Name: JOJ K MATHEW

Student Number: 209443110

Module Title: Health Inequalities And Determinants Of Health

Module Code: HNUM07

Module Lead: VIVIENNE LUND

Submission Date: 27 June 2022 at 13:00

Word Count: 2554

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Declaration

I Joj K Mathew, Student number 209443110 Confirm the assignment module

HNUM07 is my own work and has not been submitted for any other assessed work.

Signed: Joj K Mathew

Date: 26/06/2022

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Critical Review of a Published Health Inequalities Report

Introduction

This article aims to give a critical review of the National Healthcare Quality and

Disparities Report (2021) and analyses the implications for nursing practice and

health care service delivery. According to the Association of Public Healthcare

Nurses (2015) equity is an ideal state set apart by reasonableness and the

accomplishment of ideal wellbeing and prosperity for all populaces, where different

well-being statuses are accounted for by race, nationality, orientation, orientation

personality, geography, disability, religion, sexual orientation, and mental health.

Health Equity might be seen as an equivalent and fair circulation of well-being

furthermore, prosperity.

Public healthcare nurses should know that past examination on health disparities

and equity value is an advancing assortment of work and at present needs

settlement on normal definitions. The article also aims to evaluate the major

underlying trends theories and concepts that have shaped the development and

status of global health and relate these to case studies at the local level as well as

contemporary public health problems.

Statistical data

The National Healthcare Quality and Disparities Report surveys the presence of our

medical care framework and recognizes areas of qualities and shortcomings, as well

as differences, for admittance to medical services and the nature of medical

services. Quality is depicted concerning six needs: patient security, individual-

focused care, care coordination, compelling treatment, solid living, and care

moderateness. The report depends on more than 250 proportions of value and

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differences covering an expansive cluster of medical care administrations and

settings.

As per the report ready by National Healthcare Quality and Disparities Report

(2021), there exist extensive divergences in healthcare access between various

population groups. For example, in 2021, 8.2% of people conceded not having the

option to get timely medical care since they could not bear the cost of it (NHQDR,

2021). Additionally, 5.6% of individuals announced the difficulty to pay for the

medications prescribed to them. Another issue was that 10% of people could not

receive appropriate dental care because of the absence of cash (NHQDR, 2021).

These figures change from one year to another; however, the general message

continues as before: there are many individuals living in the United Kingdom that

cannot manage the cost of the medical services they need. However, it is not just the

poor population that cannot utilize medical care to the full degree. The racial, ethnic,

and sexual diversity of some individuals also poses a serious barrier to seeking

medical care.

A few critical discoveries and patterns from the 2021 report include:

- Contrasted with their White partners, the number of worse measures surpassed

the number of measures that improved for all racial and ethnic minority bunches

aside from the Asian community. This represents racial and ethnic disparities which

would be discussed in the literature review.

- While Black, Hispanic, American Indian, and Alaska Native groups all

accomplished significant upgrades in medical services quality, critical differences in

all spaces of medical services quality endure.

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- The report accentuates that even before the COVID-19 pandemic, doctor

deficiencies existed in many states the country over, and ethnic minorities stay

under-addressed in a few medical care callings. An absence of racial, ethnic, and

orientation concordance among suppliers and patients can result in poor medical

care.

Literature Review

The subsequent sections aim to support the findings of the National Healthcare

Quality and Disparities Report (2021) with relevant literature and past studies form a

wide view of sources on racial and ethnic disparities, sexual minority groups and

workforce diversity, and lastly implications of these disparities for nursing practice

and healthcare service delivery generally.

For the reasons for this report, healthcare disparities are differences that exist

among specific populace groups in the United States in the accomplishment of full

healthcare potential that can be estimated by differences in rates, prevalence,

mortality, the burden of disease, and other unfavourable ailments (APHN, 2015).

While the term disparities are frequently utilized or deciphered to reflect differences

between racial or ethnic groups, disparities can exist across numerous different

aspects too, like gender, sexual orientation, age, disability status, financial status,

and geographic location.

Racial and Ethnic Disparities

This section aims to u more in-depth explanations according to the literature on past

studies on racial and ethnic differences in the healthcare sector. Most article sources

selected for the examination analysis on the impact of disparities on healthcare

access were centred on racial and ethnic differences (Chen et al., 2016; Cook,

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Barry, and Busch, 2013; Fiscella and Sanders, 2016; Flores and Lin, 2013; Shi et al.,

2014). The research by Chen et al. (2016) aims at exploring "racial and ethnic

variations in health care access and utilisation" after the full execution of the

Affordable Care Act (ACA) in 2014 (p. 140). Researchers express that the minorities

that have generally experienced differences in access and inclusion of care have

worked on their information under the ACA in contrast with whites (Chen et al.,

2016). However, different sources demonstrate that this information is not as

optimistic as it would sound.

