“Deconstructing Health Care Reform” By Gardner Free Essay

In her article, Gardner (2011) claims that Americans need affordable health care because it is their right. Furthermore, politicians should focus on benefits associated with the promotion of the Affordable Care Act in spite of the fact that it violates the norms of the modern healthcare market. Finally, nurses also have the power to change the situation and formulate their vision of the problem. The author promotes the idea of affordable care for all Americans, and it is possible to agree with her position. The reason is that health is a human right that should be guaranteed and protected by authorities (Barnett-Vanes, Hung, Maruthappu, Shalhoub, & Chan, 2013). If individuals need to pay for supporting their health, they can lose their trust in the authorities and their abilities to provide appropriate social conditions for the population.

Such aspects as nutrition, access to safe water, access to healthcare, and living conditions, including shelter and clothing, among others, are known as the social determinants of health. If a person has access to the good food and clean water, and financial resources are enough to provide his or her with the shelter and care, there are enough conditions to develop as a healthy person, as well as to work and live productively (Marmot, Allen, Bell, Bloomer, & Goldblatt, 2012). However, certain social policies can change the situation and influence the availability of important resources for people. The Affordable Care Act discussed by Gardner (2011), in her article, is one of these policies.

The main ideas promoted by Gardner (2011) are the necessity of the available health care and the importance of the free delivery of healthcare services without discriminating uninsured persons and making the healthcare system a market. These topics are important for understanding the role of the social determinants because, currently, those people who cannot prove that they have enough resources to support their health and receive the insurance are often deprived of the right to change the situation and receive access to free healthcare services. The new approach to the healthcare delivery system should break the discussed cycle that prevents people from their main right: to be healthy.

The available health care promoted according to the principles of the Affordable Care Act means that all Americans can receive assistance and a chance to improve their health without reference to their environments or socioeconomic status. The other topic is related to the problem of the financial aspect of the healthcare system, and it directly influences the creation of environments for promoting health. If the healthcare market can accept uninsured and low-income persons, it is possible to expect the improvement of the health status of the nation.

The necessity of guaranteeing affordable care can be illustrated with different examples. For instance, a middle-aged single woman who is not employed because of her history of diseases and who is not provided with private insurance has the chance to receive the appropriate care covered only by Medicaid. If this woman has no Medicaid, there are few other resources to cover expenses associated with the necessity to purchase medications and visit doctors to monitor her chronic conditions. The Act provides the chance to receive assistance and overcome the market frame of the modern healthcare system for such persons.


Barnett-Vanes, A., Hung, K. K., Maruthappu, M., Shalhoub, J., & Chan, E. Y. (2013). Health after 2015: A human right? The Lancet, 381(9848), 1972-1978.

Gardner, D. (2011). Deconstructing health care reform. Nursing Economics, 29(3), 147-149.

Marmot, M., Allen, J., Bell, R., Bloomer, E., & Goldblatt, P. (2012). WHO European review of social determinants of health and the health divide. The Lancet, 380(9846), 1011-1029.

Asthma: Corticosteroids And Side Effects In Children

Asthma is one of the most widespread chronic diseases. Moreover, children are prone to it. Despite various medicines, corticosteroids, which are hormones in its essence, appear to be an effective way of treatment. However, many specialists are inclined to think that this type of medicine might harm the child’s health.

Corticosteroids are applied in severe bronchial asthma, which is unlikely to be treatable by other drugs. Asthma is supposed to be cured by a short-term corticosteroid medicine which has the maximum anti-inflammatory effect and minimum mineralocorticoid activity. It is recommended to take prednisolone, which exists only in pills, and Solu-Medrol (methylprednisolone – natrium succinate). The initial dose of prednisolone during acute bronchospasm is 2 mg per kilo of the child’s weight. The minimum dose is 10 mg, whereas the maximum one is 40 mg. In two or three days, when the acute stage is over, it is necessary to go on to take medicine once in the morning for two days. If the clinical improvement continues, the dose is expected to be reduced to 5 mg. However, if the child experiences another bronchospasm, it is necessary to return to the previous dose, which is supposed to be taken every twelve hours for two days, after that once for two days, and then once every 48 hours. Normally, prednisolone is taken between 7, and 8 am. Solu-Medrol is prescribed intravenously. Its dose is 1 mg per one kilo of the child’s weight. It is taken only during the acute stage. Both medicines are quickly absorbed in the bowels within an hour. Its metabolism takes 4-6 hours. However, the condition’s improvement during bronchospasm is observable only in 6-12 hours and lasts 48 hours after a single dose of prednisolone (Castro-Rodrigez, Custovic, & Ducharme, 2016). The article has provided an overview of how to cope with bronchospasm. It has given detailed information on the doses of the medicine. However, in the case of asthma, it might be reasonable to address the nearest hospital rather than resort to self-treatment.

