NURS 8310 – Epidemiology and Population Health Essay

“Epidemiology today is considered to be the core science of public health and is described as a constellation of disciplines with a common mission: optimal health for the whole community” (Stanhope & Lancaster, 2008). Epidemiology continues to play a large role in public health to improve on disease prevention and health promotion in communities across the United States and the World. The Gay, Lesbian, and Bi-sexual and Transgender (GLBT) community at it relates to HIV will be the main focus of this epidemiology paper. NURS 8310 – Epidemiology and Population Health Essay Paper

This paper will focus on the GBLT population in regards to their vulnerability and susceptibility to HIV, along with the epidemiology and levels of prevention. The following paper will discuss the definition and purpose of epidemiology, methods of epidemiology, the epidemiology triangle, as well as the levels of prevention that relate to HIV ethical and legal considerations, cultural considerations on health status, and how characteristics influence vulnerability in the GBLT community. NURS 8310 – Epidemiology and Population Health Essay Paper

According to Ard & Makadon, “Not only are lesbians, gay men, bisexual women and men, and transgender people distinct populations, but each of these groups is itself a diverse population whose members vary widely in age, race and ethnicity, geographic location, social background, religiosity, and other demographic characteristics.” In the past GLBT community was more accepted in San Francisco and New York, and with more people “coming out,” the GLBT population has become more publically recognized across the United States. According to an NIBC article the phrase “lesbian, gay, bisexual, and transgender community refers to a broad coalition of groups that are diverse with respect to gender sexual orientation, race/ethnicity and socioeconomic status.” The GLBT is a different population, but they are very diverse in race, age, location and social backgrounds. Location is one of the biggest differences due to it being easier to express your orientation in a larger city. In rural areas, the GLBT people may feel more uncomfortable coming out due to fewer support services. NURS 8310 – Epidemiology and Population Health Essay Paper

With the GLBT population, the most prevalent epidemiology is HIV/AIDS. First we need to know the definition of epidemiology. Merriam-Webster Dictionary defines Epidemiology as “Study of disease distribution in populations. It focuses on groups rather than individuals and often takes a historical perspective. Descriptive epidemiology studies a population to see what segments (e.g., age, sex, ethnic group, occupation) are affected by the disorder, follows changes or variations in its incidence or mortality over time and in different locations, and helps identify syndromes or suggest associations with risk factors. Analytic epidemiology conducts studies to test the conclusions of descriptive surveys or laboratory observations. Epidemiologic data on diseases is used to find those at high risk, identify causes and take preventive measures, and plan new health services.” HIV the most common disease within the GBLT community but it is more prevalent within gay and bisexual men. HIV is a sexually transmitted infection that is transmitted through body fluids and blood. NURS 8310 – Epidemiology and Population Health Essay Paper

According to the Mayo Clinic, HIV/AIDS is described as “AIDS (acquired immunodeficiency syndrome) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body’s ability to fight the organisms that cause disease. HIV is a sexually transmitted infection. It can also be spread by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding. It can take years before HIV weakens your immune system to the point that you have AIDS. There’s no cure for HIV/AIDS, but there are medications that can dramatically slow disease progression.” HIV is transmitted in five ways: through unprotected sexual intercourse, transmission of contaminated blood, sharing of contaminated needles, mother to child during breastfeeding. Contrary to popular belief, HIV cannot be transmitted through kissing, hugging or shaking hands. In addition, sharing eating utensils or bathroom facilities, does not transmit HIV. NURS 8310 – Epidemiology and Population Health Essay Paper

