Community Health and Population-Focused Nursing – C228 Western Governors
A community health assessment gives organizations comprehensive information about their health, needs, and issues. Collecting data about the health of a community is crucial to understanding the health status and root causes of the problems affecting the public. According to the Centers for Disease Control and Prevention (CDC) (2018), community health assessment involves a state, tribal, local, or territorial health assessment that identifies key health needs and issues through systematic, comprehensive data collection and analysis. This exercise improves organizational and community coordination while increasing knowledge about public health. This discussion focus on health assessment in Sentinel City, a virtual community, to identify the health needs of the population, and address these concerns using the healthy people 2020 goals.
Needs Assessment Summary
Demographic Assessment
Four neighborhoods make up Sentinel City including Nightingale square, Acer tech Center, Casper Park District, and Industrial Heights. The Sentinel community has a total population of 663, 862 and it contains people of varied ages including children, adolescents, adults, and the elderly. Statistically, 7.4% of the people are under five years, 21.7% below 18 years, 60.4% are adults and 10.5% are elderly people aged over 65 years (Healthcare Learning Innovations, 2021). Sentinel city demonstrates diversity in the population whereby cultural diversity and ethnicity are portrayed. The majority of the people are Whites with a representation of 52.7% followed by the Hispanic or Latino with 31.5%. Asians occupy 3.2% of the total population while Blacks or African Americans occupy 2% (Healthcare Learning Innovations, 2021). The four neighborhoods display varied incomes due to the diversity observed but generally the median household is $49,091 and 18.9% of the people live below the poverty line.
The four neighborhoods in Sentinel City exhibit differences in total population, household income, racial and ethnic distribution, and healthcare insurance coverage. These differences can be a result of the population distribution or economic status of the different people occupying the regions. Casper Park District is the largest neighborhood in the city with 352, 643 people. Demographically, the Whites are the largest occupants with a representation of 63% (Healthcare Learning Innovations, 2021). The Hispanics or Latino occupy 24% while the other populations occupy small percentages. The veteran population is 2016 people with the primary ethnicity being Whites. The largest population in the District is occupied by persons between the age of 18 yrs and 65 years. The under eighteens occupy 33.8%, under five with 10.9%, and those aged 65 years and below occupy 6.5% (Healthcare Learning Innovations, 2021). The median household income in the region is $80, 134 and individuals without health insurance cover represent 22.7% of the total population.
The second-largest neighborhood in Sentinel City is Acer Tech Center with a total population of 168,390 people. There are 6208 veterans in the region whereby the primary ethnicity is represented by the Whites with 70.2% (Healthcare Learning Innovations, 2021). The secondary ethnicity in the neighborhood is represented by the Hispanic or Latino and occupies 13.7% of the total population. Persons under the age of 65 years in Acer Tech Center represent 19.8% which is almost thrice the number in Casper Park District. Individuals under the age of 18 years represent 7.0% while those under 5 years represent 4.1%. Acer Tech Center has the second-largest median household income of $166,300 fairly below Nightingale square which leads with $269, 550 (Healthcare Learning Innovations, 2021). About 6.7% of individuals under 65 years live with disability and 1.5% of the population under 65 years represent those without health insurance.
Nightingale Square is the third largest neighborhood in Sentinel City and presumably the richest. Th neighborhood has a total population of 103,974 people with 5326 veterans. The primary ethnicity in the region is Whites occupying 81.3% of the total population followed by the Hispanic or Latino with 3.7%. Individuals aged 65 years and above occupy 13.9%, under eighteens with 5.9% while persons under 5 years occupy 2.4% of the total population (Healthcare Learning Innovations, 2021). As explained above, Nightingale Square is the richest city with a median household of $269, 550. Individuals under the age of 65 years with disabilities occupy the smallest percentage among the four neighborhoods with 3.5%. Being the most established neighborhood, only 0.7% of those under 65 years lack health insurance.
