Community Risk Assessment

The role that nursing practitioners play in community health cannot be overstated. By collaborating with such other stakeholders as government agencies and community organizations, nurses are able to identify the needs of communities and develop interventions that address these needs. If they are to be effective in responding to the health challenges that communities face, nurses must begin with an assessment of these communities. The focus of the assessment should be to identify the risk factors that expose the communities to various health challenges. It is also important for nurses and other health professionals to leverage community resources as they develop interventions. In Hicksville New York (zip code 11801), there is a small Spanish community that has been selected as the focus of a risk assessment. This assessment reveals that despite living in an area that is generally affluent, the Spanish community faces risks that mostly stem from its minority status. These risk factors can be eliminated through the adoption of an intervention that leverages the strong bonds within the members of this community.

Description of Community 

As already stated above, the community living in Hicksville, New York has been chosen for the risk assessment project. Census data indicates that this community is rather small. According to the American Fact Finder, in 2010, the total population of this area stood at 39,555 (“11801”, n.d). Of the town’s residents, 71.4% are white. Given the fact that the white community accounts for a majority of the population, it can be said that the town is primarily white and all other residents constitute the minority. While the entire town’s population would comprise an interesting group for study, it was felt wise to focus on the Spanish segment of this population. For the purpose of clarity, it should be understood that the term Spanish is used in reference to individuals from the Hispanic or Latino communities. These individuals include those with Mexican, Puerto Rican, and Cuban roots. The Spanish community makes up 14.9% of the town’s population (“11801”, n.d).

To fully understand the Spanish community described above, it is essential to examine such characteristics as poverty, educational attainment and housing. Figures released by the US Census Bureau indicate that in general, the Hicksville neighborhood is affluent with a majority of its residents having accomplished high educational qualifications and live in decent housing. For instance, on the American Fact Finder website, it is noted that there is a total of 13,358 housing units in the town (“11801”, n.d). These units are sufficient to house the town’s residents. The average annual income per household for the town is estimated at $100,245 (“11801”, n.d). This figure makes it clear that the town is affluent. Poverty remains one of the greatest challenges that the US faces today. The situation in Hicksville defies the high poverty rate trend that the nation has witnessed. It is estimated that only 4.6% of the individuals residing in the city live below the poverty line. This figure is well below the national poverty level which stands at 12.3% as of 2017 (US Census Bureau, 2018).

From the data provided above, one may wonder if the selection of the Spanish community is appropriate. To recognize why this group was selected, one needs to look beyond the data above. Being a minority group, the Spanish community suffers inequalities that have an adverse effect on health outcomes. Research has consistently established that there exist glaring disparities in healthcare in the US. For example, Sohn (2017) authored an article in which he decries the racial disparities and notes that racial minorities encounter such challenges as limited access to healthcare which are partly to blame for the poor health outcomes among minorities. Fiscella and Sanders (2016) echo the concerns that Sohn raises in his text. They agree that racial and ethnic minorities are denied access to quality health care. This research serves as the basis for the argument that the Spanish community in Hicksville does not enjoy the high income levels, the decent housing and the high educational attainment that define this town.

Conceptualization of Community 

To develop approaches and interventions that are effective, nursing practitioners need to consider how a particular group conceptualizes community. Researchers have conducted studies driven by the goal of establishing the meaning of community within the Spanish group living in such towns as Hicksville and other parts of the US. For example, according to the Centers for Disease Control and Prevention (CDC), collectivism plays a critical role in this community. This means as opposed to the larger American nation which tends to be individualistic, the Spanish community encourages its members to share responsibility, and strive toward harmony (CDC, n.d). Furthermore, the CDC has observed that cooperation is highly valued among the members of the Spanish community. Another issue that defines the Hispanic community is the focus that is placed on traditional and gender-based leadership structures. The CDC notes that within this community, men typically serve as the heads of households while women are expected to display submission.

Risk Factors 

The concept of the social determinants of health allows for a deep understanding of the risk factors that the Spanish community in Hicksville faces. Essentially, the social determinants refer to large and complex economic, social and political forces which have significant influences on human wellness and health (Donkin et al., 2018). Education, income, race and neighborhood are some of these factors. As noted earlier, in general, the conditions in Hicksville are such that they facilitate human health. However, it was pointed out that being a minority, it is highly likely that the Spanish community does not experience the gains that the affluent status of the town is expected to deliver. In this section, speculation about the possible risk factors that the community faces is made.

