know what affects health. https://www.cdc.gov/socialdeterminants/index.htm

HealthyPeople.gov (2020). Social determinants of health. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

World Health Organization. (2020). Social determinants of health. https://www.who.int/social_determinants/sdh_definition/en/

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ISOL 534 Campbellsville University Local Group Policy Essay Writing Assignment Help

Questions:

1. Where are local Group Policy Objects stored?

Explain why local GPOs are more difficult to manage that OU GPOs in AD.

2. Which of the native Windows file and folder encryption techniques would be best suited for files stored in a common directory that are shared among multiple users (on the same computer)?

What obstacles would other technique(s) pose for encrypting files for multiple users?

3. What two methods did you use to modify folder access permissions (ACLs) in your labs?

Describe a situation in which the first method would be the better choice, then describe a situation in which the second method would be better.

ISOL 534 Campbellsville University Local Group Policy Essay Writing Assignment Help[supanova_question]

Chamberlain University Congress Representatives Elections & Policy Issues Essay Health Medical Assignment Help

Instructions

Research the background of your Congressional representatives based on your address listed with CU – two senators and a member of the House of Representatives. Find out about their previous occupation(s), political experience, family, income, education, and other relevant demographics. What percentage of the vote did they receive to win in their last election? What are two policy issues areas they are interested in? How do these areas reflect their ideologies?

Here is a link to get your started:

https://www.govtrack.us/congress/members (Links to an external site.) (Links to an external site.)

Write an essay. Start by identifying all three of your representatives. Then, pick the representative you are most interested in and explain why they interest you. Present the information you found in your research required above in the essay.

Writing Requirements (APA format)

Length: 4 full pages (not including title page or references page)
1-inch margins
Double spaced
12-point Times New Roman font
Title page
References page (minimum of 2 scholarly sources beyond those provided)
Citation and Writing Assistance: Writing Papers At CU (Links to an external site.)
Library Overview (Links to an external site.)
How to Search for Articles – the Everything Tab (Links to an external site.)

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BHR 3352 University of North Alabama Stew Leonard Employee Benefits Discussion Business Finance Assignment Help

The ninth Debate Discussion assignment in this class relates to the On-the-Job video of Stew Leonard’s employee benefits, which is located in the online Mind Tap content associated with this course. When Stew Leonard’s started in 1979, it had seven items and nine employees. Today, it has four food stores, nine wine stores, and 2,500 employees. The company has tried to keep its employees feeling like they are part of making Stew Leonard’s successful. Karen Mazako, vice president of human resources, gives a long list of benefits. The company also offers fun benefits like appreciation dinners, picnics, and trips. Stew Leonard’s provides training and tuition reimbursement to help employees advance in their careers. During annual reviews, managers and employees discuss career goals. The company invests in its employees. Happy team members make the customers happy, and the business and profits flow naturally from that interaction.

Discussion Questions:

If healthcare costs increase, should Stew Leonard’s reconsider the health benefits it provides to its employees? What should it consider in making this decision?
Stew Leonard’s uses participation as a metric when evaluating its benefits. What is a disadvantage of using participation as a key metric?
Companies in the grocery business often employ many part-time workers. What are the pros and cons of Stew Leonard’s offering benefits to its part-time employees?

Your assignment is to 1) watch the video, 2) answer these questions, 3) present/defend your ideas with thoughtful logic or relevant evidence, and 4) respond to at least two other students’ posts with other thoughtful analyses. Your posts should be comprehensive (multiple lengthy paragraphs), as well as concise and detailed.

Grades are assigned using a rubric with the following dimensions: 1) logic/support, 2) clarity/conciseness, 3) depth, 4) length, 5) contains multiple postings/responses.

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University of North Alabama Stew Leonards Employee Benefits Debate Discussion Business Finance Assignment Help

Discussion Questions:

If healthcare costs increase, should Stew Leonard’s reconsider the health benefits it provides to its employees? What should it consider in making this decision?
Stew Leonard’s uses participation as a metric when evaluating its benefits. What is a disadvantage of using participation as a key metric?
Companies in the grocery business often employ many part-time workers. What are the pros and cons of Stew Leonard’s offering benefits to its part-time employees?

Grades are assigned using a rubric with the following dimensions: 1) logic/support, 2) clarity/conciseness, 3) depth, 4) length, 5) contains multiple postings/responses.

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Walden University Week 8 EU Closing the Gap on Health Inequities Discussion Health Medical Assignment Help

Is the EU Closing the Gap on Health Inequities?

The World Health Organization and European Union (EU) DETERMINE Consortium has acknowledged gaps in health equities within and between member countries. A variety of efforts are underway to help close those gaps.

