NUR4244 Public Health Material Deliv 2 Socioeconomic Causes of Health Disparities In the last twenty years, professionals involved in setting the Healthy People objectives have taken into consideration the social and economic factors that can affect health status. These can include living in a rural versus metropolitan versus crowded urban location, varying levels of income and financial resources, education levels, family structure, race and ethnicity, gender, sexual orientation, genetic predisposition, and occupation. Each of these variables can be factored into reasons for varying health outcomes for specific diseases, as well as for overall perceptions of well-being. Geography Geography affects both the environment and the ability to access health care services. The residents of rural communities are much the same as urban communities with varying levels of education, professions, and beliefs about disease prevention and health promotion. Disease and life expectancy are affected by income. Higher levels of income improve access to health care. However, even the wealthy may have to travel long distances for health services and specialty care, so access continues to be a factor for all. Education and Income Higher educational levels are associated with higher incomes. Those with regular employment are more likely to have health insurance, access to safe housing, the resources for adequate nutrition, and good schools for their children. Those with lower education levels often have poorer health outcomes for a multitude of reasons, including less income for affordable and safe housing, food, and healthcare. Families with lower incomes and no health insurance tend to put off primary preventive care and seek healthcare only when ill. NUR4244CBE Rasmussen College Child Obesity in Harlem Paper

Poverty and crowded inner city communities have higher rates of youth and gun violence, higher reported rates of mental health issues and substance abuse, as well as prostitution. Sub-standard living conditions can contribute to asthma, lead poisoning, and poor immune status due to less access to healthy food. Occupation Exposure to occupational injury and the potential for disabling conditions are higher in certain professions than others are. Those who work in mines, meat processing, building trades, and manufacturing have poorer health outcomes than those who work in white-collar jobs. These jobs are also less likely to offer health insurance, another confounding variable. Race and Ethnicity Minorities in the United States have higher morbidity and mortality for certain disease conditions, including hypertension and diabetes, certain cancers, and HIV/AIDS. While statistics are available for black and Latino populations, increasing inter-marriage is blurring this distinction in generations that are more recent. Asians account for an increasing minority in the US, and health outcomes vary according to economic status. Smaller populations such as those of Middle Eastern descent are still too small to be statistically significant in estimating overall health disparities. Gender and Genetics Women are at more risk for female reproductive disorders, as males are for prostate and testicular cancer. In general, women seek out medical and mental health services more often than men do, and their life expectancy is longer. Whether this is related to gender, genetics, or selfcare is poorly understood. The opioid epidemic of the 2010s has resulted in decreased life expectancy in white males, as this epidemic has disproportionately affected low and middle-income males in their midlife years. Men have more vehicular accidents and are more likely to have untreated hypertension than women are. Genetic predisposition is also a cause of health disparities and is an area of substantial research interest in the years since the human genome was mapped. This rapidly evolving area is one to watch in the future. Sexual Orientation While there are some studies suggesting health disparities between the LGBT population and the heterosexual population, little is known about whether this is related to fear of discrimination, stress, and anxiety related to societal norms, or physical health related conditions. Public Health Nursing and Disparities Public health nurses are frequently in contact with those who are considered at risk for health disparities. Most often, these are poor, minority populations. It is important for understanding and acceptance, as there are many complicating educational, economic, and social factors. Health and language literacy may be factors in communication and compliance. Lack of resources may restrict the ability to obtain healthy foods and medications. It is critical to advocate for your population, regardless of socio-economic handicaps. Source(s) Adler, N. E. & Rehkopf, D. H. (2018). U.S. disparities in health: Descriptions, Causes, and Mechanisms. Annual Review of Public Health Vol. 29:235-252. Retrieved from https://www.annualreviews.org/doi/full/10.1146/annurev.publhealth.29.02 