Florida residents who can afford health insurance pay an average of $11,480 per year for family coverage, which is about what the average minimum-wage earner brings home. Premiums are up 87% according to Kaiser Family Foundation. The days of “low-cost” health insurance are all but gone unless you have help from a professional insurance consultant.

The cost of caring for “disease” continues to rise faster than inflation according to an article this month in Newsweek magazine. It said “over 47 million Americans don’t have health insurance at all”. Those with low-cost health insurance usually get these from employers, but with costs rising, it is obvious that the health insurance situation in Florida is getting worse.

Taking care of employees is the primary concern of a good employer. But that has been perceived as “expensive” by some companies as it means providing the employee with vacations, bonuses, incentive pay, and of course, health insurance coverage. In the future, Florida businesses may be able to offer low-cost health insurance to residents who are willing to make a few changes in lifestyle.

The New England Journal of Medicine published a major study on health insurance recently that said low cost insurance rates may be made available to those willing to go through a certified “health risk assessment”. These health risk managers look at your lifestyle, and your current state of health, and certify that the person is “healthy” and a “low-risk” which can qualify the applicant for lower insurance rates. The only other way to get low-cost health insurance in Florida is to get it from your employer as part of their group health insurance plan.

There are many health insurance consultants out there who can help Floridians find low-cost insurance, such as Florida Health Insurance Web – www.FloridaHealthInsuranceWeb.com – insurance consultant, Morgan Moran said, “Change a few things about your lifestyle, and lower rates could be available”. The insurance industry believes, most people would change a few things to get lower insurance rates, and assure living a longer happier life. These changes may include a better diet, more exercise, and less high risk behavior like “skydiving″ or “bungee jumping″. Until now, insurance plans rarely took behavior into account.

Many Floridians are looking for a quick fix. If they can take a pill or have a stint plugged into their heart they would, rather than change their lifestyle, after all, it does sound easier. The New England Journal confirmed what other research showed— that angioplasties and stints don’t prolong life and don’t even prevent heart attacks, yet $30 billion was spent on those last year. Mutual of Omaha found that almost 76% percent of people eligible for angioplasty or heart bypass surgery were able to “safely avoid it by making the comprehensive lifestyle changes″, saving almost $30,000 per person. It is plain to see that changing lifestyle is more cost effective than surgery.Low-Cost Insurance Consultation

In an effort to find affordable health insurance rates, many are turning to health insurance consultants for help. In a phone interview, consultant Morgan Moran said, “The best way to find affordable, low-cost health insurance is to have an employer-sponsored group health insurance plan.” Group health insurance plans are the most affordable, low cost health insurance plans out there, aside from state-sponsored health insurance plans. If you can obtain health insurance from your employer, you will pay even less for your health insurance than you would if you purchased a group health insurance plan on your own.

Most employers have certain requirements an employee must meet before he or she can be a part of the employer-sponsored group health insurance plan. These requirements range from the number of hours the employee works, to the employee’s status, i.e., whether the employee works full-time or part-time. Employers sometimes have time requirements as well. This means the employee must be with the company for a certain amount of time before he or she is considered eligible for the employer-sponsored group health insurance plan.

Employer-sponsored group health insurance plans are usually the most affordable, low cost health insurance plans for a variety of reasons. If you have an employer-sponsored group health insurance plan, the health insurance premiums are either divided between you and your employer, or paid completely by your employer. This means one of two things. Either you are required to pay half of the health insurance premiums plus a low cost co-payment or you are only required to pay an affordable co-payment.

Employer-sponsored group health insurance plans like this have become even more affordable and low cost when you factor in your spouse and children. Rather than purchase individual health insurance policies for each of your family members, or pay out-of-pocket for health care costs, you can add your spouse and your children to your employer-sponsored group health insurance plan.

Rates on health insurance policies change daily, and vary from carrier to carrier so it’s a good idea to speak to a consultant like Moran. Their fees are paid by the carrier without passing the cost along to the consumer. Find out more at www.FloridaHealthInsuranceWeb.com

SOCIAL JUSTICE THROUGH HEALTH CARE

We hardly come across a person who may be fully satisfied with the health care delivery system run by either the government or the private sector. This is true not only for developing but for all the developed countries as well. Every law abiding, contributing individual has some legitimate expectations from the state. Disenchantment with present dispensation of health care compels people to seek better options across the borders. Even the present flow rate of patients from developed to developing countries has assumed the proportions of Medical tourism. Medical tourism is not a one-way traffic. Poor from India are known to visit Rashid Hospital at Lahore for kidney transplants. Medical tourism will definitely bring in world class equipment and services in our corporate hospitals. These corporate tertiary care hospitals can act as excellent referral hospitals. Lack of enough clinical material, as the patients are often referred to in medical parleyences is prompting the doctors from developed world into medical adventurism. Very recently two NGO′s headed by renowned plastic surgeons of Indian origin were in India, claiming to their credit hundreds of cleft lip and palate surgeries conducted in one week. During my brief interaction when I asked them one basic question that how do you justify single step surgery by a single specialist for a clinical entity that require 3-5 set up surgeries by 10 specialists over a period of 20 years, there was no answer. On record local doctors conduct all these surgeries. These NGO′s bring in a battery of trainee resident doctors for hands on training. Dumping of questionable services and drugs continues unabated in the absence of stringent regulations. Clear-cut up to date guidelines by health authorities have yet to be issued to safe guard the health interests of this nation. Most of the drugs banned in developed countries are still being dumped in the Indian market. Commerce alone dictates the policies of multinational companies in health sector of developing countries. State and national medical councils, the watch dogs of our national health interests are controlled by elected representatives from among the doctors. Competitive populism for being elected to these high offices takes away the very sting off these regulators. In this ‘market forces’ driven health sector, apart from other factors, size of the population, economic prosperity and literacy levels dictate the out look of key players. Subjective as well as objective assessments of the health care operations leave people confused with huge piles of data and endless interpretations. At the tail end of govt. health care delivery system is the rural dispensary or the slum revamping center, and the end user an illiterate or semi literate villager or a slum dweller. Dispensary is the humane face, the welfare state can present to its people. In yesteryears the service providers were from among the same social class they used to serve. Doctor can be a friend, philosopher and guide to the locals. Unfortunately the economic and social disparity between the service providing doctors and the service user population has grown enormously. Ad-hocism in health care delivery should be done away with immediate effect. Doctors and paramedical staff appointed on yearly contract basis are not showing any interest in the national programmes. Established private health care providers also have not shown any meaningful commitment for national programmes. Middle class itself has fragmented. Now it is fashionable to assign economic values to any issue like gender, but for social responsibility and justice. In this era of fast paced growth, the unorganized, silently suffering millions can not be wished away. Once reading on biodiversity I stumbled upon a very interesting quote, “only the species with economic importance will survive”. In our active pursuit for magnetizing economy, we assigned economic values to any thing except for morals. Commercialization of education has produced a new breed of professionals who have scant regard for professional ethics. Privatization is the buzzword with governments, because it takes away government responsibility. Private sector players are eyeing many ‘viable’ health institutions. There are no takers for commercially non-viable rural institutions. Rural health institutions dispense social medicine. Very recently one of the key players from private sector health care quoted the cost of developing one bed in corporate hospital at Rs. 30-60 lacs. These corporate health services are definitely out of each of the common man. These type of hospitals are definitely required for a nation with the present rate of growth but ‘bharat’ definitely needs different kind of hospitals. There are very strong social under currents against the exploitive private healthcare, inadequate government sector health care resources and the indifferent approach of welfare state. Health for all is a very lofty but expensive proposition. There are ways and means to reduce the pressure from government institutions. Private-public partnership, health insurance, monitoring and regulation of private sector health care can all make the things bit easy. Preventive health care education can go a long way in improving the public health. Community participation in health care has produced few but wonderful examples. Complementary community participation can make up for minor but critical deficiencies in the government run health care system. Setting up of health system corporations with World Bank assistance has already improved the working of govt. sector health care institutions considerably. Community participation through NGO′s can still improve the system, but most of the meaningful NGO′s turn their back on govt. run health care institutions because of their doubts on the integrity of government officers. Government health care institution are increasingly seen not as caring hospitals but like police stations, where medico legal reports are written and postmortems conducted. Most of the government doctors’ time is spent in courts appearing as medico legal experts witnesses. Emergency, post mortem, and then the VIP duties in addition hardly leave the doctors free for any meaningful job at government hospitals. There is an urgent need to have separate curative, preventive, legal, administrate and health intelligence wings. Government hospitals attract the poorest of the poor, mostly people from the unorganized sector. Their contribution to national GDP is by no means small. With the present growth rate, upward social mobility is seen in every strata of society. Many segments of this unorganized sector can be organised so that they also enjoy the patronage of welfare state in the form of health insurance policies. Apart from direct benefit to these segments of society, the state will benefit from the ‘off loading’ of burden from government run health care system and loading it on insurance driven private sector health care institutions. Poorest of the poor will repose faith in welfare state. Sanjivini, health insurance policy with the Punjab Milkmen Cooperative Societies is already a big success. ECHS (Ex servicemen Contributory Health Scheme) is an other success story. These success stories can be replicated with countless groups like, panwallas, dhabewallas, autorikshaw drivers etc. Simply organize the unorganized sector. There is no dearth of role models from among government doctors also. Their inclusion rather than drift after dissent from the present dispensation of health care will immensely improve the system. Stability of tenure is an excellent incentive government can give to its doctors without costing anything to exchequer. Yet tenure beyond decades should be discouraged as it leads to development of vested interests of the old incumbents and denial of chance to the youngsters. Resource mismatching is a major problem in the govt. run health care system. There are dispensaries where specialists are posted and still many more civil hospitals where non-specialist are posted. These mismatching result in defective and inefficient health care. Nodal Hospitals can be created for round the clock emergency services by cannibalizing defunct and sick institutions where equipment worth crores is lying unused and salary bills are bleeding the exchequer white. Most of the medical officers retire in the same administrate rank. This undue stagnation has forced many a brilliant doctors out of service. By simply seeking options for place of posting, honestly implementing with minimum displacement on merit can also revitalize the govt. doctors’ cadres. Private sector health care delivery system is a totally market driven commercial enterprise. So called ‘market forces’ have least respect for ethical and moral value systems. Multi level marketing chains have evolved in the name of referral systems. End result is exploitation of the unsuspecting common man, who still regards his healer a holy person. This ‘incentive’ system is strengthening the hold of unqualified, unscrupulous and unregistered medical practitioners on illiterate masses. Not many qualified doctors are unscrupulous. A large section of private health care providers feel genuinely threatened by blackmailers of all sorts. Consumer protection act is a very convenient beating stick in the hands of their tormentors.

