Blog assignment #12: Identifying Key Determinants

Key determinants are important precursors of a public health problem, and therefore possible targets for prevention initiatives. There can be five different types of key determinants: Biological, socio-cultural, environmental, economic and political determinants. In my public health problem's case -- increased incidence of lung cancer associated with cigarette smoking among adult women (age 18 to 65) in the United State from 1991 to 2006, biological factors mostly can be identified as genetic, biologic differences that affect development of lung cancer in women. According to American Society of Clinical Oncology, there has been studies shown genes that cause women to be more vulnerable to the harmful effects tobacco smoke. They also mentioned that the increase in the incidence of lung cancer in women from 1991 to 2006 (when the incidence of lung cancer in men decreased)can be attributed to the differences in how the chemicals in tobacco are metabolized by the body; also changes to genes that control cell growth, which may result in the development of cancer,a decreased ability of the body to repair damaged DNA,as DNA damage can promote the development of cancer, difference in hormone secretions can be reasons why there has been a discrepancy between the incidence of lung cancer in women and in men. This issue also can be attributed to many socio-cultural factors which are related to social class, social environment, and the social norms. Although the status of women the society is now equated to that of men, there has been a long stereotype that women are inferior to men. Seeking gender equality, self-confidence, freedom, many women this time period started smoking; According to a study in the journal, Tobacco Control, in this time period, many tobacco advertisements targeting younger women focused on the themes of friendship with other women, self-confidence, and independence. Not only for younger women, advertising messages targeting older women included social acceptability, relaxation, a woman's need for pleasure, and an escape from daily life. These cigarette advertisements may have helped form illusions about women's smoking cigarettes, therefore leading to decisions that "benefits outweigh advantages" despite numerous campaigns warning the harmful effects of cigarette. Also, wrong impression that smoking helps you lose weight lured many adult women to start smoking. According to the U.S Centers for Disease Control and Prevention (CDC), at least 500,000 teenage girls use tobacco products, and they claimed that the reasons why they started smoking included the popular belief that smoking can help control weight. For environmental determinants, which are physical factors that individuals are not usually able to change, include secondhand smoking and exposure to asbestos which are used as flame retardant in buildings. Economic determinants include any issues related to money; in this case, as the number of women with jobs increased (U.S department of labor: women's share of force -- By 1998, nearly three of every five women of working age were in the labor force. Among women age 16 and over, the labor force participation rate was 33.9 percent in 1950, compared with 59.8 percent in 1998), more women were able to afford cigarettes. I do not believe there were any executive, legislative or judicial decisions that may have promoted the increase in women's cigarette smoking, because thanks to numerous efforts of public health agencies tax on tobacco has been increased to deter people from buying cigarettes. Considering this public health issue in many aspects,I conclude this issue to be multifactorial (mostly biological and socio-cultural determinants) and needs more attention from the society


Reference - citations are not in proper formats but i will put them later when I write the final paper
http://www.cancer.net/patient/All+About+Cancer/Cancer.Net+Features/Cancer+Screening+and+prevention/women+and+lung+cancer
http://www.lungcancer.org/reading/about.php
CDC
U.S. department of labor

