NURS 242- Exam 3

what are the theoretical links with healthcare disparities?

1. social- ecological model- explains dynamic interrelations among various personal and environmental factors- five socially organized subsystems (microsystem, mecosystem, exosystem, macrosystem, chronosystem) 2. structural- constructivist model- based on an assumption of dual nature of human existence- reality of life is based on mental representation constructed by a combo of socially shared understandings within a society 3. social culture construction of race/ethnicity that freq results in health disparities 4. culture competence model- grew out of effort to bridge divide bw largely biomedical, white middle class american culture perspective of clinicians and perspectives of patients (mainly immigrants) whose experience and language put them at a substantial cultural distance from american healthcare.

health disparities... context into nursing care...4 types?

1. unavoidable and acceptable- health disparities that are unavoidable and acceptable shouldnt be a concern for nurses (ie aging causes more health concerns) 2. unavoidable and unacceptable- should be concern for nurses (ie high diabetes prevelance among Hispanics- can be avoided by defeating health disparities due to access healthcare) 3. avoidable and acceptable- rare in healthcare (ie natural disasters and unequal health outcomes among residents in affected areas may be acceptable eventhough disaster and resultant health disparity could be avoidable) 4. avoidable and unacceptable- target for intervention (ie therapy in pain mgmt bw asians and whites- cultural diff in pain mgmt- educate if needed) 5. lack of insurance and high healthcare costs 6. language barriers 7. lack of transportation 8. patient- provider communication 9. biased clinical decision making 10. pt mistrust and refusal

3. What is the definition of health disparity according to Healthy People 2020?

3. What is the definition of health disparity according to Healthy People 2020? Healthy People 2020 defines a health disparity as "a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.

examples of adolescent health issues? who's at highest risk?

Although adolescence and young adulthood are generally healthy times of life, some important health and social problems either start or peak during these years.3 Examples include: Mental disorders Substance use Smoking/nicotine use Nutrition and weight conditions Sexually transmitted infections, including human immunodeficiency virus (HIV) Teen and unintended pregnancies Homelessness Academic problems and dropping out of school Homicide Suicide Motor vehicle collisions highest risk: There are significant disparities in outcomes among racial and ethnic groups. In general, AYAs who are African American, American Indian, or Latino, especially those living in poverty, experience worse outcomes in a variety of areas such as obesity,13 teen and unintended pregnancy,14tooth decay,15 and educational achievement,16 compared to AYAs who are Caucasian or Asian American. In addition, sexual minority youth have a higher prevalence of many health risk behaviors.17

Discuss cancer disparities among the following groups: a. African Americans b. American Indian and Alaskan Native c. Asian Americans, Native Hawaiians, and other Pacific Islanders d. Hispanics/Latinos

Discuss cancer disparities among the following groups: a. African Americans Cancer rates highest in black men. African Americans have highest mortality rate (25% higher for African Americans than white for all cancers combined), African Americans women have higher death rates despite lower risk of cancer overall compared to white. African Americans men lower 5 year cancer survival rates for lung, colon and pancreatic cancers. b. American Indian and Alaskan Native Second leading cause death in American Indian/Alaskan Natives over 45 yr. The decrease in rate of mortality each year for AI/AN is less than others. Have the poorest 5 year survival rates for all cancers combined. c. Asian Americans, Native Hawaiians, and other Pacific Islanders Highest incidence for liver and stomach cancer and 2x as likely to die from them as whites (may be d/t high prevalence of Hep B and H. pylori). Also 30% more likely to be dx with cancer compared to whites. d. Hispanics/Latinos Highest rate for cancers associated with infection (liver, stomach, cervical). Higher prevalence of papilloma virus, Hep B and H. Pylori in immigrant countries of origin. Lower incidence and death rates but more likely to be dx with advanced stages of disease.

