Community health nursing principles and practice

Community Health Nursing

The health disparities in the United States are shocking. There are disparities evident in nearly every factor associated with healthcare such as cost, quality, access, and equity. As a result, a new wave of research has begun using geocoded data to try to identify the sources of these disparities among factors such as poverty, racial, and geographic information (Krieger, Chen, Rehkopf, & Subramanian, 2004). Poverty is closely correlated with negative health outcomes in many areas and ethnic backgrounds can also serve as a good predictor of outcomes.

The problem however isn't necessarily just one of individual outcomes. The average cost of health care in the United States is estimated to be over eight thousand dollars per person and on the aggregate accounts for nearly eighteen percent of the total U.S. gross domestic product (Kane, 2012). The expenses in health care really make this a national emergency. The United States spends roughly two and a half times the OECD average on health care and with substantially lower outcomes.

The World Health Report 2000, Health Systems: Improving Performance, ranked the U.S. health care system 37th in the world1 -- a result that has been discussed frequently during the current debate on U.S. health care reform (Murray, 2010). Not everyone agrees with the conceptual framework that underlies such studies but it is difficult to ignore facts such as the U.S. was rated thirty-ninth in infant mortality; a measure that is commonly used as a proxy for the well-being of many populations. The high costs of patient care as well as numerous people without health insurance likely underpin such measures.

The U.S. health care dilemma is subject to public policy. However, one of the problems with building support for any reforms of the health care has been that there has not been a significant amount of cultural competence developed within the American population with respect to the problem. Others have suggested that the key is to maintain an awareness of the lack of one's cultural competence to address disparities in health care. There is no easy answer how to address these disparities and it is likely that different groups will respond to different approaches better than others.