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Course: Fundamentals of Nursing�Topic: Community

The Nurses International Community

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COPYRIGHT

NI Privacy Policy and Terms of Use.

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Module Goals

Learners will be able to:

Define the term community.
Identify the factors that define a healthy community.
List the elements of a community assessment.
Describe what makes a population vulnerable.

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Community Definition

"....... Communities" are groups of people that may or may not be spatially connected, but who share common interests, concerns or identities. These communities could be local, national or international, with specific or broad interests.”

World Health Organization [WHO], n.d.a

“A community is a group of people who have common characteristics or interests. Communities can be defined by: geographical location, race, ethnicity, age, occupation, a shared interest or affinity (such as religion and faith) or other common bonds, such as health need or disadvantage. People who are socially isolated are also considered to be a community group.”

National Institute for Health and Care Excellence, 2017

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Community

Mengistu & Misganaw, 2006

Often defined by geographic boundaries, thus called a ‘Geographic community’.

Bound by common interest and goals, regardless of geographical areas are ‘Common interest community’.

Members in some communities might share almost everything while others share/involve only in common interests and certain goals.

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Healthy Community

According to the review of public websites/documents of 153 organizations engaged in healthy communities work by Health Resource in Action (2013):

There is no standard universal definition for ‘healthy community’.

Each community should define its own notion of a healthy community.

Healthy community process is as important as health outcomes.

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Elements of Healthy Community

Some of the common elements of healthy community mentioned by Organizations engaging in healthy community work are:

Equity (lack of disparities)
Strong economy and employment opportunities
Education
Health care and preventive health services
A stable, sustainable ecosystem and environment
Housing / Shelter
Access to healthy food and water
Safety
Opportunities for active living
Transportation
Empowered population
Healthy child development
Healthy public policy

Health Resources in Action, 2013

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Healthy Community Processes

Common healthy community processes mentioned by Organizations engaging in healthy community work are:

Inclusive equitable & broad community participation
Collaboration between partners
The capacity to assess & address its own health concerns
Civic engagement
Engage multi-sector participation
Employ environmental strategies
Use data to guide and measure efforts

Health Resources in Action, 2013

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Principles of Healthy Community

Health Resource in Action (2013) recommends following principles of healthy community:

A broad definition of community that is multi-sectoral
A broad definition of health
A shared vision and values
Community ownership
Asset-based
Equity
Monitoring and evaluation
Sustainability
Systems change
Use of evidence-based interventions while encouraging innovative practices
Maximum transparency to improve community engagement and accountability

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Critical Thinking Question:

Which of the following are elements of healthy community?

(Select all that apply)

Children park
Hotel
Addiction intervention programs
Social inclusion policy
Religious and cultural celebrations

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Community Assessment

CDC (2018) states community health assessment (CHA), or community health needs assessment (CHNA) as-

‘..state, tribal, local, or territorial health assessment that identifies key health needs and issues through systematic, comprehensive data collection and analysis..’

Smathers and Lobb (2014) states following as key principles of CHA:

Residents are the best experts on the community in which they live
All residents have skills, abilities,and talents that they can contribute to the community
A strong community is built upon the resources of its members

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Community Assessment

Smathers and Lobb (2014) proposes consideration of following questions to during the pre-assessment phase:

What is going to be assessed?
What is already known?
What data will need to be collected?
How and by whom will data be collected?
How and by whom will data be analyzed?

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Community Assessment and Planning Framework

According CDC (2015), common elements of community assessment and planning frameworks are:

Organize and plan
Engage the community
Develop a goal or vision
Conduct community health assessment(s)
Prioritize health issues
Develop community health improvement plan
Emergency plans
Implement and monitor community health improvement plan
Evaluate process and outcomes

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Community Assessment and Planning Framework

The Association for Community Health Improvement (2017) provides 9-steps framework for CHA and developing implementation strategies:

Reflect and strategize
Identify and engage stakeholders
Define the community
Collect and analyze data
Prioritize community health issues
Document and communicate results
Plan implementation strategies
Implement strategies
Evaluate progress

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Critical Thinking Question:

