Healthy People 2010, Research Paper Example

Healthy People 2010: An Examination of the Leading Indicators of the Risk of Heart Disease and Stroke

The “Healthy People 2010” (HP 2010) initiative establishes the following set of indicators to measure the health of the nation over the next decade:

• Physical Activity
• Overweight and Obesity
• Tobacco Use
• Substance Abuse
• Responsible Sexual Behavior
• Mental Health
• Injury and Violence
• Environmental Quality
• Immunization
• Access to Health Care

In 2006, the Los Angeles County Department of Health Services issued a report entitled “Premature Death from Heart Disease and Stroke in Los Angeles County: A Cities and Communities Health Report.” As noted in the report, “public health actions have dramatically reduced deaths from infectious diseases;” in 1900, infectious diseases accounted for 80% of all deaths, while in 2000 that number was reduced to 20%. It is clear that well-targeted initiatives can have a significant impact on public health (Fielding, 2006). According to the report, chronic diseases –for example: heart disease, diabetes, and cancer- have become the leading causes of death.  In Los Angeles County, approximately 80% of all deaths were caused by various chronic diseases, with half of those being caused by heart disease (Fielding, 2006). It is clear that this is an epidemic, made all the more significant by the fact that many of these deaths could have been prevented by changes in lifestyle in the vulnerable population. It is for reason that I chose to focus on this area of concern.

The report notes that social and economic conditions can have a significant impact on a person’s health. As a means of studying the relationship between these conditions, the report created the “Economic Hardship Index,” specifying the following six factors:

• Crowded Housing (the percent of housing units with more than one person per room)
• The percent of households living below the federal poverty level
• The percent of persons over the age of 16 that are unemployed
• The percent of persons over the age of 25 without a high school diploma
• Dependency (the percent of the population under 18 or over 64)
• Median income per capita

Using these indicators, it is possible to assess which sectors of the population are most vulnerable to premature death from cardiovascular disease and stroke, as well as apply the information offered in the HP 2010 initiative to develop strategies designed to help improve the health of the vulnerable population.

The report ranked communities throughout Los Angeles County according to the Economic Hardship Index on a scale of 1 to 100; the higher the number, the higher the level of economic hardship. It then measured the rates of premature death from heart disease and stroke in the same communities, and compared the two sets of results. Perhaps not surprisingly, they found a “statistically significant” correlation between them; the communities that ranked the highest on the Hardship Index also had a greater likelihood of per capita deaths from cardiovascular disease or stroke. West Compton, for example, was given one of the highest rankings on the Hardship Index and had the highest rate of premature deaths in Los Angeles County (Fielding, 2006).

The report specifies a number of strategies that communities can implement to combat the effects of heart disease and stroke; many of these strategies overlap with the initiatives set out by HP 2010. The report recommends that communities first take actions to “promote healthy living,” such as increasing access to walking, hiking, and biking paths; ensuring the continuity and connectivity of sidewalks; and promoting the development of high-density residential and commercial properties designed to promote walking and biking (Fielding, 2006).

In addition, the report recommends that communities promote healthy eating, engage in smoking prevention and cessation efforts, and promote regular medical care (Fielding, 2006). It is this last factor that may be among the most difficult, yet most important, to effectively implement. The report suggests that communities help those in the community to get the information needed to enroll in state and federal health insurance programs, but the question remains of what, exactly, those in the health care profession can do to help those in need.

In “Theory of Human Caring,” creator Jean Watson emphasizes the need for nurses to recognize and respect their patients’ humanity. She suggests that nurses establish a caring relationship with patients and treat them as “holistic beings” (that is, recognizing the body, the mind, and the spirit); that they spend time with patients to provide “caring moments” that allow a genuine connection between nurse and patient. She further revises her theory by replacing her concept of “carative factors” with the term “caritas factors” (“caritas” is a Greek word meaning “to cherish” or “to give special attention”) (Chantal, 2010).  This updated theory placed greater emphasis on the spiritual dimension of care. She suggests that nurses should cultivate their own spiritual dimensions so as to better serve the spiritual needs of patients. In short, Watson’s theory places emphasis on a nurse’s ability to meet not just the medical needs of a patient, but their emotional and spiritual needs as well.

In applying Watson’s Theory of Human Caring, it is imperative that those charged with caring for patients with cardiovascular disease and stroke, as well as those charged with implementing strategies designed to prevent those illnesses, have a firm understanding of the “human element” involved in such roles. The data from Los Angeles County, for example, demonstrates that those who are most vulnerable to these illnesses are also those people most likely to be suffering from economic hardship. These factors must be considered both when treating patients and when educating the public about the dangers of cardiovascular disease and stroke.

