Community Health Assessment; Jamaica and Holis
This community health needs report focuses on older population aged 65 years and over in Queens Community District 12, named Jamaica and Holis in New York City. The objective of the assessment is to enable health care professionals identify and understand the various needs of the population and develop a plan for addressing the needs of the vulnerable group using the available resources to improve the health outcomes.
The geographical location of the community comprises of North Springfield gardens, Jamaica Centre, Holis,Jamaica, Rochdale, South Jamaica and St Albans (New York City Health, 2016). The health status of any given community isdetermined by various factors, including the physical and socialenvironment surrounding the population(Carey, Crammond, & Keast, 2014). In 2015, the total population in the Queens Community District 12 was 230,527 people.
Although the population is multi-ethnic, the majority ethnic group in the community is African Americans, accounting to about 67% of the total population followed by Hispanics at 17%. The age distribution in the community indicates that majority of people are aged 25-64 years, which represent 54% of the entire population. The senior population aged 65 years account to 13% of the population. Additionally, the proportion of people aged 44-64 years is the joint highest with 25-43 years olds at 27% (New York City Health, 2016).
The health state of the community in Jamaica and Hollis indicates high prevalence of obesity, diabetes, heart disease and cancer. Heart disease,cancer and diabetes mellitus are the leading causes of death in the community. The community has higher prevalence of mental disorders and obesity compared to New York City average.
The factors that contribute to high prevalence of the diseases in the community include poor nutrition, substance use, physical inactivity, smoking and lack of access to healthcare facilities. Medical statistics indicates that about 25% of adult population in Jamaica and Hollis do not have health insurance cover. The eating habits in the community indicates that adults have a higher rate of consuming unhealthy diet with high sugar and fat content compared to the New York City (New York City Health,2016).
The social determinants of health identified in Jamaica and Hollis include socioeconomic status, social exclusion, social capital, employment and early life. Social economic status of any given population is determined education level, occupation and income level (WHO, 2013). People from poor social and economic backgrounds are at higher risk of dismal health,higher prevalence of disease, mortality and life expectancy than those from more economically and socially empowered backgrounds (Australian Institute of Health and Welfare, 2016). In Jamaica and Hollis community, 21 % of the adult population has not completed high school education and only 28% have college degrees (New York City Health, 2016).
High education attainment is associated with better health outcomes and increased access to secure and higher income. Additionally high level of education attainment increases the ability of people to make informed health decision such as adopting healthy lifestyle (WHO, 2013). Low income limits people from accessing healthcare services and making healthy lifestyle choices, including good nutrition (Douglas, Marlene, Dula & Callister, 2014). In Jamaica and Holis community, about 14.2% of peopleaged 16 years and above are unemployed (New York City Health, 2016).
Another social determinant of health in the community is the early life. Early life refers to the prenatal and childhood phase, which is critical in determining the health of people in adulthood stages. The diverse domains early childhood development, including physical,cognitive, social, emotional and psychological progression determines success of a child in academics, sports and participation in the labor market. Children brought up in a healthy environment with good social and psychological support have higher chance of transitioning to healthier adults, with wider opportunities fo rhigher incomes (Australian Institute of Health and Welfare, 2016). In Jamaica and Holis, the community has higher rate of preterm births and teenage birthrate than in New York City. The rate of teen births in Jamaica Holis is at 11% compared to 9% in New York City(New York City Health, 2016).
Social exclusion is another social determinant influencing health outcomes in the community. Communities that experience discrimination, stigmatization and prejudice are at higher risks of poor health outcomes (Adler, Cutler & Fielding, 2016). In Jamaica and Holis, the minority groups in the United States are the majority in the community. About 67 % of the population is African American, a group that has historically faced social, economic and political discrimination in the country (New York CityHealth, 2016). As a result, the community reports one of the lowest levels of education, economic development and highest unemployment rates in the country.
The evident health issue in Jamaica and Hollis community is poor nutrition. Poor nutrition is associated with various unhealthy dietary habits, which includes intake of food with high sugar, fat and salt content, unbalanced diet, and low intake of fresh fruits and vegetables (WHO, 2013). Poor nutrition is a major health issue in the community as demonstrated by several health indicators.
First, adults in the community consume the highest proportion of sugary drinks in Queens and New York City region. Secondly, the community reports lower intake of fruits and vegetables than the entire region. Another indicator of poor nutrition is the high obesity rates reported in Jamaica and Hollis community. The prevalence of diabetes in the adult population in Jamaica and Hollis is 12% compared to 10% in New York City. The diabetes prevalence in the community is over three times that of Turtle bay (New York City Health, 2016). One of the major risk factors of diabetes is consumption of unhealthy diet and low physical activity.
The Risk Population
In Jamaica and Hollis community, the elderly (65 years and older) is the population at risk of the effects of poor nutrition. At 27%, the elderly population is the joint highest demographic group in the community (New York City Health, 2016). Various factors increase the vulnerability of the group to the effects of poor nutrition. First, the elderly people in the community have the highest prevalence of chronic diseases, especially diabetes, obesity and hypertension. One of the major risks factors of the chronic disorders is poor nutrition. By the virtue of advanced age, the older population demonstrates declined functional and physiological functioning of various body systems including immunity. Thus, poor nutrition undermines their immunity, exposing the group to greater risks of bacterial and viral infections (New York City Health, 2016).
