Analyze the health status of a specific minority group. Select a minority group that is represented in the United States (examples include: American Indian/Alaskan Native, Asian American, Black or African American, Hispanic or Latino, Native Hawaiian, or Pacific Islander.)

In an essay of 750-1,000 words, compare and contrast the health status of the minority group you have selected to the national average. Consider the cultural, socioeconomic, and sociopolitical barriers to health. How do race, ethnicity, socioeconomic status, and education influence health for the minority group you have selected? Address the following in your essay:

1. What is the current health status of this minority group?
2. How is health promotion defined by the group?
3. What health disparities exist for this group?

Describe at least one approach using the three levels of health promotion prevention (primary, secondary, and tertiary) that is likely to be the most effective given the unique needs of the minority group you have selected. Provide an explanation of why it might be the most effective choice. Cite a minimum of three references in the paper.

Health Promotion among Diverse Populations

According to the 2010 U.S. census report, approximately 36 percent of the population belong to a racial or ethnic minority, of which 17 percent is represented by the Hispanic community. (“Minority Health,” 2014, p. 1). The author of this paper has chosen to compare and contrast the health status of the Hispanic community to the national average in the United States.

In order to promote health and wellness, it is first of all necessary to assess the overall health, morbidity and mortality rates of the Hispanic population. This ethnic group is comprised of several different nationalities including, but not limited to, the well-established populations of Mexicans, Puerto Ricans, and Cubans as well as the relatively newer groups of Dominicans, Salvadorians, Guatemalans and Columbians. There are many variations in health status among these groups, but all have a common denominator when it comes to mortality.

The leading causes of death among the Hispanic community includes, cancer, diabetes, cardiovascular disease, chronic liver disease and cirrhosis, chronic lower respiratory disease, stroke, unintentional injuries, kidney disease, influenza and pneumonia. (“Minority Health,” 2014, p. 2). Among all of these debilitating disorders, Diabetes is the most prevalent condition in the Hispanic population. Compared with non-Hispanic whites, Hispanics have a higher rate of type 2 diabetes. Using the data from the Hispanic Health and Nutrition Examination Survey, it was found that 27.7 percent of Hispanics had diabetes compared to 13.6 percent of non-Hispanic whites. (Mitchell, 2006, Chapter 9). Cancer is the leading cause of death in all racial and ethnic groups. While Hispanics have a higher rate of certain cancers, including cervical and stomach cancer, they experience an overall lower cancer incidence that non-Hispanic whites in breast, lung, prostate, colon and rectal cancer. (Mitchell, 2006, Chapter 9).

For Hispanics in the United States unfortunately there are many health disparities leading to the prevention of obtaining proper healthcare. These include socioeconomic status, educational level, language barriers and cultural beliefs. Many Hispanic families have a documented income which is less than the federal poverty level. It is also reported that approximately 29 percent of this group do not have health insurance. This alone is a deterrent to seek out medical attention when needed. Families with such insufficient income feel that the risk of becoming homeless, by not paying for rent, is more of an imminent threat than seeking out preventative medical care. Ironically when medical issues are ignored, the eventual cost becomes much higher. Another disparity associated with the inability to obtain essential healthcare is the level of education and language barrier. Many Hispanic individuals do not have the means to complete a proper formal education which in turn leads to non-comprehension of the English language. It is quite common for individuals to fear doctor visits due to the inability to communicate effectively. Many have experienced negative situations whereby they were not completely understood, thus feeling follow up visits would be un-necessary, a waste of time, and money. Culturally, Hispanics believe strongly in the family unit and religion. Parents often put their children first when it comes to healthcare, which is very important, but in the process, inadvertently neglect their own health.

The most effective approach in the promotion of health in the Hispanic population is education at the primary level and the effective delivery of necessary information in the secondary and tertiary levels.

Primary prevention

Prevention is key to maintaining a healthy life, but for those who do not comprehend the consequences of unhealthy lifestyles, education is vital. In the Hispanic culture people feel safe and protected utilizing the resources within their own community, relying on family and support groups, such as Hispanic community services, local churches and clinics. Many Hispanic people utilize the emergency room as their “primary care,” which turns out to be very costly; not knowing that there are alternative options available. There are many low cost clinics with Spanish speaking employees that are available to this population, assisting with their medical needs. It is imperative for health care workers to inform the Hispanic population of the resources available to them. Health screenings, genetic screenings, and immunizations are an integral part of primary prevention.

Secondary prevention

Once disease has been diagnosed, secondary prevention comes into effect. This is the prevention of the spread of disease or prevention of further complications. Secondary prevention encompasses early diagnosis, treatment and shortening the period of disability. In the case of HIV infection, secondary prevention promotes the interruption of the spread of the disease and the inhibition of complications.

Tertiary prevention

This mode of prevention encompasses the restoration and rehabilitation of individuals who have experienced disease progression. It focuses on maximizing the individual’s remaining capabilities to regain an optimal level of functioning, regardless of the initial debilitating condition. (Edelman, Kudzma, & Mandle, 2014, p. 11)

This may be regarded as the final step in assistance, but is essential in order to provide quality care to every individual, regardless of race, ethnicity, educational or cultural background. In the end, everyone needs to be treated with dignity and respect.

