In a paper of 1,000-1,250 words, compare and contrast the health status of the African-American minority group to the national average

NRS 429 Health Promotion in Minority Populations

A minority population refers to a group of people who make up less than half of a country’s or state’s population and whose members have common characteristics of religion, culture, race, ethnicity, or language. Minority racial/ethnic groups in the US have distinctive health characteristics and attributes that are often socially disadvantaged due to being subjected to potential discriminatory acts. The purpose of this paper is to discuss the health status of American Indians/Alaska Natives and explore the health disparities, barriers to health, and health promotion activities and approaches.

Ethnic Minority Group

American Indians/Alaska Natives (AI/AN) are a minority ethnic group in the US comprised of people with origins from North, Central, and South America who preserve the tribal and community affiliation. According to the Census Bureau, 9.7 million people identified themselves as AI/AN alone or in combination with another race in 2020 (Frey, 2020). The number has increased from 5.2 million in 2010. AIAN currently accounts for 2.9% of the US population. AI/AN are the second-largest racial group in various states after Whites (Frey, 2020). States with the highest population of AIAN are Alaska (14.8%), New Mexico (8.9%), South Dakota (8.4%), Montana (6 %), and North Dakota (4.8 %).

Generally, AI/ANs have a poorer health status than the majority population. Statistics show that 22.4% of adults aged 18 years and older are in fair or poor health. The common diseases among AI/AN include heart diseases, cancers, diabetes, stroke, and unintentional injuries. The U.S Office of Minority Health (OMH) states that AI/ANs have a high incidence and risk factors for obesity, diabetes, mental health disorders, substance use, suicide, unintentional injuries, sudden infant death syndrome, teenage pregnancy, liver disease, and hepatitis. The leading causes of death among AI/AN in 2020 were COVID-19 complications, Heart disease, and Cancer (OMH, 2021). AI/AN continues to have higher mortality rates than the general population due to various conditions, including chronic lower respiratory diseases, diabetes mellitus, chronic liver disease, cirrhosis, assault/homicide, unintentional injuries, and intentional self-harm/suicide. In 2020 AI/AN had 967.1 deaths per 100,000 population (OMH, 2021). Race and ethnicity influence the health of AI/AN since individuals encounter various issues that bar them from receiving quality medical care, including geographic isolation, cultural barriers, poor sanitation facilities, and low income.

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A health disparity refers to a health difference that negatively affects disadvantaged or minority populations. AI/AN have a lower

In a paper of 1,000-1,250 words, compare and contrast the health status of the African-American minority group to the national average

quality of life and a lower life expectancy. In addition, they are disproportionately affected by numerous chronic disorders. A study by Adakai et al. (2018) found that AI/AN had a significantly higher prevalence of overweight/obesity, diabetes, hypertension, physical inactivity, and consumption of sugar-sweetened beverages. Compared to the entire U.S. population, chronic liver disease, diabetes, and cirrhosis are more common causes of mortality among the AI/AN population (Adakai et al., 2018). Chronic respiratory diseases are also prevalent among the population. According to OMH, AI/AN had a tuberculosis rate about seven times more than Whites, with an incidence rate of 3.4, while for Whites was 0.5 (OMH, 2021). Furthermore, mental health and substance use disorders are a disparity in AI/AN. Disorders like depression, psychological distress, alcohol abuse, and suicide are the leading cause of death.

Nutritional challenges are prevalent among AI/ANs, as evidenced by nutrition-related disorders. Poor dietary habits in this community have been associated with a high prevalence of lifestyle diseases like overweight/obesity, diabetes, cancer, and heart disease. Obesity/overweight rates are higher among AI/ANs than in the general population. Their diet is of poor nutritional value with high calories (Adakai et al., 2018). This is associated with limited access to healthy traditional foods, westernization, and poverty levels limiting access to healthy food options resulting in high consumption of unhealthy foods.

Barriers to Health

Cultural, socioeconomic, education, and sociopolitical factors are common barriers to health among AI/AN. Cultural factors like the use of traditional healers affect their health-seeking behaviors, while language barriers limit the interactions with health providers and accessing health education. AI/ANs have a low socioeconomic status with poverty levels above the national average, contributing to poorer health outcomes. The community has high uninsurance rates of 27.3% among adults aged 18–64, limiting their access to essential and specialized healthcare services (Cromer et al., 2019). Furthermore, AI/ANs have a low education level compared to the general population, with a high population not completing high school. In 2019, 84.4% of A AI/ANs had completed high school, as opposed to 93.3% of non-Hispanic whites. The low educational levels adversely affect their health-seeking behaviors leading to poor health outcomes (Cromer et al., 2019). Sociopolitical factors like the late 19th century policies that banned the AI/AN religious practices, native language, and traditional healing practices and confiscated their land have limited access to health (Mangla & Agarwal, 2021). AI/ANs developed a mistrust of other ethnic groups and are thus reluctant to access health care from providers of other ethnic groups.

