Medical tourism (also called medical travel, health tourism or global health care) is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of traveling across international borders to obtain health care.

Such services typically include elective procedures as well as complex specialized surgeries such as joint replacement (knee/hip), cardiac surgery, dental surgery, and cosmetic surgeries. However, virtually every type of health care, including psychiatry, alternative treatments, convalescent care and even burial services are available. As a practical matter, providers and customers commonly use informal channels of communication-connection-contract, and in such cases this tends to mean less regulatory or legal oversight to assure quality and less formal recourse to reimbursement or redress, if needed.

Over 50 countries have identified medical tourism as a national industry. However, accreditation and other measures of quality vary widely across the globe, and there are risks and ethical issues that make this method of accessing medical care controversial. Also, some destinations may become hazardous or even dangerous for medical tourists to contemplate.

Adapted from the Wikipedia article Health care industry, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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The study of height is known as auxology. Growth has long been recognized as a measure of the health of individuals, hence part of the reasoning for the use of growth charts. For individuals, as indicators of health problems, growth trends are tracked for significant deviations and growth is also monitored for significant deficiency from genetic expectations. Genetics is a major factor in determining the height of individuals, though it is far less influential in regard to populations. Average height is increasingly used as a measure of the health and wellness (standard of living and quality of life) of populations. Attributed as a significant reason for the trend of increasing height in parts of Europe is the egalitarian populations where proper medical care and adequate nutrition are relatively equally distributed. Changes in diet (nutrition) and a general rise in quality of health care and standard of living are the cited factors in the Asian populations. Average height in the United States has remained essentially stagnant since the 1950s even as the racial and ethnic background of residents has shifted. Severe malnutrition is known to cause stunted growth in North Korean, portions of African, certain historical European, and other populations. Diet (in addition to needed nutrients; such things as junk food and attendant health problems such as obesity), exercise, fitness, pollution exposure, sleep patterns, climate (see Allen’s rule and Bergmann’s Rule for example), and even happiness (psychological well-being) are other factors that can affect growth and final height.

Adapted from the Wikipedia article Human height, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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Comparison of the health care systems in Canada and the United States are often made by government, public health and public policy analysts. The two countries had similar health care systems before Canada reformed its system in the 1960s and 1970s. The United States spends much more money on health care than Canada, on both a per-capita basis and as a percentage of GDP. In 2006, per-capita spending for health care in Canada was US$3,678; in the U.S., US$6,714. The U.S. spent 15.3% of GDP on health care in that year; Canada spent 10.0%. In 2006, 70% of health care spending in Canada was financed by government, versus 46% in the United States. Total government spending per capita in the U.S. on health care was 23% higher than Canadian government spending, and U.S. government expenditure on health care was just under 83% of total Canadian spending (public and private) though these statistics don’t take in to account population differences.

Studies have come to different conclusions about the result of this disparity in spending. A 2007 review of all studies comparing health outcomes in Canada and the US in a Canadian peer-reviewed medical journal found that “health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.” Life expectancy is longer in Canada, and its infant mortality rate is lower than that of the U.S., but there is debate about the underlying causes of these differences. One commonly-cited comparison, the 2000 World Health Organization’s ratings of “overall health service performance”, which used a “composite measure of achievement in the level of health, the distribution of health, the level of responsiveness and fairness of financial contribution”, ranked Canada 30th and the U.S. 37th among 191 member nations. This study rated the US “responsiveness”, or quality of service for individuals receiving treatment, as 1st, compared with 7th for Canada. However, the average life expectancy for Canadians was 80.34 years compared with 78.6 years for residents of the U.S.

A 2004 study found that Canada had a slightly higher mortality rate for acute myocardial infarction (a kind of heart disease), because of the more conservative Canadian approach to revascularizing (opening) coronary arteries.

The WHO’s study methods were criticized by some analyses.

Although there is a measure of consensus that life-expectancy and infant mortality mark the most reliable ways to compare nation-wide health care, a recent report by the Congressional Research Service carefully summarizes some recent data and notes the “difficult research issues” facing international comparisons.

The health care system in Canada is funded by a mix of public (70%) and private (30%) funding, with most services delivered by private (both for-profit and not-for-profit) providers.