Industrial Heights is the smallest neighborhood in Sentinel City with a total population of 38,855 people. The veterans in the region are 607 and unlike other neighborhoods, the majority are Hispanic or Latino. This population makes up the primary ethnicity with 46.8% while the Black or African American is the secondary ethnicity with 13.1% (Healthcare Learning Innovations, 2021). The region has the second largest number of individuals under the age of 18 years that represents 20.8%. The elderly above the age of 65 years represent 0.9% while 10.9% represent children under the age of 5 years. Industrial Heights is the poorest neighborhood with a median household of $24,672 and it is observed that 37.5% of the people aged 65 years and below lack health insurance coverage (Healthcare Learning Innovations, 2021). Regarding disability, 12.9% of those under 65 years are disabled.
Neighborhood/Safety Assessment
Sentinel City exhibits major differences regarding the neighborhood and safety across the four neighborhoods. The first aspect of this discussion focuses on the safety hazards in the neighborhoods. During the assessment, several sidewalks were broken and remained unattended creating a fall hazard to the elderly and other special populations. Walking through the neighborhood, multiple amounts of trash at the side of the buildings could be seen. These sites could harbor rodents that could in turn be a source of diseases in the city. Another concern is water contamination from pesticides and other contaminants as reported by the district representative. Nightingale Square appears to be more organized because litter bins are placed along the busy roads and most are emptied.
The neighborhoods in Sentinel City exhibit different levels of crime. With regard to the drugs and substance abuse in the region, 22% of the common arrests are from drug abuse. Reports indicate that 6% of these arrests are attributed to substance use while 16% are associated with public intoxication, and controlled substance abuse (Healthcare Learning Innovations, 2021). Statistically, 36% of the arrests involve alcohol abuse, 24% are tobacco-related while 18%, 12%, and 10% represent prescription drug, marijuana, and methamphetamine use respectively (Healthcare Learning Innovations, 2021). The seriousness of these abuses indicates that there is a need to mitigate strategies to decrease substance use and abuse in the city. Statistics indicate that Industrial Heights exhibits the highest crime rates which include battery, trespassing, shoplifting, and disorderly conduct. The female is the most affected individual in the city because of their vulnerability. High-income areas like Nightingale Square have safe neighborhoods.
The other aspect of safety in the neighborhood involves response to emergencies. Police Officer Rodney Cooper explained that the general response time during emergencies in the region is 15 minutes. City Hall Data does document the EMS response time at 7.46 minutes which was faster than 2 of the 3 comparison cities (Healthcare Learning Innovations, 2021). This leaves a gap for exploiting the medical resources available to provide timely care to the people. Additionally, the officer talks about crimes like property damage, shoplifting, bicycle theft, and drunk and disorderly conduct. Gang violence is also rampant in the city with aggravated assault being the most predominant crime.
The housing of the city is reflective of the income and level of poverty of the four neighborhoods. The housing condition in Industrial Heights is poor with old houses and boarded-up buildings with graffiti and trash. High-income areas like Nightingale Square and Acer Tech Center have good houses that can be observed from the road. In these regions also, good air conditioning is available because of the minimized industrial activities. Places like the Industrial heights have polluted air because of the numerous industries available. High-income areas have water tanks on the roof of the houses to conserve water and their drainage systems are well-built to prevent flooding and stagnation of water.
Windshield Survey
A windshield survey is an important tool during community assessment that allows the provider to record the behavior and patterns of a community. Analysis of data from the survey helps healthcare professionals to identify health concerns of the community and resources available to deal with the health issues. The first part of the survey involves observed housing and commercial building status. Generally, the majority of the buildings were multi-level, multi-resident styles like apartments and condominiums with no individual dwelling space in front or behind. As I walked through the area, there were no visible solar panels or windmills in the city. I noticed a lot more graffiti in the lower-income areas like Industrial Park compared to developed neighborhoods. Buildings in the more affluent neighborhood of Acer Tech and Nightingale Square seemed newer with lighter exterior than the mostly brick dwelling of the less affluent part of the city. Another crucial aspect was the spacing of the houses whereby the more developed sides had good houses with spaces compared to the less spaced houses in Industrial Park.
