Introduction
Health disparities among the different populations pose a great threat to the progress of all countries in spite of their constant effort to minimize them. Reasonable access to health care has become very critical because of this. In the USA, even though it is the most developed country in the world, health disparities in minority sections such as the Latinos, African and Asian Americans, etc., are higher than the Whites. Their mortality rates, poor health conditions, and incidence of diseases like cancer, diabetes, and heart failures are of deep concern. Therefore, implementation of cultural strategies and interventions to address health disparities through cultural and linguistic abilities are essential for the well being these vulnerable populations. By minimizing the elements that thwart the cultural orientations, quality of life in HF patients can be promoted through cost-effective prevention programs. To achieve this, culture-oriented strategies and interventions are needed in health promotion plans to allure them into the mainstream.
Health disparities
Though the word “disparities” generally relates to ethnic disparities, there exist several facets in the United States. If a health status shows much difference between populations, it means there is disparity. The major elements that lead to these disparities are ethnicity, age, sex, socioeconomic status, location, etc. (Asada, Yoshida & Whipp, 2013). The “Healthy People 2020” aims to achieve equity and improvement of health in all sects of the American population irrespective of racial and gender discrimination. Health equity, according to Healthy People 2020, is “attainment of the highest level of health for all people” (The National Plan for Action Draft, 2010), whereas, health disparity is “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage…” (Phase I report: Recommendations for the framework and format of Healthy People 2020).
Health disparities have an effect on populations belonging to different groups based on sex, age, race and ethnicity, culture and socioeconomic status, location, etc., and on the groups that have undergone prolonged sufferings and social discrimination. They experience more health risks than the privileged (Health Disparities Research and Intervention Program, 2014).
As inequalities and health disparities are pointers to community health, any steps to reduce preventable morbidity and mortality will invite national attention (CDC Health Disparities and the Inequalities the Report-United States, 2011). Since cardiovascular illness causes 1.4 million deaths every year, and most of them are African Americans (Mensah & Brown, 2007), cardiac rehabilitation programs are desirable to improve health care in HF patients. Such a rehabilitation plan shall be systematic, but cost-effective. Health promotion and disease prevention are connected with the vulnerable populations’ culture, ethnicity, and their interaction with the health care system.
Health Disparities noticed during clinical practice
During clinical practice, it was observed that socioeconomic marginalization was a decisive factor in HF development. The major outcome noticed was continued hospitalization of the patients for HF. The socioeconomic elements that led to it were poor education, employment, class, and income. The lower SES group had a higher rate of HF admittance to the hospital. In most cases, they were at the risk of 50% HF. The readmission subsequent to hospitalization was more in the deprived patients and the survival rate was less. It was clear evidence of health disparities in the deprived population (Hawkins, Jhund, McMurray & Capewell, 2012). Their socioeconomic status has an immediate relation to the incidents of HF in older adults, whose pension and other amenities are very low.
The concern of health care providers about health disparities in the vulnerable populations
Racial and ethnic minorities acquire only a low socioeconomic status, which is a decisive barrier in getting care. National strategies aim to lessen these barriers by increasing their accessibility to health care through Health insurance and Medicare (Shi & Stevens, 2005). Even though several researchers have attended to health disparities in the vulnerable populations, no all-inclusive frameworks were conceived so far (Kilboume, Switzer, Hyman, Crowley-Matoka & Fine, 2006). Despite continued health disparities in these ethnic groups, proper understanding about it is still lacking among them. Without the active participation of health care providers and partners in services like housing, education, etc., health disparities cannot be addressed effectively. That is why the health care providers are the most concerned about health disparities (Morbidity and Mortality Weekly Report, 2013).
DNP graduates’ contribution to reducing health disparities
DNP graduates can become leaders in bringing up drastic changes in society as they are equipped with tools to provide high-quality healthcare. They have practical experience and are familiar with research and evidence-based practice, which are powerful instruments in shaping health care policies and procedures. They are skilled clinicians with orientation for inter-professional collaboration to promote teamwork while extending quality health care to minorities. Therefore, their involvement in meeting the challenges of the nation, in diminishing health disparities among the vulnerable populations is decisive. With the leadership skills, knowledge, and ability to intervene, they can become powerful advocates for health care policies that lessen health disparities among the minorities (Mullin, 2009).
