Health Promotion and Disease Prevention: Homeless Population Analysis

This report, submitted by a student and available on Desklib, provides a comprehensive overview of health promotion and disease prevention, with a specific focus on the homeless population. The report begins by defining health and exploring various health concepts, including the ecological model and historical perspectives. It then delves into the levels of prevention, including primary, secondary, and tertiary prevention, and the role of nurse practitioners in health promotion. The second section examines vulnerability, its types, and related theories, emphasizing the importance of cultural competency and resilience in healthcare professionals. The third section focuses on homelessness as a vulnerable population, analyzing the social justice issues and other problems associated with it, including factors contributing to homelessness and its impact on physical and mental health. The report discusses the definition of homelessness, the prevalence rates, and the primary causes. The report also touches on social justice perspectives and the need to address the material needs of the homeless population. The paper also discusses the role of advocacy and the need to address the social justice aspects of homelessness.

Running head: HEALTH PROMOTION
Population Specific Health Promotion and Disease
Name of the Student
Name of the University
Author Note

HEALTH PROMOTION
Section 1
According to the World Health Organization, the mere absence of infirmity or
diseases does not define health, and it is referred by the complete social, mental and physical
well-being (Brook, 2017). Health can be considered as a useful resource to live life fully,
with greater ability to recover from illnesses and diseases. It is a fundamental human right
and forms the basis of health care (Pleasant et al., 2016). The ecological models of health
behaviour emphasize on the policy and environmental contexts with the integration of
psychological and social influences affecting behavior. Such a model is critical in the
development of interventions as it considers multiple levels of influences affecting the
behavior. These multiple levels include intrapersonal, interpersonal, environmental, physical,
policy, community and organizational influences. The effect of such multiple factors
influencing health behavior is the core of the ecological framework, which helps to develop
intervention approaches that are comprehensive and systematic to ensure changes in each
targeted level of influence.
The roots of health promotion and education can be found in the Greek antiquity;
however, notable differences in the concepts of health were made only in the last three to four
decades. The ancient perspective of health was concerned with the equilibrium of four bodily
fluids, which were black bile, yellow bile, phlegm and blood. The perfect balance and
harmony of these elements were considered to be determinant for health. Overturning of such
equilibrium results in the pathogenic process. Thus, it can be stated that the historical
perspective regarded health as equilibrium and illness as the upset of such equilibrium.
As different community members such as ecologists, health administrators, social
scientists or biomedical scientists have a different perception of health, there is a rise in the
confusion regarding the actual concept of health. The four key concepts of health include
biomedical concept, holistic concept, psychosocial concept and ecological concept (Svalastog
et al., 2017). The biomedical concept holds the root consideration of the definition of health,
which was the complete absence of disease or illness from an individual as criteria to mark
them healthy. This concept is evident to support the historical perspective of health, which
was ‘absence of disease’. However, with the development of social and medical sciences, the
biomedical concept of health was marked as ‘inadequate’. The ecological concept of health as
viewed by the ecologists represents health as the existence of a dynamic equilibrium between
people and their environment, in addition to the disease marked as mal-adjustment of the
humans to the environment (Mallee, 2017).

HEALTH PROMOTION
The advancement in social sciences leads to the addition of social aspects in the
definition of health, marking the impact of political, economic, cultural, psychological and
social factors influencing the health of an individual. This is known as the psychological
concept of health and helps in the development of the final concept, that is, a holistic concept
of health. The holistic concept of health recognizes the collective synthesis of all the other
three concepts to present multidimensional well-being to mark the health of an individual,
and it is also concerned with the protection and promotion of health.
An important national objective to improve the health of all the American population
is the initiative of Healthy People. Thus initiative has primary objectives of empowering
American population to make informed health decisions, measuring the effect of preventive
activities and encouraging collaborations across different sectors and communities to improve
the overall health status of the country. Healthy People 2020, is a 10-year agenda of the
American government aiming at increasing public awareness, improve understanding of
disability, disease, and determinants of health among people, offer measurable health goals at
different governmental levels and identify the health improvement priorities in the nation (US
Department of Health and Human Services, 2020).
Prevention of disease is a critical aspect of health promotion and can be categorized
under three subcategories; primary prevention, secondary prevention and tertiary prevention.
The goal of primary prevention is to take immediate measure to prevent the onset of injuries
caused by disease, prior to the beginning of the process of the disease cycle. Prochaska and
DiClemente developed a theoretical model of behaviour change that focused on the decision
making of an individual. This model can be critically integrated with the primary level of
disease prevention, due to the fact that it encourages the individuals to bring intentional
changes, which can critically prevent the onset of disease and fulfill the purpose of health
promotion. In secondary prevention, the undertaken measures prevent the deterioration of
health due to complications posed by disease by early diagnosis and prompt treatment of it. In
tertiary prevention, rehabilitation of the person posts, the incidence of significant illness is
kept in focus. In all the three levels of prevention of disease, health education plays a major
role.
The nurse practitioners can play a proactive role in disease prevention and health
promotion as they are increasingly enhancing their proportion of workforce and service
provisions in primary care, which was usually dominated by primary care physicians.
Advanced Practice Registered Nurses contribute majorly to the nursing workforce, and as
they are usually the first point of contact with the patient, they have a significant role in

