NURS 4015 – Public and Global Health Essay Paper

NURS 4015 – Public and Global Health Essay Paper NURS 4015 – Public and Global Health Essay Paper Public Health and Global Health Definitions Public Health For the purpose of having a common language, we broadly define public health as focusing on the science, practice, and art of collective efforts to prevent disease, promote health, and prolong quality of life among populations, while assuring conditions in which all people can be healthy. Rather than being a single discipline, public health as a profession includes the contributions of many disciplines/fields that impact the health of a population including, but not limited to epidemiology, behavioral science, medicine, social work, engineering, communication, business, law, and global health (CDC 1994, ASPH 2006, & WHO 2002). Permalink: https://nursingpaperessays.com/ nurs-4015-public…alth-essay-paper / Global Health Global health is an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. It emphasizes transnational health issues, determinants, and solutions; involves many disciplines within and beyond the health sciences; and is a synthesis of population-based prevention with individual-level clinical care. Although global health places greater priority on prevention, it also embraces curative, rehabilitative, and other aspects of clinical medicine and the study of basic sciences (Koplan 2009). NURS 4015 – Public and Global Health Essay Paper Difference Between Global Health and Public Health Global health as a scientific and evidence based specialty of Healthcare has created a trivialization paradigm in healthcare delivery using the strengths inherent in globalization, geopolitical interdependence, and individualization. Global health training at JLI provides a very strong foundation for the knowledge and skills a healthcare professional requires for international public health engagements, health systems management, careers in domestic and international healthcare policy and disciplines like environmental and occupational hygiene. Opportunities in Global Health Policy and Operations are in Institutions and departments where research, technology, government, and society intersect and include large worldwide agencies like the WHO, UNESCO, UNICEF, Red Cross etc., governmental and non-governmental institutions, private healthcare service providers (public health CROs), research based companies, corporate social responsibility (CSR) departments or foundations/trusts (e.g., Bill and Melinda Gates foundation, Garfield Weston Foundation, ) of large corporate houses, etc. NURS 4015 – Public and Global Health Essay Paper What is the difference between Global Health and Public Health? Global Health and Public Health as two specialties of healthcare have similar overarching goals with professionals engaged in betterment of individual health, constant improvement in longevity, improve quality of life, socioeconomic enlistment, manage and mitigate short term and long-term health risks, etc. However, the approach and operations of both the specialties differ in relation to geopolitical symbiosis, population health, healthcare economics and interrelationship among allied disciplines. With an expected overlap between the two streams table below provides a few basic differences: Global Health Public Health Geopolitical Healthcare problems and policy issues that transcend internationally Major focus is on specific communities or meeting national goals Collaboration and Alliances Global. Strongly propagates interdependence and not merely a flow of resources and information from the developed to the developing nations National. Based on economic and knowledge dependence of the developing on the developed, directly or via world associations and organizations. Population Health Prevention and clinical Primarily Prevention Healthcare economics and outreach Equitable distribution of healthcare resources including finances among nations Healthcare equity within a nation or locality Interrelationship among st Allied Disciplines Supports high interdisciplinary approach Multidisciplinary, especially with healthcare and social sciences Global Health: The Role of Nursing Research A decade ago, the Institute of Medicine defined global health as “health problems, issues, and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions” (Board on International Health, Institute of Medicine, 1997). This definition continues to guide and shape the understanding of the role of nursing in advancing global health. NURS 4015 – Public and Global Health Essay Paper More recently, Bunyan and Walk up (2001) identified a paradigm shift in which the concept of global health has replaced international health . The concept of global health acknowledges the interconnections of nations and the impact of geopolitical, social, and fiscal considerations on healthcare policy. In contrast, international health creates a distinction based on the border between a specific nation and other nations. Currently, the more inclusive concept of global health acknowledges the necessity of addressing socioeconomic disparities; global patterns of migration; redistribution of the healthcare workforce often to more affluent nations; environmental change; urbanization; and violence, whether related to war, terrorism, or security threats (Gilliam International Health Initiative, 2007). Although nurses have been on the front line in addressing global healthcare problems and issues, relatively little has been documented about the contributions of nurse researchers and nursing research to global healthcare priorities. In delineating an agenda and framework for nursing research regarding global health, researchers may draw upon the overarching goals of the United Nations Millennium Project (2005). Global healthcare priorities