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185 Cards in this Set
- Front
- Back
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Social Ecological approach to behavior change
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Behavior has multiple levels of influence •Behavior change is more likely when a combination of individual, interpersonal, organizational, community, and policy-level interventions are put into place. |
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Health Education |
“any combination of planned learning experiences based on sound theories that provide individuals,groups, and communities the opportunity to acquire information and the skills to make quality health decisions”(Joint Committee, 1991).
one part of health promotion focused on voluntary behavior change |
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Health Promotion |
“any planned combination of educational,political, environmental, regulatory, or organizational mechanisms that support actions and conditions of living conducive to health of individuals, groups, and communities” |
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Program planning |
Process by which an intervention is planned •May or may not be associated with community organizing/building •Involves a series of steps •Success depends on many factors •Experienced planners use models to guide work•e.g. PRECEDE/PROCEED, Social Marketing •Before process begins, important to understand and engage target population (i.e. priority population |
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Generalized model for program planning |
1. Assessing needs 2. setting goals and objectives 3. developing an intervention 4. implementing the intervention 5. evaluating the results |
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Assessing needs of the target population |
Determining purpose and scope of needs assessment • Gathering data – e.g. surveys, focus groups,interviews with key informants • Analyzing data • Identifying factors linked to health problem • Identifying program focus • Validating prioritized need |
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Setting appropriate goals and objectives |
Foundation of the program • Portions of the programming process are designed toachieve the goals by meeting the objectives |
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Goals |
• More encompassing than objectives • Written to cover all aspects of the program • Provide overall program direction • Are more general in nature • Do not have a deadline • Often not measured in exact term |
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Objectives |
More precise than goals • Steps to achieve the program goals • The more complex a program, the more objectives needed • Composed of who, what, when, and how much |
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Intervention |
Activities that will help the target population meet the objectives and achieve the program goals •The program that the target population will experience •May be several or a few activities |
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Intervention Considerations |
Multiplicity• Dose• Best practices• Best experience• Best processes |
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Implementing the intervention |
Implementation: putting a planned program into action • Pilot test •Trial run-implementation to a small group •Determine problems and fix before full implementation • Phasing in •Step-by-step implementation; implementation with small groups |
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Evaluating the results |
Determine the value or worth of an object of interest • Guided by comparison to standards of acceptability (i.e.objectives) |
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formative (process) evaluation |
Completed during planning an implementation for the purpose of making refinements. |
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Summative evaluation |
completed after implementation |
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impact evaluation component |
aimed at measuring changes in the behavioral, environmental, or learning objectives. |
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outcome evaluation component |
aimed at measuring program objectives. |
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Steps to Evaluation |
Planning the evaluation • Collecting the data • Analyzing the data • Reporting the results • Applying the results |
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community organizing |
Process through which communities are helped to identify common problems or goals, mobilize resources, and develop and implement strategies for reaching the goals they have collectively set • Not a science, but an art of consensus building |
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community capacity |
Community characteristics affecting its ability to identify, mobilize, & address problems (Goodman et al., 1999) |
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Empowered community |
•“One in which individuals and organizations apply their skills and resources in collective efforts to meet their respective needs”
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Participation and Relevance |
“Community organizing that starts where the people are and engages community members as equals” (Minkler &Wallerstein, 2005) |
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Social Capital |
“relationships and structures within a community that promote cooperation for mutual benefit” (Minkler & Wallerstein, 2005) |
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Need for Organizing Communities |
Changes in community social structure has lead to loss in sense of community •Advances in electronics •Communications •Increased mobility • Community organizing skills extend beyond community health |
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Community Organizing Methods |
No single preferred method • All incorporate fundamental principles •Start where the people are •Participation •Create environments in which people and communities can become empowered as they increase problem-solving abilities |
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Locality Development |
Broad self participation; process oriented; stresses consensus and cooperation; builds group identity and sense of community |
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social planning |
Heavily task oriented; involves people and outside planners |
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Social action |
Task and process oriented; disadvantaged segments of the population |