Research by Flores and Lin (2013), zeroed in on the examination of patterns in racial

and ethnic contrasts in US youngsters' ease with healthcare and offers the

accompanying statistics. In the period ranging from 2003 and 2007 upwards, 10 new

disparities in healthcare access showed up, and two have deteriorated (Flores and

Lin, 2013). While researchers note that fifteen gaps have diminished during the

research period, the ascent of new ones implies the situation is yet unacceptable.

Another review zeroed in on kids' disparities in healthcare access is the one by Cook

et al. (2013). Researchers examine youngsters' psychological well-being care

access in roughly a similar period as Flores and Lin (2013): from 2002 to 2007. Cook

et al. (2013) reason that there are considerable variations for Latino and black

children in access to emotional well-being care, psychotropic drug use, and

outpatient care. According to researchers, large numbers of these young patients do

not get the important care because of the reluctance of clinical staff to initiate

treatment.

Shi et al. (2014) concentrate on financial and racial disparities in accessing primary

care among patients determined to have constant circumstances. Researchers note

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that there are critical racial disparities in such categories as a typical source of care,

types of suppliers for usual sources of care, and area of the usual source of care.

Additionally, Shi et al. (2014) report no disparities in the simplicity of receiving

medical care providers or getting to patients' source of care as well access.

Fiscella and Sanders (2016) likewise examine the disparateness in the quality of

care for racial and ethnic minorities. Researchers infer that the gap for the most part

results from complex connections between patient-specific factors and industry-

related factors. As well as Flores and Lin (2013), and Fiscella and Sanders (2016)

consider that the advancement in hoisting such disparities is excessively slow.

Sexual minority groups and workforce diversity

This section aims to give more in-depth explanations according to the literature on

past studies on racial and sexual minority groups and workforce diversity in the

healthcare sector. Discoveries of a deliberate survey directed by Mitchell et al.

(2016) report that the absence of nurses' schooling on LGBT mindfulness is the

essential obstruction to this minority populace's admittance to top-notch care.

Likewise, researchers comment that this gathering of people is not treated with

respect and consideration. Mitchell et al. (2016) underscore that nurses are not

ready to talk about disparities and medical services worries of the LGBT people

group since they are not offered any schooling on this issue.

To resolve the issue of the absence of such schooling for medical caretakers,

Jackson and Gracia (2014) and Williams et al. (2014) examine the role of a different

labour force and social determinants of health. Research recommends such

arrangements as advancing social skill training and community health workforce

models. Jackson and Gracia (2014) and Williams et al. (2014) consider these ideas

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as significant advances that could guarantee equality in admittance to care among

ethnic and racial minorities.

Social Determinants of Health and Social Needs (SDOH)

This section aims to give more in-depth explanations according to the literature on

social determinants of health and social needs in the healthcare sector and evaluate

explanations for inequalities in health and the implications for nurses. Nurses serving

locally frequently work directly to address social necessities at the individual and

family levels, and frequently function to address SDOH at the local area and

populace levels. Public health nurses specifically have wide information on

healthcare problems and the related SDOH, as well as needs and resources, at the

community level. Embedded inside the community, they likewise are strategically set

up to construct trust and are regarded among community pioneers. At the individual

and family levels, home visiting medical caretakers frequently address the principal

line of medical care suppliers with supported commitment intending to social

requirements for some people (Wakefield, Williams, and Le Menestrel, 2021).

Public health nursing is described as a coordinated effort and partnerships with

communities to address SDOH (Kulbok et al., 2012). Center to general wellbeing

nursing is working across disciplines and areas to propel the soundness of

populaces through community organizing, alliance building, policy analysis,

contribution to nearby city and province gatherings, cooperation with state wellbeing

divisions, and social showcasing (Canales et al., 2018).

However, while public health nurses' work is basic to the soundness of the

community, their work is seldom noticeable. Moreover, concerning quantifiable

decreases in health disparities, little research is accessible that straightforwardly

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connects and unequivocally to public health nursing roles (Davies and Donovan,

2016; Schaffer et al., 2015; Swider et al., 2017). The recent experiences with Zika

infections were identified as one of the systems utilized by the U.S. Department of

Health and Human Services (HHS) to manage nursing associations to reach nurses

and through them, assist to reach out to the general population with authentic data

and limit superfluous resource use (Minnesota Department of Health, 2019). In their

job as confided-in experts, and given their boundless presence in communities,

integrating public health nurses into local, state, and national government techniques

for health education and information dissemination can assist with expanding the

span and effect of informing during infectious diseases and other public health

crises. Medical caretakers can act as master wellsprings of data (e.g., on forestalling

irresistible disease transmission inside their communities) (Audain and Maher,

2017).

