Population Health: Influencing Factors & Disparities

• Population health focuses on health outcomes within a group of individuals, including the distribution of those outcomes.

Factors Influencing Health

• Healthy behaviors/habits have the greatest impact, yet healthcare spending is disproportionately allocated to medical services rather than promoting these behaviors.
• Medical services account for 88% of US healthcare spending, while only 4% goes towards healthy behaviors, and 8% towards other areas.

Upstream Thinking

• Focuses on interventions promoting health and preventing illness, rather than treating illness after it occurs.
• Involves examining the root causes of poor health to address the source of the issue.
• Upstream thinking can educate patients, providing them with knowledge for prevention.
• Examples include encouraging healthier fast-food options, increasing tobacco prices, health screenings, health fairs, and smoking cessation classes.

Health Disparities

• Differences in health outcomes among different groups, reflecting inequalities and unequal treatment in healthcare.
• Ethnic minorities, the elderly, those in poverty, the uninsured, children, and those with a lack of education tend to experience health disparities.

Healthy People 2030

• Aims to improve the health of all Americans with science-based, 10-year national objectives.

Leading Health Indicators

• A smaller set of Healthy People 2030 objectives highlight high-priority health issues and actions for addressing them.
• Progress on these indicators is influenced by biological, social, economic, and environmental factors.

Overarching Goals of Healthy People 2030

• Attain healthy lives free of preventable disease, disability, injury, and premature death.
• Eliminate health disparities, achieve health equity and health literacy.
• Create social, physical, and economic environments promoting health and well-being.
• Promote healthy development and behaviors across all life stages.
• Engage leaders and the public to design policies improving health and well-being.

Social Determinants of Health

• Include neighborhood and built environment, health and healthcare access, social and community context, education, and economic stability.

Defining Health

• A state of physical, mental, spiritual, and social functioning that realizes a person's potential within a developmental context.

Health Belief Model

• Explains why some individuals take preventive actions while others do not.
• Individuals are more likely to make behavior changes when they have a greater investment in their health, and perceive the risks as outweighing the benefits.

Patient Perceptions

• These are important for willingness to take action: perceived susceptibility, perceived severity, risk factors, perceived benefits, perceived barriers, cues to action, and self-efficacy.

Transtheoretical Model of Change

• Determines a patient's readiness to change, with stages including pre-contemplation, contemplation, preparation, action, maintenance, and termination.

Self-Efficacy

• Belief in one's ability to complete a task or meet a challenge.
• Behavioral change is more likely when perceived benefits exceed perceived barriers.

Health Coaching

• Involves partnering with clients to inspire them to maximize their potential through a thought-provoking and creative process.

Risk Assessment

• Absolute risk is an individual's risk of developing a disease over time.
• Relative risk compares the risk between two groups, one with a risk factor and one without.
• Modifiable risk factors include tobacco use, harmful alcohol use, unhealthy diet, and poor oral hygiene.
• Non-modifiable risk factors include age, gender, family history, and ethnic background.

Stress Management & Physical Activity

• Stress management is an effective intervention for health promotion, disease prevention, and symptom management.
• Physical activity serves both health promotion and disease prevention purposes.

Impact of Physical Activity

• Decreases the risk of death from heart disease, cancer, diabetes, hypertension, depression, and anxiety.
• Promotes healthy weight, better sleep, improves mood, and maintains cognitive function in the elderly.

Exercise Recommendations

• Stretching, walking, Pilates, cycling, hand strengthening, and water exercises are good for arthritis.
• Walking, hiking, jogging, aerobics, and weight-bearing exercises are good for osteoporosis.
• Aerobic exercise, walking/running, lifting weights, yoga, and bouncing on a trampoline are good for depression.

Target Heart Rate Calculation

• Maximum heart rate (MHR) for exercise is estimated by subtracting age from 220.
• Moderate exercise MHR is calculated as MHR x 0.64 to MHR x 0.76.
• The lower range for moderate activity and the upper range for vigorous activity is MHR x 0.77 to MHR x 0.93.

Sleep Importance

• It is an essential component of chronic disease prevention and health promotion.

Clinical Model of Health

• Individuals may delay seeing a doctor until they are ill and may not seek preventive services.

Wellness-Illness Continuum

• Wellness is on one side, illness is on the other. Prevention moves towards wellness, medicine moves towards illness.

SMART Goals

• Specific, Measurable, Attainable, Realistic, and Timely goals.

Exercise Guidelines

• Adults should engage in 150 minutes of moderate exercise per week, or 75 minutes of vigorous aerobic activity per week.

Effects on Physical Activity on Aging & Conditions

• Regular physical activity improves bone health, fitness, cardiovascular and metabolic health, and body composition.
• It lowers the risk for conditions including heart disease, stroke, hypertension, type 2 diabetes, metabolic syndrome, cancers, weight gain, and depression.
• Reduces risk for falls and improves cognitive function.

