Healthy People 2020 and Targeted Communication Within Cultural Groups

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The goal of Healthy People 2020 is to provide accessible and comprehensive quality healthcare services for people of all backgrounds. Even though the quality of contemporary medicine has improved, ethnic and racial healthcare disparities are still common in clinical practice. Racial and ethnic minorities make up to 40% of the US population, so the improvement in the health of minorities will respectively enhance the health of the nation (Norris & Nissenson, 2020, p. 112). I have chosen the topic area called Access to Health Services and the problem of chronic kidney disease for the research of disparities related to the issue. The following work will contrast the existing disparities and propose a public health communication strategy aimed at promoting health for every population.

The Access to Health Services topic area explains the importance of healthcare accessibility and describes the steps for its achievement as well as barriers and limitations. Access to health services is defined as “the timely use of personal health services to achieve the best health outcomes” (ODPHP, “Why is Access to Health Services Important?”). According to the ODPHP, “access to comprehensive, quality health care services is important for promoting and maintaining health, preventing and managing the disease, reducing unnecessary disability and premature death, and achieving health equity for all Americans” (ODPHP, “Overview”). The components of the Access to Health services are insurance coverage, services, and timeliness.

Despite the governmental efforts to improve coverage and the quality of care, millions of Americans do not have health insurance coverage. Moreover, there are disparities impeding patient access to quality healthcare such as age, sex, race, ethnicity, education, and income in multiple areas of care, including primary care. The National Institutes of Health defines disparity as a “health difference that adversely affects disadvantaged populations, based on one or more health outcomes” (as cited in Norton et al., 2016, p. 2576). Access to Health Services aims to increase insurance coverage, address the disparities, and adapt to the current methods of healthcare delivery, such as telehealth.

Chronic kidney disease (CKD) is a noncommunicable disorder and a major contributor to premature death. Racial/ ethnic disparities are linked to multiple CKD risk factors including hypertension and diabetes. Hispanic patients are 1.5–3 times more likely to reach end-stage renal disease (ESRD) than the members of the non-Hispanic White population (Norris & Nissenson, 2020, p. 111). Moreover, the Agency for Healthcare Research and Quality reported that during the quality of care measures, ethnic/ racial minority groups demonstrated worsening twice as often as improvement (as cited in Norris & Nissenson, 2020, p. 114). Additionally, Black patients have fewer chances to be considered as candidates for a kidney transplant and receive evaluation compared to their White peers (Norton et al., 2016). Healthcare barriers and negative health outcomes in ethnic or racial minorities might be explained by the disparities currently existing in the healthcare sector.

The causes of disparities related to CKD often depend on factors attributed to a specific population. According to Norris and Nissenson (2020), CKD rates and outcomes for racial/ethnic minority groups are affected by “social position/ exclusion, marginalization, discrimination”, access to care and resources, as well as educational and income inequalities (p. 112). There are other causes of disparities such as “health system barriers, unconscious provider biases, medical mistrust, patient beliefs and behaviors, and stereotype threat” (Norris & Nissenson, 2020, p. 112). Stereotype threat is a recent concept referring to a patient’s fear of negative stereotypes and judgment from medical professionals.

In contrast, the White population does not suffer from health inequality and disparities as often as racial or ethnic minorities. However, White patients receiving hemodialysis have higher mortality rates compared to Black peers. The disparity is possibly caused by racial differences in metabolism and cardiovascular comorbidities in White patients (Norton et al., 2016). Moreover, White patients in the US demonstrate higher rates of early CKD compared to Black Americans. Finally, White veterans with CKD have higher mortality rates than their Black peers. Therefore, disparities in ethnic and racial minority groups are caused by socioeconomic factors, while White patients are mostly affected by specific biological factors.

The Healthcare system should be optimized to eliminate disparities, improve the efficiency of treatment and health outcomes for ethnic and racial minorities. Therefore, there is a need for a public health communication strategy aimed at reducing disparity, removing the barriers, and promoting health for all. The strategy should be based on the culture-centered approach and create the communicative infrastructure for collecting and sharing of knowledge (Dutta, 2018). Social support by healthcare professionals and community members will provide CKD patients with valuable information and resources. Such contributions might help to improve patients’ quality of life and decrease mortality (Norton et al., 2016). Community involvement in the forms of meetings and interviews will also serve as a source of health knowledge and education for all populations preventing stereotype threat and social disparity. Emphasis should be made on joint efforts and effective communication between academic researchers, healthcare professionals, community members, and CKD patients.

