community health issue (ch6)

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Course Learning Outcomes for Unit VI Upon completion of this unit, students should be able to:

3. Compare and contrast the different approaches of caring for different age groups in community health. 3.1 Determine age-specific community health interventions to reduce the occurrence of injuries or

death.

Course/Unit Learning Outcomes

Learning Activity

3.1

Unit Lesson Chapter 10 Chapter 12 Unit VI Project

Required Unit Resources Chapter 10: Population Dynamics and Control Chapter 12: Injury Control and Other Environmental Issues

Unit Lesson

The Social Determinants of Community Health The age-old debate, of course, is nature versus nurture. Is our genetic make-up the primary determinant of how healthy and successful we will be in life? Is that really determined for us at birth? Or is the environment in which we are raised the more important consideration? Clearly, both factors have important impacts on individual health and thus in the health of the community. But the reality is that we have little control over our genetics. You can’t pick your relatives, as they say, and we have not yet achieved effective gene therapy to address inherited health risks. The ethical debate continues on that latter topic. Should we manipulate human genetics? There is not consensus on that point and no clear indication as to how far we should go in that direction. Meanwhile, there is a lot that we can do to improve the environment in which we live and the social factors that promote or inhibit health. That is our topic for this unit’s lesson, and it is a very important topic. Research for this lesson was very easy to accomplish, simply because so many people are interested in the environment in which we live today. Much is being studied and written on the environmental and social aspects of health. Fascinating information is available online from the World Health Organization, Robert Wood Johnson Foundation, Centers for Disease Control and Prevention (CDC), the National Academy of Medicine, and Healthy People 2030. We will share some of the most important research observations here. We will also consider what might be done to improve community health on this evidentiary basis. When the environment is conducive to a sense of community, the community will emerge to nurture the health of the people. That has been well demonstrated around the globe, and a key aspect here is equity. The importance of equity can be observed and documented by studying nations all over the world. Wherever inequities are high and widespread and community assets are low, health outcomes are predictably poor. Wherever inequities are low and community assets are high, better health outcomes are predictably present.

UNIT VI STUDY GUIDE

Population Health and Injuries

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Life-Enhancing Resources Certain resources are consistently associated with better individual and community health. Safe drinking water and nutritious food supply come at the top of that list, which is no surprise. But many people in our world do not have those essential resources in their lives. Even today, with so much technology available, the most important worldwide improvements in human health status would come from a consistently available supply of safe food and water. Safe housing is also near the top of the list. It is often taken for granted in the developed world but tragically lacking in many developing nations. Effective economic and social relationships come next, especially opportunities for meaningful and gainful employment and social opportunities to feel part of a group and supported by others. Safe and affordable transportation is more important than one might realize. Transportation allows people to seek better opportunities in life and, perhaps, better jobs. It gives them educational opportunities that they otherwise would not be able to access. It truly improves their lives and thus their health. Education is so important. Later in this lesson, we will share very clear worldwide data that demonstrates that human beings have better health when they have received education. The last item on our list is the one you might have thought would be first. Yes, access to health care improves health, but it is less important than many other factors that we have mentioned here. One very key concept here is that life-enhancing resources are most effective when they are distributed across populations and when there is equity in access to these resources. Some of the worst community health problems in the world are the result of disparity of access. We will discuss that in more detail as we move forward in this unit.

Communities and Health Equity When a group of people share an identity, living in a particular geographic area, interacting with each other, and sharing a sense of belonging, we refer to them as a community. Health equity is the opportunity for everyone in the community to achieve his or her full health potential. When health equity exists, nobody is prevented from attaining full health potential because of discrimination, social status, or other socially determined disadvantage. Health inequity is one of the most pressing problems in worldwide public health today. When health inequities exist, there is systematic and unfair distribution of the conditions that we described above, the things that lead to health. Health inequity means unequal access to education, limited access to health care, substandard housing, transportation problems, and unequal employment opportunities. Many nations around our world have achieved quality education, housing, transportation, and other life- enhancing resources, but they do not have these resources for the population overall; they have them for a privileged few. Health disparity is different from health inequity. Here, we can actually measure differences in the incidence and prevalence of health problems among groups based upon the list below:

• ethnicity,

• race,

• social status,

• economic status,

• gender,

• sexual orientation,

• disabilities, and

• residence location within the community.

