Introduction
It is important to note that identifying health inequities requires a thorough analysis of the key metrics, including social determinants of health. The assessment of health trends in the Nassau (NA) county of New York State allowed an in-depth overview of major points of interest in this regard. Despite the fact that NA is the top-performing county in NY compared to other neighboring regions, it still has problems with premature death among African Americans due to low birth weight. The given summative assessment will primarily focus on the health inequity among African Americans in the Nassau country, who are faced with a low birth weight below the state and county average. From the previous analysis, the identified health inequities were low birth weight, obesity, and long commutes.
Making the Case – Relevant Data
The identified population experiencing a health disparity in Valley Stream, NY, is the African-American community living in the area. It is important to note that Nassau (NA) County is considered among the healthiest counties in the state of New York (NY) and is ranked as the fourth best-performing location. However, African American individuals living in Nassau not only fall behind in premature death behind the county average but the mean of the entire state. The Premature Death values for the NA and NY are 4600 and 6000, respectively (County Health Rankings & Roadmaps, 2022). African American community has a value of 7000, with a margin of error between 6600 and 7500, which still is significantly higher than the presented averages (County Health Rankings & Roadmaps, 2022).
Community Context
In order to properly understand the nature of health inequity, one needs to view the issue within the community context. It should be noted that Nassau County is one of the best-performing regions in the State of New York, where almost all health metrics are massively above the average values. Therefore, the fact that African Americans of NA are below average in regards to premature death due to low birth weight indicates a presence of serious health inequity. The Root Cause Analysis revealed that Nassau (NA) is the healthiest region in New York, and the top three health inequities are low birth weight (LBW), obesity, and long commute. A potential underlying reason for the problem is poor maternal nutrition during pregnancy since there are no other plausible disparities to be found in history and context. The issue is urgent and severe due to the sufficiency of resources available in the country.
Policy Context
The policy change based on nutritional improvements and pregnancy care for African American mothers needs to be implemented to improve the low birth weight. The rationale is rooted in the fact that NA is a prosperous and high-performing county with no significant limitations in resources and community support. The existing policy does not have sophisticated and evidence-based support for African American mothers in regards to providing better nutritional education, pregnancy care, and access to effective means of tracking the fetus’s growth. It is critical to reiterate that the health metric of premature death is the most impacted by deaths at younger ages. Infant mortality due to low birth weight is likely to be the key driver of the problem. It is reported that “newborns with extremely low birth weight were 200 times more likely to die in the first year of life” (Vilanova et al., 2019, p. 3). The opposition can be countered by the fact that NA’s African Americans are not experiencing other disparities to be identified as root causes.
Message Variations
The message variations will be divergent depending on the audience, which includes community members, collaboration partners, and decision-makers. For the former, raising awareness about the facts will be of paramount importance because the community might not be aware of such a disparity. For collaboration partners, it is critical to approach the messaging with encouragement for higher engagement in resolving the problem. Decision-makers are policymakers in the county from the health departments and legislators, who require factual data as well as public pressure to act promptly.
Community Engagement – Approaches to Engage Community
The community is comprised of the entirety of the Nassau population because the disparity is based on race, and the measures needed are rooted in gender, which means that all residents of NA are affected either directly or indirectly. The core strategy to engage the community of NA is through community leaders and proactive involvement based on facts (Mason et al., 2021). It is stated that the most effective engagement strategy for health inequities experienced by African Americans is to “proactively prepare public health leaders … and advance community leadership toward health equity” (Akintobi et al., 2020, p. 1). Therefore, the goal is to present the facts, raise awareness, educate the population, engage community leaders, and ensure proactive measures.
Building Trust
In order to make sure that the proposed actions are effective, building trust and credibility is critical. A study reports that “community trust is significantly associated with community engagement, while the sense of community is not. The proposed community trust indicator offers … social empowerment and community well-being” (Napoli et al., 2019, p. 551). In other words, the trust will be harnessed through engagement, as well as the prioritization of empowerment and well-being. Empowerment is an effective element in engaging activists and campaign runners (Amor et al., 2019). Thus, there is a reciprocal connection between community engagement and trust, which can be proactively induced by empowering African-American mothers.
Barriers to Community Engagement
The key barriers to community engagement include the lack of community distrust, insufficiency of resources allocated, and poor communication. The first challenge is about a potential distrust in the overall endeavor because many residents might consider the issue as an exaggeration and health inequity non-existent. The second barrier is related to the final response in the form of policy design and implementation. In other words, the strategies might only introduce partial solutions without addressing the inequity systematically and comprehensively. The third problem could be the communication itself, where the reach or effectiveness is either low or shallow. In order to overcome these barriers, it is vital to connect with the community through the people and leaders it trusts, negotiate until all measures are incorporated, and speak clearly and directly to the public. An example of a leader is Nassau County Executive Bruce Blakeman, who could introduce a member of the local government to the community (Bethany, 2022).
Identifying Community Relationships
Building community relationships can be a significant challenge, which is why it is necessary to engage key community leaders and activists. The county’s community is diverse and multicultural, and most people live in an environment of high socioeconomic status. Therefore, they trust only authoritative, credible, and reliable people with a long history of good reputations. The process of community engagement will need leading pediatricians, nutrition health experts, county policymakers from Nassau’s Health Department, and activists. The NA’s population needs to be connected from a multitude of angles, which is why it is important to have medical professionals, policymakers, and political representatives, as well as activists.