Through all entities in its public-private system, the U.S. spends more per capita than any other nation in the world, but is the only wealthy industrialized country in the world that lacks some form of universal health care. In March 2010, the US Congress passed regulatory reform of the American ”health insurance” system. However since this legislation is not fundamental ”health care” reform, it is unclear what its effect will be and as the new legislation is implemented in stages, with the last provision in effect in 2018, it will be some years before any empirical evaluation of the full effects on the comparison could be determined.

Health care costs in both countries are rising faster than inflation. As both countries consider changes to their systems, there is debate over whether resources should be added to the public or private sector. Although Canadians and Americans have each looked to the other for ways to improve their respective health care systems, there exists a substantial amount of conflicting information regarding the relative merits of the two systems. In Canada, the United States is used as a model and as a warning against increasing private sector involvement in financing health care. In the U.S., meanwhile, Canada’s mostly monopsonistic health system is seen by different sides of the ideological spectrum as either a model to be followed or avoided.

Adapted from the Wikipedia article Comparison of the health care systems in Canada and the United States, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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Primary health care, often abbreviated as PHC, is essential health care based on practical, scientifically sound and socially acceptable methods and technology that are universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at at every stage of their development in the spirit of self-determination (Alma Ata international conference definition)

It was a new approach to health care that came into existence following this international conference in Alma Ata in 1978 organized by the World Health Organisation and the UNICEF.

Primary health care was accepted by the member countries of WHO as the key to achieving the goal of Health for all.

As people all over the world become more and more frustrated at the inability of today’s health systems and services to meet their needs, demand for a renewal of primary health care – and health for all – is increasing.

Selective primary health care is a form of primary healthcare in which diseases are more specifically targeted in developing countries to initiate the process of primary health care. In developing primary health care, which is the ultimate goal, selective primary health care can be a very useful tool in helping to alleviate some of the more pressing issues.

Adapted from the Wikipedia article Primary health care, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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Oregon AFL-CIO is a federation of labor unions in the U.S. state of Oregon that promotes the rights of working people in the electoral and legislative arenas on the local, state and national level. It is an affiliate of the national AFL-CIO. In the past several years, the Oregon AFL-CIO has played a leadership role in Oregon’s ballot initiative process, working in coalition with other labor unions, businesses and community groups to defeat several conservative ballot measures like paycheck deception and Taxpayer Bill of Rights (Measure 48). They have also played a lead role in several ballot measure victories, including passing a minimum wage initiative (Measure 25) in 2002 by a 3-1 margin. Oregon’s minimum wage increased to $7.80 an hour on January 1, 2007, due to its automatic cost of living adjustment.

Other top issues include affordable health care, Social Security and other retirement security, workforce development, right-to-organize, and more. Headquarters are in Salem, with a second office in Portland.

Adapted from the Wikipedia article Oregon AFL-CIO, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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To put Health Transfer in context, it is useful to understand from a historical perspective how First Nations, Inuit, Métis and the Federal Government through Indian and Northern Affairs have worked together to respond to Aboriginal peoples expressed desire to manage and control their own health programs.

1969 White Paper

Federal Government Policy Paper which proposed to remove the status of treaty individuals under the Indian Act and to discontinue special services so identified, advocating the increased assimilation of Indigenous people into the culture of Canada.

1970 Red Paper

Aboriginal response to the White Paper emphasizing federal responsibility for health care to First Nation peoples and emphasizing plans to strengthen community control of their lives and of government-delivered community programs.

1975 Indian Relationships Paper

The White and Red Papers served as an impetus for the collaborative effort of the Federal Government and Aboriginal to begin serious planning for the future.

This resulted in the 1975 paper, The Canadian Government/The Canadian Indian Relationships, which defined a policy framework for strengthening Indian control of programs and services. In the health sector, under contribution agreements 75% of the Bands became responsible for such programs as the Native Alcohol and Drug Abuse Program and the Community Health Representative Program.

1979 Indian Health Policy

The Federal Indian Health Policy is based on the special relationship of the Aboriginal/Indian people to the Federal Government, a relationship which both the Indian people and the Government are committed to preserving. It recognizes the circumstances under which many Indian communities exist, which have placed Indian people at a grave disadvantage compared to most other Canadians in terms of health, as in other ways.