The only absolute sure way not to contract HIV is 100% abstinence but it is not for everyone. The community health nurse role is crucial, they must have a full spectrum of understanding the HIV virus. When a patient comes in for testing, the nurse must understand their fears and offer emotional and psychosocial support. To better understand the disease works we need the Epidemiological Triangle that is “disease results from complex relationships among causal agents, susceptible persons, and environmental factors. These three elements, the agent, host, and an environment, are traditionally referred to as the epidemiologic triangle. This model, originally developed as a way of identifying causative factors, transmission, and risk related to infectious diseases. Changes in one of the parts of the triangle can influence the occurrence of disease by increasing or decreasing a person’s risk for disease. Specific characteristics of agent and host, as well as the interactions between agent and host, are influenced by the environmental context in which they exist, and may in turn influence the environment” Stanhope & Lancaster, (2012). NURS 8310 – Epidemiology and Population Health Essay Paper

The Epidemiologic Triangle describes the potential imbalance of health. The agent is the HIV virus, and the host is human interaction such as race and education, and the environment represents the risky behavior such as unprotected sex or sex with multiple partners. Quantitative and qualitative is used to evaluate community interventions. The community nurse must have a full spectrum and understanding of HIV. The primary importance of the community health nurse and the Epidemiology Triangle is education thru prevention. According to the Stop HIV website, there is a primary and secondary prevention, “Primary Prevention: Preventing an individual from becoming infected with HIV. Secondary Prevention: Once a person is infected with HIV, assisting the person in staying healthy as long as possible and not developing complications.” In the primary prevention stage, individuals are taught how better to protect themselves against HIV and other sexually transmitted diseases. The use of condoms and monogamy is two of the easiest ways to prevent the spread of HIV among the GBLT populations. NURS 8310 – Epidemiology and Population Health Essay Paper

The secondary prevention is actually to use the techniques they learn in the primary prevention. According to the CDC ” Gay, bisexual, and other men who have sex with men (MSM) represent approximately 2% of the United States population, yet are the population most severely affected by HIV. In 2010, young gay and bisexual men (aged 13-24 years) accounted for 72% of new HIV infections among all persons aged 13 to 24, and 30% of new infections among all gay and bisexual men. At the end of 2010, an estimated 489,121 (56%) persons living with an HIV diagnosis in the United States were gay and bisexual men, or gay and bisexual men who also inject drugs.” Some characteristics with the population that may affect their vulnerability would include promiscuity among bisexual men, overtly effeminate, and the differences within the population. Bisexual men are more likely to have unprotected and infect their female partner without her knowing. NURS 8310 – Epidemiology and Population Health Essay Paper

By being very feminine in public, opens them up to bullying and discrimination. With differences among the population varies from open public affection to still remaining in the closet, and same partner violence among lesbians. “About 17-45% of lesbians report having been the victim of a least one act of physical violence perpetrated by a lesbian partner and sexual abuse by a woman partner has been reported by up to 50% of lesbians” (Suzana Rose, Ph.D.). Health People 2020 reports that “Research suggests that LGBT individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights. Discrimination against LGBT persons have been associated with high rates of psychiatric disorders, substance abuse, and suicide. Experiences of violence and victimization are frequent for LGBT individuals, and have long-lasting effects on the individual and the community. Personal, family, and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBT individuals.” Insurance is a significant problem with same sex partners because many companies do not recognize them, and they are not able to able to be placed on their partner’s insurance. NURS 8310 – Epidemiology and Population Health Essay Paper

Having no medical insurance makes it hard to provide medicines that are needed to help keep HIV from turning into AIDS. There is a need for more LGBT health centers and the expansion of insurance coverage to include domestic partners of the same sex. Doctors must be informed about LGBT health issues due to biases in health care despite the communities growing acceptance of the homosexual population lifestyles. Second, although there are no specific diseases that affect only the LGBT health because of various health disparities. These disparities include a lack of culturally competent health care, legal factors and social discriminations. The LGBT community faces discrimination, biases, and legal issues every day, but the Transgender population feels it more. According to the ACLU “Much of the discrimination transgender people face mirrors that experienced by lesbian, gay, and bisexual people, but is often more severe. NURS 8310 – Epidemiology and Population Health Essay Paper

