Treatment available but not being used

Geneva, 4 October— One in four people in the world will be affected by mental or neurological disorders at some point in their lives. Around 450 million people currently suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide.

Treatments are available, but nearly two-thirds of people with a known mental disorder never seek help from a health professional. Stigma, discrimination and neglect prevent care and treatment from reaching people with mental disorders, says the World Health Organization (WHO). Where there is neglect, there is little or no understanding. Where there is no understanding, there is neglect.

In a new report entitled “New Understanding, New Hope” the United Nations’ health agency seeks to break this vicious cycle and urges governments to seek solutions for mental health that are already available and affordable. Governments should move away from large mental institutions and towards community health care, and integrate mental health care into primary health care and the general health care system, says WHO.

“Mental illness is not a personal failure. In fact, if there is failure, it is to be found in the way we have responded to people with mental and brain disorders,” said Dr Gro Harlem Brundtland, Director-General of WHO, on releasing the World Health Report. “I hope this report will dispel long-held doubts and dogma and mark the beginning of a new public health era in the field of mental health,” she added.

The report invites governments to make strategic decisions and choices in order to bring about positive change in the acceptance and treatment of mental disorders. The report says some mental disorders can be prevented; most mental and behavioural disorders can be successfully treated; and that much of this prevention, cure and treatment is affordable. Despite the chronic and long-term nature of some mental disorders, with the proper treatment, people suffering from mental disorders can live productive lives and be a vital part of their communities. Over 80% of people with schizophrenia can be free of relapses at the end of one year of treatment with antipsychotic drugs combined with family intervention. Up to 60% of people with depression can recover with a proper combination of antidepressant drugs and psychotherapy. Up to 70% of people with epilepsy can be seizure free when treated with simple, inexpensive anticonvulsants.

A lack of urgency, misinformation, and competing demands are blinding policy-makers from taking stock of a situation where mental disorders figure among the leading causes of disease and disability in the world, says WHO. Depressive disorders are already the fourth leading cause of the global disease burden. They are expected to rank second by 2020, behind ischaemic heart disease but ahead of all other diseases.

The responsibility for action lies with governments, says WHO. Currently, more than 40% of countries have no mental health policy and over 30% have no mental health programme. Around 25% of countries have no mental health legislation.

The magnitude of mental health burden is not matched by the size and effectiveness of the response it demands. Currently, more than 33% of countries allocate less than 1% of their total health budgets to mental health, with another 33% spending just 1% of their budgets on mental health. A limited range of medicines is sufficient to treat the majority of mental disorders. About 25% of countries, however, do not have the three most commonly prescribed drugs used to treat schizophrenia, depression and epilepsy at the primary health care level. There is only one psychiatrist per 100 000 people in over half the countries in the world, and 40% of countries have less than one hospital bed reserved for mental disorders per 10 000 people.

The poor often bear the greater burden of mental disorders, both in terms of the risk in having a mental disorder and the lack of access to treatment. Constant exposure to severely stressful events, dangerous living conditions, exploitation, and poor health in general all contribute to the greater vulnerability of the poor. The lack of access to affordable treatment makes the course of the illness more severe and debilitating, leading to a vicious circle of poverty and mental health disorders that is rarely broken.

The report says new knowledge can have a tremendous impact on how individuals, societies and the public health community deal with mental disorders. We now know that large mental institutions no longer represent the best option for patients and families. Such institutions lead to a loss of social skills, excessive restriction, human rights violations, dependency, and reduced opportunities for rehabilitation. Countries should move towards setting up community care alternatives in a planned manner, ensuring that such alternatives are in place even as institutions are being phased out.

“Science, ethics and experience point to clear paths to follow. In the face of this knowledge, a failure to act will reflect a lack of commitment to address mental health problems,” said Dr Benedetto Saraceno, Director of WHO’s Mental Health and Substance Dependence department.

The policy directions have never been so clear, says WHO. Governments who are just starting to address mental health will need to set priorities. Choices must be made among a large number of services and a wide range of prevention and promotion strategies. WHO’s message is that every country, no matter what its resource constraints, can do something to improve the mental health of its people. What it requires is the courage and the commitment to take the necessary steps. The report is part of a year-long campaign on mental health. For the first time, multiple events at WHO including its premier report, technical discussions at the World Health Assembly and World Health Day, have all focused on one topic–mental health.

