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NUR 740 Discussion 5.1: Health Disparities

Healthy People 2020 categorizes the determinates of health into five categories including economic, personal, biological, environmental, and social (Office of Disease Prevention and Health Promotion, n.d.). These categories overlap and intertwine with each other to influence a person’s overall health. Some factors are impossible to change like genetic makeup and family history of a disease. Others seem more malleable such as diet and exercise. However, social determinants can largely impact personal behaviors and physical environments. Food insecurity is when individuals or households do not have access to the nutritious and fresh food options needed to sustain a healthy lifestyle (National Academics of Sciences, Engineering, and Medicine, 2021). Food insecurity can be caused by physical location. Neighborhoods in low-income or rural areas may only have a high concentration of fast-food chains and gas stations nearby (National Academics of Sciences, Engineering, and Medicine, 2021). This circumstance is known as a food desert. People have limited choices for their diet when grocery stores and other fresh food options are out of the way. Income is another source of food insecurity. High quality food and ingredients can be expensive. Dollar menu fast food may be a more affordable alternative than a homemade salad. The United States has seen the largest increase in food insecurity since the 1990s due to COVID-19 pandemic (Hake, et al., 2021).

The National School Lunch Program (NSLP) is a federally funded program created in 1946 to provide balanced meals to children in public and private schools (United States Department of Agriculture, 2017). The program came from the passage of the Richard B. Russell National School Lunch Act (United States Department of Agriculture, 2017). It works to distribute free or low-cost nutritious lunches to students. It is important for children to have food that properly fuels their body to promote physical and mental development. School is an environment allowing convenient access to children. School also has lunchtime schedule so meals can be delivered seamlessly. The COVID-19 proved to challenge these standard conditions. School was cancelled and students were required to stay home. The NSLP attempted to restructure by offering ‘to-go’ style lunches where parents could pick up the meals to take home (U.S. GAO, 2021). However, participation was still down 30% from the last year (U.S. GAO, 2021). I would suggest the program continue expanding to offer more flexible options. The pick-up option can be standardized and continued even after the pandemic. Meals can be prepared and stored to last longer than one sitting. For example, a parent can pick up an insulated box with three meals instead of one. This is a great option for when school is remote, or students are on a holiday break. The NSLP should also consider providing additional items for children to have as an after-school snack. Ideal options would be food that can be stored at room temperature such as apples, nuts, and granola bars. The NSLP only caters to children; however, there are other federally funded programs targeted towards adults. All federal food programs work towards ending food insecurity in the United States.

References

Hake, M., Dewey, A., Engelhard, E., Strayer, M., Dawes, S., Summerfelt, T., & Gundersen, C. (2021, March). The impact of the coronavirus on food insecurity in 2020 & 2021. Feeding America. Retrieved May 19, 2022, from https://www.feedingamerica.org/sites/default/files/2021-03/National%20Projections%20Brief_3.9.2021_0.pdf (Links to an external site.)

National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on the Future of Nursing 2020–2030. (2021, May 11). Chapter 2, “Social determinants of health and health equity (Links to an external site.) (Links to an external site.).” In J. L. Flaubert, S. Le Menestrel, D. R. Williams, & M. K. Wakefield (Eds.), The future of nursing 2020–2030: Charting a path to achieve health equity. National Academies Press.

Office of Disease Prevention and Health Promotion. (n.d.). Determinants of health. Healthy People 2020. Retrieved May 18, 2022, from https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health (Links to an external site.)

United States Department of Agriculture. (2017). The national school lunch program. Retrieved May 19, 2022, from https://fns-prod.azureedge.us/sites/default/files/resource-files/NSLPFactSheet.pdf

U.S. GAO. (2021, October 12). Addressing food insecurity in America, before and during the pandemic. https://www.gao.gov/blog/addressing-food-insecurity-america%2C-and-during-pandemic

Hi Skylar

In this case, I would agree with some of your overviews, especially regarding determinates of health. Healthy People 2020 effectively systematizes them into five subsections. These include personal, biological, social, economic, and environmental. In this respect, it is then logical to ascertain that a specific social indicator relevant in the framework of Healthy People 2020’s overview of determinates of health entails food insecurity. Based on your analysis, insecurity as a social factor of health can be directly attributed to individual behaviors and physical environment. I like the fact that you discussed the notion of a food desert, which is a major food insecurity concern in low-income and rural areas across the country. However, in addition to the federally funded National School Lunch Program (NSLP), can you also identify any other state-operated program or policy endeavored to mitigate the issue of food insecurity in your current state? NAP (2022) indicated that most states had defined unique policies to alleviate food insecurity, such as the Chicago Initiative on Global Development.

