Running head: AT RISK POPULATION PAPER

At Risk Population Paper

JoAnn Norman-Metcalf
Ferris State University

At Risk Population Paper

Despite efforts to improve health disparities in vulnerable populations they continue to exist.
According to The American Journal of Managed Care (2006) Vulnerable populations include:
the economically disadvantaged, racial and ethnic minorities and low-income children and is
defined as those populations being at a greater risk for poor physical, psychological and/or social
health outcomes health status (para 2). The purpose of this paper is to identify a at risk
population , elaborate on the dynamics of this population including: :risk factors, health
concerns, prevalence of disease, improvement of delivery of care and how nurses can impact
this vulnerable population.

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Identified Vulnerable Population

The vulnerable population I have identified is Obesity in Low Income Hispanic

Children. Although statistics have shown that childhood obesity rates are high among the
general population, they are higher in low income ethnic minority groups (Kumanyika & Grier,
2006). Childhood obesity affects minority low income families and is associated with the risk of
adverse health related illness including: serious physiological, psychological and social
consequences (Centers for Disease Control and Prevention, 2012). As noted by the Food
Research and Action Center (2009) Due to additional factors associated with poverty, food
insecurity and low-income people are vulnerable to obesity (p.1). While these factors influence
other Americans, Hispanics are at higher risk because of additional challenges they face on a day
to day basis. This is a cause for health concern as obese children become obese adults and have a
shorter life expectancy than their parents due the high prevalence of obesity which puts them
at greater risk for developing chronic illness in the future that can lead to life
altering consequences (p. 3).
Factors that cause vulnerability
Social economic and cultural differences including: Values, beliefs, attitudes as well as
language barriers and lack of resources put this population at risk for vulnerability. Provider bias
is one of the most prevalent forms of bias identified for this population. I have seen bias in
providers assumptions and lack of experience based on knowledge of racial or ethnic
background alters provisions for care and treatment. Medical translators are needed to effectively
communicate with the Hispanic population and language barriers are often referred to as the
greatest obstacle for a parent who are trying to provide health care for their children. There is
also a shortage of minority physicians and health care providers .Materials are often unavailable

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in Spanish which makes it difficult to sign up for programs (Galarraga, 2007). Low income

neighborhoods often lack access to full service grocery stores and often results in convenience
stores shopping in the neighborhood where fresh produce is exempt and low fat items are
limited. Also, this population lacks access to health care and where health care is available is
often of lower quality which results in lack of diagnosis and treatment of chronic health
problems such as obesity (FRAC, 2009).
History and cultural description
According to Young & Koopsen (2012) the Hispanic population is a diverse group who
has many levels of assimilation and acculturation (p. 127). Religion has major influence on
health beliefs and practices. Hispanics are family oriented and often have a large extended
family that place the needs of the family before their own and go beyond the nuclear family unit.
The desire for Hispanic families to be involved in decision making shows that there is a strong
interdependence among family members. Therefore, it is important for healthcare providers to be
comfortable communicating and sensitive to the cultural needs of this population (p. 128).
According to the Patient Centered Outcomes Research Institute (2014) by 2060 the Hispanic
population in the United States is expected to account for more than thirty- percent of the overall
population. Hispanics are more likely to be uninsured and have a higher prevalence of chronic
disease than other ethnic groups .Those that do have insurance are less likely to treat their illness
and have problems communicating with their healthcare provider (p .1).
Demographics
In Muskegon County, a general overview of the county showed that 4.8% of residents
were Hispanic .The overall obesity rate in Muskegon in all age and ethnic groups is 36%. A child
living in poverty is 25.2%; no distinction was documented across ethnic groups (Public Health

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Muskegon County, 2012). Community efforts to partner with local farmers and vendors via the
local farmers market have proven successful in providing accessibility to fresh produce and
healthy items at affordable prices. This is a great way to take care of the community and provides
a much needed service. In Michigan, 14% of low income children were obese, as compared to
20.2 % of low income Hispanic children (CDC, 2012). State initiatives have been developed to
decrease the amount of sugary drinks in schools as well as limiting purchases of sugary drinks
and food with low nutrition value for those who receive food assistance. The state is also
providing vouchers to purchase fresh produce at local farmers markets to make produce available
to low income families. As noted by the CDC (2012) nationally, there has been an increase in
obesity rates overall and obesity is more common among ethnic groups and is associated with
low income households. The prevalence of obesity among Hispanic children is higher than other
ethnic groups as seen in data. According to CDC (2012) in 2011-2012, on a national average, the
obesity rate for Hispanic children was 22.4% as compared to other populations which ranged
between 14% in White children and 20% in African American children. Obesity significantly
increases medical costs and puts a burden on the U.S care delivery system (see Appendix A for
percentage of Michigan children who are low-income and obese).
Possible Health Concerns
The Hispanic population including children and adults are vulnerable to certain health
risks that are exacerbated by obesity including: diabetes, hypertension, heart disease and stroke.
Hypertension is a major risk factor for heart disease .The Hispanic population has a higher risk
of heart disease compared to other populations with hypertension because of delay in care,
dropping out of treatment when symptoms subside and avoiding doctor visits (Heart.org, 2015).
Furthermore, the Centers for Disease Control and Prevention (2012) noted that more than a

