Good Example Of Community Health Nursing Essay

Part A. Identification of a Community

The City of Greer is located between the counties of Greenville and Spartanburg in South Carolina at the foothills of the Blue Ridge Mountains. It is home to several industries, namely rail-to-port transportation and car manufacturing, and is a top tourist destination as well. The city has an estimated population of 26,088 of which 11.8% are immigrants (US Census Bureau, 2014). Majority are between the ages of 25 and 54, and around 11.1% of the population are older adults aged 65 years or over. The elderly population is expected to double by 2017. Whites compose 60.3% of the population, 18.9% are African Americans, 17.8% are Hispanic, and 1.9% are Asians (US Census Bureau, 2014). The city is fast growing at a rate of 4.5% in the past year. Despite a high birthrate, more than 70% of pregnant women did not have prenatal care in their first trimester (Greenville Health System, 2013). Of Hispanic pregnant women, more than 50% had no prenatal care and nearly 40% had inadequate care based on the Kotelchuck Index.
According to the Greenville Health System (2013), which has jurisdiction over the city, the top cause of death was cancer especially of the prostate and breast with incidence rates higher than the state. Malignancy is followed by cardiovascular disease as the second top cause of death. Greer residents have many risk factors predisposing them to chronic disease including being overweight or obese which has a prevalence rate of 64.91% (Greenville Health System, 2013). Approximately 80.4% of residents do not consume the recommended amount of fruits and vegetables. Hypercholesterolemia is noted in 43.22% of the population higher than the state prevalence, and 8.7% have diabetes albeit lower than the state prevalence (Greenville Health System, 2013). Around 27.43% are considered sedentary, and 23.15% are current smokers. Infectious diseases also affect the population with influenza and pneumonia being the 10th leading cause of mortality especially among older adults (Greenville Health System, 2013).

Part B. Health Needs Assessment

Population-Economic Status Assessment
Most of the data used in this assessment are from Greenville County. The total county population is 463,977 of which 5.6% are residents of the City of Greer. The annual average household income in Greenville County is $45,936 with 19.4% living below the poverty level (US Census Bureau, 2014). Of those with low-income, 10% are White and 28% are African American. Sixteen-percent of African Americans living in poverty are 64 years or younger. Among Hispanics, 18% of those aged 18 years or younger are considered poor (US Census Bureau, 2014). Around 13.9% of the county population is receiving public assistance. Meanwhile, the unemployment rate is 7.1%. Half of the population has employment-based health insurance, but 16.5% of adults and 8.6% of children do not have health insurance (US Census Bureau, 2014). Of those with health insurance, 50% are private plans, 14% is from Medicare, and 12% is from Medicaid. About 14.1% of Greenville residents report unmet health needs because of financial constraints. A small number, 0.2%, is homeless (US Census Bureau, 2014).

Neighborhood/Community Safety Inventory

One area of Greer covered by Spartanburg County was listed in the EPA’s national priorities list because of ground water and soil contamination from the inappropriate operations of a hazardous waste facility (EPA, 2012). Soil and groundwater clean-up continues as goals have not yet been achieved. In addition, the site of a former battery plant is also regarded as an environmental hazard because of contamination highlighting poor industry compliance with safety standards (GreenvilleOnline, 2015). Monitoring of air quality shows that the ozone and particulate levels remain minimal leading to a good air quality index (AirNow.gov, 2015). However, noise pollution is also a problem of residents nearest to the major airport adjacent to the City and the port train transporting containerized products.
The Fire Department personnel respond to fire alarms and calls for fire within an average of 3 minutes (City of Greer, 2015). Personnel are also trained first responders and are capable of rescue support. Police response time to calls is exceptionally short because of the higher number of officers for each square mile. The police department partners with the community in crime prevention through neighborhood events and meetings (City of Greer, 2015). The Greer City crime rate is 292.7, lower than the national average of 315.5 and the Greenville County average of 390.8 (City-Data.com, 2015). Burglaries, thefts, and auto thefts comprise the majority of crimes followed by assaults.
Rabies is a problem associated with invasive animal species such as coyotes, raccoons, bats, opossums, and rats transmitting the virus to household pets (Greenville Police Department, 2015). Drowning hazards are related to the 3 lakes in the City. In addition, there are old rundown mill houses in the city posing hazards to the residents. Although lower than the state incidence, also of concern is the incidence of traffic accidents related to drunken driving (CityData.com, 2015).