Discuss cancer disparities by the following types: a. Breast b. Cervical c. Colorectal d. Kidney e. Liver f. Lung g. Multiple Myeloma i. Prostate j. Stomach

Discuss cancer disparities by the following types: a. Breast Rates increased in African Americans women (although more common in white their rate stabile), more likely to die from it. 40 % more likely to die from it. 5 year survival rate lower. Aggressive tumors more common in African Americans and Hispanics in low SES. Rates for triple negative breast cancer highest in AA women. African Americans screened less, more advanced when diagnoses. b. Cervical African Americans more likely to be dx with. Higher mortality rates. Hispanics 2x likely to be dx and 1.5x to due than whites. Asians rates are 3x higher in Vietnamese than China or Japanese. c. Colorectal African Americans higher mortality rates and incidence (except American Indians/Alaskan Natives) d. Kidney Incidence and mortality 2x likely in men. American Indians/Alaskan Natives higher incidence and mortality. American Indians/Alaskan Natives women 40% more likely than whites. e. Liver Incidence in Asian/pacificer 1.5x more. Hispanics 2x likely to be dx and die from it. f. Lung African Americans highest incidence. Mortality rates highest in African American males. g. Multiple Myeloma African Americans 2x incidence and mortality. h. Pancreatic African Americans higher incidence and mortality i. Prostate 20% African American men will be dx in lifetime. AA men highest incidence and 2x likely as whites to die. 2nd leading cause cancer related deaths in AA men. j. Stomach Incidence rates highest in American Indiands/Alaskan Natives then hispanics, Asian/Pacificers and African Americans. Mortality rates highest in Asian/Pacificers and AA, then hispanics, AI/AN and whites. African American women 2.4x likely to be dx with and to die from. Asian/Pacifcer men 2x likely to die and their women 2.7x to die. Hispanic women 2.2x more likely to have.

Discuss each of these neglected diseases" a. African trypanosomiasis b. American trypanosomiasis c. Hookworm d. Leishmaniasis e. Lymphatic filariasis f. Malaria g. Onchocerciasis h. Schistosomiasis i. Buruli ulcer j. Trachoma k. Yaws 6. What can be done to prevent neglected diseases? 7. How can neglected diseases be treated?

Discuss each of these neglected diseases" a. African trypanosomiasis "sleeping sickness" This is caused by a parasitic microbe transmitted by tsetse flies. If untreated, parasite migrates to CNS, causing seizures, mental disorders and ultimately, death. 70,000 people are infected in Central and East Africa. b. American trypanosomiasis "Chagas disease" Caused by parasitic microbe transmitted by blood-sucking bugs. It can cause organ damage and infects 13 million people, mostly in Latin America. c. Hookworm Caused by intestinal worm parasites transmitted to humans from contaminated soil. Causes internal blood loss and is the world's leading cause of anemia and protein malnutrition, particularly in pregnant woman and children. More than ½ a billion people in poverty-stricken areas of Africa, Latin America, Southeast Asia and China are infected. d. Leishmaniasis Disease Caused by a parasitic microbe transmitted by sand flies. Can cause skin lesions and swelling of the spleen and liver. More than 12 million people are infected in Asia, Africa, Europe, and the Americas. e. Lymphatic filariasis "Elephantiasis," the parasitic worm disease is spread by mosquitoes. Can lead to disabling swelling of the legs and other body parts. About 120 million people are infected throughout Asia, Africa, and Western Pacific, South America, and parts of the Caribbean. f. Malaria Caused by a parasitic microbe spread by mosquitoes. Malaria infects 300 million people living in tropical regions each year. It can cause brain damage or death if RBC's infected with Malaria build up in the brain's blood vessels. The annual death toll is about 1 million people, many of whom are children under age 5 and pregnant women. g. Onchocerciasis Called "Liver Blindness," this parasitic worm disease is spread by black flies. It can cause extreme itching, sores on the skin and blindness. The parasite infects about 18 million people, mostly in Africa, but also in Latin America. h. Schistosomiasis Known as "Bilharzia or snail fever," this parasitic worm disease is transmitted by snails that live in fresh water. It can impair growth, cause severe anemia and lead to kidney and liver malfunctions. More than 200 million people are infected, mostly in Africa and Asia. i. Buruli ulcer This is a bacterial disease caused by massive open sores on the legs and arms. If untreated, it can spread to bones. The disease has been reported in 30 countries, but is not known how many people it infects. j. Trachoma A bacterial disease that can scar the inside of the eyelid. If untreated, it can lead to blindness. About 80 million people worldwide are infected. The disease occurs mostly in poor regions of Africa, Asia, and the Middle East, but has been reported in South America and Australia. k. Yaws A Bacterial disease that affects mainly the skin, bone, and cartilage. Rarely fatal but can lead to deformities and disability. It isn't known how many people have the disease. Tens of thousands of cases have been reported in Gahana, Indonesia, and Papua New Guinea, with most occurring in children under 15. 6. What can be done to prevent neglected diseases? Provide people with safe drinking water, good sanitiation, adequate housing, and access to health care. Other measures like pesticides or hanging nets around beds may help prevent or reduce risk of getting infected. People can also reduce their risk by not bathing or wading in water at high risk of contamination. Boiling water used for cooking, bathing, handwashing, etc., may reduce risk of bacterial disease. Medications may prevent infection or possible vaccines. 7. How can neglected diseases be treated? Lack of health care services cause people to not be treated. Medical researchers are searching for less costly drugs for neglected diseases, and working to develop new drugs for disease that lack treatments.