The stated goal of the Indian Health Policy adopted by the Federal Government on September 19, 1979, is “to achieve an increasing level of health in Indian communities, generated and maintained by the Indian communities themselves”. In this regard the policy recognized the historic responsibilities of both federal and provincial governments in providing health services to First Nations and Inuit people, and it removed the issue of treaty rights from health policy considerations to where it rightly belonged – Indian Affairs. The policy reasoned that improvements to the health status of the Indian population should be built on three pillars: (1) community development, both socio-economic and cultural/spiritual, to remove the conditions which limit the attainment of well-being; (2) the traditional trust relationship between Indian people and the federal government; and (3) the interrelated Canadian health system, with its federal, provincial, municipal, Indian and private sectors.

A further important aspect of the new policy was the recognition that First Nation and Inuit communities could take over any or all aspect(s) of the administration of their own community health programs, at their discretion and with the support of the Department of National Health and Welfare.

1980 (Berger Report)

The report of the Advisory Committee on Indian and Inuit Health Consultation knoes as the “Berger report”. Recommended methods of consultation that would ensure substantive participation by First Nations and Inuit people in the design, management and control of health care services in their communities.

1983 (Penner Report)

The Report of the Special Committee on Indian Self-Government knows as the “Penner Report” recommended that the Federal government establish a new relationship with First Nations and Inuit people and that an essential element of this relationship be recognition of Indian Self-Government. The report identified health as a key area for takeover.

1983-86 Community Health Projects

First Nations and Inuit Health Branch sponsored demonstration projects for First Nations. The experiment was initiated to provide both Federal and First Nation authorities with the same substantive information with respect to First Nation control of health services.

1986 The Sechelt Band Self-Government Act

The Sechelt Indian Band Self-Government Act was passed by Parliament in 1986. In April of the following year, the British Columbia Legislative Assembly unanimously passed a bill to give the Sechelt community municipal status. Consequently, the Sechelt Indian Band signed the first Self-Government agreement in which a First Nation community assumed control of their health services.

1988 Health Transfer South of the 60th Parallel

In order for First Nations and Inuit Health Branch to proceed with health transfer to First Nations as part of administrative reform, the policy framework, authorities and resources had to be developed and secured. A Subcommittee on the Transfer of Health Programs to Indian Control was established with representation from First Nations with experience in health care. The Subcommittee incorporated the experiences from the Community Health Projects and recommended a developmental and consultative approach for health transfer. These recommendations were then used to finalize the health transfer policy framework.

On March 16, 1988, the Federal Government Cabinet approved the health transfer policy framework for transferring resources for Indian health programs south of the 60th parallel to Indian control through a process which:

permits health program control to be assumed at a pace determined by the community, i.e., the community can assume control gradually over a number of years through a phased transfer;

enables communities to design health programs to meet their needs;

requires that certain mandatory public health and treatment programs be provided;

strengthens the accountability of Chiefs and Councils to community members;

gives communities:

the financial flexibility to allocate funds according to community health priorities and to retain unspent balances;

the responsibility for eliminating deficits and for annual financial audits and evaluations at specific intervals;

permits multi-year (three to five year) agreements;

does not prejudice treaty or Aboriginal rights;

operates within current legislation;

is optional and open to all First Nation communities south of the 60th parallel.

1989 Treasury Board Authorities for Transfer

In 1989, Treasury Board approved the financial authorities and resources to support pre-transfer planning and to fund community health management structures.

Adapted from the Wikipedia article Indian Health Transfer Policy (Canada), under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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There are many social, environmental and physical causes of developmental disabilities, although for some a definitive cause may never be determined. Common factors causing developmental disabilities include:

* Brain injury or infection before, during or after birth.

* Growth or nutrition problems.

* Abnormalities of chromosomes and genes.

* Birth long before the expected birth date – also called extreme prematurity.

* Poor diet and health care.

* Drug misuse during pregnancy, including alcohol intake and smoking.

* Child abuse, which can severely affect a child’s socio-emotional development.

* An autism spectrum disorder.

Developmental disabilities affect between 1 and 2% of the population in most western countries, although many government sources acknowledge that statistics are flawed in this area. The worldwide proportion of people with developmental disabilities is believed to be approximately 1.4%. It is twice as common in males as in females, and some researchers have found that the prevalence of mild developmental disabilities is likely to be higher in areas of poverty and deprivation, and among people of certain ethnicities.

