NRS 428 Community Assessment and Representative Interview Analysis

Sample Answer

Introduction

This presentation will describe a community in my State that I used in community assessment. This will include the people and geographic, geopolitical, financial, and educational characteristics. I will also describe the ethnic and phenomenological features of the community, types of social interactions; common goals and interests; barriers and challenges, and social determinants of health.

I will give a summary of community assessment and the interview with the community health provider. In addition, I will discuss an opportunity for health promotion that I identified from the community assessment.

Description of the Community

The chosen community of interest was Native Americans/American Indians living in Livingston Town, Polk County in Texas.

Livingston town has a total area of 8.4 square miles (22 km2) and is 16 km east of Lake Livingston. The community has a population of 5,335 as per the 2010 census. It is located about seventy-five miles north of Houston.
Geopolitical features Native American Movements were characterized by a strong emphasis on the elimination of alien people, customs, values, and material from the maze way.

Native American millennialism emerged as a response to the pan-continental colonization of the Americas and the subsequent periods of social oppression. Convergence with incoming European culture hinted at the dissolution of indigenous religion-cultural practices, ways of life and hence, instigated self-styled prophets to preach loyalty to ancestral ways and relinquish European traditions.

Financial Levels

The community is the most impoverished ethnic group in US with 29.2% living below the poverty level. The average household income of Native Americans is $36,252 which is below the average US household income of $52,176 (Adamsen, Schroeder, LeMire & Carter, 2018). They have higher levels of financial fragility and distress than most communities. Native Americans also fall behind whites and Asian-Americans on a range of measures of financial capability.

They demonstrate low levels of financial knowledge and low use of formal financial products. Besides, there is a low possibility of Native Americans learning about managing finances from parents and they exhibit lower levels of confidence in financial management.

High-income Native Americans demonstrate much higher levels of financial capability than low-income Native Americans (Adamsen et al., 2018). Besides, Native Americans have lower incomes and higher unemployment than racial groups (Adamsen et al., 2018). Between 2015 and 2016, Native Americans had an average household income of $39,719. This was 69 percent of the national average in 2016 and -2.9%/ $1,194 lower than the group’s pre-recession level in 2007.

Education Levels

The community has lower education levels compared to the general US population. 17% of Native American students pursue higher education after high school, which is a low percentage compared to 60% of the U.S. population (Fish & Syed, 2018). The number of Native American students aged 18-24 years who enrolled for undergraduate studies in 2017-2018 decreased to 124,000 compared to the 2016-2017 year, which had 128,600 undergraduate students. Besides, the number of students who enrolled in for post-bachelor studies decreased from 13700 to 13600.

A high percentage of Native Americans attend public institutions of higher learning compared to private institutions. Nonetheless, the number of Native Americans who attend Tribal Colleges and Universities (TCU) has increased over the years (Fish & Syed, 2018). Native Americans have a lower school completion rate compared to their white counterparts. For instance, of the students who began attending full-time learning in four-year institutions and graduated within four years, 23% were Native Americans, while 44% were whites (Fish & Syed, 2018). Besides, in 2017, only 27% of the community had completed an associate degree or higher, while white students had a completion rate of 54%.

Ethnic & Phenomenological features

• Ethnic

The community belongs to the Native Hawaiians/American Indians’ ethnic group. It belongs to the Alabama-Coushatta tribal group.

• Phenomenological features

The community believes that useful knowledge can only be acquired through individual experience, which is valid to that space and time (Adamsen et al., 2018). The method of interacting with the environment is never fixed in the Native Americans community but instead is carried through generations who continuously revise it and add to it. This creates a web of knowledge shaped by the personal experiences of the community.

Social Interactions & Common Goals

Types of social interactions

The community works together to achieve their goals and have a cooperative type of interaction. However, due to scarce resources in the community, there are frequent conflicts. There are also frequent incidences of assault and gender violence.

The non-native communities bring intense competition in the area, especially in investments.

• Common goals and interests

The community have a common goal of improving the quality of life and lowering poverty levels.