Blog assignment #11: magnitude of the topic of interest

The purpose of surveillance is not only to collect various data from the states (data collected by local states), but also to actively conduct a number of surveys to understand the status of American population's health better. In my topic's case, surveillance is used to assess the prevalence of lung cancer as a whole -- not only the population of American women--, to identify risk factors, and find the trends. Some public health agency actively go to the public, get some samples, and conduct examinations and tests. Further, surveillance could be used to assess the how the health-related behaviors such as smoking cigarettes and alcohol consumptions. There are two types of indicators: direct indicators and indirect indicators. In my case, direct indicators will be prevalence of women in the united states who got diagnosed with lung cancer and the increased number of lung cancer deaths in women. Because smoking is now commonly known to be the primary cause of lung cancer, indirect indicators will be increased number of female smokers, the number of cigarette purchases made by female customers. Of course, lung cancer can develop due to various factors such as genetic factors, hormones, and environmental factors, but according to cancer.com, "From 1991 to 2005, the number of new lung cancer diagnoses in women in the United States increased by 0.5% per year, while the number of new lung cancer diagnoses in men decreased by 1.8% per year. The number of male smokers has declined by about half over the last four decades; however, the number of women smokers has decreased by only 25%" From this piece of statistic, I think the increase number of women with lung cancer can be more attributed to smoking habits. I think the source of this data is pretty reliable since the website is run by American Society of Clinical Oncology. The American Cancer Society's most recent lung cancer statistics in the United States for 2009 include an estimated 116,900 men and 103,350 women will be diagnosed with lung cancer and an estimated 88,900 men and 70,490 women will die from lung cancer. This indicates that lung cancer tend to affect men more than women; this however does not mean that this statistic contradicts with the one above since its comparing the the prevalence of lung cancer in men vs. in women. This source is again reliable because its from the American Cancer society. Its weakness is that it does not show the "increase number of female smokers," it rather only compares the number of cases of lung cancer in men to women. National Cancer institute stated on their website that a new study reveals that incidence rates of lung cancer among people who have never smoked (never smokers) are higher in women than in men. Lung cancer incidence rates among female never smokers aged 40 to 79 ranged from 14.4 to 20.8 per 100,000 person-years, while incidence rates among male never smokers aged 40 to 79 ranged from 4.8 to 13.7 per 100,000 person-years. This is a reliable source as well because its by National cancer institute. Though it indicates that women are more prone to get lung cancer than men-- it only shows genetic factors or factors that can contribute to development of lung cancer, excluding the primary cause of lung cancer. This is also a weakness because it's missing out the biggest factor.

Blog assignment #10

In my last blog post, i said that i wanted to write my paper on the increased incidence of leukemia after atomic bombings in japan in the early 1900s. However, after i discussed my topic with Dr. Kahan, i realized that it will be much easier for me to analyze more of a current problem. So, I picked one topic of my interest: lung cancer. Because my parents and my boy friend have been smoked cigarettes, I am very interested in lung cancer and its current status. I went to the website of CDC, which i believe a reliable source. On its website, CDC said that although the number of smokers in the United States has decreased due to the decrease in the number of male smokers. However, among women in the United States, reductions in smoking are more recent, beginning in the late 1970s. Lung cancer death rates for U.S. women are among the highest in the world. To mention the particular statistics, it said that "in the United States, incidence of lung cancer has increased significantly by 0.4% per year from 1991 to 2006 among women" Time frame is from 1991 to 2006 and the population of this problem definition is women in the United States (CDC did not mention the age group; i have not gotten any chance to contact them and ask them, but i am soon going to ask them about it). As i said above, I am very interested in this topic because so many people around me, including myself (rarely), are smokers. I am very worried about my mom particularly because she has attempted to quit smoking so many times but failed. this is reason why i am interested in this topic

Blog assignment #9: my topic for the final paper

I have not done any full research on this topic, but I have always wondered and fascinated by the atomic bombings of Hiroshima and Nagasaki during world war II. On Wikipedia, it says that within the first two to four months of the bombings, the two atomic bombs killed 90,000–166,000 people in Hiroshima and 60,000–80,000 in Nagasaki, with roughly half of the deaths in each city occurring on the first day. What I am interested in is the aftermath rather than the acute effects. In my paper, I would like to address the increased incidence of leukemia attributed to radiation exposure among 1905-1920 birth cohorts from 1940-1970 in Japan exposed to the two atomic bombs in 1945. This is very important because nuclear weapons have been developed and improved over the course of couple decades, and under the contract the use of nuclear weapons is prohibited; however, we still often are threatend by nuclear weapons present, and just in case it is important to learn how it affects/might affect the health of the population. Some people would not find this interesting because this topic could feel unrealistic since nuclear weapons are not as common-- should not be common :) I, however, find this interesting because I read a book about this japanese family who raised a monkey deformed due to exposure to radiation during atomic bombing. It was many years ago but the story was very touching, and I have always wanted to learn about radiation exposure and how it affects people. Also, since I am from South Korea, which is a country in vicinity to Japan, and therefore could have gotten affected by the bombing and radiation follwed, I would like to investigate.