Additionally, transgender people face a range of legal issues the LGB people rarely do. Identity documents are not reflecting ones gender.” Not only do they have a problem with their identification papers but there is the problem of public restrooms. Which restroom would one use if their transition has not been completed? One of the biggest legal issues in most states is same sex marriages and same sex domestic partnerships. Same sex marriages are not recognized and this leaves the one partner’s unable to be the next of kin in order to make medical decisions. One ethical issue would be the development of a vaccine that must be tested on HIV in different stages. And if the vaccine is developed, who would be able to afford the medication. How would third world countries such as Africa where HIV and AIDS are prevalent be able to afford it? With society taking significant steps toward accepting current views on sexuality, we have begun to remove the stigma that have been associated with being gay, lesbian, bisexual or transgender for many years. NURS 8310 – Epidemiology and Population Health Essay Paper

Accepting lesbian, gay, transgender and bisexual orientations, behaviors, relationships, lifestyles and same sex marriages may also remove any biases. In conclusion, Epidemiology is everywhere in today’s society. HIV is one disease that is most associated with the GLBT population. Because of this there still the stigma that if you are homosexual that you have HIV/AIDS. With education of the GLBT population as well as other populations on how HIV is spread and can be prevented, we can break the epidemiological triangle at the host point.

The break in the triangle is completed by primary and secondary prevention of education on preventing the spread of the disease itself. We also discussed some legal and ethical issues that the GLBT population face every day. Over the years many psychologists, behavioral scientists, and community health nurses have made great strides in changing the community views of homosexuality, recognize the legitimacy of gay male, lesbian, bisexual, and transgender behaviors, relationships and lifestyles in today’s society. Until biases are removed there with always be some kind of legal and ethical issues dealing with HIV and AIDS among the Gay, Lesbian, Bisexual, and Transgender population. NURS 8310 – Epidemiology and Population Health Essay Paper

References:
American Civil Liberties Union: Discrimination against Transgender People Retrieved June 11, 2014 from
https://www.aclu.org/lgbt-rights/discrimination-against-transgender-people

Center for Disease Control and Prevention Fact Sheet
Retrieved June 12, 2012 from:
http://www.cdc.gov/hiv/risk/gender/msm/facts/

Healthy People 2020
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=25

Lesbian Partner Violence Fact Sheet Suzana Rose, Ph.D. National Violence against Women Prevention Research Center University of Missouri at St. Louis Retrieved June 14, 2014 from:
https://www.musc.edu/vawprevention/lesbianrx/factsheet.shtml

In this section of coursework I am going to produce a three-part report for a nursing student newspaper detailing key aspects of public health strategies. In the first part of this assignment I am going to describe the reasons behind public health strategies and their implementation. In the second section I am going to provide a description of the statistical and epidemiological sources of information which could be used by three organisations to determine patterns of ill health. Lastly for the third section of this coursework I am going to provide a brief description of the government, a national organisation and an international organisation reasonable for setting and influencing public health policy. NURS 8310 – Epidemiology and Population Health Essay Paper

Part one- Public Health Strategies

Identifying the health needs of the populations

This is where trends and patterns are identified through statistics; they can be collected directly from doctors or from other secondary statistical evidence. One specific example of identifying the health needs of the populations could be looking at obesity, this means assessing the likely increase in diabetes due to obesity. They would look at the mortality and the morbidity rates which would allow them to identify what causes the problems and put something in place to prevent it from occurring. Furthermore some organisations may collect data on communicable and non-communicable diseases, for example they may focus on a main non-communicable disease such as heart disease because there are many things which can be put in place to prevent it which would be the organisations responsibility. The world Health Organisation (WHO) would be one of the main organisations that would collect this statistical data and would make comparisons to other countries which would help them identify the problem. Once they had identified the problem, they would put strategies in place, for example: if they were looking at heart disease they would think about campaigns which are related to lifestyle factors. Monitoring the health status of the community. NURS 8310 – Epidemiology and Population Health Essay Paper