Cultural Assessment Tool

The major cultural groups in the City are Whites, African Americans, and Hispanics. English as the first and only language is spoken by 80.5% of the City’s residents. Of the 19.5% who speak other languages, 9.1% are not fluent in English (US Census Bureau, 2014). Spanish is spoken by 15.7% of the population. Other languages are Asian and Indo-European. At the county level, 57.34% of the population report affiliation with any of 449 faith-based groups (CityData.com, 2015). Half of those who are affiliated are Southern Baptists, 11% are United Methodists, 8% are Catholics, 6% are Presbyterians, and 25% belong to other congregations.

Disaster Assessment and Planning Guide

The Greenville County Office of Emergency Management (2013) is tasked with leading the efforts of preparing for, responding to, and recovering from major disasters and emergencies. Its operations are aligned with the Emergency Operations Plan that describes the disaster risks in the community, the responsibilities of the individuals and offices involved in disaster management, the concept of operations, the process of warning and evacuating residents, providing public information, and logistics (GC OEM, 2013). The major foci of disaster management are woodland fires and natural disasters such as from tornadoes, tropical, storms, and flooding and also extremes in weather such as severe winter and drought. The City is also close to a nuclear power plant, and its railway system is used to transport, among others, hazardous materials for industry use (GC OEM, 2013). Furthermore, there are 19 dams in the City which, in the event of failure, can cause death and damage to property.

Windshield Survey

The houses range from mill houses built in the early 19th century to recently-built modern and mostly detached houses. The houses have spaces in front and behind them with most of the lots approximately 10 acres. Commonly-used materials are wood with vinyl or brick. The general condition of the mill houses is rundown with chipped paint and dirt yards. In contrast, the vinyl-and-brick houses have landscaped, well-tended yards and are generally in great condition. There is central heating, modern plumbing, and air conditioning. Scattered in the community are trailer parks built in the 1980’s and relatively new apartment buildings. The poor trailer houses and wealthy large homes represent the stark differences in housing. There are no solar panels or windmills.
The city is generally suburban with two parks serving as open space for the public’s leisure and recreational activities. However, the poorer sections of the community have abandoned textile mills and equipment. Only the main artery through the City has a green island. The neighborhoods are labeled clearly, but the labels depend on the price point level – a small, simple sign with chipping paint or a grand archway with accent lights and manned by security guards. Railroads serve to divide the City into the poor and affluent sections. The commons include the Greer City Park frequented by families from varied social or cultural backgrounds during the day from spring through fall. Downtown is popular for its coffee bars and chef-owned restaurants and is mostly patronized by middle and upper-class families.
Most residents have cars as there is no public transportation other than taxis. Most streets and neighborhoods have sidewalks but are not conducive for riding bikes because of the hilly terrain. People have access to broadcast media and communication through cellphones. There are signs of activity in the schools, parks, and the YMCA. There are no stray animals. Commonly seen are construction-type vehicles due to infrastructure projects associated with new housing and industry. The community reflects heterogeneity with Hispanic retail and grocery stores in Hispanic sections of the city. There are numerous doctors’ and dentists’ offices. There are also many urgent care facilities and two community hospitals serving the population. Moreover, there are many fast food restaurants and more being built and are likely to contribute to obesity in the community.

Population Health Scavenger Hunt

The City of Greer Parks and Recreation Department offers passive and active recreational programs for the public with the purpose of promoting a healthy lifestyle and individual growth (City of Greer, 2015). The YMCA of Greenville (2015), on the other hand, caters to both Greer and Taylor and provides after school programs, day camps, swimming and dancing lessons, youth sports, and family activities. Pelham Medical Center (2015) of the Spartanburg Regional Healthcare System offers emergency care, primary care, diagnostic services, surgical treatments, medical care, and cancer care. Meanwhile, the Greer Chamber of Commerce (2015) is a provider of leadership trainings for professionals and high school students. The Chamber, in collaboration with its members, organizes the Greer Family Fest and the Greer Station Oktoberfest. The Greer Community Ministries Food Pantry operates a pantry as well as clothing closet for older adults, disadvantaged, or disabled individuals (FoodPantries.org., 2015). Public health services across the lifespan are offered by the Greenville County Health Department. Services include immunizations, infant and children’s health, women’s health, family planning, environmental health, community health, home health, nutrition education and counseling, sexually-transmitted disease, infectious disease treatment, vital records and surveillance (GCH Department, 2014).