WHAT ARE MACRONUTRIENTS?
Macronutrients are nutrients that provide calories or energy. Nutrients are substances needed for growth, metabolism, and for other body functions. Since “macro” means large, macronutrients are nutrients needed in large amounts. There are three macronutrients:

• Carbohydrate
• Protein
• Fat

While each of these macronutrients provides calories, the amount of calories that each one provides varies.

Carbohydrate provides 4 calories per gram.
Protein provides 4 calories per gram.
Fat provides 9 calories per gram.

This means that if you looked at the Nutrition Facts label of a product and it said 12 grams of carbohydrate, 0 grams of fat, and 0 grams of protein per serving, you would know that this food has about 48 calories per serving (12 grams carbohydrate multiplied by 4 calories for each gram of carbohydrate = 48 calories).

Besides carbohydrate, protein, and fat the only other substance that provides calories is alcohol. Alcohol provides 7 calories per gram. Alcohol, however, is not a macronutrient because we do not need it for survival.

WHY DO WE NEED CARBOHYDRATES TO SURVIVE?
Carbohydrates are the macronutrient that we need in the largest amounts. According to the Dietary Reference Intakes published by the USDA, 45% – 65% of calories should come from carbohydrate. We need this amount of carbohydrate because:

• Carbohydrates are the body’s main source of fuel.
• Carbohydrates are easily used by the body for energy.
• All of the tissues and cells in our body can use glucose for energy.
• Carbohydrates are needed for the central nervous system, the kidneys, the brain, the muscles (including the heart) to function properly.
• Carbohydrates can be stored in the muscles and liver and later used for energy.
• Carbohydrates are important in intestinal health and waste elimination.
• Carbohydrates are mainly found in starchy foods (like grain and potatoes), fruits, milk, and yogurt. Other foods like vegetables, beans, nuts, seeds and cottage cheese contain carbohydrates, but in lesser amounts.

Fiber refers to certain types of carbohydrates that our body cannot digest. These carbohydrates pass through the intestinal tract intact and help to move waste out of the body. Diets that are low in fiber have been shown to cause problems such as constipation and hemorrhoids and to increase the risk for certain types of cancers such as colon cancer. Diets high in fiber; however, have been shown to decrease risks for heart disease, obesity, and they help lower cholesterol. Foods high in fiber include fruits, vegetables, and whole grain products.

WHY DO WE NEED PROTEIN TO SURVIVE?
According to the Dietary Reference Intakes published by the USDA 10% – 35% of calories should come from protein. Most Americans get plenty of protein, and easily meet this need by consuming a balanced diet. We need protein for:

• Growth (especially important for children, teens, and pregnant women)
• Tissue repair
• Immune function
• Making essential hormones and enzymes
• Energy when carbohydrate is not available
• Preserving lean muscle mass

Protein is found in meats, poultry, fish, meat substitutes, cheese, milk, nuts, legumes, and in smaller quantities in starchy foods and vegetables.

When we eat these types of foods, our body breaks down the protein that they contain into amino acids (the building blocks of proteins). Some amino acids are essential which means that we need to get them from our diet, and others are nonessential which means that our body can make them. Protein that comes from animal sources contains all of the essential amino acids that we need. Plant sources of protein, on the other hand, do not contain all of the essential amino acids.

WHY DO WE NEED FAT TO SURVIVE?
Although fats have received a bad reputation for causing weight gain, some fat is essential for survival. According to the Dietary Reference Intakes published by the USDA 20% – 35% of calories should come from fat. We need this amount of fat for:

• Normal growth and development
• Energy (fat is the most concentrated source of energy)
• Absorbing certain vitamins ( like vitamins A, D, E, K, and carotenoids)
• Providing cushioning for the organs
• Maintaining cell membranes
• Providing taste, consistency, and stability to foods

Fat is found in meat, poultry, nuts, milk products, butters and margarines, oils, lard, fish, grain products and salad dressings. There are three main types of fat, saturated fat, unsaturated fat, and trans fat. Saturated fat (found in foods like meat, butter, lard, and cream) and trans fat (found in baked goods, snack foods, fried foods, and margarines) have been shown to increase your risk for heart disease. Replacing saturated and trans fat in your diet with unsaturated fat (found in foods like olive oil, avocados, nuts, and canola oil) has been shown decrease the risk of developing heart disease.

