West Virginia State University

Student of Community Health Education

Healthy Communities Build Healthy Lives

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Creative, prolific, professional, captures a room…. Just a few words that describe Bradley. I have worked with Bradley in several different capacities over the years. I have watched him grow from a post-acute representative to the Executive Operations Lead position he holds today. Bradley has a strong desire to learn and grow. He has recently completed his Bachelor’s degree and quickly embarked on his goal of obtaining his Master’s degree. He has worked hard to advance within the organization, as well as heading up ERGs within Signify Health. His communication skills shine through in both internal and external meetings; he captures the room and keeps his audience engaged during presentations. Brad is a skilled educator who has done a phenomenal job not only educating internal and external teams on care redesign tools but was instrumental in the development of an on-boarding education process for new-hires. It has been exciting to see Bradley’s growth and development over the years and I am confident that this will continue throughout his career.

Nancy

Bradley was an amazing boss and leader! He guided our team with energy, compassion, and he inspired us to all excel to the top of our field. He helped us develop strong strategic skills, analytic skills and he empowered us to grow as leaders for our value based care clients. Bradley was an inclusive, encouraging, and positive leader who was a huge asset to our team. He allowed us to learn and strategize together while offering us guidance when needed. He was a great listener and was always open to our ideas and suggestions. I am grateful to have learned so much from Bradley and to have been able to grow both professionally and personally under his expert guidance. Thank you for all you have done for me here at Signify!

Ashley

Bradley is one of the most engaging and innovative healthcare leaders I have ever worked with. As a people leader, Bradley’s thoughtfulness, ability to motivate and mentor, and identify the strengths of his teammates creates a team that is supported, fulfilled in their work, and successful in their jobs. Bradley’s ability to engage difficult audiences of all types in stories and examples that bring the patient to the front of the care innovation conversation is unparalleled. He makes care redesign matter. He is organized, motivated, and creative to ensure KPI’s are met and exceeded. I highly recommend Bradley as a team leader and endorse him as a proven asset to any organization

Lindsey

A leader is one who knows the way, goes the way and shows the way. Bradley has exemplified true leadership to me in such inspirational fashion. From onboarding to program sunsetting, he has displayed grace, charisma and compassion to me as my team leader. I feel beyond privileged to have crossed into his path and will carry his words of professional wisdom forever. Bradley is a cut above the rest. A born leader!

Melissa

Leadership is learned and fostered through careful personal construct. It is not often that leaders are born out-of-the-box. Bradley is one of a handful of humans I have had the pleasure to work with whom in my opinion was born as a leader. Under his tutelage, I have been able to progress my career and grow as an individual and team contributor. Bradley is full of warmth and charisma. I can rely on him to create an easy going atmosphere to feel free to speak your mind and voice your ideas. As a nurse, I have learned from his diverse background and clinical expertise. Operationally, he can keep the team on track and motivated to ensure KPI’s are met and exceeded. I highly recommend Bradley as a team leader and endorse him as a proven asset to any organization.

Priscilla

Bradley is a truly inspirational leader. His charisma, his passion and his ability to connect with others is admirable. Not only is he personable which drives individual relationships of trust and respect, but his leadership naturally brings groups of people together and inspires them to work towards a common goal. Bradley has a way with words; he can paint a vision, he can lift spirits and inspire when times are tough, and he can express the why to create motivation in others. His passion for health equity, for people and for change shines brightly, leaving a lasting impression on both the people and projects he supports. He is a true people leader, a true class act.

Jennifer

Bradley is the embodiment of what a thoughtful, innovative, and supportive leader should be. Working with Bradley is like working with a never ending roladex of resources wether the resources are people or ideas, Bradley has got a way to connect you with them at the drop of a dime. His passion for motivating others while driving business outcomes is beyond admirable.

I can honestly say that I could not have understood my strengths and pushed my limits to pursue my passions if it wasn’t for Bradley’s leadership and personal connection. I consider Bradley the sponsor that everyone needs. He truly goes beyond general mentorship and leadership. Bradley is everything.

Mariel

Most people, as they look back, can pick one or two leaders that truly engaged and inspired them. For me, Bradley is one of those leaders. He has a keen sense of another’s skills and how to use those skills to the benefit of the organization. How many leaders try to make us what we are not? Instead, Bradley as a mentor finds the perfect balance of enhancing already-strong skills in an individual whilst strengthening weaker skills where needed for success. He understands the need for intrinsic motivation, and helps employees tap into those motivators to increase drive and setting goals. This produces a team structure and talent base that consistently exceed expectations. I benefited greatly while reporting to Bradley, taking advantage of his guidance, mentorship and empowerment. He is a true people leader.

Elaine

Bradley is one of the most fearless and thought provoking leaders I’ve ever worked with. Bradley is an expert in value based care and an experience clinician. I’ve worked closely with Bradley on numerous accounts and also on the leadership team for Signify Health’s black employee ERG. He’s organized, a natural leader and a forward thinker. Bradley also exhibits excellent supervisory skills. He has the able to get the best out of his employees and makes them feel worthy.

Tristan

I have had the privilege to work with Brad for the last three years. He has been both a mentor and a colleague. He has a rare ability to inspire his staff to achieve more than I have ever seen in my 20 year career history. He has mentored and led the most successful operational teams across our book of business. This same natural ability to inspire and lead is evident in the transformational leadership he has achieved with many of our strategic health system clients. Brad has a perfect blend of a humble nature, mission driven passion, and healthcare knowledge. This makes him a highly respected and sort out resource. Its an honor to work with him.

Tonya

Employee Evaluation Signify Health

Bradley Plantin Employee Evaluation Signify HealthDownload

Commitment to Health Education Profession

At West Virginia State University I would be interested in pursuing the Masters In Public Administration.  Having this advanced degree would position me for roles in the public sector such as a Program Director, Program Coordinator and Program Manager.  I believe with my background in Nursing, and my Bachelor of Science Degree in Allied Health Leadership and upcoming Bachelor of Science Degree in Community Health Education this advanced degree would fully complement my skill set and educational portfolio.  At the University of Charleston I would be interested in the MPAS-Masters Physician Assistant Studies.  As a youth, my dream was to become a Physician’s Assistant. I ultimately became a nurse, but the dream remains.  I believe I would offer a lot to a Physician Group Practice as PA-C with a background as a RN, as well as my upcoming education in Allied Health Leadership and Community Health Education.  There is a lot of opportunity with the National Health Service Corps to obtain advanced education scholarships to support rural communities once licensed.   

