/ Introduction: Families & Health Care


This issue of the Michigan Family Review explores a wide range of current health care issues affecting families. The guest editor summarizes the current status of family health at both the national and state levels and provides an overview of the issue's articles as well as the film, book and web site reviews on the topics of health care in the United States, African American family health, caregiving, and HIV/AIDS education.

Key Words: Family health, health care systems, uninsured, caregiving, HIV/AIDS

    1. Carla J. Groh is Associate Professor, College of Health Professions, University of Detroit Mercy, Detroit, Michigan 48219-0900. Electronic mail may be sent via Internet to grohcj@udmercy.edureturn to text

    Describing the U. S. health care system and its impact on family health is no easy feat. Our health care system is fragmented (Shi & Singh, 2001), and has been called "a paradox of excess and deprivation" (Enthoven & Knonick, 1989). While some persons receive too little care, others receive either too much care or inappropriate care (Bodenheimer & Grumbach, 1995). Despite efforts in recent years to reform the health care system, many challenges still exist that directly impact the health of families. The most pressing health care issues facing families in 2002 include the following:

    • The increasing cost of health insurance premiums. Premiums are rising at double-digit rates, far outpacing growth in wages and general inflation (Commonwealth Fund Annual Report, 2001). Higher premiums place young families and seniors at risk for being priced out of the medical insurance market.
    • The number of American families that lack health insurance. More than 9 million parents are uninsured, with the vast majority being low-income: 66 percent, or 6.2 million. Although the rate of uninsured, low-income parents is greater than for uninsured, low-income children (33 percent compared to 23 percent), recent studies indicate that when parents are insured, their children are more likely to get the health care they need (Lambrew, 2001). What is even more troubling about families who lack health insurance is that the vast majority of parents work (73 percent), and that women (59 percent) and minorities (62 percent) are disproportionately represented among uninsured, low-income parents (Lambrew, 2001).
    • The cost of prescription medication. The cost of prescription drugs is a critical issue, especially for those over 65. Medicare beneficiaries spent an average of $928 out of their own pockets on medications in 2001 and are expected to spend $1,051 in 2002 (Bailey & Norris, 2002). Although seniors on fixed incomes are probably the hardest hit, prescription costs are an issue for all age groups and insurance types.
    • The lack of mental health parity. It is estimated that one third of Americans suffer from some mental or emotional problem (Satcher, ND). Treatment for mental illness does not always receive the same level of intervention as physical health problems, despite the fact that Congress passed and the President signed the Mental Health Parity Act in 1996. Mental or emotional problems can have a profound impact on the well being of families if the mental illness is not appropriately and adequately treated (National Institute of Mental Health, 1999). The emotional aftermath of 9/11 may provide the impetus to re-examine the issue of parity and the impact of emotional stress on both individual and family health.

    These national health issues are experienced at the state level as well. It is critical for us as administrators, educators, practitioners, and providers of service to understand better how these issues impact the health of families in Michigan. For example, more than 10 percent of Michigan's population lacks health insurance, or 1.1 million people. Of the uninsured, about 284,000 are children, many of whom are eligible for Medicaid or the MIChild program (implemented in 1998 for children of the working poor), but are not enrolled (Michigan Health & Hospital Association, 2002). How can this be? Is it a systems problem or a human resource problem?

    This issue of the Michigan Family Review explores a wide range of contemporary health care issues affecting families. In the first paper, Thomas Conklin, social worker and Executive Director of Catholic Family Services in Saginaw, traces the evolution of the U. S. health care system and identifies the economic factors driving the current health care reform efforts. Mr. Conklin provides a fresh perspective as he examines the issues from the perspective of both provider and administrator.

    The second article presents research of particular significance to the study of African American family health. Stephanie Mitchem, feminist scholar in the Religious Studies Department and Director of the African American Studies program at the University of Detroit Mercy, reviews the literature on spirituality and healing among black women and reports the results of interviews conducted with black women in Detroit.

    The next two articles focus on specific health issues: caregiving and HIV/AIDS. Rosemary Ziemba, a registered nurse and post-doctoral fellow in social work at the University of Michigan, summarizes the literature on the risks and benefits for adult children taking care of their elderly parents, focusing on the potential consequences for the health of the family. And Lenoraann Ryan, professor in the Department of Human Environmental Science at Central Michigan University, addresses the issue of HIV/AIDS and describes the findings of her research on the importance of needs assessment and context when planning HIV/AIDS education.

    The final paper is a reflection of the film John Q (Burg & Cassavetes, 2002). Mary Kelly, chair of the Health Services Administration program at the University of Detroit Mercy, offers a commentary on the public perception of health care in the United States as portrayed in this film, and the role the media plays in shaping public perception. Lastly, two books, four web sites, and a photo exhibit are reviewed. Two Michigan scholars review recently published books related to the theme of families and health care on the critical topics of minority health and Alzheimer's disease. The web sites reviewed include both government and private sector sites that both professionals and consumers may find helpful in navigating the health care system. The traveling exhibit highlights the history of black hospitals in southeastern Michigan.


    Bailey, R. L. & Norris, K. (2002, July 15). Drugs: Anxious seniors caught in a cash crunch. Detroit Free Press, pp. Al, A3.

    Bodenheimer, T. S. & Grumbach, K. (1995). Understanding health policy: A clinical approach (1st ed.). Norwalk, CT: Appleton & Lange.

    Burg, M. (Producer), & Cassavetes, J. (Director). (2002). John Q [Motion picture]. United States: New Line Productions.

    Commonwealth Fund Annual Report (2001). Retrieved September 9, 2002 from http://www.cmwf.org/annreprt/annreport.asp?link=7

    Enthoven, A., & Kronick, R. (1989). A consumer-choice health plan for the 1990s. New England Journal of Medicine, 320-329.

    Lambrew, J. M. (2001). Health insurance: A family affair. A national profile and state by state analysis of uninsured parents and their children. Retrieved September 9, 2002 from http://www.cmwf.org/programs/insurance/lambrew_familyaffair_464.pdf

    Michigan Health and Hospital Association (2002). The 2002 guide to nonprofit hospitals and health care issues. Retrieved September 9, 2002 from http://www.mha.org/nonprofitguide/coverage.htm

    National Institute of Mental Health (1999). Retrieved September 10, 2002 from http://www.nimh.nih.gov/about/index.cfm

    Satcher, D. (ND). Mental health: A report by the Surgeon General. Retrieved on September 1, 2002 from http://www.surgeongeneral.gov/library/MentalHealth/#topper

    Shi, L., & Singh, D. A. (2001). Delivering health care in America: A systems approach (2nd ed.). Gaithersburg, MD: Aspen Publications.