Chapter 7: Exam 2

Question 1

A health outcome is seen to a greater or lesser extent between populations. Differences in health and health care between population groups. Disparities occurs across many dimensions, including race/ethnicity, socioeconomic status, age, location, gender, disability status, and sexual orientation.

Answer 1

Health disparities

Question 2

Why do health disparities matter?

Answer 2

Identifying a disparity is the 1st step in understanding the underlying risk factors and the development of possible interventions to reduce or eliminate the disparity.

Question 3

What is an example of health disparities?

Answer 3

Infant Mortality Rate (IMR)

In 2016 the IMR for babies whose mothers were non-Hispanic black women was double the IMR for babies whose babies whose mothers were white non-Hispanic women. (11.4 per 1,000 live births vs. 4.9 per 1,000 live births) The top 5 leading cause of infant death in the U.S. in 2016 were birth defects, preterm birth, and low birth weight (LBW), sudden infant death syndrome (SIDS), maternal pregnancy complications, and injuries.

Question 4

What are actions to reduce health disparities?

Answer 4

-Speak out about health inequities in communities
-Be advocates for: individuals, communities, neighborhoods, populations, systems.
-Initiate/support healthier school programs
-Collect accurate data for policy makers
-Assist in developing health programs for the vulnerable
-Culturally design programs of health promotion, intervention, and prevention
-Educate communities on disparities they have and engage them to help find solutions
-Educate coworkers on health as well as social disparities
-Invest in social justice for all

Question 5

The social and environmental conditions in which people live and work. These social determinants include neighborhood and the built environment, economic stability, education, social and community context, and health and health care.

Answer 5

Social Determinants of Health (SDOH)

Question 6

What are ACEs?

Answer 6

Adverse Childhood Experiences. These experiences can include things like physical, sexual, and emotional abuse, neglect: physical and/or emotional, household disfunction: mental illness, incarcerated relative, mother treated violently, substance abuse, divorce, etc.

Question 7

What are things to reduce ACEs? What are evidence based interventions that can prevent ACEs?

Answer 7

Preventing child abuse and neglect

Strategy: Strengthen economic supports of families
Approach: Strengthen household finance security and family-friendly work policies

Strategy: Change social norms to support parents and positive parenting
Approach: Public engagement and educational campaigns and legislative approaches to reduce corporal punishment.

Strategy: Provide quality care and education early in life
Approach: Preschool enrichment with family engagement and improve quality of child care through licensing and accreditation.

Strategy: Enhance parenting skills to promote healthy child development
Approach: Early childhood home visitation and parenting skill and family relationship approaches.

Strategy: Intervene to lessen harm and prevent future risk
Approach: Enhance primary care, behavioral parent training programs, treatment to lessen harms of abuse and neglect exposure, and treatment to prevent problem behavior and later involvement in violence.

Question 8

What is culture of health?

Answer 8

“Where good health flourishes across geographic, demographic, and social sectors; where being healthy and staying healthy is an esteemed social value; and everyone has access to affordable, quality health care.”

Question 9

What is the health impact pyramid?

Answer 9

Triple aim of Health Equity
-Implement Health in All Policies with health equity as the goal. (Top of pyramid)
-Expand Our Understanding of what creates health (Bottom left of pyramid)
-Strengthen the Capacity of Communities to create their own healthy future (Bottom right of pyramid)

Question 10

What is health in all policies?

Answer 10

Good health requires policies that actively support health. It requires different sectors working together, for example:
Health
Transport
Housing
Work
Nutrition
Water and Sanitation

To ensure all people have equal opportunities to achieve the highest level of health.

Characteristics of Vulnerable Populations: especially of the poor, Migrants and the Homeless, barriers to care, health concerns of each group, types of care needed. LOP for all groups.

Question 11

economic factors are, perhaps, the most important ones influencing the health status of an individual or group.

Answer 11

Policy

Question 12

a compost measure of income, education, and occupation.