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Recognizing the issue |
Initial organizer •Recognizes that a problem exists and decides to do something about it •Gets things started •Can be from within (grass-roots, citizen initiated,bottom-up) or outside of the community (top-down, outside-in) |
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organizers need: |
Cultural sensitivity, cultural competence, cultural humility |
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Organizers need to know: |
Who is causing problem and why; how problem has been addressed in past; who supports and opposes idea of addressing problem; who could provide more insight |
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Gatekeeper |
A health care professional, typically a physician or nurse, who has the first encounter with a patient and who thus controls the patient's entry into the health care system. |
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organizing the people |
Executive participants • Leadership identification • Recruitment •Expanding constituencies • Task Force • Use of Coalitions |
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Assessing the community |
Community building •Strengths-based orientation •Identification, nurturing and celebration of communityassets • Needs assessment vs. mapping community capacity |
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Criteria to consider when selecting priority issue or problem |
•Must be winnable •Must be simple and specific •Must unite members of organizing group •Should affect many people •Should be part of larger plan • Goals written to serve as guide for problem solving |
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Arriving at a Solution and Selecting Intervention Strategies |
Alternate solutions exist for every problem • Examine alternatives in terms of: •Probable outcomes •Acceptability to the community •Probable long- and short-term effects •Costs of resources |
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Final Steps |
Implementing • Evaluating • Maintaining • Looping Back |
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The need for school health |
An unhealthy child has a difficult time learning • Health and success in schools are interrelated • CSHP provides the integration of education and health |
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Coordinated School Health Program (CSHP) |
An unhealthy child has a difficult time learning • Health and success in schools are interrelated • CSHP provides the integration of education and health |
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School Health Advisory Council |
Individuals from a school or school district and its community who work together to provide advice and aspects of the school health program • Should include diverse representation • Primary role: provide coordination of the CSHP components |
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Key Personnel: School Nurses |
•Can provide great leadership for the CSHP •Has medical knowledge and formal training •Has multiple responsibilities •Often districts do not have resources to hire full time nurses |
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Key Personnel: Teachers |
Heavy responsibility in making sure the CSHP works •Often spend more waking hours with children than parents |
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Foundations of the School Health Program |
School administration that supports the effort • A well-organized school health council • Written school health policies |
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School Health Policies |
Steps for creating local health-related policies: •Identify the policy development team •Assess the district’s needs •Prioritize needs and develop an action plan •Draft a policy •Build awareness and support •Adopt and implement the policy •Maintain, measure, and evaluate |
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Monitoring Policy Status |
School Health Policies and Practices Study (SHPPS) •National survey conducted by CDC every 6 years •Assesses: •School health policies •School health practices at the state, district,school, and classroom levels |
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Components of a CSHP |
1. Administration and organization 2. School health services 3. Healthy school environment 4. School health education 5. Counseling, psychological, and social services 6. Physical education 7. School nutrition services 8. Family/community involvement 9. School-site health promotion for staff |
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A CSHP should be administered by: |
a School Health Coordinator •Usually a nurse or health teacher •Multiple responsibilities •Often not a position required by states |
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School Health Services |
Health services provided by school health workers or the school nurse to appraise, protect, and promote health •Health screenings, emergency care for injury and sudden illness, chronic disease management,communicable disease prevention and control,health counseling • Advantages: equitability, confidentiality, breadth of coverage, user friendliness, convenience |
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Healthy School Environment |
Implemented by all• By law, school districts are required to provide a safe school environment |
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Physical Environment |
Buildings and structures •Location, age, air quality, food service, temperature, etc. •Behaviors of those using them •Pedestrian safety, violence, traffic, drugs, etc. |
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Psychosocial environment |
Attitudes, values, feelings of students and staff |
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School Health Education |
The development, delivery, and evaluation of a planned curriculum primarily by a school health teacher • Includes all health education in the school: inside or outside of the classroom |
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Curriculum outlines |
Scope –the content that will be taught • Sequence –the order the content will be covered • Learning objectives • Learning activities • Possible instructional resources • Methods for assessment |
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National Health Education Standards |
Eight standards •Not a federal mandate or national curriculum •Provide foundation for curriculum development,delivery, and assessment |
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Counseling, Psychological, and Social Services |