Blog assignment #8

We have learned a lot of things; As i said on my blog page at the beginning of this semester, I just vaguely thought public health is about promoting the health of the public, the population. I feel like since the beginning of the semester, i have gotten to know the various branches of public health and their roles and health care/ 2010 health reform which recently was passed. Although all the lectures were very interesting, i found infectious diseases, chronic diseases, and obesity lectures very engaging. I think i am most interested in diseases like epidemiology part of public health, rather than politics.. I had vaguely known that many Americans suffer from, dying from chronic diseases, I did not expect it to be that problematic. When i was listening to obesity lecture, I was upset how some people in our society did not get to choose but to become obese. It was a big shock to me when i found out that 67% of American are obese. Before i took this course, i did not know how public health was so much related to politics. We learned in class that the core functions of public health are assessment, policy development and assurance. As much as policy development is one of the core functions of public health, it is so much related to politics and it has to be statigic..so i think this is the thing that was most unexpected..Since the beginning of this class, i think i got to learn more about public health and what part of public health im most interested in. i still want to major in public health (Epidemiology) But i know there are still many branches in epideology; i think i will need to see which part of epidology i want to study and contribute.

Blog assignment #7: 2010 healthcare reform bill

This week, in public heatlh, we learned about health insurance, access to care, and the new health care reform. One statistic presented in class was comparing Per capita health spending to Per capita GDP. Compared to the other OECD countries, US is an outlier, in this case. This indicates that the United States spends way too much money on health care; however, international comparison (in a different statitstic) shows that average life expectancy of the United States is low relative to other developed countries. To tackle this irony, and to provide Americans better health care services more effectively, president Obama and the Congress have been working on and have finally gotten passsed "the 2010 Health Care reform bill." First of all, this bill will expend insurance to 32 million uninsured Americans. Under this health care reform bill, small businesses will get tax credits covering up to 50% of employee premiums. Also, it will constrain the growth of Medicare (which will be very helpful in paying for reform) by various ways, one of which, the donut hole coverage. Seniors with this coverage will be given rebate but be given limited precription medication coverage. As we have seen in class, among the uninsured, many of them are actually young adults because after thier parents' coverage, they do not feel the need of being insured. To solve this problem, the cut off age for young adults tto be covered by their parents' insurance became the age 27, indicating more young adults will be insured. New insurance plans will include checkups and other preventive care with no co pays. To improve transparency in insurance companies, from now on, they need to reveal how much money is spent, and there will be more and enhanced fraud abuse checks. Some small businesses might not be happy with health care reform bill because it will require them more than 50 workers to provide medical insurance for their employees or pay a 2-thousand dollar fine per worker. Also, now that the budget became tighter and the transparency is more emphasized, insurance companies are not satisfied. I think educated middle class will be the most happy with it because among the uninsured, most of them are uneducated, and therefore they do not realize how important it is to be insurance in a long term. They tend to see what's directly in front of them. Also, minorities and women are very in favor of this bill because this bill emphasiezes equity: for example, it is now illegal for insurance companies to make health care more expensive for women. I think it is a good piece of legislation; however its too ideal. it will be very hard to first implement this. I think it will cause so much chaos, especially, educating the uninsured will be extra hard...This will affect my family because we currently have Masshealth(we are from Massachusetts), which is a state-level insurance; Massachusetts provide insurance even for the people with no social security number(we are international students).