Under the constant threat of being blackmailed, the private health care providers are becoming more defensive in attitude. More patients are being referred to tertiary care institutions for this reason only, thereby flooding the referral institutions. People have a common feeling that sickness is an invitation for exploitation at the hands of private health care providers. Even the charitable hospitals are charging as heavily as fully private hospitals. Medical profession is fully responsible and capable of self-correction. Medical councils and associations can jointly evolve a fail-safe mechanism to keep their black sheep under check even without government help, but the buck stops with the government. Welfare state is duty bound not only in providing health care delivery system but also proper health care administration and social justice through its health care delivery mechanism.

Name : Dr. Pardeep Kumar Sharma

Email-ID : omfspardeep@yahoo.com.

(M) : 0988456296

Date of Birth : 12.02.1962

Education Qualifications : BDS (Bachelor of Dental Surgery)

MDS (Master of Dental Surgery in Oral and Maxillofacial Surgery)

Educational Institutes Attended

Govt. High School Bargari : Matriculation (1969-1977)

Distt. Faridkot, Punjab, India

DAV College Chandigarh : Pre-University (1973-79)

(Punjab University)

Barjindra College Faridkot : Pre-Medical (1980)

Dental Wing, Medical College : BDS (1981-1986)

Patiala

Dental College and Hospital : MDS (2003-2006)

Amritsar

Professional Experience

House Officer, Christian : 1987-1988

Medical College & Hospital,

Ludhiana

Research Officer, All India : Jan. 1989 to June 1989

Institute of Medical Science

AIIIMS, New Delhi

Dental Officer, Indian Armed : July 1989 to August 1994.

Forces in the Rank of Capt.

3

Medical Officer (Dental) : w.e.f. Nov. 1995 till date

in Punjab Civil Medical Service

(PCMS)

Research papers Published

“Role of Programmed cell death in dental anomalies associated with cleft lip and Palate”. “Medical Hypotheses” Churchil Living Stone Publishers London-1991

Post traumatic polatoglossal adhesion, a case report stomatologica India (1990).

Research Project Undertakes

“Malocclusion and associated Factors among Delhi Children″ a study sponsored by Indian Council of Medical Research (ICMR).

Areas of Interest : Environment, Health, Defence, International Affairs and Rationalism

New York Health Insurance

Health insurance is insurance that pays for all or part of a person’s health care bills. A health insurance policy is an annually renewable contract between an insurance company and an individual. With health insurance claims, the individual policy-holder pays a deductible plus co-payment (for instance, a hospital stay might require the first 1000 dollar of fees to be paid by the policy-holder plus 100 dollar per night stayed in hospital). Usually there is a maximum out-of-pocket payment for any single year, and there can be a lifetime maximum.

The purpose of health insurance is to help people cover their health care costs which usually include doctor visits, hospital stays, surgery, procedures, tests, home care, and other treatments and services.

According to the latest United States Census Bureau figures, around 85% of citizens have health insurance. 59.5% of these people receive their health insurance coverage through an employer, and about 9% purchase it directly from the market. Government sources cover 27.3% of the population. Those without health insurance coverage are expected to pay privately for medical services.

Types of New York Health Insurance (http://new-york.ixs.net/General/New-York-Health-Insurance/index.aspx ) The types of health insurance in New York are group health plans, individual plans, and government health plans such as Medicare and Medicaid. In the United States, government-funded Medicare programs help to insure the elderly and end stage renal disease patients.

Group Health Plans

A group health plan offers health care coverage for employers, student organizations, professional associations, religious organizations, and other groups. The employer may pay for part or all of the insurance cost (premium).

Individual and Family Health Insurance

Individual and family health insurance is a type of health insurance coverage that is made available to individuals and families, rather than to employer groups or organizations. These types of health care plans are sold directly to individuals. For those of you who are unemployed or self-employed, an individual health insurance policy is always an option. Unfortunately rates for these policies are high and the coverage is usually less comprehensive than a managed care plan. The good news is that, in many cases, your insurance premium will be tax deductible. Of course, if you’re married, you can always try to catch a ride on your spouse’s group health insurance benefits plan.

Health insurance can be further classified into fee-for-service or indemnity (traditional insurance) and managed care. Both group and individual insurance plans can be either fee-for-service or managed care plans.

Managed Care Health Insurance

These include HMO, PPO, and POS plans. Managed-care plans typically make use of healthcare provider networks. Healthcare providers within a network agree to perform services for managed-care plan patients at pre-negotiated rates and will usually submit the claim to the insurance company for you. In general, you’ll have less paperwork and lower out-of-pocket costs with a managed care health insurance plan and a broader choice of healthcare providers with an indemnity plan.

There are three main types of managed care plans:

• Health Maintenance Organizations (HMO)

• Point-of-Service (POS)

• Preferred Provider Organizations (PPO)

All of these plans offer substantial health insurance benefits to members and their families. If you’re fortunate enough to have a choice of plan, consider the advantages, and disadvantages, of each. Compare the cost of care, the difference in premiums, deductible amounts and your freedom to choose a doctor outside the plan. There are numerous other coverages to compare as well — from prescription drugs to dental to alternative therapies. Be sure you understand the fine points of each.

