The relationships between the government, medical field, and society
The relationships between the government, medical field, and society are extremely interrelated in regards to the creation of health policies. As a result of these relationships, problems in the United States are addressed very slowly, even if sufficient information is available to suggest immediate attention. This paper addresses some of the factors contributing to this effect with cigarette smoking as an example.
The United States government, with full knowledge that cigarette smoking is now the “single most preventable cause of premature death in the United States,”1 has been hesitant to impose regulations on smoking because such involvement could be construed as revoking the rights of citizens. If a government mandates certain behaviors, or a lack of certain behaviors, citizens, especially those who engage in the activity, may feel deprived of their rights as an individual.
Conversely, if citizens who do not engage in the activity are negatively affected by others’ behavior, they may also feel deprived of their rights as an individual. If the said activity is cigarette smoking, smokers choose to smoke of their own accord, whereas non-smokers may be, and often are, affected by this behavior, even though they have chosen to forego cigarette smoking. Both parties have exercised individual rights to make decisions, but the latter party can argue that an additional right is challenged as smokers are allowed to smoke in both public and private areas where non-smokers may be affected.
The negative health effects of exposure to second-hand smoke have increased this controversy. National laws and regulations have not been enacted in regards to smoking because the government must walk a fine line between these two parties to ensure equitable treatment, while maintaining citizens’ individual rights. The United States government has only recently begun to take action in regards to cigarette smoking among the general population.
In the Healthy People 2010 Report issued by the government in 2000, there are many areas that focus on the issue of smoking. An important distinction to make regarding Healthy People 2010 is that these are stated goals, not laws or regulations. The government is attempting to become involved with the issue of smoking, but has yet to take quantitative or enforceable actions.
One of the most ambitious goals of this report is the objective of an “increase in counseling about tobacco use cessation, physical activity, and cancer screening. 2 Within this objective are the specific goals to have internists, family physicians, dentists, and primary care providers counsel their patients about smoking cessation and cancer screening. The goal is to have an eighty-five percent participation of such physicians in this preventative measure. With the participation rate currently at an average of about forty-three percent, this goal will require substantial governmental support, along with support from health insurance and managed care organizations.
An additional goal of the 2010 Report is the objective to have an “increase in insurance coverage of evidence-based treatment for nicotine dependency. “2 There is currently about a seventy-five percent participation rate by the insurance companies to provide such support, but the goal is to have one-hundred percent participation. This goal is indicative of the government’s attempt to assist citizens in the battle against smoking, but an additional, and possibly more relevant concern, is putting in place the incentive for physicians to perform an initial smoking cessation evaluation and consultation.
There are not currently any reimbursement policies for smoking cessation consultations. This lack of reimbursement is providing a vicious circle between physicians, patients, and health policies. Health policies do not currently reimburse physicians for time spent counseling patients on smoking cessation. As a result, physicians do not regularly provide such information or advice to patients because other reimbursable issues are more frequently and consistently addressed first in the short time frame allocated to each patient visit.
Patients often feel that physicians are the most highly knowledgeable individuals to prescribe treatment or intervention options to increase their health. If physicians seem relatively unconcerned with a patient’s smoking habits, it is reasonable that the patient then assumes the problem must not have the exigency for correction or cessation, resulting in a disregard of any consultation or intervention assistance. Following this logic, patients then do not advocate to the insurance companies the need to compensate for such services provided by the physician.
This lack of lobbying by patients results in no new policies allowing smoking cessation consultations to be reimbursed, and the physician continues to not provide this health consultation. It is only recently that an interest in public health has brought more attention, exploitation, and controversy to cigarette smoking. Health insurance companies and managed care organizations currently provide very little, if any, smoking cessation support for patients. As mentioned above, physicians are not reimbursed for the time spent with patients discussing and reviewing treatment options for smoking cessation.
Physicians are among the most highly regarded professionals regarding an individual’s health, and patients generally consider, if not directly act upon, the suggestions and advice from their physician. In a recent study on changing behavior, the effects of interventions that involved advice from physicians and trained counselors to quit smoking had beneficial effects in that “systematic reviews have found that simple, on off advice from a physician during a routine consultation is associated with 2% of smokers quitting smoking without relapse for 1 year.
Advice from trained counselors who are neither doctors nor nurses also increases quit rates compared with minimal intervention. “3 Although a two percent incidence of smoking cessation may seem inconsequential, this amounts to 720,000 people who quit smoking each year due to a simple physician suggestion. Anti-smoking interest groups have also become a growing force in the campaign against cigarette smoking. Millions of dollars have been spent by numerous interest groups to lobby for a smoke-free environment.
For example, the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) has taken the initiative to set up a worldwide tobacco-control policy to curtail tobacco use. This WHO project is such that it “has provisions that set international standards on tobacco price and tax increases, tobacco advertising and sponsorship, labeling, illicit trade and second-hand smoke. “4 These types of interest groups represent portions of the population by lobbying to the government about changes in current regulations, or the enactment of regulations that are nonexistent.
These interest groups are the initial forerunners to have placed an importance public health, and in this example, on the health of nonsmokers. The number of anti-smoking interest groups has grown dramatically in recent years, with many of them focusing on a smoke-free America. The campaigns that are run by these groups aim to educate the public regarding the adverse effects of smoking and to decrease the number of people who begin smoking in their teens.
The efforts of these groups have been successful in attracting the attention of the general public and the government. An example would be the proliferation of businesses and restaurants that no longer allow smoking on the premises. There are many other significant factors that interact with the government, health service delivery, and interest groups, but the ones mentioned above have had the most significant impacts on the current viewpoints of smoking and where these will lead in the future.