INTERNATIONAL HEALTH CARE

Beyond recognized disease concepts, the most deadly pandemic destroying society for the future, is the rapid and irreversible destruction of our environmental and communal resources. In addition to inducing susceptibility to new pandemics, the resultant degradation is causing widespread poverty, a world of war and famine.

Among the goals of Friendships Without Borders Inc., (see web fwbinc.org) is a reclamation of the whole human family - sharing and caring, a universal dedication with local direction and organization of an affordable, accessible Health Care system retaining full regional autonomy, participation and accountability. A mission in which the community plays a role in regional health care; a project with the prospect of a vital volunteer component.

In the United States, there is a growing dependent, elder population, most unable to afford prescribed medicine and, more than fifty million of this population without adequate or any health insurance. A significant development, with a billion live births in the past decade, an even more vulnerable population segment, the twenty-five year olds and under, forming over fifty percent of the world's population by the year 2010. In the presence of an increasingly informed patient population, too many seeking appropriate treatment or legal redress, and many more educated to contemporary diagnostic and treatment options and their urgent right to the same.

Britain's National Health Service, a once 'prized example' of 'total people care', has fallen on hard times, described in a recent review in the Economist, 'The English Patient' - adequate services are unaffordable in its present structure, with an 'overload' bureaucracy administering unequal care, of varying quality, rife with malpractice claims, overlong, delayed treatment - widening quality differences between the public and private sectors. A complete revamping of the organization and funding of care - further recruitment of personnel - restructuring of the in hospital role and closer monitoring of the quality of care delivered in and out of hospital, is in the process of implementation.

.In a recent survey of the Northern Ireland Health Care system, peripheral to the UK system of Health Care - assessing performance response to the sudden acute demands of the widespread flu attack of '99; it was concluded the situation was totally unsatisfactory, the quality of care poor. Compared to the rest of Europe, it was found - 'Life expectancy, in NI among the worst - the third highest death rate in Europe - female lung cancer death rates twice the EU average. Breast cancer death rate the highest in Europe - and, with 43% of people of retirement age, found to have long standing illness. And, finally, in NI, the highest long term unemployment rate in the UK. This last reference recognizing the diverse contributing factors in the overall Health Care picture.

A restructuring of the role, priorities and mandate of a more efficient health care team. From the roles of the specialist and the general physician in 'In Hospital' and 'Out of Hospital' preventive, emergency, and long term care - a redistribution of qualified personnel to provide effective and cost efficient coverage.

With a 'first line' of detection, designed to include para-medical and technical support, roles of nurse practitioner and other emergency, technical and nursing support. This, allied to medical student participation, is invaluable to educate other priorities for the physician 'in training' at an early stage. This 'first line' of detection, if indicated, reaches then, for consult, to the 'out of hospital' general physician. Available and upgraded communication systems utilized by the technical support team, will allow appropriate monitoring from the 'patient site'. The goal, to redistribute the physician input to a more affordable 'back up' location.

Preventive medicine sets up the regional or local environment - analyzing how the community might best meet local health care standards - with the responsibility of ongoing evaluation and updating of standards and their compliance. Monitoring this role will be a public health community team, in consult and immediate contact with 'out of hospital' general physicians - the ultimate overall community health care providers.

Preventive medical care and early detection will include health care education of the community, with a stress on ecological factors, and their own role and responsibility to ensure a safe environmental program.

In hospital roles of specialists, general physicians, nurse practitioners and other assistants will evolve in similar manner. The cost of this team is set by the inclusion of the specialist and the appropriately qualified technician, nurse, and nurse practitioner at an early and continuing stage. This applies from the hospital 'admission phase' - emergency or elective - from laboratory, pathology and ongoing monitoring, to operating and ward coverage. The basis of the 'team' component would also apply to the anesthesiologist and nurse anesthetist.

The quality of care and its administration will be the same for all patients. Funding for a regional health care program - for 'in hospital' and 'out of hospital' must come from public funding, tax revenues, including a redistribution of infrastructure and defense spending, and from private sources - proportionate charges for services according to patient resources, both public and private funded insurance coverage. Taxes from all corporate health care industry and pharmaceuticals earnings will also provide a significant and appropriate contribution, as well as resources and income represented by insurance companies.

