Brittany Bruening
Dr. Kimberly Brodie
MPH 584-Community Health
March 30th, 2014
1. Explain the role of health insurance and place of healthcare for promoting health across the
lifespan.
The process by which health care is delivered in the United States is unlike the processes used in other
countries of the world. Other developed countries have national health insurance run or organized by
the government, and paid for, in large part, by general taxes (McKenzie, et al., 2012). Also, in these
countries almost all citizens are entitled to receive health care services, including routine and basic
health care. Health care in the United States is delivered by an array of providers, in a variety of settings,
under the watchful eye of regulators, and paid for in a variety of ways (McKenzie, et al., 2012). Our
health care system is referred to as a spectrum of health care delivery due to the range of providers in a
variety of settings. Within the spectrum, four levels of practice have emerged: population-based public
health practice, medical practice, long-term practice, and end-of-life-practice (McKenzie, et al., 2012).
This structure helps to promote health across the lifespan.
Health insurance, like all other types, is a risk-and cost-spreading process. That is the cost of one
person’s injury or illness is shared by all in the group. Each person in the group has a different chance of
having a problem and this needing health care. The concept of insurance has everyone in the group, no
matter what their individual risk, helping to pay for the collective risk of the group (McKenzie, et al.,
2012). Some types of health insurance include self-funded insurance programs and health insurance
provided by the government, like Medicare and Medicaid.
2. Describe the Behavior Surveillance System and what age groups and risk categories are
addressed.
The Behavior Surveillance System is a state-based telephone survey of the civilian, noninstitutional,
adult population conducted by the Behavioral Surveillance Branch, a division of Adult and Community
Health, National Center for Chronic Disease Prevention and Health Promotion at the CDC (McKenzie, et
al., 2012). This survey seeks to determine the prevalence of such high-risk behaviors as cigarette
smoking, excessive alcohol consumption, and physical inactivity, and the lack of preventative health care
such as screening for cancer (McKenzie, et al., 2012). There is also a Youth Risk Behavior Surveillance
System and a National Health Care Survey to examine issues within those populations.
3. List factors that affect the size and age of a population.
There are three factors that affect the size and age of a population: its fertility rates, its mortality rates,
and its gain or loss from migration of individuals into or out of a population (McKenzie, et al., 2012).
Fertility rate is an expression of the number of births per 1,000 women of childbearing age in the
population during a specific period of time (McKenzie, et al., 2012). The mortality or health rate also has
an impact on the aging population. Another demographic variable that interacts with mortality rate is
life expectancy (McKenzie, et al., 2012). Life expectancy has continued to increase in the last several
decades, while the morality rate has stayed relatively constant. Lastly, migration if the movement of
people from one country to another. Historically, in the United States, net migration has resulted in
population gain; more people immigrate than emigrate (McKenzie, et al., 2012). As these factors change
over time, it will influence the size and age of the population.
4. Identify six instrumental needs of older adults.
The six instrumental needs of older adults include income, housing, personal care, health care,
transportation, and community facilities and services (McKenzie, et al., 2012). The aging process is not
uniform and can act in u predictable ways. According to McKenzie, Pinger, and Kotecki (2012), those
elders in the young older group usually do not experience appreciable changes in their lifestyles relative
to these six needs, elders in the middle old group and the old old group eventually do.
5. Discuss the 1985 issues identified by The Secretary's Task Force Report on Black and Minority
Health.
A landmark1985 report, The Secretary’s Task Force Report on Black and Minority Health, first
documented the health status disparities of minority groups in the United States. This report provided
substantial data documenting the minority populations, compared to the nation as a whole, experience
higher rates of morbidity and mortality (McKenzie, et al., 2012). Specifically, the report identified six
causes of death that accounted for more than 80% of the excess mortality observed among black
Americans, Hispanics, Asian Americans and Pacific Islanders, and Native Americans (McKenzie, et al.,
2012). These six causes were infant mortality, cancer, cardiovascular disease and stroke, diabetes,
homicide and accidents, and chemical dependency (McKenzie, et al., 2012). This report is one of the
most significant contributors to the development of the Health People 2000 objectives. Reducing
disparities among the minority population will continue to be on the forefront of discussion as we
continue to see that differences still exist between these groups of people.
6. Define and describe cultural competence and health literacy, and the significance to
qualitative and quantitative outcomes of community health services.
Cultural competence can be defined as a set of congruent behaviors, attitudes, and policies that come
together in a system, agency, or among professionals that enables effective work on cross-cultural
situations (McKenzie, et al., 2012). Health literacy is defined as the degree to which individuals have the
capacity to obtain, process, and understand basic health information needed to make appropriate
health decisions and services needed to prevent or treat illness (U.S. Department of Health and Human
Services, n.d.).
Both cultural competency and health literacy can make a major impact in terms of the effectiveness of a
program. For example, if there is a program that has been designed to create to try and create ways to
eat healthy and the target population holds certain religious beliefs about eating a certain way, it may
not be appropriate to come in and try and change those behaviors, but present the information about
healthy eating that respects those beliefs. Taking into account customs and beliefs of certain groups of
people, programs can be tailored so that the information is received in a meaningful way, which
generally translates to the desired behavior change.
7. Today in the United States, one of the approaches for operationalizing and prioritizing health
needs for communities relies on categorizing racial or ethnic minorities; Identify and discuss
the evidence to explain the disproportionate numbers of HIV and AIDs cases in black
Americans and Americans of Hispanic origin.
Part of the reason for the disproportionate numbers of HIV and AIDS cases in black Americans and
Americans of Hispanic origin has been attributed to a higher prevalence of unsafe or risky health
behaviors, existing co-conditions, and the lack of access to health care that would provide early
diagnosis and treatment (McKenzie, et al., 2012). This condition may not be viewed as something that is
of utmost priority in terms of survival within these minority populations. With no cure for HIV/AIDS,
educations and prevention are going to be the most important methods in reducing these
disproportionate numbers.
8. Identify one issue presented in the Unnatural Causes video, which address health inequities in
the United States and how it affects patient outcomes. How does this influence prioritization
and planning for community health services?
One issue that was presented in the Unnatural Causes video was the prevalence of low-birth-weight
(LBW) babies among black Americans. Regardless of education, socioeconomic status, or location, there
is still a greater number of black women who deliver LBW infants compared to their white counterparts.
The video then speculated that racism may in fact be one of the reasons as to why the issue is present.
In terms of prioritizing and planning community health services, it may come down to creating an
environment free of judgment and providing the same care regardless race.
References
McKenzie, J.F., Pinger, R.R., & Kotecki, J.E. (2012). An introduction to community health (7th ed.).
Sudbury, MA: Jones and Bartlett Learning.
U.S. Department of Health and Human Services. (n.d.). About Health Literacy. Retrieved from
http://www.hrsa.gov/publichealth/healthliteracy/healthlitabout.html