 

Reference

NAP. (2022). 7 U.S. policy in food and nutrition: Mitigating the nutritional impacts of the global food price crisis. The National Academies Press. https://nap.nationalacademies.org/read/12698/chapter/9

Hi Skylar,

R: Thank you for your post. I agree with you that social determinants can affect personal behaviors and physical environments. Evidence points that unhealthy diet lead to various chronic diseases such as heart disease, diabetes, cancer and many more. Even though high quality food and ingredients can be expensive, the benefit outweighs the cost. Food is a determinant to health and lack of access to affordable and nutritious food is a major public health problem especially for those in low socio economic status. Just like The National School Lunch Program (NSLP) that provides free foods or low cost lunches to the students  to help fuel their body to promote physical and mental development. The Supplemental Nutrition Assistance Program (SNAP) also defend against food insecurity and hunger. It has reduced food insecurity by 30%.

I: Do you know that more than some of the people who are food insecure do not qualify for SNAP, therefore they are left with few options of getting healthy food?

S: The eligibility status of these free food or discounted food supply makes it difficult for many to have assess to healthy foods. I refer you to read the “Social Determinants of Health – Food Insecurity by Altarum” to learn more on the eligibility stamp by these food suppliers. I believe that there should be no barrier to receiving foods from these organization.

E: Good post.

Reference

Social Determinants of Health – Food Insecurity by Altarum” https://www.healthcarevaluehub.org/improving-value/browse-strategy/social-determinants-health-food-insecurity

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NUR 740 Discussion 5.1: Health Disparities

NUR 740 Discussion 5.1: Health Disparities

Hello Skylar,

I agree with you that the Healthy People 2020 lists five categories of health determinants as economic, personal, biological, social, and environmental. Surprisingly, most of these determinants overlap (People, 2020). The overlapping nature confirms that personal health is an accumulation of various aspects. Therefore, as people work to become healthy it is important to consider the five categories of health determinants.  Genetic makeup may cause hereditary health complications.  Similarly, poor nutritional choices are a threat to individual health. The National School Lunch Program (NSLP) was a project initiated after realizing nutritional problems among learners (Joyce et al., 2018).  Under and overweight are common nutritional complications in most modern households. Therefore, government intervention is helpful in maintaining good nutrition choices. The outbreak of COVID-19 pandemic was a global health concern. People were required to stay at home. As a result, there were minimal physical fitness exercises. Movement restrictions increase chances of people adding more weight.

 

References

Joyce, J. M., Rosenkranz, R. R., & Rosenkranz, S. K. (2018). Variation in nutritional quality of school lunches with implementation of National School Lunch Program guidelines. Journal of School Health88(9), 636-643. https://doi.org/10.1111/josh.12665 (Links to an external site.)

People, H. (2020). Healthy People 2020 framework. The vision, mission, and goals of Healthy People 2020. Overarching goals.

Skylar,

Thanks for your post. I agree with you. Adults who are food insecure may be at an increased risk for a variety of negative health outcomes and health disparities. Physical location can cause food insecurity. In 2020, in Detroit, 31.6% of low-income households were food insecure, compared to the national average of 12.3% (Carlson et. al., 2020). It leads to various health issues.  For example, a study found that food-insecure adults may be at an increased risk for obesity (Holben et.al., 2016). Another study found higher rates of chronic disease in low-income, food-insecure adults between the ages of 18 and 65 and food-insecure children may also be at an increased risk for a variety of negative health outcomes, including obesity and developmental problems (Gundersen, 2019). In addition, reduced frequency, quality, variety, and quantity of consumed foods may have a negative effect on mental health (Gundersen, 2019).

What other factors besides location can influence food insecurity? Do you think factors such as  employment, race/ethnicity, and disability affects food insecurity?