The Johns Hopkins International Health Care Plan contains the essential components to set and maintain the standards of quality health care - its participation in a consultant capacity in association with business development plans and their agencies to implement universal health care and community coverage. They have expressed interest and support.

We have approached representatives of health care education and providers in the UK regarding an affordable, accessible health care program. Dr. Joe Hendron, MP at Westminster - Chief Medical Officer Etta Campbell in Northern Ireland, Dean Bob Stout of the Medical School of Queen's University, and others, including Maurice Slapak, Director of the UK Transplant Games program, formerly of Cambridge University. All have expressed a keen interest in our plans.

We have received ongoing support of our proposals in promoting the economic initiative, from President Clinton, from Lt. Governor of Maryland, Kathleen Kennedy Townsend, from Bernadine Healy, President of the American Red Cross, a former colleague at Hopkins and others, including international economists well recognized in their field. Professor Steve Hanke of 'Hopkins, Professor Bob Rowthorn of Cambridge, Professor John Bradley of ESRI, Dublin, Professor Amartya Sen of Harvard and Cambridge and Professor Michael Smyth of Ulster U.

In Baltimore, Md, we are presently working with agencies to formulate the appropriate role for FWB and its social empowerment commitment with Johns Hopkins in implementing the Universal Health Care program on an international basis - also in developing an appropriate monitoring system for the community care component of the 'out of hospital' patient as well as its application in the emergency situation.

For proposed healthcare "team" concept (FWB 1-23-04) see below.

The two faces of Eve. 1776 1:5 in slavery. 2004 1:5 in poverty. Today, the richest nation on earth and over a trillion dollars in debt - confronting its inability or unwillingness to meet its moral priority commitments. Recall the promises post WW II, The Twentieth Century Fund and the Stuart Chase six volumes - the 'Guide to America's Future' - or, 'For This We Fought' - the core promises to the returning veterans and their families.

Full employment, social security, affordable health care for all - the NIH report on the relation of income to health - the negative effects of poverty - suggestions that citizens organize their own hospitals and medical services. None of these goals have yet been achieved. In the words of the old folk song, 'another day older and deeper in debt I owe my soul to the company store.'

The nation's resources are grossly misspent. This, in the face of the highest rate of poverty among the western industrialized nations (Irish Times report July '02). According to the U.N. on World Health - the U.S. is number 17 in the western nations, with the highest infant mortality, single parent families, incidence of HIV, in disparity in wealth and health and opportunity. A future with the deliberately inflated projected needs of its weapons manufacturers (Caldicott); the fears of Washington, of De Toqueville, Eisenhower, Truman etc. are being realized. A 'corporate hegemony' with the inevitable outcome, the social factor all but totally neglected.

In the U.S., life expectancy, regionally compared, is among the worst. Preventable death and disease - the recent upsurge of deaths from HIV-AIDS, tuberculosis, lethal variations of influenza, more than a million medical mistakes, over one hundred thousand resultant annual deaths, 18,000 per year dying from inadequate, untimely or unaffordable detection of their problem.

Community Health is now the foremost budget casualty. In 2010 or before, when the 'baby boomers' come of age, Medicare will be unavailable. In Oregon, presently over 400,000 have insufficient insurance or government coverage - over 270,000 in Maryland alone. Some seventy-six million are now with inadequate health coverage, especially among Afro-Americans, Hispanics, single parents with temporary jobs (N.Y. Times, Robin Toner, March 5, 2002), and with significantly declining positive education indices. The earlier and preventable deaths result from unaffordable, privatized or otherwise unavailable health care or, 'the wasted resources from funding unwarranted treatments.'(Brownlee) Clearly no choice but to address the present health system deficiencies - independent, unregulated and haphazard, grotesque, inefficient, unaccountable, unaffordable and inaccessible - time to take urgent steps to design and describe the first true Community Health Care Team, its goals and its sources of funding. Our proposal, to create a public/private Health Assurance System.

