Posted: January 16th, 2023
Antibiotic Resistance Global Healthcare Comparison Matrix and Narrative Statement Assignment
Global Health Comparison Grid
NURS – 6050C: Policy and Advocacy for Improving Population Health
Global Health Comparison Grid and Narrative Statement
|Global Healthcare Issue||Antibiotic Resistance
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|Description||Antibiotic resistance (AMR) is a global public health problem that was listed by the World Health Organization (WHO) among the top 10 leading world health issues in 2020 (WHO, 2020). AMR is described occurs when microbial pathogens, such as fungi and bacteria, develop the capacity to repel or survive the antibiotic agents intended to kill them, thereby threatening the globe’s advances in food production and healthcare, which, in turn, negatively affect life expectancy (WHO, 2020). Statistics from the Centers for Disease Control and Prevention (CDC) (2020) reveal that >2.8 million AMR infections are documented in the U.S. annually, resulting in >35000 mortalities each year. Similar trends have been observed in China, where the AMR crisis is deteriorating and seriously threatening animal and human health (Qu et al., 2019). Addressing AMR calls for concerted efforts among countries in both industrialized and developing regions to detect, mitigate, and respond to the associated disasters. A comparison of policy efforts adopted by China and the U.S. will be presented in this Global Healthcare Comparison Matrix Antibiotic Resistance Global Healthcare Comparison Matrix and Narrative Statement Assignment.|
|Describe the policy in each country related to the identified healthcare issue||The U.S. government issued Executive Order 13676 directing the Department of Health and Human Services to formulate and lead the execution of the 2020 – 2025 National Action Plan for Combating AMR, aka CARB (Federal Task Force on Combating AMR, 2020). CARB outlines that the U.S. will collaborate with both overseas and local agencies to detect, prevent, and control infections and mortalities attributed to AMR. The primary aim of the Plan is structured around five objectives for collective actions by the federal government in collaboration with organizations, individuals, and international administrations (Federal Task Force on Combating AMR, 2020). The five goals encompass 1) fast-tracking applied and basic research and formulation of novel antimicrobial agents, 2) advancing formulation and application of rapid and inventive diagnostic assays for detection and characterization of resistant microbes, and 3) strengthening the national collaborative, multisectoral, and transdisciplinary (One Health) surveillance attempts to curb AMR (US Department of Health and Human Services, 2019). Fourth, improving overseas capacities and collaboration for AMR mitigation, and lastly 5) slowing the incidence of resistant microbes and curbing the dissemination of AMR infections.||Like in the U.S., infections resulting from multi-drug resistant organisms, particularly CRE, are exponentially increasing in China, and they are often allied to elevated death rates owing to a lack of therapeutic alternatives (Qu et al., 2019). As a result, the Chinese Ministry of Health introduced the zero mark-up drug policy (ZMDP) in 2009 to rationalize antibiotic use and discourage public hospitals from benefiting from the over-prescription of antimicrobial agents that are allied to AMR (Yan et al., 2020).|
|What are the strengths of this policy?||One of the core strengths of the 2020 – 2025 Plan is the One Health approach to the implementation of the policy, where stakeholders are drawn from multiple sectors at the global, national, regional, and local levels collaborate to accomplish the shared goal of combatting AMR (CDC, 2019). Second, the readiness of Congress to support the investment in and implementation of the Plan has allowed the U.S. to make significant advances in combating AMR (US Department of Health and Human Services, 2019).||The implementation of the ZMDP was preceded by a nationwide campaign, which helped in creating extensive public awareness of the policy (He et al., 2019). In addition, the policy execution was piloted first at primary care facilities before it was progressively scaled up to the county, tertiary, and national public hospitals (He et al., 2019). The progressive scale-up allowed the implementers to address potential challenges before expanding to larger institutions Antibiotic Resistance Global Healthcare Comparison Matrix and Narrative Statement Assignment.|
|What are the weaknesses of this policy?||While the One Health approach is a major enabler of the 2020 – 2025 National Plan, it also represents a key weakness. One Health requires local and international governments to collaborate. The U.S., however, influences local agencies; thus, the unwillingness of other countries to actively partake in the intervention is beyond the control of the U.S.||Early assessment of the efficacy of the ZMDP at the pilot stage showed an insignificant reduction in unreasonable prescription and use of antimicrobials in various provinces, including Hubei, Anhui, and Guangxi (He et al., 2019). The inefficacy of the policy in achieving its core mandate can be attributed to failure to involve physicians in the design and implementation process, yet, they are the key stakeholders in the prescription of the drugs (Yan et al., 2020).|
|Explain how the social determinants of health may impact the specified global health issue. (Be specific and provide examples)
|Poor administrative governance is one of the social determinants of health that has been associated with the overuse of antibiotics, which, in turn, contribute to AMR (Collignon & Beggs, 2019). In low-income countries, the lack of understanding and knowledge of the pharmacokinetics of antimicrobial agents has been ascribed to the misuse and overuse of antibiotics (Collignon & Beggs, 2019).||Poor administrative governance is one of the social determinants of health that has been associated with the overuse of antibiotics, which, in turn, contribute to AMR (Collignon & Beggs, 2019). In low-income countries, the lack of understanding and knowledge of the pharmacokinetics of antimicrobial agents has been ascribed to the misuse and overuse of antibiotics (Collignon & Beggs, 2019).|
|How has each country’s government addressed cost, quality, and access to the selected global health issue?||The U.S. has addressed the cost, quality, and access to efforts to combat AMR through the One Health approach. The latter is steered by the CDC, a global health agency that directly works with international governments through capacity building, training, and research (CDC, 2019).
