Health in the Global Community

Women’s health

Read chapters 15 and 17 of the class textbook and review the attached PowerPoint presentations.  Once done, answer the following questions.

1.  Describe globalization and international patterns of health and disease.

2.  Identify international health care organizations and how they collaborate to improve global nursing and health care.

3.  Identify and discuss the major indicators of women’s health.

4.  Identify and discuss the barriers to adequate health care for women.

As stated in the syllabus present your assignment in an APA format word document, Arial 12 font attached to the forum in the discussion tab of the blackboard titled “Week 10 discussion questions” and the SafeAssign exercise in the assignment tab of the blackboard “Week 10 SafeAssign APA”.  For you to receive the total points of the assignment it must be posted in both places.  I will have DL monitoring, so we don’t have the same problem that happened in week 6.   A minimum of 3 evidence-based references besides the class textbook no older than 5 years must be used.  You must post two replies to any of your peers sustained with the proper references no older than 5 years as well and make sure the references are properly quoted in your assignment.  A minimum of 800 words is required.  Please make sure to follow the instructions as given and use either spell-check or Grammarly before you post your assignment.

Chapter 15

Health in the Global Community

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Human health and its influence on every aspect of life are central to the global agenda.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Health in the Global Community

Population characteristics

Environmental factors

Patterns of health and disease

International agencies and organizations

International health care delivery systems

The CHN’s role in the global community

Research in international health

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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International Community Assessment Model

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Courtesy J. C. Novak.

Population Characteristics

Large populations create pressures

Goal is to improve quality of life (QOL)

Health promotion

Effective health care delivery systems

Enhancement of the environmental infrastructure

World population distribution is uneven

More than 50% live in China, India, United States, and Indonesia; 30% are children; 8% are over 60

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Population Characteristics (Cont.)

Life expectancy varies significantly in different countries.

Japan 86 years, Zambia 43 years

As the world population grows, a global trend toward urbanization occurs.

Live closer together and migrate to urban areas for employment

Increased living density and global travel threatens health of general population by environmental factors

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Environmental Factors

Environmental stressors

Directly assault human health

Damage society’s goods and services

Affect quality of life (QOL)

Interfere with the ecological balance

Natural disasters, terrorism, and war affect all of the above

The field of environmental health and sustainable development has exploded since 1990.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Patterns of Health and Disease

Lifestyles, health and cultural beliefs, infrastructure, economics, and politics affect existing illnesses and society’s commitment to prevention.

Disease patterns vary throughout the world.

Racial, ethnic, and access disparities exist within and between countries.

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International Organizations

WHO (World Health Organization)

PAHO (Pan American Health Organization)

UN (United Nations)

UNICEF (United Nations International Children’s Fund)

World Bank

CDC (Centers for Disease Control and Prevention)

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“Health for All by the Year 2000” (WHO Goal, 1978)

Goal framed at the Alma-Ata conference in the Soviet Union in 1978; now extended to 2010 again without attainment

Concept of primary health care

Health as a fundamental human right for individuals, families, and communities

Unacceptability of the gross inequalities in health status

Importance of community involvement

Active role for all sectors

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Millennium Development Goals (United Nations, 2000, 2006)

Target date of 2015

Eradicate extreme hunger and poverty

Achieve universal primary education

Promote gender equality, and empower women

Reduce child mortality

Improve maternal health

Combat HIV/AIDS, malaria, and other infectious diseases

Ensure environmental sustainability

Develop global partnerships

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Other Organizations Impacting International Health

Nongovernmental organizations (NGOs)

Carter Center

Bill and Melinda Gates Foundation

ICN (International Council of Nurses)

HHS (U.S. Department of Health and Human Services)

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HHS and Healthy People

Serves as a foundation for efforts across the HHS to create a healthier nation

1979 Surgeon General’s Report, Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention

Healthy People 1990: Promoting Health/Preventing Disease: Objectives for the Nation

Healthy People 2000: National Health Promotion and Disease Prevention Objectives

Healthy People 2010: Objectives for Improving Health

Healthy People 2020: Improving the Health of Americans

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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International Health Care Delivery Systems

Much to learn from one another.

Research and development must be relevant to infectious diseases that affect the poor.