To prepare for this Discussion, review your Learning Resources, particularly the readings from the DETERMINE Consortium and European Commission and the National Social Marketing Centre video programs. Select two EU countries on which to focus. (It is advised to select two countries from the list of EU members and avoid repeating the same ones mentioned in the required media of this week resources). Look at efforts in those countries designed to reduce health inequities and inequality and examine appropriate outcomes for those efforts. Evaluate the performance of the health systems in those countries as reflected in population health data for each of the countries. Be sure to access the CIA country profiles (found within the CIA World Factbook) and WHO websites provided earlier for the most current resources.

By Day 4

Post a brief comparison of the health status of the two EU countries you selected with that of the U.S. Then, describe two efforts in those EU countries to reduce health inequities. Explain what lessons can be learned from the EU efforts you selected that can be implemented in the U.S. nationally or by individual states. Explain how the community you live in might adapt these interventions. Expand on your insights utilizing the Learning Resources.

Use APA formatting for your Discussion and to cite your resources.

By Day 6

Respond to your colleagues’ postings. Provide a substantive reply to your colleagues in one or more of the following ways and expand on your insights utilizing the Learning Resources:

Validate an idea with your own experience.
Offer polite disagreement or critique, supported with evidence.

In addition, you may also respond as follows:

Offer and support an opinion.
Make a suggestion or comment that guides the discussion.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

2 days ago

Shelby Miller

RE: Discussion – Week 8

COLLAPSE

When looking at the European Union (EU), we see that health outcomes have a lot to do with political policies, rules, and regulations that govern a society (Laureate Education, 2011). For the purpose of this assignment, we will explore how health outcomes in Poland and Sweden are impacted by public health policies and programs.

Poland has only recently begun to place a strong emphasis on public health. Prior to 2015, little money was spent on public health programs in Poland, and they did not have a concrete definition of “public health” in the country until the 2015 Act on Public Health (Topor-Madry, Balwicki, Kowalska-Bobko & Wlodarczyk, 2018). In Poland, the infant mortality rate is 4.3 deaths/ 1000 live births, which is slightly lower than in the United States (Central Intelligence Agency, n.d.).After the passing of the 2015 Act on Public Health, the life expectancy in Poland has started to slowly increase; the infant mortality rate has started to decrease and, tobacco consumption among men has begun to decrease. Poland has also started to implement programs addressing HIV prevention and encouraging vaccines against preventable diseases (Topor-Madry, Balwicki, Kowalska-Bobko & Wlodarczyk, 2018). Overall, Poland’s total health expenditure is 6.5%, compared to 17.1% in the United States, yet, we see that they have significantly lower rates of maternal mortality (2/100,0000 live births vs. 19/100,000 live births, respectively), a lower infant mortality rate and a lower rate of obesity (23.1% vs. 36.2%) (Central Intelligence Agency, n.d.).

So, why is it that the United States ranks lower in important health indicators than a country that only started focusing on public health five years ago and spends a great deal less on health every year? An important factor to consider when comparing health outcomes between Poland and the United States is the issue of income inequality. Although Poland is significantly less wealthy than the United States, income inequality within a country is a much greater predictor of health status than overall wealth (Wilkinson & Pickett, 2010). Wealth inequality in Poland is lower when compared to other EU countries and significantly lower than in the United States (Brzezinski, 2017). When looking at these data, we can see that there is possibly an association between the income inequality and these differences in health outcomes. To properly address poor health outcomes, the United States needs to focus on the underly systematic issues that lead to these poor outcomes. When looking at our health expenditure, we see that simply throwing money at the problem is not going to work, if we do not address the root cause of the problem.

When looking at Public Health data for Sweden, most of their health outcomes are better than the United States. Sweden has a much lower maternal mortality rate (4/100000 live births vs. 19/100000 live births), a lower infant mortality rate (2.6/1000 vs. 5.3/1000 live births), and a lower rate of obesity (20.6% vs. 36.2%) (Central Intelligence Agency, n.d.). As with Poland, Sweden has a much lower health expenditure (10.9%) when compared to the United States (17.1%) (Central Intelligence Agency, n.d.).

Sweden fares particularly well in terms of child wellbeing (Wilkinson & Pickett, 2010), which is an essential component of a health society. It is critical that children are healthy and well because that can impact the society as a whole. The United States scores extremely low on the UNICEF child wellbeing scale, when compared to similar countries. In Sweden, the government provides a generous parental leave program, which can be delegated between both the mother and father. This program provides parents with 80% of their wages for the first 18 months, an additional three months can be taken at a set pay rate, and an additional three months can be taken on top of that, for a total of 24 months (Wilkinson & Pickett, 2010). The United States has a notoriously poor parental leave program, which does not allow for parents to spend an adequate amount of time with their children during the initial critical years of their lives. If the United States could take one thing away from Sweden, it should be the critical importance of proper parental leave programs. Transforming the parental leave programs in the United States could prove to have positive impacts on infant mortality rates, maternal health, and child wellbeing, which are all critical public health indicators.