|AMR is associated with significant mortalities in China annually. The Chinese government has therefore invested in a series of policies and interventions to combat the associated cost (Wang et al., 2016). In addition to the bottom-up enforcement of the ZMDP policy to ensure a decline in the irrational use of antimicrobial agents, the government has also funded evaluation studies to determine the quality and effectiveness of the policies (Yan et al., 2020).|
|How has the identified health policy impacted the health of the global population? (Be specific and provide examples)||Since its roll-out in early 2020, CARB is anticipated to significantly decline the occurrence rates of key antibiotic-resistant bacteria, including Clostridium difficile, Methicillin-resistant Staphylococcus aureus (MRSA), and carbapenem-resistant Enterobacteriaceae (CRE) (Federal Task Force on Combating AMR, 2020). The above improves global health by eliminating the odds for the development and spread of antibiotic-resistant mutations, and subsequently, reducing mortality rates attributed to AMR infections.||Like the U.S. 2020 – 2025 Plan, the Chinese ZMDP policy has progressively facilitated the reduction of the spread of CRE superbug (Yi et al., 2015). Subsequently, it has prevented the introduction and dissemination of virulent mutants of CRE across international borders and the associated elevated mortality rates.|
|Describe the potential impact of the identified health policy on the role of a nurse in each country.||Nurses serve a central role in the fight against AMR through their roles in infection control and antibiotic stewardship. Thus, they play a core function in the implementation of the 2020 – 2025 Plan by serving as the primary sources of community and patient education on AMR (Wiley & Villamizar, 2019).||Similar to the case of the U.S. 2020 – 2025 Plan, nurses played a core function in the implementation of the ZMDP by serving as the primary sources of community and patient education on AMR (Wang et al., 2016).|
|Explain how global health issues impact local healthcare organizations and policies in both countries. (Be specific and provide examples)||Global health issues, like the eruption of the ongoing COVID-19 pandemic and AMR, directly affect local organizations and policies (Healthy People 2020, n.d.). For example, the COVID-19 pandemic has seen the U.S. develop policies that guide international and local vaccination drives and support international collaborative efforts to safeguard its citizens from newer variants that cross international borders through global travels Antibiotic Resistance Global Healthcare Comparison Matrix and Narrative Statement Assignment.
|Global health issues, like the eruption of the ongoing COVID-19 pandemic and AMR, directly affect local organizations and policies (Healthy People 2020, n.d.). For example, the COVID-19 pandemic has seen the U.S. develop policies that guide international and local vaccination drives and support international collaborative efforts to safeguard its citizens from newer variants that cross international borders through global travels.|
|General Notes/Comments||In summary, AMR is a global public health crisis that calls for collaborative, multisectoral, and transdisciplinary approaches explained by the 2020 – 2025 National Action Plan for Combating AMR.||In summary, AMR is a global public health crisis that calls for collaborative, multisectoral, and transdisciplinary approaches. Unlike the U.S. 2020 – 2025 Plan, the implementation of the ZMDP policy did not involve a multisectoral approach but targeted a single player of the stakeholders. The failure to embrace a collaborative, multisectoral approach might have contributed to reported ineffectiveness.|
Part 2: A Plan for Social Change
As outlined in Part I of the assignment, AMR is one of the global health issues that call for worldwide collaboration in preparedness, prevention, planning, response, and care reflecting health equality across countries (Centers for Disease Control and Prevention, 2020). Such global health issues, like AMR, go beyond transnational, regional, and national borders, and they are also inclined to unduly impact susceptible and underprivileged populations. Thus, nurses at the clinic, community, and classroom should adopt a global health standpoint to proficiently function in the current multicultural clinical settings (Edmonson et al., 2017). In the above case, nurse leaders can advocate for the inclusion of the global health perspective by engaging in transdisciplinary teams, through which they can communicate and collaborate across and within organizations and disciplines that are fundamental to enhancing global health (Edmonson et al., 2017).
