Professor and class,

The determinant of health I chose to discuss is Health Services. Being on an island in Hawai’i poses a great factor to limited access to health care services, especially if a community is impoverished and far from the closest hospital. “Lack of access, or limited access, to health services greatly impacts an individual’s health status.” (Healthy People 2020,2018)

The Wai’anae Coast is located on the west side of O’ahu, where many native Hawaiians and homeless families live. These communities are in remote rural areas. The nearest hospital is approximately 30 miles east from the furthest western parts of these poverty-stricken communities. Fortunately, a few clinics have been recently built within these remote areas, which are invaluable resources to these Hawaiian communities. Although these community clinics may assist with the treatment of some chronic conditions, someone who suddenly suffers a major heart attack or stroke may find himself in a less fortunate position.

Out of the 17 intervention categories from the Public Health Intervention Wheel, a community health nurse (CHN) could address the Health Services determinant through health teaching. This public health intervention is a call to action which “communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors and practices of individuals, families, systems, and/or communities.” (Nies & McEwen, 2019, p. 15)

Health teaching for the CHN is essential in the education of low-income groups, as well. A CHN can teach about the benefits of a nutritious diet and exercise, promoting self-care, and preventing exacerbation of chronic conditions due to poor behavior choices, thereby lowering the incidences of heart attack or stroke.

Through the health teaching intervention, with main hospitals being so far, a CHN could be the forerunner of education also by communicating to local and Hawai’i state officials about data and statistics regarding the public needs of a main hospital closer to these disadvantaged communities. “Improving access to appropriate and timely medical services is an equally important factor in preventing and treating chronic medical conditions that lead to health disparities.” (Okihiro, May et al., 2014)

References,

Nies, M. A., & McEwen, M. (2019). Community/Public health nursing: Promoting the health of populations (7th ed.). St. Louis, MO: Saunders/Elsevier.

Okihiro, M., Sehgal, V., Wilkinson, T., Voloch, K.A., Enos, R., & O ‘Brien, J. (2014). Addressing health disparities by building organizational capacity in the community: a case study of the Wai’anae Coast Comprehensive Health Center. Hawai’I journal of medicine & public health: a journal of Asia Pacific Medicine & Public Health, 73(12 Suppl 3), 34-9

U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2018). Healthy People 2020: About determinants of health. Retrieved from https://www.healthypeople.gov/2020/about/foundation-health-

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