Running head: DETERMINANTS OF HEALTH 1

Determinates of Health

Allison N. Brown

Bon Secours Memorial College of Nursing

Kathy Faw, MSN, RN

NUR 3116

10/05/2017

Honor Code “I Pledge”

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Determinants of Health

Determinates of health exists not only oversees but also right here in the United States.

There are many determinants of health including socioeconomics, population factors, and

healthcare system factors (Fawcett & Ellenbecker, 2015). In the United States, these factors

mainly happen in lower, social and economic communities such as in rural communities in the

mountains. The interviewee is from the mountains of southwest Virginia where low income and

lack of healthcare facilities are an issue. Rural communities often lack good jobs and often

individuals are living pay check by paycheck, hoping to be able to pay all the bills without

running out of income. The lack of healthcare facilities in rural areas can affect health

tremendously and prevent individuals from going to the doctor for routine screenings. With

healthcare facilities being so far away and income being so low, transportation is also another

reason why individuals do not go to regular doctors’ appointments. Healthcare insurance and

policies are too expensive to afford and is almost unheard of in the small, rural community.

Determinates of Health

Socioeconomics:

Socioeconomics is big factor that negatively impacts individuals living in rural

communities. Jobs are limited in small towns due to a decrease in the population and tourism.

The interviewee worked in coal mines which provided the main source of income for the

household to supply the needs of the family. Jobs are limited in rural communities with the most

popular jobs being coalminers, individuals working on gas lines, and farming. These are very

strenuous on the body which often leads to even more illness and strains on an individual’s

health. Other jobs include small cafes or local super markets which only provides individuals a

check to live off with no extra expenses available. With hospital facilities being so far away from
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the home it cost too much to be able to drive countless number of miles to the hospital. Often

medications and treatments are too expensive for individuals to afford. The physical environment

in which the interviewee lives is filled with chemicals and dust from a rock quarry company that

is situated right down the road. Individuals in the community are constantly breathing in the

dusty air that surrounds homes in the community. Explosives are sat off frequently to blast more

rock off the mountain. Employees at the quarry are breathing in this stagnate air as well, causing

an increased risk of health-related problems due to particles, allergens, and smoke. Also, coal

mines that were once active within the community also spread smoke and allergens around

causing workers to develop black lung. The interviewee currently has black lung due to working

in the coal mines and breathing in the dust that was in the air. It is a conditional that miners

receive from breathing in the coal dust, damming the lungs.

Healthcare system factors.

Rural areas do not have the resources available to accommodate the citizens. Hospitals,

inpatient and outpatient clinical, and community centers, are few and far in-between. The

interviewee discussed that individuals must travel in access of an hour to the closest hospital

when women are in labor, serious trauma occurs, or even heart attacks. The interviewee also

discussed that the closest hospital does not have all the up-to-date modern equipment and

technology to accommodate certain medical necessities. With that being said the next option

would be to be airlifted to a hospital that is even further away while dealing with a medical

emergency. This brings on another determinant because families are then separated hours away

from loved ones which could result in poor or slow healing process. Often individuals do not

make doctors’ appointments or exams because of the long commute. The interviewee has a

couple conditions such as hypertension, diabetes, and dizziness spills that have been going on for
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a couple years now. This is not good because many individuals are deteriorating in their own

homes because of the lack of health care facilities which could be prevented by having more

local clinics. However, these conditions are like this due to the decreased population living in the

rural areas. In home care is unheard-of in these rural communities because there is a lack of

funds to be able to support this kind of care. The interviewees mom had to be taken care of by

the interviewee due to having dementia and the lack of healthcare facilities and in home

healthcare services in the area.

Fortunately, the interviewee can afford Aetna healthcare and see nurse practitioners and

cardiovascular doctors regularly. The interviewee discussed that others from the community wait

for a yearly clinical called RAM which stands for Remote Area Medical Volunteer Corps. In

2015 1,500 volunteers and 2,172 patients attended the 2.5-day clinic in Wise county where

medical and dental services were provided (“Mission of Mercy, July 17th-19th,” 2015). People

from all over the rural mountain area attend this clinical because most cannot afford healthcare

plans or the outrageous cost of going to any healthcare facility. Healthcare policies have become

almost unaffordable during the last couple of years making it almost impossible to be able to

afford insurance in the rural communities while living pay check to pay check. Because of this,

many individuals attend the free RAM clinic so medical and dental care can be given to the low

socioeconomic class. Individuals come from all over for the services waiting in line for almost

24 hours to make sure secured spot to receive the services. For many this is the only care that

will be received until RAM comes around the following year.

Population factors

Genetic factors play a huge part for the individuals that need to be seen at healthcare

facilities frequently. The interviewee has hypertension and diabetes that was passed on from past
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generations. These types of disease need to be kept under control to prevent more severe

complications from occurring. The interviewee must travel to the nearest clinic a couple of times

a year to get the needed care and treatment. The interviewee did use smokeless tobacco for 30

years which could have been another factor that contributed to the hypertension, but denies

alcohol or illicit drug use. The interviewee discussed that the use of methamphetamine and

heroin is huge epidemic that is taking place in the community. This is leading to an increase in

needed medical care because of the overdoses that are frequently taking place. Sadly, people are

dying because there are not enough healthcare facilities around the area. The interviewees

physiological factor is black lung that came from working in the coal mines for 20 years.

Resilience is a major issue in the community where the interviewee lives and

many individuals do not abide to the care plan that are designed for certain diseases. This is also

due to the lack of hospitals and clinics within the area and because of financial circumstances.

Individuals typically do not follow through with treatment plans since finances or low and do not

allow for it. The interviewee is able to follow a care plan at home by eating healthy and well

balanced diets to accommodate the diabetes and hypertension. The interviewee knows that

visiting the doctor regularly is a must in order to stay in a good health state.

Conclusion

Overall, determinates of health exist all around the world, including right here in the

United States. These things include socioeconomics, population factors, and healthcare system

factors. This poses a huge impact on an individual’s health and can prevent people from getting

the care that is needed to stay at a healthy state. Usually multiple factors prevent individuals

from seeking care because one thing leads to another. It is important for individuals to explore

and overcome these obstacles to receive the best care possible and remain in a good health state.
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Reference

Fawcett, J., & Ellenbecker, C. H. (2015, JUNE). A proposed conceptual model of nursing

and population health. Nursing Outlook, 63(3), 288-298. Retrieved October 7, 2017.

Mission of Mercy, July 17th-19th. (2015, August 18). Retrieved October 08, 2017, from

https://www.cvillefreeclinic.org/remote-area-medical-in-wise-va
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