Because so many of the factors that contribute to cardiovascular disease and stroke are “lifestyle” factors, nurses familiar with Watson’s Theory of Human Care have an advantage in educating and treating patients at risk for these illnesses. Unlike some medical conditions whose treatment is primarily pharmacological, treating –and more importantly, preventing- these illnesses involves the implementation of changes in a patients’ lifestyle, such as getting more exercise, making dietary changes, and quitting smoking (which are also several of the Leading Health Indicators from the HP 2010 Initiative). In many of the populations that are most vulnerable to these illnesses, the best way to effect these changes may be through education programs offered by community health clinics ((Burke et al, 2007).

In the field of community health, adherence to the principles of Watson’s theory may serve to help nurses in their interactions with patients. It is easy to tell a patient that he or she needs to exercise, or eat better, or quit smoking, but the practical application of those recommendations may be difficult for patients who rank higher than others on the Economic Hardship Index. A community health nurse who empathizes with her patients may be better suited to treat them than a nurse who takes a more “clinical” approach, viewing every patient they see as more or less the same (Medi-Smart, 2010).

In applying Watson’s theory to the community health clinic setting, a nurse who recognizes that her patients face social and economic difficulties might work to provide not just the information about diet, exercise and smoking, but also provide access to resources that will help the patient make the necessary lifestyle changes (Hayman et al, 2007). This means that non-compliance with the prevention and treatment protocols must be avoided (Burke et al, 2007); a nurse may wish to help patients find ways to make compliance easier and more practical.

For example, the nurse may make arrangements for patients to receive free or reduced-cost smoking cessation products. Some states have programs that provide these products free to those who qualify (FL Dept. of Health, 2009); the nurse would simply have to provide the necessary contact information.

Where diet is concerned, it may be helpful to provide recipes and other suggestions for making healthy meals at a low cost; this information goes beyond simply suggesting that a patient improves his or her diet, and takes into consideration the human dimension affecting the situation. Or where exercise is concerned, a nurse who is charged with implementing prevention strategies might compile a list of parks and recreational centers in the area, or information about any low-cost gyms that might be within reach of the patient. And in addition to these more concrete actions, it is important that a nurse in this setting simply recognize the humanity of each and every patient.

While working as a nurse in any setting is challenging, nurses in the community health setting face some unique challenges. They see patients from all walks of life, especially those on the lower end of the socio-economic scale (Medi-Smart, 2010). These patients often have very limited access to health care; this makes the application of Watson’s Theory of Human Care all the more necessary. As the saying goes, “prevention is the best medicine;” nowhere is this more important than in the prevention of cardiovascular disease and stroke.

As we have seen, several of the Leading Health Indicators have a direct correlation to preventing these illnesses. Understanding the ways which people can prevent these diseases is important; understanding the human dimension of the problem, and identifying ways that patients can make the necessary changes is even more so. Using Watson’s theory, a community health nurse will be better suited to treat not just the body, but the mind and the spirit as well.

References  

Burke, Lora E., Jaqueline M. Dunbar-Jacob, and Martha N. Hill. “Prevention of Cardiovascular Disease.” Annals of Behavioral Medicine 19.3 (2007): n. pag. Web. 10 Jun 2010. <http://www.springerlink.com/content/e13088x3g5105384/>

Chantal, Cara PhD, RN. “A Pragmatic View of Jean Watson’s Caring Theory.” Université de Montréal n. pag. Web. 10 Jun 2010. <http://www.humancaring.org/conted/Pragmatic%20View.pdf>.

Fielding, Johnathan C. MD, MHP. “Premature Deaths from Heart Disease and Stroke in Los Angeles County: A Cities and Communities Health Report.” Los Angeles County Dept. of Public Health, 2006. Web. 10 Jun 2010. <http://lapublichealth.org/epi/docs/CHR_CVH.pdf>.

Hayman, Laura L. et al. “Primary Prevention of Cardiovascular Disease in Nursing Practice: Focus on Children and Youth .” Circulation: Journal of the American Heart Association (2007): n. pag. Web. 10 Jun 2010. <http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.184595>.

“Healthy People.” Healthy People 2010, 2010. Web. 10 Jun 2010. <http://www.healthypeople.gov/LHI/lhiwhat.htm>.

“Keep Your Community Healthy.” MEDI-SMART: Nursing Education Resources. N.p., 2010. Web. 10 Jun 2010. <http://www.medi-smart.com/nursing-careers/compare/community-health-nursing>.

“Quitline.” Florida Dept. of Health, 2009. Web. 10 Jun 2010. <http://www.doh.state.fl.us/tobacco/quitline.html>.