The Higher Risk for Black and African American Populations for Stroke within Iowa - Research Paper Example

? The Higher Risk for Black and African American Populations for Stroke within Iowa & Number Introduction Stroke is the fourth leading cause of death in the United States (Kochanek, Kirmeyer, Martin, Strobino, Guyer 2012). The rate of stroke in Iowa increased by 30% between the year 2000 and the year 2009 (Kochanek et al, 2012), suggesting that it is a significant public health problem. Additionally, stroke can cause significant disability in those who do not suffer from a fatal stroke, increasing the cost to insurers and families in those affected. Within Iowa, a stroke is a staggering 66% more likely in African American men than in white men, and 39% higher in black females than white females (Kochanek et al, 2012). This health disparity is extremely worrying for those working within the public health sector. Evidently, public health initiatives need to target black Americans in Iowa from a number of different angles to help equalise the disparity in health outcomes. Description A stroke, also known as a cerebrovascular accident, occurs when there is some kind of fault with the blood supply to the brain; either a burst blood vessel or a clot that disrupts the supply of oxygen to this vital organ (Public Health Leadership Society, 2002). Without oxygen, the brain cannot function to its normal capacity and therefore begins to fail, most commonly by impairing movement or speech in the affected individual (Public Health Leadership Society, 2002). Having a stroke is a serious medical emergency, and can lead to permanent neurological damage (that can be of significant economic cost, as well as emotional) or death (Turnock, 2012). This highlights the importance of providing adequate services and healthcare advice to those at risk of stroke, as well as advising otherwise healthy people on how to minimize their risk. There are a number of risk factors for stroke, which may be linked to the high incidence of stroke in the African American population of Iowa. Diabetes, high cholesterol and high blood pressure are all important risk factors (Trust for America’s Health, 2009), and in turn are linked to obesity (U.S. Department of Health & Human Services, 2011). As rates of obesity are higher for those of Black and Hispanic origin in Iowa, this could be linked to the higher prevalence of stroke (U.S. Department of Health & Human Services, 2011). The use of cigarettes and tobacco products is also a major risk factor for stroke (Kochanek et al, 2012), and the use of these products is 45% higher in black people than white, and 83% higher in black individuals than in Hispanics (Kochanek et al, 2012). Again, this suggests a major reason why the rate of stroke might be higher in African American populations. Epidemiology Data In 2009, there were 1627 deaths from stroke in Iowa, which equates to around one death every five hours from this cause (Kochanek et al, 2012). More women than men typically have strokes (Kochanek et al, 2012), although men under the age of 65 are more at risk than women in the same age group (Kochanek et al, 2012). This may be due to the higher prevalence of vascular disease in men within this age group (Kochanek et al, 2012). Overall, black men have a 66% higher risk of stroke than white men, with the rate being 76/100,000 as opposed to 46/100,000 (Kochanek et al, 2012). In African American women, the rate of stroke death is 59/100,000 as opposed to 43/100,000 in white women, a 39% difference (Kochanek et al, 2012). Stroke deaths were higher in 42 Iowan counties than the national goal, and 55 counties had a rate lower than the national goal (Kochanek et al, 2012). Unsurprisingly, those counties above the national goal rate had a larger population of African Americans residing there (Kochanek et al, 2012). Resources Available There are a number of resources available to help inform the Iowan population about the risk of stroke and to offer advice on the prevention of stroke. One important resource is the Iowa State Stroke Task Force (ISSTF), which is designed to ensure that everyone in Iowa receives adequate advice and care with respect to stroke (Rubin, 2010). It is run by the Iowa Healthcare Collaborative and also ensures that there are adequate rehabilitation services available to victims of stroke. One important part of the ISSTF is that it is aimed at helping everyone deal with strokes, including African Americans, and therefore provides a valuable resource in reducing the number of strokes affecting this population. The Iowa Department of Public Health also receives funds from the Centres for Disease Control and Prevention (CDC) to support a state Heart Disease and Stroke Prevention (HDSP) program (CDC, 2010). Within Iowa, this has had the result of increasing the number of dentists able to screen for smoking and high blood pressure issues that could lead to stroke, leading to an increase in the number of people who were aware of their high blood pressure (CDC, 2010). Additionally, a program has been started using this funding in an attempt to cut down on sodium consumption and reduce obesity in the young by auditing school meals (CDC, 2010). These programs have been implemented in areas with high populations of African Americans. There is currently only one hospital in Iowa that has the Gold Seal of Approval and Primary Stroke Center certification, and that is the Mercy Des Moines (Kochanek et al, 2012). Interestingly, this hospital may be significant