Need to systematically generate an information base.

Need to consider determinants of health.

Use population-based approaches to address access, cost, efficiency, and effectiveness.

Collaborate to solve the problems of health care delivery systems.

Market- and population-based approaches need to learn from each other.

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International Health Care Delivery Systems (Cont.)

Effective health care delivery systems must:

Increase access and efficiency.

Improve health status through health promotion and disease prevention.

Eliminate health disparities.

Protect individuals, families, and communities from financial loss caused by catastrophic illness.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Role of the CHN in International Health Care

Seek to ensure the attainment of health for all in a cost-effective, efficient, accessible health care system.

Be involved in research, community assessment, planning, implementation, management, evaluation, health services delivery, emergency response, health policy, and legislation.

Coordinate work with other health care personnel and community leaders as well as local and global community leaders.

Utilize changes in the health environment to form the basis for the nursing role.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Role of the CHN in International Health Care (Cont.)

Primary health care

Essential services that support a healthy life.

Involves access, availability, service delivery, community participation, and the citizen’s right to health care.

Primary care

First line or point-of-access medical and nursing care controlled by providers and focused on the individual.

May not be the norm as needs of the group outweigh the needs of the individual.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Role of the CHN in International Health Care (Cont.)

All nurses in the world must understand and learn from one another. Nurses are health care’s most valuable assets.

Community public health nurses can improve access to care for the most vulnerable and hard-to-reach groups in any country.

The future demands evidence-based learning, engagement, service, and growth in information technology and local and global health policy.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Figure 15-2 Distinction Among Service Programs. Furco, Andrew. “Service-Learning: A Balanced Approach to Experiential Education.”  Expanding Boundaries: Service and Learning. Washington DC: Corporation for National Service, 1996. 2-6.  

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Population-based nursing experts are critical to solving the challenges of the fragmented, mismanaged, expensive, ineffective, inefficient health care delivery system that exists in many parts of the global community.

– Nies and McEwen (2015)

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Research in International Health

Since 1990, international nursing research has focused predominantly on:

Student and faculty educational exchange programs

Diverse clinical experiences

The international development of home care or transition from hospital to home

WHO Collaborating Centers contributed to a partnership for educational programming, clinical practice, and research for graduate students in primary health care nursing and community health

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Chapter 17

Women’s Health

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Women’s Health

“… essential to the development of health care for women are the concepts of health promotion, disease and accident prevention, education for self-care and responsibility, health risk identification and coordination for illness care when needed.”

– Preamble to a New Paradigm for Women’s Health,

Choi (1985)

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Major Indicators of Health

Mortality rates

Cardiovascular disease (CVD) continues to be the number one overall killer of women.

Cancer rates are increasing because of lifestyle choices, environmental carcinogens, and increase in life expectancy.

Diabetes mellitus causes the premature death of many women and is a risk factor for CVD.

Gaps exist in the availability and quality of reproductive health care services globally.

Life expectancy for Americans is at an all-time high.

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From http://ndep.nih.gov/partners-community-organization/campaigns/SmallStepsBigRewards.aspx

From http://www.nhlbi.nih.gov/educational/hearttruth/

Major Indicators of Health (Cont.)

Morbidity rates

More women than men are hospitalized each year in the United States.

Women are more likely than men to be disabled from chronic conditions.

Women are more likely than men to have surgery; many surgeries relate to reproductive health.

The most frequently occurring interruption in women’s mental health relates to depression.

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Social Factors Affecting Women’s Health

Health care access

Education and work

Employment and wages

Working women and home life

Family configuration and marital status

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Health Promotion Strategies for Women

Collaboration and an interdisciplinary approach are necessary to meet the health care needs of women.

Women should receive services that promote health and detect disease at an early stage.

Many women seek information that will allow them to be in control of their own health.

Women desire to become more knowledgeable about their own health.

Health promotion for low-income, underserved women may differ from that for middle-class women.

Knowledge deficits about one’s own health prevail among women regardless of socioeconomic or educational level.