References

Central Intelligence World Factbook. (n.d.). Europe: Poland. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/pl.html

Central Intelligence World Factbook. (n.d.). North America: United States. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/us.html

Laureate Education (Producer). 2011.Global Health and Issue s in Disease Prevention Multimedia file].Retrieved from https:// class. Waldene.edu

Topór-Mądry R, Balwicki Ł, Kowalska-Bobko I, et al. Poland. In: Rechel B, Maresso A, Sagan A, et al., editors. Organization and financing of public health services in Europe: Country reports [Internet]. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2018. (Health Policy Series, No. 49.) 8. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507318/

Wilkinson, R., & Pickett, K. (2010). The spirit level: Why greater equality makes societies stronger. New York, NY: Bloomsbury Press.

2)Philip Ndoki

RE: Discussion – Week 8

COLLAPSE

European Union Health Status

Introduction

The European Union (E.U.) currently consists of 27 unique nations, amongst which France and Austria have been member countries since 1958 and 1995, respectively. France is a semi-presidential republic with a permanent representation of the E.U. According to Eurostat, France has a population of about 67,012 883 million inhabitants as of January 1, 2020, with a gross domestic product (GDP) of per capita in purchasing power standards (PPS) of 104. France also has a life expectancy of 81.90 and an infant mortality rate of 3.20 (2017 estimate).

Austria is a federal parliamentary republic and also a permanent representative to E.U. According to statistics from Eurostat, Austria has a population of 8 858 775 million inhabitants as of January 1, 2020, with a GDP of per capita in PPS of 128, with a life expectancy of 80.80 and infant mortality rate of 3.40 (2017 est.).

The U.S. practices a federal system of government, with a life expectancy of 80.00, an infant mortality rate of 5.80 (2017 est.), and a population of 332,639,102 million people (July 2020 est.). The U.S. per capita GDP is $59,500 (CIA site redirect — Central Intelligence Agency, 0154).

Strategies to reduce inequalities in France and Austria

Europe, just like other regions of the world, has social inequalities that affect the health and wellbeing of the population (Saurel-Cubizolles et al., 2009). This is why members of the E.U. signed the WHO-Europe 1985 health declaration, which was aimed at reducing inter-countries health disparities by 25% by the year 2000. However, unfortunately, the various countries are still at different stages of implementation (Mackenbach & Bakker, 2003).

France had one of the highest premature mortality rates in Europe (Kunst et al., 2000). The strongest predictor of premature mortality and morbidity worldwide is low levels of socioeconomic status. In 1994, the high committee on public health focused its attention on the reduction of social inequalities to address the issue of premature mortality. But the 1998 law against exclusion was focused mainly on access to health care, even though it has been proven that health care has a limited role. This law’s main objective was to improve access to curative and preventive health care to needy citizens (Fourcade et al., 2004). This law led to the Universal Medical Coverage (UMC) in 2000, in which approximately five million people were covered (Boisguérin, 2005). Also, people of low socioeconomic status were exempted from co-payments. Even though the 1998 law against exclusion and 1999 health conference didn’t include social inequality (Lang et al., 2002), the scientific communities published documents which emphasized the importance of addressing social disparities to improve health outcomes, including premature mortality (Leclerc et al., 2000; Joubert et al., 2001). So, on August 9, 2004, a public health law was established that recognized social inequalities as a significant determinant in health outcomes. Hence, France instituted policies to reduce social disparities such as reduction of the financial burden to obtain insurance for those whose income was slightly above the minimum requirements for UMC, etc.

Austria has inequality in income and opportunity despite being ranked 8th and 10th in GDP per capita and income inequality index respectively amongst OCED countries (“GDP and spending – Gross domestic product (GDP) – OECD data,” 2019; “Inequality – Income inequality – OECD data,” 2019). In Austria, the top 20% of the population earns four times higher than the bottom 20%. About 1.5 million minorities living in Austria are poor and marginalized (Stavkova et al., 2012), majority of whom are women, immigrants, and unemployed people, etc. (Kessler, 2019).

But the Austrian government reduced its poverty and social exclusion risk below that of E.U. average to 18% from 2011 to 2016 (European Commission, 2018). Austria developed a comprehensive system that reduced social security and welfare to 14% (Statistics Austria, 2017), free social housing, public school system, and affordable transportation. The Austrian government spends more on health than most members of OECD, hence ensuring that all Austrian have access to quality health care (Bachner et al., 2018). Austrians also have access to the cleanest water in the world, and Austria was ranked as a high performer in the OECD Environmental Performance Review of 2013, even though they face ecological challenges (OECD, 2013).