for the African American population because it provides charity care and community benefit to the Iowan population of the area (Kochanek et al, 2012). This is significant because year on year, African American people are more likely to be uninsured than white people (Kochanek et al, 2012), and are also statistically more likely to be of a lower income (Kochanek et al, 2012). There is no data available for how many African Americans benefit from the presence of this accredited hospital in Iowa. Finally, the Iowa Department of Public Health has a Heart Disease and Stroke Prevention program that aims to target hypertension (a major risk factor for stroke and highly prevalent in African American populations) in the aim to reduce morbidity and mortality (Kochanek et al, 2012). It allows healthcare providers and clinics to join a collaborative to receive advice on how to improve the rate of stroke death by giving out information on research, resources and current stroke-related guidelines (Ablah, Konda, Konda, Melbourne & Gebbie, 2010). Evidently, this is going to be useful because any healthcare provider who is familiar with stroke will be better prepared to prevent it, and may also be more aware of the higher risk for African American populations (Rubin, 2010). Barriers to Care There are some barriers to reducing the prevalence and incidence of stroke in the African American population of Iowa. Firstly, it can be quite difficult to equalise access to both advice and healthcare services between different counties (Baum, Gollust, Goold & Jacobsen, 2007) and therefore there may always be a difference in local availability (Baum et al, 2007). This may affect any area with a high African American population. Additionally, as previously mentioned many African Americans do not have health insurance and may also be of low economic status (Rubin, 2010), which may prevent access to a high quality care (or any care at all). Again, this needs to be researched and access improved to help tackle the high rate of stroke in this population. Providing care to those without insurance, particularly long-term care for the follow-up of stroke victims, can be extremely economically expensive and this needs to be taken into consideration when planning resources and interventions (Thacker et al, 2006). There may also be issues in communication. It is interesting that smoking dramatically increases the risk of stroke (Thacker et al, 2006), and yet only 11% of smokers in Iowa wanted to quit smoking (CDC, 2010). This means that it may need to be better communicated that there are risks associated with tobacco use and quitting can improve longevity (Kochanek et al, 2012). There may also be issues in social pressure for smoking, particularly as it is so common in the African American population of Iowa (Kochanek et al, 2012), which needs to be addressed if there is going to be a reduction in African American smoking-related stroke. There may also be political issues in addressing this, as care needs to be taken to ensure that any group does not feel victimized by the advice given (Thacker et al, 2006). Finally, the care needs to take into account the population of Iowa and how this relates to stroke care and the way that it is delivered. 2.9% of the population identifies as black or African American (Baum et al, 2007), meaning that this needs to be taken into account when planning care. The resources need to be aimed at this population in an appropriate way (U.S. Department of Health & Human Services, 2011). Additionally, communication between different agencies that provide care needs to be encouraged to ensure that there is an overlap in provisions and that African Americans can access care from many different starting points (U.S. Department of Health & Human Services, 2011). At the moment, a lack of interagency communication may be prohibitive to successful stroke care. Major Stakeholders A stakeholder is someone who has something to gain or lose from improving the public health of a given population (Turnock, 2012). In this case, one of the major stakeholders are the hospitals within Iowa, particularly those which have a majority of African American patients. These hospitals will gain from a reduction in the number of African Americans going to them for provision of stroke care because there will be a greater availability of resources and a flexibility in economic distribution of care (What is Public Health, n.d.). However, there will also be a reduced income, so the hospital could stand to lose a major portion of income from a reduction in the number of stroke patients (What is Public Health, n.d.). Overall, though, it would be beneficial for the health of the state to ensure that this is tackled. Health insurance providers are also major stakeholders in any public health debate. Obviously, if less people are having strokes then there will be a reduced need to pay for their care (Turnock, 2012), and thus the insurance companies will benefit greatly from a reduction in stroke deaths and morbidity. Additionally, African Americans themselves will benefit economically, as a reduced likelihood of stroke could dramatically decrease health insurance premiums for this group (Turnock, 2012). African Americans without health insurance would also benefit as there would be a reduced need to pay for the cost of treatment or to rely on charitable donations to ensure that there is good rehabilitation for victims of stroke. Recommendations There are a number of recommendations that can be made to ensure