Comprehensive Application of Epidemiology: Case of Hispanics in Brooklyn

According to Merrill (2013), epidemiology comes from the study of the various distribution, as well as determinants of health-related events in specific populations, as well as the application of the study for controlling health problems. Merrill (2013) further articulates that epidemiology is data-driven and it is reliant on an unbiased and systematic approach to collecting, analyzing, and interpreting of data. Epidemiological methods also rely on observation and use of informatics and biostatistics, within the biologic, behavioral, and economic sciences. The current paper focusses on marginalized groups, specifically the Hispanics in Brooklyn, and their health concerns, and subsequently, the intervention measures that can be implemented.

Problem Identification with Literature Review

Problem Identification

In Brooklyn, first-generation Hispanics (foreign-born) differ from second generation (U.S. born with at least one foreign-born parent) ones regarding acculturation, diet, and language use, which consequently have differential effects on the Hispanics health. Cheikh Moussa, Sanz-Valero, and Wanden-Berghe (2014), for example, articulate that second- and third-generation Hispanics tend developing obesity. Velasco-Mondragon Velasco, Jimenez, Palladino, Davis, and Escamilla (2016) point out that most of the Hispanics speak English, but educational attainment remains low. Also, the authors point out that the poverty rate among the community members increased by 5.1% between 2000 and 2010 and by 2014, approximately 23.6% lived below the poverty level. Due to poverty, in 2014, 26.5% of the Hispanic population was aged under 65 and 4.4% aged above 65 was uninsured (Velasco-Mondragon et al., 2016). In addition, as the researchers posit, even though the community has the highest birth rate ethnically, infant mortality is at 5.1% per 1,000 births.

Also, the group is affected by local, regional, and national conditions. Locally, the Hispanic community can be affected due to poor employment, which is proportional to poverty, and thus, poor health conditions. Regionally, Hispanics are affected by adverse living conditions, language barrier, and poverty, which can limit health access. Nationally, the federal government may pursue policies that only include Hispanics who are legally in the country, which may lead to less health care access among illegal Hispanic migrants. The entire Brooklyn, about a fifth (19%) are Hispanics. Most of the Hispanics are young. The eldest among them are Cubans with a median age 40.7 years. South Americans, Dominicans, Central Americans, Puerto Ricans, and finally Mexicans follow, with median ages of 33.1, 29.5, 29.2, 27.3, and 24.2 years respectively. Even so, 27% of the Hispanics population did not study past the 9th grade, and 15% have a 9-12th-grade education. 28%, 19%, 7%, and 3.5% have a diploma, associate degree, bachelors degree, and an advanced degree respectively (Marsella, Johnson, Watson, & Gryczynski (2007).

Regarding the socioeconomic status, 36% of the Hispanics aged 16 and above, have skilled jobs in the transportation sector and precision work, and the percentage also encompasses laborers, repairers, machine operators, and inspectors. However, most of the Hispanics perform unskilled jobs, and 59% have high-risk jobs in construction, repair services, household and personal services, nondurable manufacturing, and domestic maintenance (U.S. Bureau of Labor Statistics, 2014). The Hispanics in Brooklyn have attained low education levels. In fact, 27% of the Hispanics population did not study past the 9th grade, and 15% have a 9-12th-grade education. 28%, 19%, 7%, and 3.5% have a diploma, associate degree, bachelors degree, and an advanced degree respectively (Marsella et al., 2007). As such, only a few have skilled jobs while many are employed in the unskilled jobs sector. In effect, this leads to low socioeconomic status. Regarding the socioeconomic status, 36% of the Hispanics aged 16 and above, have skilled jobs in the transportation sector and precision work, and the percentage encompasses laborers, repairers, machine operators, and inspectors. According to the U.S. Bureau of Labor Statistics (2014), most of the Hispanics perform unskilled jobs, and 59% have high-risk jobs in construction, repair services, household and personal services, nondurable manufacturing, and domestic maintenance.

The Hispanic community in Brooklyn is faced with the problem of poor health. One of the most common health concern is obesity. Besides obesity, other risk factors afflicting Hispanics in Brooklyn include tobacco and alcohol use, poor cardiovascular health, diabetes, cancer, and liver disease. As Healthy People 2020 (2010) highlights, cancer is the leading cause of mortality in many communities. Therefore, it is also a leading mortality cause among the community members despite the fact that cancer has reduced for both men and women. For instance, in 2015, approximately 125,900 cases of cancer were reported among the community, and the case-fatality was about 30% (Velasco-Mondragon et al., 2016). As the authors posit, most common cancer types among men include prostate (22%), colorectal (11%), and lung (9%) cancers. On the other hand, among the female Hispanics, cancer types included breast cancer (29%), thyroid (9%), uterine (8%), and colorectal (8%) cancers.

