Community Health exam 1 (KINS 3303-GCSU-Dr. K)
Myths of aging
"After age 65, life goes steadily downhill." "Old people are all alike." "Old people are lonely and ignored by their families." "Old people are senile." (prone to disease) "Old people no longer have any sexual interest or ability." "Most old people are sickly."
What is cultural competency?
"To be culturally competent doesn't mean you are an authority in the values and beliefs of every culture. What it means is that you hold a deep respect for cultural differences and are eager to learn, and willing to accept, that there are many ways of viewing the world."
community health needs assessment
"refers to a state, tribal, local, or territorial health assessment that identifies key health needs and issues through systematic, comprehensive data collection and analysis."
size and growth
- 2013: 14% of Americans (1 in 7) were 65+ - By 2040: almost 20%; 1 in 5 will be 65+ People 85+ will triple to 15 million
5 major requirements
1. Define the community (scope) - Identify gatekeepers 2. Collect secondary data on community health 3. Gather community input and primary data 4. Prioritize community needs 5. Implement strategies to address needs
20th century
1900: life expectancy less than 50 years Leading causes of death were communicable diseases Vitamin deficiencies and poor dental health common in slums
introduction
2018: 8th year since passage of Patient Protection & Affordable Care Act (ACA) Non-profit hospitals classified by IRS as 501(c)(3) must show community benefit as condition of tax exempt status ACA requires non-profit hospitals to: Conduct a CHNA & Adopt implementation strategies Every 3 years (began in 2012)
Alzheimer's disease (AD)
5 million in U.S. today, will be 16 million by 2050 Brain disorder Early, middle, late stages Meds exist to treat mild-moderate symptoms Ongoing research! No cure Progressive, Eventually fatal Age is primary risk factor More Females than Males are affected (F live longer)
vision
95% will have cataracts or other _______ loss Task lighting, night lights, keep glasses clean
Why complete a CHNAP
A community health assessment gives organizations comprehensive information about the community's current health status, needs, and issues. This information can help develop a community health improvement plan by justifying how and where resources should be allocated to best meet community needs.
community
A group of people who have common characteristics Can be defined by location, race, ethnicity, age, occupation, interest in particular problems or outcomes, or common bonds
race
A human population considered distinct based on physical characteristics. _____ is predominantly a social construct. Only 2% of our genes are ultimately responsible for the visible differences, such as skin color.
community organizing
A process through which communities are helped to identify common problems or goals, mobilize resources, and in other ways develop and implement strategies for reaching the goals they have collectively set Is not a science, but an art of consensus building within a democratic process
21st century
Achievement of good health is worldwide goal of the
community/public health activities
Activities aimed at protecting or improving the health of a population or community Maintaining birth and death records, protecting food and water supply, etc.
Implementation Strategies
Address each significant health need identified Explain if hospital plans to address needs Interventions may target: Social Behavioral and/or Environmental factors
History of Community and Public Health
Almost as long as the history of civilization Knowledge of the past helps us better prepare for future community health challenges
Arriving at a Solution and Selecting Intervention Strategies
Alternate solutions exist for every problem Probable outcomes Acceptability to the community Probable long- and short-term effects Costs of resources
mapping community capacity
An approach to community assessment that focuses on identifying community assets, capacities and abilities, not concerns or problems. Even in the poorest neighborhoods, individuals & organizations represent resources upon which to rebuild. There are three building blocks to Community Mapping.
