By


Team Bluefish:

• Brenda Benavides
• Liyang Hayworth
• Janelle Moulder
• Jesse Phillips
• Timothy Weigand
• Melecia Wright

Introduction

In recent years, United States healthcare expenditure focused on expanding health care coverage and increasing access to medical services. For example, the state of California has been grappling with the burden of cardio-metabolic diseases such as diabetes and obesity. Though billions of dollars are spent annually to treat these lifestyle diseases, the prevalence of both obesity and diabetes is still on the rise (Meng, Pickett, Babey, Davis, & Goldstein, 2014; Mirzadehgan, Harrison, & DiSogra, 2004).

While access to basic health services is critical to maintaining health status, it is important to also acknowledge and capitalize on the roles of social, economic and/or environmental determinants contexts within which people live as they hold tremendous potential to positively influence health status. The objective of this Issues Summary is to address the current status of health care spending in California and demonstrate how an emphasis on the underlying social, economic, and environmental determinants of health may reduce financial hardship for the state while managing its most problematic chronic diseases more effectively in the long term.

Background

History

Although health care spending in California is high, quality of care for individuals is low. Quality of care remains low because approximately 20% of California’s population is uninsured, and the majority of these individuals avoids seeing a doctor until emergency care is required (Helfand, 2011; “Emergency as normal”, 2002). This reliance on emergency care, which should act as a safety net and not a patient’s primary source of health care, leads to steep health care costs.

Healthcare spending in California has come under scrutiny since the passing of the Patient Protection and Affordable Care Act (ACA) in 2010. In that year’s general elections alone, two health care spending measures were approved for the ballot. Proposition 45 would force health insurance companies to be more transparent about rate hikes and increase accountability through mandated review of requested rate changes. The other, Proposition 46, was meant to increase accountability from healthcare providers. The measure specifically required random drug testing for doctors and that those found to be impaired would face disciplinary action from the California Medical Board. Proposition 46 also proposed an increased cap on pain and suffering damages from medical negligence lawsuits. These propositions encourage increased vigilance from doctors with the aim of ultimately improving the quality of the services administered. However popular, neither of these propositions capitalized on the potential for decreasing direct healthcare expenditures while increasing quality of care.

With the increased financial cost of cardio-metabolic disease, Californians have recognized the strain that chronic disease such as diabetes and obesity-related illnesses put on the state’s health care system, as evidenced by recent policies such as Senate Bill 1000, which outlines the potential consequences of soda consumption and subsequently reduce its demand (“Warning Labels on Sugary Drinks”). Providing health education and more affordable preventative care services to vulnerable populations can significantly reduce the burden of chronic disease and its related healthcare costs.

Current Status

In 2011, nearly one-third of hospitalizations among Californians age 35 and older were related to diabetes; interestingly, only 8.4% of California adults had diabetes (Meng et al., 2014). According to the California Health Interview Survey (CHIS) in 2009, 22.7% of California adults were obese based on their body mass index (Cook et al., 2013). Obesity is strongly associated with the incidence of chronic diseases, including coronary heart disease, type 2 diabetes and hypertension (Cook et al., 2013).

The rising prevalence of obesity and diabetes in the United States is of particular concern among low income and minority populations (Melius, 2013). Researchers have shown that income is negatively associated with adolescent obesity: youth from low-income families were more likely to be obese than their higher income counterparts (Babey, Hastert, Wolstein, & Diamant, 2010). This inverse correlation suggests that a successful intervention against obesity and its related diseases should address the conditions that drive differential behaviour and nutritional patterns in people of various socioeconomic strata (Melius, 2013). One such intervention is the proposed “soda tax” that will be on the ballot in Berkeley and San Francisco in this November’s general election. Evidence suggests that when prices of sugary drinks increase, “consumers, including low-income consumers, [make] more nutritious purchases” (Varney, 2014). The “soda tax” is estimated to “prevent 240,000 cases of diabetes per year” according to Dr. Bibbins-Domingo, a professor of medicine at UCSF, who co-authored a study on the tax (Cook, 2014). In addition, the tax revenue generated by this measure may be utilized for programs focused on childhood nutrition (Cook, 2014). While taxes on unhealthy foods may be highly controversial, California may consider adopting other strategies that target nutritional choices and low-income populations throughout the state.

