Category: Population

Infertility is one of the most common problems these days, and it means that a person does not have a chance to get pregnant for several health issues. Many couples in the United States may face this problem, and the causes can vary from congenital diseases to acquired physical or psychological trauma. This body condition does not always affect only females but also males can suffer from this issue. Genetics has a strong influence on infertility, and it may be connected to people of all ages and nationalities. Around 18% of women in the United States between the age of 21 and 52 stated that they had faced infertility in their lives (Mancuso et al., 2020). I believe that environment plays a significant role in this issue. People should be more cautious about their health to predict health problems that may cause the inability to become pregnant or impregnate a partner.

The causes of infertility are diverse and might not be seen by non-professionals. For instance, age plays a significant role as the older males and females are, the more chances of receiving infertility. Moreover, hormones play an important role in pregnancy, and when any type of disbalance appears in the human body, problems with pregnancy might arise. Obesity or anorexia can also indicate infertility as the human body spends crucial resources on other areas to support life without giving a chance for women to become pregnant. Some physiological problems like anomalies of the uterus or ovaries may also become the main cause of the issue.

The percentage of male infertility is not high compared to the opposite gender. Nevertheless, 7% of men suffer from this problem, and the causes of these cases are different (Krausz et al., 2022). Around 20% of those males who cannot impregnate their couples are suffering from genetic factors that were transferred throughout generations. When males check their health conditions and diagnose infertility at early stages, they have a chance to overcome this problem and protect the ability to procreate. Low sperm production may also happen due to psychological factors like depression or any type of disorder.

The percentage of females suffering from infertility is higher, and it is usually related to diseases that cannot be treated. When women become diagnosed with several health issues which do not allow them from becoming pregnant, doctors rarely have a chance to restore the ability to procreate (Barbieri, 2019). Nevertheless, a females mentality is under a lot of pressure due to sentimentality, which is specific to this gender, and this factor may cause psychological problems which cause infertility. Abortion might also become the reason for the inability to become pregnant. While the procedure is at the late stages of pregnancy, doctors might not restore the functions that allow women to become pregnant again.

Infertility remains the main problem that is not under full control. In some cases, it may become impossible to give a person a chance to continue becoming pregnant or impregnate their partner. However, sometimes it is possible to solve the problem by using medicines, surgical procedures, and In vitro fertilization (Repping, 2019). Moreover, a psychotherapist can help deal with psychological problems that are barriers to conceiving a child. Every case is unique, and only doctors can decide if any treatment would be useful or not.

References

Barbieri, R. L. (2019). Female infertility. Physiology, Pathophysiology, and Clinical Management, 556-581. Web.

Krausz, C., Rosta, V., and Swerdloff, R. S. (2022). Genetics of male infertility. Perinatal and Reproductive Genetics, 121-147. Web.

Mancuso, A. C., Summers, K. M., and Mengeling, M. A. (2020). Infertility and health-related quality of life in United States women veterans. Journal of Womens Health, 29(3). Web.

Repping, S. (2019). Evidence-based medicine and infertility treatment. The Lancet, 393(10170), 380-283. Web.

Problem Statement

Individuals at risk of poor health and healthcare disparities are normally regarded as being vulnerable. For homeless persons and other socially marginalized populations, an effective healthcare system is always not within their reach. Moreover, other social determinants of health, such as income, housing, and social support are often not present. No clear approach to healthcare delivery for homeless persons and other vulnerable people has been defined. Vulnerability, which is likelihood to harm, emanates from an interaction among various factors, including an individual, society, and prevailing life challenges encountered.

Notably, vulnerable people experience extremely high rates of acute and chronic behavioral health disorders and physical conditions and injuries than the general population. Usually, these conditions remain unmet medical needs. Further, competing interests, such as housing and food, implies that vulnerable people may not always prioritize health needs. Most of them are uninsured and often seek care in emergency departments (EDs) when unmanaged symptoms lead to hospitalization.

Project Description and Overall Goal(s)

The practicum, Improving the Overall Health of Hope House Residents in Middletown, Ohio, seeks to improve health of homeless individuals. The program will target 40 homeless residents aged between 18 and 75. The overall objective of the project will be to ensure that those who reside in the shelter are encouraged to take care of their own health through access to the necessary knowledge.

This project will be implemented in Hope House Mission, a faith-based shelter for the homeless. Its mission is to provide a wide of range of programs and services designed to achieve long-term, sustainable life transformation for homeless children, men, and women. Homeless persons usually have perceived unmet health needs, and they use high-levels of healthcare, usually in costly emergency departments or acute care settings (OToole, Johnson, Aiello, Kane, & Pape, 2016). Thus, the practicum, which is a holistic in approach to public health, will ensure that Hope House Mission and homeless persons have enhanced capacity to address healthcare needs they experience.

Rationale

The practicum is expected to run for about 24 weeks (six months), and will be performed via PowerPoint presentation and following with discussion. Since the facility lacks the equipment to accommodate for the laptops or projectors, I plan on giving each individual a print out of the desired topic being addressed. Having identified the health needs that continue to affect the residents of Hope House, the project leader developed several topics that will be used to improve the overall health of people at the facility.

These topics will aim not only to empower the residents with the knowledge on how to deal with common health issues, but also to underscore the importance of self-worth and self-esteem in managing challenging conditions. Some of the topics that will be addressed in this project are medication management, diabetes and hepatitis C management, self-neglect, oral health management, and vision management. Classes and group discussions will be held on a weekly basis with the residents of the Hope House, who will be encouraged to attend to ensure they gain useful knowledge on how they can deal with common health issues.

Objectives

The objectives of this practicum address multiple areas of public health improvement among homeless persons in Hope House. The objectives include:

1. Increase awareness in homeless people about the significance of overall health and well-being
2. Increase acceptance and usability of effective preventive interventions and treatments in homeless persons at Hope House
3. Promote educational interventions to lessen healthcare problems in homeless shelters
4. Enhance the capacity of homeless shelter programs to offer preventive health services to homeless persons at homeless shelters

These objectives are designed in line with the overall goal of the practicum. Thus, at the end of the practicum, noticeable changes in knowledge, awareness, and practices would be expected in homeless persons at Hope House.

Review

Homeless persons are considered vulnerable, and vulnerability, as previously noted, emanates from multiple sources (Grabovschi, Loignon, & Fortin, 2013; Culo, 2011). For homeless persons, the rate of healthcare challenges are higher compared to the general population (Lin, Bharel, Zhang, OConnell, & Clark, 2015). For medication management, it is shown that vulnerable people are at greater risks because of limited abilities to manage a complicated medication regimen based on multiple conditions they may experience. Non-adherence to medication, therefore, is a primary contributing factor for poor healthcare outcomes in vulnerable people. As such, interventions, such as education, that help such individuals to manage their medication could assist in avoiding needless, costly emergency department visits, admission, and hospitalization, as well as help in improving quality of life (Knowlton, Nguyen, Robinson, Harrell, & Mitchell, 2015).

Diabetes and hepatitis C virus are two health problems considered as chronic. Studies have demonstrated a significant relationship between diabetes and hepatitis C virus (Ba-Essa, Mobarak, & Al-Daghri, 2016). Notably, patients who share personal items, occupational exposure to blood or its related products, tattooing items, increased transaminases and risk practices were most likely to have both conditions leading to frequencies of hospital admission (Ba-Essa et al., 2016). These results underscore the need for educational intervention for vulnerable persons.

From a broader perspective, self-neglect is a growing condition that is poorly understood social and medical challenge. Self-neglect is a multifactorial behavioral issue that accounts for an individuals inability or a rejection to attend to own health, personal hygiene, and personal and environmental needs (Culo, 2011).

Self-neglect is the chief reason for referral to adult protection services (Culo, 2011, p. 421). In this case, unsafe behaviors expose individuals to self-endangerment, which is an isolated risk factor for death and institutionalization. Vulnerable persons, especially older adults, who demonstrate self-neglect tendencies, usually live in situations of greater isolation, squalor, and foulness. Such individuals may refuse any help because they do not see anything amiss in their conditions.

However, they present safety hazard and health risks to self and others. It is imperative to understand that such cases are controversial and, thus, care providers often argue whether the condition is social or medical, especially when mental conditions are absent (Culo, 2011). In the end, the issue of self-neglect comes to semantics. Nevertheless, individuals who neglect themselves are incapable and sick, and care providers should not ignore them (Culo, 2011). This explains why the practicum will adopt a holistic approach to address overall health and well-being of homeless persons.

Not much is known about the ocular condition of homeless persons (Noel et al., 2015). Visual acuity is significantly associated with reduced overall well-being. Thus, it is a critical educational program for homeless shelters, which host majorities with such complications. The training program will explore factors related to visual impairment and demonstrate the relevance of constant visual screening programs and treatment for homeless persons, especially where free eye clinics are found to help address this unmet health need.

Poor oral health based on all measurement indicators, such as decayed teeth, missing teeth, and oral pain, have been found among homeless persons (Costa et al., 2012). The educational program will cover causes, symptoms, diets, and offer a list of physicians who accept Medicaid and Medicare.

Competencies

This project lies squarely on the public health domain as it aims to protect the safety and improve health of the homeless members of the Hope House community through education. Rather than seeking to provide diagnostic interventions for the health problems affecting the homeless, the project aims to create awareness and empower the homeless on how to manage these issues through education. Additionally, this project is in the public health realm because the feedback received from the intervention could be employed to develop policies and processes in order to ensure the safety and health improvement of the homeless members of the community. Overall, the projects focus on improving the overall health of Hope House residents makes it a public health issue as the main goal of public health interventions is to safeguard improve health of different community members through education, policy making, and research on disease and injury prevention.

Methods

A holistic approach to public health was used to ensure that the project helps develop all aspects of peoples lives that are critical to improving the overall health of the targeted population. The approach was based on the realization that most residents of Hope House face different health challenges and, thus, a holistic perspective was needed to ensure that the project would have an impact on physical, emotional, mental, and spiritual needs of the residents. The justification for using this perspective was due to difficulties to improve the overall health and well-being of the targeted population without adopting such a perspective. The integrated educational package ensured a holistic approach to improve health and well-being of homeless persons while addressing care and underlying health challenges leading to emergency department use (OToole et al., 2016).

This practicum containing educational programs prepared by the presenter was presented to homeless persons through face-to-face using oral PowerPoint presentation and brochures. I printed out the copies for each individual participants. The educational interventions happened in a private room, which had a sitting arrangement for about 50 people. These learning materials were kept in a binder to be used as toolkits and references to ensure the continuity of the project even in the absence of the main implementer and for educating new residents. The toolkits contained information and resources to assist the homeless people residing in the shelter in improving their overall health on different levels  physical, emotional, mental, and spiritual.

The project targeted between 35 and 45 homeless individuals at Hope House (note that it was not difficult to find all homeless people at the shelter on a specific day). One general approach to assess learning in the educational package was to administer a pre-test and a post-test examination (Boston University, 2013). The pre-test was administered at the start of the instruction to assess pre-existing knowledge of the content program, including medication management, diabetes and hepatitis C management, self-neglect, oral health management, and vision management. Dr. Jaana Gold (my advisor) and Mrs. Lisa Field (my preceptor) approved the questionnaire before I gave to the residents. Later on at the end of every instruction program involving oral presentations and group discussions, a post-test assessment was administered in an effort to show measurable achievements in homeless persons knowledge. The entire practicum lasted 24 weeks (see the table below).