Indemnity or Fee-For-Service Plan

Normally it covers the same expenses as managed care. The difference is your doctor is paid for each visit with the claim filed by either the patient or the medical provider. A big advantage– unlike some managed care plans, Fee-for-Service allows the patient a great deal of freedom in choosing which doctors and hospitals to use, but will probably involve higher out-of-pocket costs and more paperwork.

However, you’ll likely be required to pay an annual deductible before the insurance company begins to pay on your claims. An Indemnity plan may also require that you pay up front for services and then submit a claim to the insurance company for reimbursement.

Short-Term Health Insurance

Short-term health insurance plans are designed to protect against unforeseen accidents or illnesses, rather than to provide comprehensive coverage, and, as such, typically do not include coverage for preventive care, physicals, immunizations, dental or vision care. It covers for a limited period of time, and may be an ideal solution for those between jobs or those waiting for other health insurance to start. Typically, short-term plans offer coverage up to six months, although some plans may offer coverage up to 12 months. Purchasing a short-term medical insurance plan will make you ineligible for any guaranteed issue individual health plans commonly referred to as HIPAA (Health Insurance Portability and Accountability Act) Plans. HIPAA plans are usually very expensive and are generally intended for people with pre-existing medical conditions who would have trouble getting health insurance otherwise.

Medical Savings Account (MSA)

Medical savings account (MSA) is the most recent development in the area of health insurance. The principle behind the MSA is to take the bulk of the financial risk, and premium payments, away from the managed care and indemnity insurers, and allow individuals to save money, tax free, in a savings account for use for medical expenses. Individuals or their employers purchase major-medical policies, medical insurance policies with no coverage for medical expenses until the amount paid by the patient exceeds a predetermined maximum amount, such as 2500 dollar per year. These policies have extremely high deductibles and correspondingly low monthly premiums and the participants take the money that they would have spent on higher premiums and deposit it in an MSA. This money accrues through monthly deposits and also earns interest, and can be spent only to pay for medical care

What’s The Best Health Insurance Plan?

There is no one “best” plan for everyone. The best match for you and your family may be different than the best match for someone else. In order to help you answer this question, here are a few things to consider:

1. Are you going to need long-term coverage or just something for the short-term?

If you’re between jobs for 1-6 months, you may want to go for short-term coverage options. Alternatively, if you have no prospects of receiving group health insurance coverage through an employer, you may value the stability and increased benefits offered through an individual and family health insurance plan which will provide longer term coverage.

2. Are you looking for basic coverage or more comprehensive coverage?

Some insurance plans offer basic coverage (i.e., primarily inpatient hospitalization and outpatient surgery coverage) to cover you in case of a major accident or illness. These insurance plans typically have a lower monthly premium than plans with more comprehensive coverage, and may be appropriate for people who intend to use their insurance primarily in the event of a serious accident or illness. Other insurance plans that offer more comprehensive coverage may include benefits such as preventative care, physician services, prescription drug benefits and routine office visits. These insurance plans typically have a higher monthly premium than plans that only offer basic coverage, and may be appropriate for people who intend to use their insurance on a regular basis.

3. Would you pay for your services before you use them or when you use them?

If you choose a health insurance plan with a low monthly premium, you’re likely to have a higher co-payment or deductible. If you don’t anticipate making frequent use of your health insurance coverage, a higher-deductible plan with a lower monthly premium may suit you best.

4. How important to you is easy access to specialists?

Health insurance plans that require you to coordinate your care through a primary care physician typically require that you obtain a referral before seeing a specialist. So, if you prefer easier access to specialists, you may wish to consider a different type of plan.

5. Do you have a specific doctor or hospital that you would like to visit for healthcare?

Some insurance plans utilize provider networks. Pay special attention to the network of doctors or facilities that each health insurance plan utilizes. Also note that networks utilized by health insurance plans can change, so there is no guarantee that your doctor will always be contracted with your chosen health insurance plan.

6. What is the most you could pay out in case of a serious illness or injury?

Health insurance plans typically place limits on how much a member is required to pay out per year for his or her healthcare. This limit is often referred to as an out-of-pocket maximum. Once you’ve contributed this maximum amount toward your healthcare, the health insurance company typically covers all other costs for the remainder of the benefit year. If you’re concerned about what may happen to you in case of a serious illness or injury, you may wish to pay special attention to the out-of-pocket maximums for the health insurance plans you’re considering.

No matter what insurance plan you may choose, educate yourself and understand all the basics of the health insurance before finalizing anything.

For more information about New York Health Insurance visit: http://new-york.ixs.net

Imbalance of Ecosystems and Its effect on Public and Livestock health

Dr.Kedar Karki M.V.St. (Preventive veterinary Medicine)

Central Veterinary Laboratory Tripureshwor

The health of humans, like all living organisms, is dependent on an ecosystem that sustains life. Healthy ecosystems are the sine qua non for healthy organisms. Yet there is abundant evidence that many life-support systems are far from healthy, placing an increased burden on human health. In some areas of the world, gains in life expectancy and quality of life made during the twentieth century are at risk of being reversed in the twenty-first century. The consequences of ecosystem degradation to human health are numerous, and include health risks from unsafe drinking water, polluted air, climate change, emerging new diseases, and the resurgence of old diseases owing to ecological imbalances. Reversing this damage is possible in some cases, but not in others. Prevention of ecological damage is by far the most efficient strategy.

DEFINING ECOSYSTEMS

An ecological system may be defined as a community of plants and animals interacting with each other and their abiotic, or natural, environment. Typically, ecosystems are differentiated on the basis of dominant vegetation, topography, climate, or some other criteria. Boreal forests, for example, are characterized by the predominance of coniferous trees; prairies are characterized by the predominance of grasses; the Arctic tundra is determined partly by the harsh climatic zone. In most areas of the world, the human community is an important and often dominant component of the ecosystem. Ecosystems include not only natural areas (e.g., forests, lakes, marine coastal systems) but also human-constructed systems (e.g., urban ecosystems, agro-ecosystems, impoundments). Human populations are increasingly concentrated in urban ecosystems, and it is estimated that, by the year 2010, 50 percent of the world’s population will be living in urban areas.

A landscape comprises a mosaic of ecosystems, including towns, rivers, lakes, agricultural systems, and so on. Precise boundaries between ecosystems are often difficult to establish. Often regions slide into one another gradually, over a protracted “transition” zone, as for example between the boreal forest and the Taiga regions of Canada.

ECOSYSTEM HEALTH

It is important to recognize the inherent difficulties in defining “health,” whether at the level of the individual, population, or ecosystem. The concept of health is somewhat of an enigma, being easier to define in its absence (sickness) than in its presence. Perhaps partially for that reason, ecologists have resisted applying the notion of “health” to ecosystems. Yet, ecosystems can become dysfunctional, particularly under chronic stress from human activity.Example for this can be cited the discharge of nutrients from sewage, industrial waste, or agricultural runoff into lakes or rivers affects the normal functioning of the ecosystem, and can result in severe impairment. Excessive nutrient inputs from human activity was one of the major factors that severely compromised the health of the lower Laurentian Great Lakes (Lake Erie and Lake Ontario) and regions of the upper Great Lakes (Lake Michigan). Unfortunately, degraded ecosystems are becoming more the rule than the exception.

The study of the features of degraded systems, and comparisons with systems that have not been altered by human activity, makes it possible to identify the characteristics of healthy ecosystems. Healthy ecosystems may be characterized not only by the absence of signs of pathology, but also by signs of health, including measures of vigor (productivity), organization, and resilience.