Differential factors in the physical environment are also an issue. For instance, low income diets and neighbourhoods are characterized by low intake of vegetables and high consumption of fast food due to the lack of supermarkets in low-income neighborhoods (Melius, 2013). Additionally, access to public parks and other sites of recreation encourage increased physical activity, which can influence the development of obesity and diabetes (Melius, 2013). However, public parks are more likely to be absent or in a state of disrepair in low-income neighborhoods, due to limited funding or resources. Zoning regulations and incentives programs can be effective ways to produce changes in the physical environment. Finally, home environments that do not encourage healthy eating habits from an early age or encourage regular physical activity contribute to the development of obesity-related conditions (Meng et al., 2014). However, healthy eating habits and a healthy, active lifestyle is a learned behavior, which requires adequate health education, particularly early in life.

Diabetes and obesity, and their comorbid conditions are expected to continue to increase in prevalence. It is absolutely essential to address the underlying factors contributing to obesity-related illnesses. With the current state of health care expenditures for acute care of largely preventable conditions, it is imperative that California consider measures that will maximize health status within the confines of a tight state health care budget (Meng et al., 2014; Helfand, 2011). These measures must include increasing access to preventative care or early intervention in the care of chronic disease.

Recommendations

Pandemic obesity and diabetes in the state of California and across the nation is a call to action to develop prevention strategies, rather than solely focusing and relying on providing primary health care. Both lack of physical activity and poor diet (high carbohydrate, high fat, and low fiber intake) increase the risk of developing obesity and diabetes. As such, our proposed policies are 1) establishing amicable environments encouraging physical activities 2) promoting healthy and nutritious dietary intake at a young age and 3) providing access to affordable preventive health care. The proposed policies intend to modify underlying causal determinants of disease and therefore improve the health of the general population and reduce health care related costs.

Recent surveys and research on California’s population have shown that diabetes and obesity will continue to be of significant concern for the health status of the state’s population in coming years. While creating an environment where people can exercise and engage in regular physical activity and ensuring access to affordable health care are important steps to take in order to manage these diseases, we recommend prioritizing social policies aimed at improving nutrition and lifestyle choices. Californians are receptive towards policies that address social determinants of health, including early childhood nutrition, and these policies can have a tremendous impact on health outcomes in the long term at a lower cost than would be required of policies that simply increase health care services.

Two policies recently approved in California that address social determinants of health are Senate Bill 402 and Assembly Bill 290. Senate Bill 402 was enacted in 2013 and requires that all hospitals with a prenatal unit adopt an infant-feeding policy that is equivalent to “Ten Steps to Successful Breastfeeding” (De León, Pavley, 2013). It was adopted to manage obesity in California by addressing early life nutrition, supported by evidence that “early infant-feeding practices can affect later growth and development, particularly with regard to obesity” (De León, Pavley, 2013). Assembly Bill 290 also aims to prevent obesity by ensuring that child care centers have an employee with “at least one hour of childhood nutrition training” as part of an already required health and safety training (California Senate, 2013). The bill targets child care centers because child care participation is at an all-time high, so they are a great space to reach a large number of youth at an age when “lifelong nutrition habits are formed” (California Senate, 2013). These policies have great potential to stem obesity and its associated chronic diseases and reduce healthcare costs in the future.

In order to achieve our goals to positively influence health status in California, we recommend enlisting public health practitioners more frequently in the policy making process. With their background in health, social and economic determinants, and fluency in interpreting data from academically-driven research, public health practitioners are an untapped resource for policymakers. In fostering this collaboration between public health providers and our state policymakers, we will effectively bridge the data gap and provide the opportunity to maximize health status, while minimizing health care expenditures. The collaboration would promote active assessment of the impact of policy change, which can increase recognition of social determinants of health and of inter-sectoral responsibility for health (Oxford, 2013).