1. The community, its effective voice - its political representation
3. Regional medical teaching institutions.
4. Pharmaceutical, biotechnological and medical supply companies

Our purpose is to work together to ensure profitable marketing of the original product by all members of the team, by addressing avoidable areas of duplication - sharing facilities, staff and resources, decreasing R&D, staff, medical and lab facilities cost - also to include medical, nursing and health related student participation. This essentially must also include ongoing social and economic community input to address inequities in sharing the final role for all - to provide effective and affordable community health. The concept of the TEAM inclusion of health administration components is to ensure accountability and participation adhering to optimal practice standards - presently varying from state to state. (Shannon Brownlee, Atlantic Monthly. January 2003.)

With ongoing evaluations and monitoring by and between the component members of the team, from medical teaching institutions to the medical supply industries, student level to graduate studies, and from the community input, disparities and deficiencies on all registered patients would be recorded and evaluated on a timely basis. The resulting information would be used to improve and enhance function of the program. Other functions of the team; ongoing study and monitoring of the use and misuse of public monies, i.e., unwarranted tax concessions, capital gains or other subsidies - re-directed to the primary social imperatives - to the primary exertion of the public will - e.g. optimal equal health care, education, Social Security etc.

The program requires appropriate restructuring of the present community health system including reallocation of components - appropriate housing, security, efficient telecommunication systems, transport, home care requirements. Ongoing studies by the community team will identify the disparities between what is available and what is needed. The absence of ongoing professionally acquired data results in the absence of standards for adequate community care. Just as Shannon Brownlee illustrated - "excess treatment" wastes more resources - should be replaced with "early detection", avoiding unnecessary and later, costly treatment modalities.

Data on hospital bed and emergency requirements, according to age group of population chosen - i.e., should recognize proportionate special surgery facilities per regional statistical requirements. These issues must be addressed - again, in relation to standards and deficiencies revealed through the community health care team data - in ongoing Public Health studies. To optimize this we recommend an intercommunity student and community exchange program. (See Community Health Care Team, Jan. 25, 2003) Without addressing the broader context of community health - unexpected results will confront the community. For example, for men under 25 in the Bronx, N.Y. life expectancy is less than the equivalent group in China's Quangtung Province, or young men in Kerala in India (Amartya Sen). Northern Ireland health statistics show life expectancy in Northern Ireland is the worst in the E.U. Community health depends on the availability of the basic instrumental precepts for optimal health and development - political freedom, economic facility, transparency of guarantees and agreements - of protective security and trust. An example of lack of trust and security resulting in poor health - a high proportion of heavy smoking, fatty diet, drug abuse, violence, and accompanying poor and inadequate preventive health programs.

A model has been addressed in the U.K. (Michael Smyth, Economist, Ulster University, Colm McClean, Friendships Without Borders, Inc.) The infra-structural requirements funded from telecommunications company, government and private sources.

As described in previous papers, with the decline of the inner city viability, a structural equivalent to the regional mall shopping facility, its large food chain component, seems adequate to meet the requirements of a motorized society. The sale of essential consumption products is organized and made available under optimal customer - provider standards, conditions and infrastructure - accountable health care provided at affordable prices. Paid for by relative tax assessment of community members, including relevant corporate organizations. Health care monies i.e. presently, not meeting or matching required minimal standards, we propose a mandatory assessment of government subsidies from forgone tax revenues - e.g. from presently misdirected Agriculture or Defense subsidies.

Community Health Care Team medical and paramedical components are critical factors in the basic needs for optimal community health and development. Broadening the supervisory role for the physician, general practitioner, proportionately redistributing cost, increasing efficiency; optimal patient load through team components, i.e. physician assistant, nurse practitioner and paramedics. Ensuring coverage for all, proportionate general hospital bed requirements - special surgery and other emergency requirements, i.e. triage service. The Community Health Care Team to be informed on an ongoing basis of events and progress - regional statistics to be addressed in these selected areas. The government assuming and fulfilling its priority role, avoiding the increasing attempts, unaffordable trends to privatization, or to support increased insurance company demands.