Vigor can be assessed in terms of the metabolism (activity and productivity) of the system. Ecosystems differ greatly in their normal ranges of productivity. Estuaries are far more productive than open oceans, and marshes have higher productivity than deserts. Health is not evaluated by applying one standard to all systems. Organization can be assessed by the structure of the biotic community that forms an ecosystem and by the nature of the interactions between the species (both plants and animals). Invariably, healthy ecosystems have more diversity of biota than ecologically compromised systems. Resilience is the capacity of an ecosystem to maintain its structure and functions in the face of natural disturbances. Systems with a history of chronic stress are less likely to recover from normal perturbations such as drought than those systems that have been relatively less stressed.

Healthy ecosystems can also be characterized in economic, social, and human health terms. Healthy ecosystems support a certain level of economic activity. This is not to say that the ecosystem is necessarily self-sufficient, but rather that it supports economic productivity to enable the human community to meet reasonable needs. Inevitably, ecosystem degradation impinges on the long-term sustainability of the human economy that is associated with it, although in the short-term this may not be evident, as natural capital (e.g., soils, renewable resources) may be overexploited and temporarily enhance economic returns. Similarly, with respect to social well-being, healthy ecosystems provide a basis for and encourage community integration. Historically, for example, native Hawaiian groups managed their ecosystem through a well-developed social cohesiveness that provided a high degree of cooperation in fishing and farming activity.

Another reflection of ecosystem health lies directly in the public health domain. In spring 2000, a deadly strain of the bacterium E-coli (0157:H7) entered the public water supply in Walkerton, Ontario, Canada, causing seven deaths and making thousands sick. This small town, with a population of five thousand, is in a farming community. Inadequate manure management from cattle operations was the likely source of this tragedy.

HOW HEALTHY ECOSYSTEMS BECOME PATHOLOGICAL

Stress from human activity is a major factor in transforming healthy ecosystems to sick ecosystems. Chronic stress from human activity differs from natural disturbances. Natural disturbances (fires, floods, periodic insect infestations) are part of the dynamics of most ecosystems. These processes help to “reset” ecosystems by recycling nutrients and clearing space for recolonization by biota that may be better adapted to changing environments. Thus, natural perturbations help keep ecosystems healthy. In contrast, chronic and acute stress on ecosystems resulting from human activity (e.g., construction of large dams, release of nutrients and toxic substances into the air, water, and land) generally results in long-term ecological dysfunction.

Five major sources of human-induced (anthropogenic) stresses have been identified by D. J. Rapport and A. M. Friend (1979): physical restructuring, overharvesting, waste residuals, introduction of exotic species, and global change.

Physical Restructuring. Activities such as wetland drainage, removal of shoals in lakes, damming of rivers, and road construction fragment the landscape and alter and damage critical habitat. These activities also disrupt nutrient cycling, and cause the loss of biodiversity.

Overharvesting. Overexploitation is commonplace when it comes to harvesting of wildlife, fisheries, and forests. Over long periods of time, stocks of preferred species are reduced. For example, the giant redwoods that once thrived along the California coast now exist only in remnant patches because of overharvesting. When dominant species like the giant redwoods (arguably the world’s tallest tree—one specimen was recorded at 110 meters tall with a circumference of 13.4 meters) are lost, the entire ecosystem becomes transformed. Overharvesting often results in reduced biodiversity of endemic species, while facilitating the invasion of opportunistic species.

Waste Residuals. Discharges from municipal, industrial, and agricultural sources into the air, water, and land have severely compromised many of the earth’s ecosystems. The effects are particularly apparent in aquatic ecosystems. In some lakes that lack a natural buffering capacity, acid precipitation has eliminated most of the fish and other organisms. While the visual effect appears beneficial (water clarity goes up) the impact on ecosystem health is devastating. Systems that once contained a variety of organisms and were highly productive (biologically) become devoid of most lifeforms except for a few acid-tolerant bacteria and sediment-dwelling organisms.

Introduction of Exotic Species. The spread of exotics has become a problem in almost every ecosystem of the world. Transporting species from their native habitat to entirely new ecosystems can wreck havoc, as the new environments are often without natural checks and balances for the new species. In the Great Lakes Basin, the accidental introduction of two small pelagic fishes, the alewife and the rainbow smelt, combined with the simultaneous overharvesting of natural predators, such as the lake trout, led to a significant decline in native fish species. The introduction of the sea lamprey, an eel-like predacious fish that attacks larger fish, into Lake Erie and the upper Great Lakes further destabilized the native fish community. The sea lamprey contributed to the demise of the deepwater benthic fish community by preying on lake trout, whitefish, and burbot. This contributed to a shift in the fish community from one that had been dominated by large benthics to one dominated by small pelagics (fish found in the upper layers of the lake profile). This shift from bottom-dwelling fish (benthic) to surface-dwelling fish (pelagic) has now been partially reversed by yet another accidental introduction of an exotic: the zebra mussel. As the zebra mussel is a highly efficient filter of both phtyoplankton and zooplankton, its presence has reduced the available food in the surface waters for pelagic fish. However, while the benthic fish community has gained back its dominance, the preferred benthic fish species have not yet recovered owing to the degree of initial degradation. Overall, the increasing dominance by exotics not only altered the ecology, but also reduced significantly the commercial value of the fisheries.

Global Change. Rapid climate change (or climate warming) is an emerging potential global stress on all of the earth’s ecosystems. In evolutionary time, there have of course been large fluctuations in climate. However, for the most part these fluctuations have occurred gradually over long periods of time. Rapid climate change is an entirely different matter. By altering both averages and extremes in precipitation, temperature, and storm events, and by destabilizing the El Niño Southern Oscillation (ENSO), which controls weather patterns over much of the southern Pacific region, many ecosystem processes can become significantly altered. Excessive periods of drought or unusually heavy rains and flooding will exceed the tolerance for many species, thus changing the biotic composition. Flooding and unusually high winds contribute to soil erosion, and at the same time add to nutrient load in rivers and coastal waters.

These anthropogenic stresses have compromised ecosystem function in most regions of the world, resulting in ecosystem distress syndrome (EDS). EDS is characterized by a group of signs, including abnormalities in nutrient cycling, productivity, species diversity and richness, biotic structure, disease prevalence, soil fertility, and so on. The consequences of these changes for human health are not inconsiderable. Impoverished biotic communities are natural harbors for pathogens that affect humans and other species.

ECOSYSTEM HEALTH AND HUMAN HEALTH

An important aspect of ecosystem degradation is the associated increased risk to human health. Traditionally, the concern has been with contaminants, particularly industrial chemicals that can have adverse impacts on human development, neurological functions, reproductive functions, and that appear to be causative agents in a variety of carcinomas. In addition to these serious environmental concerns (where the remedies are often technological, including engineering solutions to reduce the release of contaminants), there are a large number of other risks to human health stemming from ecological imbalance.

Ecosystem distress syndrome results in the loss of valued ecosystem services, including flood control, water quality, air quality, fish and wildlife diversity, and recreation. One of the major signs of EDS is increased disease incidence, both in humans and other species. Human population health should thus be viewed within an ecological context as an expression of the integrity and health of the life-supporting capacity of the environment.

Ecological imbalances triggered by global climate change and other causes are responsible for increased human health risks.

Climate Change and Vector-Borne Diseases. The global infectious disease burden is on the order of several hundred million cases per year. Many vector-borne diseases are climate sensitive. Malaria, dengue fever, hantavirus pulmonary syndrome, and various forms of viral encephalitis are all in this category. All these diseases are the result of arthropod-borne viruses (arboviruses) which are transmitted to humans as a result of bites from blood-sucking arthropods.

Global climate change—particularly as it impacts both temperatures and precipitation—is highly correlated with the prevalence of vector-borne diseases. For example, viruses carried by mosquitoes, ticks, and other blood-sucking arthropods generally have increased transmission rates with rising temperatures. St. Louis encephalitis (SLE) serves as an example. The mosquito Culex tarsalis carries this virus. The percentage of bites that results in transmission of SLE is dependent on temperature, with greater transmission at higher temperatures.