Impact evaluation was used at the end of the interventional educational program to determine the degree to which the practicum met its main goal of knowledge acquisition in homeless persons at Hope House. It was an important instrument to improve the quality of program and improve the outcomes. In this case, pre-test and post-test assignments was used for the practicum evaluation.

Collected data were analyzed using frequencies and percentage to determine changes in knowledge following implementation of the project for homeless persons. Changes in percentage prior to and following the practicum determined potential new knowledge acquired.

Sufficient resources, such as time, funds, instructional materials, and others, were provided to facilitate the implementation of this practicum. The overall interventional educational practicum addressed the following topics: medication management, diabetes and hepatitis C management, self-neglect, oral health management, and vision management within 24 weeks. The topics were divided into different weeks to facilitate the implementation of the practicum through oral PowerPoint presentation, group discussions, pre-tests, post-tests, and brochures to reinforce learning.

Data Analysis

Data analysis involved determining the difference between pre-test scores and post-test scores of homeless men who took part in the integrated educational program to improve their oval health. Analysis was done by examining the change in scores of individual participants to determine if there were any indications of a gain because of education provided. For each participant who took part in both pre-test and post-test, a variation in score (the value of post-test score less the value of pre-test score) for the entire topics covered during the program. This is generally the appropriate way to interpret the impacts of a training program in a given pre-test post-test test, since it allows the researcher to determine the extent of the difference in scores. Scores are displayed in graphic formats and tables for clarity.

Individual improvements of a given point show enhanced thinking (diminished weakness to basic thinking mistakes) and improvements of many points are great confirmation that learners actually benefited incredibly from the training program. These increases in the whole score demonstrate significant changes in learners. The variation in percentile score depends on where the learners score is found in the curve. It is imperative to recognize that scores of an individual may drop if the individual is not sure or lacks consistency when they select the best responses for the tasks. However, a drop in scores of many points is normally a characteristic of poor effort at post-test without some other influencing factors, for example, cognitive damage, exhaustion, or testing conditions. Data were analyzed using Excel.

Results

It is important to recognize that the number of participants in who participated in this program in different educational topics were not the same because of homelessness status of participants. For each educational topic, the participants ranged between 35 and 45 (hence, n = 35  45). The program was delivered over the course of five months. Only homeless men sheltered at Hope House Residents in Middletown, Ohio and aged between 18 years old and 75 years old took part in this educational program.

For educational program on scabies, the number of participants was 45. Pre-test was administered before the start of the educational program and post-test was also administered at the end of the educational program. The mean score percentage for pre-test was 56.84, and the mean score percentage for post-test was 80.27. Tests administered in the pre-test assessment were the same tests used in the post-test assessment. The mean score percentage difference between pre-test and post-test was 23.43, indicating an improvement of many points, which was a great confirmation that learners actually benefited incredibly from the educational program.

Participants were also tested on diabetes mellitus after the educational program. There were 42 learners who took both pre-test and post-test tests. Pre-test was administered before the start of the educational program and post-test was administered at the end of the educational program. The mean score percentage for pre-test was 66.67 and the mean score percentage for post-test was 84.52. Tests administered in the pre-test assessment were the same tests used in the post-test assessment. The mean score percentage difference between pre-test and post-test was 17.85, indicating an improvement of many points, which was a great confirmation that learners actually benefited incredibly from the educational program.

Learners change in knowledge was also tested following educational program on hepatitis C. This class had 35 participants who took both pre-test and post-test tests. Pre-test was administered before the start of the educational program and post-test was administered at the end of the educational program. The mean score percentage for pre-test was 47.8 and the mean score percentage for post-test was 79.06. Tests administered in the pre-test assessment were the same tests used in the post-test assessment. The mean score percentage difference between pre-test and post-test was 31.26, demonstrating an improvement of many points, which was a great confirmation that learners actually benefited incredibly from the educational program.

Learners change in knowledge was also tested following educational program on depression. This class had 40 participants who took both pre-test and post-test tests. Pre-test was administered before the start of the educational program and post-test was administered at the end of the educational program. The mean score percentage for pre-test was 56.85 and the mean score percentage for post-test was 78.65. Tests administered in the pre-test assessment were the same tests used in the post-test assessment. The mean score percentage difference between pre-test and post-test was 21.8, demonstrating an improvement of many points, which was a great confirmation that learners actually benefited incredibly from the educational program.

Participants change in knowledge was also tested following educational program on anxiety disorder. This class had 45 participants who took both pre-test and post-test tests. Pre-test was administered before the start of the educational program and post-test was administered at the end of the educational program. The mean score percentage for pre-test was 51 and the mean score percentage for post-test was 78. Tests administered in the pre-test assessment were the same tests used in the post-test assessment. The mean score percentage difference between pre-test and post-test was 26, demonstrating an improvement of many points, which was a great confirmation that learners actually benefited incredibly from the educational program.

Participants change in knowledge was also tested following educational program on lice. This class had 45 participants who took both pre-test and post-test tests. Pre-test was administered before the start of the educational program and post-test was administered at the end of the educational program. The mean score percentage for pre-test was 60.91 and the mean score percentage for post-test was 93.64 Tests administered in the pre-test assessment were the same tests used in the post-test assessment. The mean score percentage difference between pre-test and post-test was 32.73, demonstrating an improvement of many points, which was a great confirmation that learners actually benefited incredibly from the educational program.

For educational program on nutrition, the number of participants was 45. Pre-test was administered before the start of the educational program and post-test was also administered at the end of the educational program. The mean score percentage for pre-test was 48.04 and the mean score percentage for post-test was 77.02. Tests administered in the pre-test assessment were the same tests used in the post-test assessment. The mean score percentage difference between pre-test and post-test was 28.98, indicating an improvement of many points, which was a great confirmation that learners actually benefited incredibly from the educational program.

Summary of the Results

The above findings demonstrated that participants who took part in the educational program to improve overall health of homeless male at Hope House Residents in Middletown, Ohio did exceptionally well. For educational program on scabies, the mean score percentage for pre-test was 56.84, and the mean score percentage for post-test was 80.27, indicating a percentage gain of 23.43. Test scores for diabetes mellitus showed the mean score percentage for pre-test as 66.67 and the mean score percentage for post-test as 84.52, showing a percentage gain of 17.85. Additionally, for educational program on hepatitis C, the mean score percentage for pre-test was 47.8 and the mean score percentage for post-test was 79.06, which showed a percentage gain of 31.26.

Assessment results for showed that the mean score percentage for pre-test was 56.85 and the mean score percentage for post-test was 78.65, reflecting a knowledge gain of 21.8%. For anxiety disorder, the mean score percentage for pre-test was 51 and the mean score percentage for post-test was 78, depicting an increment in knowledge by 26 percent. The results of the assessment for lice showed that the mean score percentage for pre-test was 60.91 and the mean score percentage for post-test was 93.64, reflecting a change of 32.73 percent. Finally, The mean score percentage for pre-test was 48.04 and the mean score percentage for post-test was 77.02, showing a gain of 28.98 percent in the case of nutrition.

The participants who received this educational program gave overwhelming responses and enjoyed the educational materials left for references and future programs. They were delighted to have these classes and looked forward for more.

Discussion

This project focused on improving the overall health of Hope House Residents in Middletown, Ohio. Its mission was to provide wide-ranging programs and services designed to achieve long-term, sustainable life transformation for homeless men aged between 18 years old and 75 years old. The overall objective of the project was to ensure that men who reside in the shelter were encouraged to take care of their own health through access to the necessary knowledge. A holistic approach to public health was adopted for this educational program.

It should be clear that limited literature is available to provide empirical evidence for health educational programs for homeless individuals. In fact, a more comprehensive work was done in 1994 by May and Evans, and they too observed little report in research specifically for health education targeting homeless persons. Instead, current literature tends to focus on health promotion, which is a wide scope approach for interventions for health education for homeless populations. Nonetheless, the past research determined that healthcare educational programs for the homeless persons in shelters were often delivered by volunteer instructors, such as nurses, who offered lessons on health promotion, disease prevention, and self-care (May & Evans, 1994).

In light of the review of assessment results for a year and a half, it was found that 50 volunteer educators, the greater part of whom were nurses, provided 49 healthcare topics in 176 classes (May & Evans, 1994). Learners showed that the classes were useful, and they expressed their desires for future studies. This research conducted in 2017 still reflects findings established more than two decades ago by May and Evans. It confirms that health educational programs are hardly available to homeless individuals in their shelters, although they always express their desire to have search services.

Homeless is a complex, far-reaching issue in the United States (Coles, Themessl-Huber, & Freeman, 2012). Current health promotion underscores the ideas of lifestyle change, risks, and preventive health behavior, as well as the more extensive societal issues of the environment, public policy, and cultural influences. Therefore, the focus has shifted to a more planned way to deal with health promotion for individuals who are socially excluded, stressing behavioral change by focused interventions at the level of community settings, including homeless shelters.

Research concentrated on homelessness and related health challenges (Costa et al., 2012; Grabovschi, Loignon, & Fortin, 2013; Knowlton et al., 2015), and findings demonstrate the need for urgent action, yet little consideration has been given to the health promotion needs of homeless persons, and there is no clear proof of evidence-based outcomes following interventions. One issue for health promotion is to create and deliver suitable educational activities to a heterogeneous populace that is not generally simple to classify but rather has an extensive variety of health needs. As such, this study settled on a holistic approach to address multiple health concerns of homeless men.

For instance, the healthcare needs of a young fellow without a shelter vary widely from those of an old homeless man with other conditions related to advance age. To be destitute goes beyond a lack of a shelter alone, and it includes other health-related issues among other challenges. Homelessness has as much to do with social exclusion as with housing, and requires a wide range of health promotion methodologies.

Due to lack of earlier interventions and exclusion (Campbell, ONeill, Gibson, & Thurston, 2015), homeless persons are more probable than other populations to present with a severe illness and regularly utilize accident and emergency units for their healthcare needs. As a result, they are frequently missed by essential care health promotion initiatives.

Usually, healthcare services focused on homeless persons incorporate visiting care providers, community workers, health advocates, and occasional specialists, for example, general practitioners and community nurses, who have given intervention in homeless facilities and day centers (Jego et al., 2016). This study supports a more sustained implementation of educational programs for homeless persons as constituents of health promotion programs. Given these results, health promotion ought to be created with regard to how homeless persons look for care services. As such, this may include significant adjustment of, or specifically a move away from, conventional cases of care delivery, for example, in primary care setting situated in main hospitals.

Many intervention programs aimed for homeless persons have concentrated on illness prevention and are to a great extent not published (Jahan, 2012). These interventions incorporate immunization programs, mobile screening facilities, and the dissemination of condoms, but educational programs are not generally common because of resources (Ba-Essa et al., 2016; Knowlton et al., 2015). Intervention programs also tend to focus on youthful homeless living in the streets, in hostels, or other forms of accommodation facilities. Groups, for example, elderly individuals and families living in temporary settlement have largely been disregarded.

