Healthy People 2020 Objective: Asthma

Healthy People 2020 Objective: Asthma ‘Healthy People 2020’ was launched by the department of Health and Human Services in 2010 with the hope of achieving high standards of life without suffering from preventable diseases, disability, injury and premature death. It focuses on ensuring equity in accessing health by eliminating disparities existing in various groups, establishing social environments that enhance better health for everyone, and advancing better living standards, healthy development and desirable behaviors throughout life. There are almost 1200 objectives under Healthy People 2020 structured into 42 topic areas of significance in the public health sector. One major topic of health people 2020 is asthma..

Asthma Asthma is a chronic respiratory disease that is caused by narrowing and obstruction of the airways. It is characterized by breathing problems which range from mild to life threatening.

Asthma is associated with symptoms such as wheezing, coughing, chest tightness and shortness of breath. The initial onset of asthma cannot be prevented, neither can it be cured. However, the episodic attacks and symptoms can be alleviated by the administration of daily treatment and avoidance of environmental allergens thus enabling asthmatic individuals to lead productive lives

Buy this excellently written paper or order a fresh one from acemyhomework.com

HEALTHY PEOPLE

2

.

Asthma as a Healthy People 2020 objective is classified under respiratory diseases.

Healthy People 2020 aim to enhance respiratory health by the provision of better preventive, diagnostic, disease management and educational services. It is estimated that more than 23 million people in the United States are asthmatic, with yearly expenditure for asthma being approximately $30 billion. This places a burden on individuals, families, employers and the state in terms of health care costs. Because of the resultant strain in the healthcare system for this condition, the burden is extended to the society in terms of higher health insurance premiums, low productivity and higher taxation. There are specific methods that can be employed in the diagnosis, prevention and treatment of the disease to minimize the health burden thus promoting wellbeing (Woodside & McClam, 2011). Under this objective, focus is on reducing asthma deaths, decreasing hospitalization for asthma, and decreasing hospital emergency department visits for asthma. The objective also targets decreasing the percentage of asthmatic individuals who miss school or workdays. It also focuses on increasing the number of asthmatic patients who have access to appropriate care. This is in addition increasing the number of primary health care facilities with comprehensive asthma surveillance system to monitor asthma cases at state levels.

Prevalence Since the 1980s, there has been a rise in the number of asthma cases across all the population groups. More than 8% adults and 9% children are asthmatic. In adults, asthma is more prevalent in females. However, it is more prevalent in male children. Approximately 20% of people suffering from asthma are those below 18 years of age. Across ethnic groups, asthma is more common in African Americans than in Caucasians (Rose et al, 2006). The disparities

HEALTHY PEOPLE

3

across the ethnic groups are attributed to poverty, lack of access to proper medical care, environmental pollution, and residual allergens. A majority of African Americans live in poor neighborhoods and lack adequate access to health care.

Morbidity of Asthma Asthma related cases account for over 25% of the total emergency hospital visits in the United States annually, including about 10 million outpatient visits and almost half a million hospitalizations. An average hospitalization for asthma cases is about 5 days. Children make up to 44% of those hospitalized for asthmatic conditions. Asthma is ranked as one of the leading causes of hospitalizations for children. It is also the major cause of absenteeism in school age children. In adults asthma accounts for over 10 million days of absenteeism from work annually.

The rate of hospitalization for African Americans is three times that of Caucasians (Rose et al, 2006).

Mortality of Asthma It is reported that each day, approximately nine Americans die due to asthma. It also contributes to about 7,000 other deaths annually. Deaths attributed to asthma have generally increased across the entire population with a much greater increase occurring in children. The death rate is higher in women than in men with the rate being significantly higher in African Americans (Woodside & McClam, 2011).

Disparities in the Population Asthma prevalence and death rates across the ethnic groups correlates to poverty index, knowledge levels, and inequality in access to medical care. African Americans are at a greater risk of being hospitalized due to asthma and have the highest mortality rates of all the ethnic groups, with the African American women leading in morbidity and mortality rates. Most

HEALTHY PEOPLE

4

Hispanics live in places that do not meet the established standards of air quality; hence, they are at a greater risk of being in contact to pollutants.

The risk exposure level of Hispanics is higher than in African Americans and Caucasian populations. Puerto Ricans are at higher risk of exposure to allergens and more likely to develop allergies than Caucasians. The incidence rate in Hispanics is lower as compared to non-Hispanic, African Americans, and Caucasians. In spite of this, studies show that the prevalence and mortality rates of asthma are higher in Puerto Ricans than in all other groups (Rose et al, 2006).

This has been related to interaction of genetic and other factors such as exposure to allergens, and inequity in access to health care. Therefore, the epidemiological trends of asthma in the US population show that prevalence differs in the various demographic and economic groups, with prevalence being higher in females, children, the poor, the multiracial, and the Puerto Rican Hispanics. The disparities among the various groups correlate to genetic factors, levels of contact to pollutants, and allergens.

Asthma Statistics in Ohio The prevalence of adults developing asthma in their lifetime is in Ohio is about 14.0 percent, while the prevalence in children is approximately 15.2 percent. Children have problems getting health care, and they have unmet health needs. 20 percent of African American children in Ohio are asthmatic, and they are mostly from poor family backgrounds. In the adult population, those at greater risk are women, black residents, and people with poor education backgrounds.