The temperature dependence of vector-borne diseases is also well illustrated with malaria. Malaria is endemic throughout the tropics, with a high prevalence in Africa, the Indian subcontinent, Southeast Asia, and parts of South and Central America and Mexico. Approximately 2.4 billion people live in areas of risk, with some 350 million new infections occurring annually, resulting in approximately 2 million deaths, predominantly in young children. Untreated malaria can become a life-long affliction—general symptoms include fever, headache, and malaise.

The climate sensitivity of malaria arises owing to the nature of the interactions of parasites, vectors, and hosts, all of which impact the ultimate transmission rates to humans. The gestation time required for the parasite to become fully developed within the mosquito host (a process termed sporogony) is from eight to thirty-five days. When temperatures are in the range of 20°C to 27°C, the gestation time is reduced. Rainfall and humidity also have an influence. Both drought and heavy rains tend to reduce the population of mosquitoes that serve as vectors for malaria. In drier regions of the tropics, low rainfall and humidity restricts the survival of mosquitoes. Severe flooding can result in scouring of rivers and destruction of the breeding habitats for the mosquito vector, while intermediate rainfall enhances vector production.

Ecological Imbalances. Cholera is a serious and potentially fatal disease that is caused by the bacterium Vibrio cholerae. While not nearly so prevalent as malaria, cases are nonetheless numerous. In 1993, there were 296,206 new cases of cholera reported in South America 9,280 cases were reported in Mexico 62,964 cases in Africa and 64,599 cases in Asia. Most outbreaks in Asia, Africa, and South America have originated in coastal areas. Symptoms of cholera include explosive watery diarrhea, vomiting, and abdominal pain. The most recent pandemic of cholera involved more regions than at any previous time in the twentieth century. The disease remains endemic in India, Bangladesh, and Africa. Vibrio cholerae has also been found in the United States—in the Gulf Coast region of Texas, Louisiana, and Florida the Chesapeake Bay area and the California coast.

The increase in prevalence of V. cholerae has been strongly linked to degraded coastal marine environments. Nutrient-enriched warmer coastal waters, resulting from a combination of climate change and the use of fertilizers, provides an ideal environment for reproduction and dissemination of V. cholerae. Recent outbreaks of cholera in Bangladesh, for example, are closely correlated with higher sea surface temperatures. V. cholerae attach to the surface of both freshwater and marine copepods (crustaceans), as well as to roots and exposed surfaces of macrophytes (aquatic plants) such as the water hyacinth, the most abundant aquatic plant in Bangladesh. Nutrient enrichment and warmer temperatures give rise to algae blooms and an abundance of macrophytes. The algae blooms provide abundant food for copepods, and the increasing copepod and macrophyte populations provide V. cholerae with habitat. Subsequent dispersal of V. cholerae into estuaries and fresh water bodies allows contact with humans who use these waters for drinking and bathing. Global distribution of marine pathogens such as V. cholerae is further facilitated by ballast water discharged from vessels. Ballast water contains a virtual cocktail of pathogens, including V. cholerae.

Two other examples of how ecological imbalances lead to human health burdens concern the increased prevalence of Lyme disease and hantavirus pulmonary disease. Lyme disease, sonamed because it was first positively identified in Lyme, Connecticut, is a crippling arthritic-type disease that is transmitted by spirochete-infected Ixodes ticks (deer ticks). Ticks acquire the infection from rodents, and spend part of their life cycle on deer. Three factors have combined to increase the risk to humans of contracting Lyme disease, particularly in North America: (1) the elimination of natural deer predators, particularly wolves; (2) reforestation of abandoned farmland has created more favorable habitat for deer; and (3) the creation of suburban estates, which the deer find ideal habitat for browsing. The net result is a rising deer population, which increases the chances of humans coming into more contact with ticks.

By 1995, in the southwestern United States, hantavirus infection was confirmed in ninety-four persons in twenty states, with 48 percent mortality. Variants of the strain that causes hantavirus pulmonary syndrome have also been found in other areas of the country, as well as in Asia and Europe. The virus is apparently asymptomatic in rodents, and it is transmitted in their saliva and excreta. In humans it has a flu-like presentation, which is followed by acute respiratory distress syndrome. The primary reservoir in the Four Corners area of the southwestern United States is the deer mouse. Climatic disturbances, which in recent years are thought to be exacerbated by human activity (e.g., global warming), appear to set up conditions that trigger outbreaks. In the early 1990s, ENSO events initially caused drought conditions to develop in the southwestern United States. This led to a decline in plant and animal populations, including natural predators of the deer mouse. Heavy rains followed the drought in 1993, resulting in a bumper crop of piñon nuts, a major food supply for the deer mouse. Subsequently the deer mouse population greatly increased, bringing about increased contact with humans and triggering the outbreak of hantavirus.

Antibiotic Resistance and Agricultural Practice Antibiotic resistance is a growing threat to public health. Antibiotic resistant strains of Streptococcus pneumoniae, a common bacterial pathogen in humans and a leading cause of many infections, including chronic bronchitis, pneumonia, and meningitis, have greatly increased in prevalence since the mid-1970s. In some regions of the world, up to 70 percent of bacterial isolates taken from patients proved resistant to penicillin and other b-lactam antibiotics. The use of large quantities of antibiotics in agriculture and aquaculture appears to have been a key factor in the development of antibiotic resistance by pathogens in farm animals that subsequently may also infect humans. One of the most serious risks to human health from such practices is vancomycin-resistant enterococci. The use of avoparcin, an animal growth promoter, appears to have compromised the utility of vancomycin, the last antibiotic effective against multi-drug-resistant bacteria. In areas where avoparcin has been used, such as on farms in Denmark and Germany, vancomycin-resistant bacteria have been detected in meat sold in supermarkets. Avoparcin was subsequently banned by the European Union. Another example is the use of ofloxacin to protect chickens from infection and thereby enhance their growth. This drug is closely related to ciprofloxacin, one of the most widely used antibiotics in the year 2000. There have been cases of resistance to ciprofloxacin directly related to its veterinary use. In the United Kingdom, ciprofloxacin resistance developed in strains of campylobacter, a common cause of diarrhea. Multi-drug-resistant strains of salmonella have been traced to European egg production.

Food and Water Security. Agricultural practices are also responsible for a growing number of threats to public health. Some of these are related to inadequate waste management, which has resulted in parasites and bacteria entering water supplies. Others are of entirely different origins and involve apparent transfer across species of pathogens that affect both animals and humans. The most recent and spectacular example is mad cow disease, known as variant Creutzfeldt-Jakob disease in humans, a neuro-degenerative condition that, in humans, is ultimately fatal. The first case of Bovine Spongiform Encephalopathy (BSE), the animal form of the disease, was identified in Southern England in November 1981. By the fall of 2000, an outbreak had also occurred in France, and isolated cases appeared in Germany, Switzerland, and Spain. More than one hundred deaths in Europe were attributed to what has come to be commonly called mad cow disease.

Improper manure management was the likely source of the outbreak of E. coli 0157:H7 in Walkerton, Ontario, Canada. Other health risks associated with malfunctioning agroecosystems include periodic outbreaks of cryptosporidiosis, a parasitic disease that is spread by surface runoff contaminated by feces of infected cattle. This parasite causes fever and diarrhea in immunocompetent individuals and severe diarrhea and even death in immunocompromised individuals.

ECOSYSTEM RESTORATION

Ecosystem pathology in some cases can be reversed simply by removing the source of stress. In cases, for example, where ecosystem degradation is the result of point-source additions of nutrients or toxic chemicals, removal of these stresses may result in considerable recovery of ecosystem health. A classic case is Lake Washington (near Seattle, Washington). This lake had become highly anoxic (oxygen-depleted) owing to a sewage outfall entering the lake. Redirecting the sewage outfall away from the lake reversed many of the signs of pathology.

