Healthcare

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 Essay 2

Healthcare Policy and Regulation: Global Health Goals and Health Disparities

Selected Sustainable Development Goal (SDG)

For this assignment, SDG 3: Good Health and Wellbeing was selected, which aims at

ensuring healthy lives and promoting well-being for people of all ages. This goal focuses on

reducing mortality rates, fighting epidemics, improving the healthcare systems, and promoting

mental health, maternal, and childcare globally.

Country of focus
In this case, the country of focus is Rwanda, which is an eastern African country with a

population of 13. 95 million by 20203(World Bank, nd). According to the World Health

Organization, the country has a fatality rate of 3.75 per woman. Rwanda has made tremendous

steps in improving healthcare over the past couple of decades, particularly in maternal and child

health, infectious disease control, and health system strengthening. One key outcome

measurement for SDG 3 in Rwanda is the maternal mortality ratio (MMR), defined as the

number of maternal deaths per 100,000 live births.

Progress in Rwanda

According to WHO(2023), Rwanda's maternal mortality ratio has decreased dramatically,

from 1071 deaths per 100,00 live births in 2000 to 248 in 2020 . This significant improvement

illustrates the country's commitment to improving its maternal health services, training

healthcare providers, and expanding access to emergency obstetric care.

Nursing Roles in Achieving SDG 3

In developing countries such as Rwanda, nurses play a critical role in achieving SDG 3.

The nurse's responsibilities revolve around providing maternal and neonatal care. The nurses

offer essential prenatal, postnatal, and delivery services, which decrease childbirth risks and
improve health outcomes for mothers and their newborns. Secondly, they are involved in health

education and counseling (Nkurunziza et al., 2023). The nurses play a vital role in educating the

community members on safe pregnancy, family planning, and the significance of receiving

skilled care, addressing myths and cultural barriers. Thirdly, the nurses are involved in

community outreach. They operate mobile clinics and conduct home visits to reach rural areas

with limited access to health services, which reduces high maternal mortality rates. Lastly, they

are involved in policy advocacy. Through policy advocacy, nurses promote the acquisition of

maternal healthcare resources and supplies, which improves service access and quality. The

public health interventions form an essential part of Rwanda’s national strategies to enhance

maternal health outcomes and achieve SDG 3.

Health Disparities in Vulnerable Populations

Article 1:

Title: Cancer health disparities in racial/ethnic minorities in the United States

Source: CINAHL Full Text

This article explores the racial or ethnic disparities among cancer patients in the USA.

Cancer patients from racial or ethnic minorities continue experiencing systemic disparities in

access to oncological care compared to their white counterparts. The study attributes these

disparities to socioeconomic status, geographic isolation, language barriers, and institutional

bias. The study suggests that these disparities be addressed, as it would be crucial to facilitate

access to and utilization of health services to all individuals regardless of their ethnic or racial

background and address the structural inequities.

Article 2:
Title: The Southern Rural Health and Mortality Penalty: A Review of Regional Health

Inequities in the United States

Source: CINAHL Full Text

This study examines health disparities among people living in the rural South in

comparison to their counterparts living in urban settings and other rural areas in the United

States. The study outlines that people living in the rural south encounter higher morbidity and

mortality. Among these communities in the rural south, people of color have a higher death rate

and are more prone to diseases compared to their white counterparts. While individual behavior

is a contributing factor, this study suggests that structural factors contribute significantly to this

disparity.

Conclusion

The health goals, such as SDG3, influence countries to put more effort towards reducing

mortality and improving healthcare outcomes. A good example of countries aiming to achieve

these goals is Rwanda, which has had major success in reducing maternal mortality through

healthcare programs. However, equal healthcare access remains an ongoing challenge for the

population. Direct health service delivery, along with education programs, advocacy work, and

community outreach activities, enable nurses to handle these gaps successfully. Health

disparities between vulnerable groups remain significant in racial/ethnic minorities and the

elderly populations, which requires the implementation of targeted and equitable healthcare

interventions at both international and local levels.