• Interests

The community participates in social activities such as festivals. Their interests include music, art, and ball games.

• Barriers & Challenges

Barriers to economic development faced by the community include lack of access to capital, inadequate human capital with education, skills, and technical expertise, and lack of means to develop capital. There are also insufficient natural resources, and the community lacks enough control over the available scarce natural resources.

Barriers to accessing health care include lack of health insurance, which limits a majority of the people from accessing quality and specialized health care. The high number of individuals without health insurance coverage is linked to the high poverty levels in the community. Inadequate healthcare facilities is a major challenge that limits community accessibility to essential health care services. A majority of people in the community have to travel for long distances to access specialized health care services or access a health facility with modern diagnostic services.

Social Determinants of Health

• Health Disparities

Native Americans have a lower life expectancy compared to the rest of the American population, with a difference of 4.4 years. Besides, the community has a higher death rate than the average American population (Stepanikova & Oates, 2017). Prevalent conditions in the community include chronic lower respiratory conditions, chronic liver diseases, Diabetes, assault, unintentional injuries, and suicide. The health disparities in the community are contributed by behavioral issues that are not adequately addressed in the community, such as substance abuse, alcohol addiction, and depression.

• Food insecurity

The community experience food insecurity, which has been attributed to poverty. The U.S. federal and Texas government supports the community with food commodities to low-income community members. Although the food commodities help feed the families, they are often limited to foods that have a low nutritional value and high in fats and carbohydrates (Stepanikova & Oates, 2017). This contributes to the poor health in the community as well as multiple health issues.

For instance, Native Americans have the highest prevalence of type 2 diabetes in the country. Besides, they are twice as likely as other Americans to die from Diabetes, and they also struggle with overweight and obesity (Cho et al., 2014).

• Discrimination

The community faces racial discrimination, which has been associated with high-stress levels in the population. The stress causes impaired working memory and impaired self-regulation among the community members (Stepanikova & Oates, 2017). The long-term effect of discrimination and stress has been withdrawal and avoidance behavior in the population.

Funding Sources & Partnerships

The community receives its health funding from the Indian Health Service. The Indian Health Service (IHS) in the Department of Health and Human Services (HHS) is the lead federal agency mandated to improve the health of the American Indians. IHS has three major sources of funding, namely, Discretionary appropriations, Collections, and Mandatory appropriations. Discretionary appropriations are received through the Interior/Environment appropriations act, which is then divided into three accounts, Indian Health Services, Contract Support Costs, and Indian Health Facilities (Harfield et al. 2018). This is the major source of funding.

The second common source of funding is collections. The IHS collects funds as compensation for the health services it provides. It receives compensation from federal programs such as Medicare, the Department of Veterans Affairs, and Medicaid and state programs and private insurance (Harfield et al. 2018). The IHCIA allows the IHS to retain the reimbursements to increase the availability of health services for the Native Americans. Repayments are the largest source of collection for IHS, followed by the rent from its facilities.

The third and smallest source of funding is a mandatory allocation of $150 million to support Special Diabetes Programs for Native Americans (Harfield et al. 2018). Partnerships IHS has a system of programs and healthcare facilities located near Native American reservations that provide health services for Native Americans. IHS provides care to the Native Americans community since it is a federally recognized tribe (Harfield et al. 2018). IHS provides health services either directly or through programs and facilities which are operated by Native American tribes or tribal organizations through self-governance compacts and self-determination contracts.

Community Health Needs

Based on the interview with the community health provider, the prevalent health issues in the community are chronic illnesses such as diabetes mellitus, heart diseases, hypertension, and T.B. Alcoholism is also prevalent in the youth population and has significantly contributed to the high prevalence of individuals developing chronic liver diseases, depression, and committing suicide. The chronic illnesses have been linked to poor lifestyle habits among the people, such as a diet with high amounts of starch, fat, and sodium. A majority of individuals do not engage in physical activities, which has led to a high prevalence of overweight and obesity and eventually type 2 diabetes, heart disease, and hypertension.