When it comes to analyzing the causes of rural health care disparities, how does reliable transportation impact rural residents' access to healthcare?

Far away from healthcare and most often no reliable way to get there Negative impacts due to distance and lack of transportation include: Increase in delayed or missed trips to receive healthcare services Disruption in ongoing treatments and services for chronically ill pts Travel distance to health services and the related costs affect pts' healthcare decisions Travel time spent to access healthcare can affect pts physically and cause stress Use of some medications, like insulin, declines as pts live farther from their source of care Gotta get some services to improve transportation, especially for the elderly, people with disabilities, low-income individuals/families, and veterans and people with special healthcare needs

What are rural risk factors for health disparities? What intensifies these risks for the rural residents? Who is working to reduce rural health disparities and what are they doing?

Geographic location, lower socioeconomic status, higher rates of health risk behaviors, limited access to healthcare specialists and subspecialists, and limited job opportunities Rural residents are less likely to have employer-provided health insurance coverage, and if they are poor, often are not covered by Medicaid Federal and state agencies, membership organizations, and foundations They want to reduce disparities and improve the health and overall well-being of rural Americans Some organizations provide funding, information, and technical assistance to be used at the state, regional, and local level, while others work with policymakers to help them understand the issues affecting population health and healthcare in rural America

After reviewing the Social Determinants of Health for Rural People topic guide, in what areas of rural differences did it focus on? (Hint: there are 11 areas)

Income, employment, and poverty Educational attainment and literacy Race/ethnicity Sexual orientation/gender identity Health literacy Adequate community infrastructure, which can ensure public safety, allow access to media, and promote wellness Environmental health, including water quality, air quality, and pollution Access to safe and healthy homes, including issues related to energy costs and weatherization needs, lead-based paint, and other safety issues Access to safe and affordable transportation, which can impact both job access and healthcare access. Unsafe transportation, such as vehicles in poor condition, may increase risk of injury. Access to healthy and affordable food Access to healthcare services

Name the determinants of health. 5. What are the other influences on health for Americans in regards to availability and access?

Name the determinants of health. Powerful, complex relationships exist between health and biology, genetics, and individual behavior, and between health and health services, socioeconomic status, the physical environment, discrimination, racism, literacy levels, and legislative policies. These factors, which influence an individual's or population's health, are known as determinants of health. 5. What are the other influences on health for Americans in regards to availability and access? For all Americans, other influences on health include the availability of and access to: High-quality education Nutritious food Decent and safe housing Affordable, reliable public transportation Culturally sensitive health care providers Health insurance Clean water and non-polluted air

what is a neglected disease? who is affected?