HEALTH PROMOTION
educating them to prevent disease and promote health in them. For service delivery in
preventive care, history has majorly relied on primary care physicians. However, over 90 per
cent of the nursing practitioners are prepared for the provision of primary care and are able to
manage around 80 per cent of the care that is provided by the physicians. Advanced
Registered Nurse Practitioners can play a crucial role in educating and empowering
individuals to ensure lifestyle changes and make better health choices to increase the
prevention efficiency of chronic diseases. It is evident that individual clinical environments,
worksite health centers and college campuses provide an adequate environment for the
nursing practitioners to perform their health promotion and disease prevention activities.
Section 2
The greatest focus on disease prevention and health promotion should be concerned
with the welfare of vulnerable populations. Vulnerability as a concept can be defined as the
adverse reaction of a system to the occurrence of a hazardous event. The system’s ability to
handle the event is highly affected by the risk factors associated with vulnerability, including
economic, social and physical aspects. The concept of vulnerability, determined by the health
of a population, can be defined as diminished capacity of a group of individuals to access
health care resources adequately. The four types of vulnerability as recognized today are an
attitudinal, economic, social and physical vulnerability. Few of the theories of vulnerability
include societal and personal factors. A theory by Flaskerud and Winslow recognizes
vulnerability as social groups with a high risk of susceptibility to negative health outcomes
(Havrilla, 2017). Lessick, Woodring, Naber, and Halstead developed a vulnerability model
concerned with neonatal and perinatal nursing (Havrilla, 2017). Theory of vulnerability by
Aday is concerned with relative risk and is further explained by the Vulnerable Population
models that add up health status and resource availability in addition to relative risk to define
vulnerability (Havrilla, 2017).
According to Braveman, health disparities are potentially avoidable, systematic and
socially determined influences on health between the groups of individual, among which, one
group is more susceptible to lack of health care resources and is determined to be vulnerable
(Sklar, 2018). Cultural competency in healthcare professionals is deemed to be a necessity as
it helps them to understand and effectively interact with the vulnerable population to address
their health needs.
The development of Cultural and Linguistic Competence Health Practitioner
Association (CLCHPA) critically aims at enhancing the care delivery for the diversified

HEALTH PROMOTION
client population. This requires the integration of cultural and linguistic competence
approaches to ensure the highest standards of care delivery by the working professionals to
the targeted client population and remove the incidence of health disparities among them. To
improve the personal scores regarding cultural competency, I need to improve my linguistic
abilities which will critically help in engaging with clients from the diversified cultural and
linguistic background.
In addition to cultural competency, one of the vital quality that nursing professionals
need to ensure is building resilience. According to psychologists, resilience can be defined as
the ability to efficiently adapt to situations of significant stress, threats, tragedy, trauma and
adversity. Resilience is the marked capability of an individual to recover back from stressing
situations, and it critically ensures involvement of profound personal growth. Nursing
professionals face several such stressing situations in their workplace condition, and it is
important that they possess the resilience to overcome their stressing situation and perform
their duties competently.
In addition to cultural competency and resilience, the health care providers should
fulfill their role of advocacy to protect the health care rights of the vulnerable groups and
maintain high standards of care delivery to them (Kohlbry, 2016). Advocacy in nursing
requires the nursing and other healthcare professionals to plead for the right of the nurses and
defend them (Martin & Zolnierek, 2020). The advocacy role of healthcare providers will
include actions such as patient education, helping the patient to get access to resources,
protecting the patient’s right, ensuring safety, and giving the needy client a voice.
Susceptibility to harm is a critical indicator of vulnerability, which is applicable to
human populations too. The complex interaction of degraded environments, interpersonal
supports and networks, disadvantaged social status, personal incapacities and developmental
problems leads to the issue of vulnerability (Larkin, Aykanian & Streeter, 2019). Social
values can be determined by analyzing any form of neglect or priority given to such
vulnerabilities. The behavior received by such vulnerabilities depends on public views, which
can be categorized into either sinner or victims. Social policies and political salience affect
the theme of such public perception. It is observed that governments provide greater
assistance to the vulnerable population who cannot be deemed responsible for their
vulnerability. The public perception of sinner becomes common when the vulnerabilities are
responsible for the life circumstances they are currently living in, such as ex-offenders,
unwed mothers and substance abusers, and such population receive less public compassion
but greater stigma.