Measures Taken to Lower Prevalence of Illnesses

The community health provider has taken various steps to help lower the incidence of chronic diseases in the community. They include conducting health promotion programs in the community to educate people on prevention and control of the common chronic diseases and educating people with existing illnesses on self-management to lower morbidity and mortality levels. The health provider also conducts screening programs for Diabetes, hypertension, and cancers to enable early detection, treatment, and referrals. Besides, they link patients with a history of alcohol dependence, depressive disorder, and suicide attempts to community support groups.

The community members have also taken various measures to prevent illnesses such as attending screening programs, engaging in health promotion activities such as exercises and taking healthy diets. They also organize health programs in the community with the aid of community health volunteers to educate community members on how to prevent illnesses and healthy life practices.

Challenges in the Delivery of Health Care

Challenges faced by the health care provider in delivering care to the community include a shortage of health providers to meet the health needs of the community. There is also a shortage of medical specialists in the community to provide specialized care, and patients with diseases at advanced stages have to be referred to other facilities. In addition, there are inadequate screening and secondary prevention programs in the community due to a shortage of health providers and scarce resources. This makes it challenging to detect and treat chronic conditions among high-risk individuals. Lack of infrastructure is a major challenge, especially advanced diagnostic facilities, and patients have to be referred to other facilities.

Opportunity of Health Promotion

I identified mental health awareness as an opportunity for health promotion in the community. This is based on the high prevalence of substance abuse, alcoholism, and depression, which has contributed to suicide (Trimble, King, LaFromboise & BigFoot, 2019). The community, especially adolescents and youth, should be educated on mental disorders such as alcohol and substance dependence and depression.

Mental health awareness programs can be introduced to educate the community on the symptoms of mental disorders, how to recognize a person with a mental illness such as depression, and on available treatment options. Mental health awareness will not only help lower suicide rates in the community but will also reduce the social stigma associated with mental illnesses. Besides, adolescents and youths can be educated on the effects of alcohol and substance use and be provided with resources to help those with dependency.

Mental health awareness can be conducted in the health care facilities and in screening programs where individuals can also be screened for depressive symptoms and substance use disorder.

Conclusion

Based on the findings, the community has a poor health status compared to the US general population. It has low education and financial levels, which significantly determine the health status of a population. High poverty levels in the community have resulted in a majority of individuals being unable to afford health insurance. The community has a high prevalence of chronic lifestyle diseases such as hypertension, diabetes, heart diseases, and chronic liver disease.

Alcohol and substance use is also prevalent among adolescents and youths, which have contributed to high rates of depression and suicide. Challenges encountered when accessing health care include lack of insurance, inadequate healthcare providers, lack of health infrastructure, and inadequate screening programs. Mental health awareness programs can be a great way of promoting health in the community and lower suicide rates.

References

• Adamsen, C., Schroeder, S., LeMire, S., & Carter, P. (2018). Peer reviewed Education, income, and employment and prevalence of chronic disease among American Indian/Alaska native elders. Preventing chronic disease, 15.
• Cho, P., Geiss, L. S., Burrows, N. R., Roberts, D. L., Bullock, A. K., & Toedt, M. E. (2014). Diabetes-related mortality among American Indians and Alaska natives, 1990–2009. American journal of public health, 104(S3), S496-S503.
• Fish, J., & Syed, M. (2018). Native Americans in higher education An ecological systems perspective. Journal of College Student Development, 59(4), 387-403.
• Harfield, S. G., Davy, C., McArthur, A., Munn, Z., Brown, A., & Brown, N. (2018). Characteristics of indigenous primary health care service delivery models A systematic scoping review. Globalization and health, 14(1), 12.
• Stepanikova, I., & Oates, G. R. (2017). Perceived discrimination and privilege in health care The role of socioeconomic status and race. American journal of preventive medicine, 52(1), S86-S94.
• Trimble, J. E., King, J., LaFromboise, T. D., & BigFoot, D. S. (2019). American Indian and Alaska Native mental health. In The Massachusetts General Hospital Textbook on Diversity and Cultural Sensitivity in Mental Health (pp. 127-148). Humana, Cham.