secondary building block for community mapping
Assets located in the neighborhood but largely controlled by people outside e.g. Social service agencies; schools, hospitals, & housing structures
cross cultural communication skills
Being nonjudgmental Understanding stereotypes Treating people as individuals Looking at whether expectations are real Accepting ambiguity Empathizing Checking assumptions Being open to differences
social and cultural factors
Beliefs, traditions, and prejudices Economy Politics Religion Social norms Socioeconomic status
health
Can mean different things to different people A dynamic state or condition of the human organism that is multidimensional in nature, a resource for living, and results from a person's interactions with and adaptations to his or her environment
more racial and ethnic diversity
Caregiver shortages (Consider this as a profession!) In 2013, >half of adults age 80+ had a severe disability 30% needed help with ADLS
18th century
Characterized by industrial growth Cities overcrowded, water supplies inadequate and unsanitary, problems with trash, workplaces unsafe 1796: Dr. Jenner demonstrated process of vaccination against smallpox First census taken: 1790
secondary data
Collection, aggregation done for you Standardized data comparable across sites (always use rates not numbers (e.g. 50 cases of _____ per 1,000 population) Be careful in reading, reporting of data Many online sources gives ease of access County level data common
World Community and Public Health In the Twenty-First Century
Communicable diseases Poor sanitation and unsafe drinking water Hunger Migration and health
individual actions
Community health requires __________ __________ to improve personal health and organized community actions
problematic changes
Consistent poor judgement Loss of ability to manage money Inability to keep track of date/season Difficulty planning or solving problems Misplacing things and can't retrace steps to find Not knowing purpose of common objects (i.e. keys) Difficulty having a conversation
Determining the Priorities and Setting Goals for Implementation
Criteria to consider when selecting priority issue Problem must be winnable Must be simple and specific Must unite members of organizing group Should affect many people Should be part of larger plan Goals written to serve as guide for problem solving
cultural awareness
Defined as the process of conducting a self-examination of one's own biases towards other cultures and the in-depth exploration of one's cultural and professional background. Involves being aware of the existence of documented racism and other "isms" in healthcare delivery.
socialization
Depression - Home Bound & Nursing Home Weekly Visits "Adopt a Grandparent" RSO Pet Therapy - Dogs On campus RSO: Cupid's Club Gardening Projects Improving Cognition/Memory -Cards; Board games Conversation
hearing
Diminished Leads to social isolation, _________ aids help
nutrition
Encouraging to eat and drink Eat with them (your own snack) Nursing Home Home Dweller Nutritional Assessment* Meals on Wheels Grant Funds
2nd half of the 19th century
Epidemic problems in major cities London cholera epidemics and Dr. John Snow Many scientific discoveries 1850: Shattuck report 1850: Modern era of public health begins
Period of Social Engineering (1960 - 1973)
Federal government became active in health matters 1965: Medicare and Medicaid established Improved standards in health facilities Influx of federal dollars accelerated rate of increase in cost of health care
physical factors
Geography Environment Community size Industrial development
Health Resources Development Period (1900-1960)
Growth of healthcare facilities and providers Reform phase (1900-1920) 1920s Great Depression and WWII Postwar years
WHO definition of health
Health is a State of complete physical, mental, and social well being, and not merely the absence of disease or infirmity
Period of Health Promotion (1974 - Present)
Identification that premature death traceable to lifestyle and health behaviors Healthy People publication established Healthy People 2020 MAP-IT National Prevention Strategy
Benefits of a community assessment plan
Improved organizational and community coordination and collaboration Increased knowledge about public health and the interconnectedness of activities Strengthened partnerships within state and local public health systems Identified strengths and weaknesses to address in quality improvement efforts Baselines on performance to use in preparing for accreditation Benchmarks for public health practice improvements
instrumental needs of elders
Income Housing Transportation Personal Care Health Care Increasing desire to "age in place"
the impact of personal culture on communication
Incorrect assumption about the other Language and communication style issues Biases against the unfamiliar Personal values in conflict Expectations that others will conform to established norms
personal health activities
Individual actions and decision making that affect the health of an individual or his or her immediate family members or friends
aging
Life expectancy at birth in U.S.: 78 Female: 81.2; Male 78.8 Life expectancy at age 65: 84 A complex process associated with an: - exponential increase in mortality with age - physiological changes typically lead to functional decline - increased susceptibility to certain diseases
dementias
Loss of cognitive function serious enough to interfere with daily functioning Reversible causes (infections, medications, nutritional, etc.) Irreversible causes Alzheimer's Disease most common cause 70% of dementias are Alzheimer's Disease
earliest civilization
Many community health practices went unrecorded Practices may have involved taboos, rites, and spiritual beliefs Archeological evidence of community health activities dating back to 2000 B.C.E.