Health Promotion in Hispanics

Health Promotion Among Diverse Populations

The United States is a melting pot of ethnicity, in which, the healthcare system and its benefits vary widely. Those who are able to obtain primary care insurance via a full time employer, typically have the benefits of full coverage care. However, for many minority groups, full time work alone is hard to acquire, along with the health benefits full time employment provides. Culturally competent care among the diverse populations helps increase health promotion and gain a cultural perspective. One of these mentioned groups is the Hispanic population which is steadily increasing within the United States.

As of 2012, the percentage of Hispanics without health insurance was 29.1 percent Center for Disease Control and Prevention [CDC] (2014). While heart disease and cancer both hold the top spots as the two leading causes of death amongst whites and Hispanics, they are transposed for each racial group, with cancer being the leading cause for the Hispanic population. Many Hispanic families who either migrated to the United States originally, or whose parents migrated here, have often only achieved lower levels of education as compared to other ethnicities. This is primarily due to most of their countries of origin being more economically depressed, causing the need to migrate to the United States where work is more plentiful. This necessity to work often supersedes the necessity for many families to focus on advanced education and also often causes them to often ignore otherwise potentially serious health problems. A higher percentage of Hispanics versus whites and non-Hispanics are employed in high risk occupations, which also likely contributes to the fact that unintentional injuries is the third highest cause of death amongst the Hispanic population.

Within the Hispanic culture, health promotion can be perceived in a variety of ways. It is very important as a healthcare provider to provide and recognize culturally competent care. An example of this would be to focus on the woman of the family. In the article Culturally Competent Nursing Care for Families: Listening to the Voices of Mexican-American Women, Eggenberger, S., Grassley, J., Restrepo, E. (2006) state, “Gaining a cultural perspective of health care in the Mexican-American population necessitates listening to the voices of women because they assume primary responsibility for maintaining family health” (p.1) Having an insight on the importance of matters such as religion, health beliefs, and attitudes can open up the idea of the individuals family on the promotion of health.

There are many health disparities that exist among the Hispanic population. Many of these are chronic conditions that affect the population. Obesity is one of the many examples of conditions that have increased for the Hispanic population. The CDC (2014) states, “The prevalence of obesity among female Mexican American adults during 2007–2010 was larger than the prevalence among female white, non-Hispanic adults during the same years” (p. 1). This is one of the many statistics that show an example of a health disparity in the Hispanic population. Another example of a problem that is prevalent in the Hispanic community is the health promotion and screening rates. The CDC (2014) states, “A smaller percentage of Hispanic adults aged 50-75 years reported being up-to-date with colorectal cancer screening in 2010 than their non-Hispanic adult counterparts” (p.1). Many different factors contribute to these statistics.

With many of the chronic health conditions the Hispanic population face, there can be different approaches to education and prevention for these conditions. One approach would be health promotion of different types of cancer, one being colorectal cancer. An example of primary prevention for the Hispanic population would be to do health camps or campaign fairs to educate on the benefits of lifestyle changes. This includes colorectal screening and high fiber diets. Education about lifestyle changes can help decrease the risk factors and reduce the incidence of colorectal cancer.

The next step of approaching this condition is secondary prevention. The Association of Faculties of Medicine of Canada [AFMC] (n.d) states, ‘Secondary prevention includes procedures that detect and treat pre-clinical pathological changes and thereby control disease progression” (para 5). Secondary prevention for colorectal cancer would be colonoscopy screenings. These screenings can play a huge part in detecting this cancer early.

The third step is tertiary prevention. Tertiary prevention is aimed to modify risk factors and reduce the impact of the disease. In the example of colorectal cancer, it would include access to health care and follow up exams. The AFMC (n.d.) states, “The key goal for tertiary prevention is to enhance quality of life” (para 6). With the examples above, it is apparent that approaches such as these would likely be most effective for the Hispanic population. With certain chronic conditions affecting the Hispanic population such as colorectal cancer, it would be the most effective choice to educate and use this approach to reach out to the Hispanic population.

With the variety of minority groups, the health statuses of each can vary. Gaining cultural knowledge can help increase the prevalence of health promotion. Due to the rapid growth of the Hispanic population in the United States, it is very important to gain knowledge on this minority group. Culturally competent care among the diverse populations helps increase health promotion by gaining a cultural perspective.

References

Center for Disease Control and Prevention. (2014). Hispanic or Latino Populations. Retrieved from http://www.cdc.gov/minorityhealth/populations/REMP/hispanic.html

Eggenberger, S., Grassley, J., Restrepo, E. (July 19, 2006). “Culturally Competent Nursing Care for Families: Listening to the Voices of Mexican-American Women”. OJIN: The Online Journal of Issues in Nursing. Vol. 11 No.3.

