NR_553 Week 3 Discussion, Inequality, Power, and Privilege

Inequality, Power, and Privilege NAME Chamberlain College of Nursing NR 553: Global Health Policy DATE “Today’s real borders are not between nations, but between powerful and powerless, free and fettered, privileged and humiliated. Today, no walls can separate humanitarian or human rights crises in one part of the world from national security crisis in another” (Markle, Fisher, & Smego, 2007). Consider the above statement from your text by Kofi Annan. Identify one existing global health inequality and discuss how power and privilege play roles in the inequality. Week 3: Inequality, Power, and Privilege The impacts of socioeconomic issues on health have over the last decade emerged as a crucial factor in health. Pickett and Wilkinson (2015), also assert that evidence strongly suggests income inequality affects health and wellbeing. In addition, Powel (2016) states inequality is profoundly entrenched in health systems as a result of social problems such as disparities in education, income, race, gender as well as geography. Power and privilege predispose some to critical resources, while others languish in poverty. Consequently, people have a significantly different life expectancy and morbidity rates, depending on where they are born or live. Powel (2016) also states income inequality is a primary concern in health, as it leads to lower access to clinics, hospitals, skilled healthcare providers as well as the technology and medications which are crucial for effective treatment of illnesses and diseases. Moreover, institutionalized discrimination may also limit the access of care such that even when they access health professionals, they may not be attended adequately. Therefore, even the easily treatable infections and conditions develop into severe complications leading to higher morbidity and mortality rates. Some of the poor populations can also hardly afford basic needs such as food and drinking water leading to malnutrition. Further, hygienic resources such as water, soap, and sanitation are inaccessible to some, leading to the higher prevalence of infectious diseases in some regions. For example. Daley et al. (2015), explain about 200 million children born in developing countries like Bangladesh are at risk of not reaching the development potential due to lack of adequate nutrition. In addition, nutritional supplementation was proven to increase development. Williams, Priest, and Anderson (2016) also explains that socioeconomic status predisposes people to the higher risk of cardiovascular diseases, violence, and drug abuse as well as psychological issues among others, leading to higher mortality rates. References Daley, K., Castleden, H., Jamieson, R., Furgal, C., & Ell, L. (2015). Water systems, sanitation, and public health risks in remote communities: Inuit resident perspectives from the Canadian Arctic. Social Science & Medicine, 135, 124-132. Pickett, K. E., & Wilkinson, R. G. (2015). Income inequality and health: a causal review. Social science & medicine, 128, 316-326. Powel, A. (2016). The costs of inequality: Money = quality health care = longer life: Federal insurance has helped many, but system’s holes limit gains, Harvard analysts say. The Harvard Gazette. Retrieved from Williams, D. R., Priest, N., & Anderson, N. B. (2016). Understanding Associations among Race, Socioeconomic Status, and Health: Patterns and Prospects. Health Psychology, 35(4), 407. RESPONSE TO PEER: Naomi, According to the World Health Organization, “the first 28 days of life known as the “neonatal period” represent the most vulnerable time for a child’s survival” (2015). Children who die within the first 28 days of life are a result of diseases and conditions that are readily preventable or treatable with proven, cost-effective interventions. Wardlaw, You, Hug, Amouzou, & Newby reported half or more of all under-five deaths are now concentrated in the first 28 days of life in the regions of South Asia, East Asia and the Pacific, Latin America and the Caribbean, and the Middle East and North Africa (2014). Only 12 of the 60 countries with high under-five mortality rates are on track to achieve Millennium Development Goal 4. To provide life-saving care to the greatest number of women and children, reduce duplicative efforts, and promote community empowerment the strategy to use trained frontline workers, including qualified or unqualified medical practitioners, community health workers (CHWs), traditional birth attendants, trained midwives and other skilled birth attendants (e.g., nurses) together can provide a significant link to address the problem of lack of access to quality healthcare and vital interventions (Darmstadt et al., 2013). In connecting multidiscipline of frontline workers who are community-based with those who work in health facilities, a larger number of families can be supported through combined counseling, health education, pregnancy care, skilled care at birth, and postnatal healthcare in the communities and health facilities (Darmstadt et al., 2013). Nurses partnering with midwives is necessary to achieve MDG 4 because neonatal-related causes accounted for 44% of mortality among children under age 5 in 2013 (WHO, 2015). CHWs can effectively reach the poorest, sickest children, with the potential to save lives by providing care when and where it’s needed most. By working closely with CHWs, nurses can share their knowledge and provide technical clinical guidance. Collaborating with CHWs is an important means for helping strengthen local capacity and the