Introduction
The health status of the American population has continuously been affected by disparities in healthcare distribution. While some populations have dominantly been able to access and acquire quality healthcare, other groups have been sidelined from accessing and acquiring such care. This has been caused majorly by individual and group factors which have at one instance or another affected the distribution, access, provision and acquisition of quality health care. Health disparity refers to the overall difference related to prevalence, incidence, mortality, disease burden as well as other unfavorable health determinants that exist unequally among individuals or populations. These factors are in one way, or another related to cultural, social, biological, economic, genetic, environmental and behavioral variations that exist among different communities (Halverson, 2004). However, socio-economic and cultural variations tend to have a great effect on the access and quality of care available to the population. The Centre for Disease Control has played a major role in trying to bring to level the access to quality healthcare across all populations despite the variations listed above. Other organizations such as the National Culturally and Linguistically Appropriate Services and other organizations have been set up in a bid to ensure that individual and group variations do not compromise the quality of care offered to the population (United States (CLAS), 2013).
Eastern Kentucky is a population that over the years lagged behind in terms of the access to quality health care. The elderly population in particular has been subjected to low quality healthcare coupled with the fact that most of the population in Eastern Kentucky is comprised of the poor. Disease prevalence and incidence in this region have been at an all time high, and the region has always been ranked nationally as the worst in terms of health status of the population. The elderly populations as well as the children are the most prone groups affected by healthcare disparities. This is particularly due to the decreasing body resistance ability in the elderly. On the other hand, socio-economic problems tend to have a greater influence on the elderly population who are physically disadvantaged in maintaining a sustainable livelihood especially in a community dogged by high poverty levels. Since the year 2008, Kentucky State has been ranked last at position 49 nationally in terms of the population health status. In the year 2008, the region was ranked 48 nationally which implies an alarming state of health for the population within this region (Kentucky Institute of Medicine, 2007).
Among the older generation, that is 65 years and above, the most prevalent death causes include heart diseases, cancer and stroke respectively. These diseases are associated not just with the lack of access to quality care but also poor lifestyles and poverty. As recent as the year 2010, the region recorded a higher percent of persons living below the Federal poverty level at 13.6% against the national levels at a lower figure of 12.4%. The figure below shows the most prevalent death causes within the State of Kentucky in the last one decade (Centers for Disease Control and Prevention (U.S.) (2011).
While poverty is the most common factor associated with this disparity, there are other factors that have greatly led to the prevalence rates shown in the figure above. These include low levels of education and limited income caused by high levels of unemployment, racial differences, lack of health insurance plans and strained health care resources (Halverson, Ma, Harner & West Virginia University, 2004).
Causes
Health insurance cover, a number of elderly people lack insurance cover to cater for their medical care. The insurance companies are unwilling to subscribe the elderly to their services since they considered them vulnerable and bad for business. This is because the elder fall sick more often than, the younger age group, and they mostly suffer deadly illnesses like cancer and diabetes which attract heavy medical cost (Williams, 2001). Therefore, the insurance cover shies away from the elderly to avoid making losses.
Income challenges, most of the elderly are not working, and they depend on relatives for upkeep. This dependency and lack of proper channels for income make the elderly to miss quality health care services. The pension scheme for retirement is not enough to sustain all the needs of the elder since some are still educating their children in college or taking care of their grandchildren. Thus, little money is left for health care needs (McNeill, Moy, & Clancy, 2006).
Lack of equipment and infrastructure, most of the healthcare facilities lack facilities to cater for elder people. The national and local governments have not funded many health facilities adequately so that they can attend the elder who require special attention. The elderly since they cannot walk for long distance require an ambulance equip with oxygen supply to transport them to and from the hospital and they need a wheelchair to move from place to place. Most of the hospitals and healthcare facilities lack this essential item.
Research and civic education, there is lack of research on the chronic diseases that affect the elderly. The governments have put little money for adequate research to be done on the illness and the difficulties the elderly faces as they go about their daily life. there is no adequate fund to do civic education from door to door to educate the elderly on how to take care of themselves and what they can do to prevent some of the illness which are associated with old age. The civic education will also help to inform the elderly where to get treatment fast in case they fall ill and during emergency (In Dutta & In Kreps, 2013).