Which of the following are components of community assessment? (Select all that apply)

Define community
Conduct health prevention programs
Identifying data to be collected
Engaging community members

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Determinants of Community Health

Determinants of health are factors that have significant influence, positive or negative, on health of an individual, families or community (WHO Team, n.d.)

the social and economic environment,
the physical environment, and
the person’s individual characteristics and behaviours

Social determinants is shown to be more important than health care or lifestyle choices in influencing health (WHO, n.d.b)

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Determinants of Community Health

WHO (n.d.b) lists examples of social determinants of health as follows:

Income and social protection
Education
Employment and job security
Working life conditions
Food security
Housing, basic amenities and the environment
Early childhood development
Social inclusion and non-discrimination
Infrastructure
Access to affordable health services of decent quality

Poor conditions of the above factors makes community vulnerable to health disparities and inequities (Healthy People 2030, n.d.)

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Provide an example where a factor of social determinants of health impact community negatively?

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Vulnerable Population

Vulnerable populations are groups and communities at a higher risk for poor health as a result of the barriers they experience to social, economic, political and environmental resources, as well as limitations due to illness or disability (National Collaborating Center for Determinants of Health, n.d.)

Vulnerability is defined as -

‘The characteristics determined by physical, social, economic and environmental factors or processes which increase the susceptibility of an individual, a community, assets or systems to the impacts of hazards’ (UNDRR Terminology, 2017, as cited in United Nations Office for Disaster Risk Reduction, n.d.)

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Vulnerable Populations

According to IFRC (n.d.), following questions need to be asked to determine populations vulnerability:

To what threat or hazard are they vulnerable?
What makes them vulnerable to that threat or hazard?

Factors that makes populations vulnerable are:

Poverty
Chronic diseases, mental illness
Disability
Age (Children and elderly)
Sexuality
Abusive relationship
Ethnicity, racisim, discrimination
Disasters, Displacement, migration

IFRC, n.d.; Wakefield JSNA, n.d.

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Vulnerable Populations

Poverty is a major contributor to vulnerability¹

Poor people are more likely to live/work in areas exposed to potential hazards, and less likely to have resources to cope with disaster

Inequality, inequity, social/distributive/environmental injustice also contribute to vulnerability marginalized community or population

Social norms and institutional processes shape the distribution of power and resources².
Discriminatory practices are often embedded in institutional and systems processes, leading to groups being under-represented in decision-making at all levels or underserved².

IFRC, n.d.
WHO, n.d.d.

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Health Equity:

‘.... is defined as the absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically or geographically” (WHO, n.d.c)

Health Equality:

‘...equal treatment and availability of health care services for all people.’ (Florida Health Office of Communication, 2017)

Social Justice:

‘...is a communal effort dedicated to creating and sustaining a fair and equal society in which each person and all groups are valued and affirmed. It encompasses efforts to end systemic violence and racism and all systems that devalue the dignity and humanity of any person….’ (John Lewis Institute for Social Justice, n.d.)

‘....is the view that everyone deserves equal rights and opportunities — this includes the right to good health…’ (American Public Health Association, n.d.)

Distributive Justice:

‘Distributive justice is concerned with the fair allocation of resources among diverse members of a community. Fair allocation typically takes into account the total amount of goods to be distributed, the distributing procedure, and the pattern of distribution that results..’ (Maiese, 2003)

Environmental Justice:

‘..deals explicitly with the distribution of environmental benefits and the burdens people experience, at home, at work, or where they learn, play and spend leisure time. Environmental benefits include attractive and extensive greenspace, clean air and water, and investment in pollution abatement and landscape improvements. Environmental burdens include risks and hazards from industrial, transport-generated and municipal pollution…’ (Forest Research, n.d.)

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Difference Between Equity and Equality

Health equality, Social justice, Distributive justice, Environmental justice all relate to treating all in same way or providing equal share or opportunities to available resources.

However, equal share/opportunities will not yield the same outcome, i.e health equity, without the consideration to the individual needs and requirement that allows reaching full potential.

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Vulnerable Populations

IFRC, n.d.