If taken every day for a long period, corticosteroids entrain a range of side effects. They have been studied for many years. Several experiments have been carried out. According to the research (Aljebab, Choonara, & Conroy 2016), the most common side effects are retaining fluid, increasing appetite, gaining weight, developing a cataract, and developing an emotional instability, and retaining growth. Besides, corticosteroids might result in diabetes and dysfunction of atrabiliary capsules. What is more, corticosteroids tend to affect the immune system? The researches state:

The most serious side effect of short courses of oral corticosteroids was infection due to their immunosuppressant action. Five RCTs reported that 20 children experienced infection during treatment periods (incidence 0.9%). Three cases were reported of children infected with varicella-zoster, one of whom died, and the other two were admitted to the intensive care unit with severe complications. (Aljebab et al., p. 4)

This research is helpful. It reveals the side-effects of corticosteroids. However, it does not provide any insight into how the problem might be solved.

To sum up, it is necessary to point out that corticosteroids are effective in the treatment of asthma. However, they might have serious side effects. Therefore, specialists have not concluded whether corticosteroids have a positive or negative impact on a child’s health.


Aljebab, F., Choonara, I., & Conroy S. (2016). Systematic review of the toxicity of short-term oral corticosteroids in children. Diseases in Childhood, 2016(1), 1-6.

Castro-Rodrigez, J. A., Custovic, A., & Ducharme F. M. (2016). Treatment of asthma in young children: Evidence-based recommendations. Asthma Research and Practice, 2(5), 1-11.

Green Infrastructure In Water Management


Green infrastructure provides a modern approach to the conceptualization and management of landscape resources. Green infrastructure has proved to be common in the UK, North America and in the European countries since it is able to meet the various challenges of spatial planning. Research indicates that the literature of green infrastructure provides an understanding of the landscape resources and this has increased the rate of its growth in many countries. (Beatley, 2000, p. 76).

Green infrastructure is a concept with varied definitions but Hobden (2004, p. 60) defines it as “a strategically planned and delivered network of high quality green spaces and other environmental features. It should be designed and managed as a multifunctional resource capable of delivering a wide range of environmental and quality of life benefits for local communities.” This definition suits best the rural sector but Beatley (2000, p. 76) comes up with a different definition which is often applicable for urban areas. He defines green infrastructure as a “multifunctional, networks of green features and the blue ribbon networks excluding the hard surfaced public realm.” This paper explores and evaluates the utility of water management in urban areas by focusing on the aspect of perception and interpretation of green infrastructure in water management.

Perception and interpretation on green infrastructure

This essay explains how the perception and interpretation of green infrastructure has helped in the development of green infrastructure and its uses such as water management in the urban areas. Research indicates that the perception of landscape differs depending on the major factors such as age, place of residence and experience as well as gender. The manner in which people perceive their landscape affects the entire interpretation of green infrastructure. The issue of perception and interpretation helps planners to plan the developments that meet the social and ecological needs of the intended group (Dunn & Stoner 2007, p. 12).

Studies suggest that perceptions of green infrastructure vary in relation to what is being viewed. A research conducted with the students of Northumbria University in the UK, the University of Massachusetts, USA, and the Gateshead Conservation Group in the UK indicates that the students were able to collect information from individuals with different perceptions of the landscape. The study focused on the features of landscape that the respondents preferred as well as the reasons behind their choices (Hobden, 2004, p. 77). The table below represents the respondents group, focus and sample size that the universities took into consideration.

Table 1: A case study on the different perceptions of the environment.

Location Respondent groups Focus Sample size
Northumbria University Environmental management and Geography students Environmental studies, planning 25
University of Massachusetts Landscape architecture and regional planning students Landscape architecture, green urbanism 14
Gateshead group Current and former conservation volunteers Community outreach and conservation 20


Green infrastructure examples illustrating the forms of green infrastructure including (a) rain garden, (b) permeable pavement, (c) rain barrels, and (d) trees curbside
Figure 1: Green infrastructure examples illustrating the forms of green infrastructure including (a) rain garden, (b) permeable pavement, (c) rain barrels, and (d) trees curbside (Hobden, 2004, p. 78).