Interventions and evaluation
The ‘National Culturally and Linguistically Appropriate Services’ has taken a major role in ensuring equity in health care across culturally and linguistically diverse populations. In particular, the National CLAS seeks to ensure that the healthcare systems apply both individual and population based mechanisms in administering health care while being sensitive to the cultural and linguistic limitations that may affect care delivery. The Eastern Kentucky population is inhabited by a diverse population of whites, African Americans, Hispanic, Latinos and Asians. The Hispanic however, forms the largest racial and ethnic group in this region. With such diversity there are due to be challenges especially on the elderly population when receiving care in health facilities. In this aspect, the healthcare system should provide a favorable platform that caters for the linguistic as well as cultural limitations that may be imposed on health care. The elderly populations are less educated and thus communicating with healthcare providers and nurses in healthcare facilities in most cases prove to be a challenge. The National CLAS suggests that a well educated and trained nurse workforce on handling diverse populations can be the key to ensuring equity in healthcare.
In a similar approach, healthcare facilities should take a leading role in providing health literacy programs to the surrounding community. Cultural limitations as well as stereotyped perceptions play a role in how the community views the health care system. Thus, healthcare facilities should set out to implement population-based health literacy programs that seek to educate the elderly on maintaining healthy lifestyles as well as sensitizing them on the role of the government in their health care matters (United States (2011): National healthcare disparities report 2010). Issues such as health care insurance for the elderly are uncommon in this region. This has been caused by lack of programs aimed at sensitizing the elderly population of such programs available to them. In a further step to ensure that this elderly population can easily access quality healthcare, the healthcare facilities should practically involve the relevant health insurance companies to focus primarily on the elderly population in this region who have without doubt been identified as the population-at-risk.
The Center for Disease Control has also played a significant role in combating these challenges especially in the socio-economic context. All in all, there has been a practical agreement that the elderly population in Eastern Kentucky does not just require quality healthcare but also empowering them economically (Centers for Disease Control and Prevention (U.S.) (2011). This cannot be achieved without focusing on imparting knowledge to this population. Heath literacy programs should thus incorporate both health education as well as empowerment programs. Improving the lifestyles of this population and helping them redeem a worthy lifestyle has been adopted and should remain in place as the best possible solution to combating the healthcare problem.
“Health People 2020” has been closely monitoring the health status of the population within the US to determine the success of programs initiated in this region to improve the lifestyle and health of the population. Despite noting that much has been achieved over the last few years, Health 2020 report on Kentucky, notes that measures to reduce the disparities in healthcare have been quite ineffective (Crosby, 2012). However, the report suggests that sort out such dominant disparities all health care stakeholders should seek to increase community awareness on disparity and possible solutions and setting priorities in health at federal, state and local levels. They should also providing necessary resources to reduce the strain on healthcare facilities in prone areas and to implement individual based and population- based mechanisms simultaneously (Ludke et al., 2012). These measures, the report explains that this will go a long way in reducing disparities within the elderly population in Eastern Kentucky as long as they are earmarked as the population at risk. With the current state of affairs, the elderly population in Kentucky needs to be redeemed socially, empowered economically and provided with health awareness in a platform that serves those three objectives. Leaving any of the objectives out, would compromise the effectiveness of the program and this population may be not be rescued from the afflicting issues on health.
References
Centers for Disease Control and Prevention (U.S.) (2011). Health disparities and inequalities report--United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.
Crosby, R. A., Wendel, M. L., Vanderpool, R. C., & Casey, B. R. (2012). Rural populations and health: Determinants, disparities, and solutions.
Halverson , J. A., Ma, L., Harner , E. J., & West Virginia University (2004). An Analysis of Disparities in Health Status and Access to Health Care in the Appalachian Region.
In Dutta, M. J., & In Kreps, G. L. (2013). Reducing health disparities: Communication interventions. New York: Peter Lang.
Kentucky Institute of Medicine (2007). The health of Kentucky: A county assessment. Lexington, KY: Kentucky Institute of Medicine.
Ludke, R. L., Obermiller, P. J., & Couto, R. A. (2012). Appalachian health and well-being. Lexington: University Press of Kentucky.
McNeill, D., Moy, E., & Clancy, C. M. (2006). The Agency for Healthcare Research and Quality’s National Healthcare Quality and Disparities Reports: Action Agendas for the Nation. American Journal of Medical Quality. doi:10.1177/1062860606288003
United States (2011). National healthcare disparities report 2010. Rockville, Md: Agency for Healthcare Research and Quality.
United States (2013). National standards for culturally and linguistically appropriate services in health and health care: A blueprint for advancing and sustaining CLAS policy and practice.
Williams, D. (2001). Racial residential segregation: a fundamental cause of racial disparities in health.