Lessons for the U.S.

The goal of healthy people 2020 was to provide the highest quality of health to all people. Health equity can only be achieved if health disparities are eliminated. But, in the U.S. the current policy of achieving health equity has been focused solely on diseases and access to health care. There are many determinants of health, of which access to health care is even the least (McGinnis, 1993). The U.S. should focus more on improving the social determinants of health, such as socioeconomic, cultural, racial, and environmental, etc., especially on minorities and disadvantaged people. For instance, France, who enacted public health laws that established universal medical coverage, exempted people of low socioeconomic status from co-payments, etc. In Austria, all its citizens have access to high-quality education, nutritious food, quality, and safe housing, affordably reliable public transportation, culturally sensitive health care providers, affordable health insurance, clean water, non-polluted air, and safe neighborhoods, etc. These are examples worth emulating. These are proven methods, and that’s why they rank better than the U.S. in most of the measurable health outcomes.

Lessons for my community

I live in the Hamilton-county in Ohio, USA. In 2010-2012, both the county poverty rate of (16%) and the rate of children living in poverty (24%) were higher than those of the state, which were 15% and 21%, respectively. Living in poverty has an impact on the academic performances of students, and that’s why the average graduation rates of the schools in this county were less than 35% within that same time frame. The unemployment rate was 8.5%, and those uninsured was 11.5%. During this same period, 12% of the population didn’t have access to enough food. The infant mortality rate of 10% and life expectancy of 77.3%, were worse than the national average. (U.S. Census Bureau, 2014).

Apart from helping low-income earners and their families by providing them with supplemental nutrition assistance program (SNAP) and declaring racism a public health crisis, the county has not offered concrete solutions to the socio-economic inequalities facing the county. So, the county can also make plans, and implement inclusive policies for minorities, provide affordable free high public-schools. Tax reductions for individuals on low incomes, increase access to affordable social housing, provide free and reliable transportation for the disadvantaged people, and provide safe neighborhoods, etc.

Summary

There are health inequalities across Europe, and even though one of the objectives of the WHO-Europe 1985 health declaration was to reduce inter-country disparities by 25% by the years 2000, the various member states are still in different levels of implementation of the policies. But within the European Union, there are countries such as France, Austria, etc., that have realized that to achieve quality health and wellbeing of their population, the other determinants of health such as the socioeconomic, cultural, and environmental aspects of health, etc., needs to be addressed. Since these holistic methods are producing positive health outcomes in those nations, they are worth emulating in a country such as the U.S. and also in our local communities.

References

Bachner et al. (2018). Austria. Health system review, European Observatory on Health Systems and Policies. http://www.euro.who.int/__data/assets/pdf_file/0009/382167/hit-austria-eng.pdf?ua=1 (20.02.2019)

Boisguérin, B. (2005). “Les bénéficiaires de la CMU au 31 décembre 2003”, Etudes et Résultats (381).

CIA site redirect — Central Intelligence Agency. (0154). https://www.cia.gov/library/publications/the-word-factbook/rankorder/2102rank.html

European Commission, Monitoring report on progress towards the SDGs in an E.U. context (38). (2018). https://ec.europa.eu/eurostat/documents/3217494/9237449/KS-01-18-656-EN-N.pdf/2b2a096b-3bd6-4939-8ef3- 11cfc14b9329 (20.02.2019)

Fourcade, M., Jeske, V., Naves, P., & IGAS. (2004). “Synthèse des bilans de la loi d’orientation du 29 juillet 1998 relative à la lutte contre les exclusions”, Paris : La documentation française, rapport 2004 054.

GDP and spending – Gross domestic product (GDP) – OECD data. (2019, February 20). the OECD. https://data.oecd.org/gdp/gross-domestic-product-gdp.htm

Inequality – Income inequality – OECD data. (2019, February 20). the OECD. https://data.oecd.org/inequality/income-inequality.htm

Joubert et al, M. (2001). “Précarisation, risques et santé”, Collection Questions en santé publique’,. Paris : Editions de l’INSERM..

Kessler, R. (2019). Soziale Ungerechtigkeit und intervention Gottes. Theologie und Soziale Arbeit im Gespräch, 3-21. https://doi.org/10.1007/978-3-658-24213-8_1

Kunst, A. E., Groenhof, F., Mackenbach, j. P., & EU Working Group on Socioeconomic Inequalities in Health. (2000). “Inégalités socials de mortalité premature: La France comparée aux Autres pays européens,” in Leclerc A., Fassin D., Grandjean H., Kaminski M., Lang T., Les Inégalités Sociales de Santé, Paris: La Découverte/INSERM.

Lang, T., Fassin, D., Grandjean, H., Kaminski, M., & Leclerc, A. (2002). “France,” in Mackenbach J.P., Bakker M. (Eds), Reducing inequalities in Health: A European Perspective, Routledge.

