Community Health Assessment Report: City of Horizon, Texas

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Assessment 2: Community Health Assessment Report
Introduction
Health is affected and influenced by multiple factors including the physical and social
aspects. These factors are known as determinants of health that influence the individual’s
health and wellbeing. The different region presents different health determinants that affect
the health of the residents of that region. This report is based on a thorough psychosocial
analysis and assessment of the City of Horizon, Texas. The report is aimed at producing a
well-organized evaluation of the psychosocial status of the city and the following will include
assessment of social, cultural, environmental and physical factors present in the region that
affects the health. The whole report is conducted in three parts part A is the psychosocial
assessment or appraisal of the factors present in the chosen region that affects the health of
the individual. This part gives a thorough understanding of the entire region, its
demographics, population, surroundings and the culture. Part B is based on choosing one
specific health condition that is prevalent in the City of Horizon and requires to be studied.
The health determinants leading to increased prevalence of this disease in this region will be
discussed here. Part C will focus on the explanation of the role of registered nurses in health
promotion. The roles of an RN will be well explained with the help of 3 key principles
including enablement, advocacy and mediation. The evident literature will be provided to
support the claims and evaluate the statements. The report will help future clinical practice by
providing thorough information and evidence. It will also enable the researchers to pay focus
on the prioritized diseases in the region.
City of Horizon Psychosocial Assessment
Horizon city also is known as the City of Horizon is a city in El Paso County, Texas, United
States. As peer 2018 census the population of this region is estimated to about 19,332 with an
increase of around +269.4% since 2000 (Horizon public health., 2018). The overall
population is the third highest in the entire area. As compared to the population change in
Texas that is 9% the Horizon city compared to be larger by the change of 15.5% (Horizon
public health., 2018). The median age of the population estimated in the region is about 28.4
years. The ethnic communities in the area are majorly focused on Hispanic and Latino people
with every 6 in 10 people from this background. The largest industry sector in Horizon is the
educational services, retail trading, health care and social services and mining and quarrying
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with larger parts of industries belonging to agriculture, forestry, fishing and hunting. Paying
attention to this detail it can be considered that the 100% population in the city is dwelling in
urban areas with a minimum amount of people in rural areas. The estimated household
income in the region is $52,393 annually (Horizon public health., 2018). The male to female
income inequality in the region is present that shows 0.482 deviations from national
inequality. The wages comparison on the basis of ethnicity and race in this region was that in
2016 the highest paid ethnic group was Asian with $64,947 income annually (Horizon public
health., 2018). This discrimination and inequalities present in the income and socioeconomic
status of people in the region determine their health. Socioeconomic status also influences the
ability of the person o access health and social care as well as it is seen that the person from a
low-income group tends to be iller than the one with a high-income source. The housing
statistics show that the homeownership of the individual in the Horizon is 84.7% (Horizon
public health, community health improvement plan., 2015 to 2019). Housing is considered as
one of the crucial factors in influencing the health of the individual. Lack of housing and
proper housing facility adds up to the stress and psychological issues of the individual that
leads to health issues and a variety of other comorbidities. As stated the majority of families
in the region have their owned houses this factor will not be adding up as a stressor for the
individual in Horizon.
The education levels of the city are considerably high with average 86.1% of the 25 years
population enrolled in high schools, graduation programmes and professional degree
programmes. Education is another factor that is held accountable for better health and
reduced prevalence of diseases such as HIV / AIDS, obesity, cardiovascular diseases, etc.
Education enables the population to be aware of the health issues and the risk factors
associated with it and modify the living as per to avoid the incidence of such diseases. The
unemployment rate in the region is estimated to be 3.5% (Horizon public health, community
health improvement plan., 2015 to 2019). Unemployment is another factor that determines
the deteriorated wellbeing of the individual. Unemployment will add up as a stressor in an
individual’s life and this will hamper a person's ability to develop positive social
relationships, and maintain the healthy living (Horizon public health., 2018). Stress is
considered to be the most crucial factor that is presented as a link for the presence of chronic
illness and several health-related issues.