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Common Acute Illnesses in Women

Urinary tract infection and dysuria

Diseases of the reproductive tract

Vaginitis, vulvovaginitis, pelvic inflammatory disease (PID), and toxic shock syndrome (TSS)

Chronic diseases

Coronary vascular disease (CVD) and metabolic syndrome, hypertension, diabetes, arthritis, osteoporosis, and cancer (breast, lung, gynecological)

Mental disorders and stress

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Reproductive Health Concerns

Nutrition

Includes total life nutritional experience

Dysmenorrhea

Family planning

Includes fertility control and infertility

Need multiple safe options designed to meet the individual needs of all women

STIs, HIV, and AIDS

Women need age-appropriate STI prevention, education, and counseling.

Worldwide, AIDS is a leading cause of death among young women.

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Other Issues in Women’s Health

Unintentional injury or accidents

Domestic violence is the single largest cause of injury to women between the ages of 15 and 44 in the United States.

Disabilities resulting from acute and chronic conditions

Women have fewer disabilities than men because they tend to report their symptoms earlier and receive necessary treatment.

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Major Legislation Affecting Women’s Health Services

Public Health Service Act (1982)

Provides biomedical and health services research, information dissemination, resource development, technical assistance, and service delivery.

Includes the Family Planning Public Service Act

Title VII of the Civil Rights Act of 1964

Prevents discrimination based on sex, race, color, religion, or national origin

Amended to also include pregnancy and childbirth

Sexual harassment is violation of Civil Rights Act

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Major Legislation Affecting Women’s Health Services (Cont.)

Social Security Act

Provides monthly retirement and disability benefits to workers and survivor benefits to families

Occupational Safety and Health Act (OSHA)

Enacted in 1970

Ensures safe and healthful working conditions

Family and Medical Leave Act (FMLA)

Enacted in 1993

Provides 12 weeks of unpaid leave each year for family and medical reasons

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Health and Social Services to Promote the Health of Women

Affordable Care Act (ACA) of 2010

Protection from being denied coverage by insurance companies

Protection from being charged more for health care services because of their gender

Preventive care without copays including:

Well-women visits with screening and counseling for gestational diabetes, HPV, STIs, HIV, contraception, and domestic violence

Breastfeeding counseling support and supplies

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Health and Social Services to Promote the Health of Women (Cont.)

Medicaid (1965)

A federal- and state-funded health insurance program for the poor

Expanded under ACA to persons under 65 with an income below 133% of poverty level

Largest source of funding for people with limited income, regardless of age eligibility

Five broad coverage groups:

Children, pregnant women, adults in families with dependent children, individuals with disabilities, individuals 65 years or older

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Health and Social Services to Promote the Health of Women (Cont.)

Women’s health services

Provide primary health care needs, as well as reproductive and maternity care services including:

Eating disorders

All forms of abuse

Disease prevention, including smoking cessation

Health promotion focusing on nutrition, exercise, and stress management

The National Women’s Health Network is a strong advocate for women’s concerns.

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Other Community Voluntary Services

Women’s organizations

Promote voluntary involvement with community; many others have made women’s health a major item on their agenda.

Networking

Help women advance careers, improve lifestyles, and increase income and success.

Crisis hotline services

Provide counseling to battered women, battering parents, rape victims, those considering suicide, and those with multiple needs.

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Levels of Prevention

Primary prevention

Recognize risk for disease and target health care behaviors to reduce risk

Never smoking, following a nutritious diet, safe sex practice, avoiding drugs, limiting alcohol consumption, and staying physically active

Secondary prevention

Routine screening for cervical cancer, STIs, breast self-exams, and mammograms

Tertiary prevention

Education and resource utilization

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Roles of the Community Health Nurse

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Direct care

Educator

Counselor

Researcher

Research in Women’s Health

Research efforts to include women in studies have grown; not based only on male subjects

NIH Office of Research on Women’s Health (ORWH) established in 1990

Many topics examined based on special task force recommendations

Research on financing and delivery of health services for women

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Office of Research on Women’s Health

Overarching themes for research:

Developmental, psychological, spiritual, and physiological factors effect on lifespan

Female determinants’ (such as genetics and gender expectations) effect on health

Health disparities and diversity

Diseases and conditions affecting women

Career development and advancement of women in the sciences

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“Women are at the center of the health of the United States; therefore, if better models are developed for improving the health of women, the health of the entire nation will benefit.”

– Nies and McEwen (2015)

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