Summary of the Assessment

The population and economic status assessment enabled the collection of data about the total population and economic indicators including annual income, poverty rates, unemployment rate, insurance status, unmet health needs, and homelessness. The data assisted in identifying the most vulnerable subsets of the population. These are low income individuals, uninsured children and adults, the unemployed, and the homeless. Furthermore, by looking at the poverty rate, there is evidence of economic disparity that relates to ethnicity since a larger proportion of low-income individuals are African Americans or Hispanics. Meanwhile, the Neighborhood/Community Safety Inventory facilitated data collection on safety hazards in the natural, built, psychological, and sociocultural environments as well as the community’s disaster potential. A safe environment for people to reside and work in promotes health and wellness. Based on the assessment, the biggest threat to safety involve contaminants from industrial waste, invasive animal species, noise pollution, the disrepair of houses, and drunken driving.
The Cultural Assessment Tool, on the other hand promotes a better understanding of the cultural make-up of the population. Results show that the City of Greer is a heterogeneous community consisting of Whites, African Americans, and Hispanics as major groups. Spanish is the next most common language spoken besides English, and there are immigrants who are not fluent in English. The Disaster Assessment and Planning Guide was used to determine the degree of preparedness in the event of catastrophes. There is an existing operation plan that identified and aims to address the community’s hazard risks. Meanwhile, the windshield survey was used to obtain a general picture of the community. Despite improvements in the economy, driving through the community again emphasized the economic disparity in terms of location of residence, type of residence, and social activities. The survey also highlighted the importance of open spaces and inspecting homes for hazards. The Population Health Scavenger Hunt, meanwhile, assisted in identifying some service providers in the community including the YMCA, Parks and Recreation, and Chamber of Commerce that initiate leisure and recreational activities. The Greer Community Ministries Food Pantry serves as safety net against hunger among the most vulnerable.