Leclerc, A., Fassin, D., Grandjean, H., Kaminski, M., & Lang, T. (2000). “Les Inégalités Sociales de Santé”, Paris: La Découverte/INSERM.

McGinnis, J. M. (1993). Actual causes of death in the United States. JAMA: The Journal of the American Medical Association, 270(18), 2207. https://doi.org/10.1001/jama.1993.03510180077038

OECD. (2013). Environmental country review: Austria (13). http://read.oecd-ilibrary.org/environment/oecd-environmental- performance-reviews-austria-2013_9789264202924-en#page15 (20.02.2019)

Saurel-Cubizolles, M., Chastang, J., Menvielle, G., Leclerc, A., & Luce, D. (2009). Social inequalities in mortality by cause among men and women in France. Journal of Epidemiology & Community Health, 63(3), 197-202. https://doi.org/10.1136/jech.2008.078923

Statistics Austria, Armutsgefährdung vor und nach sozialen Transfers nach soziodemographischen Merkmalen (1). (2017). https://www.statistik.at/web_de/statistiken/menschen_und_gesellschaft/soziales/armut_und_soziale_eingliederung/index. html (20.02.2019)

Stavkova, J., Birciakova, N., & Turcinkova, J. (2012). Material deprivation in selected EU countries according to EU-SILC income statistics. Journal of Competitiveness, 4(2), 145-160. https://doi.org/10.7441/joc.2012.02.10

US Census Bureau. (2014, October 13). US census Bureau/American Factfinder, 2010-2012 America Community Survey. https://factfinder2.census.gov

William Payne

RE: Discussion – Week 8

COLLAPSE

1. Post a brief comparison of the health status of the two EU countrys you selected with that of the U.S.

The United States – the world’s leading “economic … superpower” – is one of the wealthiest and most technologically advanced societies on earth (BBC, 2012), and yet, amongst the world’s developed nations, it is also strikingly anomalous its non-universal health insurance coverage (Teitelbaum & Wilensky, 2013) and its high level of income inequality (Wilkinson & Pickett, 2010).

Comparison of USA’s health outcomes in relation to other, European Union (EU) nations can help inform population health scholars how societies might intelligently seek out desirable states of population health. Two such nations (chosen arbitrarily, on account of my being the least familiar with them) are: 1) Slovakia and 2) Estonia.

A brief comparison follows (The World Bank, n.d.a; The World Bank, n.d.b ; HDRO, 2019; CIA World Factbook, n.d.).

USA has GDP per capita (in current international $ – PPP) of $65,280.70 and a Gini index of 41.4. It has a Life Expectancy at Birth (LEaB) of 78.9 years, an Infant Mortality Rate (IMR) (number of deaths of infants aged under one year, per year per 1,000 live births) 5.8 infant deaths, and Human Development Index (HDI) of 40.8. This set of observations paints for USA a profile of excellent relative wealth profile and of moderate relative health.

Slovakia (i.e., the Slovak Republic) has a GDP per capita of $34,178.00 and a Gini index of 25.2. Overall, this means that Slovakia is only about half as wealthy as USA but that its overall share of income is distributed almost twice as equally. Its LEaB is 77.4, its IMR is 5.1, and its HDI is 25.8. HDI notwithstanding, its general health profile seems comparable or nearly comparable to USA’s, despite its lower overall wealth.

Estonia (i.e., the Republic of Estonia) has a GDP per capita of $38,811.10 and a Gini of 30.4. This makes Estonia slightly more wealthy than Slovakia and also slightly more unequal in income, functioning as a kind of intermediate between Slovakia and USA on both counts. Its LEaB is 78.6, its IMR is 3.8, and its HDI is 36.0. This suggests perhaps a slightly superior health profile to that of USA’s.

Each of these EU countries has a universal public health insurance system, unlike USA (SSA, 2018a; SSA, 2018b).

2. Describe two efforts in those EU countries to reduce health inequitys.

Estonia:

To begin, the Estonian constitution “enshrines” a right among its people to universal health care (EC, 2018). However, the nation falls conspicuously short of realizing this ideal. As of 2017, the nation spends only 6.0% of GDP on health (among the lowest in OECD countries) (OECD, 2017a) and has the EU’s greatest health inequalities by income (OECD, 2017b). Unsurprisingly then, Estonia has one of the highest rates of unmet medical needs in the EU (Habicht et al., 2018).