Socioeconomic Factors 

Low educational attainment is one of the risk factors that the Hicksville Spanish community faces. Various researchers have raised the alarm over the glaring and highly dangerous racial and ethnic disparities in education in the United States. For example, Noguera (2017) warns that minorities grapple with hardships which help to explain their low graduation rates. It has been confirmed that the Hispanic community in the US lags behind other groups as regards high school and college graduation. Figures place the graduation rate for this community at a meager 45% (Field, 2018). The low educational attainment is indeed a risk factor. It is understood that those with low levels of education are less likely to seek medical services (Ihaji, Gerald & Ogwuche, 2014). Furthermore, educational attainment has been linked to the avoidance of risky behaviors like smoking, the adoption of healthy practices such as physical exercise and nutritious diets (“Understanding the Relationship”, 2015). Since the Spanish community in Hicksville has disappointingly low educational achievement levels, it is clear that this community is exposed to hazards that could present adverse impacts for the health of its members.

Another risk factor that could be to blame for the poor health outcomes among the Spanish community is poverty. In a previous section, it was reported that the Hicksville community’s average annual income is in excess of $100,000. However, given the fact that minorities tend to grapple with poverty, it is speculated that the income levels for the Spanish community are much lower than this average. Furthermore, it is highly likely that the members of the Spanish community account for much of the town’s poverty. Among other things, poverty makes it difficult for individuals to access quality health care. Furthermore, the poor are unable to obtain medical insurance, engage in healthy practices such as physical exercise. Moreover, poverty breeds crime and insecurity which have adverse effects on health outcomes.

Housing and Built Environment 

Housing is yet another social determinant of health. In general, decent housing conditions contribute to positive health outcomes. Oudin, Richter, Taj, Al-Nahar and Jakobsson (2015) are some of the researchers who have performed studies whose goal was to establish the association between housing conditions and human health. They established that housing situations with such poor conditions as dampness expose children to an elevated risk of developing asthma. The observation that they made lends validity to the fear that the Spanish community’s poor housing conditions are a risk factor. In their text, Thomas, Moye, Henderson and Horton (2018) lament that racial minorities usually live in poor housing conditions. These conditions have an adverse effect on their health. It would not be surprising if it is confirmed that the Hicksville Spanish community reports higher levels of illness as a result of its member’s poor housing environment.

Assets and Resources 

When responding to the health needs of a community, it is critical for practitioners to leverage the resources and the assets that the community possesses. Well-developed healthcare infrastructure is one of the resources that can be used to promote the wealth of the Spanish community in Hicksville. The state of New York has invested huge amounts in developing facilities through which health services are delivered. Another resource that can be employed concerns the strong sense of community and neighborliness within the Spanish community. This sense of community can be used to encourage all members to fully participate in the health promotion initiative. Parks and other recreational activities can also be incorporated into the health promotion intervention. For example, the parks can be used to encourage the community to embrace a more active lifestyle.

Health Promotion Initiative 

In response to the risk factors discussed above, a health promotion project has been developed. Details of this initiative are outlined in the following sections:

Purpose 

The primary purpose of the health promotion initiative is to tackle systemic failures and injustices that are responsible for the disparities which lead to poor health outcomes. As noted above, the Spanish community lags behind the white community in such areas as housing, education and income. These disparities can be blamed on years of institutionalized injustice and failure to invest in the wellbeing of minorities. The US has a long history of neglecting racial minorities. For example, the country has not invested adequate resources and effort in providing employment opportunities and establishing educational institutions for minorities. Health risk factors are the direct result of these historical failures. It is hoped that the implementation of the health promotion program will engage all concerned stakeholders and challenge them to take action that results in marked improvements in the health and general wellness of the Hicksville Spanish community.

Plan 

For any health promotion program to deliver the desired results, it should be accompanied with a clear plan. To enhance the health of the Spanish community, the plan involves petitioning the town’s leadership to prioritize the creation of employment opportunities for this community. It is hoped that these opportunities will set the stage for the elimination of the risk factors identified earlier. For example, with decent and well-paying jobs, the members of this community will be able to afford quality education for their children. As a result, the community will register an encouraging improvement in educational attainment levels. The employment opportunities also promise to address the problem of poverty. With jobs, the members of this community stand a better chance of boosting their living standards and to improve their conditions. Furthermore, as the town’s leadership makes the creation of employment opportunities as priority, it will facilitate upward social mobility and make a significant contribution to the war on crime and poor housing. In general, employment holds the key to reversing the years of injustice that the Spanish community and other minorities have suffered. More importantly, when they are gainfully employed, the members of this community will develop a greater sense of pride and purpose.