Provided to improve students’ mental, emotional, and social health • Services can include: •Individual and group assessment •Interventions •Referrals • Professionals who deliver services include: •Certified school counselors •Psychologists •Social workers |
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Physical Education |
Planned curriculum that emphasizes physical fitness and skill development that lead to lifelong physical activity • Concerns/Goals: •Daily physical education •High involvement of children in movement activities for the majority of class. •Recess no substitute for P.E. •Teach lifelong fitness and skill development (as opposed to only team sports) •PE viewed as an intervention on health. • Taught by: P.E. teachers and homeroom teachers |
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School Nutrition Services |
• Should provide access to variety of nutritious and appealing meals • Accommodate health and nutrition needs of all students in school district • Should offer learning lab for classroom nutrition and health education • Serve as resource for links with nutrition-related community services • Implemented by school cooks |
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Family/ Community Involvement |
Allows for integrated approach to enhancing health and well-being of students • School is agency within community; does not function in isolation • Schools that actively engage parents and community in school health efforts respond more effectively to health needs of students |
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School-Site Health Promotion for Staff |
May include: •Opportunities for school staff to improve their health status and engage in healthy behaviors •Health-related assessments, health promotional activities,classes, newsletter, etc.• May result in: •Improved health status •Improved morale •Positive health role modeling •Reduced health insurance costs •Decreased absenteeism |
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Issues and Concerns of the School Health Program |
Lack of support for CSHP •Need for supportive legislation•Limited resources •Lack of buy-in and investment • School health curriculum challenges •Controversy •Strong opinions on various topics •Improper implementation •Often provided by individuals other than health education specialists |
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More Issues and Concerns of the School Health Program |
Violence in Schools •High profile incidents of violence in schools •Bullying •Electronic aggression •Recommendations for improving school climate as it relates to violence |
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Why is Maternal, Infant, and Child (MIC) health important? |
MIC statistics important indicators of effectiveness of disease prevention and health promotion services in a community •Many risk factors for poor health outcomes can be reduced or prevented with early intervention among women, infants, and children •Decline in U.S. MIC mortality in recent decades,but serious challenges remain |
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Family and Women's Health |
Families are the primary unit in which infants and children are nurtured and supported regarding healthy development |
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U.S. Census Bureau Definition of Family |
A group of two people or more (one of whom is the householder)related by birth, marriage, or adoption and residing together; all such people (including related subfamily members) are considered as members of one family. |
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Friedman Definition of Family |
Two or more persons who are joined together by bonds of sharing and emotional closeness and who identify themselves as being part of the family. |
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Family Impact |
Marriage, or having two parents, important family characteristic to a child’s well-being • Research indicators •Increased health risks for infants and children who are raised in single-parent families •Adverse birth outcomes •Low birth weight •Higher infant mortality •More likely to live in poverty |
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Unmarried Mothers |
Compared to married counterparts, generally have: •Lower education •Lower incomes •Greater dependence on welfare assistance |
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Teenage Pregnancy |
Teens who become pregnant and have a child are more likely to •Drop out of school •Not get married or to have a marriage end in divorce •Rely on public assistance •Live in poverty • Substantial economic and health consequences |
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Teenage Pregnancy Continued |
Teen mothers less likely to receive early prenatal care • Teen mothers more likely to: •Smoke during pregnancy •Have preterm birth •Have low-birth-weight babies •Have pregnancy complications |
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Effective Community Health Programs |
Due in part to effective community health programs and public health campaigns aimed at reducing teenage pregnancies, teen pregnancy, and birth rates have steadily declined in recent years. • Between 1991 and 2010, the teenage birth rate in the U.S. declined by 44.6%to a record low of 34.2 births per 1,000 teenage girls. • Despite the recently declining rates, 1/3 of teenage girls get pregnant once before they reach age 20, resulting in approximately 754,000 pregnancies a year. |
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Family Planning |
Determining the preferred number and spacing of children and choosing the appropriate means to accomplish it • Most important approach to reducing unintended pregnancies and their adverse consequences |
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Family Planning: Individual Level |
Preconception Healthcare |
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Family Planning: Community Level |
Family planning and care programs involving private providers, governmental and nongovernmental organizations |
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Unintended Pregnancies |
Pregnancy that is mistimed or unwanted at time of conception • Approximately ½ of pregnancies in U.S. are unintended •40% of those end in abortion • Associated with negative health behaviors •Delayed prenatal care •Inadequate weight gain •Smoking, alcohol and other drug use |
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Title X: Family Planning Act |
Only federal program dedicated solely to funding family planning and related reproductive healthcare services • Designed to provide services to low-income women • Nation’s major program to reduce unintended pregnancy • Supports 61% of the 4,000+ family planning clinics in U.S. • Every year, more than 5 million women receive care at clinics funded by Title X |
