This paper defines stroke as a health disparity among the Chinese Canadian population. Further, the paper discusses the nine determinants of health and the factors that influence health as highlighted by the World Health Organization (WHO, 2010) and how they are likely to influence stroke. Nevertheless, the paper identifies the epidemiological linked to stroke and its incidence to both national and state levels. The cultural considerations for the Chinese Canadians with regards to stroke are as well described along with the health care literacy challenges and the applicable health promotion theory towards the development of the treatment plan of stroke is identified.
Purpose of the Study
This study intends to identify the health promotion process of stroke among the Chinese-Canadians population suffering from stroke.
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Definition of Health Disparity
Even though the word disparity is usually applied to denote ethnic or racial disparities, several measurements of disparities exist in the United States, specifically in health. If a health outcome is observed to a greater or lesser level between populations, a gap exists. Ethnicity or race, sexual identity or sex, disability, age, geographic location, and socioeconomic status all lead to a person's ability to realize good health. It is essential to recognize the impact that social determinants have on health outcomes of a given population. According to Healthy People 2020, health inequality is a certain type of health variance that is relatively connected with socioeconomic and environmental disadvantages. Health disparities negatively impact on groups of humans who have steadily undergone major hindrances to health on the basis of their ethnic or racial group; socio-economic status; religion; sensory, cognitive or physical disability; mental health; age; sexual orientation, gender identity or sex; geographic location and other features historically associated with discrimination and exclusion (Boehme, Esenwa, & Elkind, 2017).
Stroke as a Health Disparity
Stroke disparities are prevalent and widespread across the world. This health promotion process examines the determinants of health and how they are likely to impact on stroke as a health problem. Whereas increases in stroke risk, as well as mortality in third world nations, are linked to increasing social economic status, decreases in stroke in first world nations are linked to increasing social economic status. For instance, in the rural villages in China, increased incomes led to prosperity and the associated higher risk of stroke. Thus, when new money circulates in the earlier impoverished area some unhealthy behaviors are adopted. Adopted behaviors may include consumption of meat and foods rich in sugar content and the use of motorized transport as opposed to walking. Thus, there is the need to increase health literacy so that economic advantage is focused on good use with improved diet, and exercise as well as access to medical prevention and treatment.
The Nine Determinants of Health in Relation to Stroke
The social and economic environment
According to Anna, Lena, Christina, Ann and Marie (2018), high-quality care that is centered on safety, efficiency and individualization requires high physical environmental standards both in terms of the built environment and architecture. But, more importantly, in recent research such as Nordin, McKee, Wijk, and Elf (2017) there is an emphasis on residential care. On the other hand, Stein (2015) emphasizes on emergency care as well. Both residential care and emergency care are more important than rehabilitation environment such as the stroke units.
The physical environment
There are different outcomes on the impact of the physical environment on patient's activities and care such as efficiency to navigate support patient's activities, responsiveness, flexibility, and diversity on the ways the physical environment has an impact on patient's activities and care as well as privacy and respect for individual integrity rather than publicity. Therefore, the quality of the environment is a complicated concept that is problematic to define. But, according to Anaker and colleagues (2016), it is important to be certain about the meaning of quality in a building project to involve support for participation and social interaction.
The person's individual characteristics and behaviours
Nonetheless, a person's specific characteristics and behaviours can influence stroke problem. Personality means a person's characteristic trends of thought, and emotion combined with the psychological mechanisms whether hidden or not behind those trends. As suggest most psychological literature and the general population, social constructs are essential in shaping physical activities. The factors might apply after stroke. It must be noted that social normative viewpoints relate to other people's views about an individual's engagement in physical activity, assumed beliefs regarding others who are participating in the act. More practically, and a shift from a unique to a social model of behaviour, factors due to socio-environment are likely to influence physical activity behaviour. Support from both friends and family seem vital in affecting enthusiasm for physical activity in adults. Thus, group exercise is essential for encouraging healthy lifestyles (Jellema et al., 2017).
Income and social status
Furthermore, the context of people's lives plays a significant role in determining their health status. Therefore, it is unsuitable to accuse people for having poor health rather than acknowledging them for their good health. Individuals are likely to be unable to regulate many of the health determinants. Higher social and income status are related to better healthcare; thus, the larger the disparity between the rich and the poor, the larger the disparity in health. Stroke overly affects both low-income as well as middle-income nations. Besides, stroke socio-economically deprives people within the high-income nations. The disparities are exposed in both risks of stroke and in immediate and enduring outcomes after stroke. Increased average intensities of usual risk factors, for example, hyperlipidemia, hypertension, obesity, smoking, sedentary lifestyle and excessive alcohol intake among people with low socioeconomic status account for nearly half of the effects. In a number of nations, evidence indicates that individuals with lower socioeconomic status are less prone to obtain high-quality serious hospital and rehabilitation care compared with higher socioeconomic status individuals. Therefore, for clinical practice, improved application of well-instituted treatments, effectual management of risk factors and fairness in access to high-quality critical stroke care coupled with rehabilitation will lessen discrimination considerably.