Volunteerism and Internships

Professional Artifacts

Planning Community Health Education

Health Belief Model Case Study

Case Study, a 41 year old African American Male that has a BMI of 33, History of Idiopathic Hypertension,  a 20 PPD smoking history with a strong family history of CVD, Stroke, Cancer, Diabetes and both maternal grandparents died before 70 and mother died at 68.

1. Name the Health Behavior: Cigarette Smoking
2. Individual Perception:  This client has been a lifelong adult smoker. His mother passed away at 68 who was also a lifelong smoker as well.  Even though his mother did not die of a pulmonary illness she too had lifelong hypertension and CVD.  Recently the client went to the physician for a check up and despite being on four blood pressure medications his blood pressure reading at the time of the appointment was 138/82.  This got him to consider that a change needed to be made. 
3. Perceived Susceptibility:  This client remembered learning of the negative impacts to health caused by cigarette smoking such as increased heart rate and increased blood pressure during a college health course.  He also knows that smoking causes heart disease and knowing that longevity does not run in his family he identifies a susceptibility to this disease process.
4. Perceived Seriousness:  The client at 41 is just beginning to enjoy success in his life and he fully understands that if he does not break the chain he too may have a shorter life than the national life expectancy.  Also the client fears that he will also develop diabetes as both parents have that and his sister as well.  The devastation of Diabetes insult on the Cardiovascular system complicated with smoking doubles his risk factors.  
5.   Modifying Factors:  This client works in healthcare and smoking is largely frowned upon.  It is frowned upon so much that the client who is a healthcare employee has to walk across a busy street in rain and winter to smoke during break times at work.  By the time the employee gears up for the weather and goes across the street to smoke his break is over.  
6. Perceived Threat:  While at his physicians appointment, the PCP said that it may be time to see either a cardiologist or a nephrologist to see why the client’s blood pressure was not controlled on a Beta Blocker, ARB, diuretic and calcium channel blocker.  This made the threat very real to the client.  This client has a perceived barrier in the fact that his remaining family that is still alive still all smokes as well and his social supports also smoke cigarettes. 
7. Cues to Action and Likelihood of taking Action:  This clients cue’s to action are the fact that his hypertension is not responding to normal pharmacological interventions thus he is looking at health decision making changes to assist in this process.  The client has talked with his sister and his best friend who all three smoke and they are willing to take the challenge together and be each other’s support system.  So the client has weighted his perceived benefits against his barriers and due to the overwhelming support of his sister and best friend to join as social supports he has adopted the likelihood of taking the action. 

Transtheoretical Model of Behavior Change.

The Transtheoretical Model 

Teenage Smoking in Middle School
What is the best approach to determine the stage of change?	Because so many young people are peer pressured into taking on detrimental health habits, I would prefer to do individual interviews.  During the individual interviews I would be able to assess not only individual influences to smoking such as anxiety or stress, but also social institution influencers such as the school, family and peer groups.  The teens may be more willing to open up and discuss these issues in a one to one interview environment with an interviewer trained on Motivational Interviewing techniques.
What is the best education method to facilitate decisional balance?	For this educational method, I would use Role Playing.  Through this construct I would also be able to analyze the teenagers ability to take on the concept of Mead’s Generalized Other.  Thus using the same social forces of peer pressure in the middle school environment use the role play as a series of vignettes to have the students convince and persuade each other that the pro’s of quitting smoking far outweigh the cons.
What is the best education method to facilitate self-efficacy?	Within this construct for this age group I believe I would use a video with a credible role model.  Children at this age are very influenced by pop culture and social media influencers.  I would locate and procure a celebrity video that speaks to how they overcame cigarette smoking (who, what, when, where why and how).
What is the best educational method to facilitate overcoming temptations?	Within this construct I would again use the Role Playing model.  Because children in this age group may not legally purchase cigarettes, their chances of first smoking or continuing to smoke are precipitated by negative social situations.  I would role play with them how to either avoid these negative situations such as sneaking out back of the school house during lunch, or setting boundaries with friends that smoke.
What is the best education method to facilitate consciousness raising?	Within this construct I would do two things to meet a discussion with feedback for consciousness raising and also see dramatic relief below.  I would coordinate a community service activity and have the teenagers volunteer at a COPD lung clinic for a day.  Helping check in patients, or help them walk into the clinic with their oxygen tanks etc.  Then I would have a round table discussion with them at the end of the day with a pulmonologist to show them pictures of what smoking does to the inside of their lungs and what their prognosis will look like if they continue to smoke.
What is the best educational method to facilitate dramatic relief?	In the same session after the pulmonologist talks I would then bring in two patient volunteers to talk about when they started smoking and what their life is like living hooked up to oxygen 24/7.  After this, the students’ homework will be to do a 1 page essay about how living with COPD and oxygen would destroy or alter their dreams of what they want out of life.
What is the best educational method to facilitate self-reevaluation?	For this education I would do a discussion about values.  This is an important time as many values are being instilled into young people during this age range.  One definition of value is what is important in one’s life.  Through this process I would like for the youth to be able to see the benefit of weighing the risks of unhealthy behaviors against their value positions.  This should be a tool that they would be able to apply to any situation throughout their life.
What is the best educational method to facilitate environmental reevaluation?	For this education I would use both empathy training and values clarification.  I would begin by surveying the group to determine how many of them want to be parents when they grow up.  Then I would share with them research on the impact of second hand smoke or now known as Environmental Tobacco Smoke on children and other non-smoking family members.
What is the best educational method to facilitate self-liberation?	Within this construct I would have the group make a commitment to themselves publicly that they will support each other.  That to error is human and that if one of them backslides to their commitment that they will hold each other accountable to recommitment.  This goes back to the concepts of the generalized other and working again within the constructs of peer pressure that is naturally occurring within this age group.
What is the best educational method to facilitate helping relationships?	For this construct, I will pretend that I have already successfully launched a smoking cessation program at an upstream highschool and have highschoolers that have completed the program and have quarterly nicotine screens that are negative act as cessation mentors.  I would create a buddy system where these middle school kids can come up to the high school and participate in learning activities and model behaviors of the “big kids”.
What is the best educational method to facilitate counterconditioning?	For this process of change, I would first have to assess at what level the youth are at with Nicotine Addiction Stages I-IV to better align my intervention stratgies.  Stages I-II would require replacement activities for them to seek out, Stages III-IV would require more intensive counterconditioning and even perhaps permission from their guardians for nicotine replacement to help with cravings etc.  With all groups I would teach guided imagery, mindfulness and progressive relaxation.
What is the best educational method to facilitate reinforcement management?	For this process change, I would have a reward system funded by the school system that included a field trip to Cedar Point at the end of the year.  However, once the students signed the contract to participate they must adhere to random nicotine mouth swabs to maintain compliance in the reward program.  More than one positive nicotine mouth swab test would disqualify them from the reward trip to Cedar Point at the year’s end.
What is the best health promotion method to facilitate stimulus control?	Within this process change, I would also have gained an insight into their family smoking behaviors during that initial 1:1 interview.  Interventions would be designed to teach these youths how to talk to their families about Environmental Tobacco Smoke.  Many times, youth are change agents to make their entire families more healthy.  Also, the youth would have T shirts made that they can wear at school.  On the front would be two clean pink lungs.  On the back, smoke and soot filled lungs with the words, “What’s in your lungs?”  Lastly, the youth would have Social Media banners that affirm their commitment to a smoke free life.
What is the best health promotion method to facilitate social liberation?	Because the theory is relaxed in its application of where this fits best, I see it best in the action and maintenance phase for smoking cessation as it relates to advocacy and empowerment. Many people will backslide with smoking, yet if they are advocating for others interest and health it will keep the values in line with their own health and behavior practices. I would have the youth work in Community Activism at the American Lung Association.

