Global Healthcare Policy and Healthcare Delivery

The world is turning into a small geographical place for a vast number of people due to the interaction of many global factors such as technology and modern media of transport among many other factors. This phenomenon has led to the globalization of healthcare and its delivery to different groups of people including the older adults. As such, healthcare is a common aspect shared by many countries around the globe through various bodies such as the World Health Organization; besides, many countries are borrowing different healthcare strategies from others because of having similar healthcare needs and challenges. Consequently, elder care is one of the most prioritized global healthcare issues due to the rapid growth of this group of population and the subsequent increase in the development of different health conditions including chronic illnesses. According to Sambamoorthi, Tan, and Deb (2015), older people account for most of the chronic disease burdens globally; in the United States alone, a minimum of 117 million people suffer from chronic diseases with the elderly population representing the majority of the affected individuals. Therefore, it is critical to understand different global issues concerning the historical perspectives of elder care, significance of health disparities, regulatory guidelines, economic costs and productivity, moral issues, and the availability of clinicians.

Historical Perspectives on Global Health Learning in Gerontology Nursing

The past experience provides little evidence to suggest that nurses and other health professionals paid much attention to the health of older adults, a phenomenon that has gradually changed over the years. For more than a century, the society seems to have neglected gerontology with aging being viewed as a normal process of growth and development, being associated with different diseases caused by aging. However, the discipline of gerontology was introduced by Ignatz Leo Nascher in 1909 before the American Board of Internal Medicine recognized it as a separate professional field that required certification in 1988 (Merrell, 2015). Further, disease prevention and treatment along with health promotion were being introduced during the past five decades as the society started to support longevity and vitality in elderly populations (McMahon & Fleury, 2012). Recently, the field of healthcare has drawn more attention to elder care issues including the normal process of growth and development, associated health challenges, and the role of clinicians in promoting health as well as preventing and treating different health conditions.

Gerontology began to develop in Great Britain before spreading to other parts of the world as the entire global healthcare system started appreciating elder care as a mandatory requirement in the healthcare provision. Elliot (2016) reiterates that modern health care for seniors began in Britain when Warren, an English physician started providing care for seniors in 1935, a time when most of this group of population was suffering from different health conditions. Surprisingly, Warren was challenging the status quo characterized by the problem of healthcare professionals ignoring older people with various disabilities and illnesses (Elliott, 2016). Before that time, older adults were not a priority for the healthcare system since old age was considered a health problem that lacked serious medical solutions. According to Merrell (2015), children’s hospitals were more prominent in the 19^th century, something that the elderly lacked; the primary reason was that the older population was too small to attract the attention of health providers. Therefore, older people were less significant to the then healthcare system due to the lack of attention from care providers. 

Further study reveals that lifespan and healthcare issues for the older people began to draw attention with the subsequent increase in life expectancy. Since little happened in the field of gerontology during the 19^th and early 20^th centuries, most of the newborns had reduced life expectancies; in 1900, a huge population of newborns was not expected to live beyond 50 years (Merrell, 2015). At the moment, the World Health Organization (WHO) (2015) explains that a child born in Myanmar or Brazil is expected to live at least 20 years longer than individuals born some five decades ago. Currently, life expectancy at birth is beyond 80 years across many nations all over the world due to the increased attention to gerontology, which gained momentum in the previous century (Merrell, 2015). According to Elliott (2016), the second half of the 20^th century was marked with a better understanding of the aging process and its associated health disparities and illnesses. As such, much contribution was geared towards the reduction of these disparities and curbing of the age-specific health conditions to reduce both morbidity and mortality rates in elderly populations. 

That notwithstanding, further study of gerontology has gained momentum with much advances in terms of improving its application in the field of health care provision for the elderly. The development and delineation of the discipline of gerontology marked the beginning of its progress in the field of learning and teaching the art of nursing. According to Liu et al.'s (2017), geriatric nursing was present in many countries at different times; in China, the learning and teaching of this discipline have existed for more than two decades. In Russia, research on gerontology started in the 1960s, although much focus was placed on the professional functioning of the aged populations, their retirement adaptations, and neurological and personality functioning (Strizhitskaya, 2016). As such, those countries that began teaching geriatrics early currently have more geriatric experience and better care conditions compared to those states that provided only a few years of education in the field of internal medicine.

