ANSWER:

Community Assessment 

Introduction.

Despite the explicit knowledge in the public domain about community-related health issues, the community responsiveness to these health hazards is alarming. Consequently, more awareness is needed by employing teaching mechanisms to improve disease preparedness, control, and prevention. According to Maurer and Smith (2013), teaching is the process of imparting cognitive values, skills, and knowledge to a specific audience. Therefore, it is ethically imperative to foster human development through client education to promote health. Community engagement and education are critical aspects of nursing hence aids in health promotion and disease prevention (Ali & Katz, 2015). Comparatively, community assessment offers the scale to determine the effectiveness of interventions to optimize healthcare services in the community. It helps in ensuring consistency in community-based service delivery. This paper covers the experiences of teaching the Hispanic community, the largest minority in the United States, the need and importance of healthy practices to reduce morbidity rates, mortality rates, and increase life expectancy ratio.

The Hispanic community is considered one of the largest ethnic minorities in the United States. According to the 2019 U.S. Census Bureau population estimation, Hispanics contribute 18.4% of the total U.S. population. Therefore, assessing their health concerns informs policy formulation and intervention programs. Hispanics in the United States consist of indigenous-born and foreign-born individuals migrating from Latin America, the Caribbean, and Spain (Eduardo et al., 2016). Cultural considerations reflect on the attitudes, expectancies, and norms of Hispanics. The basis for developing targeted group-specific intervention underscores societal differences and the need for culturally appropriate interventions. Additionally, culture entails behavioral preferences and expectations. A holistic interpretation of culture enables purposive and appropriate health intervention for Hispanics.

Insurance is central to the modern-day dispensation of healthcare services and health management. The role of a dynamic insurance system cannot be overstated. According to Dieleman (2020), the United States spends more on healthcare per person and comparatively more in spending than other countries. Increased expenditure presupposes an improved state of her healthcare system and management. As part of the transformation, the method used to finance health care in the United States has evolved over the last century, mainly incorporating public or private insurance. Legislative changes to the federal tax code led to employer-sponsored private insurance in the 1940s, and Medicare & Medicaid were created in the 1960s. Across time, public policies have been debated and enacted, and innovative payment models have been transacted. However, despite the cosmetic progress, it is notable that Hispanics have the highest uninsured rates of any racial or ethnic group within the United States. A Census Bureau report conducted in 2019 shows that 50.1% of Hispanics had private insurance coverage, compared to 74.7% for non-Hispanic Whites, which indicates skewed healthcare infrastructure. Conclusively, 36.3% of all Hispanics had Medicaid or public health insurance coverage compared to 34.3% for non-Hispanic Whites. Significant disparities in health insurance coverage and access to health services have long persisted in the U.S. health care system (Thomas Buchmueller, 2019). Whereas insurance has increasingly developed over time to guarantee cost-effective healthcare, a majority of the Hispanic population remains uninsured.

Morbidity refers to a state of being symptomatic or unhealthy for a disease or condition. It is usually represented or estimated using prevalence or incidence. On the flip side, mortality is related to the number of deaths caused by the health event under investigation. Whereas Hispanics are assessed collectively, birth location and cultural heritage can make a difference in health behaviors and outcomes. Collectively, Hispanics are disproportionately affected by poor conditions of daily life, shaped by structural and social position factors, thereby impacting mortality and morbidity. Mortality and morbidity provide an essential basis for community assessment within Hispanics. According to Hernandez et al. (2021), both parameters, morbidity, and mortality, facilitate the continuous evaluation of the efficacy of either a specific healthcare system or an implemented intervention in place. Hispanic morbidity is higher for infectious diseases such as tuberculosis, septicemia, viral hepatitis, meningitis, pneumonia, and AIDS (Furino, 1992). According to Deaton et al. (2017), mortality rates increased exponentially at different rates in different parts of the United States from 1999 to 2015. The hardest hit of the nine census divisions was East South Central (Alabama, Kentucky, Tennessee, and Mississippi), which saw mortality rates rise 1.6 % per year on average for white non-Hispanics 50–54, increasing from 552 to 720 deaths per 100,000 over this period. According to Borrell (2008), Hispanics ages 25–44 had greater death rates than non-Hispanic-white adults regardless of sex and nativity. Matter-of-fact, various studies show that ethnic differences in morbidities such as tuberculosis and cervical cancer partly reflect barriers to access to health insurance and health services among Hispanics.