Precede-Proceed

Phase 1 Social Assessment

Through a variety of methods such as Polls, Surveys, Interviews and Focus groups I would determine what, if anything, is causing concerns among women 30-60 in Kanawha County WV.  (Surveys would be sent out through email, US mail through contacts through women’s organizations.  Polls would be done through Facebook and other social media outlets and Interviews would be conducted at the Health Fair at the Civic Center.)  Upon evaluation of that information I found that a significant percentage of the female population, between the ages of 30-60, were concerned about being diagnosed with Breast Cancer.  (I now need to know if this is a valid concern for these women) Because of this information I can now move on to Phase 2.

Phase 2 Epidemiological Assessment.

Causative Factors Genetics, Behavior and Environment

Descriptive Epidemiology (Time, Place and Population) attributes through mortality, morbidity and disability rates

Analytical Epidemiology (determinants of health). (Behaviors and Environments)

• For the Epidemiological Assessment to narrow down my search for the County of Kanawha for the State of WV I would use the WV Health Atlas a tool within the WV Department of Health and Human Resources to use data from Vital Statistics and the WV Behavioral Risk Factor Surveillance System (WVBRFSS).  https://www.wvdhhr.org/bph/hsc/statserv/HealthAtlas.asp
• From Vital Statistics I can find the mortality rate of Breast Cancer for Kanawha County.
• Some of the known Risk Factors for Breast Cancer are Exposure to high dose of radiation, early menarche, late menopause, no pregnancy, 1st birth after 30 years of age, a diet high in animal fat, high alcohol consumption, hormone replacement therapy and obesity.
• From the  WVBRFSS I can narrow down to modifiable risk factors for this age group 30-60 such as diet, alcohol, HRT, and obesity.

Phase 3 Educational and Ecological Assessment. 

Predisposing Factors (antecedents to behavioral change to motivate change=knowledge, beliefs, attitudes, values, perceptions). 

Enabling Factors (antecedents to behavior change availability of resources, accessibility, laws, legislations, skills). 

Reinforcing Factors (continuing reward for sustaining behavior such as family, peers, employer, health providers). 

• Predisposing Factors.
  • Assesses Need for Knowledge=Mammography Education and American Cancer Society Guidelines for screening. 
  • Assess Need for Beliefs=Listening Circles with Survivors of Breast Cancer about the importance of early detection and self care.  
  • Assess Need for Attitudes=Education with a Family Nurse Practitioner about the importance of and correct way of doing an at home monthly breast self examination.
  • Assess Need for Value and Perception= Education with a female GYN about the importance of the female request a Clinical Breast Examination at least every three years between 20-40 and then yearly thereafter. 
• Enabling Factors
  • Assess resources=Mammography services, locations, mammography for low income or underinsured patients.
  • Assess for accessibility=Is mobile mammography offered.  Do worksites offer mobile mammography.  Do senior centers offer mobile mammography?
• Reinforcing Factors.
  • Assess Need for Community, School, Religious and Worksite sponsorship to support women to continue to stay involved in breast self care and cancer surveillance such as Cancer Walks, listening circles, survivor celebrations.  

Phase 4 Administrative and Policy Assessment and Intervention Alignment.

Priorities, resources, barriers, policies, (time, personnel and budget). 

• Because this is a grassroots community organizing public health initiative we must ensure that we have the correct “gatekeepers” aligned with our program.  These gatekeepers, are the power brokers of the community and understand it’s internal functions and how to accomplish goals within the community. 
• We need a steering committee established with those gatekeepers, key religious leaders, industry leaders, health department, local physician leaders in gynecology, area hospital leaders and local government. 
• We need a CHES to be stakeholder leading the steering committee to ensure application of Health Education and Health Promotion Theory is the cornerstone of the work. 

Phase 5 Implementation

Program, Implementation Organization, Political Milieu, and Environment. 

• Kickoff Program at Magic Island with tents from local companies such as CAMC, Thomas Health, YWCA, Bonnie’s Bus, Breast Cancer Support Groups, fun activities for the whole family to enjoy so that women and men can come and enjoy. Also each hospital to have a service provider tent where women who do not have a GYN or PCP can find a provider who is accepting new patients.
  • 8 Free weeks of healthy cooking classes from a Registered Dietician.  How to make healthy foods that the whole family will enjoy that they will not even know they are eating healthy. 
  • 8 Free weeks of classes from an LPC about alcohol consumption.  What is and is not alcoholism and why people drink.  Healthy alternatives to drinking after a stressful day at work or with the family such as mindfulness or meditation. 
  • 8 Free Weeks of aerobics classes at YWCA that also teaches busy women home workout programs that they can do when they are too busy to get to the gym.
  • 8 Free Weeks of Mammography Education and American Cancer Society Guidelines for screening. Taught by CHES. 
  • 4 weeks-biweekly=Listening Circles with Survivors of Breast Cancer about the importance of early detection and self care.  
  • 2 events 1 per month Education with a Family Nurse Practitioner about the importance of and correct way of doing an at home monthly breast self examination.
  • 1 time wrap up event Education with a female GYN about the importance of the female to be self advocate and request a Clinical Breast Examination at least every three years between 20-40 and then yearly thereafter from their PCP or GYN. 
  • Weekly mobile mammography clinics advertised for women that do not have access to transportation or do not know where to go to obtain a mammogram.
  • Local Industry leaders such as Chase, BBT, Dow, CAMC, Thomas Health etc. should offer mobile mammogram days where women during work hours can schedule time to get their mammograms done if they are overdue. 

Phase 6 Process Evaluation. 

Roadmap Review, Scorecard Review, Reception of Program Reviewed, Response of Person Implementing the Program Reviewed, Competency Assessment. 