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Success of Community Health Family Planning Programs |
Clinics have improved MIC health indicators •Large reductions in unintended pregnancies,abortions, and births •Help prevent 1.9 million unplanned pregnancies each year • Each public health $ spent saves $4 in Medicaid costs |
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Abortion |
A 1973 Supreme Court decision that made it unconstitutional for state laws to prohibit abortions(Roe vs. Wade) •Hotly debated topic •Viewpoints •Pro-Life position •Pro-Choice position |
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Maternal Health |
The health of women in the childbearing years, including those in the pre-pregnancy period, those who are pregnant, and those who are caring for young children •Effect of pregnancy and childbirth on women important indicator of their health •Pregnancy and delivery can lead to serious health problems |
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Maternal Mortality |
The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes |
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Preconception Healthcare |
Care before pregnancy that is health improving and risk reducing |
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Pre-natal healthcare |
Medical care from time of conception until birth process Three major components: •Risk assessment •Treatment of medical conditions or risk reduction •Education • Early and continuous prenatal care leads to better pregnancy outcomes |
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Infant Health |
Depends on many factors •Mother’s health and her health behavior prior to and during pregnancy •Mother’s level of prenatal care •Quality of delivery •Infant’s environment after birth(home and family, medical services) •Nutrition •Immunizations |
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Infant Mortality |
• Death of a child < 1 year of age •Used as a measure of a nation’s health •Infant mortality rate =deaths of children under 1 year/ 1000 live births • Decline in infant mortality due to • Improved disease surveillance • Advanced clinical care • Improved access to health care • Better nutrition • Increased education |
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Leading Causes of Infant Mortality |
•Congenital abnormalities •Preterm/low birth weight •Sudden infant death syndrome (SIDS) •Problems related to complications of pregnancy •Respiratory distress syndrome |
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Improving Infant Health |
• Reducing premature births, which are babies born prior to 37 weeks’ gestation • Reducing low birth weight, which are infants that weigh 5.5 pounds or less at birth • Reducing smoking during pregnancy • Eliminating heavy maternal alcohol use • Increasing breastfeeding rates • Placing babies on their back to sleep to reduce SIDS |
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Child Health |
Good health during childhood years (1-4) essential • Failure to provide timely and remedial care to children leads to unnecessary: •Illness•Disability•Death |
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Childhood Mortality |
• Most severe measure of health in children • Rates have generally declined in past few decades • Unintentional injuries leading cause of death in children •Specifically, motor vehicle related deaths,especially those not wearing seat belts/restraints |
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Childhood Morbidity |
• Unintentional injuries •Significant economic, emotional, and disabling impact • Child maltreatment •Includes physical abuse, neglect, sexual abuse, emotional abuse, abandonment, exploitation, or threats to harm. •Multifaceted community response needed • Infectious diseases •Importance of immunization schedule |
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Community Programs for Women, Infants, and Children |
The vast majority of MIC healthcare and support services in the U.S. is provided via private or nongovernmental providers. • However, the federal government has over 35 programs in 16 different agencies tasked with addressing MIC issues • Many are categorical programs •Only available to people who fit into a specific group •Some fall through the cracks |
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Title V |
Only federal legislation dedicated to promoting and improving health of mothers and children •Set standards and guideline |
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Maternal and Child Health Bureau |
•Subdivision of HRSA in the DHHS •Established in 1990 to administer Title V funding: •Funding for four core public health services •Infrastructure building, population-based, enabling, and direct health care services |
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Women, Infants, and Children (WIC) |
• Supplemental food program for women, infants, and children sponsored by USDA since 1974 • Eligibility requirements •Residency in application state, income requirements, at “nutritional risk” • 2008: 9.5 million participants; nearly half of all infants born in U.S., ¼ of children ages 1-5 • Positive outcomes for women and children |
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Medicaid |
low-income individuals and families; children are slightly more than half of all Medicaid beneficiaries |
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CHIP |
targets uninsured children whose families don’t qualify for Medicaid |
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Family and Medical Leave Act (FMLA) |
Grants 12 weeks unpaid job protected leave to men or women after birth of child, adoption, or illness in immediate family •Only affects businesses with 50+ employees |
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Family Support Act and Child Care and Development Block Grant |
Provide funds for child care for poor families |
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Other Advocates for Children |
Numerous groups advocate for children’s health and welfare •Ronald McDonald House Charities •Action for Healthy Kids •United Nations Children’s Fund (UNICEF) •American Academy of Pediatrics (AAP) |
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Adolescence |
difficult stage; period of transition from childhood to adulthood •Comfort and security to complex and challenging situations |
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Young Adult |