that African Americans have a reduced chance of stroke within Iowa. Firstly, education needs to be improved to ensure that this population are aware of their heightened risk and understand that avoidance of risk factors could dramatically improve their longevity (What is Public Health, n.d.). This could be done by public health announcements and campaigns (What is Public Health, n.d.). Healthcare providers could also be encouraged to educate African Americans in Iowa on the warning signs of stroke, as treating this disease early is one way of massively improving the chances of survival (What is Public Health, n.d.). African Americans could also be actively encouraged to seek a diagnosis of high blood pressure and diabetes to ensure that this is kept under control to reduce the likelihood of stroke (What is Public Health, n.d.). Another recommendation is to improve services in areas which have a high proportion of African Americans residing there. This can be done by taking note of population demographics in each county, and identifying how many services there are aimed at preventing and reducing the number of strokes in that area. As previously noted, there is only one hospital with primary stroke center status, and this needs to be noted and perhaps improved upon when making this decision. Evidently there will be some economic issues in providing more services, but the health benefits for the population will be greatly improved (Turnock, 2012). Additionally, the services do not necessarily need to be hugely improved, just made more accessible to African Americans. Finally, there is evidence that reducing obesity reduces the chance of stroke (Turnock, 2012). As African Americans are more likely to be obese than white Americans, this is an interesting point to target. Firstly, exercise programs explicitly aimed at African Americans and young black people in Iowa could be developed and made local to areas with large numbers of this population (What is Public Health, n.d.). Exercise is a very good way of reducing obesity and improving cardiovascular health. Additionally, efforts could be made to ensure that the food provided in schools, particularly those with a high percentage of African American children, is healthy and less likely to lead to obesity. Conclusion Overall, there is a huge amount of evidence that African Americans could benefit from specifically being targeted by public health initiatives aimed at reducing their susceptibility to stroke (What is Public Health, n.d.). Having such a high risk when compared with white or Hispanic populations suggests that something needs to be done to ensure the health of the population. Black and African Americans are more likely to be involved in many of the risk factors associated with stroke, including obesity, diabetes and tobacco use, and this could be used to target African Americans and help to equalise the risk. There may also be a benefit in ensuring that health services are aimed specifically at African Americans and are accessible to anyone that needs them. These need to be local to areas that have high African American populations. Aside from this, more money should be aimed at reducing the risk that this population have, as it seems unfair that the morbidity and mortality for this group is so staggeringly high compared with those of other ethnicities and racial backgrounds. References Ablah, E., Konda, K. S., Konda, K., Melbourne. M., Ingoglia, J., & Gebbie, K. M. (2010). Emergency preparedness training and response among community health centers and local health departments: Results from a multi-state survey. Journal of Community Health, 35 (3), 285- 293. Retrieved from the ProQuest database. Baum, N. B., Gollust, S. E., Goold, S. D, & Jacobsen, P. D. (2007). Looking ahead: Addressing ethical challenges in public health practice. Global Health Law, Ethics and Policy, 35 (4), 657- 67. Retrieved from the EBSCOhost database. CDC. (2010). CDC - National Heart Disease and Stroke Prevention Program - Iowa - DHDSP. Retrieved February 4, 2013, from http://www.cdc.gov/dhdsp/programs/nhdsp_program/ia.htm Kochanek, K. D., Kirmeyer, S. E., Martin, J. A., Strobino, D. M., & Guyer, B. (2012). Annual summary of vital statistics: 2009. Pediatrics, 129(2), 338–348. Public Health Leadership Society. (2002). Principles of Ethical Practice of Public Health. Retrieved from (http://www.apha.org /NR/rdonlyres/ 1 CED 3 CEA- 287 E- 4185- 9 CBD-BD 405 FC 60856 / 0 /ethicsbrochure.pdf) Rubin, D. B. (2010). A role for moral vision in public health. Hastings Center Report, 40 (6), 20- 22. Retrieved from the EBSCOhost database. Thacker, S. B., Stroup, D. F., Carande-Kulis, V., Marks, J. S., Roy, K., & Gerberding, J. L. (2006). Measuring the public’s health. Public Health Reports, 121, 14- 22. Retrieved from (http://www.ncbi.nlm.nih.gov /pmc/articles/PMC 1497799 /pdf/phr 12100014. pdf) Turnock, B. J. (2012). Essentials of public health. (2 nd ed.). Sudbury, MA: Jones and Bartlett. ISBN: 9781449600228. Trust for America’s Health. (2009). Shortchanging America’s health: A state-by-state look at how federal public health dollar s are spent and key state health facts. Retrieved from (http://healthyamericans.org /assets/files/shortchanging 09. pdf) (pp. 1- 21) U.S. Department of Health and Human Services. (2011). Final review Healthy People 2010 : Executive summary. Retrieved from (http://www.cdc.gov /nchs/data/hpdata 2010 /hp 2010_ final_review_executive_summary.pdf) What is Public health? (n.d.). (http://www.whatispublichealth.org) Read More