Even in this study, the focus was only on male, leaving out female homeless persons irrespective of their needs. Homeless care services are frequently engaged in emergency services provision and, thus, the long-term care of homeless persons is not generally a priority. Undoubtedly, health may not be a need for homeless persons themselves. Rather, basic survival needs, for example, food, water, and shelter may occupy their thoughts more than the likelihood of diseases. Hence, one valuable intervention may just be to inform such an individual where the closest shelter offering food and drink is. Thus, health promotion ought to likewise give useful help, for example, food, drink, and clothing. In the meantime, information can also be given about how to avoid some health risks and improve general hygiene.

The main objective of the homeless health educational program is usually to offer health information to homeless people and families in an unmistakable, precise, socially acceptable way to advance understanding, involvement, motivation, empowerment, and constructive health behavior change. This aim is successfully realized by applying different techniques drawn from the areas of health education and social or community work.

Engaging homeless persons is extremely important to service delivery because offering specific health information and supportive solution can only take place when individuals have expressed their concerns openly to care providers. Once educational programs have been provided, it is imperative to explore the recommendations and implement them. For instance, shelter providers should now strive to improve the provision of health information by organizing many formal educational and interventional classes and individually focused sessions on health subjects or topics important to needs of specific groups.

Health instructors give training and support around a wide scope of themes, for example, hypertension, nutrition, asthma, diabetes, hepatitis, HIV/AIDS, condom use, pregnancy, tuberculosis, physical activity, cancer, tumor, smoking, alcohol abuse and other substance abuse, oral health, and stress management, to give some examples. This demand for health educational programs demonstrates a complex system that requires a holistic approach.

This study was based on the formal needs of homeless persons at Hope House Residents in Middletown, Ohio. Irrespective of the lack of published findings, there are cases of specific issues that healthcare promoters consider great practice. These strategies account for national campaigns designed to meet local health needs, health fairs and other group based health promotion events, and outreach programs specifically designed for homeless persons. Strategies relying on peer interventions, concentrating on counselling and rapport building have also been effective. Many experts have now established services to cater for health needs of homeless individuals.

Training materials, especially those concentrating on chronic disease, such as HIV and AIDS information tend to target young homeless people while other health information on diabetes, heart conditions, obesity and others are have been targeted for older homeless persons (Culo, 2011; OToole et al., 2016). This demonstrates attempts to reach specific segments of homeless individuals. Health promoters have additionally focused on the significance of practical solutions.

As such, instructing homeless individuals about dental care might be inconsequential simply because they a toothbrush and toothpaste, and care for personal hygiene may not generally be practical for individuals sleeping in the streets. Thus, straightforward, practical help may occasionally be the most suitable type of health promotion. Health promotion efforts, therefore, should be accompanied by some quick and practical solutions. For instance, homeless alcohol and drug abusers might be more amiable to general health promotion activities once they are some forms therapies.

It is also important to recognize that health promotion efforts targeting homeless individuals may not record the best success rates (Jahan, 2012). This implies that multiple barriers are faced before homeless individuals can receive the intended health promotion initiatives. These barriers have been linked to multiple issues. First, health educational initiatives or educators are often isolated. As such, little collaboration or coordination is noted between stakeholders. In fact, it is recommended that any interventions targeting homeless individuals should be an integrated, multidisciplinary approach (Maness & Khan, 2014).

Second, public health departments have largely ignored health promotion and education for homeless persons. Third, some health promotion materials are written in technical languages, which usually need high levels of literacy or specialized knowledge. Hence, homeless persons feel excluded by such materials. Finally, while homeless persons may eagerly seek care, low self-esteem and diminished expectations often inhibit them from involving health promotion initiatives.

Some challenges are more complex. Numerous organizations do not have the capacity to implement health promotion without support. An essential factor is to gather the right resources and workforce, and design a framework for health promotion (Jahan, 2012). Health promotion also faces vested interests of various stakeholders. Powerful entities, such as businesses, are most likely to influence health promotional outcomes, for instance.

There is an increasing acknowledgment of part of ethics and, thus, stakeholders are expected to emphasize the practical reasons and benefits for health promotion. Educational programs are the best interventions engage homeless persons to determine what they value and how they can embrace practical approaches to reduce health risks and management existing conditions. To accomplish this goal, particular interventions to local circumstances are required as opposed to treating all groups similarly. Another issue is to develop a long-term rapport with marginalized individuals, such as homeless persons.

As poverty and inequality escalate in society, homeless persons and other disadvantaged groups may fail to appreciate any messages associated with health promotion. It will require some efforts, time to stakeholders offering related services, and find the right homeless persons. More importantly, this study revealed that homeless persons in different setting require different approaches. As such, the study strives to enhance access to health care for marginalized, underserved persons in society, and this should be a matter of public health policy. There are difficulties identified with research in the field of health promotion, specifically for health education for homeless persons (Jahan, 2012).

There is absence of implementation evidence in health promotion practice and absence of use of evidence while developing promotional strategies. There are specialized challenges in assessment of health promotional strategies. For performing assessment of health promotion outcomes, it is essential to characterize and gauge the results of the intervention, as was done in this case. Suitable approaches for assessment of intervention outcomes should be developed and embraced. To enhance the quality of studies in the health educational programs, researchers and other stakeholders should enhance the quality and number of published works, specifically for homeless persons and other marginalized groups.

Despite these drawbacks, health promotions have positively influenced health care outcomes in both private settings and public health initiatives (Jahan, 2012). Various public health accomplishments are credited to health promotion. Some of the most incredible health promotion accomplishments of include immunization; more secure work environments; infectious disease control; diminished mortality rates associated with chronic conditions; safer and more beneficial diets; family arranging and enhanced maternal and child health; fluoridation of drinking water and fortification of some foodstuff; and acknowledgment of health risks associated with tobacco use.

None of these accomplishments would have been conceivable without health promotion (Jahan, 2012). In these examples, clearly, specific achievements associated with homelessness are not defined. Nonetheless, health promotion is a necessary intervention strategy, and empowers individuals to adopt practical solutions to their health needs. Health promotion should be implemented in a team with individuals and requires their committed involvement. It assists communities in enhancing their capacities and their skills to take activities, which promote healthy living. They act in groups to bringing about change and improve outcomes.

While challenges exist for health promotion initiatives, opportunities have also been identified for the same (Jahan, 2012). Various agencies, organizations, and individuals around the globe are focused on health promotion for their communities. World organizations, such as the World Health Organization (WHO) and others, continuously highlight the plight of homeless individuals as among the most vulnerable in society. As such, they respond by developing strategies, projects, and activities designed for health promotion. Any health care related visits for different reasons for existing are open doors for wellbeing advancement exercises.

It is particularly critical for homeless individuals who may face difficulties gaining access to care facilities. As such, when they are visited at their shelters, the visits should be used to advance health among the most vulnerable population. Visits for any purpose are an opportunity for health promotion to enhance health outcomes of the target groups. Although immense opportunities for promoting health can be found the existence of current advanced technology and electronic modes of communication, these tools are largely not accessible to homeless persons. Nonetheless, health educators can exploit them to deliver their topics.

As previously noted, it is important that any health promotion initiative ought to be implemented following an evaluation of health needs of the target group. This strategy will not just help distinguish needs but will help with planning and creating interventions as indicated by the needs of the target group and different settings.

The difference of specific groups of homeless persons is clear. In comparison with general health promotion efforts, directed interventions can concentrate on the specific needs of homeless groups, for example, persons without shelter, single parents, adolescent, women, or seniors. It is imperative to conduct further research to determine the key health promotion needs of various homeless groups. Identification of informal communities, networks and the engagement of homeless persons in developmental assessments will identify the places and best methods for delivering health promotion. In this study, the researcher had to identify the best venue to reach homeless persons with health educational promotional program.

That is, it is extremely difficult to offer any interventions for homeless persons without prior planning. Social networks and peer educators, and sources of food and drinks can significantly contribute in health promotion for homeless persons. It all requires any creative strategies, which require careful implementation and assessment. Education appears to be the best initial strategy for homeless persons, who lack basic knowledge on self-care.

The numerous needs of homeless individuals force them into contact with many different support organizations. However, the response of a given organization is frequently narrowly focused and determined by emerging cases, rather than long-term approaches. Yet, the different qualities of these multiagency facilities introduce a genuine chance for collaborative health promotion. For instance, health educators can work with shelter home operators to deliver educational programs to homeless individuals, for instance. These organizations can ensure long-term health promotion for homeless persons by coordinating with relevant stakeholders. Novel primary care stakeholders may offer a perfect discussion to establish procedures, supported by sufficient resources to improve interventions. Shelter services may well take part in health promotion to ensure that many homeless persons are reached during their stay.

Recommendations

Results from this study showed that participants who received this educational program gave overwhelming responses and enjoyed the educational materials left for references and future programs. They were delighted to have these classes and looked forward for more. However, from the discussion, it was established that limited literature is available on health education for homeless persons. Much literature tends to concentrate on multiple health issues homeless persons face, but do not look at educational interventions. As such, researchers should focus on impacts of health education programs targeted at homeless persons as a constituent of health promotion to enhance general health.

Research ought to show that health education programs are important for improving health among homeless persons. It is also shown that delivery and promotion for homeless persons require coordination. Hence, researchers should also work together. There is additionally a need to promote collaboration among all stakeholders.

The health promotion initiatives ought to be research based and target specific groups, for instance, vulnerable men. It is important to appreciate the role of evidence in health care settings. Hence, failure to publish findings on health promotion programs is a major drawback to stakeholders who rely findings to make recommendations on policies. In fact, only one old source, in this case, was directly linked to the subject under homeless health education.

The study shows that health care professionals play a major role in health care promotion among underserved populations. Hence, adaptation to clinical practice ensures that health care professionals play a critical part regarding treatment and education of patients and in promoting enhanced health care outcomes within vulnerable groups. Findings provide a practical basis for implementing policies that support physician engagement for the medically marginalized, underserved homeless persons. Improving the health outcomes of homeless individuals is an important initiative to reduce cases of morbidity and mortality in society. General practitioners, family physicians, and nurses are preferably appropriate to offer care, all-inclusive, and sustained care for homeless patients and to guide multidisciplinary teams.

Strengths and Limitations

Given the limited research on health education programs for homeless persons, this research was extremely useful. The learning was conducted in a normal setting (shelter for homeless persons) and, thus, the results were reliable and not prone to any external influences. It might not be possible to generalize the findings of this study to other homeless facilities because only descriptive statistics was used. It was not always easier to find all participants and, thus, their number kept on fluctuating for every topic across the four months of the study.

Conclusion

The aim of this health educational program was to improve overall health of homeless male at Hope House Residents in Middletown, Ohio. The educational program was implemented for four months using a holistic approach. The results showed an exceptional performance in knowledge gain among participants. The participants who received this educational program gave overwhelming responses and enjoyed the educational materials left for references and future programs. They were delighted to have these classes and looked forward for more. Across the seven areas evaluated, results were excellent demonstrated the desire among homeless persons to learn. As such, these results will enable the development of a new model of primary care for health education programs to improve access to healthcare for underserved homeless individuals.