References

Author Unknown (Jun 2002). Emergency as normal. The Economist. Retrieved from


http://www.economist.com/node/1168001

Author Unknown. (n.d.). Warning Labels on Sugary Drinks. California Center for Public Health Advocacy. Retrieved from


http://www.publichealthadvocacy.org/resources/warninglabel/WarningLabel_PressKit_FINAL.pdf

Babey, S., Hastert, T., Wolstein, J., Diamant, A. (Nov 2010). Income disparities in obesity trends among California adolescents.

American Journal of Public Health,

100(11):2149-55. Retrieved from


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951974/

Babey, S., Wolstein, J., Krumholz, S., Robertson, B., Diamant, A. (Mar 2013). Health Policy Brief: Physical Activity, Park Access and Park Use among California Adolescents. UCLA Center for Health Policy. Research. Retrieved from


http://healthpolicy.ucla.edu/publications/Documents/PDF/parkaccesspb-mar2013.pdf

California Senate. (2013). AB 290 (Alejo), Child day care: childhood nutrition training. Retrieved from


http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0251




0300/ab_290_bill_20131011_chaptered.pdf

Cook, C. (Oct 2014). Big Soda’s false populism. Los Angeles Times. Retrieved from


http://www.latimes.com/opinion/op-ed/la-oe-1028-cook-soda-tax-poor-people-20141028-story.html

Cook, S.N., Giddings, B.M., Parikh-Patel, A., Kizer, K.W., Kwong, S.L., Bates, J.H., Snipes, K.P. (Dec 2013). Obesity-Linked Cancers: A California Status Report, 1988-2009. Sacramento, CA: California Department of Public Health, California Cancer Registry. Retrieved from


http://www.ccrcal.org/pdf/Reports/CA_California1988-2009_Obesity_v6.pdf

DeLeon, Pavley (2013). Senate Bill No. 402: Breastfeeding. California Senate. Retrieved from

http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0401-0450/sb_402_bill_20130220_introduce



d.htm

Diamant, A., Babey, S., Wolstein, J., &Jones, M. (Aug 2010) . Health Policy Research Brief – Obesity and Diabetes: Two Growing Epidemics in California. UCLA Center for Health Policy Research. Retrieved from


http://healthpolicy.ucla.edu/publications/Documents/PDF/Obesity%20and%20Diabetes%20Two%20Growing%20Epidemics%20in%20California.pdf

Helfand, Duke (Dec 2011). California’s healthcare spending per person among lowest in U.S. Los Angeles Times. Retrieved from


http://articles.latimes.com/2011/dec/07/business/la-fi-california-health-spending-20111208

Kelin, L., & Ming, M. (Sep 2013). Racial and Ethnic Disparities in Leisure-time Physical Activity in California: Patterns and Mechanisms.

Race and Social Problems,

5(3):147-156. Retrieved from


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3779616/

Meng, Y.Y., Pickett, M., Babey, S., Davis, A., and Goldstein, H. (May 2014). Diabetes Tied to a Third of California Hospital Stays, Driving Health Care Costs Higher. UCLA Center for Health Policy Research. Retrieved from


http://publichealthadvocacy.org/_PDFs/1in3/DiabetesHospitalStudy_PolicyBrief_FINAL.pdf

Melius J. (2013). Overweight and Obesity in Minority Children and Implications for Family and Community Social Work.

Social Work in Public Health,

28:2, 119-128, DOI: 10.1080/19371918.2011.560821

Mirzadehgan, P., Harrison, G.G., & DiSogra, C. (Dec 2004). Health Policy Fact Sheet: Nearly One in Five California Adults Obese and Most Still Gaining Weight. UCLA Center for Health Policy Research. Retrieved from


http://healthpolicy.ucla.edu/publications/Documents/PDF/Nearly%20One%20in%20Five%20California%20Adults%20Obese%20and%20Most%20Still%20Gaining%20Weight.pdf

Varney, S. (Oct 2014). Soda-makers Try To Take Fizz Out Of Bay Area Tax Campaigns. NPR. Retrieved from


http://www.npr.org/blogs/thesalt/2014/10/27/359325115/soda-makers-try-to-take-fizz-out-of-bay-area-tax-campaigns