Implementation 

The plan above can only be successful if an elaborate implementation process is adopted. It has already been stated above that the purpose of the health promotion plan is to undo the years of systemic injustices by providing the members of the Hicksville Spanish community with decent, gainful and productive employment. The implementation of this plan will involve close collaboration between the community’s leaders and the town’s authorities. This collaborative effort is intended to identify the interventions that can be adopted as part of the jobs creation drive. For example, the city’s authorities could hold discussions with the community’s leadership with the aim of identifying the type of employment that is best suited to the community’s situation and needs. The health promotion initiative will involve other stakeholders with a mission of improving human health through employment. For instance, the authorities in charge of human health in the state of New York will be challenged to take part in the initiative. The business community will also be encouraged to participate by expanding their operations into Hicksville so as to create opportunities for the town’s residents and the Spanish community in particular. It is worth noting that while job opportunities will be the main avenue through which the health promotion initiative boosts the health of the Spanish community, other smaller interventions will also be implemented. Among these interventions is a health awareness campaign that will bring together the local and state governments, the healthcare community and the leadership of the Spanish community. The focus of this intervention will be to sensitize the community on the importance of adopting healthy behaviors like nutrition and physical exercise. Basically, this intervention will be aimed at encouraging individual members of the community to demonstrate personal responsibility by taking charge of their health instead of relying on the government to act.

Evaluation 

How will the effectiveness of the health promotion project be determined? An evaluation will be conducted. The purpose of this evaluation will be to ensure that the project has resulted in an improvement in the health outcomes of the Spanish community. This evaluation process will involve determining the number of new jobs created. Furthermore, the evaluation will also be concerned with tracking changes in crime, income levels and housing conditions. If it is observed that a general improvement has occurred, there will be a basis to include that the health promotion initiative has been effective. It may be years before the effectiveness of the initiative has been conclusively proven. A clear conclusion can only be reached when the Spanish community is healthier, reports fewer illnesses, has better access to health insurance, is more educated and is able to access high quality medical services with ease.

Evaluation of Community Assessment 

An understanding of the challenges that the Hicksville community faces was gained through a rigorous data collection process. This process mainly involved an examination of published data. In particular, data released by the US Census Bureau was collected and assessed for insights on such issues as income levels, population distribution and housing. The identification of the needs of the Spanish community involved examining the data for indicators of poor health outcomes. It was difficult to engage the leadership of this community. For this reason, the identification and prioritization of its needs was conducted through an evaluation of the data that was collected. In appendix one, the windshield survey that was used to gather data is outlined.

In conclusion, nurses have an important mandate of protecting communities against health hazards. The Spanish community living in Hicksville, New York provides nurses with an exciting opportunity to develop interventions that address the health challenges that this community faces. It has been noted that it is likely that the community grapples with high levels of poverty, low educational attainment and poor housing conditions. Poverty is another challenge that this community faces. Combined, these socio-economic factors have a damaging effect on the health of the members of the community. To eradicate the risk factors, it is recommended that a jobs-creation program should be implemented. This program should combine the efforts and resources of such stakeholders as the government and the business community. If implemented aggressively, the health promotion program promises to yield significant enhancements in the health and quality of life of the Spanish community.

References

11801. (n.d). American Fact Finder. Retrieved March 18, 2019 from https://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml

Centers for Disease Control and Prevention (CDC). (n.d). Cultural insights. Communicating with Hispanics/Latinos. CDC. Retrieved March 18, 2019 from https://www.cdc.gov/healthcommunication/pdf/audience/audienceinsight_culturalinsights.pdf

Donkin, A., Goldblatt, P., Allen, J., Nathason, V., & Marmot, M. (2018). Global action on the social determinants of health. BMJ Global Health. DOI: http://dx.doi.org/10.1136/bmjgh-2017-000603

Field, K. (2018). More Hispanics are going to college and graduating, but disparity exists. PBS. Retrieved March 18, 2019 from https://www.pbs.org/newshour/education/more-hispanics-are-going-to-college-and-graduating-but-disparity-persists

Fiscella, K., & Sanders, M. B. (2016). Racial and ethnic disparities in the quality of health care. Annual Review of Public Health, 37 , 375-94. DOI: https://doi.org/10.1146/annurev-publhealth-032315-021439

Ihaji, E., Gerald, E. U., & Ogwuche, C. H. E. (2014). Educational level, sex and church affiliation on health seeking behavior among parishioners in Makurdi metropolis of Benue State. Journal of Educational Policy and Entrepreneurial Research, 1 (2), 311-6.

Noguera, P. A. (2017). Introduction to “racial inequality and education: patterns and prospects for the future”. The Education Forum, 81 (2), 129-135.

Oudin, A., Richter, J. C., Taj, T., Al-Nahar, L., & Jakobsson, K. (2015). Poor housing conditions in association with child health in a disadvantaged immigrant population: a cross-sectional study in Rosengård, Malmö, Sweden. BMJ Open. DOI: http://dx.doi.org/10.1136/bmjopen-2015-007979

Sohn, H. (2017). Racial and ethnic disparities in health insurance coverage: dynamics of gaining and losing coverage over the life course. Population Research & Policy Review, 36 (2), 181-201.

Thomas, M. E., Moye, R., Henderson, L., & Horton, H. D. (2018). Separate and unequal: the impact of socioeconomic status, segregation and the Great Depression on racial disparities in housing values. Sociology of Race and Ethnicity, 4 (2), 229-44.