Early diagnosis allows for
Maximum benefit from available treatment Time to plan for the future Legal, financial, medical care, etc. Caregivers face major stressors!
community facilities and services
Meal services (meals-on-wheels) In-home services Adult day care, Senior centers Retirement Communities - Housing adaptations, Continuum of care Long term care: Home health care, Assisted Living, Nursing Homes
community is characterized by
Membership, common symbol systems, shared values and norms, mutual influence, shared needs and commitment to meeting them, shared emotional connection
Normal age-related changes
Missing an occasional monthly payment Forgetting what day it is and remembering later Losing items on occasion Forgetting which word to use on occasion
cultural desire
Motivation of the researcher/healthcare professional to "want to" engage in the process of becoming culturally aware, culturally knowledgeable, culturally skillful and seeking cultural encounters; not the "have to."
100
Much progress made over last ____ years in health and life expectancy Still room for improvement, however
assessing the community
Needs assessment vs. mapping community capacity Mapping Community Assets Primary building blocks Secondary building blocks Potential building blocks
health profile of elders
Neglect and Abuse Concerns Diet & physical activity remain very important! Mortality Morbidity Chronic conditions Impairments 4/5 live with chronic conditions More MD visits, more often, longer hospital stays, more expensive
10 absolutes for Alz. Caregiver
Never argue, instead agree. Never reason, instead divert. Never shame, instead distract. Never say "you can't," instead say "do what you can." Never command or demand, instead ask or model. Never condescend, instead encourage and praise. Never say "remember," instead reminisce. Never say "I told you," instead repeat. Never lecture, instead reassure. Never force, instead reinforce.
Alzheimer's Association
Non-profit, multiple programs, services Fundraising, advocacy, support for families, education 24 hour helpline 1-800-272-3900 www.Alz.org/georgia Mott Smith [email protected] (Macon office)
select sources of secondary data
OASIS (Online Analytical Statistical Information System) GA Dept. of Public Health County Health Rankings (Robert Wood Johnson Foundation Annie E. Casey: Kids Count Data U.S. Census Bureau American Fact Finder State and County Quick Facts
cultural encounters
Occurs when a researcher/health care professional directly engages in face-to-face cultural interactions and other types of encounters with clients from culturally diverse backgrounds in order to modify existing beliefs about a cultural group and to prevent possible stereotyping
cultural bump
Occurs when someone expects a particular behavior but gets something different when interacting with persons from another culture REDEFINING IT Make the "connection" Open the door __________ ______ Cultural congruence
primary data collection methods
Open ended questions are invaluable. Qualitative research is very useful tool Ethnographic approaches In-depth interviews Case studies Focus groups Epi with a twist Place, time, person as geography and environment of the community, history and demographic profile of community
student qualitites
Patience Listening Ability Genuine Concern and Caring Encouraging Self Care—don't "take over to rapidly" Greeting Cards - special days; pictures
ageism
Prejudice and discrimination on the basis of a person's age.
types of data
Primary Data Secondary Data
21st century Global Health Achievements
Reductions in child mortality Vaccine-preventable deaths Access to safe water and sanitation Malaria prevention and control Prevention and control of HIV/AIDS Tuberculosis control Control of neglected tropical diseases Tobacco control Global road safety Improved preparedness and response
potential building block or community mapping
Resources originating outside the neighborhood and controlled by people outside - e.g. welfare expenditures, and public information
potential outcomes
Strategic plan to assess & address needs Creates new partnerships; strengthens existing ones Builds public awareness Advocates for programs Obtain funding Implement action plan Track Progress Keep tax exempt status/avoid IRS fine!
primary data
Surveys Focus groups Neighborhood, age-group, and/or service recipient specific data Residents' perceptions of their community Residents' priorities for their community
individual behavior
Takes the concerted effort of many individuals to make a program work
cultural competency
The ability of an individual to understand and respect values, attitudes, beliefs, and mores that differ across cultures, and to consider and respond appropriately to These differences in planning, implementing, and evaluating health education and promotion programs and interventions.