Adapted from the Wikipedia article Developmental disability, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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Healthy Black Family Project

The Healthy Black Family Project (HBFP) concentrates on several East End neighborhoods of Pittsburgh. This area, called the Health Empowerment Zone, has a high percentage of Black residents and of residents living below the federal poverty line. HBFP works with individuals and families, providing a variety of activities and services to help prevent diabetes and hypertension.

HBFP provides health coaches, lay health advocates, and nutritionists at no cost to help families alter their activity and diet to create and maintain a healthy lifestyle. They offer cooking classes, exercise classes, walking clubs, a smoking cessation program, as well as yoga, tai chi, and meditation classes, all designed to promote a healthy lifestyle and prevent disease.

In addition, HBFP provides genetic counseling to ascertain family health history and any risks that might be associated with it, as well as giving a health risk assessment to create a personal health analysis, and they help individuals learn practical ways to handle chronic disease.

Healthy Black Families Project also implements the “Small Steps, Big Rewards” campaign, inspired by the findings of a NIH sponsored study, HHS’ Diabetes Prevention Program (DDP) clinical trial. This study has shown that individuals with pre-diabetes (those whose blood glucose levels are higher than normal but not yet diabetic), can delay and possibly even prevent type 2 diabetes simply by making moderate changes in diet and exercise that enable them to lose five to seven percent of their body weight. Regular physical activity such as a brisk thirty minute walk five times per week, and modest weight loss could cut the risk of developing type 2 diabetes by more than half in pre-diabetic individuals. These lifestyle changes were shown to be especially successful in individuals over age 65. HBFP has every confidence that these methods will prove effective in Pittsburgh’s neighborhoods.

The Healthy Black Family Project provides the framework for all of these programs, and tracks the progress of the families and individuals who are involved. Approximately 6000 individuals have enrolled in the program.

“The overall goal of the Healthy Black Family Project,” said Dr. Angela Ford, associate director of the center, “is to close the gap in health status between blacks and whites through coordinated community mobilization that is culturally relevant and grounded in a public health approach.”

Take A Health Professional to the People

A serious gap or disparity in health outcomes and access to medical care continues to exist for racial or ethnic groups, despite the efforts of government, community leaders, and healthcare providers. The problem is complex and entrenched, involving policy barriers, as well as cultural, social, and economic issues, and therefore demands fresh, creative solutions.

Take a Health Professional to the People Day is just the sort of innovative solution needed to address this serious disparity problem. Part of the Health Advocates In Reach (HAIR) program, it sends doctors, nurse, pharmacists and health educators into the barber shops and beauty salons of underserved communities to deliver health screenings and health education in a familiar, comfortable environment. Stephen B. Thomas, PhD, the director of CMH explains, “Far too many African Americans have no ‘medical home’ to access health care services, so government programs that promote ‘taking a loved one to the doctor’ are not as effective for this community. Therefore, CMH created Take a Health Professional to the People Day. By focusing our efforts on a single day, we believe we can help generate a greater understanding of the importance of regular health screenings while at the same time reaching people who tend to have the least access to healthcare.”

The Center for Minority Health inaugurated “Take a Health Professional to the People Day in 2002, starting with just three barber shops and salons. The program now includes nine beauty salons and barber shops, and over one hundred health professionals, some of whom continue to work with the shops in an on-going effort to provide health and wellness activities there.

In 2007, CMH linked forces with the Mayo Clinic Urban Immersion Program for ‘Take a Health Professional to the People Day’. Eight Mayo staff members traveled to Pittsburgh to gain valuable experience in delivering health care in a non-traditional setting. Dr. Sherine Gabriel, director of Education Resources for the Mayo Clinic Center for Translational Science Activities (CTSA), states, “We created the Urban Immersion Program in collaboration with Dr. Stephen Thomas and the CMH to help our students, faculty, researchers and physicians learn and apply these innovative community outreach strategies here at Mayo Clinic.”

Health Disparity Working Groups

Health Disparity Working Groups are charged with planning and organizing health promotion activities that will be implemented during National Minority Health Month (NMHM), which occurs every April. Each group in this diverse collection, brought together from the academic community, health providers, health promotion and human service organizations, and community representatives, organizes health promotion events that focus on the seven health disparity priorities of CMH.