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quarter of Hispanics have hypertension and nearly one-third were not taking their medication to
reduce the risks of heart attack and or stroke (p. 1). Unfortunately, these beliefs and attitudes
have the potential of being passed down to children who are led by example. An increase in
diabetes has been seen in Hispanic children because of cultural and monetary influences. Foods
that are a part of the cultural norms are considered high fatty foods with limited fruits and
vegetables. The cost of healthy foods compared to buying several of burgers from a fast food
venue for a low cost appears to be a trend among many families (para.5). Small changes can reap
many positive benefits for this population. Factors that make changes difficult include: language
barriers, lack of transportation, limited resources and lack of access to healthy affordable foods
(Health.Org, 2015. para.1).
Health policy
Possible health policy that might impact low income Hispanic children include: providing
education and program enrollment materials in Spanish language so that parents can be
successful in enrolling their children in programs that promote preventative and ongoing well
child care. As noted by PCORI (2014) health policy changes require legislative research to take
into account the potential for differences in the effectiveness of healthcare treatments used in
various populations and engage the Hispanic community in all aspects of the research process
which will lead to better healthcare decisions within the Hispanic community (p.1) . Providing
incentives for Spanish speaking professionals to increase the numbers of minority professionals
in practice can be of value to those who struggle with language barriers and ethnic differences.
These changes have the potential to enhance the overall medical experience of this population
and improve their health.
Prevalent Disease Process

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According to the Centers for Disease Control and Prevention (2012) the prevalence of
obesity is higher in low income households and according to ethnicity, higher in Hispanic
children with 22.4% compared to Black children 20.2% and White children 14.1%. Furthermore,
the prevalence of disease process in the Hispanic population include: heart disease and diabetes.
Cardiovascular disease is the leading cause of death among the U.S Hispanic population and is at
a greater risk because of obesity and hypertension (CDC, 2012). These preventable diseases have
the potential to become deadly if left untreated. Eliminating disparities in healthcare propose a
challenge to practitioners as they plan preventative strategies in the fight against preventable
disease where obesity plays a factor.
Improvement of health care delivery
Health care can be improved by eliminating language barriers by providing interpreters
and providing culturally competent for the Hispanic population. Having an awareness of ones
own cultural beliefs and attitudes is an important piece to providing culturally competent care to
those who receive services. According to Young & Koopsen (2012) having knowledge and
understanding of the clients culture as well as respect and acceptance of cultural differences help
shape the delivery of care and enhance services that are provided. Furthermore, to assist in
delivery of competent care, it is important for providers to be sensitive to the religious beliefs of
this population (p. 115).
The nurses impact on this population
Harkness and DeMarco (2012) noted that nurses can assist in these efforts through
advocacy by helping patients make decisions according to their own beliefs and values and by
protecting their rights by communicating with other healthcare providers to ensure their needs
are met (p. 57). Nurses can also impact this population by providing education in both public and

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private settings providing much needed resource to those who are in need. Since parents are one
of the most influential factors in a childs life, nurses can impact this population through
education and after school programs for families and being available for support in any
community programs that are tailored towards reducing preventable disease through education.

Preventing Childhood Obesity and Poverty

One of the first steps in prevention is education. Education needs to be in our homes,
school and in society as a whole. Treating childhood obesity has more to do with lifestyle.
Obesity prevention will require personal, cultural and social change (Mersch, 2014). For all
children, prevention starts in the home by changing the way that food and activity are seen by the
family as a whole by identifying risks factors related to family history and ethnicity to combat
early preventable disease in children. According to an article in The New England Journal of
Medicine (2014) there are a number of things we can do as a nation to combat childhood obesity.
This starts at the federal level and trickles down to parents. At the federal- level, the government
can implement funding to identify effective intervention, such as: offering resources to parents
and schools to provide low-income families healthier choices. Programs such as (WIC) Woman
Infants and Children and through initiatives like First Lady Michelle Obamas Lets Move
Program. At the state-level, partnering with communities to create programs for healthy eating
and preventative medical programs aimed at lowering childhood obesity rates. Locally, doctors
can provide routine check-ups and nurses can be involved in counseling families about nutrition.
Healthcare providers can also be a voice for new programs that promote health and spread the
word about the health benefits of the local farmers market with local families by utilizing funds
provided by the state. Together, childcare providers and parents can ensure their child has regular