Health Care Disparities

Heath disparities due to race, disability and socioeconomic status, gender, age, and ethnicity play a critical role in the state of health across different groups of human population including the older adults. For the elderly population, enormous health disparities manifest themselves as a part of the global chronic disease burden resulting in poor health of the elderly (Strizhitskaya, 2016). For instance, this population is majorly affected by different kinds of chronic diseases that not only shorten the lifespan but also increase the morbidity in addition to reducing the quality of life of the older adults. The leading causes of death for this group of people include cardiovascular diseases, chronic respiratory illnesses, mental disorders, and musculoskeletal conditions among many others (Prince et al., 2015). Globally, 92% of all older patients suffer from at least one chronic condition while 77% have two or more of these illnesses. Besides, this group of population is more disadvantaged given that the chances of getting a cure for these conditions are almost equal to null (Merrell, 2015). The prevalence of numerous chronic illnesses in America has shown significant increments from 21.8% in 2001 to 26.0% in 2010 (Ward, 2013). Therefore, disparities in the occurrence of chronic conditions are evident with the elderly population suffering the most, which results in the increased morbidity and mortality rates.

Further, disparities in socioeconomic status have proven to be a major challenge in regard to the improvement of health among older adults. Poverty caused by the lack of financial security is one of the major obstacles to reducing health inequities and achieving healthy aging with the prevalence of this problem occurring more in older adults than in the rest of the population groups throughout the world (WHO, 2015). For instance, 20% of the European seniors live below the recommended poverty line; out of this group of population, those aged 80 years and above are the most affected ones (WHO, 2015). This information asserts that poverty and its associated socioeconomic health challenges aggravate with aging (Zajacova, Montez, & Herd, 2014). Additionally, socioeconomic disparities persist in the specific groups of the elderly population. In OECD countries, 33% of the older women have an increased likelihood of living in poverty compared to their male counterparts, which is also peculiar to sub-Saharan Africa and other regions of the globe (WHO, 2015). That notwithstanding, the differences in poverty levels in older adults are caused by the fluctuations in their places of residence. According to Strizhitskaya (2016), those who live in villages have lower incomes compared to the working city residents. Therefore, socioeconomic disparities represent a great challenge to the health of the elderly population in various countries all over the world.

Finally, older adults experience significant disparities in accessing healthcare services with variations occurring across different countries and along with the on-going socioeconomic changes. Developed countries are likely to have better health systems that enhance access to care; an example is those countries that provide universal healthcare coverage, which enables older people from different socioeconomic classes to receive care without the risk of discrimination. The US has a better healthcare system than China, which is revealed in the improved health of the Americans compared to their Chinese counterparts (Zhang et al., 2016). However, older adults in developing economies face severe challenges in accessing better care services; African countries are one of the examples of these global nations. Also, Strizhitskaya (2016) adds that poverty reduces the chances of these people accessing better healthcare services due to the failure to afford costly health services. Eventually, most of them often develop preventable chronic conditions, which are associated with reduced quality of life, increased disabilities, and morbidity and mortality rates.

Healthy People 2020 and Other Regulatory Guidelines

Regulatory guidelines have been formulated to improve the health of older adults in the US as well as other countries across the planet. Apart from identifying health improvement priorities, Healthy People 2020 guidelines provide measurable goals and objectives to be fulfilled in an attempt to improve the health of older adults who are at a greater risk of developing both communicable and non-communicable conditions than other groups of population (Healthy People, 2017). For instance, the guidelines provide for the performance of regular age-specific physical exercises to prevent lifestyle diseases and the prevalent falls. The duty of health professionals is to screen the elderly for different conditions before providing appropriate care in primary care settings such as immunization, health education, and pharmacological treatment of diseases among others (Healthy People 2020, 2017). Basically, Healthy People 2020 guidelines are aimed at reducing challenges faced by the older people including abuse and discrimination because of their physical and financial vulnerabilities as well as the risk of developing debilitating conditions.