Natural or man-made disasters can also make community vulnerable.

Vulnerable populations are more susceptible to the hazards of disasters

they are unable to resist/mitigate the impacts of disaster hazards.

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References:

American Public Health Association. (n.d.). Social justice and health. Retrieved on September 10, 2021 from https://www.apha.org/what-is-public-health/generation-public-health/our-work/social-justice

Association for Community Health Improvement. (2017). Community Heath Assessment Toolkit. www.healthycommunities.org/assesstoolkit

CDC. (2018, July 24). Community Health Assessments & Health Improvement Plans. https://www.cdc.gov/publichealthgateway/cha/plan.html

CDC (2015, November 9). Assessment & Planning Models, Frameworks & Tools. https://www.cdc.gov/publichealthgateway/cha/assessment.html

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References:

Florida Health Office of Communications. (2017, July 7). Health equality, health equity & health barriers [Pdf]. http://collier.floridahealth.gov/programs-and-services/wellness-programs/health-equity/_documents/healthequityinfographic.pdf

Healthy People 2030. (n.d.). Social determinants of health. U.S Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved on August 28, 2021 from https://health.gov/healthypeople/objectives-and-data/social-determinants-health

Health Resources in Action. (2013). Defining healthy communities[PDF]. https://hria.org/wp-content/uploads/2016/10/defininghealthycommunities.original.pdf

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References:

IFRC (n.d.). What is vulnerability?. Retrieved on September 10, 2021 from https://www.ifrc.org/en/what-we-do/disaster-management/about-disasters/what-is-a-disaster/what-is-vulnerability/

John Lewis Institute for Social Justice. (n.d.). Our definition of social justice. Central Connecticut State University. Retrieved on September 10, 2021 from https://www.ccsu.edu/johnlewisinstitute/terminology.html

Maiese, M. (2003, June). Distributive Justice. In: Guy Burgess and Heidi Burgess (Eds), Conflict Information Consortium, University of Colorado. Beyond Intractability. https://www.beyondintractability.org/essay/distributive_justice

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References:

Mengistu, D., & Misganaw, E. (2006). Community health nursing: Lecture notes for nursing students. In collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. https://www.cartercenter.org/resources/pdfs/health/ephti/library/lecture_notes/nursing_students/communityhealthnursing_2006.pdf

National Collaborating Center for Determinants of Health (n.d.). Vulnerable populations. https://nccdh.ca/glossary/entry/vulnerable-populations

National Institute of Health and Care Excellence (2018, March 3). Community engagement: Improving health and wellbeing. https://www.nice.org.uk/guidance/qs148/chapter/Quality-statement-1-Identifying-local-priorities#definitions-of-terms-used-in-this-quality-statement

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References:

Smathers, C., & Lobb, J. (2014, October 14). Community assessment: Building coalition series. ohionline. https://ohioline.osu.edu/factsheet/CDFS-7

United Nations Office for Disaster Risk Reduction. (n.d.). Understanding Disaster Risk. PreventionWeb. Retrieved on September 21, 2021 from https://www.preventionweb.net/understanding-disaster-risk/component-risk/vulnerability

Wakefield JSNA. (n.d.). Vulnerable Groups. Retrieved on September 21, 2021 from http://www.wakefieldjsna.co.uk/vulnerable-groups/

World Health Organization. (n.d.a). Health promotion: Track 1 Community Empowerment. https://www.who.int/teams/health-promotion/enhanced-wellbeing/seventh-global-conference/community-empowerment

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References:

World Health Organization. (n.d.b). Social determinants of health. Retrieved on August 27, 2021 from https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1

World Health Organization. (n.d.c). Social determinants of health: Health equity. Retrieved on September 21, 2021 from https://www.who.int/health-topics/social-determinants-of-health#tab=tab_3

World Health Organization. (n.d.d). Health equity. Retrieved on September 9, 2021 from https://www.who.int/health-topics/health-equity#tab=tab_1

WHO Team (n.d.). Determinants of Health. World Health Organization. Retrieved on August 27, 2021 from https://www.who.int/news-room/q-a-detail/determinants-of-health

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