Clinical Practice: Health Disparities in Heart failure patients
Most of the death tolls in the US are caused by heart diseases. American Heart Association’s recent study has revealed that 789,000 Americans suffered from a heart attack in 2009, of which, 470,000 had the potential of reoccurring attack. Racial and ethnic populations are prone to increased rates of cardiovascular disease than other people. Since 1984, around 35% of African-American women have died due to heart disease. Likewise are the African-American men against the non-Hispanic White males. Mexican Americans who are minorities suffer from overweight and obesity more than their Caucasian counterparts, which poses them at risk of heart failure. Despite insurance status, income, and other health care benefits, racial and ethnic disparities in health still exist. The study evidenced that where there was unequal treatment, there were disparities in health among the racial and ethnic groups. In a clinical study of the minority populations’ relation to heart failures, cardiovascular and coronary artery diseases, it was found that the African American populations yield to heart failures and other diseases more than their counterparts. The African Americans have thrice the likelihood of dying at any given age when they are compared to the White population (Mensah & Brown, 2007).
Cultural Strategies and Interventions to Address Health Disparities
Health disparities among the disadvantaged populations can be reduced by evolving a sustaining and culturally potential health care system. It can generate increased health outcomes, including clinical staff efficiency and patient satisfaction. The flow of immigrants into the country during the past 30 years has resulted in the spread of different foreign languages and cultures. At present, people in the USA speak more than 329 languages, while some of them do not know English at all. As such, cultural and linguistic abilities can be put into use to diminish the racial and ethnic disparities. If the health care providers and the clients fail to follow each other due to language problems, the quality of health care will not reach them. Therefore, programs should be developed (1) to recruit staff that can represent the cultural diversity of the community, (2) to use the service of the interpreters to meet the needs of the clients who have partial English proficiency, (3) to impart cultural capability training to health care providers, (4) to provide cultural and linguistic oriented health education materials, and (5) to erect culture-oriented health care settings (Anderson, Scrimshaw, Susan & Fullilove, 2003).
Continuing medical education can improve the quality of health care and evaluate the result of multicultural education plans. Training of physicians and other staff can reduce the level of disparities. The multilevel intervention program targets the patient’s behaviors and intervenes at the familial cum tribal level. This community-oriented participatory avoidance strategy can improve the health of the community by altering societal environments. Such changes can include the prohibition of smoking in public, the use of pure water, clean food, air, etc. However, these interventions must be sensitive to the culture of the community, so that they will not jeopardize the community values. For answering their health literacy needs, the interventions can apply traditional cultural and health practices. An ecological approach is what’s needed here for continuing it for a longer period. The strategies involving separate elements in an intervention can be effective if such patient-focused interventions are cost-effectively executed. In this case, further information about the connected benefits of secondary invention components and their specific and non-specific outcomes must be clearly distinguished (Coulter & Ellins, 2006).
Culturally competent care
There are three standards for culturally competent care. Standard 1 requires that all healthcare organizations must verify that the patients get respectful, effective, and conceivable care in relation to the cultural beliefs, language, and practices held by them. Standard 2 stipulates that the recruiting strategies developed by the healthcare organizations should focus on the recruitment of the staff and leadership that reflects the characteristics of the target area. Standard 3 insists that the healthcare organizations shall impart cultural as well as linguistic education training to all staff at the time of delivery of service (Anderson & Scrimshaw et al, 2003).
Conclusion
The existing disparities in health care among vulnerable populations warrant effective measures to lessen the disparities. These inequities are explicit among the marginalized sects belonging to different ethnic and racial groups such as African-American, American Indian, Hispanics, etc. Cardiovascular diseases and heart failures account for a major share of the death tolls in these minority populations, and these mortalities are directionally proportional to their low economic status. The coming years will prove that these disparities are only on the increase. The US health department is striving hard to harness the problem by promoting all sorts of quality healthcare, but it is still inadequate. Therefore, the elements of health care disparities in each specific group should be identified. This is necessary for healthcare policymakers to minimize the gap of health disparities by imparting cost-effective and quality healthcare through the implementation of cultural intervention strategies.
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