In cases where it is not feasible to remove the source of stress, more innovative engineering solutions have been tried. For example, in the Kyrönjoki and Lestijoki Rivers in western Finland, spring and fall runoff leads to sharp pulses of acidity. Spring runoff from snowmelt, which releases acid from tilled or dug soils, has been particularly damaging to fish, during the critical time of year for spawning. Fish reproduction is severely curtailed, if not all together eliminated in highly acidic water. Further there have been massive fish kills resulting from the highly acidic waters. One possible remedy is to replace the original drains which take runoff from the land to the rivers with new limed drains that can neutralize the acidity. This solution has been implemented on an experimental basis and appears to substantially reduce acidic runoff.

More radical treatments for damaged ecosystems involve “ecosystem surgery.” In some cases, invading exotic vegetation (such as mangroves in Hawaii) have been removed from regions, and native vegetation has been replanted. In areas of North America where wetlands have been severely depleted owing to farming, urbanization, and industrial activity, efforts have been made to establish new wetlands.

More often than not, however, reversing ecosystem pathology is not possible. Efforts to restore the indigenous grasslands in the Jornada Experimental Range in the southwestern United States provide an example. Overgrazing by cattle has severely degraded the landscape and has lead to replacement of the native grasses by largely inedible shrubs, dominated by mesquite. Erosion by wind and episodic heavy rains have left areas between shrubs largely bare, and subsequently underlying sands have developed in dune-like fashion over a large part of the area. The resulting mesquite dunes have proven highly resistant to efforts to restore the native grasslands, although almost every intervention has been tried, including highly toxic defoliants (Agent Orange), fire, and bulldozing.

Even where it has been possible to restore some of the ecological functions of degraded ecosystems, and thus improve ecosystem health, the restoration seldom results in reestablishment of the pristine biotic community. The best that can be achieved in most cases is reestablishment of the key ecological functions that provide the required ecosystem services, such as the regulation of water, primary and secondary productivity, nutrient cycling, and pollination. In all such efforts, key indicators of ecosystem health (vigor, productivity, and resilience) are essential to monitor progress. Standard ecological indicators can be used for this purpose (e.g., measures of productivity, species composition, nutrient flows, soil fertility) along with socioeconomic and human health indicators.

Experience in efforts to restore highly damaged ecosystems suggests that ecosystem-health prevention is far more effective than restoration. For marine ecosystems, setting aside protective zones that afford a sanctuary for fish and wildlife has considerable promise. Many countries are adopting policies to establish such areas with the prospect that these healthy regions can serve as a reservoir for biota that have become depleted in the unprotected areas. Yet this remedy is not without its limits. Restoring ecosystem health is not simply a matter of replenishing lost or damaged biota. It is also a matter of reestablishing the complex interactions among ecosystem lifeforms. Having a ready source of healthy biota that could potentially recolonize damaged ecosystems is important, but it is only part of the solution.

PREVENTION OF ECOSYSTEM DISRUPTIONS

Given the difficulties in reversing ecosystem degradation, and the many associated human health risks that arise with the loss of ecosystem health, the most effective approach is simply the prevention of ecosystem disruption. However, like many common-sense approaches, this is easier said than done. In both developed and developing countries there is a strong inclination to continue economic growth, even at the cost of severe environmental damage. Apart from selfish motivations, the argument is made that economic growth has many obvious health benefits, such as providing more efficient means of distributing food supplies, providing more plentiful food, and providing better health services and funding for research to improve standards of living. These are indeed benefits of economic development, and have led to substantial increases in health status worldwide.

However, at the dawn of the twenty-first century, the past is not necessarily the best guide to the future. The human population is at an all-time high, and associated pressures of human activity have led to increasing degradation of the earth’s ecosystems. As ultimately healthy ecosystems are essential for life of all biota, including humans, current global and regional trends are ominous. Under these circumstances, a tradeoff between immediate material gains and long-term sustainability of humans on the planet may be the only option. If so, the solution to sustaining human health and ecosystem health becomes one of devising a new politic that places sustaining life support systems as a precondition for betterment of the human condition.

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A review of health seeking behavior: problems and prospects

Author: Sara MacKian               Article reviewed by: Dr Nihar Ranjan Ray

INTRODUCTION:

Health seeking behavior refers to all those things humans do to prevent diseases and to detect diseases in asymptomatic stages. In contrast illness behavior refers to all those activities designed to recognize and explain symptoms after one feels ill, and sick role behavior refers to all those activities designed to cure diseases and restore health after a diagnosis has been made.

I agree to the author that there is growing recognition, in both developed and developing countries, that providing education and knowledge at the individual level is not sufficient in itself to promote a change in behavior. We need do something extra or focus to a different dimension to bring effective changes in health indicators. One more important thing that the author has insisted that factors promoting ‘good’ health seeking behaviors are not rooted solely in the individual, they also have a more dynamic, collective, interactive element. Understanding of the social capital and proper understanding of health seeking behavior could reduce delay to diagnosis, improve treatment compliance and improve health promotion strategies in a variety of contexts. Author has given utmost importance to make studies of health seeking behavior more useful from a health systems development perspective. In initial part of the article the author suggested the two approaches namely

(a) Health care seeking behaviors: utilization of the system

(b) Health seeking behaviors: the process of illness response

According to author variety of studies were conducted on the basis of macro analysis. Taking age, sex, geographical region etc.. But author aptly suggested that these determinants can be further broken to smaller fragments like Status of women, Elements of patriarchy, Social Age and sex, Socioeconomic Household resources Education level, Maternal occupation, Marital status, Economic status, ‘Cultural propriety’, Economic Costs of care Treatment, Travel time, Type and severity of illness Geographical Distance and physical access, Physical, Organizational Perceived quality and so many to identify the reality of the back ground problems. Despite the ongoing evidence from different studies that people do choose traditional and folk medicine or providers in a variety of contexts which have potentially profound impacts on health, few studies recommend ways to build bridges to enable individual preferences to be incorporated into a more responsive health care system. I find it most interesting that has been quoted by (Needham et al, 2001).  As they suggested “the need to improve integration of private sector providers with public care to tackle this problem in a better way” And with the Indian perspective at least I can’t agree with Ahemad et al that the training to these non formal providers are wrong. At least we can use their community motivation in a modern way so that the health seeking behavior of these people will change gradually.

 Now it is time to focus upon to understand the psycho logical process of these people as discussed in the section  Health seeking behaviors: the process of illness response. The understanding of the ‘healthy choices′, in either their lifestyle behaviors or their use of medical care and treatment. Among the different models discussed here namely (a) social cognition models (b) Health belief model (c) health locus of control

•(a)  social cognition models:

Predicting health behavior with social cognition models as per the figure illustrates I am completely agree with the author as she criticizes the model as “The downfall of these models is that most view the individual as a rational decision maker, systematically reviewing available information and forming behavior intentions from this. They do not allow any understanding of how people make decisions, or a description of the way in which people make decisions.”

•(b)  Health belief Model:

The health belief model is a largely accepted theory and like any other theory it has its limitation also like the author writes “The health belief model has been criticized for portraying individuals as asocial economic decision makers, and its application to major contemporary health issues, such as sexual behavior, have failed to offer any insights″ Any how I personally feel this can be a model of reference for contemporary diseases. and also what I feel this model is still holds good in describing the STIs though stigma, shame ness and sexual conservativeness comes into play.