are identified, with eight quantifiable goals and benchmarks to be achieved by 2015. The Millennium Project goals must be tempered against regional priorities. NURS 4015 – Public and Global Health Essay Paper For example, goals related to promoting gender equality and empowerment of women may not be supported at the regional level. Thus, nurse researchers interested in advancing global health must be prepared to address the inherent tensions that exist between the regional and global priorities. As nurse researchers collectively delineate priorities for nursing research, it is important to reflect upon the factors that may adversely affect the advancement of nursing research pertinent to global health. Two broad themes are presented: (a) lack of visibility and (b) limited support for nursing research regarding global health within the larger world of nursing science. Visibility Research conducted to address global health requires use of multidisciplinary and multinational teams. Although nurse economists, health analysts, and epidemiologists may contribute to this research, authorship of reports may be dictated by political and ideological considerations. For example, Dr. Mary Paterson of The Catholic University of America has conducted seminal work on strengthening of health systems in developing nations and in countries where the health system infrastructure has been damaged by war and political unrest (Paterson, Telyukov, Faraq, & Al-Shiakhli, 2003; Telyukov & Paterson, 2004; Telyukov, Paterson, Gotsadze, & Jugeli, 2003). Her research has not been recognized readily as nursing research because it is presented within the context of health policy and analysis as opposed to pure research and because it is published in venues such as technical reports commissioned by the World Bank and other global organizations instead of the nursing journals. NURS 4015 – Public and Global Health Essay Paper The visibility of nursing research regarding global health is influenced also by the way in which nurse researchers interested in global health are educated and socialized. The traditional academic preparation for a nurse researcher involves master’s-level preparation in nursing followed by either doctoral-level studies in nursing or a related discipline and, hopefully, postdoctoral work. However, nurse researchers interested in global health may opt for graduate education in public health, health economics, and health policy because the curricula are more responsive to their career goals. By branching into related areas at the master’s level instead of at the doctoral level, these researchers join a different community of scholars. Furthermore, lacking a master’s-level degree in nursing, their appropriateness for membership as nursing faculty requires specific justification to certain accrediting bodies and groups. Thus, they may face additional marginalization and devaluation of their contribution to nursing science. Finally, some ambivalence may exist regarding the boundaries of nursing research. Although the richness of the diverse backgrounds of nurse researchers in the area of global health benefits the understanding of global aspects of nursing, some may also view their research as blurring or diluting the uniqueness of nursing research. Paralleling the discussion regarding the nature of global versus international health is a discussion regarding the nature of nursing research in an increasingly global environment versus global healthcare research of relevance to nursing. NURS 4015 – Public and Global Health Essay Paper Support for Global Health Research The role of nursing research in advancing global health is limited also by the existing nursing research infrastructure. As a result, although nursing research has been used to address many health problems with a global component, additional follow-up studies are required to make the transition to a global health perspective. For example, U.S. nurse researchers have made a significant contribution to the understanding of factors influencing the risk of HIV/AIDS transmission and the subsequent development of behavioral interventions for risk reduction. Given the global nature of HIV/AIDS, this body of behavioral research is potentially relevant in regions of the world where HIV/AIDS is endemic. However, to tailor these interventions to specific regions of the world, additional research addressing the efficacy of these interventions within the context of socio-cultural and political factors and fiscal constraints is necessary. In addition, research including subjects from other countries has often been patterned after the multi centered clinical trial model. As a result, homogeneity of study groups regardless of country of origin is a desired attribute, thus blunting the ability of the research to address complexities across nations. Thus, although this research is international , it is not global. Finally, nurse researchers interested in global health must aggressively pursue other funding avenues. Traditional funding sources such as the National Institutes of Health understandably give funding priority to research that addresses national healthcare issues. Similarly, only a small subset of private foundations and agencies funding nursing research, such as the Bill and Melinda Gates Foundation (http://www.gatesfoundation.org), promote research related to global health. NURS 4015 – Public and Global Health Essay Paper In conclusion, it is hoped that, through this initiative between Nursing Research and other journals, the hidden face of nursing research in global health will be appreciated more widely. Whether at the level of individual interventions, community action, or healthcare analysis and policy development, nursing research has an enormous yet unrealized potential to advance the global healthcare agenda. I