blog assignment #6

The economic recession has been the major effect on the health care system. Along with the economic recession, the congress is legislating helath care policies that can greatly affect the health care system; therefore, private and public health spending, or both, seem to change dynamically. The article that we are reading this week offered projections for private, public and national health spending. These projections were based on 2009 medicare trustees Report and total health spending is expected to grow faster after 2010 because of expected increase in personal income along with the economic recovery. Also as baby boommer generation move from private coverage to medicare, the private spending growth will seem to slow down, where as public spending growth will acclerate. Surprisingly, health spending is expected to grow to 4.5 trillion by 2019. However, public health spending seems to increase to 52 percent of all health spending by 2019 because of continued influence of the recession and possible demographic changes.The author of the article says, these projections do not include health care reform proposals and defense appropriations act, which extended COBRA coverage subsidization andlimited Medicare physician payment rates. Two primary factors that affect personal health care spending (purchase of health care products and services) are medical prices and utilization. Medical prices are influsenced by economywide factors. Then the author looks at various insurance payers: medicare, medicaid, private health insurance companies and people's out of pocket spending. As mentioned above, the author believes medicare spending growht will be expected to average 7.4 percent due to the baby boomers despite 21.3 percent reduction in physician payement rate recetly. The federal and state Medicaid is at its fastest growth rate for now; this is a result of rising unemployment. The article says, however, the medicaid spending growth seems to slow to 7 percent by 2012 as the economy improves. Another cause in increase of medicaid spending is increased number of the aged in the program; they tend to be more costly than other age groups. Due to reduction in the number of people with private health insurace, private health insruace premiums comparably increase. The article projects premium growth to reach 7.1 percent by 2015. At the same time, the services that require out-of-pocket costs are in less demand; enrollemnt growth in medicaid seems to increase.
Continued increases in healthcare spending and continued proportional increases in public spending suggest that the health care system in the united states is not working out efficiently, despite high demand of health care services, first of all. Also, as mentioned above, increases in pulbic spedning opposed to private insurance spending indicates that the economic recession is still influencing health care system. I think the most pressing issues for health care reform should be educating people about insurance and how being uninsured can actually lead to higher costs and how it can affect the society.

Blog assignment #5 -- Global health

A decade ago, lack of resources was the biggest public health concern. However, today, thanks to varous donations, there are enough money and resources; however, due to uncoordination, the money is directly towards high-profile disases than public health. The world now emphasizes conquering of the common diseases in developing countries with various reasons: moral duty, public diplomacy and self protection. However, the efforts are focused more on specific diseases than on broad measures. Also health care workers tend to flood to west, causing brain drain in developing countries.Among those global health projects, there hardly are methods of their efficacy; the world's poor does not have a way to tell what they want, what they actually need. Thanks to recent AIDS pandemic, there was a surge of funding from various sources such as Bill and Melinda Gates Foundation, Bush administration, and world bank. But the discrepency between the developed and the developing is still in dillema. A study showed that fewer than 40,000 subsaharan africans were reciving AIDS treatment when some 25 million in the region were infected with HIV and 600,000 of them needed the drugs immediately. However, the article looked at this surge positively, this is a "marvelous momentum for health assitance" and says 3 million of Africans could easily be on the medication. Bush administartion's fund estimates that it now supports 20 percent of HIV/AIDS programs and 66 percent of funding for TB and malaria research. However, most of funds come under conditions and must be spent according to donors' priorities, politics, and values; moreover, not all the funds end up being spent effectively. A lot of money leaks out in the process. Also, as mentioned above, lack of coordination of donor activities is another problem. For example, most of the globla HIV/AIDS related funding goe sto stand-alone programs such as HIV testing sites, ARV dispersal stations, HIV/AIDS education projects and the like. The article suggests that donors and UN agencies should at least try to integrate thier programs into general public health systems, therefore providing better coordination of the programs. Also donors and public health officials also try to build local industries, franchiese and such profit centers as well as local health infrastructures.

