● Some chronic stressors mentioned in the film are: being on guard all the time,

having little control at work, living in an unsafe neighborhood, being uncertain

about where food will come from, and worrying about one’s children.
• What additional stressors can you think of?
• How does exposures to stressors—and resources available to manage them
—vary with class position?
• Describe the societal forces that create and reinforce these stressors.
• What additional set of stressors might racism impose
Chronic stressors can have an immense negative impact on one’s life, and being on
guard all the time, having little control at work, living in an unsafe neighborhood, not
being able to afford food, and worrying about children are just a few examples of
chronic stressors. Some additional chronic stressors I can think of include living with a
dysfunctional family, being in an unsafe relationship, worrying about affording rent, living
with a mental illness, and having daily long commutes to work. Living in these
conditions are very stressful, and have a negative impact on your mental and physical
health. The In Sickness and Wealth documentary compares the health and wellness
differences between people of high socioeconomic class, to those of low socioeconomic
class.
Class position can determine the level of exposure to stressors and the resources
available to manage them. While every family and individual experiences stressors in
some way, people of low socioeconomic status often have less resources to manage
them than people of higher socioeconomic status. With these resource and accessibility
differences, people of higher socioeconomic status often live longer than those of lower
status (Adelman, 2008). Individuals and families of higher socioeconomic status have
more accessibility to healthcare and can obtain doctors appointments faster than others
to handle medical problems. Low socioeconomic status families have a higher risk of
child abuse compared to families of middle or high socioeconomic status (Martins,
Matos, & Sani, 2023). This occurs due to an increased stress level in low
socioeconomic status families.
The societal forces that create and reinforce these stressors are a lack or decreased
education for those of low socioeconomic status. People of higher socioeconomic status
often have a higher education level, which allows them to pursue a career where they
will make a living salary. They are also more educated on healthier food options and
have the means to pay for it. People of lower socioeconomic status may not have the
education to understand the foods and nutrients they need each day, which makes
them more prone to diseases. Also, the children of lower socioeconomic families may
be forced to drop out of high school in order to work to support their family. This puts
these children at a disadvantage compared to children of higher socioeconomic
families.
Racism can impose a number of additional stressors that others do not need to worry
about. Children of color aged 12-15, in middle school, are more likely to experience
anxiety and depression due to discrimination and racism (Jenkins et al., 2023). These
factors make them less likely to participate in school and decrease overall educational
engagement. This can decrease the knowledge these children possess and carry with
them into adulthood. The trauma racism causes can greatly impact a person’s mental
health. With poor mental health, it is increasingly more difficult to hold a job, pursue
education, and support a family.

Adelman, L. (Director). (2008). In sickness and in wealth: Patterns of health and racial
disparities [Film]. California Newsreel.

Jenkins, J. H., Sanchez, G., Miller, E. A., Santillanes Allande, N. I., Urano, G., & Pryor,
A. J. (2023). Depression and anxiety among multiethnic middle school students: Age,
gender, and sociocultural environment. International Journal of Social Psychiatry, 69(3),
784–794. https://doi-org.ezproxy3.library.arizona.edu/10.1177/00207640221140282

Martins, P. C., Matos, C. D., & Sani, A. I. (2023). Parental stress and risk of child abuse:
The role of socioeconomic status. Children & Youth Services Review, 148, N.PAG.
https://doi-org.ezproxy3.library.arizona.edu/10.1016/j.childyouth.2023.106879

Response 1

Hi Ava, you provided an excellent post about chronic stressors and how it
impacts people short term and long term. Clearly, there are interventions
that need to be implemented in order to promote health equity. Some
policies that I believe should be implemented are free transportation to
health appointments and free classes about nutrition. Many individuals
access public transportation in order to get to healthcare visits. There are
many barriers to this, which include timing and distance to nearest bus
stops. Patients may get to their healthcare appointments early or late
because of public transportation. There may also not be a bus stop near
the patient's home. A better and safer access to public transports must be
possible for disadvantaged populations in order to promote health equity
(Vahora et al., 2023). Free classes to educate populations about nutrition
is a much needed intervention. Many populations are not aware of the
nutrition they require on a daily basis or how to learn more about this
topic. There are online culinary and nutritional courses that can educate
these populations on their nutritional requirements. Classes like these can
result in individual increased vegetable intake, food skill confidence, and
nutritional knowledge (Asher et al., 2023). Obstacles to this intervention
include that not all online classes like these are free, and certain
populations may not be able to afford this. There needs to be a better
policy or intervention to combat nutritional misinformation and improve
knowledge.