References

Carlon, S. J., Andrews, M.S., &  Bickel, G. W. (2020). Measuring food insecurity and hunger in the United States: development of a national benchmark measure and prevalence estimates. The Journal of nutrition129, 510S–516S. https://doi.org/10.1093/jn/129.2.510S

Gundersen, C. (2019). Bounding the effects of food insecurity on children’s health outcomes. Journal of health economics28(5), 971–983. https://doi.org/10.1016/j.jhealeco.2009.06.012

Holben, D. H., & Pheley, A. M. (2016). Diabetes risk and obesity in food-insecure households in rural Appalachian Ohio. Preventing chronic disease3(3), A82.

Health disparities basically denote avoidable contrast in the burden of infection, injury, viciousness, or potential changes to accomplish the ideal wellbeing that is capable of socially distraught populations. One of the profound health disparities includes the burden of disease. The disparity in relation to the burden of infection has been recently associated with several causes, specifically differences in racial or ethnic affiliations. Essentially, system inequities rooted in ethnicity or race have been established to be a key social determinant factor leading to the variation in the rate of certain infections, such as diabetes and asthma, among individuals in the United States of America.

For instance, as apparent from an evidenced-based investigation by Fine et al. (2005), African Americans and Latino populations are more prone to diabetes and asthma than Whites or other US populace. Specifically, Puerto Ricans have the highest prevalence rate of asthma in contrast to other racial and ethnic communities in the country (Fine et al., 2005). Although genetic factors have been determined to play an integral role in the variation of infection rates between the aforementioned populations, some evidence has revealed additional social determinant factors in relation to the cause of asthma.

It is worth noting that Nevada is one of the states in the US with more than five legislations endeavored to resolve health disparities. One of these recent policies particularly focused on addressing the issue of racial inequality in health includes Bill H.4672-2020 (NV SCR 1). Precisely, the subsequent bill proposes specific activities to address the general public wellbeing and health crisis brought about by systemic racism and enormously amplified by the COVID-19 pandemic (NCSL, 2022). The respective policy attempts to reduce the emerging healthcare gap between racial groups by focusing on mitigating certain health complexities that may predispose individuals to the severe impacts of COVID-19 disease. While the policy might be relevant during the COVID-19 pandemic era, it should be further reformed to also address other perennial health disparities in systemic racism beyond just COVID-19 disease, such as diabetes and asthma in Nevada.

References

Fine, M. J., Ibrahim, S. A., & Thomas, S. B. (2005). The role of race and genetics in health disparities research. American Journal of Public Health95(12), 2125-2128.

NCSL. (2022, June 14). Health disparities: State laws. Legislative News, Studies and Analysis | National Conference of State Legislatures. https://www.ncsl.org/research/health/health-disparities-laws.aspx

Hi Romina,

Race is always an important factor to consider when diagnosing and treating a disease. In addition to diabetes and asthma, the COVID-19 virus affected Black Americans, Hispanic/Latinos, and American Indians/Alaska Natives more than Caucasians (National Academies of Sciences, Engineering, and Medicine, 2021).  What are the activities the bill proposes and how do they mitigate the health complexities? Are the activities focused toward healthcare providers, politicians, or the general public? What are ways as an advanced practice nurse (APN) you can support the disparities seen among races? One reason people of color (POC) may have a higher exposure to COVID-19 is due to lack of accessible healthcare in their neighborhood or community (National Academies of Sciences, Engineering, and Medicine, 2021). One way we can help as healthcare providers is by donating our time and expertise to free clinics or volunteer based opportunities in these neighborhoods. Another way I work to help bridge health disparities throughout my clinic is by making sure patients have the resources to follow through on treatment plans. We frequently do skin biopsies that require daily Vaseline and bandage changes. I will make sure patients have the supplies at home for dressing changes, if not I send the patient home with supplies with permission from management. I also check to make sure someone can help them if the biopsy is in a hard to reach location. If not, I provide resources in the community that can help with dressing changes.

References

National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on the Future of Nursing 2020–2030. (2021, May 11). Chapter 2, “Social determinants of health and health equity (Links to an external site.) (Links to an external site.).” In J. L. Flaubert, S. Le Menestrel, D. R. Williams, & M. K. Wakefield (Eds.), The future of nursing 2020–2030: Charting a path to achieve health equity. National Academies Press.

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