Gap in service : Mental health treatment and lack of access to care.
Section One – Summary and Background Information
Evidence in a literature review.
Detailed explanation of the priority need, including health determinants.
Succinct summary of the proposed solution for the identified gap in service.
example :
Importance of nutritional education in schools.
Detailed Explanation of the Priority Need
Children need to develop the understanding of nutritional food choices early in life (Rasheed, 2023), as well as a healthy relationship with food that is based on education (Large, et al., 2023). Poor understanding and lack of knowledge often lead children to make dietary selections that may damage their health. Research has shown that beliefs and habits established in childhood can be impactful for the entirety of the person’s lifespan, so making nutritional education available for children is a beneficial way to guide their future health and wellness. When children are unaware of nutritional knowledge, poor choices can lead to the increased development of unfavorable health conditions, namely malnutrition and obesity (Rasheed, 2023). Malnutrition affects every country in the world in all forms (Chan, et al., 2022). Childhood is a stage in the lifespan when proper nutrition is key to appropriate development. Early intervention and education can help the child desire and attain nutrition that is supportive of future growth and wellness while allowing for ideal physical and mental development through the changes of adolescent growth and development into adulthood (Large, et al., 2023). A healthy diet that a child can become aware of and gravitate towards has plentiful whole grains, fruits, vegetables, legumes, and nuts. Processed foods, salt, and sugar should be limited (Chan et. al., 2022).
Health Determinants
Effective nutritional education in schools for younger children can help reduce the prevalence of chronic diseases in the lifespan (Large et al., 2023). Other factors that contribute to the availability of educational offerings and healthy nutritional options are health determinants, including economic and social conditions that affect the child and their families. Financial resources available to the family affect their opportunities to provide healthy food options that include necessary nutrients for growth and development, including fruits and vegetables. Familial education, occupation, and income encompass this socioeconomic health determinant that impacts the child’s well-being. Providing healthy food in schools and nutritional education in schools can still help shape the child’s choices and future (Centers for Disease Control and Prevention, 2019).
Evidence in Literature Review
Studies show that 17% of the British population between the ages of 2 and 15 are obese, and 14% are overweight. Similarly, 17% of American children aged 2-19 are obese, and 16% are overweight (Rasheed, 2023).
While the prevalence of obesity continues to climb, there is a marked decrease in the number of people and families that cook in their homes, which also reflects and is an inverse reaction due to their lack of cooking skills. While ready-to-eat meals have created convenience for families, they are often energy-dense while lacking the proper nutrition that growing children need, namely the recommended daily intake of healthful foods such as fruits and vegetables (Large et al., 2023).
The prevalence of diabetes, hypertension, and cardiovascular diseases is rising. Teaching children when they are younger about how their nutritional intake will support or hinder their growth and future health will provide an opportunity for awareness and better choices (Rasheed, 2023).
A succinct summary of the proposed solution for the identified gap in service
Providing children with access to nutritional education in child-friendly applications can be advantageous to developing the child’s attitudes and beliefs about nutrition and eating habits. Utilizing strategies to make the education entertaining and effective, while teaching to the child’s grade school and appropriate learning level has proven to improve children’s understanding of nutrition and food choices to enable them to make healthier selections (Rasheed, 2023). Early establishment of healthy behaviors about eating provides the basis for developing positive patterns that last into adulthood and eventually support healthy individual adult development for generations to follow (Large et al., 2023).
Nutrition education does not have to be its own class curriculum. Studies have shown that when subjects integrate nutritional education into other subjects it has a greater effect on nutritional understanding and is better received by children while allowing teachers to still maintain education goals. Providing nutritional education in math class or physical science can enhance the learning and understanding of both subjects. Including all five senses is also beneficial with school aged children and enhances information retention (Large, et al., 2023). Exposure to different flavors, different fruits, vegetables, legumes and whole grains can help to establish the healthy nutrition in the child’s life (Chan, et al., 2022)
School garden programs can be established in cost-effective ways to help children learn about nutrition while experiencing the different tasks and parts of their food’s life cycle. Hands-on activities in the garden expose children to healthy fruit and vegetable production that they can achieve in their climate and possibly even share with their family. School gardens are often able to provide any overabundance to the children’s families so that they are able to share and show their knowledge of healthy foods with those that they love, as they begin to value the work and effort that it takes to get some delicious produce (Chan, et. al., 2022).