Other formal regulatory guidelines include those formulated by different health agencies such as the Department of Health and Human Services (HHS). For example, the federal government in the US introduced the Obama Care to increase access to healthcare services by marginalized groups including the elderly population. The HHS introduced an action plan with guidelines specifying the priorities, goals and strategies for making a country free from health disparities, which is a menace in the field of elder care (Artiga, 2016). Together with the Healthy People 2020 and Obama Care, the HHS guidelines expand the accessibility to quality care through the increased coverage without the risk of discrimination. Further, other guidelines provided by the WHO, Centers for Disease Prevention and Control (CDC), and other agencies are meant to guide clinicians in care settings through the process of providing quality care services to their patients. Therefore, these formal guidelines will not only increase the access to quality care but also make subsequent improvements in the quality of life for older people. 

Moral Issues in Global Healthcare

As the world population experiences health disparities, care provided to older adults is coupled with numerous moral issues, some of which are associated with the ethical principles governing healthcare professional practices. Some of the ethical issues that guide clinical practice for older patients include the principles of justice, beneficence, autonomy, and non-maleficence. For instance, nurses and other clinicians should provide older patients with the autonomy of making care related decisions by providing an opportunity to make independent decisions on self-care (Stapleton, Schröder-Bäck, Laaser, Meershoek, & Popa, 2014). Further, clinician decisions and actions should neither harm patients nor violate their preferences and values (Stapleton et al., 2014). Another moral issue of concern is elder abuse, which is rampant among most members of this group of population. For instance, 36% of clinicians have witnessed or committed one or more cases of physical abuse with 40% of all admission cases being accompanied with psychological abuse (WHO, 2016). Basically, older adults are vulnerable to abuse due to being unable to protect themselves from this vice as a result of their mental and physical conditions as well as their inability to communicate with their clinicians or family members.

Healthcare Productivity and Economic Costs

Challenges associated with the elderly population are coupled with problems of healthcare productivity and economic costs. Sambamoorthi et al. (2015) assert that more than 70% of this group of population having six or more chronic diseases visit emergency rooms compared to those without these conditions. Emergency care services are costly for the patients and the country as a whole. Such diseases being common for aging strain the economy due to the demand for immense financial, human, and physical resources. For instance, 86% of the 2010 healthcare expenditures were attributed to the provision of chronic care services (Gerteis et al., 2014). Surprisingly, stroke and heart conditions alone consumed more than $315.4 billion in the same year (CDC, 2016). This amount of money could have been channeled to other developmental economic activities. Additionally, productivity among the sick groups of population reduces with the subsequent increment in the consumption of massive resources, which is a huge burden for the productive societal members and the economy as a whole since the older diseased individuals consume massive resources. Therefore, global healthcare productivity and economic costs associated with elder care are a threat to the growth of the national economy.

Availability of Healthcare Providers

With the growth of aging population and the subsequent increase in chronic conditions, health provider shortage is inevitable. According to Harrington and Heidkamp (2013), 19.6 million workers in the US are expected to attain an age of 65 years in a few years to come, accounting for more than 19% of the American workforce. Further, this group of population is expected to grow by at least 75% as the group between 25 and 54 years tends to grow by a mere 2% (Harrington & Heidkamp, 2013). As such, the availability of clinicians, such as nurses and physicians, will increase at a smaller rate to meet the demand for geriatric care. Currently, the US is in need of 89,983 more physicians in gerontology and other primary care professions; the demand for nurses supersedes that of the physicians (Green, Savin, & Lu, 2013). However, colleges and universities are doing little to curb these shortages, and the situation is likely to worsen in the nearest future given that the elderly population is expected to grow. For example, the American schools of nursing rejected 67,563 qualified graduate and baccalaureate program applicants as a result of shortages in human and physical resources (Littlejohn, Campbell, & Collins-McNeil, 2012). Therefore, the lack of availability of healthcare professionals necessary for meeting the global healthcare demands of the elderly population represents a situation that is likely to get worse due to little action in curbing the inadequacies.

Conclusion

The analyzed group of population is associated with many health disparities and costly care services, although the formulation of regulatory guidelines to address elder care issues are likely to improve health outcomes despite the acute care provider shortages. The history of gerontology reveals that older adults were not a priority in healthcare systems, but many improvements have been made in the recent years. Among the health disparities for the elderly group are poverty and healthcare accessibility, while the moral issues include different forms of abuse in regard to autonomy, beneficence, and the principle of justice. Although the provision of geriatric care and other associated challenges often result in high economic costs and reduced healthcare productivity, Healthy People 2020 and other formalized regulatory guidelines are likely to improve the quality of life for the elderly. However, serious steps are required to increase the availability of healthcare professionals in elder care.