Health Promotion W#4: Pros and Cons
Discussion #1: Pros and Cons to Delivering Community-Based Participatory Care to Those Who Are Vulnerable.
Performing health assessments as an Advance Practice Nurse (APRN) will help you to develop a collaborative partnership with your patients. After reading Chapter 4 and 12 in your Pender text (see attached chapters), think about the vulnerable population that you choose: COMBAT VETERANS – consider what you perceive / know about this group in relation to the following topics:
1. Health assets
2. Health problems
3. Health-related lifestyle strengths
4. Key health-related beliefs
5. Health behaviors that put the person at risk
6. Changes that could improve their quality of life
Now consider the pros and cons of implementing a Community-Based Participatory Research health promotion project with the vulnerable group. You should consider not only the benefit of the actions but the active role the vulnerable will play in the development and implementation of the health promotion plan. How does your population’s health disparities and health inequities benefit and/or hinder this type of project’s success?
Remember that you should include citations/references from at least three scholarly sources.
Note: My background for you to have as a reference: I am currently enrolled in the Psych Mental Health Practitioner Program, I am a Registered Nurse, I work at a Psychiatric Hospital, where I also work with this vulnerable population.
APA style
Minimum 550 – 650 words.
TURNITIN ASSIGNEMNT (FREE OF PLAGIARISM)
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CHAPTER 12
Health Promotion in Vulnerable Populations
Objectives
this chapter will enable the reader to:
1. Discuss the social and economic determinants of health and their role in health disparities.
2. Describe the concept of equity in health.
3. Discuss approaches to address health inequities in diverse populations.
4. Examine strategies to promote health literacy.
5. Describe the continuum of interpersonal skills necessary for cultural competence.
6. Review strategies that facilitate culturally competent communication in vulnerable
populations.
7. Describe approaches to ensure culturally competent health promotion programs.
Vulnerable populations are diverse groups of individuals who are at greatest risk for poor physical, psychological, and/or social health outcomes. Vulnerable populations are more likely to develop health problems, usually experience worse health outcomes, and have fewer resources to improve their conditions. Various terms have been used to describe vulnerable populations, including underserved populations, special populations, medically disadvantaged, poverty-stricken populations, and American underclasses. Vulnerable groups include persons who experience discrimination, stigma, intolerance, and subordination, and those who are polit- ically marginalized, disenfranchised, and often denied their human rights. Vulnerable popula- tions may include people of color, the poor, non-English-speaking persons, recent immigrants and refugees, homeless persons, mentally ill and disabled persons, gay men and lesbians, and substance abusers.
The values, attitudes, culture, and life circumstances of individuals who are poor, socially marginal, or culturally different from traditional mainstream society, and the communities in which they reside, must all be considered when planning health promotion and prevention
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activities. Taking into account the factors that reflect the health determinants of vulnerable popu- lations is key to promoting positive health behaviors.
In spite of improvements in health and spending more money on medical care than any other nation, the United States ranks near the bottom on key indicators of health, and health disparities continue to persist, based on an individual’s racial/ethnic background and socioeconomic (income and education) characteristics (Braverman, Egerter, & Mockenhaupt, 2011). Blacks, Hispanics and other racial/ethnic minorities are more likely to be socioeco- nomically disadvantaged, a more likely explanation for health differences by race and ethnicity. Health disparities are the differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among groups who are defined by certain characteristics. Health disparities disproportionately affect individuals who are members of the racial, ethnic minority, underserved, and other vulnerable groups mentioned previously, as well as persons who live in geographic (rural) areas where they are socially and physically isolated. Elimination of disparities to improve the health of all groups is an overarching goal of Healthy People 2020, and determinants of health and health dispari- ties are included as outcome measures of the national health objectives. (See the Healthy People 2020 website for details.) Although the major causes of health disparities need the input of society and government, development of empowering health promotion programs tailored for diverse individuals and communities is a major responsibility of nurses and other health care professionals.
Determinants of HealtH Disparities anD HealtH inequities
Social determinants of health are the structural and economic conditions in which people are born, live, work, and age (World Health Organization, 2013). These conditions are also responsible for health inequities and are shaped locally, nationally, and globally by economic distribution, social policies, and politics. In other words, money, power, and resources are responsible for the major inequities in health. Health inequities are avoidable inequalities in health between groups of persons that arise from social and economic conditions which increase their risks for illness and access to health promoting and preventive services. Health equity—the absence of disparities in health across populations, genders, and geo- graphic areas—can be achieved by empowering individuals and communities to challenge and change the distribution of social resources and advocate for social policies for equal access for all.
Inequities in health are well documented and are considered to be the result of complex interactions among multiple factors:
• Biologicalvariations • Healthcareaccess • Personalhealthbehaviors • Socialandeconomicresources • Culture
One way to view health disparities is by examining the range of risk factors that increase the potential for inequalities (Table 12–1). The risk factors include personal health behaviors, popu- lation characteristics, health care characteristics, the social and physical environments, and the types of diseases that are disproportionately diagnosed in vulnerable groups (Koh, Oppenheimer, Massin-Short, Emmons, Geller, & Viswanath, 2010).
258 Part5 • HealthPromotioninDiversePopulations taBle 12–1 Range of Potential Risk Factors for Health Disparities
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Potential Risk Factor
Personal Health Behaviors Population Characteristics Health Care Characteristics Residential Physical Environment
Social Residential Environment Diseases
Examples
Tobacco use, illicit drug use, personal hygiene, dietary habits, physical inactivity, unsafe sexual practices.
Race, ethnicity, immigration status, education, social position, occupation, employment, income, age, sexual orientation, health literacy.
Insurance, access to health care services, access to prevention and screening services, regular physician, medication affordability.
Housing density, housing quality, traffic density, air pollutants, hazardous wastes, drinking water quality, urban or rural, zoning policies, proximity to health care services, and proximity to quality food.
Civic engagement, crime rate, isolation, neighborhood cohesion, neighborhood social capital.
Obesity, hypertension, cardiovascular diseases, diabetes, mental illness, HIV/AIDS, cancer, respiratory illnesses, foodborne and waterborne illnesses.
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The most important social determinants of health inequities are considered to be structural influences, or factors that generate and reinforce social stratification and social class divisions in a society and define one’s socioeconomic position (Solar & Irwin, 2010). Socioeconomic position provides access to power, prestige, and resources and is based on a person’s income, education, and occupation. Other important structural determinants include gender, social class, and race/ ethnicity. These determinants are shown in the model in Figure 12–1 that describes the social determinants of health. This model was first drafted at the World Health Organization (WHO) Commission on Social Determinants of Health Meeting in 2005 (Solar & Irwin, 2010). The model depicts how governance structures or the sociopolitical context influences one’s socioeconomic position through the distribution of resources. Socioeconomic position shapes intermediate health determinants. Intermediary determinants that are determined by socioeconomic position include the following:
· Material characteristics: neighborhood, housing, physical working conditions, buying potential
· Behavioralfactors:nutrition,physicalactivity,tobaccouse,alcoholuse
· Psychosocial factors: stressful living conditions and relationships, social supports, coping
resources
Intermediary determinants are reflective of an individual’s place in the social hierarchy, which results in differential exposure and vulnerability to health-compromising conditions (Solar & Irwin, 2010). All of these factors determine one’s health status and well-being.
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SOCIOECONOMIC AND POLITICAL CONTEXT
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