Strategies for social change differ from programs for repairing damage
because strategies for social change aim to fix the root problem, causing
the issue. Programs for repairing damage focus on fixing the after-effect of
the issue, but not aiming at fixing what is causing the damage. While fixing
issues is important, it is priority to fix the underlying problem that is
causing the specific issue. For example, a free nutritional online or in
person class is an excellent strategy for social change, since it focuses on a
root problem. If a person has the nutritional knowledge needed and
follows it, they are less likely to develop secondary problems, such as
diabetes. In order to provide more opportunities, such as this, power
would need to shift. There would need to be funding for such a program,
and people to implement it. Power would need to shift from the
government level, to the community level. Communities would need the
funding and opportunity to implement a nutritional program, for example.

Adelman, L. (Director). (2008). In sickness and in wealth: Patterns of health

and racial disparities[Film]. California Newsreel.

Asher, R. C., Clarke, E. D., Bucher, T., Shrewsbury, V. A., Roberts, S., &
Collins, C. E. (2023). Impact and evaluation of an online culinary nutrition
course for health, education and industry professionals to promote
vegetable knowledge and consumption. Journal of Human Nutrition &
Dietetics, 36(3), 967–980.
https://doi-org.ezproxy2.library.arizona.edu/10.1111/jhn.13109

Vahora, K. I., Dove, R. M., Par, J. B., Mustefa, L., & Saelens, B. E. (2023).
Navigating Health Equity Through Mobility Justice: Youth of Color
Organizing for Transportation Equity in Our Backyards. Health Promotion
Practice, 24, 28S–40S.
https://doi-org.ezproxy2.library.arizona.edu/10.1177/15248399221142
628

Week 3 Initial Post

Angelique Anderson says: “I always wanted to have a house with a big back
yard...” Corey adds: “I want to own a house so that if anything happened to me,
she wouldn’t be put out on the street.”

● What health benefits might derive from affordable, quality and secure
housing?
● How might you empower patients and families?
● What data do you need to gather that can be aggregated to inform the
allocation of resources and services and to identify disparities between
patient populations?
● What local health system (s)might encourage and strengthen partnerships
across organizations
● How might you plan and implement a solution?

There are many health benefits that can derive from affordable, quality, and secure
housing. Families who do not have affordable, quality, and secure housing are more
likely to experience acute and long-term health related problems. If a family does not
have a safe and affordable home, they can not efficiently take care of themselves or
their children. This puts these families at greater risk for developing health issues or
becoming homeless. Families are less likely to receive eviction notices if they are in
good health (Cutts et al., 2022). There are mental health benefits to having an
affordable and safe home. An individual’s wellbeing and health is improved when they
are exposed to natural light, have a high indoor air quality, don’t have pest problems,
and have little or no material damage (Tejada et al., 2021). It is incredibly important to
have a safe and affordable home in order to be as healthy as possible. In order to
empower patients and families to pursue a safer and more affordable lifestyle, it is
important to educate them. It is easy to forget that many people don’t have the same
resources, tools, and knowledge that you have. This makes it even more important to
provide patients and families with nutritional education, affordability education, and self
care activities to help. These seemingly simple tasks can greatly benefit a person’s life.

The data that needs to be gathered in order to inform resources and services is
population and community struggles. Every community has some kind of struggle, and
they may differ from one area to another. It is important to research and ask people
about their biggest struggle in their community, in order for the proper resources to be
provided to them. Some populations struggle with homelessness, and housing
resources would be beneficial. Another community might be greatly struggling with
mental health, and therefore, mental health resources should be provided. This would
also help to identify disparities between patient populations and would allow nurses to
provide better care to their patients.

A local health system that could encourage and strengthen partnerships across
organizations is a health disparity map. On this health disparity map, it would highlight
the region or area and identify the main health issue the population is dealing with. This
map would be available to everyone, including organizations that have the ability to help
manage the issue. On this map, you would be able to click the region and see if any
organizations are helping with the problem. This would enhance communication
between organizations since they can see what each is involved in, and other
organizations can contribute to what one is having trouble handling. For example, if one
of the organizations is having trouble with housing, another organization could
contribute to the solution of that problem, improving the health and safety of the
population.

A solution can be planned and implemented by organizations, services, healthcare

workers, and interdisciplinary teams. Not one person can achieve the solutions to
achieving safe and affordable housing, however, multiple people with different
backgrounds can implement a solution. As a nurse, to help with this problem, it is
incredibly important to understand the social determinants of health. If you, as a nurse,
can identify them, you can contact social work to help contribute to the solution.
Interdisciplinary teams are essential to finding the solutions and implementing them.

