Topic 4: Ch 23 Health Equity & 24 Rural/Migrant Health

Robert Wood Johnson Foundation (Johnson and Johnson)

largest organization that focuses solely on health

health equity

everyone has a fair and just opportunity to be healthier which requires moving obstacles to health (poverty, discrimination, consequences, powerless, lack of access to good jobs with fair pay, quality education, housing, safe environments, and health care) and that everyone can attain the highest level of health

health inequities

barriers that prevent individuals and populations from attaining maximum health like poverty, access to care, transportation, job discrimination, and no insurance

populations

collections of individuals who have one or more personal or environmental characteristics in common

health determinants

includes a range of individual characteristics and behaviors, social and economic circumstances, and physical environmental factors that includes health status and outcomes such as mortality, morbidity, life expectancy, health care expenditures, health status, and functional limitations

modifiable health determinants

health determinants that result from actions and behaviors and can be changed

social health determinants

the conditions in which people are born, grow, live, work, and age that shape health like economic status, education, neighborhood, physical environment, nutrition, stress, employment, social support networks, prejudice, and access to healthcare

health disparities

differences that exist among specific population groups that prevent them from attaining their full potential and can exist across many dimensions like race, ethnicity, gender, sexual orientation, age, disability status, socioeconomic status, and geographic location

better health, less stress, increased confidence

what can higher income, education, and social status lead to

safe water, clean air, healthy workplaces, safe homes/communities/roads, good working conditions

what factors in a physical environment contribute to better health

vulnerability

susceptibility to actual or potential stressors that may lead to adverse effects that often results from interacting effects of many internal and external factors over which people have little or no control

vulnerable populations

groups with increased risk for adverse health outcomes that are more likely to develop health problems as a result of exposure to risk or to have worse outcomes from those health problems than the population as a whole, are more sensitive to risk factors because they are often exposed to cumulative risk factors, and increased incidence of unstable behavior, coping skills, beliefs, and lower education

ask why they are coming in for care and address their needs for THAT day because you may not see them again, so need to assess their immediate health

if a client comes for care who is vulnerable what should the nurse do

poverty

a primary cause of vulnerability and a growing problem in the US that can lead to low life expectancy

human capital

all of the strengths, knowledge, and skills that enable a person to live a productive, happy life; increases with higher levels of education

disenfranchisement

a feeling of separation from mainstream society in which the person does not seem to have an emotional connection with any group in particular or with the larger society; ie. poor, homeless, veterans, those released from prison, migrant workers are seen invisible to society as a whole and tend to be forgotten in health and social planning

• poor

• homeless

• pregnant adolescents

• immigrants

• severely mentally ill

• substance abusers

• abused/victim of violence

• HIV

what are examples of vulnerable populations

• how the environments where people live, learn, work, plan, worship, and age influence their health

• safe housing, transportation, and neighborhood

• racism, discrimination, violence

• education, job opportunities, income

• access to nutritional foods, physical activities, polluted air/water

• language and literacy skills

what SDoH does Healthy People 2030 focused on

poverty

what is the number one indicator of health disparity that most vulnerable groups share

• poor morbidity and mortality outcomes

• high prevalence of chronic illness and communicable disease

• high mortality rates from crime and violence

• delay in seeking health care

• cycle of vulnerability

what are common outcomes with vulnerable populations

wrap around services

available comprehensive health services, and social and economic services are provided either directly or through referrals; social and economic services that will help ensure effectiveness of health services are “wrapped around” health services

comprehensive services

health services that focus on more than one health problem or concern; helpful if in areas where people live and work

advocacy

taking action on behalf of others

social justice

values equality and recognizes the worth of all members of that society

• adults of color

• incarcerated adults

• LGBTQ

• adults with physical and mental disabilities

• frail older adults

what special groups of adults have health disparities

• access to care and services

• scarcity of health professionals

• poverty

• social isolation

• language barrier/cultural differences

what issues to rural populations and migrant workers experience

Red Cross Rural Nursing Service (1912)

began formal rural nursing

migrant worker

a worker who moves place to place seasonally looking for work that may be within the same country or between different countries

• diabetes

• dental disease

• mental health (stress, depression, anxiety)

• drug and alcohol use/abuse

• TB

• HIV/AIDS

what specific health problems are prevalent in migrant workers

refugees

people fleeing conflict or persecution that are protected in international law and must not be returned/expelled to situations where their life and freedom are at risk

• higher proportion of whites

• higher than average numbers of younger and older residents

• persons 18+ are more likely to be/have been married

• more likely to be widowed

• fewer years of formal schooling

• poorer

• under/uninsured

what are common characteristics of patients in a rural population