NURS 434-001: public / community lecture- unit 3

Janis Barner

epigenetics

“The study of how changes in organisms through modification of gene expressions are occurring through not only human behaviors but also the environment.”

the study of how environmental and behavioral factors modify gene expression without changing DNA itself—shows that environmental conditions linked to SDOH can influence health outcomes. Because these epigenetic changes are reversible, improving social and environmental conditions can positively affect health, reinforcing the importance of health justice and equitable public health interventions.

genomics

“The study of DNA sequencing to analyze the function and structure of complete sets of DNA in a cell of an organism.”

the study of all genes and their interactions, unlike genetics, which focuses on individual genes. Understanding genomics helps explain why some individuals and communities are more susceptible to certain diseases and highlights the need to address social determinants of health (SDOH) as part of improving public health outcomes.

 Underresourced populations  

Health inequities often arise because public and private healthcare systems distribute resources inequitably due to factors such as lack of access, discrimination, and systemic bias. Underresourced populations are those more likely to face health problems because of limited economic means, social marginalization, or institutional prejudice. These groups may include people with chronic illnesses (e.g., depression, HIV/AIDS), racial and ethnic minorities, immigrants, older adults, and others who face barriers to care.

Groups such as rural residents, prison inmates, LGBTQIA+ individuals, and veterans are especially at risk for adverse health outcomes linked to social determinants of health (SDOH).

rural populations

Rural areas tend to have aging populations due to youth migration and fewer economic opportunities. Although some younger families and retirees are returning for affordability and space, many rural residents face low education levels, limited employment, and persistent poverty, which heighten vulnerability—especially for women and children.

The Rural Healthy People 2030 initiative identifies top rural health priorities, with access to care as the leading concern, followed by issues such as nutrition, diabetes, mental health, substance use, and heart disease. Innovative solutions like the Veterans Affairs Geriatric Scholar Program (GSP) train interprofessional teams—including nurses—to provide geriatric care in rural clinics.

elderly people are at risk bc they tend to stay in rural areas.

migrant and seasonal farmworkers also experience rural health inequities due to poor sanitation, language barriers, and low health literacy

correctional health

Common health concerns include mental illness, substance use, HIV/AIDS, STIs, hepatitis C, and tuberculosis. Overcrowding, despair, and underfunded healthcare worsen outcomes. Nurses in these settings may face ethical conflicts with wardens and institutional policies, especially regarding standards of care or participation in capital punishment.

Women prisoners, though a minority, have unique and often neglected health needs. They experience higher rates of mental illness, substance dependence, reproductive health issues, and past trauma or abuse. Lack of gender-sensitive policies leads to human rights violations and inadequate care, especially for women who are mothers and primary caregivers.

Correctional healthcare quality suffers from staff shortages, poor working conditions, and limited funding. Some states contract with private managed care organizations to fill gaps, though this raises ethical and quality concerns. Public health and community nurses can play a critical role in improving mental health, disease prevention, and rehabilitation, ultimately benefiting both inmates and the broader community.

After release, former inmates face social and economic hardships—difficulty finding housing, employment, and support systems—which increases the risk of recidivism.

LGBTQIA+ healthcare

Key health issues affecting LGBTQIA+ populations include STIs, HIV, substance use, depression, suicide, interpersonal violence, and barriers to preventive care.

Programs such as Transgender Awareness Training and Advocacy (TATA) help raise awareness and promote evidence-based, inclusive practices.

Ultimately, culturally competent and respectful communication helps reduce stigma, promote trust, and improve health outcomes for LGBTQIA+ individuals

veterans health

Men and women face PTSD, SUD, depression, homelessness.

Women veterans face distinct challenges, including higher rates of maternal/child health issues, sexual trauma, and suicide (twice the rate of male veterans). Military sexual trauma has lasting negative effects on both personal and family well-being.

To improve care, all healthcare providers routinely ask patients if they have served in the military. This simple screening question can identify potential health risks and guide appropriate, culturally sensitive, veteran-centered care.