The incorporation of the global health perspective will positively impact the delivery of nursing care and advocacy at the local level. For example, acquiring global health encounters via interdisciplinary teams, health initiatives, medical missions, and community work targeted at tackling health inequalities reinforce nurses. In particular, the integration of a global health standpoint enables nurses in U.S. hospitals to build comprehension of international health systems, improve cultural sensitivity, and forge international or interprofessional relationships (University at Buffalo, n.d.). As a nurse leader, the incorporation of a global health outlook represents a social change as it reflects the transformative shift from local approaches to care delivery to a broadened advance to prevent the dissemination of worldwide health concerns, like AMR, and protect the global populations (Edmonson et al., 2017).
CDC. (2019). One Health. https://www.cdc.gov/onehealth/index.html
Centers for Disease Control and Prevention. (2020). About antibiotic resistance. https://www.cdc.gov/drugresistance/about.html
Collignon, P., & Beggs, J. J. (2019). Socioeconomic enablers for contagion: Factors impelling the antimicrobial resistance epidemic. Antibiotics, 8(3), 1–9. https://doi.org/10.3390/antibiotics8030086
Edmonson, C., McCarthy, C., Trent-Adams, S., McCain, C., & Marshall, J. (2017). Emerging global health issues: A nurse’s role. Online Journal of Issues in Nursing, 22(1). https://doi.org/10.3912/OJIN.VOL22NO01MAN02
Federal Task Force on Combating AMR. (2020). The National Action Plan for Combating Antibiotic-Resistant Bacteria 2020-2025. U.S. Department of Health and Human Services.
He, P., Sun, Q., Shi, L., & Meng, Q. (2019). China’s health system reforms: Review of 10 years of progress: Rational use of antibiotics in the context of China’s health system reform. The BMJ, 365. https://doi.org/10.1136/BMJ.L4016
Healthy People 2020. (n.d.). Global health. https://www.healthypeople.gov/2020/topics-objectives/topic/global-health
Qu, J., Huang, Y., & Lv, X. (2019). Crisis of antimicrobial resistance in China: Now and the future. Frontiers in Microbiology, 10(SEP), 1–6. https://doi.org/10.3389/fmicb.2019.02240
University at Buffalo. (n.d.). Embracing a global perspective in nursing. http://nursing.buffalo.edu/news-events/UBNursing-magazine.host.html/content/shared/nursing/articles/ubnursing-magazine/2019/global-health/global-perspective-nursing.detail.html
US Department of Health and Human Services. (2019). Antibiotic resistance in threats in the U.S. 2019. CDC. https://doi.org/10.1186/s13756-020-00872-w
Wang, L., Zhang, X., Liang, X., & Bloom, G. (2016). Addressing antimicrobial resistance in China: Policy implementation in a complex context. Globalization and Health, 12(1), 1–9. https://doi.org/10.1186/s12992-016-0167-7
WHO. (2020, December 24). 10 global health issues to track in 2021. https://www.who.int/news-room/spotlight/10-global-health-issues-to-track-in-2021
Wiley, K. C., & Villamizar, H. J. (2019). Antibiotic resistance policy and the stewardship role of the nurse. Policy, Politics, and Nursing Practice, 20(1), 8–17. https://doi.org/10.1177/1527154418819251
Yan, K., Yang, C., Zhang, H., Ye, D., Liu, S., Chang, J., Jiang, M., Zhao, M., & Fang, Y. (2020). Impact of the zero-mark-up drug policy on drug-related expenditures and use in public hospitals, 2016-2018: An interrupted time-series study in Shaanxi. BMJ Open, 10(11), 1–9. https://doi.org/10.1136/bmjopen-2020-037034
Yi, H., Miller, G., Zhang, L., Li, S., & Rozelle, S. (2015). Intended and unintended consequences of China’s zero markup drug policy. Health Affairs, 34(8), 1391–1398. https://doi.org/10.1377/hlthaff.2014.1114
The Assignment: (1- to 2-page Global Health Comparison Matrix; 1-page Plan for Social Change)
Part 1: Global Health Comparison Matrix
Focusing on the country you selected and the U.S., complete the Global Health Comparison Matrix. Be sure to address the following:
Part 2: A Plan for Social Change
Reflect on the global health policy comparison and analysis you conducted in Part 1 of the Assignment and the impact that global health issues may have on the world, the U.S., your community, as well as your practice as a nurse leader.
In a 1-page response, create a plan for social change that incorporates a global perspective or lens into your local practice and role as a nurse leader.
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