Estonia’s recent Health Insurance Act marks one effort by the Estonian government to reduce health inequalities (Habicht, Habicht, & Ginneken, 2015). Estonia’s Estonian Health Insurance Fund (EHIF) is the governmental agency which buys up insurance policies, designed to then cover the entire population. This recent legislation’s four main changes to purchasing criteria include: 1) redefining access criteria to be based on population need rather than on historical supply, 2) more optimal work load criteria to increase specialist care, 3) greater consideration of patient movement, and 4) re-emphasizing quality (Habicht, Habicht, & Ginneken, 2015). If carried out well, this effort could mark the latest success in Estonia’s 20(+) years of slowly but surely improving population health outcomes and may help counties most in need, such as Ida-Viru (Lai & Leinsalu, 2015).

Slovakia:

Like Estonia, the Slovakian government begins from the premise that all Slovak citizens have a right to health care (IOM, n.d.). Also like Estonia, Slovakia fails to deliver on this ideal, with noticeable systemic deficiencies that result in health inequity by ethnicity and by spatial distribution (IOM, n.d.).

One particular ethnic group – the Roma – is striking in its disproportionate share of poor health outcomes (IOM, n.d.). This is true of the Roma not only in Slovakia but indeed across much of Europe, with Roma having lower LEaB, higher IMRs, higher rates of infectious disease, and lower rates of vaccination uptake almost wherever in Europe they are found (e-RR, n.d.; EC, 2014).

The Roma (singular Rom, and informally called Gypsies) are a large, heterogeneous, traditionally itinerant ethnic group originating from northern India, now scattered throughout Europe (Encyclopaedia Britannica’s editors, 2020). Thus, the Roma’s presence in and comparatively poor health outcomes within the nation are by no means unique to Slovakia, but Slovakia has one governmental intervention formally aimed at addressing the Roma situation – a project called (or rather, translated as) “Healthy Communities” (Smatana et al., 2016). This is one of a few projects in Slovakia aimed at Slovakia’s 10% Roma minority (OECD, 2017c). The project, run now by Slovakia’s Ministry of Health, refers to disadvantaged groups as PPZZS (e.g., elderly persons, homeless persons, rural communities, etc.) and the Roma comprise it chiefly (WHO, n.d.; Smatana et al., 2016). The project reaches out to Roma communities in 239 locations, mostly around central and Eastern Slovakia, and it aims to promote preventive health care and health education (Smatana et al., 2016).

3. Explain what lessons can be learned from the EU efforts you selected that can be implemented in the U.S. nationally or by individual states.

Parts of Estonia’s Health Insurance Act are reminiscent of the United States’ Patient Protection and Affordable Care Act. In particular, the idea of restructuring reimbursement from more of a Fee-for-Service system to a Value-based seems familiar (Teitelbaum & Wilensky, 2013). The major difference, of course, is that in Estonia, the disadvantaged populations were already covered, in theory. The Estonian legislation is recent enough that long-term evaluation of its success is scarce, but, USA can take note of two things. First, USA should note that Estonia has far less wealth to spread around and spends far less of its budget on health care and yet has health outcomes that are nearly equal to USA’s. Regarding Estonia’s Health Insurance Act specifically, USA could also pay more attention to patient mobility. Since, in USA, many insurance programs are tied to one’s employer and/or to one’s recent residence in a given state, USA could do more to provide some safety net to persons in the midst of a transition either to a different job or to a different state.

Regarding Slovakia’s “Healthy Communities” Project, it’s difficult to say what, if anything, USA can learn. USA does not face the challenge of a 10% Roma population specifically, although it does have number of itinerant ethnic groups who sometimes have worse health outcomes than the average American and who can pose unique challenges in targeting for intervention. However, USA already provides stabilizing care in any of its Medicaid/Medicare-recipient emergency rooms, along with translation services, so emergency medical care for the indigent and/or marginalized ethnic groups is largely an already-met need. But, perhaps USA could do more in reaching out to certain communities to promote preventive care and uptake of vaccinations. After all, preventing people from needing to use the emergency room in the first place seems a more cost-effective stabilizing than ensuring stabilizing care once there.

4. Explain how the community you live in might adapt these interventions.

USA’s system leaves much discretion up to states and local governments. Here in Houston, TX, health officials might be able to find zip codes or neighborhoods with migrant ethnic groups of poor health outcomes and might try to find ways to educate them on preventive care or of taking up vaccinations more reliably. It sounds simple, but I think it’s pretty much always easier said than done, though.

Regarding Estonia’s restructuring of insurance, it’s a change closer to the heart of the central government. I don’t think that the Houston community has much power to change that on its own, except perhaps by participating in the governmental process to try to change the terms of reimbursement here in Texas or here in Harris county.