A NOTE ON MICRONUTRIENTS
Although macronutrients are very important they are not the only things that we need for survival. Our bodies also need water (6-8 glasses a day) and micronutrients. Micronutrients are nutrients that our bodies need in smaller amounts, and include vitamins and minerals. (See the Vitamins and Minerals handout for more information).

What is Obama Care? What is the Health Care For America Plan?

You’ve heard of ObamaCare, but what is ObamaCare exactly? ObamaCare (also known as Health Care reform) is a national health care plan aimed at reforming the American health care system. ObamaCare’s main focus is on providing more Americans with access to affordable health care, regulating the health insurance industry and reducing spending in health care.

What is ObamaCare?: ObamaCare is the unofficial name for The Patient Protection and Affordable Care Act which was signed into law on March 23, 2010. In a more general sense ObamaCare and The Health Care for America Plan or any such name is a reference to the ongoing health care reform under President Obama.

(What is ObamaCare? President Obama Portrait Public Domain by WhiteHouse.org)

The Obama administration has been working on a plan for American health care reform since Barack Obama was first elected into office. (The Democratic Party has been working on health care reform much longer than that.) ObamaCareis modeled after “Romeny Care”, which was health care reform implemented in the State of Massachusetts.

ObamaCare: What is it, and What Does it Mean to American Health Care?

So what is ObamaCare and what does it mean to you? There are really only a few things you need to know about President Barack Obama’s “ObamaCare”.

• The Affordable Care Act contains over a thousand pages of reforms to the insurance industry and the health care industry in order to cut healthcare costs and to provide affordable health insurance to all Americans.

• There are around 44 million Americans who currently are unable to get health insurance. One of the major thingsObamaCare does is help these individuals to get health insurance through expanding Medicaid and Medicare and offering assistance to Americans who cannot currently afford healthcare.

What is the ObamaCare Health Insurance Marketplace?

Did you know that starting October 1st, 2013 Americans making less than 400% of the Federal Poverty Level can use the “Health Insurance Marketplace” (also known as an exchange) to shop for affordable quality insurance. Find out how you, your family and your business can qualify for federally subsidized health insurance. Read the ObamaCareFacts.com Health Insurance Marketplace Guide.

What Does ObamaCare Do?

Now that we know what ObamaCare is, it’s time to find out what President Obama’s health care reform bill does. Here are some of the most important aspects of the law:

• ObamaCare improves the quality of care that Americans receive by providing better preventative and wellness services and raising the standards of the quality of basic health care coverage.

• ObamaCare gives tens of millions of low-income and middle-income Americans access to quality health care by providing discounts on state or federal run health insurance exchanges. Find out exactly what the Health Insurance Exchange is and how it works.

• Although the Affordable Care Act (ObamaCare) was signed into law in 2010, the health care reforms it enacts roll out year by year until 2022. Many of the biggest reforms don’t kick in until 2014. Find Out More About ObamaCare Benefits and Services.

• ObamaCare helps to ensure that health care coverage is available to any legal U.S. resident who cannot otherwise obtain “quality” healthcare through their employer. Your access to health care is no longer in the hands of health insurance companies.

• ObamaCare gives American employers with over 50 full-time employees the choice between providing insurance that meets the standards of ObamaCare or paying a penalty. This penalty helps to offset the cost of employees who aren’t covered through their employer to purchase insurance through the public health insurance exchanges instead of using emergency services.

• Employers with less than 25 full-time employees may qualify for tax credits, tax breaks and other assistance for insuring employees.

• ObamaCare increases consumer protections. These help to protect you from being dropped while sick, cut off for lifetime limits, denied for pre-existing conditions and offers a better legal standing.

• Unless you make over $200k individual / $250k as a family or small business you are exempt from almost every tax ObamaCare levies.

• ObamaCare requires that all Americans have health insurance either through a private provider or through a state or federal assisted program. If you don’t have insurance you must pay a tax equal to 1% of your income in 2014 and 2.5% in 2016.

• ObamaCare expands Medicaid to over 15 million uninsured low income Americans.

• President Obama’s health care law aims to reform the healthcare industry by cutting out waste, reallocating where government funding goes, fixing what doesn’t work and most of all ensuring healthcare for Americans.

Now that we’ve answered the question “What is ObamaCare?”, it’s time to figure out what the ObamaCare $700+ billion dollar tax cut to Medicare really means and to get the rest of the ObamaCare Facts.