Question

What is the overall ranking of that county or city in its respective state? Does that surprise you, why or why not? b. Choose an indicator from the Health Outcomes list or the Health Factors list. Look at the most current value for that indicator as well as a past value (you choose the year, can be any from the list of years). Describe what you found. What is the trend and why is it relevant? c. Now compare the most current value of the indicator for your chosen county/city to the state value and to the Top US Performers value. How does the county/city compare and why is that relevant? d. using the Minnesota Wheel briefly describe a potential action/intervention that a public health nurse could take to address the chosen indicator. Discuss which of the three core functions (assessment, assurance, policy development) AND which 10 essential service the action addresses.

Answer 1

a. 2019 was a challenging year for many Americans. The well-being of the average American dropped more in 2018 than in any year.

Health outcomes in the County Health Rankings represent measures of how long people live and how healthy people feel. Length of life is measured by premature death (years of potential life lost before age 75) and quality of life is measured by self-reported health status (% of people reporting poor or fair health and the number of physically and mentally unhealthy days within the last 30 days) and the % of low birth weight newborns.

*According to a Gallup survey assessing different self-reported gauges of well-being, South Dakota ranks as the happiest state. State residents report a particularly high sense of purpose. In the survey, 82.3% of respondents agreed they liked what they do every day, 62.7% believed they have reached most of their goals in the past year, and 75.1% said they get to use their strengths in their daily work -- each the largest share of any state. South Dakota’s healthy job market may help some workers in the state find a job that best utilizes their talents. Just 3.3% of the workforce is unemployed, one of the lower unemployment rates in the country. State residents also rank highly in financial health and community pride.

b.An ideal population health outcome metric should reflect a population's dynamic state of physical, mental, and social well-being. Positive health outcomes include being alive; functioning well mentally, physically, and socially; and having a sense of well-being. Negative outcomes include death, loss of function, and lack of well-being. In contrast to these health outcomes, diseases and injuries are intermediate factors that influence the likelihood of achieving a state of health.

Measuring health in a standardized way that allows comparisons among people, countries, and cultures and over time is challenging. They include methods to assess and classify the health, function, and disability of members of a population, Measures of the distribution of health in and among populations are as relevant as measures of the level of health in and among populations. Understanding the distribution of health can focus attention and action on specific health determinants and population groups to reduce inequalities in health and improve the overall level of health. Although the distribution of health outcomes could be assessed on any measurable geographic, demographic, social, or economic characteristic.

The indicators will be used to assess the health of the Nation, facilitate collaboration across sectors, and motivate action at the national, state, and community levels to improve the health of the U.S. population.

Here I am listing out some of the health indicators.

• Access to Health Services
• Clinical Preventive Services
• Environmental Quality
• Injury and Violence
• Maternal, Infant, and Child Health
• Mental Health
• Nutrition, Physical Activity, and Obesity
• Oral Health
• Reproductive and Sexual Health
• Social Determinants
• Substance Abuse
• Tobacco

Access to health care:

Almost 1 in 5 Americans going Without Health Care. Almost 20 percent of Americans, or more than 40 million adults, can't afford or access needed health care, according to a new U.S. Government report. About 44 million people in this country have no health insurance, and another 38 million have inadequate health insurance. This means that nearly one-third of Americans face each day without the security of knowing that, if and when they need it, medical care is available to them and their families.

The U.S. health care system is unique among advanced industrialized countries. The U.S. does not have a uniform health system, has no universal health care coverage, and only recently enacted legislation mandating healthcare coverage for almost everyone.

c.Length and quality of life vary not only based on where we live but also by our racial/ethnic background. In South Dakota, there are differences by race/ethnicity in length and quality of life that are masked when we only look at differences by place.

In South Dakota, measures of length and quality of life indicate:

• American Indians/Alaskan Natives are most similar in health to those living in the least healthy quartile of counties.
• Asians/Pacific Islanders are most similar in health to those living in the middle 50% of counties.
• Blacks are most similar in health to those living in the least healthy quartile of counties.
• Hispanics are most similar in health to those living in the middle 50% of counties.
• Whites are most similar in health to those living in the healthiest quartile of counties.

Health factors in the County Health Rankings represent the focus areas that drive how long and how well we live, including health behaviors (tobacco use, diet & exercise, alcohol & drug use, sexual activity), clinical care (access to care, quality of care), social and economic factors (education, employment, income, family & social support, community safety), and the physical environment (air & water quality, housing & transit).

d.The Minnesota Model ("The Intervention Wheel") depicts the use of these public health interventions at the various levels of practice. This model is the basis for the framework of the SPHERE (Secure Public Health Electronic Record Environment) system in Wisconsin.

Public health nurses and other public health professionals work collaboratively with communities to create environments that promote health and prevent disease and disability. They use an ecological approach to respond to the needs of the communities and are proactive in program and policy development to enhance the health of populations.

Public health nurses use the Nursing Intervention Wheel to define the scope of public health nursing practice by the type of intervention and the level of practice. Regardless of the site or the population, this core set of interventions represents public health nursing as a specialty practice of nursing.

Public Health Nursing Practice Contributes to the Achievement of the 10 Essential Services Implementing the interventions ultimately contributes to the achievement of the 10 essential public health services The 10 essential public health services describe what the public health system does to protect and promote the health of the public. Interventions are the means through which public health practitioners implement the 10 essential services. Interventions are the how of public health practice (Public Health Functions Steering Committee, 1995).

The three core functions of Intervention wheel:

*Assessment

1. Monitor environmental and health status to identify and solve community environmental health problems
2. Diagnose and investigate environmental health problems and health hazards in the community

*Policy Development

3. Inform, educate, and empower people about environmental health issues
4. Mobilize community partnerships and actions to identify and solve environmental health problems
5. Develop policies and plans that support individual and community environmental health efforts

*Assurance

6. Enforce laws and regulations that protect environmental health and ensure safety
7. Link people to needed environmental health services and assure the provision of environmental health services when otherwise unavailable
8. Assure a competent environmental health workforce
9. Evaluate effectiveness, accessibility, and quality of personal and population-based environmental health services
10. Research for new insights and innovative solutions to environmental health problems

The 10 Essential Public Health Services

The 10 Essential Public Health Services describe the public health activities that all communities should undertake:

1. Monitor health status to identify and solve community health problems
2. Diagnose and investigate health problems and health hazards in the community
3. Inform, educate, and empower people about health issues
4. Mobilize community partnerships and action to identify and solve health problems
5. Develop policies and plans that support individual and community health efforts
6. Enforce laws and regulations that protect health and ensure safety
7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable
8. Assure competent public and personal health care workforce
9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services
10. Research for new insights and innovative solutions to health problems