References

British Broadcasting Company [BBC]. (2012, January 10). United States of America Country Profile. Retrieved July 14, 2020, from http://news.bbc.co.uk/2/hi/americas/country_profil…

Electronic Roma Resource [e-RR]. (n.d.). Slovakia: Health. Retrieved July 14, 2020, from http://www.eromaresource.com/slovakia/health.html

Encyclopaedia Britannica’s editors. (2020, June 11). Roma. Retrieved July 14, 2020, from https://www.britannica.com/topic/Rom

European Union’s European Commission [EC]. (2014, August). Roma Health Report: Health Status of the Roma Population. Data collection in the Member States of the European Union. Retrieved July 14, 2020, from https://ec.europa.eu/health/sites/health/files/soc…

European Union’s European Commission [EC]. (2018, February 26). Health Equity Pilot Project (HEPP): Summary of the HEPP Coaching Workshop Estonia 26 February 2018. Retrieved July 14, 2020, from https://ec.europa.eu/health/sites/health/files/soc…

Habicht, T., Habicht, J., & Ginneken, E. V. (2015). Strategic Purchasing Reform in Estonia: Reducing Inequalities in Access while Improving Care Concentration and Quality. Health Policy,119(8), 1011-1016. doi:10.1016/j.healthpol.2015.06.002

Habicht, T., Reinap, M., Kasekamp, K., Sikkut, R., Laura Aaben, L., & Van Ginneken. (2018). Estonia: Health System Review. Health Systems in Transition,20(1), 1-193. Retrieved July 14, 2020, from https://www.euro.who.int/__data/assets/pdf_file/00…

International Organization for Migration [IOM]. (n.d.). Implementation of the National Roma Integration Strategy and Other National Commitments in the Field of Health: Slovakia – A Multi-Stakeholder Perspective Report on 2005–2014 Developments. Retrieved July 14, 2020, from https://eea.iom.int/sites/default/files/publicatio…

Lai, T., & Leinsalu, M. (2015). Trends and Inequalities in Mortality of Non-Communicable Diseases. Retrieved July 14, 2020, from https://www.euro.who.int/__data/assets/pdf_file/00…

Organisation for Economic Co-operation and Development [OECD]. (2017a, March). OECD Health Policy Overview: Health Policy in Estonia. Retrieved July 14, 2020, from http://www.oecd.org/els/health-systems/Health-Poli…

Organisation for Economic Co-operation and Development [OECD]. (2017b). State of Health in the EU: Estonia Country Health Profile 2017. Retrieved July 14, 2020, from https://www.euro.who.int/__data/assets/pdf_file/00…

Organisation for Economic Co-operation and Development [OECD]. (2017c). State of Health in the EU: Slovak Republic Country Health Profile 2017. Retrieved July 14, 2020, from https://www.euro.who.int/__data/assets/pdf_file/00…

Smatana, M., Pažitný, P., Kandilaki, D., Laktišová, M., Sedláková, D., Palušková, M., . . . Spranger, A. (2016). Slovakia: Health System Review. Health Systems in Transition,18(6), 1-210. Retrieved July 14, 2020, from https://www.euro.who.int/__data/assets/pdf_file/0011/325784/HiT-Slovakia.pdf?ua=1(24.7.2017)

Teitelbaum, J. B., & Wilensky, S. E. (2013). Essentials of Health Policy and Law (2nd ed.).
Burlington, MA: Jones & Bartlett Learning.

United Nations Human Development Report Office [HDRO]. (2019). 2019 Human Development Index Ranking. Retrieved July 14, 2020, from http://hdr.undp.org/en/content/2019-human-developm…

United Nations World Health Organization [WHO]. (n.d.). Promoting Health and Reducing Health Inequities by Addressing the Social Determinants of Health. Retrieved July 14, 2020, from https://www.euro.who.int/__data/assets/pdf_file/00…

United States Central Intelligence Agency’s World Factbook [CIA World Factbook]. (n.d.). Country Comparison: Infant Mortality Rate. Retrieved July 14, 2020, from https://www.cia.gov/library/publications/the-world…

United States Social Security Administration [SSA]. (2018a). Estonia. Retrieved July 14, 2020, from https://www.ssa.gov/policy/docs/progdesc/ssptw/201…

United States Social Security Administration [SSA]. (2018b). Slovakia. Retrieved July 14, 2020, from https://www.ssa.gov/policy/docs/progdesc/ssptw/201…

Wilkinson, R. G., & Pickett, K. (2010). The Spirit Level: Why Greater Equality Makes Societies Stronger. New York, NY: Bloomsbury Press.

World Bank, The. (n.d.a). GDP per capita, PPP (current international $). Retrieved July 14, 2020, from https://data.worldbank.org/indicator/NY.GDP.PCAP.P…

World Bank, The. (n.d.b). GINI index (World Bank estimate). Retrieved July 14, 2020, from https://data.worldbank.org/indicator/SI.POV.GINI/

Odion Clunis

RE: Discussion – Week 8

COLLAPSE

Health Status in the European Union

A brief comparison of the health status of Denmark and Hungary to the U.S.