References
Centers for Disease Control and Prevention. (2019). NCHHSTP Social Determinants of Health. https://www.cdc.gov/nchhstp/socialdeterminants/faq.html#:~:text=Health%20is%20influenced%20by%20many,These%20five%20categories%20are%20interconnected.
Chan, C. L., Tan, P. Y., & Gong, Y. Y. (2022). Evaluating the impacts of school garden-based programmes on diet and nutrition-related knowledge, attitudes and practices among the school children: a systematic review. BMC Public Health, 22(1), 1–33. https://doi.org/10.1186/s12889-022-13587-x
Large, A., Morgan, R., Kalas, S., Appleton, K., & Giglia, R. (2023). Determining best practice for school-based nutrition and cooking education programs: A scoping review. Issues in Educational Research, 33(3), 1047–1065.
Rasheed, M. (2023). Promoting nutritional education in primary school children. British Journal of Nursing, 32(8), S14–S18. https://doi.org/10.12968/bjon.2023.32.8.S14
example 2 :
Diabetes Prevalence in the American Indian Population
Explanation of Priority Need
Prior to the colonization of the American Indian (AI) population, American Indians had a diet that was nutritionally rich from a plethora of agricultural systems (Edwards & Patchell, 2010). However, after AI communities were forced out of their homelands, their dietary habits changed drastically to support survival (Edwards & Patchell, 2010). AI communities survived on foods that were high in sugars and fats, resulting in a decline in health and the development of health disparities (Edwards & Patchell, 2010). Health disparities amongst the AI population result in a life expectancy that is, on average, five and a half years lower compared to non-AI Americans (Lucero & Robideaux, 2022).
Specifically, type II diabetes mellitus disproportionately affects AI populations globally (Lucero & Robideaux, 2022). Type II diabetes is a chronic disease that, without proper treatment and management, has serious implications for one’s health (Lucero & Robideaux, 2022). Complications caused by type II diabetes include but are not limited to, kidney disease, heart disease, nerve damage, and death (Lucero & Robideaux, 2022). As of 2019, mortality rates caused by type II diabetes in the AI community were 3.2 times higher than non-AI Americans (Lucero & Robideaux, 2022). The increased incidence of type II diabetes in AI communities has serious implications for the health and wellbeing of American Indians across the globe.
Review of Evidence
In a study completed by Walker et al., researchers studied the diabetes prevalence, incidence, and mortality rates of the First Nation American Indian community in Ontario, Canada (2020). Researchers used health services data linked to the federal Indian Register to analyze diabetes statistics (Walker et al., 2020). Researchers found that between 1995 and 2014, diabetes was substantially higher in the First Nation community in comparison to non-AI Ontarians (Walker et al., 2020). Additionally, First Nation community members had consistently higher mortality rates related to diabetes than non-AI Ontarians (Walker et al., 2020). Researchers discuss the importance of addressing the ongoing social, political, and economical inequities of the AI community to reduce diabetes prevalence and improve health outcomes (Walker et al., 2020).
In an article written by Warne & Wescott, the authors discuss in detail the rich culture of the American Indian population, and the social determinants of health (SDOH) that have a significant impact on the physical and mental health of the AI population (2019). Specifically, authors discuss how historical trauma, poverty, substance abuse, lack of education, and adverse childhood experiences have contributed to the overwhelming rate of diabetes and other chronic disease in the AI population (Warne & Wescott, 2019). Authors discuss that the AI population has the highest diabetes mortality rates in the United States (Warne & Wescott, 2019). Additionally, authors discuss potential solutions for the SDOHs contributing to the adverse health outcomes of AIs. Improving breastfeeding rates and childhood nutrition, improving existing food programs, and taxing unhealthy foods are some suggestions authors make to help improve the health outcomes of AIs in the United States (Warne & Wescott, 2019).
Social Determinants of Health
Social determinants of health are defined as non-medical factors that contribute to and influence health outcomes (World Health Organization, 2024). There are a plethora of social determinants of health that impact the wellbeing of AI populations (Warne & Wescott, 2019). However, poverty, substance abuse, and historical trauma play a significant role on the physical health of the AI population (Warne & Wescott, 2019).
Poverty is directly correlated to poor health outcomes (Warne & Wescott, 2019). As of 2019, American Indians were approximately 2.4 times more likely to be living at or below the federal poverty line in comparison to white Americans (Warne & Wescott, 2019). Those living in impoverished communities have limited access to resources that support a healthy lifestyle, such as safe and stable housing, nutritious foods, and healthcare (Warne & Wescott, 2019). Additionally, those living in poverty have limited access to education and stable employment opportunities, which furthers the cyclical outcomes of poverty (Warne & Wescott, 2019). Without access to healthy food choices and proper healthcare, the likelihood of diabetes is substantial (Warne & Wescott, 2019).