1

Policy plays a significant and significant role in influencing both the U.S. government and private healthcare systems when addressing the problem of health care. Health policy relates to choices, plans, and actions conducted within a community to attain particular health care objectives (Health policy, 2019). An explicit health policy can accomplish multiple things: it describes a vision for the future, which in turn helps to set short-and medium-term goals and reference points (Health policy, 2019). It describes distinct groups’ priorities and anticipated roles; and builds consensus and informs individuals (Health policy, 2019).              Without major health care measures that encourage healthy living, people are not faced with the likelihood of reaching their complete healthy life because they face difficulties in acquiring even fundamental preventive care, let alone care that will assist if they are to become ill with a chronic disease that can be prevented. Policies should establish methods of obtaining and retaining healthcare coverage for Americans so that they can be productive members of society for longer lives because they have adequate access to quality and accessible healthcare.

In this nation, the policy can have a huge impact on government and private healthcare. Policy rules enable healthcare suppliers permitted for facilities, which are the emergency zones, who can give facilities, who will be financed, and how to bill and spend the financial plan (Pellegrin, 2018). Policy on health care implies more than just a policy on health. In five primary respects, public policy affects health:

1. Creating government goods regulation
2. Natural resource regulation
3. Citizen protection requirements and mandates
4. Support
5. Chances and incentives are created

(Pellegrin, 2018)

A network of hospitals and clinics consists of the private healthcare industry. Policies impact the private sector by involving the establishment of laws and regulations on issues such as the price of particular drugs and insurance premium costs. Private-sector policies safeguard working Americans from pharmaceutical and other health-related services ‘ excessive or price gouging.  For example, a health insurance company has a maximum amount that they can charge for an annual premium (Alex, Mnuchin, & Acosta, 2018).

Our healthcare system is split into a range of branches, including health information, insurance, and pharmaceuticals (Alex, Mnuchin, & Acosta, 2018). The government-run public sector that includes Medicaid, Medicare programs and the Affordable Care Act program to name a few (Alex, Mnuchin, & Acosta, 2018). Healthcare policy impacts the access and quality of medical care accessible to Americans (Alex, Mnuchin, & Acosta, 2018). One of the greatest impacts is the cost to the American people of healthcare plans, premiums, taxes, etc. (Alex, Mnuchin, & Acosta, 2018). By setting rigid rules and mandates, public policies safeguard Americans. The drunk drive or seat belt laws would be an instance. Public policies can also regulate the use of natural resources to avoid individuals or the environment from being overused or harmed (Alex, Mnuchin, & Acosta, 2018). Organizations such as the Environmental Protection Agency are helping to control water and air norms to ensure drinking and breathing are secure (Alex, Mnuchin, & Acosta, 2018).

According to the U.S. Department of Health and Human Services, “Public policies can provide direct support in ways that affect the drivers of health” (Alex, Mnuchin, & Acosta, 2018). The Temporary Assistance for Needy Families (TANF) program can be an instance of this, helping low-income families achieve independence through jobs. For fundamental requirements, they will provide temporary money (Alex, Mnuchin, & Acosta, 2018). “Public policies can reduce barriers, create opportunities, or provide incentives that influence the choices that impact health”, including scholarships to decrease economic circumstances and enable learners to attend college (Alex, Mnuchin, & Acosta, 2018). Education and earnings can strongly predict the future health of a patient. All strategies can have an adverse or beneficial impact on government and private healthcare in this nation.

Healthcare policy plays an undeniable part in health policy framework and execution. The highest priority of health policy in both the government and private industries is to guarantee American people’s health and well-being.