Neglected diseases are conditions that inflict severe health burdens on the world's poorest people. Many of these conditions are infectious diseases that are most prevalent in tropical climates, particularly in areas with unsafe drinking water, poor sanitation, substandard housing and little or no access to health care. The World Health Organization (WHO) estimates that more than 1 billion people — one-sixth of the world's population — suffer from one or more neglected diseases. The diseases are most heavily concentrated in low-income nations in Africa and Latin America. In addition, neglected diseases take a heavy toll in parts of Asia and the Middle East, although the range of diseases is narrower. Some of these diseases also are occasionally found in areas of the United States with high rates of poverty.

name some healthcare disparities with oral health

Overall. Non-Hispanic blacks, Hispanics, and American Indians and Alaska Natives generally have the poorest oral health of any racial and ethnic groups in the United States. Children and Tooth Decay. The greatest racial and ethnic disparity among children aged 2-4 years and aged 6-8 years is seen in Mexican American and black, non-Hispanic children. Adults and Untreated Tooth Decay. Blacks, non-Hispanics, and Mexican Americans aged 35-44 years experience untreated tooth decay nearly twice as much as white, non-Hispanics. Tooth Decay and Education. Adults aged 35-44 years with less than a high school education experience untreated tooth decay nearly three times that of adults with at least some college education.In addition, adults aged 35-44 years with less than a high school education experience destructive periodontal (gum) disease nearly three times that of adults with a least some college education. Adults and Oral Cancer. The 5-year survival rate is lower for oral pharyngeal (throat) cancers among black men than whites (36% versus 61%). Adults and Periodontitis. 47.2% of U.S. adults have some form of periodontal disease. In adults aged 65 and older, 70.1% have periodontal disease.Periodontal Disease is higher in men than women, and greatest among Mexican Americans and Non-Hispanic blacks, and those with less than a high school education

When identifying cancer health disparities, what part does socioeconomic status play when it comes to medically underserved populations?

People with lower SES have higher cancer death rates regardless of race. Also associated with their risk of developing or surviving cancer even more than race. SES factors include education, occupation, insurance, living conditions, exposure to toxins. It also influences behavioral risks (smoking, inactivity, obesity, drugs, health, not getting screened). Also less likely to be diagnosed early.

What regions of the country experience higher levels of rural health disparities?

The South: leads in mortality rates; lower life expectancy; highest rates of potentially excess deaths related to heart disease, cancer, chronic lower respiratory disease, and stroke Appalachia: overlap with the south The Delta region: lowest life expectancy anywhere in the country US/Mexico border: prevailing problems include obesity, heart disease, diabetes, unintentional injuries, TB, and asthma; highest rates of diabetes in the US Tribal communities: higher mortality rates

When it comes to analyzing the causes of rural health care disparities, how does the healthcare workforce impact rural residents' access to healthcare?

There are higher rates of uninsured individuals residing in rural areas Healthcare workforce shortages are extremely prevalent throughout rural America Specialties and subspecialties healthcare services are less likely to be available in rural areas and are less likely to include specialized and highly sophisticated or high-intensity care Reliable transportation is also an issue due to long distances, poor road conditions, and limited available of public transportation options Poor health literacy Social stigma and privacy issues

What are the benefits of addressing health concerns and reducing disparities among the LGBT community? 4. What are the efforts to improve LGBT health?

What are the benefits of addressing health concerns and reducing disparities among the LGBT community? Reductions in disease transmission and progression Increased mental and physical well-being Reduced health care costs Increased longevity 4. What are the efforts to improve LGBT health? Collecting sexual orientation and gender identity (SOGI) data in health-related surveys and health records in order to identify LGBT health disparities Appropriately inquiring about and being supportive of a patient's sexual orientation and gender identity to enhance the patient-provider interaction and regular use of care Providing medical students with training to increase provision of culturally competent care Implementing anti bullying policies in schools Providing supportive social services to reduce suicide and homelessness among youth Curbing human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) with interventions that work

What attributes contribute to an individual's ability to achieve good health? 2. What is the difference in goals of Healthy People 2020 and Healthy People 2010?