Health care professionals and researchers could effectively advance to the improvement of health care and outcomes for homeless persons, if homeless shelters and other stakeholders can coordinate their efforts. It is necessary to establish a group of multidisciplinary to support vulnerable people in society.

While outcomes were positive and participants were delighted, limited works exist on outcomes of education programs targeting homeless persons. As such, it was difficult to find current empirical data to support the findings of this study. This study therefore recommended further studies in health care educational programs specifically targeting homeless persons.

References

Ba-Essa, E. M., Mobarak, E. I., & Al-Daghri, N. M. (2016). Hepatitis C virus infection among patients with diabetes mellitus in Dammam, Saudi Arabia. BMC Health Services Research, 16, 313. Web.

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Campbell, D. J., ONeill, B. G., Gibson, K., & Thurston, W. E. (2015). Primary healthcare needs and barriers to care among Calgarys homeless populations. BMC Family Practice, 16, 139. Web.

Coles, E., Themessl-Huber, M., & Freeman, R. (2012). Investigating community-based health and health promotion for homeless people: A mixed methods review. Health Education Research, 27(4), 624-644. Web.

Costa, S. M., Martins, C. C., de Lourdes, C. B., Zina, L. G., Paiva, S. M., Pordeus, I. A., & Abreu, M. H. (2012). A systematic review of socioeconomic indicators and dental caries in adults. International Journal of Environmental Research and Public Health, 9(10), 35403574. Web.

Culo, S. (2011). Risk assessment and intervention for vulnerable older adults. British Columbia Medical Journal, 53(8), 421-425.

Grabovschi, C., Loignon, C., & Fortin, M. (2013). Mapping the concept of vulnerability related to health care disparities: A scoping review. BMC Health Services Research, 13, 94. Web.

Jahan, S. (2012). Health promotion: Opportunities and challenges. Journal of Health Education Research & Development, 1, e105. Web.

Jego, M., Grassineau, D., Balique, H., Loundou, A., Sambuc, R., Daguzan, A.,& Gentile, S. (2016). Improving access and continuity of care for homeless people: How could general practitioners effectively contribute? Results from a mixed study. BMJ Open, 6(11), e013610. Web.

Knowlton, A. R., Nguyen, T. Q., Robinson, A. C., Harrell, P. T., & Mitchell, M. M. (2015). Pain symptoms associated with opioid use among vulnerable persons with HIV: An exploratory study with implications for palliative care and opioid abuse prevention. Journal of Palliative Care, 31(4), 228233.

Lin, W.-C., Bharel, M., Zhang, J., OConnell, E., & Clark, R. E. (2015). Frequent emergency department visits and hospitalizations among homeless people with Medicaid: Implications for Medicaid expansion. American Journal of Public Health, 105(S5), S716-S722. Web.

Maness, D. L., & Khan, M. (2014). Care of the homeless: An overview. American Family Physician, 89(8), 634-640.

May, K. M., & Evans, G. G. (1994). Health education for homeless populations. Journal of Community Health Nursing, 11(4), 229-37. Web.

Noel, C. W., Fung, H., Srivastava, R., Lebovic, G., Hwang, S. W., Berger, A., & Lichter, M. (2015). Visual impairment and unmet eye care needs among homeless adults in a Canadian City. JAMA Ophthalmology, 133(4), 455-460. Web.

OToole, T. P., Johnson, E. E., Aiello, R., Kane, V., & Pape, L. (2016). Tailoring care to vulnerable populations by incorporating social determinants of health: The Veterans health administrations homeless patient aligned care team program. Preventing Chronic Disease, 13, E44. Web.

Introduction

Human health is a priority to individuals, communities, non-governmental groups, governments, and international associations. An effective planning process addresses the current and future needs of the people. Human health is an essential requirement, and individuals should invest in their well-being while the government lays necessary measures to provide health services primarily to vulnerable groups. The vulnerable population living at high health risks includes children, the poor, the aged, and people living with disabilities (Trusted Choice Team, 2020). The individuals in these categories have greater chances of being affected by chronic and other adverse infections due to their weak body immunity. Therefore, they should be protected constantly bypassing health bills that simplify their access to medical care. This studys scope will be limited to a health policy relating to the geriatric population using Milios approach.

The geriatric population is composed of the least productive members of society. Although they pay taxes during their years of employment, they no longer participate actively in the economic building at their advanced age. The World Health Organization (WHO) states the right to health as a claim to a set of structures that ensure everyone enjoys the rights (Baer et al., 2016). Governments should initiate healthcare measures that provide the aged access to health care services at a reasonable cost. Some of the steps may include providing health insurance plans for the aged and other health determinants such as proper housing, a clean environment, and sanitization. The provision of preventive measures for chronic diseases, pain-relieving medicines, and enough public healthcare institutions with quality services also favors health care for the geriatric population.

Milios Policy Process

Milio wrote resourceful materials discussing the health sectors improvements and other industries that can promote healthy living. She states that the physical environment and behavior patterns significantly impact either promoting or hindering healthy living (Super et al., 2020). Some of the tools discussed by Milio as health-enhancing policies in other sectors include the development of social epidemiology, improved health education and health economics, and information technology (Super et al., 2020). She also discussed the role of love and power in promoting healthy living. Milios approach is applied in this study to examine the role of the environment in health-enhancing among the elderly societal members.

The Environmental Policy

Knowing an individuals physical environment is crucial in preventing and controlling some diseases and infections common during old age. Prevention of some illnesses would be a better measure compared to managing the condition or even treatment. The geriatric population is very vulnerable to multiple functional impairments. Healthy living can be attained by maintaining a clean physical environment, a well-balanced diet, and access to social, and moral support. The geriatric population should be settled in places free from pollutants such as air pollutants, noise, harmful chemicals, unclean water, and residential areas, free from toxic metal contents such as mercury and aluminum (Fachbibliothek Umwelt, 2017). Therefore, policies relating to reliable, effective, and efficient health care of the elderly in their physical environment should be formulated.

Some human-triggered and naturally-caused changes in the environment are causes of some health problems. Environmental changes such as high air pollution and high ozone levels are harmful to the human breathing system (Fachbibliothek Umwelt, 2017). Less concern about health care is directed to the environment, while much effort and funds are invested in the other measures to maintain a healthy environment. The geriatric population is very vulnerable and should not be exposed to a harsh climate. Therefore, health policies concerning maintaining a healthy environment should be formulated.

In addition to the living conditions, the environmental factor should be considered compared to the accessibility of medical care. The geriatric population is affected by many health problems which require close medical check-ups and regular clinics. The check-ups may involve visiting a health care facility or the physician visiting the patient at their homes. The American Geriatrics Society (2020) supports implementing a policy on assisting the geriatric population in fighting Covid-19 through the establishment of Assisted Living Facilities (ALF). The policy would ensure that the elderly have close access to medical care and treatment by relocating to a residential where they can be taken care of in a better way.

This study supports the Assisted Living Facilities (ALF) policy to be implemented fully considering the health factor instead of Covid-19 infection. The policy would be sustained by the Medicare program and some individual costs to pay for the rental residence. The family members of the person under medication would take care of them during the treatment period, providing meals and other basic needs. Care and time from family members ensure both moral and physical support, which Milio was advocating for.

Inconsistence of the Policy

The main challenge facing the implementation of environmental policies on geriatric population health is inconsistency in service delivery. Poor planning has delayed the implementation of government policies on maintaining a pollution-free environment and Assisted Living Facilities (ALF) may not be fully implemented. Moreover, they are not entirely acts of mercy but mainly compensation for peoples health insurance plans. The policy demonstrates discrimination and unfairness since it is implemented effectively to the affluent members who have heavy insurance covers while delayed or denied to the poor who are even more vulnerable.

Conclusion

Therefore, the geriatric population can have better lives if the necessary measures for preventing and controlling infections are put in place. A healthy environment should be free from hazards and pollutants, access to medical care, and enough physical, material, and moral support from family members. Therefore, governments should formulate and fully implement policies relating to the environment of the geriatric population.

References

American Geriatrics Society. (2020). American Geriatrics Society (AGS) policy brief: COVID 19 and assisted living facilities. Journal of the American Geriatrics Society, 68(6), 1131-1135. Web.

Baer, B., Bhushan, A., Taleb, H. A., Vasquez, J., & Thomas, R. (2016). The right to health of older people. The Gerontologist, 56(Suppl 2), S206-S217. Web.

Trusted Choice Team. (2020). Senior health insurance. TrustedChoice. Web.

Fachbibliothek Umwelt (2017). Environmental pollution and diseases of the elderly. Umweltbundesamt. Web.

Super, S., Klerkx, L. W. A., Hermens, N., & Koelen, M. A. (2020). A multilevel transition perspective on embedding intersectoral action in local health policies. Health Promotion International, 1-12. Web.

Many people suffer from chronic diseases, which is a common phenomenon nowadays. Chronic illnesses can vary from diabetes to asthma and significantly impact a persons everyday life. Regularly individuals are unaware of having any kind of chronic disease, and they spend a decent time of their lives without knowing about it. However, some population groups are affected more than others to the particular health problems. The race or ethnicity minorities of the population may be at the higher explosion to the different chronic diseases due to numerous factors such as genetics or discrimination. Therefore, this paper aims to evaluate the black population of New York state affected by hypertension and analyze the reasons behind it and the interventions to improve the health outcomes.

One of the high-risk groups most affected by chronic high blood pressure is African Americans. Hypertension was initially a widespread issue all over the United States, but the black population has the highest rates of dealing with the illness. They can get hypertension at a young age, especially those children who also suffer from obesity. However, specific risk factors exist that influence the appearance and the development of hypertension and might cause complications of the physical state. Regarding sex, men are the ones who tend to get hypertension more often than women. At the elderly age, both female and male individuals tend to be at a higher risk, especially if they smoke, lead an inactive lifestyle, and overuse alcohol (Mills et al., 2020). In addition, more narrow-focused factors such as pregnancy, family history disease, or second type o diabetes may result in high blood pressure.

Besides all the fundamental characteristics, the black population experience additional causes of hypertension, which make them a high-risk segment. Its reasons may consist of the genetic features and their socioeconomics position in society. Considering their biological background, black people tend to be overweight and have sensory blood vessels (High blood pressure and African Americans, 2022). Nevertheless, socioeconomic reasons are the most influential in this case and intensify already existing conditions. Black population compared to the white live in the greater stress resulting from the difficulties of getting a well-paid job, existing in poverty, and having a household in the dangerous criminal districts (Clark et al., 2019). Therefore, African Americans have fewer opportunities to get a quality education, lead a healthy lifestyle, and access medical care and information (Howard et al., 2018). Moreover, because of all the factors, many black people are unaware of having the disease or its danger to their health, and as a result, they do not take any measures.