Health Promotion Activities

AI/ANs practice various health promotion interventions to improve their health and overall wellbeing. Traditional healing practices are common, including native herbal remedies and allopathic medicine. In addition, AI/ANs use spiritual healing to promote overall spiritual wellbeing, which they believe is vital in promoting better health and wellbeing (Cromer et al., 2019). For instance, AI/ANs combine herbs, spiritual ceremonies, manipulative therapies, and prayers to prevent and manage different health conditions. Positive social behaviors are reinforced among children through stories and legends, which help lower the crime rate in the community. Furthermore, AI/ANs living in Arizona have adopted daily running to improve physical health and spiritual wellbeing.

Health Promotion Approach

Health education is the most effective approach that can be applied at the primary, secondary, and tertiary levels in implementing a care plan for AI/AN. The community has a high prevalence of lifestyle conditions, and health education would be crucial in alleviating the risk factors to prevent the diseases (Kaur et al., 2022). Besides, health education can educate the community on screening services for chronic illnesses and educate individuals diagnosed with these conditions on managing their condition effectively. Health education is the most effective strategy since it changes individuals’ health behaviors and attitudes, resulting in healthier lifestyle practices (Kaur et al., 2022). For instance, educating the community on preventive measures for obesity can help them adopt weight management measures and ultimately lower the risk of other lifestyle diseases.

Cultural Beliefs/Practices to Consider in a Care Plan

A community care plan should incorporate the people’s cultural beliefs and practices to ensure it is culturally appropriate. The nurse should consider cultural beliefs and practices, including health promotion practices, dietary customs and preferences, cultural rituals, and traditional healing practices like the use of herbs. The nurse should incorporate the community’s health promotion practices (Purnell, 2019). In addition, the nurse should consider the community’s dietary customs when creating the nutrition plan and include foods available in the community. The nurse should also research the useful herbs that a community uses and include them in the care plan rather than discourage them.

The Purnell Model would be ideal for promoting culturally competent health promotion in AI/AN. It guides cultural competence among multidisciplinary members of the healthcare team. The model interrelates cultural characteristics to promote congruence and the delivery of consciously sensitive and competent patient care (Purnell, 2019). The Purnell Model supports culturally competent health promotion since it proposed that a person has the right to be respected for their uniqueness and cultural heritage.

Conclusion

AI/ANs have a high prevalence of lifestyle diseases like obesity/overweight, diabetes, hypertension, heart diseases, and cancer. In addition, mental health is a major concern due to a high incidence of depression, substance use disorders, and suicide. Inadequate access to healthy foods has led to high rates of lifestyle diseases. Factors that adversely affect their health outcomes include high uninsurance rates, low education levels, high poverty rates, language barriers, and mistrust of others. Health education can be used in the three levels of health promotion.

References

Adakai, M., Sandoval-Rosario, M., Xu, F., Aseret-Manygoats, T., Allison, M., Greenlund, K. J., & Barbour, K. E. (2018). Health disparities among American Indians/Alaska Natives—Arizona, 2017. Morbidity and Mortality Weekly Report, 67(47), 1314. http://dx.doi.org/10.15585/mmwr.mm6747a4

Cromer, K. J., Wofford, L., & Wyant, D. K. (2019). Barriers to healthcare access facing American Indians and Alaska Natives in rural America. Journal of community health nursing, 36(4), 165-187. https://doi.org/10.1080/07370016.2019.1665320

Frey, W. H. (2020). The nation is diversifying even faster than predicted, according to new census data. Brookings Institute.

Kaur, S., Kaur, M., & Kumar, R. (2022). Health promotion intervention to prevent risk factors of chronic diseases: Protocol for a cluster randomized controlled trial among adolescents in school settings of Chandigarh (India). PloS one, 17(2), e0263584. https://doi.org/10.1371/journal.pone.0263584

Mangla, A., & Agarwal, N. (2021). Clinical Practice Issues In American Indians and Alaska Natives. In StatPearls [Internet]. StatPearls Publishing.