The median age of the region is 28 years but the 40% of the overall population is 60 years
and above with chronic history of alcohol and smoking (Horizon public health, community
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health improvement plan., 2015 to 2019). It is seen that 22.4% females and 39.4% males in
Horizon suffer from tracheal, bronchus and lung cancer and one of the important factors for
this is the habit of smoking. Total of 33% of the population is considered to be having a habit
of chronic smoking and health issues in later life due to it (Horizon public health., 2018).
Smoking is highly influencing factor that is responsible for the prevalence of a variety of
diseases and health conditions.
0.4% of the females in the region are considered as obese and this is considered as one of the
important biological factors that enhances the risk towards cardiovascular diseases, stroke,
and hypertension (Horizon public health, community health improvement plan., 2015 to
2019). 247 people in every 100,000 population are considered to be affected and die due to
ischemic heart disease that is one of the consequences of chronic obesity and other comorbid
conditions. These biological factors are associated with the dietary changes and the lack of
physical activity as well as the increased prevalence of the health inequalities and differences
in the socioeconomic status of the residents living in the city of Horizon. Access to health and
social care services impact the overall health of the individual in the region. The levels of
uninsured health individuals in the region are 11%, the new facilities and policies may work
to reduce these rates (Horizon public health., 2018). The healthcare workforce in the region is
highly sparse with around 1670 patients for 1 physician (Horizon public health, community
health improvement plan., 2015 to 2019). The mental health issues were considered to be
high in an old patient in 2016 with 8.26%. The per capita income of the personal healthcare
spending in the region enhanced by 5.06% in last 3 years, the accessibility to health and
social care determines the health of the individual and also ensures the wellbeing in parity
with physical and psychological wellbeing.
The community and social support services in the region are being highly focused on and the
strategy by the council promoted the development of a community health improvement plan.
The CHIP is aimed at providing guidance to the public of the region and aims at mobilizing
the action through planning and partnership (Horizon public health, community health
improvement plan., 2015 to 2019). Following agencies are the collaborators of the
community services in the region including hospitals, schools, family and child service
centres, law enforcement officers, social service directors, child care providers and skilled
nursing and home health providers. Community services play a role in identifying health
issues and planning strategies in order to reduce its prevalence and promote better health.
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Most of the health issues in the City of Horizon are mainly focused on the children and
elderly patients making these two groups highly vulnerable to health conditions.
Health Issue
Health issue 1
Chronic diseases ex. Diabetes, asthma, cardiovascular diseases and obesity
The social and physical health determinants are the factor that is responsible for influencing
the health and wellbeing of the individual. There are several chronic health issues that are
prevalent in this region and the correlation of the incidence rate to the presence of health
determinants as discussed in Part A can be clearly seen. Overweight and obesity is one of the
leading factors for the development of chronic disease like diabetes, cardiovascular issues
and hypertension Hruby et al., 2016). The prevalence of obesity in Horizon has increased
from 17% to 25%. The dietary habits and rapid lifestyle of the region have contributed to this
increase. The factors such as increased consumption of sugary food items, unhealthy diet,
inactive lifestyle and sleep deprivation have led to weight gain. According to the Texas
nutrition, physical activity and dietary guidelines the food habits of the individual in the
region are highly responsible for the obesity prevalence as well as socioeconomic levels were
also considered a factor responsible for the increasing obesity as it is seen that 41.7% of the
individual below $25000 annual income rate are obese in the region (Hruby et al., 2016).
The prevalence of cardiovascular diseases is directly linked to the increase in obesity.