It may be right that the way Mc Phill et all thinks “developed country research has a better track record of exploring this broader contextual picture, whilst work in developing countries tends not to acknowledge the poor relationship between knowledge and health seeking behavior.” Apart from the KABP model I find the description of the Reflexive communities are interesting .Reflexive communities reflect the particular ways of behaving, thinking and reaching decisions of individuals or groups, that in turn reflect the social construction of their position in wider society at a particular place and time. Information regarding health seeking has many facets and determinants like ‘moral, affective, aesthetic, narrative and meaning dimensions’. So more scientific way of approach will be ‘aesthetic reflexivity’ which “means making choices about and/or innovating background assumptions and shared practices upon whose bases cognitive and normative reflection is founded” In order to understand how people reach the decision  we need to know also how  the underlying, unspoken, unconscious feelings and assumptions which support that cognitive process. These concepts that are been discussed here  are seems to be more theoretical to practice . But still these issues are need to be addressed aptly for events like HIV/AIDS . I and I am completely agreed with Harvey that “the way people perceive risks and experience risk should be a matter for public policy”

Health seeking behavior and the probes: a review

Health seeking behavior differs for the same individuals or communities

when faced with different persons, times& illnesses.   The article has described some of the examples here. They have  given a very nice example here regarding the health seeking practices of women when faced with abnormal vaginal discharge, as opposed to malaria. I think this is more a big problem in countries like India & Bangladesh than the developed worlds. Again the shortage of the female Health care staffs worsens the problem. And the most important thing that I feel is most of the sensitive illnesses or diseases or public health problems are having this problem. Or thinking in the reverse way that due to this embedded problem it is very difficult to address these problems or not getting quick results. Among the examples I try to touch them in short. Only the key issues are given as described the author. I think she has identified it very nicely from different studies.

Tuberculosis

(a) Late presentation and delayed diagnosis are  problems for TB, reflecting both

individual and social factor. Delay can be related to social stigma, gender, fear or multiple health seeking.

(b) Culturally sensitive and situated understanding of health seeking behavior may

Provide better  treatment compliance and shorten delay of diagnosis.

©Health education should be started  at family and community level to improve

awareness and to avoid stigma.

(d)The doctor-patient relationship may need particular attention in relation to TB due to the lengthy treatment period.

Maternal and child health

(a) The way in which women reach the decisions they can have a great influence

on child morbidity and mortality and is therefore worthy of continued study.

(b) There may be a better ways of exploring women’s involvement in health

system and social structures .

Diabetes Type 1

(a)Perhaps the lack of material suggests there is more work needed in this area?

          (b)The doctor-patient dynamic can potentially be used to promote ‘good’ health

seeking behavior and compliance with treatment, and is an issue reflected across

the probes.

Social capital and Health & Development

Social resources norms and networks or processes and conditions within society that allow for the development of human and material capital. So  social capital is created and used through individual participation. Bonding social capital which links members of a particular group, and bridging  social capital which links across groups. So the first one when addresses the Horizontal Equity the later addresses the Vertical Equity. Social capital provides a means of shifting the focus from individuals to social groups, and the social involvement of the actions of individuals. Though it varies from community to community but social capital also has implications for the operation of health systems description of that in detail is beyond the scope of this literature.

Health seeking behavior in the context of health systems

Non formal practitioners  and birth attendants so embedded in the existing social

fabric and reflexive communities so that mostly the women deny delivery in favour of trained public service doctors. And in the Indian sub-continent  public doctors running private clinics alongside their public role, where they can charge patients they have referred from the public system, may have the effect of undermining trust in the wider system.

Conclusion

  “To begin to picture the resources and constraints…the way the actor experiences them, is to take a crucial step towards understanding why and how people do what they do”

   This statement by  Wallman and Baker I think we always need to remember be coz Health care is a system that is so much embedded into the society and individuality of the people that if you search for the influencing the factors than finally you will get all the branches of science on your table. So to be practical is more important than criticizing any issue theoretically and parallely we can’t ignore any issue how ever that may seem impractical. That is the beauty and problem of designing the policy for the Health care. What I feel like head of the family neglects himself in due course of taking care of other family members we should not land in a troubled water by focusing more on the peripheral issues of Health care delivery system than the center stage. We should not forget to address the problems of the internal clients to provide a better motivated care to the external clients. Which in my view very poorly addressed in international, national & regional level. And last but not the least is the financing system and its proper management is the key issue.

                   Dr Nihar Ranjan Ray

                   Indian Institute Of Public Health, Gandhinagar

Health Risk Assessments (HRAs) are tools that identify and quantify an individual′s risk of morbidity or mortality using demographic, medical and lifestyle information. “Health Risk Assessments (HRAs) and Medicare”, an evaluation report completed by RAND for CMS, reached the following conclusions.• Effective Health Risk Assessment (HRA) plan have demonstrated beneficial effects on behavior, physiological variables and general health status• Interventions that combine Health Risk Assessment (HRA) feedback with the provision of Health Plans are most likely to show beneficial effects• To be effective, Health Risk Assessment (HRA) questionnaires should be accompanied by follow-up interventions (e.g., information, support and referrals)High quality Health Risk Assessments (HRAs) offer, a computation for individual risk from the following most common diseases and risk factors.• Asthma• Chronic Obstructive Pulmonary Diseaase (COPD)• Diabetes• High Blood Pressure• Ischemic heart disease• Major depression• Stroke• Overweight/Obesity• Use of Tobaccos Products• Mental health• ImmunizationsThe Health Risk Assessment (HRA) collects and reviews information to predict a member′s likelihood of experiencing the most common diseases.Health Risk Assessments (HRAs): Demographic characteristicsA person’s age, gender and ethnicity are indicators of elevated risk for certain diseases. At minimum, the Health Risk Assessment (HRA) should collect information, to the extent allowed by law, information on the member′s age, gender and ethnicity.The Health Risk Assessment (HRA) should include queries addressing the individual′s personal and family history of diseases or risk factors for common diseases. The Health Risk Assessment (HRA) must include queries to assess health risks related to the highly personal health characteristics and behaviors listed below.• Weight Management• Nutrition• Use of Tobaccos Products• High Blood Pressure• Cholesterol• Exercise• Alcohol consumption• Traveling by motor vehicle• Stress Management• Mental healthPerceived Health StatusThe Health Risk Assessment (HRA) should include queries that assess A person’s self-perceived health status. The queries should allow an individual to rate their own health status on a relative scale.Disclosure of use of Health Risk Assessment (HRA) informationThe organization should disclose how the information obtained from the Health Risk Assessment (HRA) will be used and to whom it’ll be disclosed. The organization may offer the disclosure and use information within the Health Risk Assessment (HRA) tool or reports or through written communications.Ability to save and print Health Risk Assessment (HRA) resultsInternet-based Health Risk Assessment (HRA) should give the member the ability to save and print his or her Health Risk Assessment (HRA) results. For paper-based Health Risk Assessments (HRAs), the organization should have a mechanism in place for the member to receive a written copy of the results.Health Risk Assessment (HRA) ResultsCompanies should offer a printed or printer-friendly internet-based report for each individual participant. The report may emphasis on either individual risks for specified diseases or on Health.Health Risk Assessment (HRA) computations may emphasis on either individual risks based upon personal risk factors or on overall risk or health. The report should offer an explanatory information to help them understand the outcome. Reports should clearly identify behaviors that can lower risk for each risk factor, and recommend targets for improvement. Reports should include resources (e.g., community plan, internet-based information and materials) that can help members change to a healthier lifestyle. At minimum, the organization should give computation for individual risk from the following most common diseases and risk factors.• Asthma• Chronic Obstructive Pulmonary Diseaase (COPD)• Diabetes• High Blood Pressure• Ischemic heart disease• Major depression• Stroke• Overweight/Obesity• Use of Tobaccos Products• Mental health• ImmunizationsHealth Risk Assessment (HRA) reportThe Health Risk Assessment (HRA) should give internet-based print-friendly results and the ability for the user to print the results. The Health Risk Assessment (HRA) report should include a profile of individual risk level for personal conditions or diseases according to age, gender, ethnicity and risk factors that were identified in the questionnaire. The report should clearly identify behaviors that can lower the risk for each risk factor and recommend targets for improvements.Available ResourcesThe Health Risk Assessment (HRA) report should also include references to resources that can help the member understand the Health Risk Assessment (HRA) results and assist the member in changing to a healthier lifestyle.The resources can include references to relevant internet-based information, materials and community plan.

Holistic remedies help thousands of people worldwide to overcome problems ranging from more serious diseases to the common cold. Holistic Therapist Nitchara Yimsuk answers some frequently asked questions, and tips us off about a versatile treatment called moxibustion.