Employed adults miss 11.8 million work days due to asthma related complications (OFHS, 2008) Literature Review In a study to establish racial and ethnic differences in adult asthma prevalence, problems and medical care, Gorman and Chu (2009) found out that there exists considerable ethnic

HEALTHY PEOPLE

5

disparities in asthma related cases and medical care. The study showed that the prevalence of asthma is high within African American and Native American adults as compared to that in Asian and Hispanic adult populations. The researchers also noticed differences in access to medical care across the various ethnic groups, with the Asians and whites having better health care services than the blacks, Hispanics, and the Native Americans do.

This study was done in 24 states and therefore may not reflect the national status. Since the study relied on self-reported data, the analysis may have been skewed. The study demonstrates that despite the intense efforts to address asthma problems in the Healthy People 2020 objectives, racial and ethnic disparities exist in the population. The differences indicate that more needs to done in the provision of environmental control interventions, promoting adherence to medications, and improving access to medical care. These interventions form the best preventive treatment measures. The community health nurses could help in providing the missing link by enhancing access to health quality care, and promoting adherence to medications.

Addressing the Asthma Epidemics and Barriers to Delivery of Care Asthma care programs are based on the guidelines developed by the National Heart Lung and Blood Institute in line with the goals established under Healthy People 2020 Objectives. The scope of these guidelines includes definitions and implications for treatment, diagnosis, and long term management through surveillance, patient education, control of environmental factors, and therapeutic options (Woodside & McClam, 2011). The guidelines also define management approaches across all the age groups and management in special settings such as in pregnancy.

Despite efforts to improve the quality of care, barriers exist at clinical and non-clinical levels.

The major barriers to quality improvement include underuse of anti-inflammatory drugs and

HEALTHY PEOPLE

6

overuse of short acting rescue medications. There is also low patient compliance to medications, lack of access to primary health care, overuse of emergency department care, lack of coordination in the provision of care, and low medical education.

Preventative programs are used to enhance the quality of life. Epidemiological data are necessary in identifying the cause of the problem, risk factors, prevalence and incidence rates.

Community nurses have a big role to play in managing asthma by implementing primary preventive measures. These primary preventive measures involve mass education or immunization programs. Primary prevention is the basic level and is used with people who have not developed asthma. Community nurses can play a role in stopping the development of asthma by enlightening people about the precursor factors for development of asthma such as the presence of allergens and irritants, hence helping people avoid such conditions (Shuldham, 1998). It is vital for nurses to be able to identify patterns of asthma in the population in order to formulate primary prevention measures.

Identifying risk factors helps in preventing the development of the disease. Nurses can empower community members to take an active role in their health by disseminating health information, encouraging lifestyle changes, and promoting better self care practices. Parents and children must be equipped with skills and information necessary to control the symptoms of the disease. Education increases understanding, compliance and management of asthma (U.S. C.D.C, 1999). Nurses should encourage the use of vacuum cleaners, plastic covers on pillows and bedding to minimize exposure to indoor allergens.

In secondary preventive measures, the community health nurse could help by conducting screening tests such as allergy tests and bronchio challenge in people who have been diagnosed with respiratory problems or asthma like symptoms. This is essential in identification of potential

HEALTHY PEOPLE

7

allergens and irritants that can trigger asthma. These preventive measures could lead to successful early diagnosis, necessitating effective intervention and enhanced prognosis.

Tertiary prevention measures are carried out when asthma has been clearly diagnosed.

They include rehabilitation of disabling conditions by removing offending allergens. It is the last intervention measure aimed at minimizing the intensity and frequency of asthma. At the tertiary level, a community nurse’s role could be implementation of intensive education pertaining to minimizing further complications from the asthma diagnosis. These efforts are important in the identification, minimization, and prevention of further exposure to potential risk factors like dust that may trigger an asthma exacerbation. The nurses could be involved in conducting environmental exposure assessments to evaluate the level of exposure to allergens, controlling indoor pollutants like tobacco smoke, and provision of medical interventions such as the use of anti-inflammatory medications, nebulizers and inhalers (Shuldham, 1998).

Conclusion Programs to improve primary care interventions and care coordination are essential in enhancing better asthma outcomes and improving cost efficiencies. These programs need to focus on encouraging use of controller medications while addressing the ethnic disparities. It is of great importance that the health care services be culturally competent and patient centered in order to enhance asthma self management and adherence to medications. Improved primary care and self-management are very important preventive measures since they help in identification of high-risk patients and factors that trigger asthma. This assists in the reduction of incidences of hospitalization. Dissemination of health information also forms an effective asthma management measure, thus improving asthma outcomes.

HEALTHY PEOPLE

8 References

Gorman, K. B., & Chu, M. (2009). Racial and ethnic differences in adult asthma prevalence, problems, and medical care. Ethnicity & Health, 14(5), 527-552.

Rose, D., Mannino, D. M., David M. B. & Leaderer B. P. (2006). Asthma prevalence among US adults, 1998-2000: Role of Puerto Rican ethnicity and behavioral and geographic factors.

American Journal of Public Health, 96(5), 880-888.

Shuldham, C., (1998). Cardiorespiratory nursing. Cheltenham: Nelson Thomes.

U.S.C.D.C., (1999). “Asthma at a glance," National Center for Environmental Health (NCEH).

Woodside, M. R. & McClam, T., (2011). An introduction to human services. Belmont, CA: Cengage Learning.

Ohio Family Health Survey, 2008.