Now, among the various reasons given by the author why global public health keeps worsening despite bountful monetary resources, this week's blog assignment question asks which one i believe the most valid. I believe lack of coordination is definitely most valid. Developing countries often lack not only proper health care system and health care workers, but they also have bad economy and political infrastructures. Although it seems like a little process, giving out appropriate medical care to people consists of multiple steps. As the article said, donations and funds tend to disease or process specific; therefore, to make an improvement, it requires coordination of these funds and various activities. The second question asks what are the most important indicators of the status of the health care system in developing countries and why are they so important. The question said "markers," and i do not really understand what it exactly means but I am guessing markers are like indicators. I think types of common diseases in one region and maternal mortaliy/life expentanc are the most important indicators. Types of common disease in one region reflects the conditions of health care centers/system, including available vaccines and treatments. Also maternal mortality is also heavily dependent on hygeine, health care system, treatments and the like, therfore indicating the current status of healtch care system in those developing countries. HIV and TB are examples of how faulty systems and lack of sustainablity of current donor practices can lead to more deadly disease states. In South Africa's KwaZulu-Natal Province, during mass vaccination, due to financial constraints, health care workers re-used syringes which might have led to more people's HIV infection. Also that region's general health system is so poor that TB treatment was poorly handleed that only a third of patients got the whole regular/complete TB antibiotic therapy; this led to promotions of drug-resistant strains.

blog assignment #4: public health and the law

For this week's blog assignment, we had to read an article about Mary V. Kirk vs board of health case. Mary V. Kirk, a resident of the city of Aiken, had anesthetic leprosy, which is infamous in its contagious nature, and she was asked to move out of the city. To this, she claimed that she is "a woman of culture and refinement" and that she cannot live in such a dirty and confortable pest house where African Americans with smallpox were isolated. Besides, the pesthouse is right next to the city's dumping ground where foul order arose. However, the board of health insisted on her isolation because leprosy is dangerous to the community and the pesthouse is only "the last resort." Also the board of health argued that they would repair the city hospital and that they would build a nice cottage just for her; therefore it is fair for the community and for Ms. Kirk. They also argued that although the dumping ground is 100 yards away from the pesthouse, unhealth odors do not arise from it. After hearing both sides, Judge Aldrich restrained board of health's order, but board of health appealed. Ms. Kirk ended up submitting to board of health's action. The article then mentions six constitutional law governing public health regulations. However, after careful observation of this case, tells us that this is an exception.
I think the difference between quarantine and isolation is that although you are usually forced to be quarantined and isolated, but i think with quarantine there is more of negative connotation and resistance of the person being quarantined. Although board of health mainly decides who should be quarantined and who should not be, i think just like Kirk vs. board of health case, it should be determined by the court (even though it can be costly, it will be more fair to both sides) i think the judge should balance the rights of individual and of the community; I believe there's more err on the side of protecting the rights of the community because rights of the community consists of the rights of the many individual belong to the community