What attributes contribute to an individual's ability to achieve good health? Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual's ability to achieve good health. It is important to recognize the impact that social determinants have on health outcomes of specific populations. 2. What is the difference in goals of Healthy People 2020 and Healthy People 2010? In Healthy People 2010, it was to eliminate, not just reduce, health disparities. In Healthy People 2020, that goal was expanded even further: to achieve health equity, eliminate disparities, and improve the health of all groups.

What environments contribute to healthy LGBT individuals? 8. What are the LGBT health disparities that require specific attention from health care and public health professionals?

What environments contribute to healthy LGBT individuals? Safe schools, neighborhoods, and housing Access to recreational facilities and activities Availability of safe meeting places Access to health services 8. What are the LGBT health disparities that require specific attention from health care and public health professionals? LGBT youth are 2 to 3 times more likely to attempt suicide. LGBT youth are more likely to be homeless. Lesbians are less likely to get preventive services for cancer. Gay men are at higher risk of HIV and other STDs, especially among communities of color. Lesbians and bisexual females are more likely to be overweight or obese. Transgender individuals have a high prevalence of HIV/STDs, victimization, mental health issues, and suicide and are less likely to have health insurance than heterosexual or LGB individuals. Elderly LGBT individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers. LGBT populations have the highest rates of tobacco, alcohol, and other drug use

What is the definition of neglected diseases? 2. Where are neglected diseases most prevalent? Why? 3. Provide the reasons why we call them neglected. 4. How many people are affected? Where?

What is the definition of neglected diseases? Conditions that inflict severe health burdens on the world's poorest people and are often over looked by drug developers or by others instrumental in drug access. 2. Where are neglected diseases most prevalent? Why? Tropical climates, especially in areas with unsafe drinking water, poor sanitation, substandard housing and little or no access to health care. 3. Provide the reasons why we call them neglected. If they are overlooked by drug developers or others instrumental in drug access, such as government officals, public health programs and the news media. Another reason is because they usually do not affect people who live in the US and other developed nations. They also lack visibility because they don't cause dramatic outbreaks that kill large number of people. 4. How many people are affected? Where? More than 1 billion people (1/6th of the population) suffer from one or more of the neglected disease. The diseases are most heavily concentrated in low-income nations in Africa and Latin America.

Why has alcohol abuse an ongoing problem among the LGBT population? 6. Provide examples of the social determinants that affect the health of LGBT individuals that relate to oppression and discrimination.

Why has alcohol abuse an ongoing problem among the LGBT population? because bars and clubs were often the only safe places where LGBT individuals could gather, alcohol abuse has been an ongoing problem 6. Provide examples of the social determinants that affect the health of LGBT individuals that relate to oppression and discrimination. Legal discrimination in access to health insurance, employment, housing, marriage, adoption, and retirement benefits Lack of laws protecting against bullying in schools Lack of social programs targeted to and/or appropriate for LGBT youth, adults, and elders Shortage of healthcare providers who are knowledgeable and culturally competent in LGBT health

Why is it difficult to estimate the number of LGBT individuals and their health needs? 2. What links to health disparities does research suggest for LGBT individuals?