Purnell, L. (2019). Update: The Purnell theory and model for culturally competent health care. Journal of Transcultural Nursing, 30(2), 98-105. https://doi.org/10.1177/1043659618817587

The Office of Minority Health. (2021, May 21). American Indian/Alaska native – The Office of Minority Health. Not Found. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=62

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The major minority ethnic/racial populations in the United States (U.S) include African Americans, Asians, American Indians/Alaska Natives, Pacific Islanders, and Hispanics. The minority groups face many cultural, socioeconomic, and sociopolitical barriers in accessing health care resulting in poor health status (Stanley et al., 2020). Consequently, the barriers cause major health disparities in these communities, which cause high morbidity and mortality rates. In this regard, this paper will discuss the health status of American Indians/Alaska Natives, including their health status, health disparities, healthcare barriers, and health promotion activities they practice.

American Indians/Alaska Natives

American Indians/Alaska Natives (AI/AN) are a minority population in the US consisting of individuals with origins from the people originating from North, Central, and South America, who keep up with the tribal or community affiliation. According to the U.S Office of Minority Health (OMH), approximately 5.7 million persons in 2019 were identified as only AI/AN or mixed with another ethnicity. AI/ANs constitute 1.7% of the overall U.S. population. Of this population, 27.5% (1.6 million) were below 18 years (OMH, 2021). The AI/AN tribes recognized federally receive health and education assistance through the Indian Health Service (IHS), a government agency. The IHS manages an all-inclusive health service delivery system for about 2.6 million AI/ANs. The AI/ANs living in urban areas generally have limited access to healthcare. Studies on AI/ANs living in urban areas have established a pattern of poor health and few health care options.

Health Status of AI/ANs

AI/ANs generally have a poor health status evidenced by a lower quality of life, a lower life expectancy, and a higher prevalence of many chronic illnesses. The 2020 life expectancies at birth for AI/ANs were 78.4 years, 81.1 years for females, and 75.8 years for males (OMH, 2021). The expectancy is lower than that of non-Hispanic whites, 80.6 years, 82.7 years for females, and 78.4 years for males. The prevalent diseases and common causes of mortality include diabetes, heart disease, unintentional injuries, cancer, and stroke. In addition, they have a high occurrence and risk factors for mental health disorders, suicide, substance use, teenage pregnancy, obesity, sudden infant death syndrome (SIDS), liver disease, and hepatitis (OMH, 2021). They also have a high TB rate, seven-fold higher than Whites. Race/ethnicity influences health for AI/ANs as they face issues that bar them from receiving quality health care. The issues include geographic isolation, cultural barriers, low income, and inadequate sewage disposal.

Health Disparities and Nutritional Challenges

AI/ANs have most of the debilitating health disparities in the U.S. According to the National Vital Statistics Reports, accidents contributed to 11.6% of total mortalities in 2017 among AI/ANs compared to 6.0% of total mortalities in the general US population (Heron, 2019). Besides, diabetes caused 5.8%, and chronic liver disease/cirrhosis led to 5.5% of AI/ANs mortalities. Depression is a major disparity among AI/ANs. AI/ANs are 2.5 fold highly likely than non-Hispanic Whites to develop severe psychological distress. Furthermore, alcohol consumption causes AI/AN accident mortality, which is the third common cause of mortality, while cirrhosis/chronic liver disease is the fifth leading (Heron, 2019). Suicide is also a significant health disparity for AI/ANs with mental health and social elements. The suicide mortality rate for AI/ANs is 16.9/100,000, while for Whites is 13.1/100,000.

The AI/ANs experience significant nutrition-related chronic illnesses, such as diabetes, obesity, cancer, and heart disease. They have higher obesity rates than nearly all ethnic groups (Carron, 2020). Poverty, in addition to a history of sponsored food programs, have contributed to diets high in calories and with poor nutritional value. Warne and Wescott (2019) explain that lack of access to traditional AI/ANs food systems and limited financial opportunities on most AI/ANs reservations are major social determinants that put the population at high risk for obesity. Furthermore, AI/ANs face challenges of limited access to grocery stores supplying healthy foods resulting in a high intake of unhealthy foods.

Barriers to Health from Culture, Socioeconomics, Education, and Sociopolitical Factors

AI/ANs culture creates barriers in accessing health care due to language barriers, making it challenging for providers to offer appropriate preventative interventions. They practice traditional healing, which lowers their health-seeking behaviors. Socioeconomic status and level of education are predictors of health status (Mangla & Agarwal, 2021). AI/ANs have a high population that has not completed high school. Besides, approximately 19% of the population has incomes lower than the federal poverty level (Carron, 2020). The low socioeconomic and poverty status has contributed to poor health-seeking behaviors and low insurance coverage rates, limiting healthcare access. Sociopolitical factors further limit access to health for AI/ANs. From the late 19th century, federal governments enacted various policies to wipe out the native culture and identity. The policies caused the banning of the native language and religious practices, confiscation of land, and ban of traditional healers, which led to a profound mistrust in the community (Mangla & Agarwal, 2021). As a result, AI/ANs have mistrust in accessing care from providers from other communities, limiting their access to healthcare.