In the survey conducted, it was discovered that the respondents based their perceptions on the physical, social and psychological factors depending on the interpretation of their emotions, feelings and their social experiences. The respondents considered the physical elements of the landscapes and discussed them based on their social and emotional values attached to the pictures (Dunn & Stoner 2007, p. 10).

After the analysis of the data received, Mell (2012, p. 46) suggests that the study facilitated the analysis of green infrastructure characteristics and perceptions to be discussed. The aim of this analysis was to find out the preferences of the individuals so as to relate the descriptions in order to design the appropriate techniques of management. The respondents showed some preference for pictures (c) and (d) giving various reasons underlying their choices. The following table shows the statistics of data collected on the perception and interpretation of the sampled landscapes.

Images Mass Versity-Like UNN-Like GVS-like total % Mass-Versity-Dislike UNN-Dislike GVS-Dislike Total %
a) 3 6 5 14 23.7 9 15 12 36 61
b) 1 7 3 11 18.6 10 12 15 37 62.7
c) 11 18 16 45 76.2 0 2 1 3 5.1
d) 10 16 15 41 69.4 2 0 3 5 8.5

Table 2: Data collected on the perception and interpretation of the sampled landscapes.

Analysis shows that ecological features are considered as important factors when analyzing landscapes. By using the physical, social and psychological elements, the survey assessed the extent to which the mentioned elements are viewed as important in contextualizing the responses with the broader thinking on landscape perceptions and greenways. Although the respondents had different perceptions of the landscapes presented, there was a similar response in relation to image (c) since 76.2 percent of the respondents perceived it positively. Image (d) was also appealing to 69.4 percent of the respondents. Images (a) and (b) were perceived negatively by the respondents, whereby image (a) was perceived negatively by 61 percent of the respondents and image (b) – by 62.7 percent of the population (Mell 2012, p. 48). This information was represented in the graph drawn below.

A chart showing the preference of the images in percentage.
Figure 2: A chart showing the preference of the images in percentage.

The manner, in which the respondents replied in relation to the images presented, indicates that there is a complexity in the manner in which respondents reason when supporting various landscape preferences in relation to social and physical elements of landscape. The respondents described the images in an emotive manner using the ideas of serenity, power and warmth (Sloan, Weber & Wolf 2006, p. 10). Benedict & McMahon (2002, p. 3) concluded that individuals can use their experience, preference and knowledge in making the judgments and decisions in relation to green infrastructure.

Various conceptual frameworks have been developed in order to link urban ecosystem, ecological health and green infrastructure. The models of social sciences have been devised to address the issue of environmental effects on the physical and mental health of human beings. When focusing on the aspect of perception and interpretation of green infrastructure, the quality of life illustrates a complex interaction of factors such as cultural, natural, social, manmade environment and personal factors (Lannduse Consultants & Natural England 2009, p. 44).

Studies indicate that there is a growing literature on the functions, roles and constraints to the implementation of green infrastructure. The perceived benefits of the green infrastructure involves a better understanding of the ecological system, safe and healthy environment, an access to urban green space and a provision of justice through the availability of green space for the lowly income earners (Allen, 2012, p. 5).

In the research conducted, analysis shows that many people consider the costs of installing a green infrastructure in relation to its durability and the benefits it is likely to yield to the community. Incentives such as grants and city demonstration projects are proposed as a way of developing green infrastructure in urban areas. The individual’s perception and interpretation of green infrastructure has led to the development and management of water resources in urban areas. In the study that was conducted in Chicago, it was noticed that many respondents perceived green infrastructure as specific projects like green roofs, rain barrels and solar arrays. A good number of the respondents suggested that there was a need for urban areas to put more efforts into the maintenance and management of the green infrastructure projects (Littlewood &Thomas 2010, p. 6).

As a result of maintaining green infrastructure in urban areas, many cities in the United States of America and other states across the world use the issue of green infrastructure to address environmental and social concerns like the provision of access to open spaces in the neighborhoods of urban cities. It is also advisable to take into consideration the measures of controlling nonpoint source pollution from urban areas as a system of managing water. The issue of storm water to street trees is another idea of enhancing tree management systems to improve the management and retention of storm water (Lannduse Consultants & Natural England 2009, p. 34).

Water management

The provision of quality water in urban areas is essential for human lives. The quality of water in an urban catchment can be heavily impacted by the high speed pollutants and runoffs collected from the urban surfaces as well as the reduced infiltration of precipitates. In addition to this, many urban centers have sewages and storm water collection systems which overflow due to heavy rains hence affecting the quality of water. In this case, green infrastructure is used to improve the quality of water by use of various means (Benedict & McMahon 2002, p. 3).