complete physical growth; experience significant life changes •Leave home, join military, begin careers, etc. • Important period in life because: •Many health beliefs, attitudes, and behaviors are adopted and consolidated |
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Demography |
Demographic variables that affect health of adolescents and young adults •Number of young people •Living arrangements •Employment status |
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# of adolescents and young adults |
1979: peaked at 21% of population • 2010: ~14% of population •Racial and ethnic makeup more diverse than older cohorts |
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Living arrangements of adolescents and young adults |
Since 1965, percentage of children younger than age 18 living in single-parent family has increased • 2010:•Approximately 1/3 of all children lived in single-parent families •Disparities by race and ethnicity •Black children: 66% •Hispanic children: 41% •White children: 24% • Economic and health consequences |
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Employment Status of adolescents and young adult |
Youth labor force makes up nearly 14% of overall labor force • Differences seen by race and ethnicity •Black adolescents and young adults are more likely to be unemployed than are whites or Hispanics • Health consequences •May affect a person’s access to health insurance, if not carried on parent(s) insurance (until age 26). |
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Mortality of Adolescents and young adults |
Significant decline in death rates over past several decades; mostly due to advances in medicine and injury and disease prevention • Male mortality rate higher than female with some racial disparities • Most threats stem from behavior rather than disease •Young people: ¾ of all mortality attributed to: •Unintentional injuries (44%) •Mostly MVAs, alcohol often involved •Homicide (16%) •Suicide (13%) |
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Health Behaviors and Lifestyle Choices of HS students |
Youth Risk Behavior Surveillance System (YRBSS) •Designed and overseen by the CDC and implemented by states •Includes a biennial national school-based survey, grades 9-12 •Tracks selected health behaviors among adolescents and young adults •Includes Data used to set and track progress toward meeting school health goals, support curriculum modification, and support new legislation and policies |
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Health Behaviors and Lifestyle Choices of college students |
Data sources •National College Health Assessment (NCHA)•Examines health behaviors of college students •Monitoring the Future •Examines drug behaviors and related attitudes of broad participant age range |
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Health Behaviors and Lifestyle Choices of HS students and college students |
Behaviors that contribute to unintentional injuries • Behaviors that contribute to violence • Tobacco use • Alcohol and other drugs • Sexual behaviors that contribute to: • Unintended pregnancy • STDs •People aged 15 to 24 acquire nearly half of all new STDs in theU.S. • Physical activity • Overweight and weight control |
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Community Health Strategies |
Main factors affecting adolescents and young adult health require a multi-faceted approach where communities work together to change social and cultural factors related to behavior. • Prevention programs should include components focused on: •Changing norms, interaction among peers, social skills training, cognitive-behavioral skills training,strengthening student’s desire to change. |
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Adults |
Ages 25-64 • Represent slightly more than half of U.S. population |
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Mortality (adults) |
Mainly from chronic diseases associated with poor health behavior and lifestyle choices • Lifestyle improvements and public health advances have led to decline in death rate for adults • 2008: leading causes of death for ages 25-44 •Unintentional injuries, cancer, heart disease,suicide, homicide, HIV •Differences seen across race and ethnicity • 2008: leading causes of death for ages 45-64 •Noncommunicable health problems |
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Cancer |
#1 cause of death for adult age group in recent decades •Male cancer mortality: 1. Lung 2. Colorectal 3. Prostate •Female cancer mortality: 1. Lung 2. Colorectal 3. Breast |
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Cardiovascular Disease |
#2 cause of death for the adult age group • Age-adjusted mortality rates dropped over past 60 years |
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Obesity Epidemic |
The documentary video, Supersize Me, trumpets the seriousness of the “epidemic” and places the blame on fast food companies. • The documentary video, Fathead, provides a counter viewpoint on the epidemic and Supersize me. • The documentary video, The Secrets of Sugar, shifts the blame from high-fat diets to high-sugar diets. *WATCH VIDEOS* links in ch 6 |
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Risk Factors for Chronic Disease |
Best single behavioral change to reduce morbidity •Stop smoking • Most significant risk factors for adults •Smoking •Lack of exercise, poor diet •Failure to maintain appropriate body weight •Alcohol consumption |
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Risk Factors for Personal Injury |
Motor vehicle safety •Seat belts •Alcohol use |
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Awareness and Screening of certain conditions |
Number of regular, noninvasive/minimally invasive health screenings recommended for adults •Hypertension •Diabetes •Cholesterol |
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Community Health Strategies |
Prevention at different levels via individuals, public health organizations, worksites, churches,businesses, hospitals, non-profit organizations, etc. |
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Primary Prevention Examples |
• Exercise & Physical Activity classes • Marketing campaigns • Nutrition education |
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Secondary Prevention |
• Smoking cessation efforts • Self-exams • BSE, TSE, BMI, etc. • Clinical exams • Mole mapping, palpation of various systems, body-fat checks, etc. • Clinical Screening • BP, cholesterol, blood sugar, PSAs, etc. • Mammograms, Pap test, sigmoidoscopy, colonoscopy, etc. |
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Tertiary Prevention |
Medication Compliance, prescribed exercise therapy, prescribed nutrition therapy, etc. |
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Seniors |