It is evident, from the simulated drive-through, that Sentinel City is an urban environment. The environment throughout the neighborhoods is full of houses with minimal spaces for other environmental activities. Although there are numerous trees around, there are limited green spaces around. Most open spaces are made of concrete with limited grass on the playfields. Regarding the boundaries, there are no distinct boundaries between the well-established and struggling neighborhoods. A smooth transition exists between the rich and the poor environments indicating an average community. Another aspect evident in the survey is the presence of common areas like parks and other recreations. Transportation across the city assumes different modes according to the neighborhood characteristics. Adequate bus lines are available to provide movement in the city. Several people are observed to move around by foot or using bicycles while the presence of parked cars indicates the use of private transportation, especially in high-income neighborhoods.
There are different service centers available in the city and they are scattered between the four neighborhoods. For instance, the public health department and Sentinel City Health are observed in Nightingale square. Industrial Heights contains a health clinic and the ABC daycare is available in Casper Park District. As one drives through the city, there are signs of vibrancy whereby people are up and about talking and sharing. People can be seen on bikes and park areas relaxing while others are side walking. School children can be seen in uniforms walking and cycling to school. Regarding religion, the only observable place of worship is the Interfaith Church located in Industrial Heights.
Population Health Scavenger Hunt
The population health scavenger allows for the assessment of a community to determine the services provided and how they affect the health of the people. The first aspect observed was the presence of parks and recreational facilities. Obtained information indicates that minimal funding is available to maintain the parks and recreational facilities. An example is the law quality facilities available in Industrial Heights. Problems with cleanliness and safety at night are observed due to maintenance problems. The second aspect addresses the healthcare system of the city to describe how healthcare services especially for the elderly are provided. Of greater concern are the health services available for the elderly such as senior transportation, assistance programs, and medical care advocacy. Statistically, there is increased demand for elderly services to cater to their health.
Sentinel City is observed to have a scarcity of healthcare services in most areas. Better Health Clinic, located in Industrial Park provides numerous services to people including pregnancy testing and counseling, contraceptive services, preconception health counseling, STI services, breast, and cervical cancer screening. The rate of STIs in the area is alarming with 70% of the screening translating to individuals with gonorrhea, 63% with chlamydia, and HIV/AIDS with 5% (Healthcare Learning Innovations, 2021). There is also an alarming rate of adolescent pregnancies. Nutritionally, the soup kitchen offers services such as free meals for the homeless, food assistance programs, and emergency food supplies. The kitchen supplies food for about 64% of the homeless people (Healthcare Learning Innovations, 2021). Lastly, the affordable Housing Project is available to deal with issues such as property disputes, tenant complaints, vacant units, and regulation of housing charges, especially in low-income areas.
Data Analysis
Epidemiology involves the study of distribution and determinants of health in a population and control of observed health problems. One of the crucial aspects of health I observed in Sentinel City was vaccination against common diseases, especially for the children. Higher-income areas like Nightingale Square have high rates of vaccination rates (94%) compared to low-income neighborhoods like Industrial heights with 78% (Healthcare Learning Innovations, 2021). The other aspect of health observed is waste disposal across the city that has the potential to cause serious infections. Low-income areas contain improperly disposed wastes and polluted water that can cause illness. Regarding safety, low-income neighborhoods are disadvantaged leading to increased crime rates, assault, and violence.
The second aspect deals with the determinants of health in Sentinel City with a great focus on access to healthcare, income level, and individual characteristics. Better Health Clinic is available in Industrial Heights to provide numerous health services to people. Lack of health insurance cover for most people due to the level of income probably causes poor healthcare-seeking behavior in low-income areas. Due to their socioeconomic status, most people indulge in irresponsible activities like drinking, smoking, and substance abuse. The result is an increased number of diseases like STIs and hepatitis B. The demographics of Sentinel City indicate a crude death rate of 693.9 of which 195.1 represents cardiovascular disease burden while 154.2 represents cancer including malignant neoplasms and lung cancer.