The following communication plan might be used to respond to the issue of healthcare disparity:

The academic team and the advisory board will identify the problems of ethnic/ racial minority groups with CKD during community meetings and interviews with healthcare professionals and CKD patients.
In collaboration with practicing clinicians, the academic team will research the problem using the data obtained from the meetings and interviews and prepare reports containing findings and possible solutions.
The advisory board will issue specific recommendations for each population affected by CKD and present them during community meetings in a form that is understandable to everyone. This will help to avoid stereotyping and social or educational discrimination.
Community members and healthcare professionals will provide social support for CKD patients regardless of their cultural group.

The advisory board will be responsible for the development of an evaluation plan for communication. To adequately demonstrate the results of the new public health communication strategy, the plan should include several essential steps. Firstly, the evaluation plan should include a survey reflecting the public opinion about the new strategy. It is important that the survey contains the responses from various individuals representing diverse populations, including racial/ethnic minorities. Secondly, the interviews with CKD patients should be conducted shortly after the introduction of the communication strategy. The interviewing process might help to detect the shortcomings of the strategy and gain vital feedback from the affected individuals. Finally, the evaluation should be supported by the academic team that will analyze the data obtained during the previous steps and define whether the strategy is effective for reducing disparities and improving nationwide healthcare equality.

The goal of the targeted health communication is to achieve the best results by tailoring the message and interventions to the needs and of the target population. According to Gordon et al. (2018), “culturally competent or targeted interventions have contributed to the reduction in health disparities” (p. 2). Thus, the public health communication strategy should be culturally, racially, and ethnically sensitive and take into consideration the unique features of each population in order to eliminate disparities in healthcare. On the one hand, communication with disadvantaged populations should prevent discrimination and stereotype threats by promoting pride and confidence among racial/ethnic groups. Additionally, since the population is vulnerable to ESRD and has lower survival rates compared to the White population, it is crucial to inform the individuals about the ways of ESRD prevention during community meetings. Treatment and psychological support might be offered by healthcare providers and community members at hospitals and online. On the other hand, the White population suffering from cardiovascular and metabolic complications of CKD should be educated on the importance of early CKD testing. Health education seminars and meetings, CKD advertisements, websites, and literature might help to raise awareness about the disease, prevent complications, and decrease mortality among White Americans.

All in all, the project was valuable as a source of knowledge in many aspects. Firstly, the project allowed me to learn more about racial and ethnic inequality in the healthcare sector and its impact on patient outcomes. Secondly, as was preparing the communication plan, I began to understand the role of community action in addition to the efforts of healthcare professionals and researchers. While Healthy People 2020 is a worthy initiative, its objectives ignore the importance of community participation supported by academic and clinical knowledge. Finally, the project led me to the conclusion that differences between cultural groups should not divide the society or the nation, since effective communication strategies can provide mutual benefits, understanding, and support for everyone.

References

Gordon, E. J., Lee, J., Kang, R. H., Caicedo, J. C., Holl, J. L., Ladner, D. P., & Shumate, M. D. (2018). A complex culturally targeted intervention to reduce Hispanic disparities in living kidney donor transplantation: An effectiveness-implementation hybrid study protocol. BMC Health Services Research, 18(368). Web.

Dutta, M. J. (2018). The culture-centered approach in addressing health disparities: Communication infrastructures for subaltern voices. Communication Methods and Measures, 1931–2466. Web.

Norris, K. C., & Nissenson, A. R. (2020). Chapter 8 – Ethnicity and chronic kidney disease – United States. In Paul L. Kimmel & Mark E. Rosenberg (Eds.), Chronic Renal Disease (2^nd ed., pp. 111–119). Academic Press.

Norton, J. N., Moxey-Mims, M. M., Eggers, P. W., Narva, A. S., Star, R. A., Kimmel, P. L., & Rodgers, G. P. (2016). Social determinants of racial disparities in CKD. J AM Soc Nephrol, 27, 2576–2595. Web.

ODPHP. (2020). Access to Health Services. Healthy People. Web.

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Healthy People 2020 and Targeted Communication Within Cultural Groups

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