From 2013-2017, AIs had the highest drug-related deaths compared to all other U.S. racial and ethnic groups (Soto et al., 2022). Additionally, approximately 7.4% of AI adults used opioids in 2018, compared to the 5.5% of adults of the general population who used opioids during this time (Soto et al., 2022). Adverse effects of substance abuse are far more vast than overdose and death (American Addiction Centers, 2024). Effects of substance abuse include, but are not limited to, seizures, cardiomyopathy, respiratory depression, acute kidney failure, blood-borne diseases, diabetes, and cirrhosis (American Addiction Centers, 2024).
Historical trauma acts as a catalyst that results in intergenerational adverse effects (Warne & Wescott, 2019). For the AI population, the loss of cultural identity, traditional foods and ceremonies, language, and more, has led to an overwhelming sense of social injustice (Warne & Wescott, 2019). Research has shown a scientifically significant correlation between historical trauma and adverse health outcomes amongst the AI population (Soto et al., 2022). This correlation is evident when viewing the levels of poverty, chronic disease, substance abuse, and education levels amongst AI people (Soto et al., 2022).
Proposed Solution
Addressing social determinants of health that have an adverse effect on health outcomes is a complex process that requires the discipline and commitment of interdisciplinary teams (Warne & Wescott, 2019). To begin, federally funded programs, such as Women, Infants, and Children (WIC), must become more widely available to the AI population (Warne & Wescott, 2019). This will allow impoverished women and children to receive access to nutritious foods, which will reduce the risk of obesity and support cardiovascular health (Warne & Wescott, 2019). Additionally, these women will receive education and resources on the benefits of breastfeeding (Warne & Wescott, 2019).
Solving the population health challenge of substance abuse will require community outreach programs and interdisciplinary collaboration amongst public health officials, medical systems, healthcare providers, and more (Warne & Wescott, 2019). Drug addiction and recovery programs must become more accessible on AI reservations to promote participation, accountability, and camaraderie (Warne & Wescott, 2019). Additionally, public health officials must make Narcan (the opioid-reversal agent) more accessible to the AI population to reduce overdose-related deaths (Warne & Wescott, 2019).
The most complex social determinant of health to solve is historical trauma (Warne & Wescott, 2019). It is impossible to provide complete solace for the generational trauma inflicted on the AI community (Warne & Wescott, 2019). However, public health officials can promote healing and support to the AI population through various avenues (Warne & Wescott, 2019). Reconnecting the AI community to their ancestry and culture can have a healing effect for those experiencing historical trauma (University of Minnesota, 2023). Providing AIs with opportunities such as affordable and safe housing, accessible education, and employment, can provide a sense of importance, belonging, and give AIs the voice they have not been allowed to have (University of Minnesota, 2023).
References
American Addiction Centers. (2024). Health Risks of Substance Abuse. American Addiction
Centers. https://americanaddictioncenters.org/health-complications-addiction
Soto, C., West, A. E., Ramos, G. G., & Unger, J. B. (2022). Substance and Behavioral
Addictions among American Indian and Alaska Native Populations. International journal of environmental research and public health, 19(5), 2974. https://doi.org/10.3390/ijerph19052974
University of Minnesota. (2023). Historical trauma and cultural healing: Video series.
University of Minnesota.
https://extension.umn.edu/trauma-and-healing/historical-trauma-and-cultural-healing#how-historical-trauma-is-perpetuated-today-378611
Walker, J. D., Slater, M., Jones, C. R., Shah, B. R., Frymire, E., Khan, S., Jacklin, K., & Green,
M. E. (2020). Diabetes prevalence, incidence and mortality in First Nations and other people in Ontario, 1995-2014: a population-based study using linked administrative data. Canadian Medical Association Journal (CMAJ), 192(6), E128–E135. https://doi.org/10.1503/cmaj.190836
Warne, D., & Wescott, S. (2019). Social Determinants of American Indian Nutritional Health.
Current developments in nutrition, 3(Suppl 2), 12–18. https://doi.org/10.1093/cdn/nzz054
World Health Organization. (2024). Social determinants of health. World Health Organization.
https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
This is how the white paper should look and what it needs to include, please write it like the exaples I have included the gap in service you need to talk about.