Communication Methods
The key communication method is proactive communication, which is based on what is already taking place as well as what could happen in the future. It should be noted that this form of communication is about anticipatory and prognostic information delivery. It is reported that “one of the most important and effective interventions in a public health response to any event is to proactively communicate what is known, what is unknown, and what is being done” (World Health Organization, 2020, p. 1). The community needs to be aware of the facts of the problem, and the people should know what the implications are of inaction.
Needs, Assets, and Priority Issues
The needs of the community are policy-based and healthcare-based, where the core priority is to ensure health equity and well-being for all NA residents. The key asset is a strong local Health Department, which is already effective at providing the best healthcare for the county. It is the policymakers’ and healthcare organizations’ collective efforts that made NA County one of the healthiest in the region. Therefore, their expertise and success record are potent assets at the given measure’s disposal. Nassau is a prosperous county with sound common values centered around equality and mutual respect, which are cornerstones of this multicultural social environment. The community is receptive to the idea of health equity, but more refining is needed in regard to providing convincing evidence for the effectiveness of the proposed solutions.
Collaboration with Partners – 3 Potential Partners in the Community
The three potential partners in the community include the Family & Children’s Association (FCA), ParentChild+, and Healthy People.org. FCA (2022) states that it is “a non-sectarian, not-for-profit organization that is dedicated to providing help and hope to Long Island’s most vulnerable children, families, seniors, and communities” (para. 1). ParentChild+’s (2022) purpose is “to ensure that all children, regardless of their race, socioeconomic status, or zip code, have equal possibilities from the start” (para. 1). Healthy People is a larger organization which can run effective campaigns to raise awareness and raise funds for the changes.
Defining Strategies
The end goal is to significantly reduce low birth weight, infant mortality, and premature death rates among African Americans in Nassau county. The evaluation of the efficacy of the change includes ultrasound device number and access, nutrition health professional number and access, birth weight among African American newborns, and the rate of anemia among African American mothers. The commonality of all three partners is a direct interest in the NA county, and group dynamics will be based on clearly defining the roles. The challenge might arise due to the divergent interests and priorities of each partner. The necessary steps involve outlining the target goals for each collaborator. Healthy People will engage with policymakers and activists, whereas ParentChild+ and FCA will focus on health professionals. The partners will be communicated more directly and transparently, especially with regard to the precise actions.
The Decision-Makers – Identifying the Decision-Makers
The key decision maker is the Commissioner of Health for the Nassau County Department of Health, Lawrence Eisenstein, M.D. He additionally is the President of the New York State.
Association of County Health Officials (NYSACHO) (CITE1). He is from New York, and Eisenstein completed his residency at Winthrop University Hospital in Mineola. His background is extensive, both as a researcher and public health expert, and he leans towards the left. Another core decision maker is Dr. Ellen J. Braunstein, who is the Chair of the Nassau County Board of Health (CITE2). She has an extensive background, but she is originally from the Chicago Medical School. Braunstein is a left-leaning public figure who is a prominent advocator for health equity. They are not politically active, but it is evident that they would be friendly to the change.
Practices Used by Decision Makers
Both Eisenstein and Braunstein adhere to evidence-based practice and seek to ensure the highest level of health equity. However, the record shows that they acted most prominently when issues were pressed and pushed by the public. In other words, the strategy needs to involve the public and engage the community to raise awareness and make the voices heard. The core opportunity is to advocate for change by applying public pressure and partners’ levers of influence.
Public Involvement
The strategy is heavily reliant on involving the public in the decision-making process because their voices will lead to the most significant changes. Both decision-makers are more likely to make profound policy shifts if pressured. In addition, Nassau County’s community is an active and organized one, which is why the most important political wills are initiated and implemented after the public civilly demands them. The role of activists and campaign runners is critical in initiating the change through education, information, and facts.
Overcoming Barriers
The strategy is centered around raising awareness about the health inequity in the Nassau community among African Americans. The change is based on “improving women’s nutritional status positively affected LBW, SGA, and PTB,” where LBW, SGA, and PTB stand for low birth weight, small-for-gestational-age, and preterm birth, respectively (Da Silva Lopes et al., 2017, p. 1). The community partners ParentChild+ and FCA will directly focus on engaging health experts to provide the relevant data and facts about premature death due to low birth weight among African Americans. This will ensure that the barrier of public distrust will be overcome. Healthy People will raise funds to run the campaigns and finance advocacy groups, such as activists. The organization will address barriers of resource insufficiency and poor communication. Community leaders will build better trust with the community since they are credible and respected figures. The public pressure will ensure that the problem is addressed comprehensively and systematically by the decision-makers.
Reason for Opposition to Change
The opposition to change might rise by the decision makers due to the sensitivity of the problem since it involves race and children. The public pressure can become excessively emotional and heated, which is why they could oppose in order not to lose control over the situation of healthcare. Therefore, it is critical to ensure that the communication is kept civil and evidence-based rather than emotional.
Cost Benefit for Making Policy Change
The cost of policy change is not significant to Nassau County, but the failure to implement it will lead to poor quality of life, racial inequality, and loss of lives among African Americans. The benefit will be the fact that Nassau will no longer have serious health inequities as a county. Most changes are based on education, expert assistance, and increased access to healthcare. Thus, the costs are not severe, even without considering the high socioeconomic state of the county as a whole. The benefits of the policy change substantially outweigh any costs incurred within the process.
Conclusion
In conclusion, the analysis of health trends in Nassau county of New York State identified key disparity points. Nassau is the healthiest region in New York, but it still has problems with low birth weight and subsequent premature death among African Americans. It is important to note that evidence-based underlying reasons include poor maternal nutrition during pregnancy. Poor maternal nutrition during pregnancy is linked to low birth weight, which is why the policy needs to systematically address maternal nutritional care aspects.
References
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