Community Health Needs Assessment

This section aims to give more in-depth explanations according to the literature on

community health needs assessment in healthcare as an underlying concept that

has shaped the development of global health. According to Health (2018) leading a

community health needs evaluation is itself a multisector joint effort as it requires

connecting with community-based partners. The after-effects of the appraisal present

open doors for multiple sectors to cooperate. For instance, a medical clinic might

collaborate with public health and regional food banks to address food insecurity. On

the other hand, it might collaborate with a health technology organization and a

nearby school committee to address digital literacy for underserved youth and their

families and stretch out the span of broadband to help health care access through

telehealth technology and reinforce digital literacy. In evaluating the local area's

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healthcare needs, these medical clinics are expected to obtain and consider

community-based input, including input from people or associations with knowledge

of or ability in public health. The reports created as a component of this cycle are

expected to be freely accessible (IRS, 2020).

Public Health Nursing's Roles, Responsibilities, and Obligations as Health

Equity Advocates

Public health nursing leaders are many times exceptionally positioned in government

organizations and are in a position to be engaged with issues connected with policy

and legislation. These potential open doors ought to be searched out. They furnish

us with a forum to "put a human face" on public health issues and problems (APHN,

2015). Persaud (2018) suggests nurses act as advocates for policy change to further

develop well-being in underserved populations. Since nurses are at the forefront of

patient care, they can give an informed understanding of existing health disparities in

communities. This data can assist with moulding arrangements and guide

community advocacy.

Advocacy is a norm of practice for public health nursing. The American Nurses

Association's Scope and Standards of Public Health Nursing Practice states

advocacy are characterized as "the demonstration of arguing or contending for a

purpose, thought, or strategy for another person's benefit, with the object of fostering

the local area, framework, individual, or family's ability to argue their own goal or

follow up on their behalf."(American Nurses Association, 2013).

Educating The Current and Future Workforce of Public Health Nurses

The schooling process should begin with mindfulness and aversion to those whose

culture is not quite the same as nurses in practice. This mindfulness should be

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interlaced into professional practice training. Healthcare nurses are not competent in

their roles except they know about and are sensitive to the necessities of others and

can work effectively in the communities to facilitate progressions important to

achieve more noteworthy value in health outcomes.

Public health institutions and nursing organizations of advanced education commit to

helping work with and support this interaction with their staff and understudies

(APHN, 2015). Kenny (2010) takes note that extra training can work on the capacity

to give patient-focused care. Nurses are familiar with the specific difficulties faced by

particular races, ethnicities, and socio-economic classes under their care can

improve patient outcomes. Understanding local societal differences and cultures can

help direct treatment and assist them in obtaining patient compliance and healthy

living decisions.

The Potential of Technology

According to NASEM (2016), Mobile technologies "can extend the things we care

about in wellbeing to this present reality as opposed to having it stay just in rarified

scholastic communities". These advances can produce easy-to-use instruments for

improving wellbeing. They can change the inquiries individuals pose about their

wellbeing and the data accessible to them. As a consequence, these advances can

be extended to whole populations, and they can be used in conjunction with

additional proficient and delegated trials of all kinds.

The accessibility of Smartphones to individuals at practically any monetary level or

location is growing the opportunities for well-being value through innovation at a

rising rate. NASEM (2016) calls attention to those portable applications that can give

some broadly accessible health management tools to phone users. Instructing

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patients about these applications can assist with further developing health equity.

Nurses can urge patients to utilize care, wellness, and nourishment applications, too,

to begin making wellbeing changes.

Conclusion

In summary, nurses need to engage with people and guarantee that they centre their

training practice on the well-being needs of the local communities or gatherings they

serve. By developing health equity, nurses can shape patient well-being on individual

and community levels. Through more noteworthy cognizance of healthcare

disparities, better training on social wellbeing, the utilization of innovation (e.g.

smartphones) were conceivable, and advocacy for health equity, nurses can assist

with guaranteeing the result of better well-being for all.

Globally, nurses should challenge strategies and policies based on health equity,

serving as advocates and medical caretakers, both as a calling and as individual

specialists, they ought to consider the social determinants of wellbeing as really

important for further developing wellbeing and medical services and lessening

imbalances in wellbeing results for various groups in society.

