Key Health Determinants

Anne Burgos 

RE: Discussion – Week 4

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Nsg 6050-Week 4 Discussion

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Key Health Determinants

There are many factors that play a part in determining the health outcomes of a population. Some key determinants include access to health care, individual behavior, social environment, physical environment, and genetics. When looking at specific health issues, these determinants should be considered during the development of policy in order to improve patient/population health outcomes. One particular population health issue that has been proven to be of significant concern is hypertension, as it correlates directly with one’s risk for heart disease, stroke, and other comorbidities.

According to the CDC, between 2015-2016, the incidence of hypertension was at 29% among Americans, with less than one-half of those individuals having their hypertension under control (Center for Disease Control and Prevention, 2017). Obvious disparities in prevalence and hypertension control were seen with varying age, race, and gender. Hypertension was seen in 33.2% of adults age 40-59, and 63.1% of adults over 60 years of age. The incidence among non-Hispanic black was significantly higher at 40.3%, while Non-Hispanic white and Hispanic were 27.8% and non-Hispanic Asian were 25% (CDC, 2017). Conversely, controlled hypertension was more evident with non-Hispanic white population being 50.8%, non-Hispanic black 44.6%, and non-Hispanic Asian 37.4% (Center for Disease Control and Prevention, 2017). These statistics beg to question which determinants are directly related to the disparities.

Access to health care is likely the most important determinant in population health and the number one topic area listed on the Healthy People 2020’s brochure (U.S. Department of Health and Human Services, 2010). “Access to health care impacts one’s overall physical, social, and mental health status and quality of life” (Offices of Disease Prevention and Health Promotion, 2018). Populations that do not have health insurance or access to adequate health care are less likely to be diagnosed, and definitively less likely to receive the necessary treatments or medications. By identifying barriers to health care it is possible to enact policies to make health care more accessible, through the development of policies and legislative acts such as the Affordable Care Act.  However, having access to health care alone does not account for the individual’s responsibility to seek the appropriate care.

Individual behaviors have an effect on whether a person participates in routine check-ups, whether they seek care for concerning symptoms, and if they comply with recommended medications or treatments. Just because a person has health insurance, and is entitled to an annual check-up with a primary care provider, does not mean that they will necessarily make that appointment. All too often you hear of someone coming into the emergency department in hypertensive crisis or with some other concern because they thought they were well, they didn’t have any symptoms, or they haven’t bothered to see a doctor in years because they didn’t feel it was necessary. Many health problems could be prevented, or diagnosed and treated earlier, simply by individual’s taking a more proactive approach to their health and getting annual check-ups.

Social environment and physical environments are two other determinants that are associated strongly with how and where one was raised and where they currently reside. One’s education level and career correlate directly to one’s income, housing situation and the neighborhood in which they live. Lower income families tend to have less access to routine health care and quality nutrition, leading to later diagnosis, fewer treatment options, and worse health outcomes. By creating policy and programs in these lower income areas it is possible to make large changes in population health outcomes. Drastic results were obtained by Dr. Beilenson’s work, when efforts were made to decrease the incidence of gonorrhea, chlamydia, and syphilis, in a lower income area in Baltimore City, Maryland. Through the implementation of various programs, in just one year there was an 82.4% decrease in the incidence of syphilis in Baltimore City, Maryland (Laureate Education, 2012h).

While some determinants are modifiable, such as individual behavior, others like genetics are not. Genetics is one determinant that plays a huge part in a person’s risk for certain health problems. Knowing that one population is more predisposed to a certain condition, such as hypertension among non-Hispanic blacks, can help patients and health care providers to act accordingly. Understanding the need for increased screening, diet and exercise modification and patient education within a certain population can help to shift these statistics in the right direction. 

The use of epidemiological research allows us as health care providers to hone in on specific populations at risk for health issues such as hypertension, and address the key determinants that place them at risk. These determinants can then be applied during the development of new policies and early intervention allowing for more efficient care. Understanding what factors (modifiable and non-modifiable) place a specific population at risk, and what barriers they have to health care access are the first steps in addressing population-specific health concerns.