Sentinel City Health Concerns
Three problem Areas
The Healthy People 2020 is a national health objective that identifies the most significant threats to health and establishes goals to meet desired outcomes. The overarching goal of the program is to attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. The first problem area in Sentinel City that corresponds to the Healthy People 2020 goals is immunizations and infectious diseases. The healthy People 2020 goal under this topic is to increase immunization rates and reduce preventable infectious diseases (Office of Disease Prevention and Health Promotion (ODPHP), 2021a). There is inequality in the immunizations rate in Sentinel City especially the low-income areas like Industrial Heights that reports a 78% immunization rate. This rate should be pushed to more than 80% to align with the program objectives.
The second health concern in the city is the alarming rate of sexually transmitted infections. Under this topic, the Healthy People 2020 goal is to promote healthy sexual behaviors, strengthen community capacity, and increase access to quality services to prevent sexually transmitted diseases (STDs) and their complications (ODPHP, 2021b). Data from the colleges and schools indicate that about 67% of high-level institutions lack comprehensive student health services (Healthcare Learning Innovations, 2021). The rate of diagnosed STIs in Better Health Clinic is also high with HIV, syphilis, and Hepatitis B accounting for 92%, 80%, and 77% of the cases respectively.
The third problem area in the region is the increased number of teen pregnancies. Under this topic, the Healthy People 2020 goal is to reduce pregnancies among adolescents aged 15 to 17 years and young adults aged 18 to 19 years (ODPHP, 2021c). Sentinel City currently stands at 475 cases of teen pregnancies and the rate is increasing. This increasing rate calls for vigorous education regarding the use of protection, birth control, and abstinence.
Community Resources
The problem selected for this discussion is adolescent pregnancies in Sentinel City. The first community resource available to address this health issue is the Better health Clinic in Industrial Heights. This clinic offers preventive and promotive health services that can be crucial in addressing this issue. For example, the organization of community outreach services and the utilization of media can help educate the youths about responsible sexual behavior. Secondly, the availability of schools can act as a resource for health education and other school health programs geared towards addressing unwanted pregnancies among adolescents. Lastly, City Hall can be utilized to address teen pregnancy as a social issue.
Primary Prevention Topic
The topic selected for this discussion is reproductive and sexual health. This topic deals with sexually transmitted infections, sexual transmission, and the prevention of STDs including HIV/AIDS. Sentinel city is observed to have this health problem where there is an increasing rate of diseases like syphilis, chlamydia, and HIV/AIDS.
Application of Assessment Strategies
The use of the provided assessment tools has broadened my knowledge on data collection and crucial aspects of population health that must be covered during the population health assessment. I have learned that a community assessment can help identify inequalities in the health status and distribution of resources in the community. I have learned that more information about a community must be collected to guide the formulation of a community diagnosis. In future assessments, I will take time to interview people and collect data to aid in identifying actual health concerns of the community. I will also involve local organizations and agencies because they have more information about the services available and those needed in a given community.
References
Centers for Disease Control and prevention. (2018). Public health professionals gateway: Assessments and plans. https://www.cdc.gov/publichealthgateway/cha/plan.html
Healthcare Learning Innovations (Sentinel City) [Computer Software]. (2021). Aurora, Co. Retrieved from http://wgu.ucertify.com/
Office of Disease Prevention and Health Promotion. (2021a). Healthypeople.gov: Immunization and infectious diseases. https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases
Office of Disease Prevention and Health Promotion. (2021b). Healthypeople.gov: Family planning. https://www.healthypeople.gov/2020/topics-objectives/topic/family-planning/objectives
Office of Disease Prevention and Health Promotion. (2021c). Healthypeople.gov: Sexually transmitted diseases. https://www.healthypeople.gov/2020/topics-objectives/topic/sexually-transmitted-diseases#:~:text=Goal,(STDs)%20and%20their%20complications.