Interpretation of Data

Despite the availability of health care services, there seems to be low utilization. As identified in Part A, there is a high birthrate but only 50-70% use of prenatal services among Hispanics and African Americans (Greenville Health System, 2013). Cultural influences such as the inability to understand or speak in English and incongruent beliefs, values, and practices are likely to have influenced this phenomenon as do the lack of health insurance and financial difficulties. Low health care utilization is also seen in the mortality rates for influenza and pneumonia, the former a preventable disease. Furthermore, non-utilization of care would make it difficult for ethnic minorities to receive screening services such as blood glucose and cholesterol checks. It also excludes them from patient education on dietary and physical activity changes and smoking cessation that constitute primary and secondary prevention against cardiovascular disease, diabetes, and cancer. The built environment has negative and positive impacts on primary prevention. The presence of open spaces and activities for leisure and recreation has the potential to encourage more exercise. On the other hand, the presence of fast food restaurants promotes obesity.
C. Community Diagnosis
Using the Healthy People 2020 goals, cancer, cardiovascular disease, and nutrition and weight status are the top three problems in the City of Greer. The Healthy People goal for cancers is to improve the rates of early detection and treatment in order to reduce the incidence and mortality rate (Office of Disease Prevention, 2015). To achieve this goal, it is important for people to undergo periodic screening and engage in behavior changes to minimize individual risk factors including smoking, sedentariness, poor nutrition, and obesity (Office of Disease Prevention, 2015). In cervical cancer, immunization against HPV is recommended for prevention.
The goal reflects reality as it includes a discussion on socioeconomic factors as determinants of the likelihood of developing cancer. The role of socioeconomic factors is evident in the disproportionate cancer incidence and deaths affecting ethnic minority and disadvantaged groups (Office of Disease Prevention, 2015). The lack of insurance, low income, unemployment, and financial difficulties, as seen in subsets of the City of Greer population, is an obvious factor as it limits a person’s access to health care. Geographic location is also a determinant of cancer outcomes (Office of Disease Prevention, 2015). Given the lack of public transportation in the City, people who do not have their own cars or are unfit to drive may have difficulty accessing health care.
Furthermore, socioeconomic status also predicts a person’s access to safe and healthy environments to live and work in (Office of Disease Prevention, 2015). Safety from environmental toxins reduces the risk of cancer. However, living near sites of contamination increases this risk. In Greer, there are sites that have not been fully cleaned of prior contamination. Socioeconomic factors, such as education and income, further impact behavioral risks factors, namely lifestyle, and the utilization of cancer screening services (Office of Disease Prevention, 2015). Achieving health goals for cancer would, therefore, include consideration of disparities and related social determinants.
In regards to heart disease and stroke, the primary goal is to enhance the population’s cardiovascular health via preventing, detecting, and treating the risk factors (Office of Disease Prevention, 2015). The goal also includes the early identification and treatment of myocardial infarction and stroke as well as preventing repeat hospitalizations for similar events. The Office of Disease Prevention (2015) identifies the modifiable risk factors as hypercholesterolemia, smoking, diabetes, sedentariness, and obesity - conditions noted as risk factors of the Greer City population (Greenville Health System, 2013). Reducing the risks improves mortality and minimizes the likelihood of disability.
Similar to cancer, socioeconomic factors, gender, ethnicity, age, and geographical location also impact the risk, morbidity, and mortality related to cardiovascular disease with the burden of illness higher in some population subsets than others (Office of Disease Prevention, 2015). It is now recognized that maternal and child health impact cardiovascular outcomes and underscores the need to utilize pre- and post-natal services, the rate of which is suboptimal especially in ethnic minority groups in Greer City. Access to education and affordable and quality health care are also crucial elements that mediate the risk but are limited among low-income and uninsured individuals in the City. Moreover, working conditions and the built environment must support cardiovascular health. In the case of Greer, there are supportive and unhelpful elements of the built environment. The availability of community resources and support as seen in Greer City further reduce the risk to cardiovascular disease.
Meanwhile, the national nutrition and weight status goal included in Healthy People 2020 is for health promotion and chronic disease risk reduction through eating healthy diets in addition to attaining and maintaining an appropriate body weight (Office of Disease Prevention, 2015). A healthy diet is one that includes a variety of nutrient-dense foods low in fat, cholesterol, sugar additives, salt, and alcohol but high in fiber with calories limited only to needs. The issue of overweight and obesity is understood using the systems perspective in that the environment and policies in schools, workplaces, health care facilities, and communities influence individual behaviors to eat healthy and lose weight to achieve a healthy BMI. For instance, the types of foods available in cafeterias, restaurants, and grocery stores affect the food choices of residents.
At the same time, food insecurity and hunger also impact the sources and types of food eaten (Office of Disease Prevention, 2015) with preferences for cheaper and more energy dense foods such as fast foods. The Greer Community Ministries Food Pantry, as a safety net for hunger, must provide healthy foods to help ensure the nutrition of recipients. Adopting a healthy diet and reducing weight requires congruent knowledge, skills, and attitudes among individuals as well as combining it with an increase in physical activity (Office of Disease Prevention, 2015). Again, social factors such as social support, cultural norms, food assistance programs, and food prices impact the individual and must be considered as well.

Obesity and Community Resources

The selected issue for further investigation is overweight and obesity. There are several community resources that can help address this issue. First, the Greer Parks and Recreation Department has adopted a health promotion approach to its programs that supports the attainment of an appropriate body weight. Second, the YMCA also sponsors youth sports, summer camps, and other physical activities for children, adults, and families. Greenfield Health Service also sponsors walks or runs. Third, there are fitness gyms in the City such as LoseWell and the Life Center Health and Conditioning Club. Fourth, the Greenville Health System identified programs in the community promoting healthy diets and exercise in children and adults including the Berea Middle Bike Club, Choosy Kids, Girls on the Run, Mobile Recreation Bus, New Impact, Greenville B-cycle, Every Woman, and Wellness Way. Fifth, there are open spaces for physical activity both organized or not and include 5 parks, one recreational center, one stadium, 5 fields for ballgames in one complex, and the GHS Swamp Rabbit Trail (City of Greer, 2015; Greenville Health System, 2013).
The chosen primary prevention topic is reducing the prevalence of obesity in adults through the promotion of healthy nutrition and physical activity. Overweight and obesity are risk factors to cardiovascular disease and is also linked with cancer. Improving chronic disease incidence can be achieved by addressing the obesity as a modifiable risk factor.

References

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CityData.com (2015). Greenville County, South Carolina religion statistics profile. Retrieved from http://www.city-data.com/county/religion/Greenville-County-SC.html
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YMCA of Greenville (2015). Programs. Retrieved from http://www.ymcagreenville.org/programs.php