hope that these statements about the limitations in the nursing research agenda will challenge nurse researchers to expand support of an increasingly global agenda. The Nurse’s Role in Global Health With a total of approximately 3 million registered nurses (RNs) in the United States, these professionals play a prominent role in healthcare throughout the country. They factor even more significantly into healthcare delivery throughout the world, with an extremely significant number of about 32 million nurses across the planet. Nurses provide about 90 percent of healthcare services in the world, and for that, they deserve intense appreciation. With those statistics in mind, here is a look at global nursing as it currently stands. NURS 4015 – Public and Global Health Essay Paper The Nurse’s Worldwide Role A world without nurses is almost impossible to imagine. Everywhere you turn, nurses are there to provide leading-edge treatments to patients from all walks of life. Nurses work in various settings, including wellness clinics, hospitals, schools, churches and businesses, and they work with people throughout the lifespan. Why Nurses Matter in Global Health In the United States, nurses have a rather clearly defined role. However, in many locations throughout the world, there are not enough doctors available to provide the care that people need. Luckily, there are nurses, and if it were not for them, these individuals would not receive any healthcare services at all. Nurses make a major contribution by addressing various health issues. Here is a short list of service situations or issues nurses might face: Birth and Delivery: In various remote areas such as in rural Africa, there is not enough money to pay a doctor who can set up a practice. Or there may be other obstacles to having a local doctor. Fortunately, nurse-midwives are excellent in the role of caring for mothers before, during and after childbirth. Primary Care: Also in rural, remote or poverty-stricken areas, physicians may not be available to provide primary care services, and nurses are there to deliver many of those services. One challenge these areas face is that the health conditions people have are often more complex and difficult to treat. NURS 4015 – Public and Global Health Essay Paper Cholera: Illnesses and diseases we rarely encounter in the U.S. can be problems in certain other areas of the world. For example, cholera is an issue in Haiti, so nurses there get the chance to help numerous people with that disease. Tuberculosis: Nurses in Peru have been able to develop a program with the world’s highest cure rates for drug-resistant tuberculosis. Partnerships and Collaboration It is wonderful to see medical centers in various areas of the world collaborate. Here are two examples of innovative and resourceful partnerships: The Dana-Faber Cancer Institute in the U.S. is working to create a nursing oncology partnership with an organization in Rwanda. Oncology nurses from the U.S. will work directly with Rwandan doctors and nurses to share knowledge. Reg is College in the U.S. is working with the Haitian Ministry of Health and PIH to address the shortage of nursing education in that country. The end result will be a three-year master’s program for Haitian nurses. NURS 4015 – Public and Global Health Essay Paper Nurses are leaders who make a positive difference by advocating for health and providing healthcare throughout the world. In many instances, despite their incredibly huge and generous contribution across the globe, nurses are treated almost as though they are invisible. They deserve to have a prominent voice when world leaders get together to address health issues and develop national and international policies. They also need more resources, such as for mentor ships, leadership and nurse education. One way of receiving additional education and preparation is through online programs, and an online RN to BSN program is ideal for receiving high-quality education in an efficient way. People who believe in the value of nursing should remind as many people as possible, as often as possible, about the value that nurses bring to the world. We need to advocate for nurses having a greater voice on the world stage. Their contributions to healthcare are already spectacular, but when they have a bigger platform, who knows how far they can go? Protecting health against potential risks such as epidemiological risks that determine disease outbreaks and pandemics, safety risks associated with poor quality of care and financial risks derived from paying for care, will ensure health security. 1 However, health security can have different meanings. Health security can be understood as securing health at the individual, national and global levels, but may also be understood as the effect of health on security. The latter is a traditional approach that focuses mainly on national security and the protection of sovereignty, borders, people, and private interests and property. 2 The discrepancy in meanings has caused confusion and mistrust between and among Member States. 3 In this paper, we discuss securing health from noncommunicable disease at the individual, national and global levels. NURS 4015 – Public and Global Health Essay Paper A recent Lancet editorial noted that noncommunicable diseases are not garnering the attention they deserve and suggested that such diseases should be considered as a global health security issue. 4 A Lancet editorial discussing the 2007 World Health Report called for leadership from the World Health Organization (WHO) to ensure that global health security is achieved. 5 The impact of noncommunicable diseases on public health is well known. In 2010, 34.5 million out of a total of 52.84 million deaths were attributed to noncommunicable diseases, and most of these occurred in low- and middle-income countries. 