World Bank (nd). https://data.worldbank.org/indicator/SP.POP.TOTL?locations=RW

Nkurunziza, A., Katende, G., Uwimana, P., Moreland, P. J., Rosa, W. E., Umwangange,

M. L., ... & Mukeshimana, M. (2023). Enhancing the education of paediatric nurses: A

positive step towards achieving sustainable development goals. Nursing Open, 10(8),

5017-5023.

Zavala, V. A., Bracci, P. M., Carethers, J. M., Carvajal-Carmona, L., Coggins, N. B., Cruz-

Correa, M. R., ... & Fejerman, L. (2021). Cancer health disparities in racial/ethnic

minorities in the United States. British journal of cancer, 124(2), 315-332.

Miller, C. E., & Vasan, R. S. (2021). The southern rural health and mortality penalty: a review of

regional health inequities in the United States. Social Science & Medicine, 268, 113443.

Conclusion

Countries are putting efforts into increasing blood pressure control rates due to its

contributions to preventable diseases and hospitalizations. Amongst adults, their primary

objective is to prevent illnesses and hospital admissions. Home monitoring and educational

sessions that meet the cultural needs of patients have demonstrated their effectiveness in

improving clinical results. The establishment of a Quality Initiative platform for hypertension

self-management support will boost patient care quality and achieve better equity in healthcare.

The dedication of nurses to quality initiatives based on their advocacy and accountability leads to

delivering care that remains focused on patients while being both evidence-based and outcome-

focused.
 References

American Nurses Association (ANA). (2021). Nursing: Scope and standards of practice (4th

ed.). ANA.

Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., ...

& Virani, S. S. (2019). Heart disease and stroke statistics—2019 update: A report from

the American Heart Association. Circulation, 139(10), e56-e528.

Centers for Disease Control and Prevention (CDC). (2023). High blood pressure facts.
https://www.cdc.gov/bloodpressure/facts.htm
Erskine, S. (2020). The Impact of Culturally-tailored Education on Knowledge and Behavior

Related to Screening and Lifestyle Management of Blood Pressure in African

Immigrants (Doctoral dissertation, University of Nevada, Las Vegas).

Kerry, S. M., Markus, H. S., Khong, T. K., Cloud, G. C., Tulloch, J., Coster, D., ... & Oakeshott,

P. (2013). Home blood pressure monitoring with nurse-led telephone support among

patients with hypertension and a history of stroke: a community-based randomized

controlled trial. Cmaj, 185(1), 23-31.

KUrt, D. U. Y. G. U., & Gurdogan, E. P. (2022). The effect of self-management support on

knowledge level, treatment compliance and selfcare management in patients with

hypertension. TheAustralian Journal of Advanced Nursing, 39(3), 14-23.

Essay 4

The Interrelationships of Socio-Cultural Influences in Healthcare

Complex social, cultural, and economic conditions strongly influence how health

outcomes develop in individuals. The four health determinants of poverty and behavior, together
with education and income, work in direct connection to affect how people access health services

and manage their lifestyles, along with maintaining their overall wellness. For nurses who focus

on vulnerable patients, including the aging and at-risk groups, it is essential to grasp these

relationships to ensure culturally appropriate and impactful care delivery. This paper examines

relationships among various health factors within Sentinel City® by studying vulnerable groups

at risk while assessing their healthcare problems alongside social influence elements and proven

improvement approaches.

Vulnerable Populations and Health Concerns

As I explored Sentinel City®, I decided to focus on the African American community

because they represent an underserved population of the urban area. One of the pressing health

concerns that this group experiences is hypertension. The widespread chronic condition presents

dangerous risks such as heart disease and stroke, particularly when compounded by barriers to

healthcare access like poverty, poor education, and minimal access to preventive services.