References:

• Alex, A. M., II, Mnuchin, S. T., & Acosta, A. (2018, December 18). Reforming America’s Healthcare System Through Choice and Competition. Retrieved from
  
  https://www.hhs.gov/about/news/2018/12/03/reforming-americas-healthcare-system-through-choice-and-competition.html
  
• Health policy. (2019). Retrieved from
  
  https://www.who.int/topics/health_policy/en/
  
• Pellegrin, M. (2018, August 14). 5 Ways Public Policy Impacts Health. Retrieved from
  
  https://www.sycamoreinstitutetn.org/2017/05/04/5-ways-public-policy-impacts-health/
  

Introduction

Vulnerable population has become a burden for the United States as because their lacks of economic stability, improper health care service, social ignorance and so many other controversial factors. As they are considered as an important portion of the total U.S. population, that’s why they are to be treated equally compared to the other U.S. citizens. One of the complex issues in their current situation is their health related problems. Their mental health problem and the drug abuse are two issues that have made them out of success. The goal set by the U.S. department of health and human services named “healthy people 2010 goals” is largely depends on this vulnerable population. Furthermore, in addition others things are also becoming obstacle to get the success.

Hispanics and African American represent a large portion of entire U.S. population. Hispanics generally come from the Latin countries and Africa American from the content Africa. But the most important fact is that, among them a huge number of people are homeless and it is to be said the self-contradictory characteristic of U.S. the richest country of the world. These communities are suffering from improper health care services and have the high tendency to suicide. Their education background is also vulnerable compared to the whites.

In this case the nurses can play a major role in regarding both providing the better health care services and educate this vulnerable population. There are also some other health related problems that can be solved by making a positive atmosphere by the nurses. The nurses need to know and understand in what circumstances they will act and how they will do that.

The homeless population is a social group considered as a vulnerable because these homeless are at an increased risk for adverse health-related outcomes. Recognize and understand the homelessness and the relationship From the last two decades a good number of American cities experienced epidemics which challenged some beliefs. These people are concerned for affecting with HIV, violence, substance abuse, asthma, infant mortality or so many others factor. The vulnerable population is to be said the most sufferers in this case. However, there are a lot of complexities in regarding the health issues from the perspective of this population. Now, in America ‘a huge number of homeless people’ is a huge headache for the government as well as for the health and human services. This homeless inner city Spanish people are not only poor but also weak in health. According to the ‘human Rights Record of the United States in 2005′, US has 727,304 homeless people nationwide. It reminds that one in every 400 Americans are living without home. The Los Angeles, according to the statistics is the capital of homeless people. The United States dubs that it is the world’s richest country, but the report given by the London school of Economics represents that U.S is has the highest poverty rate among the developed countries. This report also says that U.S. has the worst social inequality. Among them the Hispanics are at the top of the list. Now this community includes approximately 35.3 million people. By 2050, approximately 102 million Hispanics will reside in the United States which is nearly 24.5 percent of the total U.S. population. So it is needless to mention that if Hispanics experience poorer health status, then the expected demographic change will magnify the adverse economic, social, and health impact of such disparities in the United States. (J. Pumariega n.d.). Hispanic origin women can be from any race. According to estimation the Hispanic includes 63 percent Mexican American, 14 percent central and South Americans, 11 percent Puerto Ricans and the rest 8 percent are from other. Among them 90 percent resides at the urban areas and 70 percent concentrated in 6 states-California, Texas, New York, Florida, New Jersey and Illinois. Black or African American are second at the list of vulnerable population in the United States. This origin has more undetected diseases and more chronic diseases comparatively to the whites. Inadequate housing, dangerous job and improper medical care represents the limited access of African American to the prerequisites for improved and safety health status includes better education, higher incomes and use of health care services as needed. Various types of risk factors are also involved in the daily activities of this population. “U.S. Department of Health and Human Services Healthy People 2010 goals” has provided several instructions in regarding to the health issues of this vulnerable population. The large portions of this vulnerable population are suffering from mental, psychiatric and substance abuse problem. Besides this the drug problem should be mentioned if health related factors described. The Hispanics are more than two times more likely than whites to indicate current drug abuse. So, such types of problems lead to a number of big problems that is quite impossible to handle. To improve and develop the health of this population, the nurses can keep a major role strongly. The nurses need to understand the various nursing environment and they should response in accordance with the environment. In the environment of vulnerable population the nurses expand their knowledge base in leaps and bounds. The nurses need to be supported into this field and others.