Why is it difficult to estimate the number of LGBT individuals and their health needs? Sexual orientation and gender identity questions are not asked on most national or State surveys, making it difficult to estimate the number of LGBT individuals and their health needs. 2. What links to health disparities does research suggest for LGBT individuals? societal stigma, discrimination, and denial of their civil and human rights. Discrimination against LGBT persons has been associated with high rates of psychiatric disorders, substance abuse, and suicide. Experiences of violence and victimization are frequent for LGBT individuals, and have long-lasting effects on the individual and the community. Personal, family, and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBT individuals

what does the scope of health disparities entail?

acceptable, unavoidable, unacceptable health disparities acceptable, unavoidable, unacceptable (ie unavoidable- age; avoidable- health outcomes due to unsafe living conditions)

what is the gov't doing to help health disparities?

collecting data (poverty, graduation rates), supporting research, addressing heart disease, stroke, etc that primarily effect African americans, promoting healthy food environments, physical activity

________ _______= the ability to understand, communicate with and effectively interact with people across cultures; encompasses being aware of one's own world view. developing positive attitudes towards cultural differences. gaining knowledge of different cultural practices and world views ______ ______= when people of different cultures are unable to understand each other's customs, resulting in inconveniences and difficulties ______= widely held but fixed and oversimplified image or idea of a particular type of person or thing ______= preconceived opinion that is not based on reason or actual experience _____ _____= unconscious attribution of particular qualities to a member of a certain social group (ie based on race, gender, etc) _______ _______= are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

cultural competence cultural barriers stereotype prejudice implicit biases social determinants

what is the definition of health disparities?

diff in incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific populations in US Racial or ethnic diff. in the quality of healthcare that arent due to access related factors or clinical needs, preferences and appropriateness of intervention

what are interrelated concepts of health disparities?

health care quality, communication, culture, health promotion, health policy, healthcare law

attributes and criteria for health disparities?

if diff are observed in environment, access to utilization of and quality of care, health status or a particular healthcare outcome, then its a health disparity: 1. natural or biological variation, 2. health damaging behavior that is freely chosen 3. transient health advantage of one 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 ppl to move down social skill

key elements of cultural competence for individual interactions and organizations?

personal interactions: explore, respect pt beliefs, values, needs, etc build trust and rapport find common ground awareness of one's own biases knowledgeable about diff cultures awareness of health disparities and discrimination affecting minority groups use interpreters if needed organizations: diverse workforce healthcare facilities convenient and attentive to communities language assistance available ongoing staff training on cultural things

what did the leadership competencies to reduce health disparities article state?

reduction in health disparities starts in a diverse classroom Core leadership competencies described by the NCHL: identify/manage impact of life experiences, expand worldview that embraces key diversity dimensions, accept and manage one owns biases, self monitor and adjust ones communication style, utilize cognitive reframing to change ones behavior to boost nurse leader diversity competencies: encourage community/patient involvement, minority have inc communication with providers that look like them, poor communication= health disparities, commitment to diversity, keep an open mind dec in health disparities and inc in diversity starts with nursing education and nurse leaership

COMPARE AND CONTRAST the theoretical links with health disparities... socio-ecological model? structural-constructivist model? cultural competence model?

socio-ecological model- explains relations bw various personal and environmental factors- interacts with context of person's life and provides diverse options and sources of growth structural-constructivist model- based on assumption of dual nature of human existence; socially shared understandings within a society cultural competence model-aims to bridge gap between white middle class views on healthcare and other views (mainly immigrants) on healthcare

what are community org. doing to help with disparities?

train health workers in undeserved locations to link ppl to free or low cost services, effective promotion programs, connect ppl with services (housing, transporation), help ppl go see the doc, follow up appts, etc.

what are some clinical exemplars of health disparities?

unequal receipt of early and inadequate prenatal care unequal receipt of recommended immunizations unequal pain mgmt unequal breast cancer screening unequal palliative care

what are public health officials doing to help health disparities?

use programs to dec barriers and create opportunities for health, work with org. (faith, education, housing, etc) to promote health during childhood, link more medical professionals to health centers, develop cultural diff trainings for healthcare professionals

what are healthcare providers doing to help with disparities?

work to eliminate cultural barriers, connect ppl with resources in community (ie scripts, follow up, etc), learn about economic conditions that may put certain ppl at higher risk for conditions, collab with PCP to come up with care plan for pt, promote trust with pt by encouraging asking Q's