The issue of planting trees in urban areas is one of the green infrastructure practices that can be used to improve the quality of water. Trees in the urban areas provide storage of rainfall at the source, the filtration of pollutants at the canopy and the process of infiltration at the zone of the roots. Benedict & McMahon (2002, p. 4) say that riparian woodland is efficient at intercepting aerial drift of pesticides as well as in trapping the insecticides present in the sediments of runoff. Tree canopies have been discovered to reduce soil erosion by reducing the effect of raindrops on bare grounds, hence, improving the strength and stability of the soil to build up the soil organic matters for the roots of the trees to hold firm on the ground.

Water management involves the idea of harvesting rainwater which is a major practice that has the potential of managing storm water as well as supplement the water supplies. Effective landscaping helps to avoid the issue of urban runoff systems as well as improve the general appearance of the facilities. Another way of managing water in urban areas is by building wetlands and wet ponds. Wet ponds are therefore built in large sizes so as they can control offsite and onsite flooding in times of major storms. Wetlands, on the other hand, are constructed as a way of controlling the effects of urban runoff (Littlewood &Thomas 2010, p. 8).

Benefits of green infrastructure to water management

Green infrastructure provides a variety of benefits in urban areas which are both economical, environmental and benefits associated with the health of human beings. Urban runoff systems serve as an economic benefit to the state, since it acts as a source of revenue to the developers, because a clean pond or lake creates an ideal setting for the sales office. If located in a visible place, it will attract many viewers who will pay and this will help the developers repay the installation fee through faster sales. Those in charge of the ponds and lakes can charge premiums on properties with water views and many other amenities (Allen 2012, p. 6).

The issue of green infrastructure and water management in urban areas has led to the reduction of flood risks. The many alterations that are made to the natural environment affect the water movements through the hydrological cycle as well as alter its composition. Urban development retains very little vegetation and landscapes replacing them with buildings, parks, gardens and roads, which creates a major effect on the hydrology, the freshwater ecology and the terrestrial ecosystem, which are supported by river systems. Green infrastructure provides a way of restoring natural environmental features in the urban areas by providing the hydrological benefits of water quality and flood alleviation (Littlewood &Thomas 2010, p. 10).

Many states across the world have experienced floods for several years and they have always channeled their effort in flood prevention and means of mitigating the associated risks. The risk managers have always planned to change the natural shapes of the river banks beds and shores of estuaries which in most cases worsen the flood and drought risks by changing the velocity, volume and the direction of water flow (Lannduse Consultants & Natural England 2009, p. 44).

As a matter of managing water in urban areas, sustainable drainages are built to reduce the volume of urban runoff. The issue of sustainable urban drainage systems promotes green space in urban areas by controlling water at their sources through the use of vegetation and trees, basins, wetlands, green roofs and ponds. Drainage has been a major problem in urban areas but sustainable drainage can be used to prevent flooding and reduce rainwater runoff (Sloan, Weber & Wolf 2006, p. 12).

The issue of water management has proved to increase life expectancy as well as reduce healthy inequality. Research shows that access to green space is distributed unfairly across the various socio-economic groups, whereby the low class social groups receive minimal access. Green infrastructure on water management has affected the health condition of human beings positively by reducing the cases of obesity, cardiovascular diseases and mental illnesses, which are considered as significant elements to healthy problems. Mell (2003, p. 5) suggests that access to green space reduces the health inequalities which are noticed between the socio-economic groups across the world.

Urban runoff systems, which seem to appear natural, can act as a recreational site. Ponds which are built to control runoff are designed to offer extra services to the public. Such sites form the best areas for bird watching, since they create the best home for the various types of wildlife. Ponds can also be used by non-motorized boats such as canoes (Dunn & Stoner 2007, p. 13).

Developers of runoff systems, which are aimed at curbing the problem of runoff in urban areas as one of the ways of managing water, has proved to be beneficial to the owners, since they treat them as small lakes or ponds. Studies indicate that the developers of urban areas runoff regulation have capitalized on the issue and, as a result, they have designed appealing ponds and wetlands so as to market them as natural lakes, hence, improving the economic status of the individuals (Benedict & Mcmahon 2006, p. 88).