Answer 12

Socioeconomic status (SES)

Question 13

the standard of living below which a family lacks the goods and services commonly taken for granted by mainstream society.

Answer 13

Poverty threshold

Question 14

determining who is eligible for federal programs aimed at aiding those living in poverty.

Answer 14

poverty guidelines

Question 15

What are examples of how poverty directly affects health and well being?

Answer 15

Higher rates of chronic illness
Higher infant morbidity and mortality
Shorter life expectancy
More complex health problems
More significant complications and physical limitations resulting from chronic disease
Hospitalization rates three times more than for persons with higher incomes

Question 16

Describe children in poverty:

Answer 16

Poverty rate for kids is 21.8% higher than for any other age group. Poverty among African American and Hispanic kids is 3 times greater than that of which, non-Hispanic kids. Children in poverty are at risk for the following:
Lack of adequate nutrition and brain development
Material substance abuse or depression
Exposure to environmental toxins
Trauma and abuse
Lower quality daily care

Question 17

Describe homelessness:

Answer 17

Poverty can lead to homelessness. Primary night residency that is as follows:
A supervised, temporary public or private shelter
A temporary residence for individuals intended to be institutionalized
A public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for humans.
Two ways of acquiring homeless numbers: Point in time counts and period prevalence counts. Both methods typically undercount those who are homeless. Many homeless people are hard to find.

-Point in time counts: number of persons who are homeless on a given day or during a given week.
-Period prevalence counts: number of people who are homeless over a given period of time

Question 18

Who is most likely to be homeless?

Answer 18

Single homeless adults are more likely to be males
The number of homeless families has increased
42% African American
38% White
20% Hispanic
4% Native American
2% Asian
Victims of domestic violence
Veterans
1.5 million children, 42% under the age of 6 years old

Question 19

Stages of Homelessness:

Answer 19

Episodic Homelessness
Temporary Homelessness
Chronic Homelessness

Question 20

recurrent periods of homelessness

Answer 20

episodic homelessness

Question 21

a single episode of homelessness of relatively short duration

Answer 21

temporary homelessness

Question 22

an extended episode of homelessness (generally 2+ years)

Answer 22

chronic homelessness

Question 23

Marked by hardship and struggle
Transient or episodic
Brief stays in shelters
Younger and the majority

Answer 23

Crisis poverty

Question 24

Chronic state; fewer (-16%)
Older, with disabilities, additions, severe mental or chronic physical illness
Significant family difficulties

Answer 24

persistent poverty

Question 25

Common health conditions of the homeless:

Answer 25

Upper respiratory disorders
TB
Skin disorders and infestations
Alcoholism/drug use
HIV/AIDS
Mental illness
Dental caries
Hypothermia and health related illnesses
Malnutrition

Question 26

Nursing care of the homeless:

Answer 26

Be committed
Use leadership skills
Use available resources
Be an advocate
Foster communication and trust
Assess the problem
Plan and give care

Question 27

Levels of prevention homeless: Providing affordable, adequate housing

Answer 27

Low-income housing
Supportive housing
Emergency housing

Question 28

includes everyone who is living without adequate shelter — those living in vehicles, surviving on the streets, staying in parks, or squatting in abandoned buildings

Answer 28

primary prevention

Question 29

includes those who are staying in a temporary form of housing because they have nowhere else to go — those living with friends or family, or in shelters

Answer 29

secondary prevention

Question 30

includes those who rent single rooms on a long-term basis without security of a fixed or permanent residence.

Answer 30

tertiary prevention

Question 31

a person who comes to the country to take up permanent residence. U.S. Department of Homeland Security refers to them as “Permanent Resident Alien.” Legally emigrates from one country to another.

Answer 31

Immigrants

Question 32

those who move from place to place to get work and who often work in another country that is not their own. Moves from place to place following seasonal agricultural jobs.

