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RN EXPANDING ENVIROMENTS IN THE NURSING PROFESSION URBAN HEALTH CARE PROBLEMS Definition URBAN Referred to all territory, population, and housing units located in places with a population of 2,500 or more. With Census 2000, the definition changed.
URBANIZATION Refers to a process in which an increasing proportion of the entire population lives in cities and suburbs of cities. Historically, it has been connected with industrialization. Urbanization implies “considerable changes in the ways in which people live, how they earn their livelihoods, the food which they eat, and the wide range of environmental factors to which they are exposed.
Urbanization trends and patters: • • Movement of people from rural to urban areas with population growth equating to urban migration A double edged sword • On one hand- Provides people with varied opportunities and scope for economic development • On the other- Exposes community to new threats Unplanned urban growth is associated with • Environmental degradation • Population demands that go beyond the environmental service capacity, such as drinking water, sanitation, and waste disposal and treatment
Causes of urbanization due to Migration • Better income prospects • Better educational facilities • Better “Life style” • Basic amenities – health, transport, water, electricity. • Victims of natural/manmade calamities-Refugees
Consequences of urbanization due to Migration • Overcrowding • Mushrooming of slums • Unemployment • Poverty • Physical & mental stress • Family structure-Nuclear families -Single males
4. 2. 9. Risk prevention 3.Factors for increased vulnerability of urban population to health risk: 1. advocacy.) Nurses can initiate preventive and other intervention with an understanding of environmental health hazards. Occupational and environmental exposures are predominantly inhalational rather ingestional and more likely to be subacute or chronic. 10. Using epidemiological studies to determine and explain relationships between disabling agents and health of populations can best define the causes. occupation and other socioeconomic determinants. Poverty Density and diversity High rates of morbidity and mortality Disproportionate representation of minority Increased number of homeless people High crime rate and use of drugs Violence Environmental pollution Substandard housing Unemployment Undereducation Public health/ community health framework used will emphasize on : 1. impact and reduction of risk associated with environmental problem. Patients having histories of occupational exposure to environment hazards have higher morbidity and mortality and “increased utilization of health care resources” Environmental risk factors are associated with age. 11. renal and central nervous system and affects appears to be irreversible. 8. Lead poisoning Toxic heavy metal that primarily affects the hematopoietic. . 1. 5. 3. location. and treatment. Through education. 7. Risk reduction 2. 6. Health promotion Environmental problems that contribute to the urban health care problems: Environmental health in urban setting “Impact on environment is the single most important determinant of health in the near future” (Saucier. nurses can have multiple opportunities to contribute to the reduction of environmental risks.
Most devastating form of lead poisoning exists in inner cities where old. sellers and lessors will be required to disclose presence of lead-based paint hazards in all dwellings built before 1978 (Neuberger. and interference with well-being Most pollutants result from the burning of fossil fuels in industries and homes. Government effort are directed toward prevention of lead poisoning were: 1. Toxic waste Discharge or byproducts of industrial processes. Beginning 1995. known to cause serious injury to animals. humans. Comprehensive Environmental Response Compensation and Liability act of 1980 (to assist in the cleanup of hazardous waste sites) 3. Community-based nurses are in excellent position: 1. costs $2.4 billion per year to test and remove lead in private housing U. races and sex groups but more common in children Increases are attributed to environmental factors such as ozone and other air pollutants Clean Air Act identifies primary air quality pollutants (nitrogen dioxide. soil and work places 3. total suspended particles. such as cyanide compounds. aggravation of heart disease. Continued reduction of lead in food. Screening children for blood lead levels and assuring referrals for treatment. To recognize symptoms of lead poisoning that may include signs of lassitude and “slowness” 3. Increasing safe and effective reduction of lead paint and dust in high-risk housing 2. the storage of potentially harmful pollutants in the body. dilapidated housing with chipped and peeling paint which are colorful. sweet tasting that are attractive to children.S. High level of lead may result in stillbirths. Asthma Prevalence is increasing among all ages. 2. sensory irritation. . Lead reduction is an expensive process. Hand-to-mouth transfer of lead-contaminated dust and dirt occur in children through normal play activities. and heavy metals. To observe and educate the public about the danger to young children of peeling paint in old houses. To participate in case-finding activities 2. Department of Housing and Urban development. water. air.1993) Inhalation is the second major route of lead absorption. impaired breathing. sulfur dioxide. Establishment of surveillance among children with elevated blood levels 4. and plats if disposed of indiscriminately in the environment. chlorinated compounds. carbon monoxide and lead) Effects of air pollutants on human health includes death from pulmonary disease.Lead exposure to fetus may result in low birth-weight and miscarriage. Resource Conservation Recovery Act of 1976 (to control waste that is being presently produced) 2. two legislation designed for management of hazardous chemical waste 1.