HEALTH PROMOTION
Section 3
The paper is focussed on discussing homelessness as vulnerability and critically
analyses the social justice and other problems associated with the population. As defined by
the National Health Care for Homeless Council, homelessness is the absence of permanent
housing facility available to people, who may start living in other non-permanent situation
such as abandoned buildings, vehicles, in room-occupancy facility, mission, shelter or in the
streets. A United States of America point-in-time count of the year 2018 found out that over
553,000 people were facing the issue of homelessness, which shows a significant increase of
2902, people from the total count in 2017. However, the actual number might be much higher
than shown in the official records. The American states that are at the highest rates of
homelessness are Washington, Texas, New York and California. The male population is
regarded to be at more risk of homelessness as the count of 332,925 homeless men is
significantly higher than the count of homeless women, which is around 216,211 people. The
primary factors determining the cause of homelessness are unemployment, inadequate
income, poverty, education, low-paying jobs, lack of affordable housing, and mental health
problems.
Homelessness can be critically marked as a social justice issues because it correlates
to other major problems such as family breakdown, domestic violence, & poverty, all of
which can lead to unemployment and breakdown of physical health along with mental health
problems that can go critical. According to Watson and Cuervo (2017), subjectivities such as
stigma and social exclusion needs to be overlooked for a while to shift the focus on more
materialistic needs of the vulnerable population. The authors regard this as the standpoint for
the social justice approach that needs to address the issues of homelessness. The policies and
practices concerned with overcoming of homelessness require to be more focussed and
emphasized on the autonomy, self-respect and empowerment of the homeless community.
According to the Learning and Work Institute (2014), half of the homeless
community lack the ability to read and write. The report generated post the survey of
Reading Counts: Why English and maths skills matter in tackling homelessness, suggests that
around 51 per cent of the homeless community would not achieve the basic grades and will
struggle in their daily life due to lack of basic literacy skills. This result also indicates poor
health outcome of the homeless people, as they face the difficulty in accessing health care
resources and services due to their lack of basic literacy skills. Proper identification of

HEALTH PROMOTION
literacy skills of the vulnerable population is vital for addressing the needs of homeless
people.
Adaptation of nursing theories is vital in providing adequate nursing care to the
vulnerable population and help them fulfil their health needs. The model which is deemed to
be most suitable is Leininger’s Theory of Culture Care. This nursing theory is concerned with
the cultural dimensions of human care. The theory associates the definition of culture as
learned, transmitted and shared lifeways, norms, beliefs and values that a particular group
thinks (De Chesnay & Anderson, 2019). The homeless people have a similar way of living,
and a greater understanding of their lifestyle will help the nurses to ensure higher standards of
health care delivery.
A mid-range theory that most suitable to address the homeless as a concept of
vulnerability are the Watson’s Theory of Human Care. This theory is focussed on addressing
the care, health needs and illness of the target population to create a healing environment for
them with the elements of humanistic approach, sensitivity to others, faith, establishing
human care relationship, transpersonal teaching-learning, human needs assistance and
creation of a problem-solving care process (De Chesnay & Anderson, 2019).
The Healthy People 2020 initiative highlights housing instability and homelessness as
a major challenge. The initiative helps to provide financial assistance to low-income people
to get a night-time shelter and pay rent. According to the Healthypeople.gov. (2020), the
federal government is providing housing subsidies to the homeless community. However,
several issues hinder this noble cause, which includes limited funding and a large number of
the homeless population, further increasing their time on waitlists to receive federal aids and
funding. Healthy People 2020 acknowledged the need to reduce housing instability and
reduce the count of homeless people, which has been significantly increasing every passing
year.
It is evident that homeless people have less access to healthcare, which indicates a
potentially greater risk of adverse health outcomes in this vulnerable population. The three
primary health concerns for the homeless people are mental health problems, a greater risk to
substance abuse and malnutrition (Flatau et al., 2019). To understand several other health and
other needs of the homeless people, coordinate assessment using survey tools is required.
This may include a face-to-face interview with survey officers where the homeless people get
to voice their concerns to the authorities.
In-depth understanding of the mental health problems of the homeless people
indicates that it poses a high risk to the overall health outcome and safety of this vulnerable