Funding for the Community Health Care Partnership - efficient, preventive medicine program, optimal health with minimal required treatment - will come from these sources:

1. Government
   Monies from tax resources assigned to community health, proportionate to income -- e.g. the Swedish system
   1. $25,000 or less - minimal or no tax assessment - dependent family considered
   2. Income in excess of $25,000 to $50,000 - proportionate with family tax concessions, with education support
   3. Incomes in excess of $50,000 to $100,000 - proportionate with appropriate family tax concessions, also factored for education etc.
   4. Incomes in excess of $100,000 - an incremental increase in tax liability with income increase per $50,000 - Keynes "trickle down" realistically implemented
2. 1. A profit percentage generated from the pharmaceutical, biotechnology, medical institution partners - given persuasive tax incentives
   2. Hospital funding sources through priority government funded community health services - per bed utilization - per procedure cost - minimal optimal staffing. Regional major facilities and med-surg community facilities - larger community special surgery requirements equally available - working with shared facilities. Drug medication and other treatment requirements working with pharmaceutical and biotechnology companies, etc.
3. Insurance companies and other private funding
   

Among other resources presently misspent or overspent - monies estimated "medicare alone could save $59 billion a year" the system as a whole wasting about $400 billion a year - more than enough to care for over 41 million uninsured citizens." (Brownlee, Atlantic Monthly, Jan. 2003) Some restraint in a varying job market might be judicious - perhaps through selective taxation to caution the current $8 trillion U.S. household debt now exceeding the U.S. annual disposable income. With a National Debt for the first time over $2 trillion and escalating - a potential bubble situation akin to another NASDAQ threatens. Re-channeling of job resources, lay offs and export of some million blue and white collar jobs - reallocation of budget priorities - is now urgent.

Niall P. Mac Allister M.D. President, Friendships Without Borders Inc. www.fwbinc.org
Sean Byrne Ph.D., Director Mauro Peace and Justice Center, Winnipeg, Canada. VP FWB
Francis Gallagher, Director Ireland Friendships Without Borders Inc.

1-23-04

References

First paper - The Community Health Care Team International - the Affordable Partnership 1-25-03

Second paper - Health Care - the Key April 25, 2002

Third paper - excerpt Newsweek - Nov. 5, 2001 "Above and Beyond Just Doctoring"

Shannon Brownlee, Atlantic Monthly, Jan. 2003

Niall P. Mac Allister MD (FWB)

2003-2004 - Regarding the rising incidence of suicides among young people, FWB has joined with the Children of Ireland Group, Terry Ryan, director, in addressing this problem. (see Press Release from Children of Ireland Group 2004, below)

The Children of Ireland Group

P.O. Box 13241
Tallahassee, Florida, USA 32317
Phone: (850) 562-6466
An IRS 501(c)(3) Non-Profit Organization
E-Mail: terry@thetrakker.com Web: www.thechildrenofireland.us

March 17, 2004
NEWS RELEASE

The Children of Ireland Group, Inc. today announced a collaborative effort, in partnership with the U.S. based Friendships Without Borders organization, with the Northern Ireland Department of Health, Social Services, and Public Safety (Department of Health) and with the responsible authority, the North and West Belfast Health and Social Services Trust to assist in assessing the mental health needs of youth and reducing the tragic trend of youth suicides in Northern Ireland. Specifically, this collaborative effort aims to determine the feasibility of both organizations assisting the Department of Health in its efforts to reduce adolescent suicides, by providing professional volunteers from the U.S. and other countries, including psychologists, counselors, and supporting staff.

This effort was begun in February, 2004 by The Children of Ireland Group when the tragic news of thirteen (13) adolescent suicides was announced from the Ardoyne and Glenbryn areas of Belfast. Discussions with the Department of Health identified that the mental health system was eager to draw on international best practice to complement local expertise and services.