6 In 2011, the General Assembly adopted a resolution on the prevention and control of noncommunicable diseases. This political declaration was largely an acknowledgement of the burden of noncommunicable diseases and the role of governments and other stakeholders in preventing and managing this burden. Noncommunicable diseases have also been included in the sustainable development goals with a specific target. 7 Despite many efforts by WHO and the international community, however, funding for the prevention and control of noncommunicable diseases has lagged. Of the total 37.6 billion United States dollars (US$) in development assistance for health for 2016, 29.4% was allocated to maternal, newborn and child health, 25.4% to human immunodeficiency virus (HIV), 6.6% to malaria, 4% to tuberculosis and 1.7% to noncommunicable diseases. 8 The scarce funding for noncommunicable diseases is a possible indicator of their low priority on the global health agenda. Here we argue that this situation is in part due to the failure to recognize noncommunicable diseases as a global health security threat. NURS 4015 – Public and Global Health Essay Paper For example, in contrast with noncommunicable diseases, HIV, an epidemic of global significance, has attracted considerable funding. The security concerns associated with HIV were so pressing that the issue reached the United Nations Security Council. HIV is considered a national security threat because of the impact on strategically important population groups, such as soldiers and peacekeepers and because of its potential to destabilize states. Noncommunicable diseases can affect personal security in many ways: they are chronic conditions and therefore have a long-lasting impact on health and on the perception of one’s personal security and well-being. Evidence suggests that noncommunicable diseases contribute to personal poverty, because of their chronic nature, their impact on productivity and their direct and indirect costs. However, it is the scale of the premature mortality due to noncommunicable diseases, with its impact on individuals and families, that mainly threatens personal security. The WHO Global status report on noncommunicable diseases 2014 showed that in 2012, 42% of all deaths caused by noncommunicable diseases occurred before the age of 70 years and 82% were in low- and middle-income countries. 9 Noncommunicable diseases clearly have an impact on individuals; however, they also represent an economic burden to governments, and therefore are a health security challenge at the national level. NURS 4015 – Public and Global Health Essay Paper The global dimension of noncommunicable diseases as a health security issue refers to the health of all the people and efforts to reduce health inequity. The Lancet Commission on Global Health 2035 foresees that the threat of pandemics, antimicrobial resistance and noncommunicable diseases will represent the greatest threats to global public health in the future. 10 Antimicrobial resistance and pandemics have a high priority status in the global agenda and their threat to global health security is largely unquestioned. The West African Ebola outbreak prompted the creation of a global health security agenda. Interestingly, the initiative did not come from the public health community, but from the highest political levels. In 2014, the United States of America, with initially 40 partners from around the world, launched the global health security agenda with the aim to prevent, detect and respond to infectious disease threats globally. 11 The urge for a rapid response to infectious diseases is not surprising, as fear of contagion is strong; noncommunicable diseases do not pose such a threat and are therefore not perceived as threatening. 12 NURS 4015 – Public and Global Health Essay Paper We propose that the magnitude of the epidemic of noncommunicable diseases, their increasing prevalence, global costs, potential to overwhelm the response capacity of low-income countries and their contribution to the inequality of health, make noncommunicable diseases a global health security threat. For example, the increased burden of noncommunicable diseases on low-income countries that have inadequate health systems might increase global inequality and instability. The attention given to a public health issue mainly depends on how the issue is framed. 13 For noncommunicable diseases to be understood as a global health security issue, perhaps they need to be framed not only in terms of data on morbidity and mortality, or on their economic costs. Leadership to advocate for noncommunicable diseases as a global health security issue is a whole-of-society responsibility, but those who can push for this are intergovernmental organizations such as WHO, and increasingly nongovernmental organizations with global reach such as the Noncommunicable diseases Alliance. NURS 4015 – Public and Global Health Essay Paper Public health is defined as the science of protecting the safety and improving the health of communities through education, policy making and research for disease and injury prevention. The definition of public health is different for every person. Whether you like to crunch numbers, conduct laboratory or field research, formulate policy, or work directly with people to help improve their health, there is a place for you in the field of public health. Being a public health professional enables you to work around the world, address health problems of communities as a whole, and influence policies that affect the health of societies. Public health involves the application of many different disciplines: Biology Anthropology Public policy Mathematics Engineering Education Psychology Computer science Sociology Medicine Business and others The Goals and