Another problem that the Hispanic community in Brooklyn faces is the lack adequate health access. Many Hispanics, due to low employment, they are afflicted with limited health benefits, as well as a limited number of healthcare providers, which significantly prevent the issuance of better healthcare programs to the community. Other barriers that disadvantage them in receiving excellent health care include geographic mobility, cultural sensitivity, primarily due to language barriers, and undocumented status. Most of the Hispanic populations are undocumented or are illegal immigrants, making it difficult for them to get health insurance (Castaneda & Ojeda, 2012). They also face significant socioeconomic challenges, for example, poverty and low levels of education, making it difficult to access health insurance (Castaneda & Ojeda, 2012). Furthermore, most of the Hispanics are poverty-stricken, making it difficult for them to pay for health insurance and access health services. Besides, migrant and undocumented Hispanics employed in the Brooklyn are exposed to risks in the workplace, as well as have limited access to health services. Besides, according to Velasco-Mondragon et al. (2016), 42.5% of adult Hispanics are considered obese, and among American youths, they have the highest obesity rate of 21.9%.

Significance

The problem is worth tackling as it will promote better health among the Hispanics community. Epidemiology is all about health-related events is specific populations, as well as the application of the study for controlling health problems (Merrill, 2013), and thus, studying the health issues in the Hispanic community in Brooklyn is vital as through epidemiology, effective interventions can be applied.

Intervention

A primary intervention that can be applied in Brooklyn for the Hispanic community is hiring Latino medical practitioners, including doctors and nurses among other personnel. The intervention will be effective in reaching out to all Hispanics in the locality. It will be critical in addressing the health issues and concerns that primarily contribute to poor health and mortality among Hispanics. In essence, it will allow the medical practitioners to deal with health issues and diseases, including obesity, tobacco and alcohol use, poor cardiovascular health, diabetes, cancer, and liver disease. Since cancer is the leading cause of mortality among Hispanics in Brooklyn, the practitioners need to be specialized in dealing with cancer patients mainly of the county. Necessarily, as highlighted before, the medical practitioners will be able to deal with the main cancer types, such as prostate, colorectal, lung, breast, thyroid, uterine, and colorectal cancers. Besides, the medical practitioners, being Latino, will be able to speak to the Hispanic patients without any instances of the language barrier, an obstacle that was identified before. The practitioners will ensure that the health needs and concerns of all Hispanics will be taken care of.

Additionally, the government can also provide subsidies to Hispanics such that they can access healthcare cheaply because most of them are poverty stricken and a health insurance policy can be vital. Besides, there needs to be a policy where even for the Hispanic illegal immigrants should get treatment, especially when there is an emergency. As highlighted before, only a few have skilled jobs while many are employed in the unskilled jobs sector. Due to substandard employment, they are afflicted with limited health benefits, as well as a limited number of healthcare providers, which significantly prevent the issuance of better healthcare programs to the community.

Implications for Policy

The strategy will align with the Health + Hospitals program and equality in healthcare policy, as the strategy is aimed at ensuring equity in the way healthcare is offered in Brooklyn while also taking into consideration of the persistent health inequalities in the Brooklyn area (Shorris & Palacio, 2016). The health strategy will expand community-based care policy, strengthen coordination and care management, as well as integrate social supports to improve health outcomes. Essentially, this helps to expand the capacity of community-based sites through new services and to partne across City agencies and with community-based providers (Shorris & Palacio, 2016). The health strategy is in line with the inclusion of Emergency Medical Treatment and Labor Act, which according to Zuabi, Weiss, and Langdorf (2016) is consistent with federal objectives of ensuring that everyone receives emergency medical attention, regardless of whether the person is an illegal or legal migrant.

DNP Role

DNP plays a critical role in this study as it facilitates the coming up with an intervention that influences the healthcare outcomes for the Brooklyn Hispanic community, including direct care of patients with various ailments (diabetes, obesity, tobacco and alcohol use, poor cardiovascular health, diabetes, cancer, and liver disease), management of care for the population, as well as the administration of healthcare and nursing, which work in promoting better health policy. According to AACN (2006), these are factors that allow for effective nursing practice. DNP is also vital for this project as it allows for the development of advanced competencies for nursing practice that are in line with enhancing nursing knowledge to improve nursing practices, as well as promoting positive patient outcomes (AACN, 2006). Besides, it provides for the adoption of enhanced leadership skills that help strengthen the practice and delivery of effective and efficient healthcare. DNP in this project also allows for incorporation of laws and principles that allows for the promotion of optimal function of people, regardless of whether they are ill or well (AACN, 2006). DNP, in the project, has allowed for patterning of human behavior in interaction with the environment in both normal and critical life situations, which is evidenced by the fact that incorporating Hispanic healthcare practitioners in alleviating the language barrier situation that occurs in delivering health care to Hispanics (AACN, 2006). Besides, DNP in this project has allowed the translation of knowledge efficiently to benefit the Hispanic patients. Lastly, as AACN (2006) advocates, DNP has allowed the integration of nursing knowle...