Understanding the relationship between education and health. (2015). Agency for Healthcare Research and Quality. Retrieved March 18, 2019 from https://www.ahrq.gov/professionals/education/curriculum-tools/population-health/zimmerman.html

US Census Bureau. (2017). Income and poverty in the United States: 2017. Census Bureau. Retrieved March 18, 2019 from https://www.census.gov/library/publications/2018/demo/p60-263.html

Appendix 1

Windshield Survey

Boundaries  Are the boundaries geographical, political, or economic?  Do neighborhoods have names?  Are there sub-communities?  How are these identified?	Notes (to make notes about the questions on the left)  The boundaries are political and demarcated for administrative purposes.  All the neighborhoods in the area are properly named.  There are sub-communities in Hicksville. These communities are defined on the basis of such factors as race, gender, shared recreational interests etc.
Housing and Zoning  What is the age of the buildings? Are the residences single family or multifamily dwellings?	The area has both newly-built and older homes. There is also a mix of single family homes and multifamily dwellings such as apartments.
Signs of Decay  Is the area well maintained or in disrepair? Is there garbage strewn? Are there trashed/abandoned cars, places for rodents or other wildlife to hide, vacant lots?	The area appears to be well maintained. Garbage is collected by the town’s authorities. There were no abandoned or trashed cars and the area is so well-maintained that it would be difficult for rodents or wildlife to hide. A few vacant lots were noted.
Parks and Recreational Areas  Are there play areas for children and adults? Are they safe and maintained? Is there a Community Center? Who uses them?	The town has facilities designed for children to play. Adults have designated areas where they can interact and monitor the children as they play. These facilities seem safe and are properly maintained. There is a community center. It is mostly used by locals who engage in yoga and dancing.
Common Areas  Where do people collect for social gatherings; where do they “hang out”? Are they for particular groups or are they open to all? Are there signs posted?	The community center is the main facility for social gatherings. For casual interactions, the people in Hicksville prefer the numerous restaurants scattered across the town. The various social facilities are open to all. There are signs that carry the names of the facilities and outline their intended function.
Stores  What stores (grocery, retail, drug, dry cleaning, etc.) are in the area? How do residents travel to them?	There is a wide variety of stores in Hicksville. They include grocery and retain stores, pharmacies and farmer’s market. Most of these stores are within walking distance.
Transportation  How do most people get around the area? Is there public transportation? If so what kind and does it appear to be used? Who uses it? What is the condition of the streets, roads, highways?	A majority of the people in the area own cars. However, most use public transport as it is most convenient. The town has a railway station which is mostly used by people commuting to work. In general, the streets, roads and highways are in good condition.
Communication  Is there evidence of local and national newspapers to other media? Are there informational posters on streets, busses, billboards, etc.?	There are both local (eg. Hicksville News) and national newspapers in the area. An examination of the area revealed that there are posters that provide information on such issues as the location of key areas, Billboards and posters on buses are also used to convey information.
Service Centers  What services are available in the community – health care, social services, schools, employment offices etc.?	The area hosts various healthcare facilities, community centers, schools and a police department.
People in the Community  Who is in the area during the day? What evidence is thereof particular “classes” of people – upper, middle, working, lower?	On an average day, families are mostly seen in the Hicksville area. Evidence of classes can be seen in the variety of business establishments that attend to people of various income backgrounds.
Industries  What are the major industries located in the area? What types of occupations are evident?	Home improvement, chemical manufacturing and the making of plastics are the primary industries. Most occupations are of the white-collar type.
Protective Services  Where are fire and police stations located? Is there evidence of police and fire protection in the area?	The fire department is located on 20 E Marie Street, right at the heart of the town. The police department is also situated at the town’s center. Evidence of police presence and fire protection is found in the number of police cars and fire trucks in the area.
Ethnicity  What is the predominant ethnic group? Are there residents from a variety of ethnic backgrounds or is the community mostly one group? Which one? Are there stores, restaurants, churches, schools, or languages that indicate a particular ethnic group(s)?	Most of the area’s residents are white. There are other ethnic groups such as blacks and Hispanics. Most of the facilities attend to all residents, regardless of their ethnicity.
Religion  What churches and church-run schools are in the area (denomination)? How many are there of each denomination?	There are various churches such as Hicksville United Methodist and St. Ignatius Catholic Church.
Health and Morbity  Is there evidence of any health problems such as drug/alcohol abuse, communicable or chronic diseases, mental illness (etc)?	From the cursory observation, it was difficult to determine health and morbidity. However, there was little evidence of substance abuse, mental illness or communicable disease.
Politics  Is there evidence of political activity? Are there any signs that indicate a predominant political party (parties)or concern(s)?	There was little evidence of political activity and no signs indicating that a particular political party is dominant.