Education
Low education levels are linked to increased stress, poor health, and lower self-confidence. Thus, low education is linked to increased stroke risk in women and men and is likely to be sharper in women than men. The disadvantage reduces though persists into old age, specifically for women. However, modifiable risk factors are responsible for much of the additional risk from low levels of education. There is a need for public health policy and government decision-making to reflect on the necessity of education for both women and men for positive health throughout the course of life.
Physical environment
The physical setting comprise of safe water and clean air, safe housing and workplace, roads, and communities lead to stable health. Individuals in employment are healthier, specifically those who have more influence over their working surroundings. Besides, the patient's levels of activities and interactions seem to vary with the plan of the physical environments of stroke units. There should be improved health status examination, avoidance of bed-rest and establishment of early rehabilitation based on a supportive physical environment. Patients in a stroke unit with a blend of single and multi-room plans are more physically active compared with those in a unit with a single room plan. Thus, the plan of the physical environment can either be a hindrance to or facilitate the rights of the patient to preserve their integrity (Morris, Oliver, Kroll, & MacGillivray, 2012).
Social support networks
Social support networks, for example, family support, and support from friends and society are directly associated with better health. Most notably, culture such as traditions and customs coupled with beliefs of members of the family and the community at large have effects on health. It is important to encourage healthy lifestyles and control hypertension to lessen the prevalence and seriousness of stroke and its impact on people. Thus, there is a need for issuing lifestyle guidelines to increase awareness of healthy choices and hypertension. The success of health education is based on individuals' beliefs about the need for new information and their confidence in their capacity to transform their own health behaviour.
Genetics
Genetics has an active role in establishing lifespan, the health, and the possibility of having some illness. Genetic factors most probably are instrumental in causing high blood pressure, stroke as well as associated conditions. Many genetic disorders such as sickle cell can cause a stroke. Persons with a family history of stroke are more prone to sharing genetic elements and other possible factors that increase their risks. Personal behaviours and coping skills such as being active, eating a balanced diet, drinking, smoking and how people deal with life's challenges and pressures all influence their health status.
Gender and Health Services
Stroke affects both women and men; but, the prevalence and outcomes vary between the two sexes. Age-related incidence of stroke are higher in males. Women go through specific stroke occasions since their life expectancy is long compared men; though, they have a high incidence of stroke at an older age. Thus, health access and use of services that are aimed at preventing and treating stroke influences the health of individuals.
Epidemiology of Stroke
The epidemiology associated with stroke is its history, establishment of risk factors as well as predictive factors that lead to indicators for stroke mechanisms. Stroke is a highly dominant disease and is a principal cause of chronic disability, and a second primary cause of dementia (Ovbiagele, & Nguyen-Huynh, 2011). On the other hand, stroke is the fourth principal cause of death in the USA. Globally, stroke is more pronounced (Morgenstern, & Kissela, 2015).
Cultural Considerations of Chinese Canadians
Studying cultural distinctions in stroke among Chinese Canadians has several challenges being that culture is dynamic. When there is the immigration of people, their cultural beliefs and behaviours are customized as they assimilate into a new culture. However, there is no health behaviour change approach that exists and applies to every member of a cultural group to increase physical therapist's awareness of the factors that can impact on patient's health beliefs and self-sufficiency about health behavior change to assist them to modify the health education they offer to make it more effective.
Health Promotional Theory
Thus, the promotional theory to the development of a treatment plan for stroke among the Chinese Canadians is the application of the ying-yang theory of harmonious balance, which was first published in the last 2,500 years in The Yello Emperor's Classic of Medicine. The theory today offers a foundation for health beliefs and medicine in China. Even though little is known about this theory on the ways Chinese Canadians understand and conceptualize stroke, their stroke knowledge and beliefs seem to emerge from relatives, friends, as well as the media as opposed to from formal health care sources.
Conclusion
Stroke is a deadly disease that that requires evidence-based approaches to address with specificity on population that is affected.
References
Boehme, A. K., Esenwa, C., & Elkind, M. S. (2017). Stroke risk factors, genetics, and prevention. Circulation Research, 120 (3), 472-495.
Jellema, S., van Hees, S., Zajec, J., van der Sande, R., Nijhuis-van der Sanden, M. W., & Steultjens, E. M. (2017). What environmental factors influence the resumption of valued activities post-stroke: A systematic review of qualitative and quantitative findings. Clinical Rehabilitation, 31 (7), 936-947.
Morgenstern, L. B., & Kissela, B. M. (2015). Stroke disparities: a large global problem that must be addressed. Stroke, 46 (12), 3560-3563.
Morris, J., Oliver, T., Kroll, T., & MacGillivray, S. (2012). The importance of psychological and social factors in influencing the uptake and maintenance of physical activity after stroke: a structured review of the empirical literature. Stroke Research and Treatment, 2012.
Ovbiagele, B., & Nguyen-Huynh, M. N. (2011). Stroke epidemiology: advancing our understanding of disease mechanism and therapy. Neurotherapeutics, 8 (3), 319.