Unhealthy alcohol and drug use are also one of the factors associated with increased levels of
cardiovascular conditions. It is estimated that around 38 million people overall in the US
every year are exposed to drug and alcohol abuse that leads them to cardiovascular diseases
and mental illness (Horizon public health, community health improvement plan., 2015 to
2019). Smoking and exposure to second-hand smoke and EST are also considered to be the
factor increasing the prevalence of cardiovascular diseases (Davis et al., 2014). Stress is
considered as another important factor that causes an increase in the prevalence of
hypertension and that causes the development of CVD (Horizon public health, community
health improvement plan., 2015 to 2019). Socioeconomic status, housing and social support
are some of the determinants that are held responsible for the development of stress that
indirectly leads to an increase in the prevalence of such chronic diseases. According to
Steptoe and Kivimäki (2012), there is always a physiological reaction to psychological stress
in the form of hypothalamic-pituitary axes that links to the development of cardiovascular
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diseases. The data through various studies indicate that chronic stress enhances the risk of
coronary artery diseases. Income levels, employment status, work-related stress, family issues
and social isolation are some of the factors that lead to psychological stress that triggers the
cardiovascular disease pathway. The study also shows how the stress associated heart issues
named as stress cardiomyopathy is also prevalent (Horizon public health, community health
improvement plan., 2015 to 2019).
Other than obesity and CVD another common chronic health issues are diabetes that is
prevalent in the country and the chosen region specifically. According to the Horizon Health
and wellbeing strategy, the major cause of the increased prevalence of diabetes in the region
is excessive use of smoking and alcohol and lack of physical activity (Horizon public health,
community health improvement plan., 2015 to 2019). Type 2 diabetes is usually associated
with the dietary and lifestyle modifications involving the consumption of unhealthy diet and
increased inactivity in life that leads to insulin deficiency or resistance in the body. The
lifestyle and culture in the region are associated with the development of chronic diseases as
the most of the communities in the region are Hispanic, their culture supports the
involvement of highly American diet that makes them more at risk of development of chronic
diseases. The diabetes prevalence in this ethnic group is one and half times more than other
groups and one of the factors is their dietary habits (Schneiderman et al., 2014).
Role of the Registered Nurse in Health Promotion
Role of a nursing individual in promotion of health and wellbeing in the region is crucial and
it can be explained in various ways. The nurses are provided with adequate information,
education and training to be able to target the at-risk population and promote health for
specific disease prevention. According to the Ottawa Charter, health promotion is the process
of enabling the population to enhance the control over their own health and improve their
wellbeing. Health is viewed as the resource for everyday life and not only the objective of
living (Ottawa Charter of Health Promotion, WHO., 1986). The charter described three key
strategies that should be adopted for health promotion that includes enablement, advocacy
and mediation. The role of a registered nurse in health promotion includes following these
three strategies to prevent diseases. The health promotion aims at achieving equity and
reducing the inequalities in health. The role of a registered nurse can be to provide equal care
and opportunities to every individual irrespective of the discrimination and inequalities
present. This will fulfil the concept of enabling the individual to attain equal and complete
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health. It is stated that people will not be able to attain health if they are not able to control
the determinants that influence health. As per promoting the prevention of chronic diseases
the registered nurse's role should be to provide care to the individual by promoting health
campaigns and sessions with the high-risk population. Enabling the population to identify the
health issue and making them aware of the consequences of the issues (Ottawa Charter of
Health Promotion, WHO., 1986). This will help them to enable the population to adopt new
strategies and reduce the prevalence of such chronic disease by self-management and care.
According to NMBA (Nursing and Midwifery Board of Australia), the RN standards of
practice includes the seven codes that are to be followed and the health promotion through
enabling the individual for health promotion is incorporated in these codes (Registered
Nursing Standards, NMBA., 2016).
Advocacy is defined as the promotion of the factors of health that are physical, social,
political, economic and behavioural health determinants (Ottawa Charter of Health
Promotion, WHO., 1986). Good health is responsible for the enhanced quality of life and the
role of a registered nurse for promoting these factors helps in reducing the prevalence of
chronic diseases. As per the Code of nursing practice and domains the person and cultural
centred practice is to be ensured by a registered nurse in Australia and promote health and
wellbeing under domain 7 of the codes (Kulbok et al., 2012).
