Health disparities

Health disparities exist in the United States based on race, sex, age, disabilities, socioeconomic status and geographic location. A specific look at race will find many contributing factors. Mexican Americans and African Americans have large gaps of disparities when compared with Caucasians regarding hypertension. Closing this gap will require, access to healthcare, education and early detection. The nurses role to help relieve the disparities begins with educating the patient and identifying resources to assist the patient.

Health Disparities Faced by African Americans and Mexican Americans Health disparities is a term used if a health outcome is seen in a greater or lesser extent between populations. Factors contributing to health disparities include race, sex, age, disability, socioeconomic status, and geographic location.

Health disparities can mean earlier deaths, decreased quality of life, and loss of economic opportunities(CDC). Healthy People 2010 goal was to eliminate health disparities and the 2020 goal was to achieve health equity, eliminate disparities and improve the health of all groups (Healthy People 2020).

In the US, many gaps exist however the specific gap of interest will be based on race. Examine and compare factors that cause disparities in race. Strategies for improving health disparities include access to healthcare, education, and early screening and treatment. Nurses can help close the gap of disparities by educating patients and families regarding the importance of taking medication, keeping all doctor’s appointments, and following diet and exercise plans.

Health Disparities and Hypertension In a 2003-2010 study, the comparison was made between race and hypertension. Hypertension is the leading cause of cardiovascular disease and affects nearly one third of U.S adults. However, Mexican Americans and African Americans were effected by the disease more than their white counterpart. Mexican Americans had lower awareness and treatment of hypertension and had less health care coverage, as compared to whites and blacks.

Mexican Americans and African Americans with hypertension were significantly younger than whites. African Americans were found to be more aware of the fact they were hypertensive than either of the other groups. The Million Hearts initiative focuses on the awareness and treatment of hypertension especially in racial populations (MMWR 2013). Strategies for improving health care Strategies for improving health care and closing the gap of health disparities include education, healthcare access and early screening for diseases.

Education is essential for the change in disease processes. Cardiovascular disease is an example of how education can prevent disease. Education programs that promote lifestyle changes such as modifications in diet, cessation of smoking and beginning an exercise program will greatly reduce effects of hypertension and cardiovascular disease. A study focusing on the life of African Americans in the Mississippi Delta revealed a self report of increased eating, smoking and lack of exercise.

Those surveyed reported eating as a reward, smoking as a habit and lack of exercise as a lack of motivation. Mississippi ranked 50th in 2009 as most unhealthy state(Scarinci). Another aspect of education that should be considered is the patients education level. Uninsured rates for poor or near poor ranged from 30% to 39% which also showed a directed link to education. Households without a high school diploma were more than twice as likely not to have insurance(CDC). So, this brings about the second issue, access to healthcare can help close the gap of disparity.

Mexican American have less healthcare coverage than any other group(MMWR). With no health care coverage, people tend to put of seeking medical attention related to the cost. Mexican American are often farm hands or work in agriculture thus having less opportunity to receive health care through their employer. Thirdly, earlier detection of diseases can greatly lower the cost of health care and more importantly allow the patient to recover faster with less invasive procedures.

If early detection of hypertension is made then perhaps all the patient would need to control it would be diet change and exercise. Proven measures to meet disparities Vaccination and HIV/AIDS treatment were once an area of huge health disparities. However, with the work of the World Health Organization and Center for Disease Control vaccination and testing for HIV are more readily available to everyone. In the state of Tennessee, childhood immunization is at 91.4%, this is a great increase over the past 20 years(CDC).

The rise in immunization is impart related to availability. Many organizations such as Healthy People 2020, the WHO and CDC, have made vaccinations of preventable diseases to all people a goal. The Health Department offers free vaccines which are funded by the CDC through programs such as Vaccines for Children programs. The vaccination programs save 33,000 lives a year and and reduces health care cost by $9.9 billion a year (Healthy People). The WHO is working to prevent people from becoming infected with HIV, by providing education, expanding availability to treatment(WHO).

In 2012, the CDC gave $339 million to Health Department across the U.S. for HIV prevention. More people now have access to treatment and testing. Education and availability of treatment is slowing rate of HIV/AIDS and people are living longer with the disease. Role of Nurse The nurse plays a vital role in bridging the gap of health disparities. The nurse is on the front lines and must be prepared to education regarding disease processes, medicine compliance, and available resources. The nurse is a patient advocate, so physical assessment, and carrying out orders is not where the job ends.

As with the Mexican American or African American in the hypertension survey, the nurse has to be a detective and dig deeper into the problem. Assess all of the patients needs. Are there language barriers that need to be addressed? Can the patient afford the medicine that is being given to treat the disease? Inform the patient regarding changes in lifestyle that must be made. The nurse must be aware of resources to help the patient achieve long term goals.

References

1. Health Disparities and Inequalities Report. Center of Disease Control and Prevention United states. 2011. 2. Health Disparities Experienced by Black or African American. Morbidity and Mortality Weekly Report January 14, 2005 3. Healthy People 2020.

4. Scarinci, Isabel, C., PHD, Strategies for Achieving Healthy Energy Balance Among African Americans in the Mississippi Delta, University of Alabama, Birmingham, Alabama 5. WHO. World Health Organization 2012.