Primary building block for community mapping
The most accessible assets and capacities. They are located in the neighborhood and are controlled by those who live in the neighborhood. They include assets and capacities of individuals such as variety & richness of skills, talents, knowledge, experience & income of folks in a neighborhood. Assets and capacities of local organizations or associations such as faith-based and citizen organizations.
cultural knowledge
The process in which the researcher/healthcare professional seeks and obtains a sound educational base about culturally diverse groups. In acquiring this knowledge, researcher/healthcare professionals must focus on the integration of three specific issues: health-related beliefs practices and cultural values; disease incidence and prevalence (Lavizzo-Mourey, 1996).
herd immunity
The resistance of a population to the spread of an infectious agent based on the immunity of a high proportion of individuals
functioning effectively
The state of being capable of ____________ ____________ in the context of cultural differences. We are in different roles 24/7. Each of us have multiple roles and there are expectations on parameters of behavior. In every role that we have, we are in partnership with someone. In roles that we are successful, it is because we are culturally competent. In roles that fail, there are cultural bumps that have not been overcome!
physical social cultural
There are many types of factors that affect the health of a community. These are ___________, ___________, and ___________
21st century
U.S. Community/Public Health in Early 2000s Health care delivery Environmental problems Lifestyle diseases Communicable diseases Alcohol and other drug abuse Health disparities Disasters Public health preparedness
20th Century Achievements in Public Health
Vaccination Motor vehicle safety Control of infectious diseases Decline of deaths from CHD and stroke Healthier mothers and babies Safer and healthier foods Safer workplaces Family planning Fluoridation of drinking water Recognition of tobacco use as a health hazard
safety
Wheelchairs and other assistive devices-nursing home and home dwellers Rugs, Rails, Rubbish - home dwellers Special Equipment Use; educate; resources Fall prevention Lighting Smoke alarms
Impact of Biases and Stereotypes on the individual receiving service.
Why is cultural competency necessary in health care?
muscles
___________ weaken and atrophy Use them!
ethnicity
a term which represents social groups with a shared history, sense of identity, geography and cultural roots which may occur despite racial difference.
thirst
ability to detect _______ diminishes with age; dehydration greater risk; drink small amounts throughout the day
public health
actions that society takes collectively to ensure that the conditions in which people can be healthy can occur; most inclusive term
aging characterized by
changes in appearance (gradual reduction in height: weight loss due to loss of muscle & bone mass) slower reaction time declines in memory functions decline in audition, olfaction, vision declines in kidney, pulmonary, & immune function declines in exercise performance multiple endocrine changes
memory
cognitive activities help, music, word games,
skin
easily torn, less sensitive to pain Inspect
daily living tasks (ADLs)
eating, bathing, & dressing
population health
health outcomes of a group of individuals, including the distribution of such outcomes within the group
community health
health status of a defined group of people and the actions and conditions to promote, protect, and preserve their health
instrumental tasks
housekeeping, transportation, & errands
stability/mobility
impaired Modifications in home, grab bars, rails; remove trip hazards (no throw rugs); work on balance and strengthening muscles
smell
impaired ability Risk for not detecting noxious smells (gas leaks) Taste greatly impacted, may not eat because food tastes bland
individual culture
is multifaceted and encompasses - Personality, unique style Internal factors - gender, race, age, sexual orientation External influences - society, experiences Where individuals grow up or live now, religious affiliation Organizational influences - seniority, level within organization, work location
geriatrics
medical practice specializing in treatment and care of the aged
Diversity encompasses issues related to
race color class age experience ability gender ethnicity geography education language religion politics sexual orientation gender identity health status socio-economic status resident status
taste
salt receptors decreased most, may over-salt food or seek mainly sweets; May cause nutritional deficits, social isolation: encourage to eat, eat with them; try colorful foods
cognitive tasks
scheduling, reminding, & monitoring
expressive tasks
socializing & emotional support
gerontology
study of aging (social, cultural, psychological, cognitive, & biological)
Culture
the system of shared beliefs, values, customs, behaviors, and artifacts that the members of society use to cope with their world and with one another, and that are transmitted from generation to generation through learning.