Health issues

Mental problem

The previous study found that the ratio of homeless people is highest among the Hispanics. As these Hispanics are homeless, they suffer from various kinds of mental problems and that is a national concern as well. Hence, the street beggars and those sleeping in public places have increased among the Hispanics. Homeless people are in want of emotional support, caring professionals and help that work within their frame of reality. Notably, each homeless group has different demographics and health needs. There are some denominators that are the obstacles in regarding to access health care. Nurses are the best effective means of serving the needs of these homeless people. Nurse-managed clinics can be a better solution to provide these needs and wants. However, with the help of these clinics homeless people can get continuity of care, suitable follow up, and teaching to aid in illness prevention. The freer clinic needs to be established so that the nurses can provide and meet the health needs and of homeless community. Among the Hispanics the mental, psychiatric and substance abuse problem has described as one of the problem of health issues. Another problem is the drug abuse problem. Several recent reports and researches provide the identified problems in access to and caring services that affects the Hispanics groups. The 2006 national healthcare Disparities report says that Hispanics scored lower that European American on 90% of access measures. (Armando W. 2007 et all)

The focused research of this report is to improve the systems of care in order to deliver more equitable services. But the question is who will provide this desired service to this population and how they will do it. Point to be noted; “only 1% of licensedpsychologists and American Psychological Association membersare Hispanic”. (Armando W. 2007 et all). So, generally they are not in the field of getting proper support in their mental problems. It is known that the Hispanics are not efficient in speaking English. So when they conduct with the health service provider then as expected they got lower facilities because of language barriers. However, who are expert in English get more facilities and most severe symptom ratings, followed by those who spoke only English or only Spanish during the interview.

Health insurance is a critical issue in Hispanic health factors. One third of the Hispanic population lacks it, which is double the national average. Hispanics comprises the largest ethnic minority group in the United States. The previous study found that “Mexican immigrants had considerably lower lifetime prevalence rates of major mental disorders than did-U.S. born Mexican Americans.”(R. Lopez, 2000).

There are some demographic and risk factors in the perspective of Hispanic vulnerable population.

• The prevalence of mental health problems varied by racial or ethnic group. Among State prisoners, 62% of white inmates, compared to 55% of blacks and 46% of Hispanics, were found to have a mental health problem.(J. James & E. Glaze, 2006)

• Among Hispanics Americans fewer than 1 in 11 do contact with specialist and 1 in 5 contact general health care provider.

• One national study found that only 24 percent of Hispanics received appropriate care compared to 34 percent of whites.

What nurses can do

The psychiatric-mental health nurses are efficient and educationally prepared to provide the full range of health services. The primary mental health care services are the first needs to face the challenges. To do so, some especial educational programs should be provided to the nurse practitioners.teh psychiatric-mental health nurse practitioner is advanced practice registered nurses who focus to develop the psychiatric disorders or mental health problem. They provide the wide range of settings to the patients who are seeking primary mental health services. The promotion of optimal mental health, prevention and treatment of mental health problem are the function of these nurses. They play a vital role in assisting people to identify the causes of the possible results of stress. Nursing care can be delivered on a one to one basis. The mental health nurses play a key role in the primary health care team efficiently. They are also expert in health education and promotion, seeking the general public

Substance abuse

Substance abuse refers to the abuse of drugs or alcohol that is primarily illicit. Hispanics are mostly known as “hard-to-reach” population in the context of health communication. Drug use among Hispanics has a sparse which is vastly higher than among who are surrounded by their own culture.

Drug abuse among the Hispanics is another concern for the government as well as for the future generation. The following are the risk factors in regarding to the drug abuse among the Hispanics in United States.

• Rates for illicit drug abuse and dependence are highest for Hispanics (7.8%).

• Hispanic adolescents are more likely to abuse drugs; especially crack cocaine, heroin, and ‘ice,’ than are adolescents from other ethnic groups.

An overview of U.S. Department of Health and Human Services Healthy People 2010 goals

Healthy people 2010 is planned to achieve two overarching goals:

• Increase quality and years of healthy life

The first step of “healthy people 2010” is to help individuals of all ages increase life expectancy and improve their quality of life.

• Eliminate health disparities:

The second goal of healthy people 2010 is eliminate the health disparities among different segment of the population.

‘Healthy People 2010′ is a set of health objectives for the Nation to achieve over the first decade of the new century. It can be used by many different people, States, communities, professional organizations, and others to help them develop programs to improve health.

Healthy People 2010 builds on initiatives pursued over the past two decades. The 1979 Surgeon General’s Report, Healthy People, and Healthy People 2000: National Health Promotion and Disease Prevention Objectives both established national health objectives and served as the basis for the development of State and community plans. Like its predecessors, Healthy People 2010 was developed through a broad consultation process, built on the best scientific knowledge and designed to measure programs over time.

Healthy people objectives have been designed by the congress as the evaluation for assessing the development of the Indian health care improvement act.

What nurses can do in regarding homeless Hispanics or African American and their mental health problem

Mental health nurses advocate in collaboration with psychiatrists and the other practitioners to provide services as for example monitoring the Hispanics patient, mental state, managing medication and developing the links to other health care professionals and clinical service providers. Their providing services are in a range of setting and are provided at little or no cost to the patient.

The homeless Hispanics and African American both are growing rapidly in context of population. They are not only growing but also their mental health is dis-improving day by day as they are considered as vulnerable population. It has been mentioned earlier that Hispanics are the largest minority community in the United States. The percentage of homeless African American is also high in United States. They are also vulnerable because of most of them are homeless and suffering from controversial mental health problem. They do feel some bad feelings about their origin root and that’s why they are still in back position. In this regard, the nurses can play a major role to manipulate this community to improve their mental health.

Mentality is the drive that influences people toward every outcome whether it is positive or negative. Hence, the nurse’s role in educating the Hispanics homeless population about how to access health care and addresses their health needs should be reflected in a systematic manner. The nurses can make them understood about the benefit of better health that will make them established at their desired level. There are a lot of people among the Hispanics who are not able to say or understand the English. In this case, the nurses have a better opportunity to teach them about the benefit of speaking English. Whenever you talk about the vulnerable or homeless people then the word needs to mention. The racial issue is a very sophisticated factor in regarding the vulnerable population. It does reflect the whole picture of vulnerable population in America. The vulnerable population should be treated in accordance with the proper plan and therefore, there also should not be any complexity.

Notably, here needs to talk about the nursing aids and its function. Nursing aids is to care for physically or mentally weak, injured, disabled, and mental health setting. Nursing aids is applicable for those who are in need of a long term care. Their specialty is defined by their specific care.

In context of homeless Hispanics, these nursing aids should be implemented to get the better result and overcome the problem existed among this community. The nursing aids help elderly or disabled person live in their own home instead of health care facilities. The nurses can give the instruction about how the homeless Hispanics can lead a better life after being educated and having a good health. Therefore, the better health is needed to fulfill the goals set by the “healthy people 2010” project.

Lower rates of health care use by Hispanics judge against with non-Hispanics white person-in context of hospitalization, physician visit, prescribed medicine, and specific preventive service—have been found. A numerous studies found differences in culturally based attitudes in regarding health care and barriers presented by language. It has been also found that Hispanics who are less assimilated into U.S. culture face more wide-ranging barriers than those who have become acculturated with U.S. culture. Hence, there is an impact on the basis of relation between culture and use of service is quite mixed. In addition, insurance status has a larger impact on use of health care services. It is duty for the nurses to identify the specific factors that affect the function of health care services for this vulnerable population.

Nurses should advocate and educate this vulnerable population. Nursing around the world needs to feel the confident and the essential and significant contribution to the provision of safe, quality patient care. It is known that the nursing workforce is the largest group within the health care system. The theoretical and practical knowledge not only guide the nurses, but also the beliefs, values and personal thinking help them to emerging advance scope of practice.

Homeless Hispanics are to be said the obstacle for the U.S. developing program ‘healthy people 2010′ and its success. The Hispanics are suffering from different kinds of mental health problem which is day by day going to be uncontrollable. Homeless people do not get the at least primary health service in most of the cases. As it is known that by 2050, the Hispanics will be approximately 25% of the total U.S. population. So, these successes of the “U.S. Department of Health and Human Services Healthy People 2010 goals” are very much dependent on their health care.

What nurses can do in regarding homeless Hispanics or African American and their drug abuse problem

Drug abuse among the Hispanics and African American minority, is a strong concern as it has a larger impact on future generation. The people who are involved in drug abuse can be considered as patient from the medical perspective. However, drug abuse is becoming a growing distress for the U.S. government as well as for the health and human service. The qualities of substance abuse treatment are of interest to both the government and the treatment service provider. There has been a little research on treatment outcomes of Hispanics and African American in substance abuse treatment. However, Nurses have the potential to continue integrated interventions from the perspective of health care setting. The needs of the patients vary with the change of health care setting and the function of nurses as well. So, the field nurses need to clarify their roles and functions in relation to both the setting where they work and the patients to whom they deal with. The healthcare professionals need to demonstrate the effectiveness of what they are used to do and how they do to maintain the quality of patient care.

Substance abuse is to be said as the abuse of alcohol and other drugs. “Most culturally distinct groups have used and abused alcohol and other drugs throughout the ages, and they have established codes of behavior in their approach to drugs and alcohol”. Alcohol and other drugs have been used among the Hispanics or African American minority for thousands of years.

Socio-cultural beliefs can shape the approach to and behavior regarding substance use and abuse. Culture plays a central role in forming the expectations of individuals about potential problems they may face with drug use. For many social groups, this may provide a protective factor. An example is the use of alcohol by the ancient Aztecs before any contact with white settlers. Their use of alcohol was heavily regulated and was only for ceremonial purposes. Non-ceremonial use of alcohol was strictly forbidden under penalty of death.

^3,8

Another example is the development of the peyote cult in northern Mexico. Peyote was used in a ceremonial setting to treat chronic alcohol addiction. This use later became a central part of the Native American church, which provided important spiritual treatment for chronic alcoholism.

Recent research found that despite declining trends in use of drug abuse among the American youth, drug use among Hispanics youth remains alarmingly high. So in this case what the nurses can do is the million dollar question. The nurses provide their service in very practical way and for that reasons the result or outcome is always good. The African American has the highest tendency to use the drug and it is more likely in the youth generation. but the homeless African American or Hispanics are considered as the vulnerable population and they have not the ability to deal with these problem. In regarding this matter, the nurses can be used as a very effective tool. However, nurses will teach this vulnerable population about the bad effects of drug abuse and how is ruining their personal and family life as well as the society.

Nurses normally meet legal issues in their place of work. However, many of them are either unaware of their significance or unable to face these issues. Since the findings of the study identify that learning at workplace has been valuable to gain knowledge about law, it is needed to identify legal issues in their workplace. This will help them to increase their efficiency because knowledge about legal issues upgrades their sense about their tasks. These issues provide direction that what needs to do or not to do. They should focus only how the problem can be removed in this area. The “healthy people 2010” is not just a dream, it is more than that and the homeless Hispanics or African American are the barriers of this dream. This dream should be reflected by the activities performed by the nurses.

Conclusion: Now-a-days nursing has developed its all functional activities in accordance with technological, political or socio-economical rapid change. The changing boundaries of professional responsibility and its influence on their scope of practice have been emerged. For the effective care the nurses must all work together toward a common goal to meet the needs and serving the interest of the patient. According to the UKCC code of professional contact, clause 4 states that in the exercise of professional accountability, the registered nurse must, “Acknowledge any limitations in your knowledge and competence and decline any duties or responsibilities unless able to perform them in a safe and skilled manner.” (Turnbull Mark)

However, Hispanics are becoming a large portion of U.S. population day by day and they are in need of the proper health care services. A lot of barriers are involved in regarding their health problem whether it is mental or about drug abuse. The nurses are to be said as the key element who can work together in the field to make a better move of health care services for the homeless Hispanics and African American.