NRS-429N Health Promotion in Minority Populations Solved

NRS-429N Health Promotion in Minority Populations Solved

Health promotion measures are a core component of lowering the general cost of healthcare. The health promotion measures emphasize on disease prevention and promote wellness programs such as educating the public on healthy behaviors, community health surveillance, emphasizing on behavioral change, societal change and general awareness on maintaining a healthy lifestyle (CDC, 2019). The minority groups refer to the people who are disadvantaged in the society because of race, ethnicity, disability, gender or sexual orientation. This paper aims at discussing the health promotion measures among the minority native Hawaiian population.

Identification and Description of Selected Minority Group

The selected minority group is the native Hawaiian. It Guam, Samoa or the other groups of the pacific islanders. The 2019 US census data reveals that there are about 1.4 million native Hawaiian which makes up to 04 percent of the total US population (“Native Hawaiian/Other Pacific Islander – The Office of Minority Health”, 2019). Majority of this population reside in Hawaii; however, with minority population distributed in other states It is also known to have a higher percentage of youth population compared to the native white Americans with 29.9 percent of this group being below the age of 18 years compared to the 18.8 percent of the non-Hispanic whites (“Native Hawaiian/Other Pacific Islander – The Office of Minority Health”, 2019).

According to the 2019 census report, 88. 7 percent of the native Hawaiians had a high school diploma or higher qualification compared to 93.3 percent of the non-Hispanic whites. Of this population only 23. 8 percent had a bachelor’s degree or higher as compared to the 36.9 percent of the non-Hispanic whites. Moreover, in terms of attainment of professional degrees, only 7.4 percent of the native Hawaiian had this attainment compared to the 14,3 percent of the whites. Economically, the median household income for native Hawaiian was $66,695 compared to $ 71,664 for the non-Hispanic whites. Additionally, in terms of poverty level, 14 percent of the native Hawaiian live-in poverty compared to the 9.0 percent of the whites.

Health Disparities and Nutritional Challenges for Native Hawaiians

Majority members of this group depend on the state and federal aid to access healthcare services as only 65.8 percent of the group used private insurance cover as of 2019 compared to the 74 percent for the whites. The life expectancy for this group is lower compared to the national average. The native Hawaiian life expectancy for women is at 83.2 years while for men is at 78.5 years which gives an average of 80.8 years. The population also records a higher percentage of cigarette smoking, alcohol consumption and obesity. The population has also recorded higher cases of heart diseases, injuries resulting from accidents, diabetes and stroke. In addition to these health risks, the population records higher prevalence to HIV/AIDS, tuberculosis and hepatitis B.

The nutritional pattern of this population is majorly carbohydrates with vegetables and a small percentage of lean meat. This poses a greater nutritional challenge to the people. Most of the families are not able to achieve a balanced diet. This has had greater impact to the health status of the population hence recording higher incidences of obesity and other related conditions such as heart diseases and stroke. With the adoption of the western lifestyle and higher calorie intake coupled with less physical activity, the native Hawaiian population stands at a greater risk of overweight and obesity.

Barriers to Health for Native Hawaiians

For native Hawaiian population the socioeconomic barriers rank among the top. The population has is of lower economic status making it difficult to access quality healthcare services (Park et al., 2018). Most of the families do not have medical insurance covers. Lower level of education also makes it difficult to raise awareness on the health promotion measures as most of the families are not well-informed better lifestyle choices. Due to lower income, the housing, nutrition and hygiene standards are low. Families that cannot afford a balanced diet exposes the children to malnutritional disorders. It is imperative to note that as a result of low living standards, the youth are likely to resort to careless lifestyles of violence, drug and substance use that generally affect their general health standards. There are also increased of irresponsible sexual behavior that exposes this population to greater risks of HIV/AIDS and related comorbidities like tuberculosis.