Answer 32

Migrants

Question 33

Migrant workers and health: risk factors for poorer health outcomes

Answer 33

Substandard housing
Crowded living quarters
Poor nutrition
Exposure to pesticides
Lack of access to health care

Question 34

Interventions and policy for migrant workers:

Answer 34

The U.S. Immigration and Nationality Act (INA) protects immigrants and migrant workers from discrimination. The Affordable Care Act (ACA) does not directly benefit migrant workers, especially those who are undocumented.

Question 35

outside home country and unable or unwilling to return due to persecution.

Answer 35

Refugees

Question 36

impact on health: globally, refugees experience…

Answer 36

Food insecurity, poor sanitation, exposure to multiple communicable diseases, violence, and mental health issues with limited medical care.
Many live in refugee camps, some for several years, with major impact on their health
Those living in refugee camps are at greater risk for a number of health issues.
Children in refugee camps are at an increased risk for stunted growth due to chronic malnutrition.

Question 37

Unable or unwilling to return to country of nationality because of persecution.

Answer 37

asylees

Question 38

persons living under the jurisdiction of state or federal prisons, and in the custody of local jails.

Answer 38

Incarcerated population

Question 39

includes the incarcerated population as well as persons living in the community while supervised on probation or parole.

Answer 39

correctional population

Question 40

incarceration and health:

Answer 40

Poverty, limited access to health care, low education levels, substance use, mental health issues, and communicable diseases such as hepatitis and H I V. The stresses of prison life, poor diet, and frequently less-than-adequate medical care exacerbate noncommunicable conditions such as diabetes and hypertension.

Question 41

Persons who do not conform to established gender norms often face stigma, discriminatory practices, and/or social exclusion. This continuum includes persons who identify as straight (cisgender), gay, lesbian, bisexual, transgender, a-gender, or other gender-based terms (L G B T Q+). Gender identification and sexual orientation occur across a continuum rather than in the more traditional binary model of female and male.

Can adversely affect health through: increased susceptibility to diseases and poor mental and physical health and decreased access to health services.

Many L G B T+ people with H I V/AIDS avoid accessing medical and social services for fear that their health status will be discovered and result in family rejection and discrimination in employment and housing.

Answer 41

LGBTQ+ community

Question 42

L G B T Q+ persons are at greater risk for poor health than their heterosexual counterparts. This is attributable to:

Answer 42

Differences in sexual behavior
Social and structural inequities, such as the stigma and discrimination that LGBTQ+ populations experience.
Increased risk for communicable diseases, suicide, mental health issues and substance use disorders often linked to discrimination and social isolation.
Increased risk or violence, especially hate crimes.

Question 43

Vulnerable to bullying and societal/familial denial of their expressed gender
Leads to depression, anxiety and other problems that can inhibit healthy social and physical development
Medical and support may not be readily available outside large metropolitan areas
Older transgender youth are at high risk for family rejection, homelessness, substance use, risky sexual behavior, depression, and suicide, as well as being targets of sexual violence

Answer 43

Transgender Youth

Question 44

Nursing approaches to care in the community:

Answer 44

Coordinate services/ wrap-around services
Assess and identify needs
Develop interventions
Plan and deliver interventions
Evaluate results
comprehensive, family-centered services when treating vulnerable population groups; “one-stop” services
Advocacy
Social justice
Linguistically appropriate health care
Case management

Question 45

Planning and implementing care for vulnerable populations:

Answer 45

role of nurse- illness prevent and health promotion
Goals: should be responsible, manageable, set with the client
Interventions: should be culturally sensitive and linguistically appropriate and house is on teaching health promotion/ disease prevention
Client empowerment
Resources
Case management
Evaluate!

Question 46

Nursing actions to promote access to care for vulnerable populations:

Answer 46

Create a trusting environment
Show respect, compassion, and concern
Do not make assumptions
Coordinate services and providers
Advocate for accessible health care services
Focus on prevention
Know when to “walk beside” the client and when to encourage the client to “walk ahead”
Know what resources are available
Develop your own support network