164
UNIT II ■ Community Health Across Populations: Public Health Issues
enough food to eat, being behind on rent, 33 and having difficulty covering usual expenses. People who had been working in lower-wage jobs before the pandemic were most likely to be unemployed as of October 2021, pri- marily because these positions had been abolished. An- other factor that impacts economic stability is chronic disease. The Centers for Disease Control and Prevention (CDC) estimates that every 40 seconds someone in the United States experiences a stroke, 34 which can leave the person unable to provide for their own activities of daily living. This situation would necessitate that some- one else, typically a family member, provides caregiving. Persons serving as caregivers are usually an unpaid fam- ily member. Caregiving can have a direct and indirect economic impact on the family unit. The direct impact is the loss of wages and increased costs of living for the person requiring caregiving, as well as the loss of wages for the caregiver who may no longer be able to work full time. 35 The indirect impact is the cost to the caregiver’s well-being because the caregiver may be spending their previous recreational time providing care. Without res- pite from caregiving, the caregiver may experience per- sonal health consequences and a subsequent increase in personal health-care expenses. ◆ HEALTHY PEOPLE 2030 Category: Social Determinants of Health Area: Economic Stability Goal: Help people earn steady incomes that allow them to meet their health needs. Objective: Reduce the proportion of people living in poverty. Level, Baseline. SDOH‑01 Topics Covered: Community, Poverty, Access to Affordable Food, Housing, Education, and Health Care. Using Healthy People 2030 in Your Work: Identify needs and priority populations. 1. What proportion of the community is living in poverty? 2. What populations are living in poverty based on age, ethnicity, education level, gender, or other demographic marker? 3. What services are available to those living in poverty? 4. What are the gaps in services and programs, and what are the current priorities? 5. What role might an organization providing health care to the community play in reducing the proportion of people living in poverty?
Education Access and Quality SDOH related to education access and quality focus on a person’s educational attainment and the context of learning. 24 For example, a person’s language literacy, early childhood education and development, and overall educational attainment impact a person’s ability to ob- tain their optimal health and well-being. Researchers from the CDC’s Center for Surveillance, Epidemiology, and Laboratory Services studied the rela- tionship between eighth-grade school achievement and health. 36 They found that an increase in eighth-grade test scores was associated with an increase in income at age 40 as well as an increase in life expectancy. This relationship relays the need for children to strive for ed- ucational excellence as well as remain in school through high school graduation. The greater students’ educa- tional experience and attainment are, the greater the likelihood the students will later obtain employment with a “living wage” to be able to lead healthy, long lives. As an example, Sheehan and colleagues implemented a community-based youth development program for black, low-income children. 37 The researchers found that program participants reported having good to ex- cellent health, graduating from college, having money left at the end of the month, and having a better standard of living than their parents, in contrast to black children from the same neighborhood who did not participate in the program. The implications of this study show that encouraging participation in childhood education can lead to improved health in adulthood. Health-Care Access and Quality SDOH related to health-care access and quality focus on a person’s access to health-care services as well as understanding of services available for primary, sec- ondary, and tertiary prevention. 24 Availability of health insurance coverage and health literacy, as well as pri- mary care access, also contribute to health-care access and quality. The COVID-19 pandemic changed health-care access, particularly with the proliferation of telehealth services. Medical students at the MedZou Community Health Clinic converted from in-person visits to telehealth vis- its from March 2020 through March 2021 after the sus- pension of all in-person visits because of the COVID-19 pandemic. 38 Patients using the telehealth services were significantly more likely to be 45 years of age or older, which was somewhat surprising given the stereotype that older adults do not adopt and use technology as easily as younger persons. However, older adults are in
Powered by FlippingBook