Week 4 Health Promotion and wellness Discussion Questions
Week 4 Health Promotion and wellness Discussion Questions
Chapter 4 Health Promotion and Risk Reduction Copyright © 2015, 2011, 2007, 2001, 1997,. 1993 by Saunders, an
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Health Promotion Is… …any combination of health education and related organizational, economic, and environmental supports for behavior of individuals, groups, or communities conducive to health (Green & Kreuter, 1991) …that which is motivated by the desire to increase well-being and to reach the best possible health potential (Parse, 1990) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Health Protection Is …(Cont.) … those behaviors in which one engages with the specific intent to prevent disease, detect disease in the early stages, or maximize health within the constraints of disease (Parse, 1990) … an important step in maintaining health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Defining Health The way health is defined has shifted from a focus on the curative model, to a focus on multidimensional aspects such as the social, cultural, and environmental facets of life and health (Benson, 1996) Health is viewed not only as an important goal, but as a resource for living (WHO, 1986) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Healthy People 2020 … … is the health promotion initiative for the nation. … challenges individuals, communities, and professionals … to take specific steps to ensure that good health, as well as long life, are enjoyed by all. – U.S. Department of Health and Human Services, 2012 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Healthy People 2020 … (Cont.) Broad goals ➢ ➢ ➢ ➢ Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve high equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Determinants of Health Biology Behaviors Social environment Physical environment Policies and interventions Access to high-quality health care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Figure 4-1 From U.S. Department of Health and Human Services. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Theories in Health Promotion Pender’s Health Promotion Model (HPM) Health Belief Model (HBM) Transtheoretical Model (TTM) Theory of Reasoned Action (TRA) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Risk and Health Risk is “the probability that a specific event will occur in a given time frame” (Oleckno, 2002). A risk factor is an exposure that is associated with a disease (Friis & Sellers, 2004). Risk Assessment is a systematic way of distinguishing the risks posed by potentially harmful exposures. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Steps in Risk Assessment Hazard identification Risk description Exposure assessment Risk estimation Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Risk Assessment Modifiable risks ➢ ➢ Individual has control Examples: smoking, lifestyle, eating habits, activities Nonmodifiable risks ➢ ➢ Individual has little or no control Examples: genetics, gender, age, environmental exposure Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Risk Reduction … ➢ ➢ … is a proactive process … enables individuals to react to actual or potential threats to their health Risk communication … ➢ ➢ … is the process of informing the public regarding threats … is affected by perceptions, process, and actions Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Tobacco and Health Risk Leading cause of preventable death Most common in less educated populations and those living below poverty level Most common form of chemical dependency Tobacco in all forms is harmful. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Health Promotion Activities Look for teachable moments Assess client’s tobacco use Explore willingness to quit Refer to cessation programs Encourage attempts to quit Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Alcohol Consumption and Health Third leading lifestyle-related cause of death for the nation Short-term use causes acute risks Long-term effects have major impact on health and social issues Influenced by legal drinking age ➢ # 1 used and abused drug among U.S. youth Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Health Promotion Activities (Cont.) Prevent underage drinking Assist with enforcement of legal drinking age Identify individuals and groups at risk of abuse and dependence Educate adults and youth on dangers of alcohol Requires a community-wide effort to address the problem on several fronts Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Diet and Health Diet—one of most modifiable risk factors Imbalance of caloric intake and physical activity Complex interplay among metabolism, genetics, behavior, environment, culture, and socioeconomic status Geographic areas, age, ethnicity all influence weight Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Health Promotion Activities (Cont.) Special populations have different nutritional needs For individualized plans, see http://myplate.gov/ Educate clients about: ➢ Balancing caloric intake and physical activity ➢ Servings vs. portion control ➢ Eating away from home affects “portion distortion” ➢ Using social media and mobile applications to help Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Physical Activity and Health Physical activity serves both health promotion and disease prevention purposes Leisure activities are influenced by level of education, gender, age, economic level, geography One’s environment plays a significant role in activity level Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Health Promotion Activities (Cont.) Support and develop “walkable” neighborhoods and cities Determine recommended exercise levels for individuals Visit http://www.cdc.gov/physicalacti vity/data/facts.html Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Sleep and Health Sleep is an essential component of chronic disease prevention and health promotion Requirements change with age and life circumstances Regulated by waking time and circadian rhythms Hormones during sleep affect memory, blood pressure, and kidney function. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Health Promotion Activities (Cont.) Sleep assessment is important ➢ ➢ Identify disorders that may affect daily activities Keep sleep log Practice sleep hygiene ➢ ➢ Establish environment that promotes sleep Avoid food and activities that interfere with sleep Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Chapter 13 Cultural Diversity and Community Health Nursing Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Cultural Competence Cultural competence is respecting and understanding the values and beliefs of a certain cultural group so that one can function effectively in caring for members of that cultural group. Culturally competent community health nursing requires that the nurse understand… ➢ ➢ ➢ Lifestyle Value system Health and illness behaviors of diverse individuals, families, groups, and communities Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Standards of Practice for Culturally Competent Nursing Care 1. 2. 3. 4. Social Justice Critical Reflection Knowledge of Cultures Culturally Competent Practice 5. Cultural Competence in Health Care Systems and Organizations 6. Patient Advocacy and Empowerment 7. Multicultural Workforce 8. Education and Training in Culturally Competent Care 9. Cross-Cultural Communication 10. Cross-Cultural Leadership 11. Policy Development 12. Evidence-Based Practice and Research From: Expert Panel on Global Nursing and Health (2010) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Population Trends In 1970 ➢ By 2010 ➢ Minority groups increased to 36% of population By 2025 ➢ Minority groups were 16% of population More than half of all children will be minorities By 2050 ➢ ➢ More than 54% of total population will be minorities First time in U.S. history that minorities will make up a majority of the population Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Population Trends (Cont.) By 2060, projected demographic trends: ➢ White 44% ➢ Hispanic 30% ➢ African American 15% ➢ Asian 9% ➢ American Indians & Alaska Natives 2% Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Immigration to the United States Since 1991, more than 13 million legal immigrants In 2010, almost 40 million foreign-born individuals in the United States (12.9% of population) from: ➢ ➢ ➢ ➢ Latin America 53.1% Asia 28.2% Europe 12.1% Other regions 9% Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Diversity Among Nurses Minorities are generally underrepresented by nursing workforce (HRSA, 2009): ➢ ➢ ➢ ➢ ➢ White/non-Hispanic 81.8% African American 4.2% Hispanic 1.7% Asian and Pacific Islander 3.1% Native American and Alaska Native 0.3% Minority groups tend to be geographically distributed in the United States. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Cultural Perspectives and Healthy People 2020 Developed a set of national health targets…eliminating racial and ethnic disparities in health Embraced and focused on ways to close the gaps in health outcomes Focused on disparities among racial and ethnic minorities, women, youth, older adults, people of low income and education, and people with disabilities Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Health Disparities AHCRQ (2005) reveals that: Cancer mortality rates are 35% higher in African Americans than in whites. African Americans with diabetes are seven times more likely to have amputations and develop renal failure than are whites with diabetes. 30% of Hispanics and 20% of African Americans lack a usual source of health care (compared with less than 16% of whites). Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Health Disparities (Cont.) AHCRQ (2005) reveals that: Hispanic children are nearly three times as likely as non-Hispanic white children to have no usual source of health care. African Americans (16%) and Hispanic Americans (13%) are more likely to rely on hospitals or clinics for health care than are whites (8%). Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Addressing Racial and Ethnic Disparities in Health Care Disparities can be reduced or eliminated when adults have: ➢ ➢ Health insurance and A medical home – Commonwealth Fund, 2007 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Transcultural Nursing “…a formal area of study and practice focused on a comparative analysis of different cultures and subcultures in the world with respect to cultural care, health and illness beliefs, values, and practices with the goal of using this knowledge to provide culturespecific and culture-universal nursing care to people.” – Leininger (1978) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Transcultural Nursing Terminology Culture specific refers to the “particularistic values, beliefs, and patterning of behavior that tend to be special, ‘local,’ or unique to a designated culture and which do not tend to be shared with members of other cultures” – Leininger (1991) Culture universal refers to the “commonalties of values, norms of behavior, and life patterns that are similarly held among cultures about human behavior and lifestyles and form the bases for formulating theories for developing cross-cultural laws of human behavior” – Leininger (1978) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Transcultural Nursing Terminology (Cont.) Ethnocentrism is a person’s tendency to view his or her own way of life as the most desirable, acceptable, or best, and to act in a superior manner toward another culture. Cultural imposition is a person’s tendency to impose his or her own beliefs, values, and patterns of behavior on individuals from another culture. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Leininger’s Theory of Culture Care Diversity and Universality Describes, explains, and projects nursing similarities and differences focused primarily on human care and caring in human cultures. Uses world view, social structure, language, ethnohistory, environmental context, and the generic or folk and professional systems to provide a comprehensive and holistic view of influences in cultural care and well-being. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Leininger’s Sunrise Model depicting the theory of cultural care diversity and universality Figure 13-1 From Leininger MM: Culture, care, diversity, and universality: a theory of nursing, New York, 1991, National League for Nursing Press. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Overview of Culture Culture refers to the complex whole, including knowledge, beliefs, art, morals, law, customs, and any other capabilities and habits acquired by virtue of the fact that one is a member of a particular society (Tylor, 1871). Culture represents a person’s way of perceiving, evaluating, and behaving within his or her world, and it provides the blueprint for determining his or her values, beliefs, and practices. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Overview of Culture (Cont.) Four basic characteristics of culture—it is: 1. Learned from birth through the processes of language acquisition and socialization 2. Shared by members of the same cultural group 3. Adapted to specific conditions related to environmental and technical factors and to the availability of natural resources 4. Dynamic – Sir Edward Tylor, 1871 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Subculture A fairly large aggregate of people who share characteristics that are not common to all members of the culture Enables them to be a distinguishable subgroup May be based on ethnicity, religions, occupation, health-related characteristics, age, gender, sexual preferences, or geographic location Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Culture and Formation of Values Common human problems related to values and norms: ➢ ➢ ➢ ➢ ➢ What is the character of innate human nature (human nature orientation)? What is the relationship of the human to nature (personnature orientation)? What is the temporal focus of human life (time orientation)? What is the mode of human activity (activity orientation)? What is the mode of human relationships (social orientation)? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Human-Nature Orientation Innate human nature may be good, evil, or a combination of good and evil. The dominant U.S. cultural group chooses to believe the best about a person until that person proves otherwise. – Kohls (1984) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Person-Nature Orientation Destiny, in which people are subjugated to nature in a fatalistic, inevitable manner. Harmony, in which people and nature exist together as a single entity. Mastery, in which people are intended to overcome natural forces and put them to use for the benefit of humankind. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Time Orientation The focus may be on the past, with traditions and ancestors playing an important role in the client’s life. The focus may be on the present, with little attention paid to the past or the future. The focus may be on the future, with progress and change highly valued. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Activity Orientation Being, in which a spontaneous expression of impulses and desires is largely nondevelopmental in nature. Growing, in which the person is selfcontained and has inner control, including the ability to self-actualize. Doing, in which the person actively strives to achieve and accomplish something that is regarded highly. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Social Orientation Lineal relationships: Exist by virtue of heredity and kinship ties. Follow an ordered succession and have continuity through time. Collateral relationships: Focus primarily on group goals—and family orientation is important. Individual relationships: Personal autonomy and independence dominate; group goals become secondary. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Culture and the Family Cross-cultural differences may exist in: ➢ Structural differences ➢ Functional diversity ➢ Socialization context ➢ Sex roles and parenting values Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26 Culture and Socioeconomic Factors Socioeconomic status (SES) is a composite of the economic status of a family or unrelated individuals based on: ➢ Income ➢ Wealth ➢ Occupation ➢ Educational attainment ➢ Power Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 27 Culture and Socioeconomic Factors (Cont.) Poverty guidelines ➢ Determined by comparing pretax cash income with the poverty threshold adjusted for family size and composition issued annually by USDHHS. ➢ The U.S. Census Bureau (2012) reported that the poverty rate in 2011 was 15% • African American population—27.6% • Asian population—12.3% • Hispanic population—25.3% • Children under 6 years—24.5% Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 28 Culture and Socioeconomic Factors (Cont.) Distribution of resources ➢ Upper, middle, and lower classes • Total family income, occupation, and educational level • Age, sex, material possessions, health status, family name, location of residence, family composition, amount of land owned, religion, race, and ethnicity ➢ ➢ A disproportionate number of individuals from the racially and ethnically diverse subgroups are members of the lower socioeconomic class Outcome of social stratification is social inequality Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 29 Culture and Socioeconomic Factors (Cont.) Education ➢ ➢ Perhaps the single most important factor in SES. Child’s educational development affected more by differences in levels of formal schooling than by cultural differences or economic indices. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 30 Culture and Nutrition Culturally competent nutrition assessment: ➢ ➢ ➢ ➢ ➢ ➢ Cultural definition of food Frequency and number of meals eaten away from home Form and content of ceremonial meals Amount and types of food eaten Regularity of food consumption Social contacts during meals Beware of cultural stereotyping. Cultural food preferences are often interrelated with religious dietary beliefs and practices. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 31 Culture and Religion Culturally competent nursing care and religious factors: ➢ ➢ Gain a general understanding of religious calendars. • Know the customary days of religious worship. • Learn about special days of observance or celebration. Ask clients what religious practices they follow. Religious beliefs may influence a client’s belief about the cause of illness, perception of its severity, choice of healer, and source of consolation. Assess spiritual needs of clients. Know the difference between religion and spirituality. Remember that various religions have shared beliefs. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 32 Culture and Aging Different cultures view older adults in very different ways. Tasks of older adults ➢ ➢ To achieve a sense of integrity in accepting responsibility for their own lives To have a sense of accomplishment Older adults develop their own means of coping with illness through self-care, assistance from others, and social support groups. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 33 Cross-Cultural (Intercultural) Communication … … between a nurse and client attempts to understand the other’s point of view from a cultural perspective. ➢ Nurse-client relationship ➢ Space, distance, and intimacy ➢ Overcoming communication barriers ➢ Nonverbal communication ➢ Language ➢ Touch ➢ Gender Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 34 Health-Related Beliefs and Practices Understand personal culturally based values, beliefs, attitudes, and practices. Include the client’s beliefs about the cause of illness: ➢ ➢ ➢ Biomedical perspective Naturalistic perspective Magicoreligious perspective Understand the role and value of folk or religious healers. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 35 Health-Related Beliefs and Practices (Cont.) Cultural variations exist in how symptoms and disease conditions are perceived, diagnosed, labeled, and treated. Expression of pain is culturally determined. Some conditions are culturally defined—a culture-bound syndrome. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 36 Management of Health Problems: A Cultural Perspective First effort at treatment is often self-care. ➢ ➢ Mobilizes client’s social support network Provides a caring environment Cultural negotiation is used when conceptual differences exist between client and nurse. ➢ Same words but different meanings ➢ Same phenomenon; different notions of causation ➢ Different memories or emotions associated with the term and its use Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 37 Cornerstones of Public Health Nursing Focus on health of entire population Reflect communities’ priorities and needs Establish caring relationships Remain grounded in social justice Provide care for the whole person Promote health based on epidemiological evidence (evidence-based practice) Collaborate with community resources – Keller, Strohschein, & Schaffer, 2011 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 38 Management of Health Problems in Culturally Diverse Populations Providing health information and education Delivering and financing health services Developing health professionals from minority groups Enhancing cooperative efforts with the nonfederal sector Promoting a research agenda on minority health issues Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 39 Providing Health Information and Education Developing programs to increase public awareness about health problems. ➢ Plan health information campaigns: • Be sensitive to cultural factors. • Involve community leaders. • Acknowledge existing cultural beliefs and practices. • Involve families, churches, employers, and community organizations as support systems. • Use lay volunteers to organize community support networks. ➢ Client education should be interpersonal; carefully use credible printed materials and audiovisuals. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 40 Role of the Community Health Nurse Conduct a “culturological” assessment. Conduct a cultural self-assessment. Seek knowledge about local cultures. Recognize political issues of culturally diverse groups. Provide culturally competent care. Recognize culturally based health problems. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 41 Culturological Assessment Brief history of ethnic and racial origins of the cultural group with which the client identifies Values orientation Cultural sanctions and restrictions Communication Health-related beliefs and practices Nutrition Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 42 Culturological Assessment (Cont.) Socioeconomic considerations Organizations providing cultural support Educational background Religious affiliation Cultural aspects of disease incidence Biocultural variations Developmental considerations Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 43 Resources for Minority Health U.S. Department of Health and Human Services and Public Health Service ➢ Office of Minority Health • Disadvantaged Minority Health Improvement Act of 1990 ➢ Indian Health Service • Indian Self-Determination Act of 1975 National Institutes of Health ➢ National Center on Minority Health and Health Disparities (NCMHD) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 44 Federally Sponsored Initiatives to Improve Health of Minority Groups HRSA Health Disparity Collaboratives (HDC) Racial and Ethnic Approaches to Community Health (REACH 2010) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Ryan White Comprehensive AIDS Resources Emergency (CARE) Act B National Center on Minority Health and Health Disparities (NCMHD) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 45 Chapter 14 Environmental Health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Environmental Health Is … … all the physical, chemical, and biological factors external to a person and all the related factors impacting behaviors. … encompasses the assessment