Health Promotion Activities Practiced by Native Hawaiians

The native Hawaiian population have practiced the use of traditional medicines and herbs to treat basic health conditions such as stomachache, headache and other minor conditions like injuries such as burns. This tradition, commonly referred to as la’au lapa’au, has played a significant role in the health promotion measures of this population. Additionally, communities in this population have fostered strong traditions of conflict resolution and mediation that have promoted harmonious living among the family members and the community. The native Hawaiian conflict solution practice of ho’oponopono has been used for many years and has proved to be effective in resolving internal conflicts and strengthen the societal fabric hence better social wellbeing of the members (Smith, 2016).

 

Three Levels of Health Promotion Prevention

The primary health promotion measures for this population will include the use of physical exercise as a means of tackling cases of overweight and obesity (Braden & Nigg, 2016). Physical exercise helps urn the excess calories and fats hence maintain a lean body and reduce the incidences of diseases such as obesity, type-2 diabetes, high blood pressure and stroke. Secondary health promotion measure involves encouraging members of the population to attend regular screening sessions. Research findings show that early detection and treatment of most of the common cancers has proved to be successful in elimination of the cancers (Kaholokula et al., 2018). Tertiary health promotion measure involves educating the community on how to self-manage the various health conditions or chronic diseases they are suffering from. This will help the patient manage the conditions properly.

Culturally Competent Health Promotion for Ethnic Minority Population

In the process of designing the health promotion measures for various populations, it is imperative to put into consideration the cultural practices, beliefs and the traditions of the community members. This ultimately affect the decision-making process of this members when choosing the health promotion measure or the medical interventions available to them (Albougami, Pounds, & Alotaibi, 2016). The model used in developing a culturally sensitive health promotion measures for this group is the transcultural model. It focuses on the need to have the assessment of individual needs as unique and approach it in a unique way as dictated by the individual’s culture and beliefs (Albougami, Pounds & Alotaibi, 2016). The model pays keen attention to the six dimensions associated with every culture, that is; communication, social organization, space, environmental control, and biological variation.

Conclusion

The native Hawaiian population have various disparities that expose them to a greater health risk. Majority of the community members have limited access to education hence compromised ability to secure meaningful employment. It is imperative to note that the nutritional patterns of the native Hawaiian overly constitute of carbohydrates which is a contributing factor in high cases of obesity. In the development of the health promotion measures, it is important to put into consideration the cultural beliefs and practices of the community. It is these practices and beliefs that have a long-term impact to the kind of decisions made by members of the community towards achieving quality health and lifestyle.

References

Albougami, A. S., Pounds, K. G., & Alotaibi, J. S. (2016). Comparison of four cultural competence models in transcultural nursing: A discussion paper. International Archives of Nursing and Health Care, 2(3), 1-5. DOI: 10.23937/2469-5823/1510053

Braden, K. W., & Nigg, C. R. (2016). Modifiable determinants of obesity in Native Hawaiian and Pacific Islander youth. Hawai’i Journal of Medicine & Public Health, 75(6), 162. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928515/

CDC. (2019, May 29) – Healthy Communities Program – Journal Articles on Successes – NCCDPHP: Community Health.Www.cdc.gov. https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/evaluation-innovation/successarticles.htm

Kaholokula, J. K. A., Ing, C. T., Look, M. A., Delafield, R., & Sinclair, K. I. (2018). Culturally responsive approaches to health promotion for Native Hawaiians and Pacific Islanders. Annals of human biology, 45(3), 249-263. doi: 10.1080/03014460.2018.1465593

Native Hawaiian/Other Pacific Islander – The Office of Minority Health. (2019). Hhs.gov. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=65

Park, J. J., Humble, S., Sommers, B. D., Colditz, G. A., Epstein, A. M., & Koh, H. K. (2018). Health insurance for Asian Americans, Native Hawaiians, and pacific islanders under the affordable care act. JAMA internal medicine, 178(8), 1128-1129. doi:10.1001/jamainternmed.2018.1476

 

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

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

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