• Review the roadmap and see what all got accomplished.  If things were not accomplished review with the steering committee and especially the gatekeepers and find out what can be done better to overcome the barriers. 
• Send out a questionnaire to the participants of the litening circles and the self care classes to assess how beneficial the courses were.
• Assess the CHES and get their feedback on the program and outcomes. 
• Assess the competency of those in this pilot and if a grant is obtained for future work what competencies are needed to ensure successful ongoing work in this area.

Phase 7 Impact Evaluation

Immediate effect of the program on its target behaviors or environments and their predisposing enabling and reinforcing antecedents.  

• This is an 8 week program and was based on concerns brought forth by the female citizens of Kanawha County aged 30-60 regarding breast cancer.  In this program we looked at data from Vital Statistics and WVBRFSS and determined that we had both independent and dependent variables.  We determined that the modifiable risk factors for these age groups were their increased fatty diet, alcohol consumption and obesity.  Based on this information we built a program to impact the antecedents of behavior change which are awareness, information, knowledge, skills, beliefs, attitudes and values.  To evaluate the impact of this program based on its brevity the best course of action is to elicit the participants feedback by way of behavior change from telephone surveys status post completion of the program.  

Phase 8 Outcome Evaluation

Assessment to mortality, morbidity and disability and quality of life concerns are assessed. 

• Due to the brevity of this program we will not be able to evaluate impact against mortality and morbidity statistics.

Assessment of Community Needs

A Review of the Community Health Needs Assessment 

Community Medical Center 

Robert Woods Johnson Barnabas Health

Toms River, New Jersey

Author Bradley Plantin 

December 7^th, 2021

Healthcare is local.  I have the pleasure to work as an Executive Operations Lead for Signify Health.  At Signify Health, we focus on transforming the process of care for each patient experience to ensure that more healthy happy days can be spent at home and not in the hospital.  In this role, I get to interface with some of the largest health systems in the country.  Recently, I was assigned to work with Robert Wood Johnson Barnabas Health (RWJBH) which is a ten-hospital nonprofit regional health system in New Jersey.  While taking this course on Needs and Capacity Assessment Strategies, I learned that all nonprofit health systems are required to complete and publish a Community Health Needs Assessment every three years. This review is on how RWJBH has modeled its Community Health Needs Assessment based on the MAPIT framework and used other key features of the Needs and Capacity Assessment Strategies for Community Health Improvement. 

According to Ahearn et al. (2019),      

Community Medical Center (CMC) and the Barnabas Health Behavioral Health Center (BHBHC), both in Toms River, New Jersey, have jointly collaborated to develop this CHNA. The CMC/BHBHC Community Health Needs Assessment (CHNA) is designed to ensure that the facilities continue to effectively and efficiently serve the health needs of their service area. The CHNA was developed in accordance with all federal rules and statues, specifically, PL 111-148 (the Affordable Care Act) which added Section 501(r) to the Internal Revenue Code. The CMC/BHBHC Needs Assessment was undertaken in this context and developed for the purpose of enhancing health and quality of life throughout the community (pg. 1).

The RWJBH Community Medical Center (CHNA) is a two hundred- and sixty-two-page assessment that follows the MAPIT format.  First this assessment addresses the review of secondary data.  The CHNA then follows with a review of the primary research conducted through focus groups and surveyed community members.  The next section of this CHNA discusses priority setting and plan development that then flows into the communication plan down to the community constituents.  The last section of this CHNA covers both the implementation and evaluation of the strategic initiatives with SMART goals to evaluate the effectiveness of the Community Health Improvement Plan.

MAPIT is an anacronym that stands for (Mobilizing, Assessing, Planning, Implementing and Tracking).  It is a planning model to develop healthy communities as endorsed by the USDHHS Healthy People initiative (Gilmore, 2012). This is the planning model used by RWJBH as they have referenced Healthy People 2020 throughout this assessment as well.  

According to Ahearn et al.

The CMC/BHBHC Oversight Committee considered primary and secondary data to determine three top health issues based on capacity, resources, competencies, and needs specific to the populations it serves. These issues are within the Hospitals’ purview, competency and resources to impact in a meaningful manner: chronic disease prevention and management, behavioral health: mental health and substance use, and cancer (pg. 1).

Forming an oversight committee and or steering committee that has a hospital partner as a stakeholder is imperative to the success of a Community Health Initiative.  As the capacity of the community is assessed many times the hospital is one focused area with many resources from medicine and allied health to meet the needs of the community.  According to Ahearn et al, (2019) The CHNA uses detailed secondary public health data at state, county, and community levels, from various sources including Department of Health and Human Services, Centers for Disease Control and Prevention, Census Bureau, Healthy People 2020, the County Health Rankings, and hospital discharge data, to name a few (pg. 2). 

After a thorough review of the secondary data and health risk of the community surrounding Community Medical Center, the committee began its primary research.  

According to Ahearn et al. (2019) 

In order to obtain a service area-specific analysis for the CMC service area, on-line survey Interviews were conducted among 369 residents of the Hospital’s PSA. Interviews were conducted online and by telephone. A link to the online survey was displayed on hospital web pages and social media sites. Additionally, postcards were handed out at area businesses and libraries, directing residents to the online survey link. A telephone augment was conducted to capture additional interviews in specific areas and among specific ethnic groups. For the telephone portion, a representative sample of households was generated from a database of residential telephone numbers. Bruno and Ridgway Research Associates, Inc. administered the on-line and telephone surveys from August 6 to November 2, 2018. Survey results are incorporated into this CHNA (pg. 4). 

The committee overseeing this CHNA also hosted focus groups to lean into more qualitative data of the dynamic health needs of this community.  

After both reviews of secondary and primary data the Steering Committee began to rank each health threat identified in the community.  According to Ahearn et al (2019), 

The health risk identified in this community where Mental Health, Chronic Disease Management, Cancer, Access to Primary Care, Chronic Cardiac Conditions, Diabetes, Substance Abuse, Food Security, Maternal/Child Health, Insurance Coverage, Health Education/Service Awareness and Transportation.  A ballot was developed, and a survey sent to members of the Oversight Committee asking them to rank each issue based on the following criteria. Number of people impacted; Risk of mortality and morbidity associated with the problem; Impact of the problem on vulnerable populations; Meaningful progress can be made within a three-year timeframe; and Community’s capability and competency to impact.  As a result, the top three priority areas selected were: Chronic Disease Prevention and Management; Behavioral Health: Mental Health and Substance Use and Cancer (pg. 4).