Blog Assignment #3: U.S performance on various health measures

For this week's blog assignment, we were asked to read an article on the perforce of the united states on various health measures compared to the other 29 OECD countries. These various helath measures were divided to the total 5 criteria: health resources, health spending, health status, health-care activities, and risk factors. I have always known that the amount of money U.S spends on health care is a lot, but I never knew that its health care status is actually a lot worse than that of the other countries. Statistics that U.S recorded the highest among the OECD countries are MRI units per milion population, total spending on health care, helath spending per catpita, total spending on pharmaceuticals per capita, and funny and obvious enough, obese population.I still remember when I first came to America from Korea, I was surprised by the number of obese people on the street. Very proud of our public health efforts, U.S recorded the lowest on tobacco consumption. Among the health measures, i was very stunned by how high America's infant mortality is. Although U.s did not record the lowest,it's definitely higher than the OECD average. Because of improvements in medical care these days, I expected infant mortality of America to be very low, but it's still higher than the OECD average. On the sidenotes, (this is not related to public health) I was also surprised by the number of medical graduates of the U.S. U.S also had fewer number of medical graduates than OECD average; the number of practicing physicians and of practicing nurses were lower than OECD average. As a premed student, I just don't understand why it is so hard to get into medical schools and become a doctor in the U.S when we have significantly fewer number of practicing physicians, nurses and of medical school graduates. We comparatively rated low in doctor consultations per capita. Though it's important to find intelligent people for jobs like doctor or nurse who deals with one's health and life, but in terms of public health, wouldnt it be more advantageous to accept more medical school applicants? I was also surprised by the number of MRI and CT scanners units per per million population in a good way! When I first read these two i thought of secondary prevention. As I mentioned earlier in this blog post, "obese population" seemed very obvious to me and i found it least surprising. It is so obvious considering typical greasy American diet, and you can see so many obese people on the street as well. Among these health measures, i thought, as I mentioned already, MRI and CT units per million population show the greatest potential future impact on thepublic's health; public health is concerned with the health of the general public. We have learned public health officials approach three ways to improve the health of the general public: primary prevention, secondary prevention, and tertiary prevention. I think high number of MRI and CT units indicate that secondary prevention is being enforced well and this helps early detection of diseases, therefore improving the health of the public. Although U.S recorded the highest total spending on medical care, ironically, its public spending on health is significantly lower than OECD average. I think this paradox is coming from people who do not have or cannot afford insurance. I think ensuring health insurace of everyone would reduce this discrepency.

10 Great public health achievements!

Because of the unprecedented, gigantic snow storm, I did not have intro to public health class this week; professor Kahan gave us an aritcle via email so that we could discuss it on our blog! In the article, the author states that since 1900, the average life span of Americans have lenghtened by more than 30 years, which can be attributed to the great efforts of public health professions. MMWR pointed out ten great public health achievements made in between 1900 and 1999: vaccination, motor vehicle safty, safe workplaces, control of infectious diseases, decline in deaths from coronary heart disease and stroke, safer and healthier foods, healtheir mothers and babies, family planning, fluoridation of water, and recognition of tabocco. I surely have encountered these from our textbook (i believe it was chaper 30) and definitely from ourlives. Routine use of vaccination definitely contributed to control of infectious diseases. For example, vaccination enabled eradication of smallpox. Thesedays, when you first enroll school, you are always required to show them your immunization record. I cant even imagine those days when you didnt have to be vaccinated or vaccines were out of reach. It's so frightening! Engineers build not only vehicles, but also highways safer. Workers are now at safer enviorments; this reduced fatal occupation injuries by 40 percent. Clean water and improved sanitation enabled reduction in cholera and typhoid. Also, according to the aritcle, discovery of anticrobial therapy enabled control of infectious diseases that had been major causes of death such as STDs and tuberculosis. Early detection and better treatment enabled decline in deaths from heart disease and stroke. Safer foods decreased microbial infections but increased in nutritional content. Thanks to better hygiene, nutrition, health care, and availability of antibiotics, infant mortaility decreased by 90% and maternal mortality decreased by 99%!!!!! (I totally wow-ed after reading this part; 99% is surely amazing.)Family planning changed women's social and economic role; at the same time, it helped prevention of STDs. Floridation of drinking water reduced tooth decay in children and tooth loss in adults. Recognition of tobacco use as a health hazard stopped people from smoking. I particularly resonate with safer and healthier foods; I read "Jungle" couple years ago and got shocked. Although, we often read articles about e.coli outbreaks that seemed to be caused by burger patties, compared to what happned before , it definitly improved a lot and i would like to give credits to the efforts of American public health the most. I also resonate alot with "safer motor vehicle" part because we are always told to "fasten seat belts" and not to "drunk drive". Funny thing is that we rarely noticed that it is a public health related issue. I did not know that until i did the reading! However, i actually do not really resonate or agree with fluoridation of water part not because i think it helped prevent toothloss and tooth decay, but because im very used to this kind of water that i dont realize how the drinking water is protecting me from tooth decay and toothloss. The last criterion (a thing that i believe it shouldve been on the list) was really hard to think of. I think it is because I am so used to all these things around me, and therefore ive never really appreciated it as a great public health achievement. But i think availiability of medicine and medical care should have been on the list because there are always people who try to give medical help to the poor and medical care itself is in reach; this is very different from the past.