0907.090852 Robert Wood Johnson Foundation: Home. (2019, January 10). Retrieved from https://www.rwjf.org/ Role of Culture on Health Behaviors Culture means many things to different people. Culture may be tied to the country of origin, such as Ireland, India, or Cuba. Even among cultures that are often put into categories such as Asians and Latinos have different countries of origins, with their unique cultural values, norms, and habits. As different cultures adapt to new regions, there are generational differences in attitudes and beliefs. Religion and religious upbringing can also be cultural influences. Even regions of the United States celebrate different cultures and stereotypes. Culture can influence health behaviors, which is why it is important to understand that generalizing behaviors among populations can blind us to hearing what individuals have to say. Arab and Muslim Cultures Looking at specific health habits and issues in the Kingdom of Saudi Arabia can provide some insights into how culture influences health decisions. It is seen as an entry into manhood when males begin smoking. The wealthier one is, the less one does manual labor and the richer the diet. Women may not exercise in public and are limited to private gyms and studios. NUR4244CBE Rasmussen College Child Obesity in Harlem Paper

As a result, obesity is an epidemic in the Kingdom, with heart disease, diabetes, and lung cancer rates as the leading contributors to morbidity and mortality. Changing these social norms is challenging for a culture where these values are set. Asian Cultures The traditional Asian concept of health involves a balance of energy or chi. Immigrants may see health and illness differently from Western practitioners and rely more on herbal remedies and traditional methods such as acupuncture. Practitioners of Western medicine in countries like Vietnam, China, and Thailand do not have access to the level of care that is common in America and may not be accustomed to participating in care decisions. Asian societies often do not acknowledge mental illness or disability, as it may make marrying into the family undesirable. Family Relationships and the Role of Women Cultures that value family, like many Latino and Asian cultures, may have strong support for family members during illness. This type of family value may also mean that key family members should be included when making an end of life decisions. The family matriarch or patriarch may make decisions on the allocation of health resources and the support for mental health services. In some cultures, women are not allowed to seek treatment or make their own health decisions. This lack of independence can be a cause of conflict and ethical concern in American healthcare settings. Understanding these cultural differences and respecting the wishes of the family decision-maker may be key to getting women any care at all. Religious Decisions Religious Beliefs can also influence decisions about healthcare services. Traditional Catholics may follow church teachings on the use of birth control, sterilization procedures, and abortion. Traditional Jewish families chose circumcision for their male children, as do many non-Jewish families. Faiths may incorporate fasting days or dietary restrictions that can affect nutrition needs. Nursing Actions The Agency for Health Care Research and Quality (AHRQ) suggests key questions for nurses to ask when addressing culture and health decisionmaking. Noted nursing researcher Madeline Leininger first published her Theory of Transcultural Nursing in 1961. She has since developed that theory into the Culture Care Theory. Her core precepts are that culturally sensitive care helps others to achieve their optimal level of health, as everyone defines it. Culture care diversity refers to different meanings, values, and acceptable forms of care. Nurses are encouraged to use this information to encourage the adoption of acceptable behaviors that improve the human condition while retaining each person’s cultural values. This theoretical framework is beneficial in public health nursing when encountering different cultural norms and values. Source(s) AHRQ Health Literacy Universal Precautions Toolkit. (2015, February 20). Retrieved from https://www.ahrq.gov/professionals/quality-patientsafety/quality-resources/tools/literacy-toolkit/index.html Leininger’s Culture Care Theory. (n.d.). Retrieved from http://www.nursing-theory.org/theories-and-models/leininger-culturecare-theory.php Promotion of Health and Well-being The ten leading causes of death in the United States accounted for 75% of all deaths in 2017 were heart disease, cancer, chronic lower respiratory disease, stroke, unintentional injury, Alzheimer’s, diabetes mellitus, pneumonia/flu, nephritis/nephrotic syndrome, and suicide. Seven of the ten leading causes of death in the United States are attributable to a chronic illness that can be reduced with five behavioral health factors, including not smoking, maintaining normal body weight, being