Following this work the Steering Committee did a full inventory of the gaps and assets of this community and outlined SMART Goals and Strategic Initiatives to address all of the health barriers of this community.  Reviewing this Community Health Needs Assessment Process at Robert Wood Johnson Barnabas Health for Community Medical Center has been imperative to my learning in this course.  I was able to successfully identify and comprehend not only all the component parts and pieces of this process but also the adjuncts tools that we learned in this course around focus groups, surveys and SMART goals and planning.  

References

Ahearn, P., Bonacorso, D., Bryant, N., Case, B., Fitzsimmons, S., Flaherty, J., et al. (2019). Community health needs assessment:  Community medical center.  Accessed on December 6, 2021 from https://www.rwjbh.org/documents/community-health-needs-assessment/CMC-CHNA-1219.pdfGilmore, D. (2012). Needs and capacity assessment strategies for health education and health promotion (4^th ed.). Burlington, MA:  Jones and Bartlett Learning.

Diversity, Equity and Inclusion in Community Health

Can you see through the lens of implicit bias?

The Tuskegee Study of Uncontrolled Syphillis in the Negro Male was initiated in the Black Belt of Alabama during the Great Depression.  Specifically, the study was under the directorship of the United States Public Health Service (USPHS) and targeted 600 black males in Macon County, Alabama beginning in 1932.  This unethical research was a foil for the observation of the pathophysiology that occurs during the various stages of Syphilis up to and including death and post mortem. The foil was that it was presented to the unknowing participants that they were receiving treatment for “bad blood”.  In fact, the participants were all receiving placebos while being placed in risk filled procedures such as spinal taps and x rays.  Perhaps, the most insensitive treatment was the offer of free burial for the right of autopsy, so that the researchers could map and catalog the extension of the disease into the body.  

To best understand the outrage of the American citizenry to this assault and unethical treatment of Black Americans, we must first look to the causation of implicit bias and the history of racism and health in this country. As Washington (2007) related, racism for 400 years has advantaged and sustained power for the privileged.  Healthcare delivery to black Americans had been issued as a guise for years to the advancement of medical and surgical technology.  Black bodies were prized, not for the beneficence and altruism of helping a minority race, but for the work, manipulation and research to be obtained from them.  The examples of the medical assault and commodification of the black body are profane from the mutilation of the black female womb by the hands of Dr. James Marion Sims to the stealing of Henrietta Lacks immortal cells. Yet, none of these offenses stand alone, They are yoked and intersected into the fabric of the common constructs of the time “scientific racism”. Scientific Racism had been posited for many maltreatments of the black race since slavery, emancipation, reconstruction and the Jim Crow south, which held that the black mind was inferior, black body was predispositioned to hard labor, and that the black community was overtly sexual.  

Under the constructs of scientific racism and its plethora of fallacies, The United States Public Health Service set out to do this study in the Black Belt of Alabama originally due to its high percentage of active syphilis cases amongst black males.  The fallacy is that they believed or perhaps implicit bias had preconceived them to posits that these black males were not fortified to seek care on their own volition.  Therefore the researchers believed through implicit bias that this “Study in Nature ” was merely just an observation of the natural order of selection.  The most terrifying fact of this is that not only was this study deceptive, but after penicillin was widely used in 1947 to cure and treat syphilis, the USPHS was blocking access to care for these men.  They did this by sending a do not treat list to local doctors in Macon County as well as preventing the enlistment of these men into the armed forces.  This last point is significant as the US Armed Forces routinely screened and treated positive enrollees for syphilis with penicillin.  Then when you consider that the USPHS was under the order and the mandate of the Henderson Act of 1943 to screen and treat venereal diseases in the United States you see the full corruption that existed in this study.  Even after it was well known that Penicillin was the cure and treatment for Syphilis, the researchers continued to falsely claim that these study participants were beyond the efficacy of treatment.    

Beyond the constructs of “Scientific Racism” these researchers were in violation of the ethical domains of medicine, beneficence, nonmaleficence and distributive justice.  As Morrison and Furlong (2019) informed, the Tuskegee Syphilis study from 1932 until 1972 violated the tenets of Informed Consent under various standards of research.  If the researchers truly believed that the participants had inferior intellect then the participants did not have capacity and competence to understand the treatment in regards to risk versus benefits.  Also, they violated the voluntariness of the study by enticing the participants during the Great Depression to benefits offered by nurse Eunice Rivers such as free transportation, free food, free “medical care” and burial benefits.  These benefits obstructed a clear decision making process of deciding to participate on their own terms, beliefs and feelings by dangling the proverbial carrot of Maslow’s hierarchy of basic needs.   These researchers violated the process of disclosure by not informing the participants of the legal and ethical aspects of the study.  Lastly, they violated the process of authorizing the treatment plan and procedures.  

From this dark stain on the history of the United States came such reforms as the National Research Act of 1974, which established the Office for Human Research Protections.  This law created Informed Consent and the Institutional Review Boards that exist today in academia and medical facilities.  

Unfortunately, Systemic Racism continues to this day and most recently the CDC (2021) made a declaration that “Racism is a system, consisting of structures, policies, practices, and norms that assigns value and determines opportunity based on the way people look or the color of their skin. This results in conditions that unfairly advantage some and disadvantage others throughout society”.  These unlawful and unethical practices continue today through systemic racism, implicit bias and colorblind racism.  You do not have to look too far to see the exceptions to Informed Consent in our nation’s medical centers that are located within marginalized communities and their Emergency Departments. The purpose of this research is to show the multicausation of adverse health outcomes of black and brown people.  The multicausation sits with the matrix of domination and implicit bias.      

Literature Review

The literature abounds with reference to systematic racism, the matrix of domination (race, class and gender) and the particular ethical implications for healthcare providers.  Because human beings deliver healthcare and humans are imperfect, there is a specific need for education and enforcement around ethical decision making and the role implicit bias plays into making decisions.

The matrix of domination (race, class and gender). 

Cockerham (2017) posited that the adverse health outcomes of Black Americans is from socioeconomic factors and not biological.  Blacks and Latinos are more likely to have decreased life chances due to poverty, marginal employment, low incomes, segregated neighborhoods and unequal access to higher education.  The daily stress of living in these neighborhoods is linked to worse health.  Ultimately, race is important in a causal sense for health is its close association with class circumstances.   Yet, the concept of race and health does not stand alone from a socioeconomic causation.  It is a convergence of biological factors imposed onto those persons living in geographic areas with variables of culture, economic and political influence inflicted by those in power.  In fact, research has shown that just the awareness of racism is associated with poor physical and mental health. Even when the threat of racism is not overt, just the subtle exposure overtime can wear down the body’s physiological defense system and lead to disease and illness.   Andersen and Collins (2020) related that most important is the fact that race, class and gender are systems of power to produce inequality.  These systems of power are embedded in all social institutions, including healthcare.  Together all these systems of power interlock to advantage some and disadvantage others.  The binary holds true here to create those in power and otherness.    