A well planned and improved public space encompassing the green infrastructure in urban areas can improve commercial trading by up to 42 percent. For instance, the economic benefits provided by the soft landscaping as well as security improvements in Langthwaite Estates increased the returns of 2005 up to more than 12 million sterling pounds as well as creating more than 210 new jobs. This has contributed to the reduction of crimes by 72 percent within duration of one year in the region, since many people got employed (Mell 2012, p. 56).

Green infrastructure on water management has greatly contributed to the reduced consumption of energy in urban areas. Trees which are planted in urban areas as a measure to conserve water can also reduce the energy consumption of buildings by providing shelter, which helps in cooling the houses during summer seasons as well as shelter the houses from cooling winds in winter season. Well designed green roofs and walls provide an insulating effect which reduces the transfer of heat between the internal and external environments of the buildings. This is an indication that buildings will be warmer by four degrees Celsius during winter and fourteen degrees Celsius cooler during summer (Beatley 2000, p. 96).

Studies indicate that there is an improved air quality in urban areas due to the development of green infrastructure on water management. Poor air quality is said to be dangerous to human health, since it reduces the life expectancy of individuals, as when there is a combination of high temperatures and poor air quality, elderly individuals are at high risks of developing health complications such as respiratory and cardiovascular diseases. Vegetations, which are planted in urban areas around the ponds and wetlands that control runoff, help in keeping the environment safe by removing pollutants such as nitrogen dioxide and ozone from the air (Kambites & Owen 2007, p. 6).

The ecological benefits of urban green infrastructure are best forms of homes for wildlife animals. A well designed green infrastructure is more likely to create the intended habitat, hence, conserving biodiversity. The issue of green infrastructure development on water management has contributed to the improved appearance of urban areas, hence, creating a place for visitors to enjoy staying (Dunn & Stoner 2007, p. 14).


A clear analysis shows that the perception and interpretation of the landscape differs across individuals and, as a result, people are able to come up with unique ideas that are of benefit to their societies. From the information gathered, one can conclude that the benefits of green infrastructure on water management has encouraged developers of urban runoff controls to think creatively so as to create employment for the population as well as create an extra source of income to improve their living standards.


Allen, W 2012, ‘Advancing green infrastructure at all Scales: from landscape to site’, Environmental Practice, vol. 14, no. 1, pp. 17-25. Web.

Beatley, T 2000, Green Urbanism: learning from European cities, Island Press, Washington DC. Web.

Benedict, M & Mcmahon, E 2006, Green Infrastructure: linking landscapes and communities, Island Press, Washington,DC. Web.

Benedict, M & McMahon, E 2002, Green infrastructure: smart conservation for the 21st century, Renewable Resources Journal, vol. 8. no. 23, pp. 12-17. Web.

Dunn, A & Stoner, N 2007, ‘Green light for green infrastructure’, The Environment Forum, Pace Law Faculty Publication, vol. 5, no. 5, pp. 494-520. Web.

Hobden, D 2004, Landscape Partnerships: guidance for applicants, Heritage Lottery Fund, London. Web.

Kambites, C & Owen, S 2007,’ Renewed prospects for green infrastructure planning in the UK’, Planning Practice and Research, vol. 21 no. 4, pp. 483-496. Web.

Lannduse Consultants & Natural England 2009, Green infrastructure guidance. Natural England, NE176, Natural England, Peterborough. Web.

Littlewood, S &Thomas, K 2010, ‘From green infrastructure? The evolution of a new concept in the emerging soft governance of spatial strategies’, Planning, Practice and Research, vol. 25, no. 2, pp. 203-222. Web.

Mell, C 2012, Green infrastracture: concepts, perceptions and its use in Spatial Planning: developing green infrastructure planning in the UK, Europe and North America, LAP Lambert Academic Publishing, Saarcrbrucken. Web.

Mell, I 2003, ‘Can you tell a green field from a cold steel rail? Examining the “green” of Green Infrastructure development, Local Environment’, The International Journal of Justice and Sustainability, vol. 18, no. 2, pp. 152-166. Web.

Sloan, A, Weber, T & Wolf, J 2006, ‘Maryland’s Green Infrastructure Assessment: Development of a comprehensive approach to land conservation’, Landscape and Urban Planning, vol. 77, no. 2, pp. 94-110. Web.


  • Table 1: A case study on the different perceptions of the environment.
  • Figure 1: Green infrastructure examples illustrating the forms of green infrastructure including (a) rain garden, (b) permeable pavement, (c) rain barrels, and (d) trees curbside.
  • Table2: Data collected on the perception and interpretation of the sampled landscapes.
  • Figure 2: A chart showing the preference of the images in percentage.

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