What does holistic mean?

In holistic treatments we look at the whole person – physical, emotional and spiritual – rather than just treating the symptoms of the problem. We consider a person’s mind and body, diet and exercise, lifestyle and relationships, work and leisure, achievements and problems. Imbalances in any of these areas can contribute to illness.

Where do holistic treatments come from?

Holistic medicine is also known as alternative, integrative or complementary medicine, as it complements conventional practices. It may include, but is not limited to, the following disciplines: spiritual, religious, newly developed approaches to healing or pre-modern medical traditions. Chinese medicine, for instance, follows the holistic principle.

How do they work?

There are many approaches, from energy healing to the use of natural and plant products. The Taoist principles, on which Chinese medicine is based, stress the oneness of everything, the inseparability of solid matter and energy, the fact that there is a common source of all phenomena and experience.

What are some of Chiva-Som’s most popular holistic treatments?

The Detox Retreat is popular. It includes the Cleansing Diet, Colonic Hydrotherapy, Chi Nei Tsang and Acupressure Reflexology. Also high on the list are Flower Essence, Homeopathy and Moxibustion.

What is Moxibustion?

It’s a treatment from Traditional Chinese Medicine in which the herb Moxa Punk is burned on or above the skin at acupuncture points. Sometimes we use other herbs.

How does it work?

The heat warms the blood and the qi (the life force), which improves the flow within the energy channels of the body. Sometimes Moxibustion is recommended as a stand-alone treatment, at others it has a synergistic effect with acupuncture.

Why is it so effective?

The Moxa leaf is bitter and acrid and its nature is pure Yang. Depending on the amount used it produces a gentle warmth or a strong heat and expels cold and dampness.

What is Moxibustion recommended for?

It’s varied. It may be used in the treatment of acute diseases, cold syndromes, diseases of the channel and exterior syndromes, or chronic syndromes and diseases of the viscera (the internal organs). It’s frequently applied in treating arthralgia due to wind-cold-dampness. Also Yang collapse syndrome Chronic Dysentery, Asthma, Phlegm Retention and Flaccidity Syndrome. It’s also good for some external syndromes, such as carbuncles and the common cold. Additionally, it can work in general health maintenance and disease prevention.

We hear it’s also useful in pregnancies?

Yes, Moxibustion has been used for centuries in China to turn breech babies. The theory behind this practice is that the heat travels up the bladder meridian, which is linked to the uterus. Additionally, it’s useful in treating some Gynaecological Diseases – such as Dysmenorrhea, Prolapse of the uterus, and Leucorrhoea – and Infantile Diseases, including Enuresis and Diarrhoea. Moxibustion is very versatile.

What are the latest holistic treatments that Chiva-Som is offering?

Vacuum-Cupping Massage and the Emotional Freedom technique are both new, and also Maya Massage, which is part of the Detox Retreat offered in the Spa.

How can people find out more about these remedies?

They can consult the website (www.chivasom.com), where there’s a list of holistic treatments and a brief description of each, or they can visit us here at Chiva-Som. All guests are welcome, and we are willing to make initial consultations for every individual who comes.

Our team of Naturopath Doctors and Practitioners work in a very secluded and peaceful environment.

Spirulina is a variety of blue-green algae that has remained virtually unchanged since it first appeared on the earth more than 3.5 billion years ago. So named because of its helix or “spiral” shape, Spirulina has gained prominence as nature’s green “superfood” because of its rich concentration of perfectly balanced amino acids (protein), fiber, vitamins, minerals and other essential nutrients.Spirulina is also naturally “pumped″ with vitamins, especially the carotenoids like beta-carotene, essential fatty acids (EFA’s), the important fatty acid gamma linolenic acid (GLA), digestive enzymes, minerals and the richest plant source of vitamin B12. Spirulina is the “must have” green food- a complete protein with all eight essential amino acids present. Its 60% protein content is four times greater than beef (18%)! In our society, where the concept of complete protein is meat and dairy, it is very reassuring to know that greens like Spirulina can provide all the high quality protein and other nutrients needed.A single serving of Spirulina contains 45% of your daily value of vitamin B12. That’s good news and reassuring for vegetarians, many of who are incorrectly led to believe that eating animal food is critical to getting this essential blood building vitamin.Spirulina also helps with a variety of other ailments. DNA repair, cholesterol, and communication between cells are all helped with just a little bit of this supplement.One of the main benefits stands to gain is the improvement of immune system. There have been many studies conducted that have shown that spirulina greatly helps to increase not only red blood cell production, but also the activity of the cells of bone marrow. Even T cells and macrophages have been increased.Other studies conducted by Japanese scientists have shown that the growth of herpes virus, measles, and influenza have all been stunted by spirulina. Polysaccharides, phycocyanin and beta carotene are the active components of spirulina, which work to improve the immune system.Spirulina also manages to fight bacteria such as E.coli and encourages the growth of good bateria in order to ensure that our bodies function well.Another great attribute of spirulina is that it detoxifies one’s system well. A study revealed that spirulina actually helps decrease the toxicity of certain other drugs on one’s kidneys.It also works to increase good cholesterol and reduce bad cholesterol for those who have ingested just a few grams of it a day. Of course as with any other sort of supplement or drug, one should always consult their physician before taking taking it in order to avoid a possible allergic reaction.Give spirulina a try. I believe you will find that it will improve your health and support your efforts at healthy living.

in light of the current economic slump, it is no wonder that families are being picky about their expenses. When it comes to something as critical as family health insurance plans, carefully considering all of your options is crucial. Family medical coverage might not always be offered by the company that employs you, even though it is a necessity! You wind up having to go out and research each of your choices on your own, and it can feel a bit intimidating since there are so many choices when it comes to family medical insurance plans options and just as many carriers presenting those coverages.

While you’re conducting your research on these medical providers, you will want to consider the following information: Coverage plans: The choices of insurance plans might feel daunting, but you may wish to begin with the most popular kind and that is managed care coverage.

These plans provide several choices and the plan you decide to pick will depend upon the family. PPO coverage offers more flexibility, however you’ll have to visit a physician that’s in their particular network. Health Maintenance Organization plans allow you to choose your primary care doctor, however, you will need to shell out a co-payment. Point of Service plan is a great plan which offers a combination of both coverages. Cautiously give consideration to the different coverages before you make your decision. Price: The price of the different coverages will probably be a critical consideration for your family. At all times ensure the family medical insurance quote will suit the family budget before choosing a plan. Requirements of your family:

Some family members possess special medical needs. Should this be the situation for your family, then you will need to make sure your plan protects those medical needs. Deciding on the right insurance coverage is a vital component to the family’s well-being. Consider all of your options and make smart choices.

Chiva-Som stress management specialist Paul Emery has a new pioneering consultation called ‘Bio-feedback Stress Management’.  These are fun sessions that take you through a variety of stress management techniques, so you can assess for yourself which one benefits you most by way of instant feedback from the computer software that you are linked to via a simple ear sensor.

Paul first outlines the damaging emotional and physiological effects stress has on you, and then demonstrates several techniques that can transform that stress into a feeling of calm and serenity.

These stress management techniques that are easily performed lead to better overall health, reduced aches and pains and increased levels of the anti-ageing hormone DHEA in the body, so it helps you live a healthier, longer life.  And, in day-to-day terms, at work or play, you’ll start to notice the benefits immediately.

Anti-stress techniques lead to mental and emotional clarity, which means you’re less prone to general anxiety, and quicker to recover when you do get stressed.  You’ll discover a new sense of inner control that helps you develop emotional balance and more patience with other people.  Other benefits include more day to day resilience against stress and improved sleeping patterns.

As a therapist Paul Emery has forged an international reputation for helping people from all walks of life. He’s appeared on the Australian TV show Celebrity Overhaul and been featured in many publications such as the Financial Times, Women’s Health and the Sunday Independent.