Help For The Underserved In The United States

Journal of Multicultural Nursing & Health, Spring 2007 by Neff-Smith, Martha, O'Donnell, Charles, Bryant, Sharon Aneta, Riley-Eddins, Essie Alberta

Although, state and federal policies have been enacted to improve the health of populations, structural forms of inequality continues to shape the health of underserved populations. These groups within the population do not have higher morbidity and mortality rates when compared to the predominant population because of some inherent biological or genetic differences between the races but rather are based on social and environmental factors. Individuals who live in poor neighborhoods, who have lower educational attainment, are employed are less prestigious occupations are all more likely to experience higher rates of morbidity and mortality than persons at the other end of the scales. The social and environmental factors of poverty, poor educational achievement and lower paying employment contribute to health throughout the entire lifetime.

Some current health policies and health education programs have focused on individual health promotion activities. We assume that people can reduce their risk of ill health by exercising, eating nutritional foods, and eliminating their consumption of alcohol and tobacco products. These initiatives presume policies that individuals can over come negative social and political forces. For example, alcohol and tobacco companies have targeted poor communities. Also, most of the advertisement in African-American magazines are by alcohol and tobacco companies. The health of underserved populations must be placed within a context that shows the interplay between the social and political forces that influences and shapes individual behavior. It's unreasonable to expect individuals living in these conditions to overcome the multiple factors that contribute to their persistent ill health. The health needs of underserved populations must be linked to a national health policy of health for all in a specific set of health goals.

Health disparities can be approached as follows:

First, we should focus on reducing institutionalized forms of inequality that alter health status and health-related infrastructures.

There is a need for comprehensive conceptualization of health that identifies social and environmental factors that influences health differences. The relationship between excess morbidity and social and environmental exposure is well documented, and now we need to focus our affection on eliminating these factors. For example, instead of promoting that individuals need to eat five fruits and vegetables a day, we need to be sure that everyone has access to affordable fresh vegetables by increasing the number of grocery stores in poor neighborhoods. Tacking these problems requires the commitment of federal, state, and local governments committed to reducing racial discrimination. An attitude of being "colorblind" will ensure that a proportion of the poor communities will continue to suffer disproportionately from ill health.

Secondly, we need to develop an emancipatory health ethic.

There is an immediate need to develop health-related programs that are based on what is needed in our programs communities and what is acceptable to our communities. Thus, health consciousness must become political consciousness. Health justice must become one of the tools for liberation.

Martha Neff-Smith, PhD, RN, CS, MPH, FAAN, Charles O'Donnell, MS, RN, Sharon Aneta Bryant, PhD

Essie Alberta Riley-Eddins, PhD, RN, SM, ACHNE