Number of seniors and the proportion to the total population increased significantly in the 20th century • Represent 12.8% of population •1 in every 8 Americans age 65+ • Economic, social, and health issues |
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Definitions of Age groups |
Senior Adult age categories •Young old: 65-74 •Middle old: 75-84 •Old old: 85+ • Aged: state of being old • Aging: changes that occur normally in plants and animals as they grow older |
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Gerontology |
study of biological, psychological, and social processes of aging and the elderly |
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Geriatrics |
branch of medicine concerned with medical problems and care of elderly |
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Geriatrician |
physician specializing in care of patients with multiple chronic diseases whose care can be managed but may not be cured |
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Descriptive terms for seniors |
elders, older adults, mature adults, elderly, aged, senior citizens |
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Demography of Seniors |
Size and Growth •Population pyramids describe aging of populations •America’s pyramid shape has drastically shifted •Other countries have had shifts as well •85+ fastest growing segment of older population •Increase in median age |
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Factors affecting population size and age |
Fertility rates •Baby boomers: 1946-1964 •Mortality rates •Significant increase in life expectancy in20th century •Migration •In U.S. net migration has resulted in population gain |
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Dependency Ratio |
economically unproductive to economically productive (see next slide) •Traditionally defined by age •Unproductive population: 0-19 and 65+ •Productive population: 19-64 |
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Labor force ratio |
number of people actually working compared to those that do not, independent of their ages (e.g. 5:1). This can be affected by the state of the economy as well. |
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Other Demographic Variables |
Affect community health programs for older Americans •Marital status •Living arrangements •Racial and ethnic composition •Geographic distribution •Economic status •Housing |
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Marital Status |
¾ of senior men are married; just over half of senior women are married • Senior women 3x’s more likely to be widowed •Men have shorter life expectancies •Men tend to marry women younger than selves •Men more likely to remarry after loss of spouse • Number of divorced seniors continues to rise •New concerns: lack of retirement benefits,insurance, lower net worth assets |
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Living Arrangements |
Closely linked to income, health status, and availability of caregivers • 2/3 of non institutionalized seniors live with someone else •Women more likely to live alone • Only 5% of seniors live in nursing homes •¾ of nursing home residents are women •More than half of nursing home residents are 85+ |
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Racial and Ethnic Composition |
U.S. older population growing more diverse • 2010 seniors: •80% white, 9% black, 7% of Hispanic origin, 3%Asian • 2050 projection of seniors: •White 58%, Hispanic origin 15%, black 11%,Asian 8% • Need for health professionals to become more knowledgeable about cultural backgrounds of Senior clients |
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Geographic Distribution |
2/5 live in southern states • More than half live in 10 states: CA, FL, IL, MI, NJ,NY, NC, OH, PA, TX • California greatest number; Florida greatest proportion |
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Economic Status |
1970: 25% of seniors lived in poverty • 2006: less than 9% lived in poverty • Income •37% of Senior income from Social Security •15% asset income •18% pension income •28% earnings • Economically more vulnerable to circumstances beyond their control |
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Elderly Housing |
Most live in adequate, affordable housing • 2007: 80% own, 20% rent • Homes of seniors versus younger people: •Older •Of lower value •In greater need of repair •Less likely to have central heat/air • 30% of seniors pay more for housing than they can afford |
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Health Profile |
Health status of seniors has improved over the years (living longer and functional health) • Chronically disabled has been decreasing • Health status usually not as good as younger counterparts |
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Mortality |
In 2010, top causes of death for seniors (responsible for 2/3 of Senior deaths) •Heart disease•Cancer•Stroke•Chronic lower respiratory disease•Alzheimer’s Disease |
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Morbidity |
Activity limitations increase with age • Chronic conditions (longer than 3 months)•1/3 report limitation of activity due to chronic conditions •Limitations of activities increase with age • Impairments •Deficits in sense organs, or mobility or range of motion •Very prevalent in older adults •May be sensory, physical, memory |
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Health Behaviors and Lifestyle Choices |
Generally have more favorable health behaviors than younger counterparts •Less likely to consume large amounts of alcohol,smoke cigarettes, or be overweight • Areas for improvement •Healthy eating, physical activity, immunizations |
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Senior Abuse and Neglect |
Reports have increased greatly in recent years • All states have set up reporting systems • Special problem for seniors •May be frail •Unable to defend themselves •Vulnerable to telemarketing and mail scams •Most common victims of theft of benefit checks |
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Instrumental Needs of Seniors |
Six instrumental needs that determine lifestyle for people of all ages •Income •Housing •Personal care •Health care •Transportation •Community facilities and services • Aging process can alter needs in unpredictable ways |
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Income |
Change in types of expenses in Senior years • Social Security is major source of income for ~2/3 of recipients; 90% of income for 1/3 • Non-married women and minorities have highest rates of poverty |
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Elderly Housing Needs |