Commenting, J. Terry Ryan, President of The Children of Ireland Group, indicates, "The horribly tragic suicides of at least thirteen youth in Ardoyne and Glenbryn just since January 1, 2004 reveal the utter hopelessness of youth on both sides of the continuing conflict in Northern Ireland and a mental health system struggling to cope with a wide range of complex needs and very high levels of demand. Our own efforts since 1999 find these problems can only be addressed at a 'grassroots level' of each community by providing appropriate resources to mental health and social services personnel along with community volunteers, in assisting the youth and their families. We are delighted to be working in partnership with the Friendships Without Borders as we explore with the Department of Health the feasibility of providing professional volunteers to assist the Department's own resources"

Clive Gowdy, Permanent Secretary of the Department of Health, Social Services and Public Safety, said "With cooperation and commitment, even the most difficult problems can be addressed. Suicides are deeply distressing for everyone and it is important that the factors which cause them are tackled with determination. The collaboration with The Children of Ireland Group and the Friendships Without Borders organisation offers the opportunity to bring international expertise and experience to the work going on in Northern Ireland."

Dr. Niall Mac Allister, President and Founder of the Friendships Without Borders, indicates, "The goals of the community, the family, must be the focus of our social priorities. The expression of the 'young voice' of the next generation, the attention, trust and respect it merits - now, with never a greater urgency, is the key to community health, to successful socio-economic development and to their fulfillment. "

Heading up the professional volunteer effort is Dr. Fred Bemak of George Mason University who has done extensive international work in over 30 countries and been involved for the past 3 decades providing consultation and training for mental health, social service, and community organizations and professionals who work with youth. Commenting, Dr. Bemak indicated, "It is very difficult to experience the loss of our youth and see the children who are the hopes and dreams for our future take such a desperate and final step as suicide. Our hope and intent is that through this collaborative project we can begin to facilitate the personal and social healing that must take place for our children, families, and communities, contributing to a better world for our next generation and ourselves."

Richard Black, Chief Executive of the North and West Belfast Health and Social Services Trust in welcoming the initiative, commented "I very much appreciate the interest of The Children of Ireland and the Friendships Without Borders organisations in the needs of our young people. The Trust works closely in partnership with our communities to better understand the pressures that young people face and we are determined that the services we provide reflect the best international practice. This is an important opportunity to collaborate with colleagues from the United States and to share our experiences and learn from successful efforts to address the needs of young people in the United States and elsewhere".

The Children of Ireland Group, Inc. is a U.S. based organization providing recreational and educational resources to community centers working with at-risk children and young adults in Ireland, especially, Northern Ireland. Specifically, it helps community centers provide an alternative to membership in gangs, drug use and violence or resorting to the ultimate despair: suicide. Suicide among children and young adults less than 25 years of age is at alarming rates in Ireland, especially, in Northern Ireland. The goal in providing recreation and education equipment is to help attract "at-risk" children into the centers, provide a safe haven, and allow community social and health workers to work with them. Secondly and equally as important, the Group hopes its efforts in some way will open doors of opportunities to peace and cooperation between Irish youth, both Catholic and Protestant, and many long-lasting ties with their American friends.

The Group was founded in 1999 by J. Terry Ryan on his return as an international observer to the July marching season. The organization is a 501c3 non-profit organization working to make a positive difference in the lives of children and yong adults and offer hope to families who have been directly involved in and affected by years of conflict in Northern Ireland.

As of December 31, 2003 the organization has assisted over seventy (70) community centers, representing over 16,000 children and young adults. Funding requests range from arts and crafts supplies, musical instruments, school equipment, books, and conflict resolution books, to sports equipment including camping, canoes and kayaks, along with soccer and football equipment. An on-going effort to collect used personal computers in the U.S. and shipping them via FedExpress has benefited dozens of community centers and thousands of youth.

For additional information, contact:
J. Terry Ryan, President - Children of Ireland Group, Inc.
     Tallahassee, Florida
     Work: 850/562-6466 Home: 850/668-4273 Cell: 850/321-9352.
Clive Gowdy, Permanent Secretary - Department of Health, Social Services, and Public Safety
     Belfast, Northern Ireland
     Work: 011-44-2890-520573
Richard Black, Chief Executive - North and West Trust
     Belfast, Northern Ireland
     Work: 011-44-2890-327156
Dr. Niall Mac Allister, President - Friendships Without Borders
     Essex, Maryland
     Home: 410/391-3548
Dr. Fred Behak, Director - Friendships Without Borders
     Professor and Program Director - Counseling and Development Program -
     George Mason University
     Work: 703/993-3914

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