HEALTH PROMOTION
population. Recognition of special health care need is an integral part of promoting health
safety in the vulnerable population. The health promotion activity that needs to be developed
to undertake mental health service provision of the homeless people should focus on the
distrust and disaffiliation issues that affect the mental health condition of the homeless
people. The health promotional activities will ensure greater coordination and communication
between the multidisciplinary team, targeted approach and use of external and internal
resources to ease the access to mental health services for the homeless people.
Case Study
Abraham is a 21-year-old Caucasian male who has run-away from his family and is
currently taking shelter under a bridge to pass the night time. Abraham has been excluded
from his school and facing emotional abuse from his step-father; he has taken the decision to
leave home and live alone. He has been doing substance abuse for three months now and
begs in the street to get daily food and substance for abuse. He is currently associated with no
one, even on the streets and seems to be in a critical mental health state. John is a psychiatrist
living down the street who sees Abraham every day while going to the office and takes a few
minutes off to talk to him.
Analysing the above case study, it can be determined that Abraham, a homeless youth
requires support from a youth community service. To address the deteriorating mental health
condition, Abraham requires mental health assessment and necessary interventions by a
psychiatrist. In addition to this, emotional support from the step-father of the person could be
crucial in restoring the health of the youth and changing his status of being homeless.
To develop a health promotion plan, proper analysis of the situation followed by the
development of goals and objectives is required. The goals are to restore the homeless status
of the youth and his mental health condition. Other procedures which will be critical in
helping to develop a care plan for the vulnerable youth will be an assessment of his resources,
fixing priorities, a written up formulated plan, implementation of interventions, monitoring
and proper evaluation of the final outcomes of the plan. The youth will be assessed for a
mental health condition, and his father will be contacted for follow-up in the situation.
The primary prevention strategy in case of this particular youth will be to refrain the
practice of youth’s exclusion from studies. The secondary prevention plan will take care of
the deteriorating mental health condition of the youth and the tertiary prevention care plan
will ensure follow-up with the family members to ensure a hospitable environment for the
youth.

HEALTH PROMOTION
Homeless people, spread across the American nation, are at greater risk of getting
affected by mental illness, which subsequently increases the health risk, leading to increased
morbidity and mortality. A Community Based Participatory Research (CBPR) is a
partnership approach consisting of members from multidisciplinary, including community
members, researchers, organization s representatives, health care representatives and others.
To establish social change, such as reducing the count of homeless people, Community Based
Participatory Research (CBPR) project could be very vital and efficiently remove health
disparities to improve health outcomes. However, few of the associated cons with such kind
of research would be a requirement of huge funding and opportunity for capacity building, as
the total count of homeless people is immense (Collins et al., 2018).
While participating in research, it is important that vulnerable populations are
protected and greeted with dignity. Such protections should importantly include provisions of
financial assistance and other aids such as free inclusion in other relevant programs.
Conclusion
Health promotion and prevention are critical strategies to ensure standard overall
health outcome of a population. Prevention strategies sub-categorised into primary, secondary
and tertiary prevention are vital in developing care plans for a vulnerable population. The
definition of vulnerability is highly subjective; however, lack of basic resources can be
deemed as a factor increasing vulnerability. One of the most vulnerable population is the
homeless community. Homelessness can be defined as the lack of night shelter resource
availability for a person, and such population is at great risk of attaining associated health
risks and poor health outcome. The Healthy People 2020 initiative acknowledges the
homelessness as vulnerability and ensures financial aids from the federal government to
support the homeless people with low-income, to help them pay their rents. Mental health
service providers can offer vital assistance in supporting the homeless people, as they are at
increased risk of deteriorating mental health condition.
The nursing professionals have a critical role to play in identifying the health needs of
the homeless community and ensuring interventions that increase their ease of access to
health care services. Moreover, the APRNs can help this vulnerable population by playing the
role of advocacy to protect their rights to health care and help the individuals voice their
opinion.

HEALTH PROMOTION
In addition to the provision of financial aid for homeless people with low income, the
Healthy People 2030 initiative should include greater provisions of mental health campaigns
designed specifically for the homeless people, to support their emotional and mental needs.

HEALTH PROMOTION
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