In the different regions of the United States, indicators of hypertension prevalence vary significantly. New York states counties illustrate the distinction between the counties. Many African Americans live in the Monroe and Westchester counties, and Monroe county portrays a greater level of hypertension prevalence among the black population than Westchester, resulting in the indicator differences. The crucial social determinants such as quality of life, income, and unemployment determine the outcome of the prevalence in the two compared areas. Monroe county has higher adult smoking and obesity indexes than Westchester (New York, 2022). It also shows a higher percentage of excessive drinking and fewer possibilities for physical activity, resulting in a poor physiological state (New York, 2022). In addition, Westchester demonstrates noticeably lower statics regarding the socioeconomic factors, and its unemployment rate is less than Monroes (New York, 2022). Children who live in a poor household in Westchester represent 10% of the population which is almost two times lower than Monroe county (New York, 2022). Thus, some social determinants lead to disparities in the health conditions of the black communities.

In order to improve the situation with the healthcare and decrease the negative outcomes for the group at high risk, several decisions were implemented. Firstly, the initial cause of this is racial discrimination, limited access to medical resources, and crisis in public health. Consequently, the primary focus should be on the social and cultural factors in the first place. One of the efficient approaches is to spread awareness among the community and educate black people about the issue.

Several electronic and online services help people get information on health issues, particularly hypertension. For instance, websites such as the website Medicare.gov allow individuals to easily find healthcare institutions near their homes and choose from those who provide more affordable services and consultations (Find and Compare Nursing Homes, Hospitals and Other Providers Near You, 2022). Nurses are also the ones who contribute to the spread of health literacy by informing the patients about the diagnosis, causes, and treatment (Loan et al., 2018). Those who work in schools can promote knowledge among the children and teenagers, which positively affect their lives and prevent them from negative outcomes. Another way that helps to improve the medical care regarding hypertension is the cooperation with the community partners, particularly those involved in the healthcare (Ferdinand et al., 2020). Their investment and work regarding technologies and health promotion among community cities such as supermarkets or barbershops reduce the risk factor.

Overall, the black population is more affected by hypertension than the white due to some biological but mainly social factors such as poverty, lack of education, and unemployment. Racial discrimination is a huge factor that puts African Americans at high risk and exposes them to chronic disease. However, with the help of informational electronic sources and the cooperation inside of the community by providing access and the knowledge about the high blood pressure helps to lower the number of risk factors.

References

Clark, D., Colantonio, L. D., Min, Y. I., Hall, M. E., Zhao, H., Mentz, R. J.,& & Muntner, P. (2019). Population-attributable risk for cardiovascular disease associated with hypertension in black adults. JAMA cardiology, 4(12), 1194-1202.

Ferdinand, D. P., Nedunchezhian, S., & Ferdinand, K. C. (2020). Hypertension in African Americans: advances in community outreach and public health approaches.Progress in cardiovascular diseases, 63(1), 40-45. Web.

Find and Compare Nursing Homes, Hospitals and Other Providers Near You. Medicare.gov. Web.

High blood pressure and African Americans. Stanford Childrens Health. Web.

Howard, G., Cushman, M., Moy, C. S., Oparil, S., Muntner, P., Lackland, D. T.,& & Howard, V. J. (2018). Association of clinical and social factors with excess hypertension risk in black compared with white US adults. Jama, 320(13), 1338-1348.

Loan, L. A., Parnell, T. A., Stichler, J. F., Boyle, D. K., Allen, P., VanFosson, C. A., & Barton, A. J. (2018). Call for action: Nurses must play a critical role to enhance health literacy. Nursing Outlook, 66(1), 97-100.

Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews Nephrology, 16(4), 223-237.

New York. County Health Rankings & Roadmaps. Web.

Planning in an organization is very critical as it gives direction on what should be done and procedures to be followed. The CDC evaluation model is used in the obtaining of the program policies in healthcare and sickness arresting. The model possesses six steps which are based on feasibility, utility, accuracy, and propriety (CDC, 2021). These steps are involving stakeholders, outlining the program, concentrating on the evaluation perspective, collecting dependable confirmation, supporting conclusions, guaranteeing use, and sharing lessons (CDC, 2021). The Palm Island Indigenous population is the subject study in which the report shows the need for evaluation to help society and its strategy. Additionally, another objective is to raise the number of people who have received the barge of COVID-19 vaccines.

The CDC evaluation design utilizes the six steps to come up with better implementation and revision of the program strategy. The engagement of stakeholders is the first step where the Australian Government Department of Health and the Queensland Government are mainly involved. The framework gives a comprehensive tool in the vaccination and immunization program. The objectives and goals of the program are discussed in conjunction with its target groups and strategies.

The different stakeholders play unique roles to make the plan a success. The evaluator is responsible for overseeing the future and present outcomes. The evaluation includes the target population involving individuals receiving the vaccine to determine its efficiency. They should maintain their lifestyle and provide relevant feedback and report any issues related to COVID-19. The Queens Health department supports the vaccination and provides a disease-free community. Australia Immunization offers vaccination delivery services, the register monitors coverage, digital health maintains the record and the pharmacovigilance monitors adverse effects after the immunization process.

The description of the program indicates the challenges faced by the target population during the alarming pandemic. The group was underestimated in receiving medical attention during the corona period hence facing high health risks. The aged and people with pre-existing conditions like diabetes, pressure, and obesity were the most affected. A lifestyle that is diverse between the indigenous people and Australians posed a difference in the risk factors faced. False beliefs, lack of knowledge, and unhealthy lifestyles were the most contributing factors.

Links to Current Policies and Framework

The Queensland Government and the Australian Government Department of Health have a framework for the vaccination of COVID-19 for the indigenous population in Queensland.it caters to the population with varying ages as from 12,18, and 60 with the Astra Zeneca and Pfizer vaccines (Melbourne Vaccine Education Centre, 2021). The Australian Government Department of Health has two immunization and vaccination for its people. The table below shows the current policies and frameworks for the program.

Table1: Current Policies and Frameworks

Focus the Evaluation Design and Gathering and Analyzing Evidence

An impact evaluation framework is composed of three elements which include the available resources and constraints, the nature of what is being evaluated, and the nature of evaluation itself. Resources include time, staff, money, volunteers, and materials. Illiteracy can impact peoples lives negatively where most may be unaware of simple practices like keeping social distance. Intermediate outcomes such as changes in policies and behavior also have a great impact. Different evaluation designs and methods used include single group (posttest only), single group (pre and posttest), nonequivalent control (pre and post), and single group (time series).

Single group (posttest) involves taking only one measurement at the end of an intervention and its only targets the participants. A single group (pre and post) is where two measurements are taken one before the intervention and another one after (Adeoye et al., 2020). This design is suitable as it gives room for change to be observed appropriately. In a non-equivalent group, two tests are done before and after for two groups (Chesney et al., 2020). Single group time series involves multiple measures over some time only for the participants. The natural changes are being observed and the external influences. Limitations to the evaluation differ depending on the nature and size of the population. The generalization of data can sometimes give false implications of the trends involved. Age difference, inadequate timing, difficulty in locating documents, and writing reports.

Table 2: Threats to Internal Validity

Table 3: Threats to External Validity

Sampling Plans

Sampling plans provide a basis on which research is to be conducted. It has five steps that must be followed beginning with the identifying of the parameters to be measured, range of possible values, and needed resolutions (Wu et al., 2018). A sampling scheme should be designed to determine how and when the data will be collected. Selection of the sample sizes by grouping them if possible by considering similarities and differences. Design of data storage formats if in tables, graphs, or chat formats and finally assigning roles and responsibilities to each stakeholder. The participants were recruited using methods targeting the right audience, screening, incentivizing, and sustaining.

Sampling Methods

Sampling methods like simple random, systematic, and stratified, and cluster were embraced. Simple random sampling provides an equal chance for every member of a population. Tools like random number generators and techniques entirely based on chance are applied. Systematic sampling has similar characteristics to simple but its easier to conduct (Li et al., 2018). Every individual involved in the exercise is listed with a number but they are chosen randomly. Stratified sampling involves small subdivisions of populations into groups and conclusions are drawn (Varshney et al., 2017). Cluster sampling also involves the division of the populations but each group has similar characteristics.

Table 4: Developing an Evaluation Plan

Developing an evaluation plan involves the need to achieve the desired objectives. The various methods applied include interviews, observation, single group tests, using test kits and questionnaires (Quek et al., 2017). Personal interviews cover the interrogation on how people been affected by the virus have been coping with the changing lifestyle and how their relationships have changed (Callwood et al., 2018). Observations were made on the general behavior of people, social interaction, and their day-to-day activities. COVID-19 test kits are also used to give quick and accurate tests for treatment and prevention of the spread. The duration of doing the research varies from weekly, monthly, and even daily for observations.

Tools used in data collection were conducting questionnaires and interviews. The questionnaire method is very reliable and cheap to use. It involves making a photocopy of papers consisting of the questions and administering them to the target group. It can be used to collect data from a large audience over a short period (Cumpston et al., 2019). Both open and closed questions can be used to provide information that can be converted easily into quantitative data (de Block & Vis, 2018). The questions are standardized and can be suitable for all ages as they are easy to respond to. An estimate of 2000 questionnaires can be filled in a day targeting different groups in various locations like churches, schools, and hospitals.

The interview method involves one-to-one interaction where questions are asked and answers were given. It is suitable for obtaining data from a small group of people. Its very private since the information given is kept confidential (Falissard, 2021). Reliability is seen where similar groups are kept together and the others isolated and them comparison of data is made. An estimate of 500 participants can be interviewed during a day making it very reliable. It is highly flexible and can investigate different issues in a period.

The method is suitable for the target population since they have different preferences. Patients with pre-existing conditions also need privacy for to reveal their statuses (Hampton and Lenhart, 2019). Both quantitative and qualitative measures were taken during the research. Qualitative measurements tend to have a deeper understanding of why something happens (Alam, 2020). Quantitative measures involve data that can be put in numbers. The mortality rate among sick adults was very high due to emaciated immunity (Lederer et al., 2018). Conducting it privately without the knowledge of the participants showed deviation as to when conducted publicly (Kizlari & Fouseki, 2021). People tend to vary their behavior and they can pretend in some cases or give false implications.

Table 5: Evaluation Plan for the Process Evaluation

The various question asked are important in determining the components of the program. Since most people prefer privacy, administering personal questionnaires can give them the confidence to give out relevant information (Nguyen et al., 2020). Making a general observation on how persons conduct themselves in society can give a general view of the new infection. Some responses need to be noted immediately as they occur. Correspondingly, some cases involve the synthesis of raw data to come up with better assumptions.

Table 6: Justifying Conclusions

Accuracy calls upon the nature of the problems and behaviors to be observed. Distinct variables are preferred since they give researchers easy time. Awareness should be made on why such an activity is taking place, its importance, and its relevance in the general wellbeing of all the individuals (Pennycook et al., 2020). Honesty value should be emphasized since wrong data can lead to delicate decisions in the final state. The culture of a community is sensitive and must be respected (Mariani et al., 2018). One must learn to be compatible with other cultures despite of their uniqueness. Ethical issues must be adhered to by all and equal treatment of persons must be adopted Feasibility issues refer to the inadequate resources, time, and background knowledge on how to conduct the research. To accomplish the tasks in demand, enough resources must be available and be easy to access (Southwood, 2018). Tools used in data collection must be available and valid to minimize on errors. Having prior information in theoretical form enables its application easily.