Care Coordination

• Deliberate organization of patient care activities between multiple participants to facilitate appropriate healthcare delivery.

Social, Medical & Integrated Models of Care

• Social Model: Manages home and community-based services, supporting daily living, not skilled health care.
• Medical Model: Coordinates medical services, provider-driven.
• Integrated Model: Combines social and medical models to support holistic, patient-centered and family-focused care.

Key Attributes of Care Coordination

• Interprofessional team, proactive care plan, targeted activities, proactive follow-up, and communication.

Therapeutic Relationship Characteristics

• Purposeful communication, rapport and trust, empathy, and goal-directed, patient-centered approach.

Therapeutic Communication Techniques

• Using silence, accepting, giving recognition, offering self, giving broad openings, active listening, seeking clarification, and placing events in time or sequence.

Factors in Effective Communication

• Listening, flexibility, silence, humor, touch, and space.

Barriers to Effective Communication

• Asking irrelevant personal questions, offering personal opinions, giving advice or false reassurance, minimizing feelings, changing the topic, asking "why" questions, offering value judgments, excessive questioning, and responding approvingly or disapprovingly.

SBAR/ISBARR Communication Tool

• Introduction, Situation, Background, Assessment, Request, Recommendation.

Advocacy

• Speaking for others to help them meet their needs and is an expectation for all nurses.

Health Literacy Definition

• The degree to which individuals can obtain, process, and understand basic health information and services for appropriate health decisions.
• Patient education material should be at a 6th-grade reading level.

Negative Impacts of Low Literacy

• Poorer employment opportunities, outcomes, lower income and poor health.

Indicators of Low Health Literacy

• Excuses ("I forgot my glasses"), folded papers, lack of follow-through, infrequent questions, basic questions, and difficulty explaining medical concerns.

Macronutrients & Micronutrients

• Macronutrients: Chemical substances needed in large amounts (carbs, fats, proteins).
• Micronutrients: Vitamins and minerals needed in small amounts.

Basal Metabolic Rate (BMR)

• Energy needed to maintain life-sustaining activities at rest.

BMI Calculation

• Weight in pounds divided by Height squared x 703

BMI Percentiles

• Underweight: less than 18.5
• Healthy weight: 18.5-24.9
• Overweight: 25.0-29.9
• Obese: 30.0 or greater

Childhood Obesity

• Intensive behavioral programs and policy/curriculum changes are used to promote healthy eating and physical activity.

Dietary Guidelines

• Consume a healthy eating pattern including varied vegetables, whole fruits, grains, low-fat dairy, and protein.
• Limit added sugars, saturated fats, and sodium. Consume alcohol in moderation.

Calories per Gram

• Carbohydrates: 4 calories per gram
• Proteins: 4 calories per gram
• Fats: 9 calories per gram

Calculating Calories

• Multiply grams of each macronutrient by its corresponding calorie number (4, 4, or 9). To find the percentage, divide the calories per gram by the total calories on the label.

Daily Water Intake

• Women: 72 ounces
• Men: 104 ounces

Food Safety Guidelines

• Hand washing, preventing cross-contamination, proper food storage, serving foods at safe temperatures, chilling and defrosting properly, and avoiding raw milk and undercooked meat/eggs.

Cardiovascular Disease (CVD) Prevention Diet

• Balanced diet emphasizing fresh fruits, vegetables, and whole grains.
• Limit red and processed meat, eat fish 2x/week, limit saturated fats and avoid trans fats, choose low-fat dairy, limit sodium, and limit sugary beverages.

Cancer Prevention Diet

• Focus on plant-based foods: 2.5 cups of fruits/vegetables daily and whole grains.
• Limit salty foods and sugary drinks. Choose fish, poultry, and beans over red meat, and limit alcohol.

Osteoporosis Prevention Diet

• Maximize bone density through calcium intake in childhood.
• Avoid smoking, get adequate calcium and vitamin D (dairy, eggs, cereals), and consider calcium supplementation if needed.

Hypertension Diet

• DASH diet: 4-5 servings of fruit and vegetables daily, and 2-3 servings of low-fat dairy daily
• Consume lean meats, nuts, seeds, dried beans, and high-fiber grains.

Portion Size Visuals

• Fruits and vegetables = woman's fist or baseball size
• Meat = palm of hand or deck of cards
• Cheese = thumb size or pair of dice

SNAP (Supplemental Nutrition Assistance Program)

• Provides monthly allotments to help low-income families buy nutritious food.

WIC (Supplemental Nutrition Program for Women, Infants, and Children)

• Provides supplemental foods and nutrition education to low-income pregnant/postpartum women and at-risk children.

Explore population health, emphasizing factors influencing health outcomes. It highlights the importance of healthy behaviors versus medical services and introduces upstream thinking for preventative care. Understanding and addressing health disparities among different groups are crucial for improving overall population health.