The ethical implication for healthcare providers.

Morrison and Furlong (2019) related that systematic health inequality is found where two or more populations are impacted and we see this occurring not as the result of random variation.  Once this occurs these health inequalities become termed health inequities. These health inequities are a normative term that refers to a difference that society judges to be morally unacceptable.  This creates a problem in that morals are not universal throughout societies and cultures.  Determining whether a particular inequality constitutes an inequity requires a moral judgment based on beliefs about justice, fairness, and distribution of social resources.   Health inequities exist in populations that have suffered from international military and economic exploitation, inequitable distribution of economic resources, or historical patterns of race based economic and social injustice.  Cottrell et. al (2018) depicted in healthcare that people come to work with different personal experiences, thus their values and morals may not be congruent.  Therefore the application of ethics based decision making should be at the center of healthcare delivery.  Goodness and rightness is not an abstract, but should be valued in all human interactions. Because of this the ethical guideposts for healthcare are beneficence, nonmaleficence justice.  Beneficence implies doing good, demonstrating kindness, compassion and helpfulness.  Nonmaleficence is doing no harm.   Principle of justice is treating other people fairly and justly in distributing goodness and badness.

Implicit bias and decision making

Eberhardt (2019) illustrated that all people have implicit bias and that it is both biology and social.  All people have preconceptions about race and these are powerful enough to impact decision making, memories, actions and intentions.  The preconceptions are shaped by stereotypes that humans are exposed from birth to death. In fact the other race effect is bidirectional.  The human brain is much better at recognizing the faces of the same race, thus likeness and familiarity is both a function of social life and biology.  The fusiform face area in the brain registers this sense of familiarity.  Throughout human evolution the process of categorization was paramount to human survival.  Identification of one’s clan members led to safety.  However, this evolutionary process of categorizing people for safety leads to bias. People seek out these categories first to confirm their beliefs but this leads to the concepts of us versus them.    

 Discussion 

All people fall to the shortcomings of implicit bias.  The challenge here is to ensure that healthcare providers are given the best education possible to reconstruct their knowledge.  Stereotypes abound and subliminally they are absorbed into all of us unknowingly.  Through the social and evolutionary construct that is implicit bias, we must challenge our social frames and what we have learned.  In doing this we are more likely to uncover these implicit biases that predicate fallacies harmful thinking and propel the matrix of domination.  Much like the researchers of the Tuskegee Study thought through a lens of implicit bias that these black males did not have volition to seek care, we too must continually check ourselves for fallacy of thought.  If we check our preconceptions for implicit bias we may slowly be able to reframe exclusionary thoughts such as racism, classism, sexism and ageism.  Until then, the role of ethical decision making in healthcare will remain paramount because after 400 years the assaults continue.  

 References

Anderson, M., Collins, P. (2020). Race, class, gender: Intersections and Inequalities (10th ed.). Boston: Cengage Learning

CDC Office of Minority Health.  Accessed on April 28th, 2022 from https://www.cdc.gov/healthequity/racism-disparities/index.html

Cockerham, W. (2017). Medical Sociology (14th ed.). New York: Routledge.

Cottrell, R., Girvan, J., Seabert, D., Spear, C., McKenzie, J., (2018).   Principles and foundations of health promotion and education. (7th ed.). New York: Pearson. 

Eberhardt, J. ((2019). Biased: Uncovering the hidden prejudice that shapes what we see, think and do.  New York: Viking. 

Morrison, E., Furlong, B. (2019) Health care ethics:  Critical issues for the 21st century (4th. ed). Burlington, MA:  Jones and Bartlett Learning.

Washington, H. (2007). Medical apartheid: The dark history of medical experimentation on black americans from colonial times to the present.  New York: Doubleday.

Technology and Social Marketing

Leadership Philosophy

Strategic Planning

Albert Einstein: The definition of insanity is doing the same thing over and over and expecting different results. 

Now more than ever in our professional careers, we in healthcare are challenged to think about things in ways that have never been done before.  All throughout our lives of school and early careers our success was determined by doing exactly as we were told.  However, strategic thinking requires us to think about change and adaptation.  For those that have children or are around children the proverbial why is exhausting.  However, in the mindset of Strategic Thinking it is imperative.  Why do we do it that way?  We must unpack existing processes to uncover inefficiencies and better processes that lead to lean business practices that are effective, efficient and efficacious.  

Take time to listen and observe.  Creative and transformational thoughts are sometimes heard when we take time to listen.  At times the best ideas have been overlooked and may be viewed as unpopular.  This is why Tuckman’s Model of Group Dynamics is imperative to master within the realm of healthcare.   One of my favorite cartoons depicts two executives sitting in a boardroom.  One executive says to another.  “That is a wonderful idea, however, we just can’t do it because it has never been done before”.

The components of the strategic plan!

The Vision : Dorothy knew she had to get to the Wizard of Oz.  Despite her perils she knew she had to follow the yellow brick road.  Your vision must guide you down the road.  Be clear about what you will do and what you will not do.  Do not get off the path, as that violates the plan.  

The Goals  SMART goals are commonly used.  SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound).  

Tactics  How do you do the voodoo that you do?  When I was the partner lead at my current job for  Beaumont Health,  I sent them a weekly email every Friday called Beaumont Better by the Week!  In this email I highlighted the concrete activities “tactics” that we had completed that week that got us closer to our goal which therefore was driving our strategy and thus actualizing our vision!  The tactics are your process steps in your strategic plan.  The things you will do, “processes”. 

Decision Making in Healthcare today should be based on the foundation of the Interdisciplinary Team.  Most healthcare professionals today hold terminal degrees in their fields of study, therefore their input and contributions should be sought.  Decision making should be a triangulation of both quantitative and qualitative methods.  There are various decision making models and theories that can be employed in healthcare.  There is the Total Quality Management, Kaizen theory and the Shewhart Cycle.  Especially beneficial for healthcare operations is the Shewhart Cycle or the PDCA.  The plan-do-check-act cycle is efficacious in healthcare as there must be ongoing inspections of the expectations of the delivery of healthcare.  

Knowledge, Skills and Abilities (KSA) never stops in healthcare.  Healthcare is not a static industry.  There are always new technologies, tests, treatments and rules and regulations that require the healthcare institution to keep an active continuing learning environment established.  When I was a hospital nurse, each unit had a dyad model of leadership.  The Unit Manager was the administrative leader.  But each unit also had a clinical manager.  The Clinical Manager’s role was to ensure that continuing inservicing and job shadowing was completed with each nurse and nurses aide regularly.  This ensured that effective, efficient, efficacious and most importantly safe care was delivered to each patient each and everyday! 

You can’t really know where you are going until you know where you have been.” – Maya Angelou

Reference

Ledlow, G., Stephens, J. (2018).  Leadership for health professionals: Theory skills and applications (3rd. ed.). Burlington, MA:  Jones and Bartlett Learning.

Sociology of Business

Both the Social Exchange Theory as well as the Goal Setting Theory are pragmatic theories to assist the healthcare leader combat worker alienation.  Worker alienation is a construct developed by Karl Marx to explain the particular dichotomy between human individualism and working under capitalism.  As Ritzer and Stepnisky (2018) depict “We no longer see our labor as an expression of our purpose.  There is no objectification.  Instead, we labor in accordance with the purpose of the capitalist who hires and pays us.  Rather than being an end in itself-an expression of human capabilities-labor in capitalism is reduced to being a means to an end: earning money.  Because our labor is not our own, it no longer transforms us.  Instead, we are alienated from our labor and therefore alienated from our true human nature” (p. 53).  

The construct of worker alienation is broken into four parts.  As Ritzer and Stepnisky (2018) illustrate, workers are alienated from their productive activity.  They do not produce based on their own ideas, needs and wants, but in return produce based on what the capitalist sees fit.  Secondly, the worker is alienated from the product itself.  The product of their labor does not belong to them, but rather the corporation.  This is even true of intellectual products created while under the employment of a capitalist.  Thirdly, the workers are alienated from other workers.  This is seen throughout organizations undergoing diversification and division of labor.  Lastly, workers are alienated from their own human potential.  Meaning work takes up ⅓ of a human day, ⅓ to sleep and so with the previous three issues compounding many workers feel a loss of their own human potential. 

The Goal Setting Theory by Dr. Edwin Locke works to combat worker alienation in several ways.  It posits that workers need clarity, challenge, commitment, feedback and complexity to maintain their motivation in their work.  Therefore this theory may be productive in combating loss of human potential, autonomy of production and division of labor.  For the goal setting theory to work employees must be an integral part of the goal setting process.  So if we think about worker alienation, loss of autonomy over the productivity and loss of ownership of product, if the Goal Setting Theory is enacted appropriately, the employee has some control over their human potential at work. Most organizations fail miserably in the fact that they do not include the employee in the goal setting theory.  This only furthers the divide between worker and the capitalist.  When Dr. Edwin Locke formulated this theory and gave prophetic warnings that the goals of the organization are not the same of the individual.  

The Exchange Theory is a product of George Homans.  Homan focused at the micro level of sociology and in this theory he examines what rewards and costs lead people to do what they do.  As Ritzer and Stepinsky (2018) illustrate, “exchange theory is concerned not only with individual behavior but also with interaction between people involving an exchange of rewards and costs.  The premise is that interactions are likely to continue when there is an exchange of rewards.  Conversely, interactions that are costly to one or both parties are much less likely to continue” (p. 216). This theory is clearing the understanding of compensatory mechanisms to offset the loss of the ownership of the product under worker alienation.  As long as the rewards of work:  income, bonus, and raises outweigh the risks or loss of product ownership the employee may remain at the organization.  However, this theory does not address the other three components of worker alienation such as loss of production autonomy, division of labor, and  human potential. 

To contrast these two theories away from Karl Marx, I will turn to Frederick Herzberg’s Motivating Factors.  Herzberg posits that there are motivating and hygienic (maintenance) factors that keep people employed.  The motivators are work itself, achievement, recognition, responsibility, growth and advancement.  Thus I would place the Goal Setting Theory in the category as a motivator.  The hygienic factors that keep people employed are policy, supervision, working conditions, interpersonal relations and salary.  I would place the Exchange Theory as a hygienic factor.  Both are needed, but standing alone will not keep a person employed.     

References

Ritzer, G,. Stepnisky, J. (2018). Sociological Theory (10th. ed). Thousand Oaks, CA: SAGE.

Syptak, J,. Marsland, D,. Ulmer, D. (1999). Job Satisfaction: Putting Theory into Practice.  AAFP.  Accessed on April 8, 2022 from https://www.aafp.org/fpm/1999/1000/p26.html#:~:text=Frederick%20Herzberg%20theorized%20that%20employee,more%20productive%2C%20creative%20and%20committed.

Great Groups

Hospital Leadership is important to get right as human life, mortality and morbidity sits on either side of scales.  Today, more than ever, healthcare is the second most regulated industry second only to nuclear power plants.  The risk to population health is paramount and thus the high level of regulation.  As Ledlow and Stephens (2018) related healthcare is undergoing white water change.  Within this change encapsulated by the Patient Protection and Affordable Care Act, value-based purchasing, community health needs assessment, ICD-10 coding system, and meaningful use of Electronic Medical Records sits the patient.  Healthcare is moving from quantity to quality. 

To further meet these demands, allied health professionals such as nurses, therapists, pharmacists and dieticians are pursuing terminal degrees within their areas of expertise to be fully complementary members of the Interdisciplinary Team (IDT).  This is also a major shift in healthcare delivery.  Since the establishment of healthcare delivery within the United States, the physician has been the leader.  This shift to an IDT focus has necessitated leaders that are skilled in bringing great groups together and moving them into optimization.  These great groups are not only becoming IDT focused but they are also intergenerational.

This is important to note as Millennials and Generation Z employees entering healthcare as a profession have a vastly different set of expectations of what work and the work organization should do.  Kislick (2022) related that these generations of workers express their feelings more freely at work.  They do this because they expect work for them to be personalized.  Due to this high level of personalization they care deeply about the meaning of their work.  If they do not find validation of their value at work or how their work aligns to the company’s purpose they will not stay at the organization. 

This need of the younger generations of health professionals to be involved in bottom up planning has led me to expand upon my personal belief that the Transformational Leadership Model is the best at coalescing great groups.  Ledlow and Stephens (2018) related that Transformational Leadership must be grounded in moral foundations that inspire teams, take in their individual considerations, stimulate them intellectually, and influence them by ideals.  This model seems best to address the Millenial and Gen Z needs for inclusion, meaning and purpose at work.  

To accomplish the needs above my transformational leadership style would be to create these Great Groups of IDT team members that are intergenerational and assigned by hospital specialty service line.  These great groups would have charters and pilots assigned to them to meet the needs of the organizations.  Under their purview would be some of the classic components of leadership and management such as planning, leading, organizing and controlling. 