Health Promotion Activities Practiced By AI/ANs

Health promotion activities practiced by AI/ANs include traditional healing practices using allopathic medicine and native herbal remedies to improve health and wellbeing. Spiritual treatments are vital for health promotion and healing in the AI/ANs community. Natives in Arizona run every day to greet the dawn, promoting physical health and spiritual wellbeing. Besides, they use stories and legends to reinforce positive behaviors and the implications of failing to uphold the laws of nature. AI/ANs use manipulative therapies, herbs, ceremonies, and prayer in different combinations to prevent and treat diseases.

Health Promotion Approach

The primary level of health promotion attempts to remove the possibility of getting a disease. It is likely to be most effective in a care plan for AI/ANs, considering the population’s high prevalence of chronic illnesses and mental health disorders. Through primary health promotion, individuals can be provided health education directed on preventing chronic diseases such as diabetes and heart disease (Peckham et al., 2017). For instance, it can target excessive alcohol consumption, inadequate exercise, and unhealthy dietary patterns, thus reducing the chances of liver disease, obesity, diabetes, and accidents. Primary prevention is the most effective choice since it can help change the community’s behaviors, thus lowering their chance of developing diseases caused by unhealthy behaviors.

Cultural Beliefs/Practices to Consider When Creating a Care Plan

Providers must understand the differences in cultural beliefs and practices among various ethnic groups when developing a care plan. Health providers should consider the differences present in the belief of individuals from the AI/AN community. Even though many AI/AN tribes have adopted Christianity, their culture remains deep-rooted in their traditions (Mangla & Agarwal, 2021). Therefore, they should be considered to ensure the provision of culturally appropriate care. The nurses creating the care plan for an AI/AN individual or community should obtain information on their health practices, cultural beliefs, dietary customs, and cultural rituals.

The Purnell Model for Cultural Competence would be ideal for fostering culturally competent health promotion for AI/ANs. The Purnell Model enables providers to collect patient information and conduct health promotion activities focusing on 12 cultural domains (Purnell, 2019). The cultural domains are: high-risk behaviors, health care practices, nutrition, pregnancy, family roles and organization, heritage, communication, spirituality, workforce issues, biocultural ecology, health care professionals, and death rituals (Purnell, 2019). Consequently, the Purnell Model can establish unhealthy behaviors among AI/ANs and plan health promotion activities for the population.

Conclusion

AI/ANs AI have a poor health status evidenced by a lower quality of life, a lower life expectancy, and a higher prevalence of illnesses such as diabetes, obesity, liver disease/hepatitis, and mental disorders. They face substantial health disparities in various areas, including metabolic and mental disorders. Health disparities are apparent in accidents, diabetes, chronic liver diseases, and mental disorders. Besides, their lower socioeconomic and educational status is connected with worse health outcomes. Primary prevention is the most effective for this population to modify behaviors that cause chronic illnesses.

References

Carron, R. (2020). Health disparities in American Indians/Alaska Natives: Implications for nurse practitioners. The Nurse Practitioner, 45(6), 26-32.

Heron, M. (2019). Deaths: leading causes for 2017 [USA]. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 68(6), 1-77.

Mangla, A., & Agarwal, N. (2021). Clinical Practice Issues In American Indians and Alaska Natives. In StatPearls [Internet]. StatPearls Publishing.

Peckham, S., Hann, A., Kendall, S., & Gillam, S. (2017). Health promotion and disease prevention in general practice and primary care: a scoping study. Primary health care research & development, 18(6), 529-540. https://doi.org/10.1017/S1463423617000494

Purnell, L. (2019). Update: The Purnell theory and model for culturally competent health care. Journal of Transcultural Nursing, 30(2), 98-105. https://doi.org/10.1177/1043659618817587

Stanley, L. R., Swaim, R. C., Kaholokula, J. K. A., Kelly, K. J., Belcourt, A., & Allen, J. (2020). The imperative for research to promote health equity in indigenous communities. Prevention Science, 21(1), 13-21. https://doi.org/10.1007/s11121-017-0850-9

The Office of Minority Health. (2021, May 21). American Indian/Alaska native – The Office of Minority Health. Not Found. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=62

Warne, D., & Wescott, S. (2019). Social determinants of American Indian nutritional health. Current developments in nutrition, 3(Supplement_2), 12-18. https://doi.org/10.1093/cdn/nzz054