Place Really Does Matter Epidemiologists and sociologists have extensively studied the characteristics of communities in search of ways to improve health. In communities with good opportunities for health and success in life, we often find parks, well-kept sidewalks, grocery stores, restaurants with good quality food, financial institutions of various kinds, well-kept streets, and good waste control. There are high performing school systems and good public

HCA 3306, Community Health 3

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transportation. These are factors that tie closely to better health, leading to better individual and community health status. In communities with lower opportunities for health and success in life, we often find fast food restaurants only, convenience mini-marts only, poor performing schools, increased pollution and poor control of waste, and limited public transportation. These factors lead to poor health status and to specific findings such as more obesity, more type 2 diabetes, more asthma, and higher infant mortality (Centers for Disease Control and Prevention, n.d.).

Some Examples of Health Inequities Let’s take some specific examples of health inequities to help make the point.

• Infants born to African American mothers with a high school education or less were found to be 2.2 times as likely to die within the first year of life as compared with white counterparts.

• Low socioeconomic status is tied to increased risk of cardiovascular disease, arthritis, type 2 diabetes, chronic lung disease, and cervical cancer.

• Lower income communities are less likely to have access to quality grocery stores with a good selection of fruits and vegetables.

• One quarter of adults in America live in poor households and suffer health consequences as a result.

• 44% of adults in America have no education beyond high school, and their health is measurably worse as a result.

• Compared with college graduates, adults who did not finish high school are 2.5 times more likely to be in poor health, by their own self-reporting. (Centers for Disease Control and Prevention (CDC), 2016).

And very importantly, health status is closely linked with education, regardless of racial or ethnic group (Robert Wood Johnson Foundation, n.d.).

Some Examples of Health Disparities Turning now to health disparities, some important examples include the following (CDC, 2019).

• Native Americans, Alaskan Natives, and African Americans are much more likely to have type 2 diabetes than their white counterparts. The percentages are 17% of the Native populations, 12% of African American populations, and 7% of white populations.

• Heart disease death rates are 29% higher among African American adults than white adults.

• Stroke death rates are 1.6 times as high among African American men as compared with white men.

• Sudden Infant Death Syndrome (SIDS) death rates among Native Americans and Alaskan Natives are double the rate for white mothers (National Institute of Child Health and Human Development, n.d.).

Conclusion

We have a long way to go. We will not truly have strong community health in America until we have it for everyone. So what needs to happen? We know very clearly that health is linked to crucial, fundamental social determinants. First, can we achieve equitable distribution of water, food, education, transportation, and health care for all groups? And by that we mean socioeconomic, ethnic, gender, sexual orientation, disability and geographic groups? If so, then we will see things begin to change for the better. Social conditions will improve, economic opportunities improve, and the physical environment gets better and safer. Psychologically, people in depressed communities begin to experience better self-esteem and hopefulness, which leads to better health-promoting behaviors. They seek out opportunities to improve their lives and the lives of their loved ones. Ultimately we see better individual and community health. The hope is that this lesson has raised your awareness that health has as much to do with how and where a person lives as it does with his or her choice of physician, clinic, and hospital. This course was designed to give you a very broad view of community health. We consider everything that inhibits it or contributes to it.

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Yes, we have a long way to go, but perhaps there are some signs of better things ahead. As long as there are community leaders and community health professionals who care, there is hope.

References Centers for Disease Control and Prevention. (2016). Health, United States, 2016 - Individual charts and

tables: Spreadsheet, PDF, and PowerPoint files. U.S. Department of Health and Human Services. https://www.cdc.gov/nchs/hus/contents2016.htm

Centers for Disease Control and Prevention. (2019). Fact sheets. U.S. Department of Health and Human

Services. https://www.cdc.gov/diabetes/library/factsheets.html Robert Wood Johnson Foundation. (n.d.). Charts. http://www.commissiononhealth.org/Charts.aspx National Institute of Child Health and Human Development. (n.d.). Sudden infant death syndrome (SIDS).

National Institutes of Health. U.S. Department of Health and Human Services. https://www.nichd.nih.gov/health/topics/sids

Suggested Unit Resources You are encouraged to continue reading in your eTextbook to learn more about specific environmental aspects of public health. Chapter 11: Air, Water, and Noise Pollution