These NMHM community-based events and activities are deeply rooted in the history of the Black community. They are modeled on the Health Improvement Week, which under the leadership of Booker T. Washington evolved into the National Negro Health Movement, and was annually observed for 35 years. Local NMHM activities are planned to be of value and interest for the entire family – including health, mental health, and wellness screenings, as well as physical activity and entertainment that features the world famous Double Dutch Divas.

In addition to their responsibilities of planning for NMHM, the Working Groups are also valuable as an ideal forum where materials and ideas related to research studies and the EXPORT Health communication campaign can be field tested. Representing, as they do, a wide-base of constituents and organizations, they also provide a large network for disseminating valuable information to the community.

Healthy Class of 2010

The Healthy Class of 2010 is a multi-year campaign designed to prevent disease and to promote health among students in the Pittsburgh Public Schools. Initiated in the 2003-2004 academic year, targeting those students who entered sixth grade that year, the program has a twofold goal: 1) to enable staff to systematically engage every student who entered sixth grade in 2003 in “active living”; and 2) to increase students’ knowledge, attitudes and healthy choices regarding physical activity, nutrition, and a tobacco-free lifestyle. The program, which partners with the Pittsburgh Public School System and the Allegheny County Health Department, follows the student’s progress toward achieving these goals, tracking them over a seven-year period through the year 2010, when they graduate. The Center for Minority Health is working toward making the Class of 2010 the healthiest students ever to graduate from the Pittsburgh Public School System, to coincide with the deadline set for Healthy People 2010, the nation’s health promotion program.

This unique collaboration between the Center for Minority Health (CMH), Graduate School of Public Health at the University of Pittsburgh, and the Pittsburgh Public Schools, focuses on partnership building between school administrators, teachers, students and their families, and the public health community. This creates a unique opportunity to address community needs of eliminating health disparities by customizing relevant interventions to address student health issues.

Adapted from the Wikipedia article Center for Minority Health, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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His life work has been largely dedicated to bringing mindfulness into the mainstream of medicine and society. Kabat-Zinn is the author or co-author of scientific papers on mindfulness and its clinical applications. He has written two bestselling books: ”Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness” (Delta, 1991), and ”Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life” (Hyperion, 1994). He co-authored with Myla Kabat-Zinn ”Everyday Blessings: The Inner Work of Mindful Parenting”, (Hyperion, 1997). Other books include ”Coming to Our Senses” (Hyperion, 2005) and his most recent book ”The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness”, co-authored with J. Mark G. Williams, John D. Teasdale and Zindel V. Segal (Guilford, 2007).

Kabat-Zinn has made significant contributions to modern health care with his research which focused on mind/body interactions for healing, and on various clinical applications of mindfulness meditation training for people with chronic pain and/or stress-related disorders. Kabat-Zinn began teaching the Mindfulness-Based Stress Reduction (MBSR) at the Stress Reduction Clinic in 1979. MBSR is an eight week course which combines meditation and Hatha yoga to help patients cope with stress, pain, and illness by using moment-to-moment awareness. Such mindfulness helps participants use their inner resources to achieve good health and well being. Kabat-Zinn and colleagues have studied the effects of practising moment-to-moment awareness on the brain, and how it processes emotions, particularly under stress, and on the immune system.

In 1993, Kabat-Zinn’s work in the Stress Reduction Clinic was featured in Bill Moyers’s PBS special ”Healing and the Mind” and in the book by Moyers of the same title. Kabat-Zinn and his colleagues published a research paper demonstrating in a small clinical trial a fourfold effect of the mind on the rate of skin clearing in patients with psoriasis undergoing ultraviolet light therapy. A more recent paper shows positive changes in brain activity, emotional processing under stress, and immune function in people taking an MBSR course in a corporate work setting in a randomized clinical trial.

Adapted from the Wikipedia article Jon Kabat-Zinn, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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Health Advocate is a health advocacy firm that provides a range of services to companies and their employees. The privately-held company was founded in 2001 by former Aetna executives in Plymouth Meeting, Pennsylvania. The company employs registered nurses, medical directors and benefits specialists. Health Advocate provides clients with access to professionals who address a range of health care and health insurance issues.

Health Advocate was named by Inc. magazine as one of America’s 500 fastest-growing private companies in 2007, 2008, and 2009.

Adapted from the Wikipedia article Health Advocate, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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