Health Disparity: A Primary Care Challenge in an Urban Population

1. Health Disparity: A Primary Care Challenge in an Urban Population Sylvia Assiamah Coppin State University NURS 660 Family Care of the Adult/Older Adult Professor Setlow May 07, 2013

2. Introduction • The issue of health disparity affects millions of people worldwide. • Unfortunately, in America, health disparity is as much an issue for individuals, families, and communities, as it is in less developed countries. • Despite efforts to bridge the gap between populations, health disparities disproportionately affects urban communities, in comparison to other populations.

3. Introduction • The Centers for Disease Control and Prevention (CDC), cites “poverty, unequal access to health care, poor environmental conditions, educational inequalities, individual behaviors, and language barriers as significant contributors to health disparities” (CDC, 2011). • To illustrate the complexities of health disparity, Fink (2009) define health disparity as the “difference in a measurement of access to or quality of health care services between an individual and or group possessing a defined characteristic when other variables such as individual health choices, and disease progression, are manipulated” (Fink, 2009).

4. The Impact of Health Disparity in Urban Populations • Consider for instance low health literacy as an element of health disparity. If patients are not able to read and understand basic health information which will help them contribute to their health, then they face a disparity. • La Vonne and Zun (2008) writes “low health literacy is associated with lower compliance with treatment regimens and lower self-rated health status, as well as decreased ability to share in healthcare decision-making”. When low health literacy causes health disparity, the health care system becomes overburdened with cost.

5. The Impact of Health Disparity in Urban Populations • Health disparity accentuates diseases such as tuberculosis, sexually transmitted diseases, influenza, pneumonia and other air borne diseases, and has the potential of turning these diseases into a public health nightmare. • The afore mentioned diseases are preventable and manageable diseases, however, when health disparity exists, preventive care becomes, rare, and management of common ailments become difficult to treat, causing more people in the population to become sick, and difficult to treat.

6. Prevalence of Health Disparity in Urban Populations • People who reside in urban communities tend to be of a minority race, have a low socioeconomic status, and likely to lack access to health insurance. It is therefore not surprising that, “these populations face barriers to care, receive poorer quality care, and disproportionately use emergency systems” ("Urban versus rural,”). • Although health disparities transcends above racial lines, it is common to determine the extent of disparity along racial lines. In comparison to other populations, African Americans, Hispanics, and Native Americans, have poor disease survival rates. According to Williams and Mohammed (2008) “for most of the 15 leading causes of death including heart disease, cancer, stroke, diabetes, kidney disease, hypertension, liver cirrhosis and homicide, African Americans (or blacks) have higher death rates than whites”.

7. Resources/Agencies that have taken Initiatives/Efforts to Address Health Disparity • Centers for Disease and Control Prevention (CDC) • The Affordable Care Act (ACA) of 2010 • the National Institute of health (NIH), the New York Academy of Medicine (NYAM) • National Center for Complementary and Alternative Medicine (NCAAM • Food and Drug Administration (FDA), and a whole lot more.

8. Barriers Which Impede Resolving Health Disparity • A common trend is racial discrimination. Long standing racism, has led to unequal access to essential social, educational, and material resources. • These “ resources have both direct effects on health status and indirect effects on health status, through their influence on stress, psychosocial resources, and positive and negative emotions” (Williams & Mohammed, 2008). • Social, economic, and educational factors can also impede efforts to reduce health disparity in urban population. Woolf and Braveman (2011) argue that “inadequate education and living conditions-ranging from low income to the unhealthy characteristics of neighborhoods and communities can harm health through complex pathways”.

9. Review of Literature • A minority initiative health fact sheet documents that “67 million people that is one out of every three Americans under the age of 65 were uninsured for some period of time during 2007-2008. • However; a closer look at the numbers reveals alarming racial and ethnic disparities in health coverage” ("Health care reform: Critical," 2009).

10. Implications of Health Disparity for Nurse Practitioners • As more efforts are being made through legislative efforts, it is time for nurse practitioners to get involved in the process of legislation that seeks to provide equal opportunities for better health maintenance in all communities. • Nurse practitioners “should take advantage of opportunities to comment on proposals, legislative or otherwise, that have the ability to influence the health of themselves, their families, their patients, their communities, and the nation” (Newland, 2009). • It is important that nurse practitioners recognize the magnitude of the problem, and work in collaboration with other agencies to help eliminate health disparity, and provide better health for all citizens, regardless of race, culture, gender, ager or socioeconomic background.

11. References Centers for Disease Control and Prevention, (2011). CDC releases first periodic health disparities. Retrieved from website: CDC Health Disparities & Inequalities Report (CHDIR) Fink, A., M. ( 2009). Toward a new definition of health: A concept analysis. Journal of Transcultural Nursing, 20(4), 349 – 357. La Vonne, A. D., & Zun, L. S. (2008). Assessing adult health literacy in urban. Journal of the National Medical Association, 100(11), 1304-1309. Newland, J. (2009). Editor's memo: Healthy people 2020 reflects our changing times. The Nurse Practitioner: The American Journal of Primary Health Care, 34(12), 5. Orsi, J. M., Margellos-Anast, H., & Whitman, S. (2010). Black-white health disparities in the United States and Chicago: A 15-year progress analysis. American Journal of Public Health, 100(2), 349-56.

12. References Raphael, J. L., & Beal, A. C. (2010). A review of the evidence for disparities in child vs. adult health care: A disparity in disparities. Journal of the National Medical Association, 102(8), 684-691. U.S Department of Human and Health Services, (2011). HHS action plan to reduce racial and ethnic health disparities. Retrieved from website: http://minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=285 USA Minority Health Initiatives, (2009). Health care reform: critical to closing the gap for communities of color. Retrieved from website: http://www.familiesusa.org/assets/pdfs/health-reform/closing-the-gap.pdf Urban versus rural health. (n.d.). Retrieved from http://www.uniteforsight.org/global-health- university/urban-rural-health Woolf, S. H., & Braveman, P. (2011). Where health disparities begin: The role of social and economic determinants-and why current policies may make matters worse. Health Affairs, 30(10), 1852-9. Williams, D. R., & Mohammed, S. A. (2008). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32(1), 20-47.