7. industry. or work environment. Removing the asbestos insulation from older homes. virus. limb. Physical Agents: Noise. Environmental Protection Agency (EPA) recommended that organizations dealing with children or places where children spend time should have a no-smoking policy as well in workplaces. aquifers and groundwater). acting as breeding grounds for rats. Social problems that contribute to the urban health care problem: . schools. dusts. Deterioration or disturbance of asbestos-containing materials releases airborne asbestos filters that. and generating dangerous gases alike methane. and motor vehicles. Occupational hazards Danger to health. or life that is inherent in. lakes. National health objective for the year 2000 is the reduction of human exposure to toxic agents by controlling the total pounds of toxic agents released into the air. liquids (organic solvent lead) Biological Agents: Microorganism (bacteria. hazardous waste handling.oceans. Water pollution occurs when pollutants are discharged directly or indirectly into water bodies without adequate treatment to remove harmful compounds. or is associated with. sewage treatment plants. rivers. incinerators. and mosquitoes. ergonomic factors Chemical agents: Gases. Rate of respiratory diseases that are higher in cities as well as cancer deaths within cities are associated with levels of urbanization and industries. Occupational hazards include risk of accident and of contracting occupational diseases. and buildings in inner-city communities is a costly operation 6. vapours. it is associated with obstructive lung disease and mesothelioma (a form of cancer) Workers in asbestos plants and residents and school children in buildings where asbestos has been used for insulation are particularly vulnerable. vibration. 8. and soil each year directly or indirectly by industrial and manufacturing facilities. Asbestos Asbestos are commonly used in pipe insulation and fireproofing. ionizing and nonionizing radiation. particular occupation.g. Cancer Second-hand smoke as a carcinogen. if inhaled. Waste disposal Proper disposition of a discarded or discharged material in accordance with local environmental guidelines or laws Improper disposal of household waste can contribute to an array of health problems as polluting air from burning trash. Water pollution Is the contamination of water bodies (e. fungus). 5. water. animal products. flies. can cause lung cancer and asbestosis As an air contaminant.4.
adverse peer influence. thus increasing their risk of breast cancer.1. cancer. People with low incomes have death rates that are twice higher that people with incomes above poverty levels. Woman over 40 in poverty are less likely to have mammograms or clinical breast examination. which commonly includes clean and fresh water. and contributes to infant mortality. early aggressive or acting-out behavior. Elementary school behaviors as possible antecedents were: low academic achievement. early use of tobacco. often resulting in open conflict. or marijuana. education. Social isolation experienced by inner city populations was attributed to middle-class professionals moving out of neighborhood (leaving few role models) and to industry moving out of inner-city neighborhoods (leaving few working-class jobs) Few jobs that remain attract unskilled workers and usually pay less that subsistence wages. Social isolation a state or process in which persons. or cultures lose or donot have communication or cooperation with one another. and diminished self-efficacy. inadequate family management ad parental supervision. clothing and shelter Relative poverty refers to lacking a usual or socially acceptable level of resources or income as compared with others within a society or country Health disparities between poor people and those with higher incomes are almost universal for all dimensions of health. Undereducation Communities of the underclass are “plagued by massive joblessness. and unintentional pregnancy. Poverty increases the risk of death from heart disease. ) Poverty increases the risk of children’s dropping out of school Dropping out of school is associated with substance abuse. Poverty Poverty is the state of one who lacks a certain amount of material possessions or money Absolute poverty or destitution refers to the one who lacks basic human needs. health care. Relocation of industries from inner cities to suburbs Freeways built to cut through neighborhoods to form direct pathways to the suburbs from the central city. parental substance abuse. . intentional and unintentional injury. alcohol. AIDS. flagrant and open lawlessness. Impact of poverty for children includes developmental delays and the risk of lead poisoning Poverty is also associated with excess rates of obesity and high blood pressure. and traumatic injury. delinquency. Poverty decreases longetivity and dimishes the quality of life. groups. nutrition. tuberculosis. sensation-seeking behavior. 3. and low-achieving schools” (Wilson. 2.
It is important that health professionals to recognize potential and actual abusive behavior. Crime and violence Crime is the breach of rules or laws for which some governing authority The intentional use of physical force or power. Abuse Child. . maldevelopment or deprivation (WHO) Daily accounts of children’s deaths and disabilities from gunfire and the possession and use of attack weapon have resulted in public demand for corrective action. 5. and adopting alternative solution to conflict can prevent violence. that either results in or has a high likelihood of resulting in injury. and other member of the educational team. Community health nurses provide antipatory guidance and child-rearing counseling that is preventive in purpose. spousal. Infants. psychological harm. against oneself. hope for the future and self-respect comes from gainful employment that influences marriage and enables one to support a family. individual show greater frequency of illness. considering. Violent crimes vary according to the economic status of a community Lack in income is thought to contribute to out-of-wedlock births Personal values. 6. school. Less participation in the political process and had little contact with politicians 4. death. Unemployment There is a rise in crime during periods of severe unemployment and that families are under greater psychological stress at the same time. another person. For school-aged children. and elder abuse in one measurement of violence in a community. threatened or actual. pre-school children. their families. Children who repeatedly witness gunfire and homicide develop attitudes of fatalism Early interventions. or against a group or community. Current welfare system does not provide an economic incentive to wait until marriage to have children and the attitude of many poor populations is that the government will provide money for children anyway. Health providers should realize that the average case of child abuse is not physical but child neglect. Nurses can participate in preventive approaches to violence through school health programs with the children. and others who died from stray bullets from gang warfare or drive-by shootings are victims in inner-city communities. Risk reduction efforts must focus on several levels including the family. community and the media. including school-based programs that stress social and emotional skills like negotiating.