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References
American Association of Colleges of Nursing, 2015. Enhancing diversity in the
workforce (fact sheet).
Association of Public Health Nurses (APHN), 2015. The Public Health Nurse’s Role
in Achieving Health Equity: Eliminating Inequalities in Health. [Online] Available at:
https://www.health.state.mn.us/communities/practice/resources/equitylibrary/docs/
2015_APHN-The-Public-Health-Nurse-s-Role-in-Achieving-Health-Equity.pdf
Accessed 19 Jun. 2022].
Audain, G. and Maher, C., 2017. Prevention and control of worldwide mosquito-
borne illnesses: nurses as teachers. OJIN: The Online Journal of Issues in Nursing,
22(1).
Canales, M.K., Drevdahl, D.J. and Kneipp, S.M., 2018. Public health nursing.
Nursing Outlook, 66(2), pp.110-111.
Chen, J., Vargas-Bustamante, A., Mortensen, K., & Ortega, A. N., 2016. Racial and
ethnic disparities in health care access and utilization under the Affordable Care Act.
Medical Care, 54(2), 140-146.
Cook, B. L., Barry, C. L., and Busch, S. H., 2013. Racial/ethnic disparity trends in
children’s mental health care access and expenditures from 2002 to 2007. Health
Services Research, 48(1), 129-149.
Davies, N. and Donovan, H., 2016. National survey of commissioners' and service
planners' views of public health nursing in the UK.
Fiscella, K., and Sanders, M., 2016. Racial and ethnic disparities in the quality of
health care. Annual Review of Public Health, 37, 375-394...
Flores, G., & Lin, H., 2013. Trends in racial/ethnic disparities in medical and oral
health, access to care, and use of services in US children: Has anything changed
over the years? International Journal for Equity in Health, 12(1), 10.
Heath, S., 2018. 3 Things to Know to Conduct a Community Health Needs
Assessment. [Online] Available at: https://patientengagementhit.com/news/3-things-
to-know-to-conduct-a-community-health-needs-assessment [Accessed 19 Jun.
2022].
Internal Revenue Service, Department of the Treasury, 2013. Community health
needs assessments for charitable hospitals. Fed Regist, 78(66), pp.20523-20544.
Jackson, C.S. and Gracia, J.N., 2014. Addressing health and health-care disparities:
the role of a diverse workforce and the social determinants of health. Public Health
Reports, 129(1_suppl2), pp.57-61.
Kenny, A.S., 2010. Culturally competent nursing to reduce health disparities. Nursing
Outlook, 58(2), p.e14.
Kulbok, P.A., Thatcher, E., Park, E. and Meszaros, P.S., 2012. Evolving public
health nursing roles: focus on community participatory health promotion and
prevention. Online J Issues Nurs, 17(2), p.1.

13
Minnesota Department of Health, 2019. Public health interventions: Applications for
public health nursing practice.
National Academies of Sciences, Engineering, and Medicine (NASEM), 2016. The
promises and perils of digital strategies in achieving health equity: Workshop
summary.
National Academies of Sciences, Engineering, and Medicine, 2019. Integrating
social care into the delivery of health care: Moving upstream to improve the nation's
health.
National Healthcare Quality and Disparities Report, 2021. [Online] Available at:
https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/
2021qdr.pdf [Accessed 19 Jun. 2022].
National Institutes of Health, 2014. Health Disparities. [Online] Available at:
https://www.nhlbi.nih.gov/health/educational/healthdisp/ [Accessed 19 Jun. 2022].
Persaud, S., 2018. Addressing social determinants of health through advocacy.
Nursing Administration Quarterly, 42(2), pp.123-128.
Schaffer, M.A., Keller, L.O. and Reckinger, D., 2015. Public health nursing activities:
Visible or invisible?. Public Health Nursing, 32(6), pp.711-720.
Shi, L., Chen, C.C., Nie, X., Zhu, J. and Hu, R., 2014. Racial and socioeconomic
disparities in access to primary care among people with chronic conditions. The
Journal of the American Board of Family Medicine, 27(2), pp.189-198.
Swider, S.M., Levin, P.F. and Reising, V., 2017. Evidence of public health nursing
effectiveness: A realist review. Public Health Nursing, 34(4), pp.324-334.
Wakefield, M., Williams, D.R., and Le Menestrel, S., 2021. The future of nursing
2020-2030: Charting a path to achieve health equity. National Academy of Sciences.
Williams, S.D., Hansen, K., Smithey, M., Burnley, J., Koplitz, M., Koyama, K., Young,
J. and Bakos, A., 2014. Using social determinants of health to link health workforce
diversity, care quality and access, and health disparities to achieve health equity in
nursing. Public Health Reports, 129(1_suppl2), pp.32-36.

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