Monday, July 30, 2012

What Does Not Kill You Makes You Stronger

by Roni Berger, Ph.D., LCSW

Most of us heard about the German philosopher’s Nietzsche statement in the title; however, until quite recently, we heard much more about the devastating effects of struggling with highly stressful events.
As communication advances, media and social networks make all of us in the global village involved witnesses to traumatic experiences inflicted on individuals, families and communities around the world as soon as they occur. Natural disasters such as flood, hurricanes, bushfires and earthquakes, as well as human made catastrophes like wars, terrorist attacks, the failure of atomic reactors, and personal assault including rape and abuse, all take their toll in lives, injuries, devastation, psychological, health, social and financial outcomes.

Both those directly exposed and those close to them such as family members or professional service providers are affected. However, while the idea was around for a long time, only in the last three decades, we have reliable evidence that together with negative effects, traumatic exposure may also lead to benefits called posttraumatic growth (PTG). PTG has been documented in different cultural contexts followingdiverse stressor events. While its nature and manifestation are culture-specific, universally, growth may include different combinations of the core elements of interpersonal relationships, values, and beliefs, attitudes to life and view of self.

It is important to remember several basic facts:
  1. It is the struggle with the traumatic event rather than the occurrence itself that may lead to growth;
  2. Negative and positive outcomes of the struggle are two separate rather than opposite processes and may occur simultaneously;
  3. Not everybody experiences posttraumatic growth and thus, not getting benefits from the struggle is NOT a failure;
  4. Many factors determine if growth occurs such event, personal, and environmental characteristics;
  5. Growth, if it occurs, happens later in the process. No good comes of expecting it or pushing for it.

Dr. Roni Berger is a professor in the Adelphi University School of Social Work. She teaches courses in quantitative and qualitative research methods and practice with individuals, families and groups in the M.S.W. and D.S.W. programs, as well as a course on practice with immigrants and refugees. Together with Tzipi Weiss, Roni Berger co-authored the book Post-Traumatic Growth and Culturally Competent Practice.

Friday, July 27, 2012

Ready…or not?

Hurricanes, thunderstorms, extreme heat, power outages–it seems disasters are popping up daily, bringing us new challenges to think about and plan for. While we can’t control when emergencies happen, at the very least we can use them to prepare ourselves: or can we?

A new Adelphi University Center for Health Innovation poll finds that most Americans are not only unprepared for emergencies, but also incorrectly assume that they are ready for whatever comes their way.

USA Today’s ”Healthy Perspectives” blog  and the Centers for Disease Control’s “Public Health Matters” blog provides a summary of the results as well as a link to a more detailed report of the results. The poll has already ignited debate and discussion among people who are trying to make sense of how to be as prepared as possible for the unexpected.

Visit the Center for Health Innovation’s poll section for information, resources, and stories from people who have first-hand experience about the impact of disasters and the importance of being prepared. 

The Adelphi Natural Disaster Survey was conducted by Wakefield Research among 1,003 American adults, ages 18 and older, between May 15th and May 23rd, 2012, using a random-dialing telephone survey. Quotas have been set to ensure reliable and accurate representation of the U.S. adult population ages 18 and older.

Monday, July 23, 2012

Supreme Court Upholds Health Care Law: Good, Bad, or a Bit of Both?

by Philip Alcabes, Ph.D.
Although the Justices were expected to strike down the Affordable Care Act, the Obama administration’s health-care financing law passed in 2010, the Supreme Court upheld it in a 5-4 ruling today.

The law has a number of favorable effects, as Josh Levs at CNN cogently explained today.

Most important for students, Americans may now be covered on their parents’ health-insurance policies up to the age of 26. Important for everyone, it will no longer be permissible for insurance companies to refuse to cover young people with so-called pre-existing conditions or, beginning 2014, to refuse to cover anyone with a pre-existing condition.

The most vexatious provision of the law, the mandate that everyone not covered by either Medicaid or Medicare buy an insurance policy, stands for now.

To enforce the mandate, a family can be fined $285 or 1% of income, whichever is greater, if it doesn’t have health insurance in 2014. And the fine would go up to $2085 or 2.5% of income by 2016.

The Obama administration had argued that this financial penalty is okay under the Constitution: it’s a way to force more people to buy health insurance, the administration said, and that is the best way of making insurance less expensive for everyone–the more people who pay premiums to an insurance company, the cheaper the premiums can be. Congress has the right to regulate interstate commerce so, for the administration and its supporters, the Affordable Care Act is constitutional.

Others, including some private companies and 26 states’ attorneys general, had said that the mandate amounts to the federal government forcing citizens to buy a product, and therefore unconstitutional.

The big surprise is that Chief Justice Roberts, who usually sides with Court conservatives, cast the deciding vote and wrote the upholding opinion. The second big surprise is that Roberts’s opinion upholds the law not because Congress can regulate commerce – as Obama had wanted. Instead, he says it’s okay because the mandate is really a tax. And of course Congress is allowed to levy taxes.

What should we make of this? Surely it’s a good thing to make health insurance more available to more Americans. And especially good to stop insurers from refusing to indemnify people who are already sick or injured.

But if the mandate is a tax, then it seems that it’s okay for Congress to tell you to pay a tax either to the federal government (the fine for not having insurance) or to a private company (in the form of insurance premiums).

Wait–is it really okay to have to pay taxes to a private corporation?

Another problem today: the ACA’s expansion of Medicaid–the state-based programs that provide health insurance for the poor–has been questioned by the Supreme Court’s decision.

The Affordable Care Act has lots of good things in it. But it isn’t really health care reform–it’s more of a health care financing law. It doesn’t apply to everyone. And it might not work to create more insurance coverage for the poor.

Plus, the high court’s decision upholding the law seems to break new ground in giving private corporations the power to determine how Americans should look after our health and how much we should pay.

Some people think that’s better than letting governments make those decisions.

Others disagree.

What do you think?

Philip Alcabes is a professor in the Adelphi University School of Nursing and director of the Public Health Program. He is an epidemiologist and has studied the history, ethics, and policy of public health.