concept 54 Health Disparities b234

What is a barrier to accessing needed medical treatment and preventive care ?

high premiums and out of pocket payments

Example of External Chronosystem

The timing of a loved one's death

Language Barriers

these people have an increased rate of non-adherence to medication

health care provider bias

this is often a prejudice against minorities, greater clinical uncertainty when interacting with minority patients, and beliefs or stereotypes about the health behaviors of minority patients.

Uninsured people are less likely to get adequate care for disease prevention.

true

Whitehead's 7 determinants of health disparities are

1. Natural Biological variation 2. Health-damaging behavior that is freely chosen 3. The transient health advantage of 1 group over another when one group is first to adopt a health-promotion behavior 4. Health-damaging behavior in which the degree of choice of lifestyles is severely restricted. 5. Exposure to unhealthy, stressful living and working conditions. 6. Inadequate access to essential health services and other basic services. 7. Natural selection, or health-related social mobility, involving the tendency for sick people to move down the social scale.

Cultural Competence in Health Care entails what?

1. Understanding the importance of sociocultural influences on patients' health beliefs and behaviors. 2. Considering how these factors interact at multiple levels of the health care delivery systems. 3. devinig interventions that take these issues into account to ensure the delivery

WAVE 1 OF CULTURAL COMPETENCE

1st the populations of interest expanded from mainly immigrants to basically all races and ethnicities.

WAVE 2 OF CULTURAL COMPETENCE

2nd, the conceptual boundary expanded beyond culture, to issues such as; prejudice, stereotyping, and the social determinants of health.

WAVE 3 OF CULTURAL COMPETENCE

3rd, the scope expanded beyond the interpersonal domain "between patients and health care providers to health systems and communities.

Avoidable disparity

A disparity in health outcomes due to unsafe living environments could be an avoidable cause of inequality.

The Social Ecological Model

Aims to explain dynamic interrelations among various personal and environmental factors

What do avoidable disparities do ?

Avoidable disparities raise ethical questions of needless harm and justice.

The Macrosystem consist of ?

Cultural values, customs, and laws, and includes the overall patterns of ideology and organization that distinguish an individual society or social group.

Unavoidable disparity

Disparity in health outcomes by AGE is unavoidable because aging as the biological process is not subject to intervention

Health Disparities refer to what ?

Health disparities refer to gaps in the quality of health and health care among population groups that often parallel differences in socioeconomic status, racial/ethnic background, and education level.

Health inequities

Health inequities indicate differences in health , which are not only unnecessary and avoidable but, in addition, are not considered unfair or unjust.

The Structural-Constructivist Model

Is based on a mental representation constructed by combinations of socially shared understandings within a society.

Socioecological Model provides what ?

It provides an understanding of interrelationships of individuals and systems, and it can provide perspective to identify health disparities at each system level.

The most significant contributing factor to poor quality of health care is what ?

Lack of Health Insurance

Bidirectional Interactions

The interactions within and between systems, they are bidirectional and have an impact from and toward the person.

Example of Internal Chronosystem

Physiological changes due to aging

Unavoidable and unacceptable

Should be a concern for nurses

Avoidable and unacceptable

Targets of intervention. for example; a disparity in cancer pain management exists between Asians and Whites. This disparity is avoidable if Asian cancer patients were educated and instructed on cancer pain management strategies. This is unacceptable because it gives an unnecessary burden of pain to Asian cancer patients that could be easily managed.

The Mesosystem

The Mesosystem is beyond the dyad or two-party relation and links over 2 systems that a person lives. Also, it links the structures of a person's microsystem .

The Social Ecological Model "Bronfenbrenner" 5 Socially Organized SUBSYSTEMS related to human development.

These systems interact in the person's life and provide diverse options and sources of growth. 1. microsystem 2. mesosystem 3. exosystem 4. macrosystem 5. chronosystem

The Chronosystem

This includes time as a dimension as it relates environmental contexts. Chronosystem can either be external or internal.

The Structural-Constructivist Model "constructivist perspective" supports:

This model supports the idea of social and cultural construction of race/ethnicity that frequently results in health disparities observed in health care systems.

Cultural Competence movement

This movement came from early efforts to bridge the divide between the largely biomedical, white, middle-class American culture perspectives of clinicians and the perspectives of patients "immigrants" whose experiences and language put them at a cultural distance from American Health care.

The Structural-Constructivist Model "constructivist perspective"

This perspective is that people are constrained by the external structures in which they are embedded ex; "social relations created by the shared and distributed expectations of others".

The Socioecological Model allows nurses to what ?

To identify cultural barriers in access to health care at the level of Macrosystem and to develop an intervention to tackle the cultural barriers to reduce subsequent health disparities.

How do health disparities occur within countries ?

Within countries health disparities occur by social status, family income, race/ethnicity, gender, disabilities, or sexual orientation.

Health Disparities defined as what ?

differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist smong specific population groups in U.S.

Scope of health disparities

is represented by avoidable and unavoidable disparities

Incidence of Diabetes is highest among who ?

men, people older than 65 years old, non-Hispanic African Americans, those of mixed race/ethnicity, and the disabled.

Premature death "before age 75" from stroke and coronary heart disease is higher in who ?

non-Hispanic African Americans compared to non-Hispanics whites.

Avoidable and acceptable

people involved and people not involved in a natural disaster. When a natural disaster occurs, unequal health outcomes among residents in the affected area may be acceptable even though the disaster and resultant health disparity could be avoidable.

Health disparietes definition IOM

racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention