November 26, 2012
Community Health Project-Part One -Identifying the Project's Focus This paper will identify a significant health issue and a particular population for a health management plan. Support for the significance of this health issue, and rationale for the selection of this population will be presented. Evidence about the population will be examined and discussed in regards to one asset and one challenge of this particular population. An approach to address the issue and the rationale for this choice will be provided with a minimum of five appropriate references. Health Issue and Population
Defined as birth prior to 37 weeks gestation (ACOG, 2008), preterm birth affects about 12% of births in the United States. Preterm birth is an important public health priority costing over $26.2 billion in 2005 according to the March of Dimes (2011) report on preterm birth. Prematurity is the second leading cause of death in children under 5 years, and the single most important cause of death in the first month of life (March of Dimes, 2011). More than 15 million babies are born too soon, with 1 in 8 babies born premature every year worldwide; of these, over 1.1 million preterm babies die due to complications of prematurity (CDC, 2012). The cost of the first year of birth for a preterm infant is 10 times greater than for term infants (Howson, Kinney & Lawn, 2012). Support and Rationale
Women and infants are a vulnerable population. Maternal mortality and morbidity disproportionally affect vulnerable populations of women, such as those living in poverty, facing racial and ethnic discrimination, and having limited language skills (Anderson & Stone, 2013). From a public health perspective infant mortality is considered the measuring stick for determining the health of the population, whereas maternal mortality is the divider between wealth and poverty (Anderson, 2013). Eliminating racial, ethnic, and socioeconomic disparities is critical for quality health care outcomes (Shi & Stevens, 2010). Preterm births occur more often among certain racial and ethnic groups with non-Hispanic black mothers being 1.5 times more likely to have a preterm baby, and that baby 3.4 times more likely to die than a non-Hispanic white baby (CDC, 2012). Sadly, although 90% of preterm babies in high-income countries will survive, 90% of preterm babies born in low-income countries will die (Presem & McDougall, 2012). The implications of being born too soon extend beyond the neonatal period and throughout the life cycle, resulting in serious consequences such as cerebral palsy, and chronic lung disease, as well as, intellectual impairment, learning difficulties, poor health, vision and hearing loss (Institute of Medicine, 2007). In general, the more immature the preterm infant, more life-support is needed, the risks of re-hospitalization are greater, and the burden of lifetime problems more significant (IOM, 2007). Assets and Challenges
Preventing preterm birth remains a challenge (CDC, 2012). There is no test that can accurately predict a preterm birth, very little is known about the causes and mechanisms of preterm birth, or about how to prevent a preterm birth, and few effective preventative strategies are available (March of Dimes, 2012; WHO, 2009; IOM, 2007). Once a woman is pregnant, most of the interventions to prevent preterm birth only delay onset long enough to administer steroids to the mother to help prevent respiratory distress in the infant after birth and transfer the mother and fetus to a hospital for the appropriate level of care (IOM, 2007). Studies indicate that many of the factors associated the preterm birth frequently occur together, particularly in minority women, or those who have low socioeconomic status (IOM, 2007). Medical conditions such as chronic hypertension, diabetes, infections, and stress...