healthcare workforce of developing countries. Reference Darmstadt, G. L., Marchant, T., Claeson, M., Brown, W., Morris, S., Donnay, F., & ... Schellenberg, J. (2013). A strategy for reducing maternal and newborn deaths by 2015 and beyond. BMC Pregnancy And Childbirth, 13216. doi:10.1186/ Wardlaw, T., You, D., Hug, L., Amouzou, A., & Newby, H. (2014). UNICEF Report: enormous progress in child survival but greater focus on newborns urgently needed. Reproductive Health, 11, 82. World Health Organization. (2015). MDG 4: reduce child mortality. Retrieved from PEER & PROFESSOR POST: The World Health Organization (WHO, 2017) characterizes maternal mortality as a key indicator of health inequality. Also alarming is that in the United States, the rate of maternal deaths is not decreasing. Globally, Maternal Health Task Force (n.d.) reports that the maternal death rate decreased by 44% from 1990 to 2015. Professor response to peer post: Gwendolyn, Thank you for pointing out the consequences of the US lack of commitment is this area or maternal death. Please identify states that are exemptions. What essential components produced positive outcomes? Knowing this information will empower maternal and child health advocates. RESPONSE TO PROFESSOR & PEER: Dr. Fildes and Gwendolyn, A maternal death is more easily prevented in settings with access to health care providers, infrastructure, and supplies compared to settings with limited resources. In many low-resource settings, where the majority of maternal deaths occur, there is often a significant lack of infrastructure, supplies, and equipment to manage complications. Two of the leading causes of maternal mortality include postpartum hemorrhage and pre-eclampsia/eclampsia (Khan, Wojdyla, Say, Gülmezoglu, & Van Look, 2006). Both complications are preventable with timely, high-quality emergency obstetric care. Countries such as Nepal and Rwanda, are working to address maternal mortality by partnering with charitable organizations like the United Nations Children’s Fund (UNICEF). UNICEF is working to reduce maternal mortality in developing countries by getting involved in a wide range of activities including training traditional birth attendants, providing skilled care at birth, and distributing clean delivery kits. Despite Nepal reducing its maternal mortality rate from 850 deaths per 100,000 live births in 1991 to 170 deaths per 100,000 live births in 2011, the government recognized a need for further reduction and developed a strategy to reduce inequities in emergency obstetric care through a nationwide upgrade of lower-level facilities (WHO, 2015). Most maternal deaths were a direct consequence of under-utilization of appropriate health services and low quality of care. The Government of Nepal determined that health facilities would be upgraded nationwide into birthing centers to fulfill criteria set by the Family Health Division (FHD). The Government of Nepal partnered with UNICEF to conduct a needs assessment focused on facilities’ capacity to deliver 24-hour and full week services (UNICEF, 2013). Based on the findings, new facilities were constructed, and existing facilities were upgraded. With financial and technical support from UNICEF, Nepal increased the number of facilities providing basic emergency obstetric care from 18 facilities in five districts to 201 facilities in 11 districts, over a period of 5 years (UNICEF, 2013). Mobilizing female community health volunteers to increase awareness among the family and community on the importance of maternal care, obstetric services, birth preparedness and complication readiness has proved to be very effective in encouraging women to utilize services in a timely manner. Despite a 51% reduction in maternal deaths between 1990 and 2008, Rwanda has yet to reach the MDG target to reduce maternal mortality, corresponding to 325 per 100,000 live births (UNICEF, 2013). The Rwandan government developed a comprehensive information technology strategic plan that includes eHealth and mHealth as important components (UNICEF, 2013). The government adopted the Rapid SMS-MCH system from a platform originally designed by UNICEF as part of efforts to use information technology to accelerate progress in maternal health (UNICEF, 2013). In 2010, the government of Rwanda, with support from UNICEF and other collaborators, established a partnership with a private mobile phone company to conduct a pilot intervention that involved real-time, two-way communication between community health workers (CHWs) and the health system. This mHealth program strengthened the communication and referral process in cases of obstetric emergencies to facilitate timely care. An evaluation found that 100% of CHWs complied with reporting requirements, and there was a 27% increase in facility-based births (UNICEF, 2013). The Rwandan Ministry of Health has prioritized hiring and training community health workers to provide family planning education, services, and counseling to men and women throughout the country. To prevent maternal deaths and newborn deaths government commitment is essential in reaching the target MDG 4 and MDG 5 goals. References Khan, K. S., Wojdyla, D., Say, L., Gülmezoglu, A. M., & Van Look, P. A. (2006). WHO analysis of causes of maternal death: a systematic review. Lancet (London, England), 367(9516), . United Nations Children’s Fund (UNICEF). (2013). Innovative Approaches to Maternal and Newborn Health Compendium of Case Studies. Retrieved from World Health Organization. (2015). Success factors for women’s and children’s health: Nepal. Retrieved from