The Association of Faculties of Medicine of Canada. (n.d.). The stages of prevention. Retrieved from http://phprimer.afmc.ca/Part1-TheoryThinkingAboutHealth/Chapter4BasicConceptsInPreventionSurveillanceAndHealthProm

The Expanding Role of Nursing in Health Promotion

Nursing in the 21st century is being redefined. The population of the United States is increasingly diverse, with many cultural and religious influences on the health of the population. Legislative initiatives like the affordable health care act (AHC) will require a shift from the wellness-illness model to a practice focused on health promotion. When discussing a definition of health promotion published literature over the last 30 years has expanded and refined this role. One definition that is comprehensive is:

Health Promotion is the art and science of helping people discover the synergies between their core passions and optimal health, enhancing their motivation to strive for optimal health, and supporting them in changing their lifestyle to move toward a state of optimal health. Optimal health is a dynamic balance of physical, emotional, social, spiritual, and intellectual health. Lifestyle change can be facilitated through a combination of learning experiences that enhance awareness, increase motivation, and build skills and, most important, through the creation of opportunities that open access to environments that make positive health practices the easiest choice. (O’Donnell, 2009)

O’Donnell’s definition is broad and encompasses all of the areas of health promotion as it would be related to nursing practice.

Health promotion might be viewed more clearly and provide a more direct course of action if viewed with the following metaphor: You are standing on the edge of a river, a person floats by in obvious distress, you rush into the water, pull him to the shore. As you look downriver, you see another person in the same position. You rush in and again pull that person to the shore only to find a dozen more persons in distress floating downriver. Finally, having pulled the last person out of the water, you decide to look up stream to see why there are people in the water in the first place. You discover there is a large hole in the bridge spanning the river. You repair the hole, and there are no more people falling into the water (At Work, 2006). These are two examples of definitions of health promotion, providing a framework for the application of the concept.

Leavell and Clark (1965) provide a framework describe a three-tiered model of prevention and therefore promotion of health. The first component of the triad is primary prevention, emphasizing the nurse’s role as teacher and coach; the emphasis would be on promoting positive health behaviors in the community and globally. These behaviors would be immunizations, adequate food and water supplies, avoidance of high risk behaviors (unprotected sex, smoking, drug use,) adequate sanitation, and, preventative medical care, including routine gynecological and other health screenings.

Secondary prevention is described by interventions to cure and prevent the disease process, prevent complications and shorten any period of disability.

Tertiary prevention focuses on the rehabilitative process and its role in limiting the ongoing results of existing disease processes. This could include education to maximize remaining functional status, promotion of sheltered work environments to provide for continued community involvement and educating the community as to the abilities of these individuals.

The continuing evolution of nursing in the 21st century will by necessity shift from an acute care setting to a community-based setting. Community centers, home health agencies, housing developments, local and state health departments; neighborhood centers and parishes school health programs and worksites will be some of the venues in which nurses will practice primary health promotion (Kulbok, et al., 2012). The secondary level of health promotion is illustrated by the role of nursing prevention and treatment of hypertension on a global scale. High blood pressure affects between 600 and 800 million people worldwide, and the causes of over 7 million premature deaths. Evidence provided by Hong (2010) concluded that nursing interventions which stressed a decreased fat intake, limited sodium intake, and increased physical activity provided significant evidence of a positive effect on patients being treated for high blood pressure. This emphasis on education on the community level is an example of the evolving role of nursing.

Implementing health promotion and tertiary care setting will require nursing to become more adept at understanding life changes and set life choices patients and relatives unrealistic expectations could be unveiled and reoriented therefore speeding the adaption and return to community life (Portillo, Collie, 2010).

The reorientation of nursing practice to one of prevention from that of treatment will require nursing professionals to become more adept as both researchers and teachers in order to provide frameworks and programs that effectively change health promoting behaviors in the community at large.

References:

At Work, Issue 43, Winter 2006: Institute for Work & Health, Toronto http://www.iwh.on.ca/wrmb/primary-secondary-and-tertiary-prevention

Halpin, H., Morales-Suárez-Varela, M. M., & Martin-Moreno, J. M. (2010). Chronic Disease Prevention and the New Public Health. Public Health Reviews (2107-6952), 32(1), 120-154.

Kulbok, P. A., Thatcher, E., Park, E., & Meszaros, P. S. (2012). Evolving Public Health Nursing Roles: Focus on Community Participatory Health Promotion and Prevention. Online Journal Of Issues In Nursing, 17(2), 1. doi:10.3912/OJIN.Vol17No02Man01

O’Donnell, M. (2009). Definition of health promotion 2.0: embracing passion, enhancing motivation, recognizing dynamic balance, and creating opportunities. American Journal Of Health Promotion: AJHP, 24(1), iv. doi:10.4278/ajhp.24.1.iv

Portillo, M., & Cowley, S. (2011). Working the way up in neurological rehabilitation: the holistic approach of nursing care. Journal Of Clinical Nursing, 20(11/12), 1731-1743. doi:http://dx.doi.org.library.gcu.edu:2048/10.1111/j.1365-2702.2010.03379.x

Woi-Hyun S., H. (n.d). LITERATURE REVIEW: Evidence-based Nursing Practice for Health Promotion in Adults With Hypertension: A Literature Review. Asian Nursing Research, 4227-245. doi:10.1016/S1976-1317(11)60007-8