Major needs: appropriateness, accessibility, adequacy,affordability •Needs are intertwined • Single biggest change in housing needs is need for special modifications due to physical disabilities • Changing place of residence can have negative effect on Senior and family members |
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Group Housing |
Types: •Retirement communities •Group homes •Continuing Care Retirement Communities •Assisted living •Nursing homes – traditional skilled hospitalized car |
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Personal Care |
Four levels of tasks that may need assistance: • Instrumental tasks• Housekeeping, transportation • Expressive tasks• Emotional support, socializing and inclusion • Cognitive tasks• Scheduling appointments, reminders to take medication • Daily living tasks• Eating, dressing, bathing |
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Personal Care Measures |
Activities of daily living (ADLs)• Measures functional limitations • Instrumental activities of daily living (IADLs)• Measure more complex tasks |
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Informal (unpaid) caregivers |
• Care-provider•helps identify the needs of the individual & personally performs the care giving service •Care-managers•also helps to identify needs and makes arrangements for a paid or unpaid care givers who provide services |
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Caregiver Services |
National Family Caregiver Support Program (NFCSP) |
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Health Care |
Seniors heaviest users of health care services • Use of health care services increases with age •Most money spent on health care is in last years of life • Medicare primary source of payment for health care services of seniors. Obamacare (i.e. ACA) cuts the budget for Medicare |
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Options for major changes in healthcare |
Options: • Raise taxes• Reallocate funds• Cut coverage• Means test• Raise eligibility age• Complete revamping |
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Transportation |
Transportation allows seniors to remain independent • On average, seniors live 10 year after they stop driving • Greatest influence on transportation needs: •Income•Health status • Possible helps: • Private and public organizations may provide transportation•e.g. churches, local agencies on aging, local transit districts • Fare reductions, subsidies, funds for centers to buy equipped vehicles |
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Community Facilities and Services |
Older Americans Act of 1965 (OAA) to increase services and protect rights of seniors •National nutrition programs for seniors •Administration on Aging (AOA) provides funding to states to create local Area Agencies on Aging•e.g. Bear River Association of Government’sArea Agency on Aging |
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More community facilities and services |
•Meal services:Meals on Wheels & congregate meals •Homemaker services:Chore and home maintenance •Visitor services: Adult day care•Respite care•Planned short-term (days to weeks) care •Cache Valley & Sunshine Terrace Wellness Center |
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Even More Community Facilities and Services |
Home health care: Cache Valley: Community Nursing Services, IHC,Sunshine Terrace & others. •Senior centers •Other Services•Hospice, Support Groups, Volunteer Services,Mental Health, Recreation programs, etc. |
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Community Health and Minorities |
• Strength of America lies in diversity of people • Race remains an issue in U.S.• U.S. population (2010) •Majority: white, non-Hispanic (66%) •Racial or ethnic minorities (34%) • Minority health: morbidity and mortality of ethnic minorities |
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Landmark 1985 Report |
The Secretary’s Task Force Report on Black and Minority Health (1985) • First documented the health status disparities of minority groups in the United States • Contributed significantly to the Healthy People 2000 Objectives (1990) |
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Initiative to Eliminate Racial and Ethnic Disparities in Health (Race and Health Initiative)(1998) |
Now part of Healthy People 2020 •Purpose: •Prevent disease •Promote health •Deliver care to racial and ethnic minority communities |
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Racial and Ethnic Classifications Standards |
U.S. Office of Management and Budget •Directive 15 “Race and Ethnic Standards for Federal Statistics and Administrative Reporting” presented brief rules for classifying into 4 racial and 2 ethnic categories. (1978) •Revised standards issued in 1997 and expanded race from 4 to 5 categories. |
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Racial and Ethnic Classifications |
Classification used to operationalize race and ethnicity •Used in statistical activities and program administration reporting • Two ethnicity categories •Hispanic or Latino/Non-Hispanic or Non-Latino • Five race categories •Black or African American •Asian •Native Hawaiian or Other Pacific Islander •American Indian or Alaska Native •White |
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Health Data Sources and Their Limitations |
Challenges with classifications representing diversity of population • Race is a social construct, and race categories may change over time • Self-reported data can be unreliable • Many nonfederal systems do not collect racial and ethnic data • Bias analysis • Occurs when separate data reporting systems are used to collect data by race and by ethnicity to calculate rates. • Census data v.s. Death certificate data • HP 2020 objective: upgrade data collection on race and ethnicity in public health surveys |
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Americans of Hispanic Origin |
Hispanic origin is an ethnic category (not race) • Persons of Mexican, Puerto Rican, Cuban, Central American, or SouthAmerican descent, or some other Spanish origin regardless of race • Nearly all Americans of Hispanic origin in the U.S. are racially classified as white • Educational attainment- lowest of any group • Income-lower than whites and Asian/Pacific Islanders • Health beliefs- Religion plays an important role in health- Good health is seen as a matter of fortune or reward from God for good behavior. • Curanderismo a common form of folk medicine involves religion, herbs,witchcraft, and science |
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Black Americans |