Course blog: assignment #1

Hi, my name is Rosa Kim. I am a freshman at Johns Hopkins University. I am from Belmont, Massachusetts which is a little town in Boston suburb. I am a big baseball fan(Red Sox, obviously). I first came here with neuroscience major, but i am now considering switching out of neuroscience. I took neuroscience course back in high school, and I thought it was pretty interesting but I wanted to learn more applicable and more community involved. Meanwhile, i took this freshman seminar course called "From Tropical Disease to Global Health" last semester and was very inspired by how public health is so much involved with politics and the public. I still remember when I read the book "Hot Zone" by Richard Preston for required class reading; in the book, CDC and USAMRID didn't publicize the out break of marburg virus at this research lab in Atlanta, fearing the public's panic. It was so much more complicated than simply curing individual sick patients. This is a reason that i decided to take intro to public health this semester; so that i can learn more about public health in detail. From the past 3 lectures, not one from today, we learned what "public health" is, what is its goal, and three core function of "public health." Public health is defined as the science of preventing and controlling disease, injury, and disability, and of prolonged healthy life of the public. In other words, different from medical care which heavily focused on healing individual patients, public health emphasizes impovement of the health of that population and preventing illness. My interest in public health may be epidemiology, so more like the science area, rather than policies and statistics. However, I'll see how it goes as i learn more and more about public health this semester! I watched the movie "Outbreak " in Tropical disease class last semester and thought it would be very intersting to find a source of infectious disease. My initial impression of the first two classes was pretty good. I honestly learned alot from those lectures; I was able to grasp what public health is and how it is different from medical care, which is a reason why i decided to stick to this class =) However, some of the materials were repeating. I liked the fact that students can involve even though it's a lecture class.

Powers and responsibilities of government and public health

I would like to discuss assignmend reading (due monday) and my related experience. From my high school junior year to my senior year, I worked at a local newspaper company, called Boston Korea. My job was to translate articles from various fields for those korean-americans who have hard time reading English articles. Thanks to my job, I was openly exposed to current events. One of the issues that came up often was Massachusettes's "insurance for all" policy. As we all know, the cost of medical care in the United States is unbelievely high, and by ensuring everyone to get an insurance we technically can save so much money that are getting wasted from emergency room cost etc. While I was reading chapter 3- powers and responsiblities of government, I learned how public health, which i had thought to be vague and one of the government's obligations, is very systematic and there are many others besides the federal government contributing to the health of the population in the united states. Local public health agencies, which get funded by the states, the federal government, federal funds etc are concerned with medical care of the poor and everyday public health issues. State health departments set policies which would be followed by local agencies to ensure general welfare of the population. I think the Massachusettes government which set "insurance for all" policy goes into this category. Also, Federal agencies involved with public health such as CDC, NIH, and FDA, contribute to controlling and preventing human diseases including infectious diseases and chronic diseases, and to conducting various research. In addition, nongovernmental agencies also are involved in the general welfare of the public through education and lobbying. Going back to Mass. health insurance issue, when i read those articles concerend with conflicts and controversies of the policy, I simply thought "this is for everyone's well-being, why can't everyone just be happy with it? Why is it so hard to make such an easy decision?" But because there are so many agencies involved in public health along with politics and economic issues, it is very hard to do so.