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doctor visits, serve a variety of healthy choices of fruits and vegetables throughout the day, and
provide plenty of water to drink, encourage exercise and ensure routine sleep patterns.
According to Pender, Murdaugh & Parsons (2012) social determinates of health are
structural and economic conditions in which people are born, live and work and are responsible
for health inequalities. Money, power and resources are responsible for major inequalities in
health. Furthermore, social-economic gradient exists for every health indicator for every racial
and ethnic group (p. 257-9). It takes skilled leaders to provide services to all people in the
community regardless of social economic status even when cultural factors
exists that influence their choices.
Summary and Conclusion
Decreasing health disparities and eliminating inequalities across populations is a huge
task for the nation as a whole. It takes skillful leaders to identify at risk populations in our
communities and work at closing the gap to inequality. As identified, at risk populations are seen
as a national issue when it comes to health disparities. According to Harkness & DeMarco,
(2015) the identification of at risk populations and risk factors associated with certain
populations can be used to set priorities for the development of strategies to meet emerging
health needs and for change in programs and services that are directed towards secondary and
tertiary prevention (p.122). With this knowledge nurses have an opportunity to be directly
involved in advocating for vulnerable populations in their communities that promote positive
outcomes for all populations.

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References:

Centers for Disease Control and Prevention. (2015). Nutrition, physical activity and obesity
data, trends and maps web site. U.S. Department of Health and Human Services,
Centers for Disease Control and Prevention. Atlanta, GA. Retrieved from:
http://www.cdc.gov/nccdphp/DNPAO/index.html

Centers for Disease Control and Prevention. (2012) .Childhood obesity facts Retrieved
from:www.cdc.gov/obesity/data/childhood .html.
Harkness, G. & DeMarco, R. (2015) .Community and public health nursing: Evidence for
practice (2nd ed.) Philadelphia, PA: Lippincott Williams & Wilkins
Health.org (2015). Hispanics and heart disease, stroke. Retrieved from:
www.heart.org/HEARTORG/Conditions/More?MyHeartand StrokeNews/Hispanics -andHeart disease-Stroke_UCM_4.
Institute of Medicine of the National Academies. (2011). Early childhood obesity prevention
policies. Retrieved from http:iom.edu.reports/2011/early-childhood-obesity-preventionpolicies.asx
Journal of American Medicine Network. (2011). State intervention in life-threatening childhood
obesity. 306 (2), doi: 10.1001/jama.2011.903
Kumanyika, S., & Grier, S. (2006) Targeting interventions for the ethnic minority and lowincome populations. The Future of Children.16 (1) Retrieved from:
www.thefutureofchildren.org.
Mersch. J. (2012). Childhood obesity causes, prevention, statistics, facts: childhood obesity
facts. Retrieved from http:www.medicinenet.com/childhood.

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New England Journal of Medicine. (2014). Incidence of Childhood Obesity in the United States
doe: 10.1056/NEJMoa1309753
Parsons, N., Murdaugh, C., & Pender, M. (2015). Health promotion in nursing practice. (7th ed.).
Upper Saddle River, NJ. Pearson
Young, C., & Koopsen, C. (2011). Spirituality, health and healing: An integrated approach. (2nd
Ed) Sudbury, MA: Jones and Bartlett Publishers.

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Appendix A

Percent of Michigan children age 2-5 who are low -income and obese by race and ethnicity
(CDC, 2012).

Non-Hispanic
White
Year
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000

Sample
Size

Value
1
2.7

5
5,012

1
3.0

1
1
2.8

1,648

2.5

1.5

1,083

2.2

1.0
4

9,196
1

3.0
3.0

1.0

3,935

2.5

0.7

4,228

2.5

0.4

4,188

7,738

0.0

8,090
9

.8

7.2
2
7.5
2

8,354

1
,169

1
3.1

8
,396

,244

3.0

,476

1
7.3

,288

3.2

0,328

,424

2.3

0,961

1
,595

2.4

2,076

7.9
2

5
2,269

7,191

,594

1
1.7

2,253

8.3
2

7,132

1.4

1
,665

1
3,948

8.2
2

4,285

1
,580

3.1

4,753

9.7

4,652

0.6

4,702

0.3

1
,573

1.7

5,554
2

5,042

1
,762

1.0

8,096

0.1
2

1
1.9

6,820

9.6

5,987
1

Sample
Size

Value

7,835

8.5

7,524

1.6
5

1
8.4

4,914

1.0

4,822

Sample
Size

Value

7,832

1.2

9,598

3.2

1
0.8

Asian/Pacific
Islander

Hispanic

Sample
Size

Value

9,436

2.5

2.3

Non-Hispanic
Black

1
,088

1
2.1

1
,098

American
Indian/Alaska
Native
Sample
Value
Size
2
1.1
42
1
9.7
29
1
7.3
72
1
6.7
30
1
6.7
59
1
7.2
95
2
0.8
14
1
7.0
63
1
5.8
31
1
5.8
02
1
5.1
10
1
7.4
37