UAH Clinic Corner: Preventive care tips for diverse populations

When it comes to the delivery of preventive care to diverse populations, "it is imperative that the healthcare community is socially and culturally sensitive to all types of disparities," said Connie Abbott (MSN, CRNP) nurse practitioner, at The University of Alabama in Huntsville (UAH) Faculty-Staff Clinic.

Chronic diseases that affect people of color are diabetes, heart disease, cancer, stroke, hypertension, obesity, and infant mortality.

"Despite all attempts to equal the playing field, a large number of disparities still affect people of color," Abbott said. The U.S. Department of Health and Human Services Office of Minority Health (OMH) highlighted the top reasons more people of color die with chronic diseases. Abbott said according to OMH, many minority patients have lower median incomes and incidences of healthcare coverage, and there are communication problems between patients and medical providers that involve understanding complex health information. All these factors contribute to higher incidences of health conditions as well as a higher mortality rate from chronic diseases.

She said obesity, now considered an epidemic in the U.S. links to many chronic health conditions. For instance, obesity is a direct link to high blood pressure and diabetes, and it increases the risk of heart disease and stroke. Abbott noted that obesity has also been linked to cancer. "In 2015, people of color were 1.4 times more likely to have a body mass index of 25 or higher which puts them in the overweight to obese category. This trend doesn’t just affect adults but children as well. Children of color between six and seventeen years of age were 1.5 times more likely to be overweight or obese," said Abbott.

Although the term food insecurity has been around since the 1990s, it is making a comeback in a big way. According to Abbott, the U.S. Department of Agriculture defines food insecurity as ‘a household-level economic and social condition of limited or uncertain access to adequate food’.

"This differs from hunger because hunger is an individual-level physiological condition and is a potential result of food insecurity," she explained. "Food insecurity is highest in rural areas. ‘Feeding America’ is a group that focuses on gathering data about hunger in America and ways to combat it. They have mapped the counties in the U.S. with the highest food insecurity rate and ninety-three percent of counties with a majority African-American population fall within the top 10 percent of food-insecure counties.

"Although we know that it’s best to eat healthy foods, eating healthy is not cheap nor is it always accessible," said Abbott. Due to lack of financial resources and/or accessibility, processed foods are the more affordable and available option albeit not the best option."

Abbott said further, unhealthy foods contribute to obesity due to high-fat content and are usually of low nutritional value. "They also have high sodium content which in turn contributes to high blood pressure. This provides the catalyst for the increased incidence of heart disease and stroke."

Another cause for concern is the extremely high infant mortality rate for women of color. "Most infant deaths result from low birth weight and this is directly related to lack of prenatal care and education," Abbott said. "The first trimester is a critical time for organ development and many minority women don’t seek care during this period. The reasons for this are multi-factorial – lack of transportation, lack of healthcare coverage and lack of health education.

According to a recent Centers for Disease Control and Prevention (CDC) report, there is no single or simple solution to the obesity epidemic. Knowing your body mass index (BMI), achieving and maintaining a healthy weight, and getting regular physical activity are all actions you can take for yourself to combat obesity.

There are several ways state and local organizations can create a supportive environment to promote healthy living behaviors that prevent obesity: state, local, territorial and tribal public health organizations, grantees, and practitioners.

To view other CDC backed efforts on reversing obesity, visit cdc.gov/obesity/strategies/index.html.

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Sources

• nhqrnet.ahrq.gov/inhqrdr
• cdc.gov/nchs
• ers.usda.gov
• feedingamerica.org/hunger-in-america
• minorityhealth.hhs.gov
• Levine DM, Landon BE, Linder JA. Quality and experience of outpatient care in the United States for adults with or without primary care [published online January 28, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.6716 Reported in Article “Primary Care Use Associated With Improved Health Care Experience”.
• clinicaladvisor.com

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