Table 7: Use and Share of Lessons Learnt

To ensure that the information gathered is effectively used and analyzed, all the stakeholders must be involved. Monitoring on the use of data by creating online portals for patients to interact with doctors. They can get appropriate guidance on what to do when faced with any emergencies and possible first aids. Members of the public can go for the vaccines to protect themselves from exposure.

Timeline

The procedure shown above was relevant in providing a guideline on the evaluation. The first thing was to select a research area (Palm Island Indigenous Population). Research questions gave direction on what to identify and the unique features. methodologies applied were conducting interviews and conducting of questionnaires. Common open and closed questions were asked to determine the wave nature of the virus (Yassouridis et al., 2018). Various groups of participants included people of all ages with their diversity. Data analysis was done using regression mean to determine variance. after all this was done, the first, second, and final drafts were written to sum up the evaluation.

In conclusion, the CDC framework must follow all the six steps for it to be complete. The plan to vaccinate the Palm Island Indigenous Population followed the procedure as it was the most appropriate. The engagement of stakeholders solved the gap of low income and other economic factors hindering them from receiving better services. Majorly, the government of Australians response was critical. Describing the plan by considering possible risk factors and poor communication created a strong foundation and path to be followed. Goals and objectives set created better pathways to the achievement. Educating the target group and creating governing policies such as wearing masks and keeping social distance.

Evaluation designs and methods used include single group (posttest only), single group (pre and posttest), non-equivalent control (pre and post), and single group (time series). They were able to show the trends of data and variations whenever possible. Threats to both internal and external validity were also examined deeply. Program components like knowledge, attitude, behavior, self-efficacy, and health status, social and environmental support. Ensuring use and share of lessons learned by recalling the stakeholders involved and looking for ways to ensure the finding are used.

References

Adeoye, J., Wan, C., & Thomson, P. (2020). An appraisal of pivotal evaluation designs in validating noninvasive biomarkers for head and neck cancer detection. Acta Oncologica, 59(12), 1500-1502.

Alam, M. (2020). A systematic qualitative case study: Questions, data collection, NVivo analysis, and saturation.Qualitative Research in Organizations and Management: An International Journal, 16(1), 1-31.

Australian Government Department of Health. (2021). Immunization for Aboriginal and Torres Strait Islander people. Australian Government Department of Health.

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Callwood, A., Jeevaratnam, K., Kotronoulas, G., Schneider, A., Lewis, L., & Nadarajah, V. (2018). Personal domains assessed in multiple mini interviews (MMIs) for healthcare student selection: A narrative synthesis systematic review. Nurse Education Today, 64, 56-64.

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Chesney, T., Bogach, J., Devaud, N., Govindarajan, A., & Wright, F. (2020). How we did it: creating virtual interviews for postgraduate medical trainee recruitment and keeping it personal. Annals of Surgery, 273(2), e60-e62.

Cumpston, M., Li, T., Page, M., Chandler, J., Welch, V., Higgins, J., & Thomas, J. (2019). Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database of Systematic Reviews. Web.

de Block, D., & Vis, B. (2018). Addressing the challenges related to transforming qualitative into quantitative data in qualitative comparative analysis. Journal of Mixed Methods Research, 13(4), 503-535.

Falissard, B. (2021). The future of evaluation of the child and adolescent psychiatric treatments. IACAPAP Arxiv. Web.

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Kizlyar, D., & Fouseki, K. (2018). Treating resistance as data in qualitative interviews. The Qualitative Report. Web.

Lederer, J., Fellner, J., Gassner, A., Gruhler, K., & Schiller, G. (2021). Determining the material intensities of buildings selected by random sampling: A case study from Vienna.Journal of Industrial Ecology, 25(4), 848-863.

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Nguyen, T., Karney, B., & Bradbury, T. (2020). When poor communication does and does not matter: The moderating role of stress. Journal of Family Psychology, 34(6), 676-686.

Pennycook, G., McPhetres, J., Zhang, Y., Lu, J., & Rand, D. (2020). Fighting COVID-19 misinformation on social media: Experimental evidence for a scalable accuracy-nudge intervention.Psychological Science, 31(7), 770-780.

Quek, J., Brauer, S., Treleaven, J., & Clark, R. (2017).The concurrent validity and interrater reliability of the Microsoft Kinect to measure thoracic kyphosis.International Journal of Rehabilitation Research, 40(3), 279-284.

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Southwood, N. (2018). The feasibility issue.Philosophy Compass, 13(8).

Vaccination for Aboriginal and Torres Strait Islander people. (2018). Australian Government Department of Health. Web.

Wu, C., Shu, M., & Chang, Y. (2018). Variable-sampling plans based on lifetime-performance index under exponential distribution with censoring and its extensions.Applied Mathematical Modelling, 55, 81-93.

Yassouridis, C., Ernst, D., & Leisch, F. (2018). Generalization, combination, and extension of functional clustering algorithms: The R package fancy. Journal of Statistical Software, 85(9).

Varshney, R., Gupta, S., & Ali, I. (2017). An optimum multivariate-multiobjective stratified sampling design: Fuzzy programming Approach.Pakistan Journal of Statistics and Operation Research, 13(4), 829. Zucker, N., Schmitt, C., DeJonckheere, M., Nichols, L., Plegue, M., & Chang, T. (2019). Confidentiality in the doctor-patient relationship: perspectives of youth ages 14-24 Years. The Journal of Pediatrics, 213, 196-202.

In the present day, coronavirus disease (COVID-19) may be regarded as a health problem of a global scale. Identified in Wuhan, China at the end of 2019, this severe acute respiratory syndrome has spread across the globe and affected more than 180 countries (Sanyaolu et al. 2020). It infects humans at a highly alarming rate regardless of their age, ethnicity, and sex. The confirmed cases of COVID-19 have a considerably wide range of symptoms from mild complaints, such as fever and cough, to more critical cases associated with difficulty in breathing (Sanyaolu et al. 2020, 1070). The major symptoms of this disease include fever, cough, shortness of breath, chills, sore throat, muscle aches, unexplained loss of smell and taste, headache, and diarrhea. In general, clinical manifestations of COVID-19 range from a typical cold to considerably more severe illnesses such as pneumonia, bronchitis, multi-organ failure, severe acute respiratory distress syndrome, and death (Sanyaolu et al. 2020). As a matter of fact, there are still multiple limitations to knowledge related to this virus as it continues to evolve.

At the same time, there is evidence of the ability of COVID-19 to cause lasting damage to health. According to Chalmers (2020), even after being diagnosed with and recovering from the disease several months ago, coronavirus survivors currently report that they still suffer from breathlessness, fatigue, and problems. In general, the majority of coronavirus patients recover within fourteen days suffering cough, losing the sense of taste and smell, and fever for several days (Chalmers 2020). However, by some estimates, one in three coronavirus survivors, even young and relatively healthy individuals, develops particular symptoms that linger for weeks (Mervosh 2020). These symptoms traditionally include a racing heart, deep exhaustion, and piercing chest pain. People who suffer from the comorbidities of COVID-19 call themselves long haulers (Chalmers 2020). Despite the fact that these people are not contagious as they have already recovered, the diseases lasting complications considerably affect their everyday life. These patients frequently struggle to complete simple tasks without a racing heart and extreme tiredness.

In the present day, despite particular attention to racial issues in the United States, the inequalities in the health care system still exist. Due to general inequities in the public health system of the United States, such as a lack of health insurance caused by low income and unemployment, limited access to health care services, and the underrepresentation of Black specialists in medical settings, morbidity and mortality rates within the Black community, including all Black citizens regardless of their place of birth or origin, are considerably high (Gilbert et al. 2016). It goes without saying that social and economic factors currently affect Black people as well, and they are more vulnerable to the infection of COVID-19 and its negative consequences. According to recent data released by public health researchers, the coronavirus is killing Black people at disproportionally high rates (Eligon et al. 2020). In addition, across the country, they generally account for more than half of those people who have positive tests (Eligon et al. 2020).

For the majority of public health experts, the reasons behind high and disproportionate mortality rates from COVID-19 among the Black population are easily explicable (Eligon et al. 2020). Black citizens frequently do not have an opportunity to work from home as they hold a disproportionate share of retail, municipal, first responder and other jobs that interact directly with the public and have been deemed essential throughout the pandemic (Higgins-Dunn et al. 2020). In addition, Black health care providers are overrepresented in hospitals (Green & Moore, 2020). That is why they are exposed to a greater risk of coronavirus infection in comparison with White employees who work remotely in the spheres of economics, finance, and information technologies.

As previously mentioned, a substantial number of patients have additional symptoms of COVID-19 that may linger for several months after recovery. Taking into consideration the fact that the virus disproportionately affects Black communities in the United States, it is possible to conclude that the majority of long haulers will be Black people who will suffer from the long-term effects of the coronavirus at disproportional rates as well. In addition, the access Black people have to medical services is frequently limited due to their financial state and a lack of nurses and doctors in the Black community (Wingfield 2020). That is why, without appropriate and time-sensitive treatment, they are exposed to a greater risk of diabetes, hypertension, and chronic respiratory illnesses in comparison with the White population. According to recent researches, these comorbidities increase the chances of infection (Sanyaolu et al. 2020, 1071). Consequently, Black people suffer from both severe symptoms of COVID-19 and illnesses that may develop on the background of the virus.

In general, COVID-19 and its long-lasting negative health conditions disproportionally affect Black patients and their jobs as their reports concerning their general state are not well-regarded. According to Green and Moore (2020), 39% of positions held by black workers are at considerable risk, opposite to 34% for white employees. Moreover, Black coronavirus survivors have admitted that they have not been paid for several months despite their inability to work that should presuppose their need in paid leave (Mervosh 2020). Physicians and employees frequently regard patients chronic pain conditions and inability to breath as ordinary anxiety or stress (Mervosh 2020). At the same time, if the changes of policy in order to reduce racial disparities in the public health system are not initiated on the federal level, Black citizens will be more vulnerable to severe illnesses from the coronavirus in comparison with white citizens.

References

Chalmers, Vanessa. 2020. How Covid-19 causes lasting damage: Three survivors in their 20s reveal they STILL suffer fatigue, racing hearts and breathlessness MONTHS after they were first sick. Mail Online, Web.

Eligon, John, Audra D. S. Burch, Dionne Searcey, and Richard A. Oppel Jr. 2020. Black Americans Face Alarming Rates of Coronavirus Infection in Some States. The New York Times, Web.

Gilbert, Keon L., Rashawn Ray, Arjumand Siddiqi, Shivan Shetty, Elizabeth A. Baker, Keith Elder, and Derek M. Griffith. 2016. Visible and Invisible Trends in Black Mens Health: Pitfalls and Promises for Addressing Racial, Ethnic, and Gender Inequities in Health. Annual Review of Public Health 37: 295311.

Green, Jeff, and Donald Moore. 2020. Covid-19 Is Hurting Black Americans More in Almost Every Way. Bloomberg, Web.

