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N382:Disparities and Determinants

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by

Tami Bland

on 16 July 2014

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Transcript of N382:Disparities and Determinants

Finally
The most important and driving force in poverty is relationships.
Relationships are more important than anything.
To create change, we must create relationships.
Through our relationships, we help others write a future story.
Health Disparity
Health Disparities and Determinants of Health
"A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage." (Healthy People 2020)
Health Care Disparity
A difference in the quality of health care received
Socioeconomic Status (SES) is the major determinant of health.
Within each SES, racial/ethnic disparities exist
Barriers to Health Care Access
Prevent individuals and populations from getting health care
Generational Poverty
"The ability to leave poverty is more dependent upon other resources than it is financial resources." (p. 11)
Racial/Ethnic Groups
Religion
Socioeconomic
Status
Disability
Geographic
Location
Gender
Age
Mental
Health
Sexual
Orientation
Long-Term Effectors
of Health
Example:
AA and Hispanics receive less evidence based care for many diagnoses.
Cultural Differences (i.e. customs, language)
Literacy
Transportation
Fear
Knowledge Gap
Discrimination
Lack of insurance is the most significant barrier for minorities
Social
Economic
Physical
Social Determinants of Health
Housing
Food
Transportation
Safety
Environmental toxins (e.g. lead)
Childcare
Culture
Community resources
Social norms
Stress connected with poverty
Language/literacy
Education
Job opportunities
Health insurance
There is a strong correlation between health and income and children are the most vulnerable
7 fold increase in poor health for children
5 fold increase in poor health in adults
Income
Quality of Health
<Federal Poverty Level
>400% of Federal Poverty Level
WHY???
Increased income
More nutritious food
Safer neighborhoods
Increased activity
Impact on mood, mental health and sense of well-being.
Cortisol effects
Lower income women more likely to have low birth weight babies
decreased cognitive ability
increased behavioral problems
increased risk for chronic diseases
Generational
Poverty
Decreased income and socioeconomic status
Poorer outcomes including health status
Emotional, Mental, Spiritual, Physical, Support System, Relationships/Role Models, Knowledge of Hidden Rules, Coping Strategies
"Tyranny of
the moment"
Need to act
Overwhelms ability to learn
Prevents ability to see the future
Loss of Job
Loss of Home
You'll never have enough to get out of the hole so spend it before someone comes and borrows it.
Hidden Rule of Money
Poverty
$22,113 for family of 4
Poverty Index
Poor
Extremely Poor
Genetics
Culture
Job
Lifestyle
Behaviors
Chronic Stress Effects
Minority Health
Mortality
Morbidity Severity
Heavier Health Burden
Blacks
Whites
Nutritional Impact
Obesity
Nutritional Deficits
Cholesterol
Pregnancy
Food insecurity
Homelessness
Chronic Physical Disorders
•Alcoholism and other substance addictions
•Hypertension
•Gastrointestinal disorders
•Peripheral vascular disorders
•Dental problems
•Diabetes
•Human immunodeficiency virus infection/acquired immunodeficiency syndrome
•Neurological disorders
Problems Associated with Pregnancy
•Lack of prenatal care
•Inadequate nutrition
•Obstetric complications
(Maurer and Smith., 2013)
Acute Physical Disorders
•Upper respiratory tract conditions
•Trauma, including major and minor injuries
•Minor skin ailments
•Infestations (mites and lice)
•Nutritional deficiencies
•Tuberculosis

Health Problems in Children
•Anxiety
•Incomplete or no immunizations
•Speech and language problems
•Upper respiratory tract illnesses and asthma
•Minor skin ailments
•Ear infections
•Gastrointestinal disorders
•Trauma
•Eye disorders
•Lice infestations (Smith 537)
Health Impact
Mental Health Problems
•Schizophrenia
•Bipolar disorder
•Depression
•Panic disorder
•Borderline personality disorder
•Antisocial personality disorder
Nurse
Managed
Clinic
Low
Income
Housing
McKinney
Homeless
Assistance
Community
Health
Centers
Non-profit
&
Faith-based
Organizations
WIC
CHP
Section 8
Rental
Assistance
SSI
SNAP
TANF
Medicaid
Vulnerable
Population
Services
Nursing Role
Program referral
Application assistance
Case management
Culture sensitivity
Health screening
Awareness of all family members
Advocacy
Looking for community partners
Data collection and analysis
We all are vulnerable!!
Who's homeless?
C
u
l
t
u
r
e
"the learned and shared beliefs, values, and life ways of a group that are generally transmitted from one generation to the next and influence peoples' thoughts and actions" (Mauer&Smith, p. 268)
"Non-compliance" OR cultural behavior?
Race Vs. Ethnicity
Share common biological features
Share culture and a way of life
ASK THE CLIENT!!
Remember your transcultural nursing!
Time
Space
Communication
Role of Food
Sexuality
Health Beliefs
Cultural assessment tool in Table 10-4 on page 287.
History, traditions, communication
Community events
Incorporate culture into program design
Community input
Nurse cultural awareness on community level
Men
Women
Families
Teens
Tami Bland, DNP, CPNP
Start by doing what's necessary; then do what's possible; and suddenly you are doing the impossible.

Francis of Assisi
Full transcript