Cutts, D. B., Ettinger de Cuba, S., Bovell-Ammon, A., Wellington, C., Coleman, S. M.,
Frank, D. A., Black, M. M., Ochoa Jr., E., Chilton, M., Lê-Scherban, F., Heeren, T.,
Rateau, L. J., & Sandel, M. (2022). Eviction and household health and hardships in
families with very young children. Pediatrics, 150(4), 1–12. https://doi-
org.ezproxy1.library.arizona.edu/10.1542/peds.2022-056692

Tejada, C. S., Daher, C., Hidalgo, L., Corsà, L. V., Morera, A. F., Marselles, J. T., &
Moreno, C. C. (2021). Housing and health: a collaborative project for evidence-based
policy-making...14th European Public Health Conference (Virtual), Public health futures
in a changing world, November 10-12, 2021. European Journal of Public Health, 31.
https://search-ebscohost-com.ezproxy1.library.arizona.edu/login.aspx?
direct=true&db=rzh&AN=153589054&site=ehost-live

Week 3 Response Posts

Reflect on peers' post:

○ Empowering persons and families

 ○ Resources and services and to identify disparities
between patient populations
○ Local health system(s)
○ Planning and implementation

Hi Talon, you provided a very interesting and insightful secondary response. I really
liked how you used the phrase, “every dollar counts”, since in low income families, this
is an everyday thought. People experiencing homelessness experience far more acute
and chronic health conditions and have more complex needs (Hollenberg et al., 2022). I
really like how you put the perspective of how a low income family must spend 42% of
their income on transportation. This truly does leave little room for all of the other
expenses that a family must take on. I agree that housing/shelter is a basic need of
individuals and should always be safe. I think identifying education as a way to motivate
individuals to change is very smart. One person cannot come up with the solution,
however, a group of individuals can achieve far more. I like how you mentioned the AZ
Department of Housing, since they offer resources for the homeless including achieving
loans. Temporary financial assistance for the homeless can actually reduce overall
healthcare costs by enabling them to have a shelter (Nelson et al., 2021). Since loans
and other types of financial assistance can benefit the individual and hospitals in the
long term, it makes you wonder why more programs that offer this are not implemented.

Hollenberg, E., Bani, F. A., Durbin, A., Castle, D., Kozloff, N., Ziegler, C., &
Stergiopoulos, V. (2022). Using financial incentives to improve health service
engagement and outcomes of adults experiencing homelessness: A scoping review of
the literature. Health & Social Care in the Community, 30(6), e3406–e3434. https://doi-
org.ezproxy4.library.arizona.edu/10.1111/hsc.13944

Nelson, R. E., Montgomery, A. E., Ying Suo, Cook, J., Pettey, W., Gundlapalli, A.,
Greene, T., Evans, W., Gelberg, L., Kertesz, S. G., Tsai, J., & Byrne, T. H. (2021).
Temporary financial assistance decreased health care costs For veterans experiencing
housing instability. Health Affairs, 40(5), 820–828. https://doi-
org.ezproxy4.library.arizona.edu/10.1377/hlthaff.2020.01796

Hi Grace, you made a lot of great points in your discussion post. I thought it was very
interesting how you mentioned that owning a house nowadays is a luxury. I agree with
that statement and have noticed how much housing prices have skyrocketed over the
last few years. It is very interesting how you mentioned how a lack of chronic stress can
result in lower blood pressures and better immune function. I also discussed how
chronic stressors can negatively impact physical health. I think educating families on
health and nutrition can create a lot of benefits in individual communities. You provided
a great description on the housing voucher program and it is great to learn more about
it. I hadn’t heard of it before you discussed it. Your idea about community education
classes to educate individuals on how to save money and apply for housing loans is a
great idea. How do you think communities can implement classes like this? Families in
poverty experience chronic stress and depression more often than families not in
poverty (Guerrero et al., 2023). A family that does not have a home is most likely
experiencing a large amount of stress.

Guerrero, A. D., Herman, A., Teutsch, C., & Dudovitz, R. (2023). Evaluation of a Health
Education Intervention to Improve Parental Knowledge and Attitudes About Chronic
Stress and Depression Among Head Start Families. Health Promotion Practice, 24(2),
261–271. https://doi-org.ezproxy4.library.arizona.edu/10.1177/15248399211061132

Swope, C. B., & Hernández, D. (2019). Housing as a determinant of health equity: A

conceptual model. Social Science & Medicine, 243, 112571.