Determinants of Health and Observations

From the Healthy People 2030 objectives, the following three determinants of health were

selected:

1. Economic Stability (Employment)

2. Education Access and Quality

3. Neighborhood and Built Environment (Housing Conditions)

Observation 1 – Economic Stability:

In my tour in the Industrial Heights area, I observed the economic struggles, abandoned

storefronts, a large number of jobless residents, and poor and unmaintained infrastructure. A

demographic assessment from Sentinel City® shows that this neighborhood maintains a higher
unemployment rate and presents below-average income levels compared with other parts of the

area. Poor residents in this community face challenges with healthcare service and medication

expenses, which reduces their capacity to manage chronic conditions such as hypertension

(Pronk et al., 2021).

Observation 2 – Education Access and Quality

Quality school institutions and extended educational programs remained limited within

Nightingale Square and other targeted locations. Statistical records from the census revealed that

these communities had lower percentages of students completing high school education, together

with reduced numbers of adults holding college degrees. Limited education contributes to poor

health literacy, thus making it difficult for residents to understand the importance of managing

conditions such as hypertension, medication adherence, and preventive care, which leads to

unproductive health outcomes (Pronk et al., 2021).

Observation 3 – Neighborhood and Built Environment:

Many residents of the industrial district live in substandard housing, where most of the

homes appeared unsafe. The lack of parks, clean recreational areas, and sufficient healthy

grocery choices in the community promotes unhealthy lifestyles (Pronk et al., 2021). Residents

face barriers to physical exercise opportunities and fresh food access, which exposes them to

increased risks of developing hypertension.

Strategies and Evidence-Based Recommendations

Strategy 1: Community-Based Hypertension Screening and Education Programs

One of the strategies that needs to be undertaken is the implementation of community-

centered programs that will offer free screening services of hypertension and culturally tailored

education in community spaces, such as schools, churches, community halls, and others. These
programs are crucial in improving awareness and early detection of chronic conditions such as

hypertension (Pronk et al., 2021). This initiative aligns with Watson’s caritive factor of

"promoting and accepting the expression of positive and negative feelings" by creating

supportive, judgment-free environments where residents feel valued and heard.

Strategy 2: Partnerships with Local Schools for Health Literacy Initiatives

Collaborating with schools to offer health literacy workshops and nutrition education

programs can help in addressing ongoing health knowledge gaps(Pronk et al., 2021). The

approach used in this intervention demonstrates Watson’s caritive factor of "developing helping-

trusting, human caring relationships” when it provides sustained education on healthy living and

chronic disease management to young people and their families.

Strategy 3: Advocacy for Affordable Housing and Safe Community Spaces

Advocating for policies that improve housing conditions and increase access to safe,

walkable neighborhoods is crucial. Evidence shows that creating environments that encourage

physical activity and healthy living reduces chronic disease risks(Pronk et al., 2021). This

intervention ties into Watson’s caritive factor of "assisting with basic human needs," ensuring

that communities have access to shelter, nutrition, and safe spaces that support wellness.

Strategy 3: Advocacy for Affordable Housing and Safe Community Spaces

It remains essential to advocate for polices that improve housing conditions and increase

access to safe, walkable neighborhoods. Studies reveal that creating an environment that enables

physical exercise plays a big role in reducing chronic disease risk factors(Pronk et al., 2021). The

intervention upholds Watson’s caritive factor of "assisting with basic human needs" by ensuring

communities obtain shelter, nutrition access, and safe spaces that support wellness initiatives.

Conclusion
 This exploration of Sentinel City® highlighted how poverty, education, and environment

intersect to impact hypertension rates within the African American community. By addressing

these determinants through community outreach, health literacy programs, and advocacy for

better housing and infrastructure, healthcare providers can help reduce disparities and improve

patient outcomes. Understanding the interrelationships of socio-cultural influences in healthcare

is essential for nurses to deliver effective, compassionate, and culturally competent care.

References

Pronk, N., Kleinman, D. V., Goekler, S. F., Ochiai, E., Blakey, C., & Brewer, K. H. (2021).

Promoting health and well-being in healthy people 2030. Journal of Public Health

Management and Practice, 27(Supplement 6), S242-S248.