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Community resources must be identified and brought together to meet needs. Actions can be developed to prevent poor health outcomes by: appropriately identifying, collecting, and reporting racial/ethnic group-specific data; identifying where data are lacking and developing appropriate tools to collect those data; and linking poor health status indicators to social conditions and influences, as well as personal behaviors and genetics.
As indicated by other counties, the populations experiencing these disparities have many strengths and traditions to draw upon for solutions. In the African-American communities, churches provide connections and leadership on community issues. Other models have provided the use of community engagement principles encouraged throughout any state and local processes addressing eliminating health disparities, whether funded by this initiative or not. Such community engagement principles include fostering openness and participation in the planning process, ensuring that those representing a specific community truly represent that community's values, norms, and behaviors, and using strategies that insure inclusion, representation, and equality in the planning process. For example, ensuring that those representatives who are included in the process participate in a meaningful way and share fully in the decision making process; and offering orientation and skill building opportunities so that everyone will have an equal voice in voting and other decision making activities.
Other possible shared decision making processes include developing cultural competence in the organization's staff, and communicating with and involving the community in the planning process. Other general solutions include addressing issues of unequal access to affordable, nutritious food, working to improve community environments that promote physical activity and wider mental well-being and quality of life, advocating for good quality, affordable housing and promoting education, literacy, and employment. The lessons and specific effective strategies should be shared with other communities so that successful approaches can be promoted and additional new approaches tried.
Members of communities must also be intricately involved in assessing the strengths, resources, and needs of the community, and in planning for and overseeing activities toward improved health status. Community members must become actively involved in designing and implementing strategies, as that will likely lead to more effective approaches. Relationships that lead to increased mutual knowledge, comfort, familiarity and trust must be built before launching into major new efforts. Finally, research indicates that money spent on prevention of sickness, chronic conditions, and injuries is an investment in preventing or reducing more serious and expensive health crises later.
The Use of Technology to Reduce Health Disparities
High technology medical innovation remains implicated as one of the most significant driving forces behind the high costs of health care in the United States. In addition, health care organizations are faced with an increasingly complex and uncertain environment. Research indicates that these factors interrelate to affect decisions made to acquire high cost medical technology. One recent study of hospitals in three states assessed the manner in which environmental variables affect technology acquisition decision making. The results revealed that among the important criteria are physician recruitment and retention and perceived competitive pressure. An analysis of the data reveals that technology is acquired as one means of reducing environmental uncertainty. Within a growing number of integrated health systems, collaboration acts to both control costs and reduce duplicative technology. However, research also indicates that in order for collaboration to be successful, a strong bond of trust must exist between decision makers in addition to any economic benefit derived from the union.
Decision making in health care involves two sets of related decisions, those concerning appropriate service provision on the basis of existing information and those concerned with whether to fund additional research to reduce the uncertainty relating to the decision. The model becomes the vehicle of health technology assessment, managing and directing future research effort on an iterative basis over the lifetime of the technology. This ensures consistency in decision making between service provision, research and development priorities and research methods. Research effort can then be focused on those areas where the cost of uncertainty is high and where additional research is potentially cost-effective.
Health promotion and care information systems and technology adopt different roles and characteristics, depending on multiple determinants, such as the goals pursued by the health care delivery systems. The importance of information in health services relates to its support to the aspects of management and operation: Included in the management and operation aspects is the use of technology. This technology usually sustains the day-to-day operation and management of health services and health care network, and support of diagnostic and therapeutic functions.
In health services, information systems and their associated technological infrastructure are oriented to the support of two functional levels; the logistics of healthcare; flow, registry, processing, and recovery of clinical and administrative data, and the administrative operation, accounting, financing, and human and physical resources management.
Thus, systems that utilize operational data arising from the operation of health systems and services in support of decision functions, are an extremely important element of healthcare. Different levels of care and management require distinct aggregation and display of processed data. A necessary proposal involving the use of technology to promote physical activity among African-American women would be successful. Such a technological program could entail such elements as a mandatory weight, heart rate, and fat index on a regular basis. A technological mandate such as this would provide knowledge regarding diseases such as diabetes or cardiovascular disease that the individual was not previously aware of.
Mandatory physical exercises, individualized to a particular woman's age, health history and lifestyle could be implemented, however, this would be a difficult facet to implement. Any shared decisions made involving health treatment could be monitored through a personalized plan that could be easily accessible through a home computer, library, social services, or even at a doctor's office. Such a program could use technology to increase physical activity and awareness of health risks with continuous updates on those very health issues that affect African-American women. This type of technology could be used to address health disparities, as it would increase knowledge regarding such health risks, and most importantly, increase knowledge regarding strategies to improve one's health. If properly implemented, this could assist to eliminate health disparities on a gradual, but successful, basis.
Future research studies would involve further studies on the population of African-American women, with a specific adherence to the ages 35 to 50. Before implementing any technological programs to eliminate health disparity, more than one trial study would need to be conducted n order to determine the program's effectiveness, its' user friendly capability, and should contain an exit survey to collect any opinions, suggestions and criticisms of participants. This way all necessary changes could be implemented before the initiative is actually launched. Furthermore, a study of this type may indicate the impossibility of such a program, or reveal if alternate plans exist.
Future questions to be asked of this specific population would be those that would initially access the individuals general healthcare knowledge, as knowledge may be an important factor which may become overlooked. Some difficulties with the use of technology would be that in poorer and less educated areas, technological knowledge and availability may be scarce. Any technology must be simple, easy to access and readily understandable to someone who is using this type of material for the first time. This is extremely important, as the use of technology does not need to become an intimidating factor that deters its use in this population. Finally, more research is needed in this area to truly access the situation and possibilities for success.
Future actions must encourage community outreach programs in schools, workplaces, and faith-based settings. These actions should also include a strong focus on the prevention and treatment of obesity and diabetes by emphasizing attendant risk factors, prevention, and community influences. Additionally, the availability of care for all Americans regardless of race and ethnicity, socioeconomic status, and geographical barriers must be improved.
Access to continuity in primary and secondary care in urban, suburban, and rural settings must be increased, along with economic incentives to disseminate and implement evidence-based guidelines in primary and secondary prevention.
Finally, among the varied ways to address the question of disparities in health care pertaining to African-American women, a better understanding of the cultural landscape of the United States is necessary.
Notably, significant cultural diversity exists in this country, and cultural awareness, is at the center of any effort to fully address disparities. Cultural competence has a broad definition and encompasses clarity in communication with those for whom English is not the primary language, an imperative to incorporate a more attuned healthcare delivery system for the unique needs of the population served, a necessity to combine resources to effect greater change in disparities in health care, and a need to build more trust between providers and the communities served.
Alpha.org. "Racial / Ethnic Disparities." Fact Sheets. 2004. 17 May 2005. www.apha.org/NPHW/facts/RaceEth-PHW04_Facts.pdf.
Fenwick, E. et.al. "Improving the Efficiency and Relevance of Health Technology
Assessment: The Role of Iterative Decision Analytic Modeling."…[continue]
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