Healthy People is a multisectoral organization that fosters equity, fairness, and unbiased access to healthcare. It focuses on health priority areas while advancing research-based interventions. Moreover, it emphasizes public knowledge through awareness creation on health determinants. The Hispanic community faces many health-related challenges like biases in healthcare dispensation, low insurance uptake, and knowledge gap. These strings of challenges are well canvassed within the objective of healthy people. 

Cancer is one of the leading causes of morbidity and mortality among Hispanics. According to US Centers for Disease Control and Prevention (CDC, 2015), a significant number of cancer incidences were estimated to have occurred among Hispanics, with a case-fatality rate of 30%. Cancer of the prostate is the most common cancer in Hispanic men (22%), followed by colorectal (11%) and lung (9%) cancer. Among women, breast cancer is the most frequent (29%), followed by thyroid (9%), colorectal (8%), and uterine (8%) cancer. Among men, the leading cause of cancer death is lung (17%) cancer, followed by liver (12%) and colorectal (11%) cancer. Among women, the most frequent cause of cancer death is breast (16%) cancer, followed by lung (13%) and colorectal (9%) cancer. Breast cancer death rates are about 30% lower in Hispanic women than Non-Hispanic White women.

            Cancer continues to be disturbing among the children cohort, leading to disease-related deaths. Geographic and demographic variations indicate worrying trends of cancer rates among Hispanics. Whereas there have been knowledge gaps in the past, it has been variously studied that high incidence of cancer rates covering lung, breast, and prostate continues to create a huge burden. Hispanic women with cancer have been identified as having more significant spiritual needs and experiencing more life disruption than other groups (Lora E. Fleming,2002). Comparatively, Hispanics have higher incidence and mortality rates for the stomach, liver, uterine cervix, and gallbladder cancers, reflecting more significant exposure to cancer-causing infectious agents (J. Clin, 2012). Implicitly, cancer is among the leading cause of death among Hispanics. Hispanics endure significant health risks such as obesity, teen pregnancy, and tobacco use, among others. Significant and tremendous differences in risk factors, morbidity, mortality, and access to health care can also be observed among Hispanics.

Community Assessment

Community assessment is furthered by growing interest in community participation and self-determination, which characterize healthy communities' principles (Greaney et al., 2000). Community assessment aims to identify, support, and mobilize existing community resources and capacities to create a shared vision. The Hispanics largely occupy Mexico, California, Texas, Arizona, and New Mexico. The two states with the most Hispanics, California (15.6 million) and Texas (11.5 million), alone account for 45% of the nation's Hispanic population. Hispanics have a vast, complex, and expansive population structure comprised of many overlapping subgroups and vary markedly in environmental and cultural factors linked to the country of origin and history of immigration to the United States. The Hispanic population is inarguably the largest ethnic minority group in the United States, comprising nearly 60 million people (Marcelin, 2020). Assessing their health status, both traditional and emerging, and health needs are central to informing health policy formulation and program implementation. According to Mondragon (2016), Hispanics are disproportionately and comparatively affected by poor conditions of daily life, shaped by structural and social position factors. Social determinants of health have fostered health inequalities that characteristically entail conditions that affect specific socioeconomic, ethnic, and gender subgroups. There is considerable evidence that Hispanics have suffered a massive brunt of an imbalanced societal structure that accords privilege to the dominant and, consequently, sidelines the minority. A troubled and constrained access to healthcare makes Hispanics disproportionately vulnerable to disease and death.

Data Gathering

Data is an essential aspect of evidence-based research. Information is drawn and gathered from various sources and across the spectrum of government agencies. The emergence of data institutions through national health reform, state legislative initiatives, or coalitions provide a basis to explore how such information can be used appropriately (Donaldson & Kathleen, 1994). National Center for Health Statistics provides relevant and up-to-date information on health status. The agency revealed statistical information relating to the mortality and morbidity rates of the Hispanics along with contributing health status indicators, persons in poverty, and STDs. U.S. Census Bureau's Small Area Health Insurance Estimates (SAHIE) program is the only data source for single year. Health insurance coverage status estimates for all counties in the United States. The report describes demographic and economic differences in health insurance status across states and counties and trends in health insurance coverage detailing a low insurance uptake among the Hispanic community.