This is where organisations track the changes in health of the population and alert people to potential problems. After they have identified the changes they have made they will then be able to have a clear insight if there were any problems caused by the changes they made and how they could determine these problems. From statistics they will also be able to recognise any new patterns in health for example if a disease is increasing or decreasing. If a disease is increasing such as cancer they would put strategies in place such as screening which will identify the disease at an early stage which will decrease mortality rates on that specific disease. An organisation who would be informed on the problems would be public health agencies, personal health care organisations. Developing programmes to reduce risk and screen for early disease This helps to reduce levels of ill health by introducing new programmes that classify people as being at risk of a disease. For example, screening is put into place for cancer, especially breast cancer as it is very common and is available for most adults and is also available for men that are obese because they also have chances of getting it. Being able to identify cancer at an early stage will reduce the mortality rate because less people will be dying because the conditions won’t be as bad. It is also easier to treat at an earlier stage. NURS 8310 – Epidemiology and Population Health Essay Paper

Programmes are put into place to try and reduce the levels of ill health for example, health campaigns such as change smoke free which promotes a healthier lifestyle which is benefitting the individual and preventing them for certain diseases such as lung cancer. The Department of Health is the organisation who puts screening into place to try and reduce diseases being unnoticed and making sure that they catch them early. NURS 8310 – Epidemiology and Population Health Essay Paper

Controlling communicable disease

Communicable diseases are diseases that can be spread from one person to another usually through viruses, bacteria, blood or other bodily fluid. The common known communicable diseases are, Measles, Mumps, Rubella, Polio, Influenza and all of those diseases need to be controlled to prevent outbreaks which is known as ‘herd immunity’ this is why measures are put into place such as immunisations which reduces the impact of communicable diseases. The best advice if you have a communicable disease is to stay in to avoid spreading it. If you catch any of the diseases they have to be reported to the local GP so they can notify the public health director so they can put in other plans to control the disease such as food hygiene measures in restaurants and take-away’s to control the spread of food poisoning. NURS 8310 – Epidemiology and Population Health Essay Paper

Promoting the health of the population

The government promote health of the population by introducing campaigns to educate people and raise awareness. This is done by educating them what health implications there are and what diseases they could get if they have a bad die,t such as diabetes or obesity, campaigns such as ‘change 4 life’ or ‘5 a day’ promote a healthier lifestyle and have the support and resources to help individuals and their specific goals and needs. They also have health campaigns to try and improve the health of the community overall and focus at deaths due to a specific illness. The main reason as to why these campaigns are put into place is to reduce the number of health problems due to obesity, drug and alcohol and smoking within communities, the government collect statistical data of how many people use these campaigns and receive the help they need to be successful and reach their goals and they look at whether this has resulted in the health of the community improving. NURS 8310 – Epidemiology and Population Health Essay Paper

For example, the campaign Stoptober is run every year over October and the numbers of smokers has decreased which shows that the campaign is being successful and working effectively which has a positive outcome because these lifestyle factors reduce chances of people getting diseases such as obesity and lung cancer so therefore this comes as a benefit to the NHS because they will be spending less money. Planning and evaluating the national provision of health and social care target setting The organisations that present health and social care services will plan and evaluate what sort of health care the population needs and then they plan what provisions and care services they need to put into place and whether they need to introduce new health and social care services for people to gain access to. Usually more services are due to rising numbers, a prime example of this would be that because there is currently an increase in the elderly population, which means that there will need to be enough care homes to assist the elderly so organisations such as Health Protection Agency which aims to protect the public and they will see the increase and act on it. By making an evaluation it allows them to come up with an overall conclusion on what chances are needed and they will also look at what they are doing correctly. NURS 8310 – Epidemiology and Population Health Essay Paper