Higgins-Dunn, Noah, Will Feuer, Berkeley Lovelace Jr., and Jasmine Kim. 2020. Coronavirus Pandemic and George Floyd Protests Highlight Health Disparities for Black People. CNBC, Web.

Mervosh, Sarah. 2020. Its Not in My Head: They Survived the Coronavirus, but They Never Got Well. The New York Times, Web.

Sanyaolu Adekunle, Chuku Okorie, Aleksandra Marinkovic, Risha Patidar, Kokab Younis, Priyank Desai, Zaheeda Hosein, Inderbir Padda et al. 2020. Comorbidity and its Impact on Patients with COVID-19. SN Comprehensive Clinical Medicine 2: 10691076.

Wingfield, Adia Harvey. 2020. The Disproportionate Impact of Covid-19 on Black Health Care Workers in the U.S. Harvard Business Review. Web.

Introduction

The building of dams in the Pacific Northwest started later in the 19^th century. These early dams were mainly constructed on small rivers or tributaries for the purpose of irrigation. In the first years of the twentieth century, the first hydropower dams were constructed on the tributaries of the Columbia River (National Research Council 231 ). As the century progressed on, dam building activities were stepped up due to the increase in the demand for hydropower.

The construction of the Bonneville and the Grand Coulee were initiated in late in the 1930s and this was followed by a marked increase in the number of dams and their storage volumes in Oregon, Washington and Idaho (Bonneville Power Adminstration 3).

Forty five years after the authorization of the Bonneville (1933), 14 dams on the Columbia River and 13 on the Snake River had been constructed (National Research Council 131). By early 1980s, there were no more sites for large dam construction. Furthermore, public approval for such projects had significantly diminished and thus signaling the end of the growth phase.

At the completion of the rapid growth phase it was now obvious that the dams were posing a major threat to ecological sustainability. Most of the dams were built on the migratory routes of the most west Pacific Northwest salmon runs (Stewart 45). Various mitigation measures have been taken to address this issue but not much has been achieved.

This paper therefore seeks to identify the effects of the Columbia River dams on salmon runs. Though the effects are mostly negative, the paper will go further to identify if there is any benefits that have been created by the dams to the salmon population.

Negative effects

Many species of salmon breed and grow in the riffles of cold-flowing rivers far from the sea (Stewart 57). The young salmons often migrate to the sea where they live for several years before returning home to breed. The man made dams have prevented the fish from travelling up and down the river ways, despite mitigating measures such as the construction of fish ladders (Dube 13).

The insufficiency or lack of fish passage facilities have led to the loss of the upstream habitat. The dams constructed across the Columbia River blocks close to one third of the watershed from being accessed by anadromous fishes. The barriers are mainly associated with the Grand Coulee Dam which accounts for a third of the passage barriers (National Research Council 132 ).

The impassable dams have lead to a significant reduction in the rearing and spawning habitat. However, it is difficult to estimate the magnitude of the loss as record keeping was nonexistent before the dams were constructed (Pitzer 10). The following are the specific effects of the dams on salmon populations:

Dam-linked deaths

There dams have been found to account for a considerable number of salmon deaths. Even when the dams are built with fish ladders for upstream passage of salmon, the fish can still be delayed (Bonneville Power Adminstration 4, par. 2). The rapid flow of water originating from the turbines usually makes it difficult for the salmon fish to locate the tiny attraction flows that guide them to the ladders. There has been a significant improvement in the ladder design and quality of materials used since the 1900s.

However, not much has been achieved in preventing adult and juvenile salmon deaths that can be attributed to difficulties in locating or using the ladder. Some ladders tend to have high flow rates that often and thus are avoided by the salmons causing delays in upstream migration.

The ladder delays may not directly result in the death of the salmons but may interfere with other processes that increase the chances of death. For instance, salmons do not feed on upstream migration and must use stored energy as efficiently as possible to migrate upstream, mature sexually and spawn successfully (National Research Council 234, par. 3 ).

Adult salmons usually get killed if they are pulled back into the turbine intakes, although it is difficult to estimate the deaths that result this way. Counting of the salmons between successive dams shows declining numbers that are thought to result from deaths. However, poaching might account for some salmon losses (Dube 45). The losses between dams have been approximated to be as high as 25% between Bonneville Dam to John Day Dam.

The dams also pose a significant risk to the downstream passage of juveniles. The juveniles which are often referred to as the guided fish, can make contact with deflection screen surfaces, gate well walls, the vertical barrier screens in the gate wells, the orifice entrance or portions of the bypass channel or down well (Stewart 60, par. 4). Such encounters cause a considerable damage to the scale surface and thus significantly reduce the viability of the salmon fish.

The fish undergoes stress when passing through the bypasses. Sometimes the fish is made to hold in the currents to resist passing downstream (Dube 46, par. 1). This experience results into physiological stress and can recover if they are held for 48 hours. However, when the fish is under stressful conditions and directly goes through the bypass it often ends up in the outfall, where it may be preyed upon by birds and other fish.

The bypass systems may also result in the concentration of smolts in a relatively small area. Smolts from the large width of the Columbia River usually gather in the narrow bypass channel. Sometimes thousands of smolts per hour are delivered in a small volume of water to the dam tailrace, which provides a concentrated stream of prey for predators (National Research Council 236, par. 5 ). Studies conducted previously indicate that there is a high concentration of predators at the areas between the bypass and the outfall.

It is not easy to identify the total bypass mortality due to absence of carcasses. Some researchers investigators consider bypass-caused deaths to include only those which can be observe in the raceways and sampling facilities incorporated in the bypass systems (Dube 56).

But this does not give information on impingement on deflection screens, predation within the gate-well and bypass system, predation caused by bypass concentrated stream of prey, stress-related deaths that occur after smolts leave the outfall are or predation on stressed fish long after they leave the outfall pipe (Pitzer 105).

Time of travel

The time of travel effect is less clear as compared to the effect of passing through the dams. Ocean type chinook passes their first winter of life at sea while the stream type spend their first winter of life in the stream before going to sea (OLaughlin 3, par. 1).

Data revealed by some studies show that sub-yearlings travel downstream faster when the flow rate is high. Sub-yearling Chinook usually grow as they gradually travel downstream in what can be regarded as a rearing migration (Bonneville Power Adminstration 4, par. 3).

The yearling Chinook and the steelhead travel faster with an average downstream passage of up to 20 miles or more a day (Stewart 78). The fish passage Center and the Columbia Basin Fish and Wildlife Authority show that dams can result into faster rates with associated implications (OLaughlin 56).

Studies have been done to identify the survival of the salmons during the downstream passage. A study conducted in 1999 with using a passive integrated transporter (PIT) tags indicate survival near 100% through lower granite pool. However, the estimated mortality across the concrete was higher than expected (Bonneville Power Adminstration 3).

Loss of migratory path

When a diversion is made from a river so that the water is to be utilized for agricultural or domestic needs, there is a high possibility that the downstream migrating salmon and other fish will be drawn into the diversion channel or pipe (Stewart 107). The Columbia River has several channels adjacent to dams and that are not screened adequately.

These unscreened diversions have been present for years despite efforts by the authorities to add new screens and revive the old ones. No study has adequately established the overall benefit provided by the screens in comparison to the lost rearing habitat in irrigation canals and ditches downstream from the screens (Dube 63).

Estuarine dynamics

The estuaries of the dammed Columbia River are thought to have changed and thus affecting the salmon in one way or another. The reservoir storage in the upper Columbia and Snake rivers have altered both the seasonal pattern and the characteristics of the extremes of fresh water entering the estuary (National Research Council 236, par. 5 ). The average sediment supply to the estuary has greatly declined and thus affecting the natural salmon habitat.

Effects on spawning habitats

The anadromous salmon normally bury their eggs in redds in the gravel substrate at varying depths depending on the species (National Research Council 237, par.4). The presence of large dams prevents the downstream flow of the sediments and this inevitably leads to the destruction of salmon spawning habitats that are located downstream (Bonneville Power Adminstration 5).

The usual practice of regulating the water level in the dams to prevent power surges or increase the provision of electricity often leads to erosion downstream habitats. The resulting cyclic floods contribute to the extinction of the salmons by flushing away their spawning gravels (OLaughlin 3, par. 3).

Urbanization effects

The development of the dams inevitably led to the urbanization of the areas surrounding the Columbia River. The primary impact of urbanization is the degradation of the downstream water quality through pollution and reduced water flow through removal of irrigation (OLaughlin 3, par. 3). Urbanization has led to the loss of forests and thus significantly contributing to the alteration of the temperatures and sedimentation patterns.

Changing temperatures

Temperatures are observed to change significantly when a river is dammed. Normal rivers often have homogenous temperatures due to the constant flow of water. Reservoirs are layered and are worm at the top and cold at the bottom (Stewart 80). When the water is released from the dam it results into unusual cold temperatures which may compromise the survival of the salmon.

Mitigation efforts

The development of dams along the Columbia River was basically for irrigation, protection against floods, production of hydropower, recreation and for navigation purposes. Hydropower production was the main consideration until 1980 when the Northwest power Act was enacted (National Research Council 239).

One of the key areas agreed upon and captured in the act was the protection and enhancement of fishery. Thus profound changes in the operating strategies were to be planned and implemented. This section discusses the mitigation measures that have been taken so far to improve the conditions. This measures include; fish-passage facilities, predator control, transportation, spill, flow augmentation, reservoir drawdown and dam removal (National Research Council 239, par. 2 ).

Fish passage facilities

Initially, there were no fish ladders to enable the salmon to swim upstream past the dams. The ones that were constructed in the early 1900s were also found to be inadequate for that purpose. Intensive studies about fish behavior, response to attraction flows, and in ladder hydraulics led to marked improvement in ladder designs (Dube 67). However, the improved designs have not been able to offer a total solution as there are still instances of fishes being delayed by hydropower dams and falling after passage (Dube 68).

The early mainstem dams (rock island dam and the Bonneville Dam) that were constructed on the Columbia River had fish ways that only permitted the passage of adult salmons. All the other mainstem dams that were constructed later also have fish ways. The juvenile passage facilities on most mainstem dams in the Columbia River system use deflection screens that project downward into the intakes of turbines and deflect fish upward from the turbine intake into the gatewell (National Research Council 56 ).

The design of the deflection screen is founded on the fact that downstream migrating juvenile salmon tend to pass through the turbine intake high in the water column (Stewart 83). The screens often guide intercepted fish upward into the gatewell.

Predator control

The major threat downstream migrating juveniles are the squawfish that is alleged to kill millions of juveniles annually (Pitzer 34). A study conducted using the John Day pool revealed that up to 12% of the salmons that entered the pool were killed every month by the squawfish. As a result initiatives were taken to reduce squawfish related salmon deaths. The programs include bounties and intensive efforts to reduce predator densities (Stewart 84). It was particularly designed to down size the population of the larger squawfish.

Transportation

Transport systems have been developed to deliver juveniles downstream. Raceways are normally used to hold downstream migrants for delivery by barges or trucks (Dube 35). The concept is based on leap frogging in which the juveniles are delivered at some point downstream from the power projects (Pitzer 87). In the Columbia River system, raceways are used to transport juveniles to the Bonneville Dam tailrace.