In 2014, 26.5% of Hispanics were uninsured compared to 10.4% of non-Hispanics under age 65. The gap was higher for persons aged 65 and over: 4.4% among Hispanics, compared with 0.5% among non-Hispanic whites. When poverty levels were considered, gaps were higher. Among the Hispanic poor under age 65, 37.1% lacked insurance compared to 19.7% of poor non-Hispanic whites and 19.5% of poor African-Americans. Among persons aged 65 and over, 7.1% lacked health insurance compared to 0.5% of near-poor non-Hispanic whites and 2.2% of poor African-Americans. World Health Organization is a consortium of partners with the singular aim of enhancing health status across the globe. Many generated data has proved crucially important through the Centre for Disease Control and Prevention (CDC). CDC is designed to promote international comparability in peer review collection and processing. Ultimately, the processed information is classified, presenting mortality rates. Through statistics provided by CDC, 19% of deaths among Hispanics were contributed by cancer. In comparison, 20% were attributable to heart disease for 2016, while the cancer rate was higher at 26.8 % among the age cohort of 65-84.

      Proactive, evidence-based, and efficient health challenges demand a proactive community assessment.

Demographics of the Hispanics.

         Hispanics in the USA have a distinct social and cultural identity that characterizes them as an ethnic group. United States Federal Bureau of statistics defines Hispanics as deriving from heritage, nationality, lineage, or country of birth or the person's parents or ancestors before arriving in the United States. Additionally, it encompasses people who identify as Hispanic, Latino, or Spanish and may be of any race. As of 2019, Hispanics are spread across the geography of the United States, with a population of 60.6 million. The Hispanic population has a median age of 29.8 years old, a median household income of $56,814, and a poverty rate of 15.7%.

            The success of community-based health intervention relies on the quality of assessment. According to Fusch et al. (2018), research is essential for healthcare promotion and intervention. The study provides facts upon which evidence-based interventions are implemented. Such facts were gathered in diverse settings through informant interviews, in-person observation and surveys. Data obtained from these activities provided an understanding of Hispanic community needs and gaps for possible interventions.

Conclusion

         In conclusion, the state of healthcare among Hispanics leaves a lot to be desired. Trends, both subtle and obvious, indicate there's a deep-sited healthcare challenge among Hispanics. There's a need, almost urgent, that necessary structural and systematic changes be made to foster equality in the administration of the United States' healthcare system. Whereas there are positive steps done over time, exhaustive benefits are yet to accrue. There's a need to restructure insurance, alleviate poverty levels and push for targeted investments in education among the Hispanic population. Over time, the gains realized can be clawed back if there's little appreciation of inherent systemic and evolving challenges. However, as highlighted, most of the challenges require a multisectoral intervention beyond the reordering of policy. A multilevel, multifaceted approach, from social policy to health services, is needed to improve the health of Hispanics in the USA.

References

Fusch, P., Fusch, G. E., & Ness, L. R. (2018). Denzin’s paradigm shift: Revisiting triangulation in qualitative research. Journal of social change, 10(1), 2.

Green, Tiffany L. "Unpacking racial/ethnic disparities in prenatal care use: the role of individual-, household-, and area-level characteristics." Journal of Women's Health 27, no. 9 (2018): 1124-1134.

Molina, K. M., Estrella, M. L., Durazo-Arvizu, R., Malcarne, V. L., Llabre, M. M., Isasi, C. R., ... & Daviglus, M. L. (2019). Perceived discrimination and physical health-related quality of life: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. Social Science & Medicine, 222, 91-100.

People, H. (2020). Healthy People 2020 summary of objectives. Adolescent health (on-line). http://www. healthypeople. gov/2020/topicsobjectives2020/pdfs/AdolescentHealth. pdf. Accessed February, 20, 2013.