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American Indians and Alaskan Natives received worse care than Whites for one-third of quality measures.Poor people received worse care than high-income people for about 60% of quality measures. In 2011, 37.6% of poor Americans reported barriers that restricted their access to care.Blacks had more maternal deaths per 100,000 live births, and had a greater incidence of postoperative pulmonary embolism (PE) or deep vein thrombosis (DVT) per 1000 surgical admissions compared to Whites.Asians had a greater incidence of live-born low birth weight infants than Whites.Low-income (poor) people had a greater number of admissions with diabetes with short-term complications per 100,00 population than High-income people.At the same time, there was improvement in many areas of existing health disparities. For example:There was a decrease in new AIDS cases and HIV infection deaths per 100,000 population in Black compared with White.There was a decrease in new AIDS cases and HIV infection deaths per 100,000 population in Hispanics compared with non-Hispanic White.There was a decrease in admissions for uncontrolled diabetes without complications per 100,000 population in Black compared with White.There was a decrease in admissions for uncontrolled diabetes without complications per 100,000 population in Hispanics compared with non-Hispanic White.Health Promotion ActivitiesHealth promotion organizations, wellness centers, and traditional healthcare centers all offer a different approach to client care. Table7–2demonstrates
these differences. Health promotion activities can be carried out either on a governmental level (e.g., a national or state program to improve knowledge of nutrition) or on a personal level (e.g., an individual exercise program).Table 7–2 Comparison of Three Foci of Health Care: Traditional, Health Promotion, and WellnessTraditionalHealth PromotionWellnessPrimary goalDiagnosis and cureIllness/injury prevention and risk reductionImproved overall health and wellnessFocus of careDisease/injuryIndividuals, families,and communitiesIndividuals, families,and communitiesInterventionMedical/surgical/mental health treatmentHealth risk appraisal, health -information, strategies for behavior changeHealth information, nutritional -counseling, exercise/fitness, stress management,risk avoidanceDurationUntil problem is resolvedLength of programLifelongLocationHospitals, clinics, MD/ANP officesSchools, workplaces,gyms/fitness centers, community centers, hospitals, clinics, MD/ANP officesSchools, workplaces, libraries, gyms/-fitness centers, community centers,grocery stores, hospitals, clinics, MD/ANP officesExampleTreatment of client Health risk appraisalPrograms to prevent
TraditionalHealth PromotionWellnesswith acute myocardial infarctionfor client with familyhistory of heart disease and coaching for lifestylechange (e.g., smoking cessation, weight management, diet, exercise)obesity in childhood including developinglifelong nutrition and exercise habitsHealth promotion programs on an individual level can be active or passive.