Objectives of Public Health Initiatives Public health is a science that is aimed at protecting and improving the health of individuals, communities and greater populations, which may be as small as a neighborhood or as big as a region of the world. NURS 4015 – Public and Global Health Essay Paper Regardless of the size of the populations they serve, public health professionals, work to prevent health problems from occurring or reoccurring, and mitigate the effects when problems do occur. They accomplish this task through educational programs, the creation and implementation of policies, the administration of services, and through research. Therefore, a major objective of public health is to promote healthcare equity, quality, and accessibility. The objectives of public health may be carried out through public or private endeavors, and many times efforts are coordinated among a number of private and public entities. According to the World Health Organization (WHO), the goal of public health is to prevent disease, promote health, and prolong life among the population as a whole. Therefore, public health initiatives are aimed at fostering conditions in which people can be healthy within specific populations. The World Health Organization recognizes the main objectives of public health initiatives to be: To assess and monitor the health of communities and populations at risk so as to identify health problems and priorities To formulate public policies designed to solve local and national health problems and priorities To assure that all populations have access to cost-effective and appropriate care, which includes health promotion and disease prevention services NURS 4015 – Public and Global Health Essay Paper In short, the goals of public health are to save money, improve the quality of life, help children thrive, and reduce human suffering by: Assuring the quality and accessibility of health services Preventing epidemics and the spread of disease Preventing injuries Promoting and encouraging healthy behaviors Protecting against environmental hazards Responding to disasters and assisting communities in recovery Examining the Components of Public Health Public health can be distinguished from healthcare in that instead of treating diseases and injuries, one patient at a time, public health is focused on preventing disease and injury in communities and populations. In other words, public health professionals are motivated to identify the cause of disease and disability and implement solutions to address these causes. NURS 4015 – Public and Global Health Essay Paper A good example of healthcare versus public health is that a medical practitioner would treat a gunshot wound, while a public health professional would work to identify the systemic causes of gun violence and look for solutions. Similarly, while a medical professional would prescribe medication to treat high cholesterol, a public health professional would examine causes of obesity and high cholesterol and work to implement programs to encourage healthy lifestyle changes among populations. Public health encompasses a wide array of topics and issues, such as chronic disease, the science of aging, mental health, injury prevention, disaster response, and tobacco control. Just a few of the contemporary topics in public health include: Developing emergency preparedness plans Examining the dangers of secondhand tobacco smoke exposure Identifying ways to stop bullying in schools Improving technologies that make clean drinking water available Investigating the consequences of antibiotic use in industrial agriculture Promoting family planning and reproductive health programs and policies Promoting policies that protect the global environment The U.S. Department of Health and Human Services identifies 10 essential public health services: NURS 4015 – Public and Global Health Essay Paper Monitor health status so as to identify and solve community health problems Diagnose and investigate health hazards and health problems in a community Educate and empower people about contemporary health issues Inspire and support community partnerships to identify and solve health problems Set policies and plans in motion so as to support individual and community health efforts Enforce laws and regulations that are designed to protect the safety and health of communities Pair people to beneficial personal health services Provide a competent public and personal healthcare workforce Evaluate the effectiveness and the quality of personal and population-based health services Engage in ongoing research to discover innovative solutions and new insights to health problems The public health system consists of official government public health agencies, private-sector business, and nonprofit organizations. The entities of the public health infrastructure in the U.S. include: More than 3,000 county and city health departments and local boards of health About 59 state, territorial, and island nation health departments A number of U.S. public health services agencies (HHS, CDC, EPA, FDA, OSHA, etc.) Tribal health agencies (coordinated by the Indian Health Service) More than 160,000 public and private laboratories Hospitals and private-sector healthcare providers National volunteer organizations (American Red Cross, American Cancer Society, American Diabetes Association, etc.) State and local volunteer organizations NURS 4015 – Public and Global Health Essay Paper Essential Public Health Services The three core functions of public health and the 10 Essential Public Health Services provide a working definition of public health and a guiding framework for the responsibilities of local public health systems. The functions of Assessment, Policy Development, and Assurance help us to balance and focus our three core government public health responsibilities as we strive to provide essential population based services to our constituents. All public or community health responsibilities (whether conducted by the local public health department or another organization within the community) can be categorized into one of the services. These following 10 essential services serve as the framework of the local public health system assessment we are conducting. Monitor health status to identify community health problems. Diagnose and investigate health problems and health hazards in the community. Inform, educate, and empower people about health issues. Mobilize community partnerships to identify and solve health problems. Develop policies and plans that support individual and community health efforts. Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. NURS 4015 – Public and Global Health Essay Paper Assure a competent public health and personal health care workforce. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Research for new insights and innovative solutions to health problems. Essential public health functions Surveillance and monitoring of health determinants, risks, morbidity and mortality. Preparedness and public health response to disease outbreaks, natural disasters and other emergencies. Health protection, including management of environmental, food, toxicological and occupational safety. Health promotion and disease prevention through population and personalized interventions, including action to address social determinants and health inequity. Assuring effective health governance, public health legislation, financing and institutional structures (stewardship function). Assuring a sufficient and competent workforce for effective public health delivery. Communication and social mobilization for health. Advancing public health research to inform and influence policy and practice. The Public Health System Public health systems are commonly defined as “all public, private, and voluntary entities that contribute to the delivery of essential public health services within a jurisdiction.” This concept ensures that all entities’ contributions to the health and well-being of the community or state are recognized in assessing the provision of public health services. NURS 4015 – Public and Global Health Essay Paper Figure 1: The Public Health System The public health system includes Public health agencies at state and local levels Healthcare providers Public safety agencies Human service and charity organizations Education and youth development organizations Recreation and arts-related organizations Economic and philanthropic organizations Environmental agencies and organizations Public Health Infrastructure Goal To ensure that Federal, State, Tribal, territorial, and local health agencies have the necessary infrastructure to effectively pro

RECOMMENDED: [Get Solution] As the healthcare paradigm shifts from treating illness toward preventing illness, providers are challenged to adopt new models of care delivery and to embrace evolving concepts of value-driven reimbursement strategies. Moreover, healthcare providers must give increased attention to the need to improve healthcare in a manner that improves health outcomes across population groups and the entire nation as part of the population health approach. There are a variety of challenges facing healthcare leaders. The Managed Healthcare Executive published the top 6 items to watch. Read the Top 6 Challenges Healthcare Executives Face in 2020 (Links to an external site.) For this assignment, you are tasked with discussing how the issues on this list relate to population health, analyzing why these challenges exist, discovering research-based proposed solutions to these challenges, and debating the pros and cons of each of these solutions. The assignment consists of three parts. Part 1: Identify Challenges (2-3 pages) Choose five of the issues on the ACHE survey list and discuss 3-5 challenges surrounding each issue to analyze from a population health perspective. Each challenge should be a sub-heading in this part of the paper. Present the challenge, describe it, and provide some history or background, based on credible research sources. If you need writing assistance, see the Writing Center in the CSU Global Library (Links to an external site.). Part 2: Analysis of Challenges (3-4 pages) Explain each challenge you identified in Part 1 and provide a comprehensive discussion on why each has broad and far-reaching implications for improving the health of the U.S. population. Use data and scholarly research to support your thinking and bolster your discussion. Part 3: Proposed Solutions and Recommendations (3-4 pages) Discuss how the population-health paradigm can contribute to solutions for each of the five ACHE survey issues you selected. For each issue from the survey you discussed, make a specific recommendation you have identified in the research. Create a table to analyze the recommendations that identifies the following components: Pros and cons of this solution you have located. Arguments for and against this solution. Proponents or critics of this solution. Narrative discussion of your analysis. Discuss your analysis from the table. This requires critical analysis. You will want to assess the solution as well as their detractors and supporters and any possible biases in each. You will want to think through how solutions would be implemented, funded, supported, and received by various stakeholders, such as medical professionals, government, and the public. Requirements: The complete paper should consist of eight to ten pages, excluding the required title and reference pages. You must include at least eight credible sources, five of which must be peer-reviewed, scholarly sources. You may not use the textbook as one of your scholarly sources.