Part 2- Sources of information
World Health Organisation
WHO collects their data from multiple sources using a variety of data collection methods such as household surveys and routine reporting by health services and from other sources. WHO also collects information about national and international health and can make comparisons between countries. WHO works with other countries to improve health information. They collect statistical data on infectious diseases such as Cholera, Influenza, Meningitis, Tuberculosis, Malaria, Child health and HIV/AIDS. This then allows them to see clear comparisons between countries on specific diseases and can then plan ways in which to control the disease. NURS 8310 – Epidemiology and Population Health Essay Paper

Department of Health
The Department of Health aims to help people live a better and longer life they ensure that people have the support, care and treatment they need which is done by gathering statistics. They gather statistics on everything but one example they gathered statistics on surveys designed to assess the diet, nutrient intake and nutritional status of the general population aged 1.5 years and older living in private households in the UK. This then allows the government to compare diets and see if people are living a healthy lifestyle or not and help those who have not by providing resources.

PHE main objective is to protect and improve the nation’s health and to address inequalities. PHE works with local and national government, NHS and industry, to protect and improve the nation’s health and support healthier choices. The PHE look for the problems in ill health and make those changes. They make the public healthier by encouraging discussions, supporting action by local government and advising government, the NHS and others. Furthermore they support the public so they can improve and protect their own health. Mainly they help local authorities and NHS to develop the public health systems and its specialist workforce. The PHE have 36 written statistics about the health of the public, these statistics collect evidence and are
then compared against each other and they can be accessed GOV.UK. NURS 8310 – Epidemiology and Population Health Essay Paper

Part 3- Key groups
Government and government agencies- Department of Heath
The Department of Health helps people to live better for longer. They lead, shape and fund the health care in England and have many roles and responsibilities. They lead across health and care creating national legislation and policies, giving long-term determination to meet future and current challenges, by putting health and care at the heart of the government. They support the truth of the system from funding assuring everything is paid correctly “Department of Health encourages staff in every health and care organisation to learn from other people’s experience of health and care and apply this to what we do.” NURS 8310 – Epidemiology and Population Health Essay Paper

Pressure groups- Friends of the Earth

Friends of the Earth is a pressure group who looks at protecting the wellbeing of people and the planet which has been the inspiration for most of their campaigns. By protecting the environment/planet is protecting the health of individuals too. Their first campaign was to dump 1,500 non-returnable bottles outside the Schweppes London headquarters which by recycling is better for our health. Friends of the earth helps people to see things in a different way and tries to get everyone involved by looking for the best solution, backing ideas up with facts and science. NURS 8310 – Epidemiology and Population Health Essay Paper

National groups- Health Protection Agency
The Health Protection Agencies now known as Public Health England’s main role is to prevent and is preparing to meet any threat to the nation’s health. It looks at a specific risk such as radiation, poisons or chemicals and it monitors outbreaks and spread of infection. To fulfil this aim the HPA provided an approach to protect public health in the UK by providing emergency services, support and advice to the NHS and other local authorities. The HPA also had a main role in helping planning for new and rising health treats, such as bioterrorism or in the event of an emerging dangerous disease.

International groups- Who Health Organisation
WHO is a co-coordination organisation for health within the United Nations as a whole and has many roles as responsibilities such as it provides leadership on problems critical to health and appealing in partnerships where there needs to be joint action. It also shapes the research programme and stimulates the generation and dissemination of valuable knowledge. Further it puts down standards and monitors implementation. Lastly it “provides a technical support, catalysing change, and developing sustainable institutional capacity and monitoring” NURS 8310 – Epidemiology and Population Health Essay Paper

The definition of health is ‘the state of being free from illness or injury’ (Definition of health, 2013). There are five main components of health including physical, mental, social, environmental and spiritual health. All of these five components have inter-relationships in one way or another and can both positively and negatively impact the well-being of a person. An example of this is the strong link between physical health, spiritual health and mental health. Being physically healthy and exercising does not only improve your mental health but also your social and spiritual health as well. NURS 8310 – Epidemiology and Population Health Essay Paper