physically active, moderate to no alcohol intake, and getting sufficient sleep. Smoking Unfortunately, approximately 25% of American adults continue to smoke. Although smoking rates for adolescents has declined over time, the increase in vaping activity presents unknown health risks. The legalization of recreational marijuana is also not being factored into the risks of lung damage and lung cancer. Obesity American adult obesity in 2017 was reported for 39.8% of the population or 9.3 million adults. Hispanics were most impacted at 47% and the black population at 37.9%. Those with higher education and income level were less likely to be obese. Obesity contributes to rising rates of diabetes mellitus, which in turn is affecting the rates of kidney disease, cardiovascular disease, and other morbidities. Childhood obesity is a particular concern, as children become more sedentary and eat significant amounts of fast food. Childhood obesity rates have continued to rise in the last decade, which puts children at higher risk for early onset of hypertension and diabetes. Physical Activity The Centers for Disease Control and Prevention Center for Health Statistics reported that only 20% of American adults met the recommended physical activity for aerobic and strength exercise in 2017. NUR4244CBE Rasmussen College Child Obesity in Harlem Paper

Only 1 in 3 children participate in regular exercise activity, spending an average of seven and a half hours in screen time each day. Twenty percent of Americans are physically inactive. Physical activity improves overall cardiovascular health, muscle strength and balance, and overall well-being. While some areas are not near parks or sidewalk areas, there are numerous exercise regimens of all levels available on television, smartphones, and IPad. Many community facilities such as recreation centers and the YMCA have exercise and healthy eating programs, as well as organized sports for all ages. The decision to participate in regular exercise can have a significant impact on health and well-being. Alcohol Use The Centers for Disease Control and Prevention Center for Health Statistics reported that excessive alcohol use led to approximately 88,000 deaths and 2.5 million years of potential life lost between 2006 and 2010. Excessive alcohol use is responsible for 1 in ten deaths among working adults ages 20 to 64 years. Short-term risks include injuries, violence, and risky sexual behaviors. Those who binge drink (more than five drinks during a single occasion) are at risk for acute alcohol poisoning, often seen among young men of college age. Women who drink while pregnant risk miscarriage or stillbirth. Those who use alcohol regularly during pregnancy have an increased risk of fetal alcohol syndrome in their children. Fetal alcohol syndrome is a condition where the child has facial and other congenital abnormalities and intellectual disabilities. Long-term health risks include hypertension, liver disease, and digestive problems. Mental health and social problems, as well as memory issues, are common in those who drink excessively. Alcoholism, or alcohol dependence, requires both physical and mental health services, often in a rehabilitation setting. Other programs such as Alcoholics Anonymous offer peer support for abstinence. Sleep and Health Harvard University School of Medicine has taken a leadership role in addressing how insufficient sleep contributes to the development of disease. Research suggests that sleep is just as important to health as nutrition and exercise. Sleeping fewer than eight hours per night has been associated with weight gain, diabetes, cardiovascular disease, hypertension, compromised immune response, and increase in the risk for a common cold. Rates of sleep apnea, a condition where the individual stops breathing during sleep, have been increasing in parallel to the rates of obesity. Obesity is also a known risk factor for the development of sleep apnea. Public Health Nursing Public health nurses have the opportunity to work with individuals, families, and communities to educate constituents about the top three factors that account for over 75% of chronic diseases. While education is important, clients need to know what they can do to change their behaviors. It is important to know where programs are in the community that can assist with exercise, weight management, smoking, alcohol cessation, and addressing sleep disturbances. Support for accessing programs and then following through with behavior change is important to reversing risk factors. Source(s) CDC – Fact Sheets-Alcohol Use And Health – Alcohol. (n.d.). Retrieved from https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm Overweight & Obesity. (2018, August 13). Retrieved from https://www.cdc.gov/obesity/data/adult.html Physical Activity. (2018, November 13). Retrieved from https://www.cdc.gov/physicalactivity/data/index.html Sleep and Health. (n.d.). Retrieved from http://healthysleep.med.harvard.edu/need-sleep/whats-in-it-foryou/health …