Construct of Planning

Under the belief of bottom up planning, I would invest in these Great Groups to work together to make service line specific goals.  These goals would be tied to a strategic plan that by service line determines the departmental resources needed and the precise standards to meeting the goals.  With the understanding that without a margin, there is no mission, these Great Groups would develop tactics that clearly hold themselves responsible as independent operating units.  This ties to the high level of education seen in the IDT as well as addressed the needs of the younger generation to have input and autonomy in decision making.  

Construct of Leading

Within this area these Great Groups would grow as subject matter experts (SME) in their fields.  As an SME they would work within their departments to explain routines, clarify policies and provide coaching, mentoring and continuous feedback to team members on process improvement.  This ties into the construct of Continuous Quality Improvement such as PDCA.  Plan, Do, Check, Act.  

Construct of Organizing

Within this construct I would spin the Great Groups responsibility to form Employee Resource Groups (ERG) by department.  This follows along the theme that younger generations want to voice their opinions and see that their voice matters.  This would not be your typical Human Resources focused ERG, but one that is aligned on the larger needs of a department or service line culture.  As we learned from the DCL, culture takes a long time to impact, but within a hospital you have many cultures existing simultaneously by department and service line.  Culture change can occur at the grass root or bottom up level too. 

Construct of Controlling

The Great Group’s purview in this area will be to review the departments performance to their service line goals.  This is imperative as their goals feed up into the hospital or system level goals.  Doing this allows each unit to have that dynamic, optimized and autonomous voice in quality improvement and process improvement.  This review of their goals against performance standards should be done at least quarterly to ensure time to course correct.  

Reference

Ledlow, G., Stephens, J. (2018).  Leadership for health professionals: Theory skills and applications (3rd. ed.). Burlington, MA:  Jones and Bartlett Learning.

Content Knowledge Health Topics

Explain why heart disease and obesity have complex causes that include social factors.

Perhaps now, more than any other time in human history, we are seeing the impact that Social Inequality has placed on the delicate balance of human homeostasis and equilibrium.  The human being at the pinnacle of the animal kingdom still must exist within the constructs of homeostasis.  The human heart is a muscle and must be exercised to remain healthy.  Also, the human metabolism is one built upon caloric consumption and caloric expenditure.  We have a remarkable system of adipose tissue that over the human evolutionary process has protected the species from starvation.  This protective system allows the human to store fat during times of food bounty while also acting as an energy storage system during times of food precarity.  So, if we think of all other animals, they must be active to survive.  Their activity keeps their hearts exercised and bodies lean and expends calories while in search of the next meal thus maintaining equilibrium.     

To understand better the transition of obesity going from a problem to an epidemic, Cockerham (2017) has written: “CDC reports that the prevalence of obesity rose nationally from 13.3 percent in 1960-1962 to 34.7 percent in 2007-2010 and to 36.4 percent in 2011-2014, with diet (increased calorie intake) and a lack of physical activity being primary risk factors (National Center for Health Statistics 2016)” (p. 41).  The rise in obesity rates in this country directly correlates to the switch from manufacturing jobs to more service and technologically based workforces.  Most adults spend 8-10 hours per day at work if you include commuting time and also 6-8 hours of sleep.  That only leaves ⅓ of the day to devote to the domains of family life and personal interest.  One could argue that the energy expenditures required for manufacturing roles kept obesity rates controlled.  As the American workforce switched to sedentary office-based roles their caloric expenditures dropped.  Also, we began to see a change in American foodways and a switch to high fat and high calorie convenience foods such as the TV dinners, fast food dinners and an abandonment from the traditional American family style meal.  So, to tie this back to metabolic caloric equilibrium the intake has consistently remained higher than the expenditure which has resulted in rising obesity rates. 

The antidote to obesity is found in the Upper Social Classes and Privileged.  Healthy foods are more expensive than non-healthy options.  For example, while grocery shopping this week, I found the price of Fresh Frozen Cod Fillets to be $11.00 per pound whereas the price for Ground Beef 73% Lean 27% Fat to be $2.47 per pound.  Also, affordability to gym memberships and the equity of time to commit to working out is a luxury reserved to the Middle Class and above.  To those that say it costs nothing to exercise, one must look at the built environments of our disadvantaged neighborhoods.  It is hard to walk, play and exercise if that very activity could place one at risk for injury and or death.    Cockerham (2017) explains that “the type of lifestyle that promotes a healthy existence is more typical of the upper and middle classes who have the resources to support it” (p. 66).  

McKenzie, Pinger and Seabert (2018) have explained that “Poor dietary habits are associated with an increased risk for Type 2 diabetes, hypertension, heart disease, certain cancers and micronutrient deficiencies.  In 2011, more than one-third (38%) of adults reported eating fruit less than once per day and nearly one-quarter (23%) ate vegetables less than once a day” (p. 222).  Poor dietary habits with limited access to fresh fruits and vegetables caused by food deserts and most importantly cigarette smoking is a common variable seen in lower socio-economic communities and minorities and their subsequent increase in Heart Disease.  Heart disease was once a disease of the privileged but now it ranks most high in our underprivileged communities and minorities.  Causations of increased obesity and heart disease in these communities are closely traced to their Social Determinants of Health.  Paton (2011) summarizes that:

Lead author of the Oxford University study, Professor Avner Offer, Chichele professor of economic history, said: “Policies to reduce levels of obesity tend to focus on encouraging people to look after themselves but this study suggests that obesity has larger social causes. The onset and increase of large-scale obesity began during the 1980s and coincided with the rise of market liberalism in English-speaking countries.  It may be that the economic benefits of flexible and open markets come at a price to personal and public health which is rarely taken into account”.

One of our greatest challenges lay ahead of us and that is Equilibrium.  Obesity and Heart Disease was once a problem of the elite and powerful thus the saying “They live off the fat of the land.”  However, with the change to sedentary work life, socio-economic status inequities to access and affordability to healthy foods and exercise we have seen a switch of health problems be relayed down from the rich to the poor.  Until there is equilibrium in the Social Determinants of Health, we will continue to see the human race struggle with finding homeostasis and equilibrium within its Health Outcomes.          

References

Cockerham, William C. (2017).  Medical sociology. New York:  Routledge. 

McKenzie, J., Pinger, R., & Seabert D. (2018).  An introduction to community & public health. Burlington, MA:  Jones and Bartlett Learning. 

Paton, Nic. (2011, February 11). Research says that social factors are linked to weight problems. Occupational Health, (359). Retrieved on February 6, 2021 from https://link.gale.com/apps/doc/A323930097/AONE?u=inst15197&sid=AONE&xid=ec4db704

Commitment to Profession

Professional Development Plan

Professional Program Proposal