The majority of the elderly population in Jamaica and Hollis community is of African American background, which is a minority group in the United States. African Americans report lower levels of educational attainment, higher unemployment rates and lower income than the majority group in United States because of historical discrimination and social exclusion. The older population in Jamaica and Hollis has one of the lowest income levels in the region and highest unemployment levels. In addition, the community has low level of education attainment. Low income and poverty in the elderly population undermines its ability to access healthy and nutritious food (Carey, Crammond & Keast, 2014).
Currently Available Services
The available resources to help the elderly population address the issue of poor nutrition in Jamaica and Hollis community includes programs such as Medicaid, Supplementary Nutritional Assistance Program(SNAP),and Healthy People 2020. One of the major objectives of Medicaid expansion is to reduce health disparities in the American healthcare system, by investing in prevention of diseases and promoting wellness in the population including older population.
Healthy People 2020 is another program accessible to the elderly population in Jamaica and Hollis community. The program aims at evaluating health disparities across diverse populations in the country including minority groups and developing approaches of promoting health equity and outcomes across all groups in the country, including minorities (Healthy People 2020, 2018). Additionally, there are various healthcare institutions in Jamaica and Hollis which provide health assessment services for chronic conditions including those caused by unhealthy nutrition such as diabetes. Equally important Jamaica and Hollis community has a Supplementary Nutritional Assistance Program (SNAP), which enhance access to healthy and secure food to vulnerable groups in the community. In Jamaica and Hollis, about 20% of all households are beneficiaries of supplementary nutritional assistance program (New York City Food Policy Center,2017).
Healthy people 2020 objectives
One of Healthy People 2020 objectives is increasing the number of states in the country with appropriate policies which provide incentives to food retailers selling healthy foods recommended by the dietary guidelines in the United States for Americans (HealthyPeople 2020, 2018). The objective relates to the future intervention of promoting health nutrition among the elderly population in Jamaican and Hollis in various ways.
First, providing incentives to food retailers selling healthy food would increase access of appropriate nutrition to the vulnerable population. This includes increased access to fresh fruits and vegetables. Secondly, the objective highlights the need of ensuring healthy food is affordable across all groups in the country, including ethnic minorities with low income,such as the elderly people in Jamaica and Hollis community. Thirdly, the objective envisages at reducing the prevalence of disorders associated with poor nutrition, such as diabetes, which is one of the major chronic conditions affecting the population.
To address the health issue of poor nutrition among the elderly persons in Jamaica and Hollis, the appropriate nurse interventions include nurse education and screening the targeted population for blood sugar, blood pressure and other health indicators. The main objective of educating the elderly population is to empower them with relevant knowledge on importance of healthy eating, enrolling for Medicaid and other supportive social programs, including Supplementary Nutritional Assistance Program in the New York City area.
Educating the targeted population would involve working in collaboration with community health workers, community leaders and other stakeholders to identify the population assess their respective nutritional needs and ensuring that they get support from the available social support services programs. To develop a suitable teaching approach for the older population, it is important to determine their individual learning needs, including their literacy levels.
Nurse education would be conducted in group sessions to facilitate interactions between the learners and the nurse educator. By the end of the training,the older population would be able to identify healthy foods, places where they could access healthy nutrition and name health effects associated with poor nutrition. Additionally, they are expected to commit to undergoing frequent health screening for blood sugar, and high blood pressure.
Policy, finances and requirements to access support programs
For the targeted population to access support from Medicaid and SNAP programs,they should meet various conditions. To become eligible for Medicaid, the elderly persons should have attained the age of 65 years and meet the income standards determined by the federal poverty level of the state.
Eligibility to SNAP program is determined by various factors, including the size of the household, income, expenditure and other factors including age, and the number of dependents(New York City FoodPolicy Center, 2017). For the older population in Jamaica and Hollis to receive support on nutrition and healthcare, they should apply at selected community organizations. This could be done online or calling the centers.
Culturally competent care
The vulnerable population under assessment is multicultural, mainly comprising of African Americans and Hispanic. The groups are minorities in the United States,and have unique histories, traditions and cultures which influence their health outcomes. To provide culturally competent care to the multicultural population,it is important for the healthcare provider to be knowledgeable about the unique cultural characteristics of individual members and develop appropriate approaches to extract relevant information from the clients. This would promote the effectiveness of the intervention.
The main intervention for the elderly population is education to empower them with knowledge and skills on healthy nutrition. To ensure that the old population understands the information provided,using appropriate method that would facilitate effective communication between the nurse educator and the older persons is essential. To provide culturally competent care, the nurse should be able to extract information about the patient’s belief pattern and preferences to facilitate delivery of information that address individual patient’s fears, expectations and concerns (Douglas, Marlene, Dula, & Callister, 2014).
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New York City Food Policy Center. (2017). A Foodscapeof Jamaica. Available at http://www.nycfoodpolicy.org/wp-content/uploads/2016/11/FS408_2017.pdf
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