Black or African Americans •People having origins in any of the black racial groups from Africa • More than ½ live in southern regions of U.S. • Educational attainment- Slightly lower high school graduation rates than whites • Income-Lowest median income of any group |
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Asian Americans |
Asian Americans-Refers to people of Asian descent. They or their ancestors came from more than 20 different Asian countries. • Educational attainment-Higher average educational levels than all other groups, but distribution is bipolar (concentrated on lower and higher end) • Income-Higher average incomes than all other groups, but distribution is bipolar (concentrated on the lower and higher end) • Traditional health beliefs-Concept of balance is related to health, and imbalance is related to disease. |
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Pacific Islander |
•Includes peoples of Hawaii, Guam, Samoa, or other PacificIslands and their descendants • Educational attainment: Lower education levels than whites • Income: Lower median incomes than whites • Traditional health beliefs: Healer cannot be reimbursed directly for his or her therapeutic work. Believed that it is not appropriate for a healer to get paid. |
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American Indian and Alaskan Natives |
•Original inhabitants of America • Education: Lowest of any group • Income: Median income is lower than most groups • Traditional health beliefs: Various tribal groups have distinct customs, languages, and beliefs •Many share the same cultural values •Some conflict in some communities between medical/public health approach and approach used by Native American healers |
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U.S. Government, Native Americans, and Provision of Healthcare |
Some tribes are sovereign nations • Tribes transferred land in U.S. to federal government in return for provision of certain services |
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Indian Health Services |
Responsible for federal health services to Native Americans and Alaska Natives •Goal to raise health status to highest possible level • Assist Indian tribes in developing health programs • Facilitate and assist Indian tribes in coordinating health resources • Provide comprehensive health care services • Serve as a Federal advocate |
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Refugees |
People who flee their homes from danger |
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Immigrants |
Migrate from other countries to set up residence in another country. |
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Aliens |
People who were not born in a particular country. |
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Illegal Aliens |
i.e. Unauthorized immigrants): Entered a country without permission. |
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Special Concerns of new immigrants |
Language and cultural barriers • Poor • Lower levels of education • Mismatch of work skills to economic needs in the U.S. • Serious health problems • Burden on healthcare systems, housing, education, etc. |
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Race and Health Initiative |
Goal to eliminate disparities among racial and ethnic minority populations in six areas of health •Infant mortality •Cancer screening and management •Cardiovascular disease •Diabetes •HIV/AIDS •Adult and child immunization |
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Infant Mortality |
Serious disparity in U.S. among racial and ethnic minorities •Greatest disparity exists for black Americans •Lack of prenatal care and low-birth-weight babies |
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Cancer Screening and Management |
Incidence and death rates highest among black Americans for various types of cancer • Many disparities attributed to lifestyle factors, late diagnosis, access to health care • Less primary and secondary prevention in various minority groups |
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Cardiovascular Diseases |
Death rates vary widely among racial and ethnic groups • Hypertension prevalence as a risk factor varies according to race/ethnicity •Black American tend to develop hypertension earlier in life than whites; unknown reason |
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Diabetes |
Overall prevalence has risen in U.S. in recent years • Death rates vary among racial and ethnic groups •Significantly higher in minority groups • 1980-2006: End stage renal disease attributable to diabetes greatest among black men and women;lowest among white women • Hospital admissions for long-term care of diabetes highest among black Americans and Hispanics |
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HIV/ AIDS |
AIDS has disproportionate impact on racial and ethnic minority groups • Proportional distribution of AIDS cases has increased in black Americans and Hispanics and decreased in white Americans •Attributed to higher prevalence of unsafe or risky health behaviors, existing co-conditions, and lack of access to health care to provide early diagnosis and treatment |
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Child and Adult Immunization Rates |
Early childhood immunizations do not vary significantly by race or ethnicity • Older adult immunization rates are substantially lower in minority groups, even though an overall increase has occurred |
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Socioeconomic Status (SES) |
considered the most influential single contributor to premature morbidity and mortality •A demographic variable based on education and income •Association between SES and race/ethnicity is complicated and cannot fully explain all disparity |
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Equity in Minority Health |
Simple solutions unlikely • Multiple resources required • Solutions to problems for one group may not work for another • Solutions must be culturally sensitive |
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Cultural Competence |
Cultural and linguistic competence •Set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals, that enables effective work in cross-cultural situations • Culture is vital in how community health professionals deliver services and how community members respond to programs and interventions |
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Empowering the Self and the Community |
To enable people to solve their community health problems •Three kinds of power associated with empowerment •Social – access to “bases”; needed to gain political power •Political – power of voice and collective action •Psychological – individual sense of potency |