The health status of Denmark and Hungary have significant social determinates of health that impact their communities’ health and well-being. In 2017, the life expectancy at birth of the Danish population was 81.1 years(OECD,2019). Moreover, 17 % of Denmark’s adults were daily smokers, down from 30 % in 2000, and below the EU average(OECD, 2019). At birth in Hungary, life expectancy increased by approximately four years between 2000 and 2015, to 75.7 years, but remains almost five years below the EU average of 80.6 years(OECD,2017). Significant inequalities exist in health status across socioeconomic groups, driven by increased exposure to risk factors and disparities in access to health care(OECD, 2017). In Hungary, smoking among people with low education levels are more than two times greater than among the most educated(OECD, 2017). In Denmark, reductions in deaths from cardiovascular diseases, linked to reductions in smoking as a risk factor. Both countries have put forth efforts to develop programs that address social determinates of health across regions. Compared to the U.S., Life expectancy at birth in the United States for the total population was 78.6 years in 2017(CDC,2018).

Two efforts in those EU countries to reduce health inequities

1. Hungary: Opre Roma, which translates as ‘Rise Roma,’ is a housing and empowerment project based in Debrecen, which is in the eastern region of Hungary, that seeks to improve life quality for people living in slum housing (EuroHealthNet, 2010).

2. Denmark: The Municipality of Guldborgsund developed a health promotion project that involved a public-private partnership (PPP) with local employers. The program sought to improve the health of obese, inactive men with little or no education(EuroHealthNet, 2010).

Lessons learned from the EU efforts that can be implemented in the U.S., Nationally or by individual States

In Hungary, they utilize a single-payer system, with the central government playing a dominant role. The central government has almost exclusive power to formulate strategic direction and to issue and enforce regulations(OECD, 2017). Also, in Hungry, ownership of hospitals was transferred from local to the central government. The Health systems merged with local government and reorganized the health system in 2015 and made the National Healthcare Service Center, the umbrella organization for other formerly independent authorities. It is now the leading organization for health provision(OECD, 2017).

On the other hand, the Danish health system remains decentralized for service provision and public health. Structural reforms in 2007 merged 14 counties into five more prominent regions and consolidated the municipalities from 275 to 98(OECD,2019). These reforms also rationalized the hospital network to create fewer, more extensive, and more specialized hospitals(OECD,2019. Improving quality and cost control provided the political motivation for these reforms to centralize and concentrate resources(OECD,2019).

How the community might adapt these interventions

The community can benefit from programs aimed at increasing education to lower the health risk associated with low socioeconomic status. Moreover, my community can benefit from becoming more involved with the residents within the community to better understand the needs and gaps within the population’s health. Additionally, raising awareness encourages leadership to improve health equity by building capacities to enable professionals to advocate successfully(EuroHealthNet, 2010). The consistent implementation of tools and mechanisms, such as impact assessments that include a focus on health inequalities and economic evaluations, will continue to improve Americans’ health in an upward trajectory.

References

CDC. (2018). Health, United States 2018 Chartbook. https://www.cdc.gov/nchs/data/hus/hus18.pdf.

OECD/European Observatory on Health Systems and Policies. (2019). Denmark: Country Health Profile 2019: en. https://www.oecd.org/health/denmark-country-health-profile-2019-5eede1c6-en.htm.

OECD/European Observatory on Health Systems and Policies. (2017). State of Health in the EU Hungary. https://ec.europa.eu/health/sites/health/files/state/docs/chp_hu_english.pdf.

EuroHealthNet. (2010). Lessons from the DETERMINE – EuroHealthNet. https://eurohealthnet.eu/sites/eurohealthnet.eu/files/publications/Working-Document-6-Lessons-from-pilot-Projects.pdf.

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Health Status in the European Union

A brief comparison of the health status of Denmark and Hungary to the U.S.

Two efforts in those EU countries to reduce health inequities

Lessons learned from the EU efforts that can be implemented in the U.S., Nationally or by individual States

How the community might adapt these interventions

References

CDC. (2018). Health, United States 2018 Chartbook. https://www.cdc.gov/nchs/data/hus/hus18.pdf.

OECD/European Observatory on Health Systems and Policies. (2019). Denmark: Country Health Profile 2019: en. https://www.oecd.org/health/denmark-country-health-profile-2019-5eede1c6-en.htm.

OECD/European Observatory on Health Systems and Policies. (2017). State of Health in the EU Hungary. https://ec.europa.eu/health/sites/health/files/state/docs/chp_hu_english.pdf.

EuroHealthNet. (2010). Lessons from the DETERMINE – EuroHealthNet. https://eurohealthnet.eu/sites/eurohealthnet.eu/files/publications/Working-Document-6-Lessons-from-pilot-Projects.pdf.