Change_in_the_Community

Community Development Racial PRINCIPALS OF COMMUNITY DEVELOPMENT The perception of Racial and Ethnic Bias in the Healthcare System: A Case Study on one city (A Community Perspective) Introduction Public health in America has benefited from various innovations and advanced medical technology. However, these developments do not serve all Americans. Even in modern times disparities exist between whites and minorities in terms of health care. For instance the rate due to heart disease and stokes were higher for African Americans than for whites: 30% and 41% respectively, in 2002. The infant mortality rate for African Americans was higher compared to that of whites, in spite the fact that the national infant mortality rate had decreased. In 2004, African Americans had the highest diagnosis rate for HIV; 50%. (Centre for health care strategies) Ensuring equity in health care is necessary in order to prevent premature death, control disease, prevent unnecessary illness or disability and promote the quality of life for all citizens. An intervention by the Centre for Disease Control and Prevention lead to the formation of Racial and Ethnic Approaches to Community Health (REACH). The program’s mandate is to identify, minimize and eventually eliminate health disparities that exist along racial and ethnic divides. Minority groups are the main victims of health care inequity. As a result the REACH program targets; African Americans, American Indians, Asian Americans, Latinos, Alaska natives and Pacific Islanders. These communities need to be involved in the REACH program since, they are after all the beneficiaries. Individuals, community leaders and opinion leaders need to be consulted and empowered. REACH has developed strategies that improve health care in various communities, work sites, schools, after school settings and in health care facilities. (Policy link) Application of community development principles of good practice to research on racial and health care disparities. For a society to be successful then development of individual communities and organizations needs to be considered. Community development focuses on the improvement of the quality of life for an entire community. A community can be defined as a team of people who are unified due to location, common interests or ownership. For this kind of development to occur then the principles of good practice ought to be enforced. Some of the principles of good practice include; encouraging participation, problem identification and designing of solutions by community members and community leaders. Leaders in the community are also empowered and educated so that they can understand the problems that exist in their community and abstinence from practices that affect the community negatively. In other words the principles of good practice include; inclusion of community members, capacity building through management of information and resources, partnerships with all stakeholders, equity, accessibility and responsiveness in terms of action towards various initiatives. (Waller 2003) The community should be involved in the research on racial and ethnic disparities in health care. The community will provide valuable information on the disparities that exist, intervention programs and the progress made in addressing the issue. Researchers need to consider vital elements in the community; trust, cultural heritage, history, expertise, community leaders, community initiatives and resources. Community based research relies highly on participation and trust. Trust is fundamental for the research on racial and ethnic inequality in health care. The researcher needs to understand the community’s history and how it relates to their current health care situation. For example the slavery and racial discrimination history of African Americans can provide insight on why the disparity in health care exists. The researcher needs to appreciate information from participates. However, this does not imply that all information should be accepted as truth without further investigation. The views of the community members should be listened to carefully, evaluated and investigated. Researchers should view the community as a partner in the research and interact with members. (Baker 1997) The researcher needs to develop a partnership with the members of the community. Together the parties define the health care disparities and needs. They also evaluate the effectiveness of programs initiated so as to reduce the health care inequality and provide recommendations on how to improve those programs. In this partnership between the researcher and the community members the thoughts and opinions of the community members need to be reflected in the publications. It is a common practice for publishers to decide what to print. Most of the times the community participates are not co-authors of the publications; they are simply acknowledged for their cooperation in the authors’ notes. As a result some of the issues that are very vital to the community may be left out. Members of a community provide superior information on their community’s views and their culture. Thus inclusion of community members as co-authors of publications will benefit both the researcher and the community. Moreover, this effort is a form of empowerment for the community since their views and opinions will be better represented thus creating a comprehensive picture. Ethical practices should be used in data collection, ownership and publication. (Waller 2003) In order to understand the role that racial inequality has on premature deaths, infant mortality rate, disability and the spread of disease community based research are crucial. Community partners provide information on the nature of health care they receive in terms of health education, treatment, responsiveness in health care centres and the facilities that are available in their localities. Research ensures that health care delivery coincides with the needs of the community. The insight provided by community participation research is useful to the government and other stakeholders who are responsible for designing and implementing health care delivery programs. Community participants in a research usually represent the views of the community in relation to health care. Thus their views should be considered and reflected in the research. Research helps in addressing the challenges that face the health care system. Hence it provides solutions communities and policy makers, which will ultimately improve the nature and quality of health care available to all citizens. (Schultz, S 2002) For racial and ethnical disparities to be eliminated then all stakeholders need to develop strategies that will address issue. Various states and Medicaid managed organizations have developed a community-based strategy to address racial disparities in health care. The strategy emphasis on community participatory research on health care racial and ethnic inequality. The community members, community based organizations are the main source of information. The health care providers and government then analysed the information and set policies on health that ensures equality in access and treatment to all American citizens. Compared to traditional research methods community based participatory research provides pertinent findings and is less time consuming. Health care providers are increasingly using this approach; the main focus is using community-based approach to interact with minorities. For instance the ‘EXCEED’ project uses partnership between researchers, community member, community health care centres and the community organizations. EXCEED uses the community participatory research due to acknowledgement that it leads to comprehensive findings on the social, cultural and economic aspects that contribute to the racial and ethnic disparities in health care. The EXCEED program “Excellence Censers To Eliminate Ethnic/Racial Disparities” is an in initiative by the Agency of Health care Research and Quality (AHRQ). Its mandate is to investigate and understand racial and ethnic disparities in health care as well as designing and implementing strategies on eradication of those disparities. (January 1997) Conclusion Inequality in health care provision is evident in terms of health care access, prevalence of disease, health care setting and the quality of care. America’s minorities’ usually higher rates of disease, higher infant death rate and poorer health care compared to white Americans. Disparities in health care affect the individual, communities and the economy. Poor health care contributes to the cost of health care through complications due to poor care, avoidable hospital admission and preventable emergency cases. Community based participatory research on racial and ethnical disparities in health care provides data that reflects the extent of the situation. Health care providers to design strategies provision of quality health care services to all citizens use information from the research. Community based participatory research is a partnership between the community and the researcher. There is equity in power, decision-making, credit and knowledge. The community and the researchers collaborate in all segments of the research; problem identification, planning for the research, actual research, data collection, analysing of data and recommending a course of action. Data collected through community based participatory research on racial and ethnical disparities in health care is usually analysed by the government and other health care stakeholders. The revelations made by the data are useful when goals and policies are been designed so as to eliminate the racial and ethnical disparities in health care. Health care is fundamental in every society. Therefore health care providers are advised to ensure equity in quality, access and care in the health sector for all Americans regardless of their race or ethnicity.