and control of those environmental factors that can potentially affect health. … targeted toward preventing disease and creating health-supportive environments. – WHO (2013) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Environmental Health The purpose of environmental health is to ensure the conditions of human health and provide healthy environments for people to live, work, and play. Accomplished through… ➢ ➢ ➢ Risk assessment Prevention Intervention Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Using a Critical Theory Approach Uses “thinking upstream” framework. Raises questions about oppressive situations. Involves community members in the definition and solution of problems. Facilitates interventions that reduce healthdamaging effects of environments. Asks critical questions about clients’ work and home environments to help discern the contributions of specific hazards to health. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Benefits of an Environmental Health History Increased awareness of environmental/ occupational factors Improved timelines and accuracy of diagnosis Prevents disease and aggravation of conditions Identifies potential work-related environmental hazards and/or environmental hazards in and around clients’ homes Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 I PREPARE Environmental Exposure History ● ● ● ● ● ● ● ● I – Investigate potential exposures P – Present work R – Residence E – Environmental concerns P – Past work A – Activities R – Referrals and Resources E – Educate Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Figure 14-1 From U.S. Department of Health and Human Services: Healthy People 2010, ed 2, Washington, DC, U.S. Government Printing Office, 2000. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Areas of Environmental Health Built environment Work-related exposures Outdoor air quality Healthy homes Water quality Food, safety, and waste management Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Built Environment The connection between people, communities, and their surrounding environments that affects health behaviors and habits, interpersonal relationships, cultural values, and customs Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Built Environment: Examples Drunk driving Second-hand smoke Noise exposure Urban crowding Technological hazards Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Work-Related Exposure Poor working conditions that result in potential injury or illness Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Work-Related Exposure: Examples Asbestosis Asthma Lung cancer Agricultural accidents Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Outdoor Air Quality The purity of the air and the presence of air pollution Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Outdoor Air Quality: Examples Gaseous pollutants Greenhouse effect Destruction of the ozone layer Aerial spraying of herbicides and pesticides Acid rain Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Healthy Home The availability, safety, structural strength, cleanliness, and location of shelter, and indoor air quality Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Healthy Home: Examples Homelessness Rodent and insect infestation Poisoning from lead-based paint Sick building syndrome Unsafe neighborhoods Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Water Quality The availability, volume, mineral content levels, toxic chemical pollution, and pathogenic microorganism levels The balance between water contaminants and existing capabilities to purify water for human use and plant and wildlife sustenance Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Water Quality: Examples Contamination of drinking supply by human waste Oil spills in the world’s waterways Pesticide or herbicide infiltration of ground water Aquifer contamination by industrial pollutants Heavy metal poisoning of fish Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Food Safety Availability, accessibility, and relative costs of healthy food free from contamination of harmful herbicides, pesticides, and bacteria Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Food Safety: Examples Malnutrition Bacterial food poisoning Food adulteration Disrupted food chains by ecosystem destruction Carcinogenic chemical food additives FDA food safety campaign: http://www.fightbac.org/safe-food-handling http://www.foodsafety.gov/ Figure 14-5 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Waste Management The handling of waste materials resulting from industry, municipal processes, and human consumption as well as efforts to minimize waste production Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Waste Management: Examples Use of nonbiodegradable plastics Poorly designed solid waste dumps Inadequate sewage systems Transport and storage of hazardous waste Illegal industrial dumping Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Waste Management: Examples (Cont.) Nuclear facility emissions Radioactive hazardous wastes Radon gas seepage in homes and schools Nuclear testing Excessive exposure to x-rays Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Effects of Environmental Hazards Figure 14-6 From Environmental Protection Agency: Air Pollution and Health Risk. http://www.epa.gov/ttnatw01/3_90_022.html. Retrieved March 27, 2013. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Emerging Issues in Environmental Health Environmental public health infrastructure Natural disasters Global climate change Ozone depletion Fossil fuel burning Marine dumping Active land mine abandonment in war-torn areas Destruction of tropical rain forests Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Critical Community Health Nursing Practice Approach environmental health at the population level Take a stand; advocate for change Ask critical questions Facilitate community involvement Form coalitions Using collective strategies Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26
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