Chapter 7: Exam 2 Flashcards
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.
Health disparities
Why do health disparities matter?
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.
What is an example of health disparities?
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.
What are actions to reduce health disparities?
-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
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.
Social Determinants of Health (SDOH)
What are ACEs?
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.
What are things to reduce ACEs? What are evidence based interventions that can prevent ACEs?
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.
What is culture of health?
“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.”
What is the health impact pyramid?
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)
What is health in all policies?
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.
economic factors are, perhaps, the most important ones influencing the health status of an individual or group.
Policy
a compost measure of income, education, and occupation.
Socioeconomic status (SES)
the standard of living below which a family lacks the goods and services commonly taken for granted by mainstream society.
Poverty threshold
determining who is eligible for federal programs aimed at aiding those living in poverty.
poverty guidelines
What are examples of how poverty directly affects health and well being?
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
Describe children in poverty:
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
Describe homelessness:
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
Who is most likely to be homeless?
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
Stages of Homelessness:
Episodic Homelessness
Temporary Homelessness
Chronic Homelessness
recurrent periods of homelessness
episodic homelessness
a single episode of homelessness of relatively short duration
temporary homelessness
an extended episode of homelessness (generally 2+ years)
chronic homelessness
Marked by hardship and struggle
Transient or episodic
Brief stays in shelters
Younger and the majority
Crisis poverty
Chronic state; fewer (-16%)
Older, with disabilities, additions, severe mental or chronic physical illness
Significant family difficulties
persistent poverty
Common health conditions of the homeless:
Upper respiratory disorders
TB
Skin disorders and infestations
Alcoholism/drug use
HIV/AIDS
Mental illness
Dental caries
Hypothermia and health related illnesses
Malnutrition
Nursing care of the homeless:
Be committed
Use leadership skills
Use available resources
Be an advocate
Foster communication and trust
Assess the problem
Plan and give care
Levels of prevention homeless: Providing affordable, adequate housing
Low-income housing
Supportive housing
Emergency housing
includes everyone who is living without adequate shelter — those living in vehicles, surviving on the streets, staying in parks, or squatting in abandoned buildings
primary prevention
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
secondary prevention
includes those who rent single rooms on a long-term basis without security of a fixed or permanent residence.
tertiary prevention
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.
Immigrants
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.
Migrants
Migrant workers and health: risk factors for poorer health outcomes
Substandard housing
Crowded living quarters
Poor nutrition
Exposure to pesticides
Lack of access to health care
Interventions and policy for migrant workers:
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.
outside home country and unable or unwilling to return due to persecution.
Refugees
impact on health: globally, refugees experience…
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.
Unable or unwilling to return to country of nationality because of persecution.
asylees
persons living under the jurisdiction of state or federal prisons, and in the custody of local jails.
Incarcerated population
includes the incarcerated population as well as persons living in the community while supervised on probation or parole.
correctional population
incarceration and health:
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.
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.
LGBTQ+ community
L G B T Q+ persons are at greater risk for poor health than their heterosexual counterparts. This is attributable to:
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.
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
Transgender Youth
Nursing approaches to care in the community:
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
Planning and implementing care for vulnerable populations:
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!
Nursing actions to promote access to care for vulnerable populations:
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