and premature death. Chronic disease morbidity An interdependence of social and medical issues indicated patient’s malnutrition associated with illness like anemia and tuberculosis. Men make up 56%. Child neglect occurs when children are not fed. women 25% and persons under the age of majority 19% of the homeless population. 4. 9. Majority of homeless are long-term residents of the city in which they are sheltered 6. Most homeless children are under 5 years old. American Dietetic Association warned if hunger is not remedied. Pregnant women. disability. Population characteristic of homeless from Institute of Medicine (IOM) report in 1988: 1. Many of elderly live alone or with an elderly spouse and are without extended family support. Poor school performance 3. 7. The elderly Inner-city elderly are more likely to be living on fixed incomes and below the poverty level and may be unable to buy foods they need to maintain a good health state. The homeless are a special challenge to health agencies because of their mobility. Inadequate growth and development 2. . the deprivation proves fatal. for large numbers of people. so surveying medical status is difficult and follow-up is almost impossible. and they are at high risk of disease. Minorities are overrepresented in the larger cities 5. Families are the fastest-growing subgroups of the homeless 2. Homelessness is recognized as a cause of illness and illness is recognized as a cause of homelessness Homeless are people who are moving and have no permanent address. or do not receive follow up by the parent on health matters that need care. the resulting costs include: Infant prematurity and retardation 1. Decreased productivity 4. Elderly people are afraid to shop in areas where crime is high even when a grocery is relatively close to their homes. infants and children. Hunger When hunger reaches epidemic proportion the outcome is not in question. fail to attend school. Individual adult make up the single largest group of the homeless population 3. Homelessness Homelessness and hunger are consequences of poverty: poor health is often the end result. and elderly people are likely to suffer the most harm if food intake is inadequate 8. are left alone.
Homelessness complicates the delivery of care for programs designed to provide health and medical care to this special population group. Skin and blood vessel disorders including infected insect bites. septicemia 7. tetanus. Mental illness and disability. diabetes. Upper respiratory illnesses 4. cellulitis. • • • • • • Air pollution and its consequences Due to increase in the numbers of motorized vehicles and industries in the cities of the developing world Problems of noise and air pollution Air pollution can affect our health in many ways with both short-term and long-term effects Short-term air pollution can aggravate medical conditions like asthma and emphysema Long-term health effects can include chronic respiratory disease. Infectious and communicable conditions including HIV/AIDS. amebiasis. diphtheria. STD. Double Burden of Diseases Overcrowding and related health issues • Rapid growth of urban centers has led to substandard housing on marginal land and overcrowding • Outbreaks of diseases transmitted through respiratory and faeco-oral route due to increased population density • It exacerbates health risks related to insufficient and poor water supply and poor sanitation systems • Lack of privacy leading to depression. skin ulcers. and chronic obstructive lung disease 6. Chronic conditions like hypertension. Tuberculosis 5.6 billion people i. anxiety. often due to violence 2. especially schizophrenia 9. over 400 million people. Dental problems 8. heart disease. Traumatic injuries.e. Homeless children are more likely to have school problems and incomplete immunization. lung cancer. infestation. stress etc. lack even a simple improved latrine • • • . Health conditions for homeless identified by IOM report (1988) 1. and peripheral vascular disease 3. and even damage to other vital organs Water and sanitation problems Due to increasing urbanization coupled with existing un-sustainability factors and conventional urban water management Nearly 1.1 billion people worldwide who do not have access to clean drinking water and 2. Alcoholism and drug abuse Treatment facilities for secondary and tertiary diagnoses are not readily available for homeless with co-morbidity (multiple health problems) Homeless mothers are more likely not to receive prenatal care and to have low-birth-weight infants.
• • • • • • • • • Can lead to increased episodes of diarrhea and economic burden Upsurge of Non-communicable diseases The rising trends of non-communicable diseases are a consequence of the demographic and dietary transition Decreases in activity combined with access to processed food high in calories and low in nutrition have played a key role Urbanization is an example of social change that has a remarkable effect on diet in the developing world Traditional staples are often more expensive in urban areas than in rural areas. chronic diseases are estimated to account for 53% of all deaths and 44% of disabilityadjusted life-years (DALYs) lost in 2005 . whereas processed foods are less expensive This favors the consumption of new processed foods This places the urban population at increased risk of NCDs In India.
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