This transportation relies on barges which are further used to maintain water quality, for instance, by inhibiting gas super-saturation (National Research Council 243). However, a study conducted on the Snake River showed a reduction of salmon runs when barging was applied which has caused the efficiency of barging to be questioned (OLaughlin 4).

Flow augmentation

The hydropower dams result in faster passage of the juvenile salmons downstream and therefore significantly reducing their survival rates. This more observed on the middle Columbia and the Snake rivers during spring. An attempt was made to reduce passage through the use of water budget which provided some upstream storage in the snake and mainstem Columbia to increase spring flows (Dube 43).

Spill

Spill is water that is deliberately passed over the dam to aid fish passage. The river is often spilled for a short time to prevent the accumulation of water bubbles. Spilling is often done in spring and summer during juvenile migration (Dube 53).

Designing of fish friendly turbines

In real sense a negligible amount of fish pass through the turbines as compared to other passages (Pitzer 45). However, dam operators are slowly removing the old turbines and installing new ones that are designed for fish safety.

Conclusion

This paper sought to identify the effects imparted by dams on Columbia River Salmon populations. The investigation was supposed to identify both the positive and negative effects.

Several negative effects have been identified and they include; increase in mortality rates, loss of habitat, increased time of travel, change in estuarine dynamics, loss of migratory path and finally effects associated with industrialization.

All the literature reviewed had no data on the positive effects of dams on salmon populations. It remains to be investigated whether there are any positive effects impacted by the dams on the salmon populations.

The paper has also identified the mitigation measures that have been taken to improve the viability of the salmon population in the Columbia River. The following measures are currently being undertaken; Predator control, transportation, flow augmentation, spill, designing of fish friendly turbines, fish passage facilities (National Research Council 142).

Works Cited

Bonneville Power Adminstration. Managing the Columbia River System helps fish . Govtcorp.com. 4 September 2010. Web.

Dube, Kathy. The effects of large dams on salmon spawning habitat in the pacific northwest . Seattle: Waterdhed Geodynamics, 2003. Print.

National Research Council . Upstream: salmon and society in the Pacific Northwest. New York : National Academies press, 1996. Print.

OLaughlin, Jay. The varriable impacts of dams on Columbia and Snake river salmon populations. Moscow: University of Idaho, 2001. Print.

Pitzer, Paul. Grand Coulee: Harnessing a Dream. Washington: Washington state University , 1994. Print.

Stewart, Holbrook. The Columbia: The Classic Portrait of the Great River of the Northwest. New york: Comstock Editions, 1986. Print.

Summary

Roberts (2011) article highlights on the increased world population, which currently stands at about seven billion people. To estimate the worlds population, UN and USCB use statistics and censuses from over 228 political entities and countries. The censuses and statistics not only help to project deaths inclusive of those caused by epidemics but also to project births inclusive of those conceived by the refugees.

Approximately, 367,000 people are born each day while 153,000 people die each day hence resulting into an increase of 78.5 million people annually. As revealed, the increased population results from the gradual decline of deaths and gradual increase of births in a rapid manner. As a result, more people are born whilst fewer people succumb to death thus leading to population increment attainment of billion-person milestones every 12 or 13 years (Roberts, 2011, para. 11).

Analysis

However, one cannot help but note the statistical discrepancies that exist between the United Nations and USCB. USCB notes that the population will not reach 7 billion until four months are over. This implies that the United Nations miss the population estimation of 28 million, which is more that all people in Saudi Arabia (Roberts, 2011, para. 2).

The justification behind the outcome is the margin of error of at least 1 percent (Roberts, 2011, para. 4) which is said to give room for errors. Considering that UN and USCB collected information from similar sources, the estimation should be approximately the same and therefore, the error margin is not justifiable.

A close look reveals that the disparity results from interpretation of figures. USCB use silly or impractical population interpreters population clock that projects the number of persons who die or are given birth to every minute. As indicated, UN dont use a population clock (Roberts, 2011, para. 6).

Unfortunately, USCB dismisses these claims when they state that their estimates are precise remarkably close (Roberts, 2011, para. 10). This shows that they are not willing to solve the populations statistical differences between them and UN.

Interpretation

The more people the world has, the more resources are used. Therefore, if there is an increased population that the world can barely support, people will competed for the available resources including land, water and the available economic opportunities. This implies that there are people who will be destitute.

In addition, increased competition for the available resources implies that people will have to fight for the resources thus resulting to conflicts, which can lead to wars. This explains why there is a need to have proper population estimates. They form the basis of addressing the needs and problems that the worlds population is facing such as mitigating overpopulation.

Opinion/insight

Changes in population could affect all people including me. If the world becomes overpopulated, I would likely succumb to poverty or live in a war-stricken society. For this reason, I think that the USCB and the UN should collaboratively evaluate the population estimates.

This will help them come up with the most appropriate method that they can use to interpret the statistics and the censuses collected. In addition, this will help them come up with a more precise estimate for the worlds population and project how the population growth will be in future. This way, all members of the society including the government and the international bodies can come up with precise solutions that could help mitigate overpopulation.

References

Roberts, S. (2011). U.N. says 7 billion now share the world. Web.

Introduction

Bottled water is a steadily growing business in many countries of the world. Despite its long presence on the market, it continues to increase sales each year (Statistic Brain, 2016). Many people believe that bottled water is tastier, healthier, or is otherwise better than widely available tap water. However, gradually more studies show that most of these beliefs are unfounded or misunderstood. Several tests show that on many occasions tap water is cleaner and the control behind its quality is more reliable. Several blind trials also suggest that tap water is chosen as having a better taste when the participants do not know that it does not come from a bottle (Viscusi, Huber, & Bell, 2015). Finally, a question of environmental influence is constantly raised by various agencies and activist groups, which claim that the process of bottle production and the bottles usually create waste that is not properly recycled. As a result, despite the best marketing effort of industry giants, the issue of the sustainability of bottled water becomes more prominent in the later years, in part thanks to the youth activist groups which raise awareness. In particular, personal observations show that the Facebook newsfeeds of the young audience often feature information bits about the disadvantages of bottled water and advertisements of refillable bottles. However, the actual effect of activism, as well as its demographic characteristics, is unclear. The following study aims to analyze the impact of the increased information regarding water bottles at the younger population to find out whether they tend to use refillable bottles rather than buy bottled water and thus determine possible ways to improve the situation.

Methods

The study was performed by observing the students of the college in the campus area for five days. The numbers of students carrying bottled water and those carrying refillable water bottles were recorded and compared to find out which group is more numerous. Because of the personal observations made on Facebook, the hypothesis was that the number of students with refillable bottles would be higher because of better access to information and awareness of the harmful environmental effect of disposable bottles.

Results

After five days of observations, the total number of people carrying refillable bottles totaled 18, or 5, 2, 5, 4, 2, respectively. The number of students with disposable bottles of water totaled 44, or 12, 6, 8, 16, and 2, respectively. Of the total number of students carrying water bottles, only 29% had refillable ones.

Discussion

The results differed significantly from the initial assumption. They suggest that despite serious involvement in the movement to promote the use of tap water, most of the young people prefer bottled water. These results show a serious difference between the stated goals and values and the actual purchasing habits. However, the study has two serious limitations. First, the recorded number is prone to error because of the difficulties in observation. Second, there is no data on the use of bottled water among the older population, which may differ enough to partially confirm the hypothesis. Thus, it is recommended to develop a better method which would provide a better opportunity for research and conduct a similar study among different age group to be able to contrast the results against other data.

References

Statistic Brain. (2016). Bottled water industry statistics. Web.

Viscusi, W. K., Huber, J., & Bell, J. (2015). The private rationality of bottled water drinking. Contemporary Economic Policy, 33(3), 450-467.

Introduction

Nowadays, the possibility of wolf populations restoration in the Northeast districts of America draws significant attention. The researchers continue to evaluate the potential advantages and disadvantages of the idea, and, in the state of New York, the public opinion is gradually shifting from negative to positive attitudes towards the reestablishment of the wolf population (Enck & Brown, 2002). The recent findings in the wildlife populations research demonstrate that the restoration of wolves in the Adirondack Park may positively influence regional development and may contribute to the improvement of the environmental condition.

The Adirondack Park

The Park occupies a massive part of New York. The territory of the Park comprises a few cities and yet the surroundings of the Adirondack Mountains are in the preserved zone (The Adirondack Park, 2016). It is one of the favorite holiday destinations for many people who love nature, and the initiative for the gray wolf population restoration has the potential for the acceleration of tourism development. Ecotourism is a promising trajectory in the industry, and many people can be attracted by the opportunities to encounter wolves (Enck & Brown, 2002). In this way, economic growth may be regarded as an indirect consequence of animals restoration, and economic development will contribute to the enhancement of local infrastructures and increase in life quality.

Wolf Population

When the Americans first commenced the settlement in the Northeast of the country, the wolves were perceived as deleterious and dangerous animals. As a result of such prejudiced attitudes and lack of objective knowledge about wolves behavior, the animals were completely expatriated by 1874, and at the moment of the official establishment of the Adirondack Park, there were no wolves on its territory (Enck & Brown, 2002). Nowadays, gray wolves are protected under the Endangered Species Act, which remains in force in forty-eight states. And the further expansion of wolves living environment will contribute to species conservation.

Ecosystem Balance

One of the biggest environmental challenges in the Adirondack Park is the large and uncontrolled population of deer that significantly harms the environment and raises the issues of deforestation. Deer eat the young shoots of trees and, in this way, contribute to the extinction of some other species. However, the reestablishment of wolves population may provoke favorable outcomes in problem-resolving.

It is possible to observe in the example of Yellowstone Park where the similar problems with elk overpopulation took place that the restoration of wolf population may help to maintain the environmental stability (White & Garrott, 2005).

For a long time, elk put the population of beavers at the risk of extinction. Beavers played a huge role in the ecosystem, but when they were deprived of access to the food they simply left the Parks area, and it led to the gradual desiccation of water reservoirs. The reappearance of wolves helped to restore the delicate balance of the ecosystem. The wolves influenced elks behavior  they became more cautious and started to spend most of the time hiding in the forests. As a result, deforestation near the ponds decreased, and other wildlife populations could return to their living environments.

Conclusion

The review of research findings revealed that the restoration of the wolf population may provoke multiple positive outcomes in regional development and environmental stability maintenance. Moreover, the reestablishment of the wolf population has implications for environmental education. The potential benefits for the ecosystem achieved through the reappearance of wolves in the Adirondack Park may be explored and evaluated, and the accumulated evidence will serve as a historical document for the prevention of the similar mistakes provoked by the lack of knowledge.

References

Enck, J. W., & Brown, T. L. (2002). New Yorkers attitudes toward restoring wolves to the Adirondack Park. Wildlife Society Bulletin, 30(1), 1628. Web.

The Adirondack Park. (2016). Web.

White, P. J., & Garrott, R. A. (2005). Northern Yellowstone elk after wolf restoration. Wildlife Society Bulletin, 33(3), 942955. Web.