Mediation is the process of coordination among different sectors and health and social care
are not only responsible for the promotion of health (Ottawa Charter of Health Promotion,
WHO., 1986). This strategy helps the registered nurses to take support from the agencies and
departments such as education, law, government, social care, community services etc. to be
able to promote health and reach the individuals. The collaboration of media and government
with the registered nurses is crucial in order to promote the campaigns against disease
prevention and aspects like smoking and alcohol cessation. Hence it is evident that the
strategies for health promotion as described can be appropriately used by registered nurses
under the codes of nursing practice to establish a better rapport with the patient and promote
the health for the target population.
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Conclusion
Health determinants play a major role in the health and wellbeing of an individual and are to
be considered while planning the care for the individual. As per the assessment of the city of
Horizon, it was evident that the overall income status and poverty ratio off the region
influences the health of the population, the dietary habits and prevalence of smoking and
alcohol in the region are also considered as major ailments for deterioration of health. The
chronic disease is more prevalent in the ethnic group of the Horizon communities due to their
genetic predisposition and the lifestyle modulations. Also, the report successfully described
the role of the registered nurse in health promotion by following the key strategies of
enablement, advocacy and mediation. It can be concluded that this report is beneficial in
imparting a range of information regarding the current health status of the region as well as
the economic, social and other health determinants in the city working along to influence the
health of the population.
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Reference List (presented in accordance with 2018 UniSA Harvard Style guidelines)
Davis, S.K., Gebreab, S., Quarells, R. and Gibbons, G.H., 2014. Social determinants of
cardiovascular health among black and white women residing in Stroke Belt and Buckle
regions of the South. Ethnicity & disease, 24(2), p.133.
Horizon public health, community health improvement plan., 2015 to 2019. Approved by
Horizon Community Health Board. Retrieved from
(https://www.health.state.mn.us/communities/practice/assessplan/lph/2014cycle/docs/
horizon_chip_rsz.pdf) last accessed on 09/05/2019.
Hruby, A., Manson, J.E., Qi, L., Malik, V.S., Rimm, E.B., Sun, Q., Willett, W.C. and Hu,
F.B., 2016. Determinants and consequences of obesity. American journal of public
health, 106(9), pp.1656-1662.
Kulbok, P.A., Thatcher, E., Park, E. and Meszaros, P.S., 2012. Evolving public health
nursing roles: focus on community participatory health promotion and prevention. Online
Journal of Issues in Nursing, 17(2), p.1.
Nursing and Midwifery Board of Australia, Registered Nursing Standards., 2016. Retrieved
from (https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/
Professional-standards/registered-nurse-standards-for-practice.aspx) last accessed on
10/05/2019.
Ottawa Charter of Health Promotion., (WHO)., 1986. Retrieved from
(https://www.betterhealth.vic.gov.au/health/ServicesAndSupport/ottawa-charter-for-health-
promotion?viewAsPdf=true) last accessed on 10/05/2019.
Scanlon, A., Cashin, A., Bryce, J., Kelly, J.G. and Buckely, T., 2016. The complexities of
defining nurse practitioner scope of practice in the Australian context. Collegian, 23(1),
pp.129-142.
Schneiderman, N., Llabre, M., Cowie, C.C., Barnhart, J., Carnethon, M., Gallo, L.C.,
Giachello, A.L., Heiss, G., Kaplan, R.C., LaVange, L.M. and Teng, Y., 2014. Prevalence of
diabetes among Hispanics/Latinos from diverse backgrounds: the Hispanic community health
study/study of Latinos (HCHS/SOL). Diabetes care, 37(8), pp.2233-2239.
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Steptoe, A. and Kivimäki, M., 2012. Stress and cardiovascular disease. Nature Reviews
Cardiology, 9(6), p.360.
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