Introduction
Philadelphia is a city in the Commonwealth of Pennsylvania. Not only is it one of the largest cities in the United States, but it also showcases many health problems that are typical of Americans. According to Pennsylvania Health Department (2019), Philadelphia has more than a million and a half people living in it. The city’s demographic is unusual for the United States, as there is no strictly defined white majority. Instead, 44,8% of residents are white, 43,6% are black, 15,2 % are Hispanic, and 8,0% are Asian. The city’s population is predominantly adult, which makes it particularly susceptible to health issues. The three issues that will be the focus of this presentation are diabetes, obesity, and dementia. Existing intervention will be analyzed, which will be complemented by a proposed intervention.
Target Population
The population under focus is composed of adults aged 45-65 years old. The median average household income is close to $54,895 (Pennsylvania Department of Health, 2017, p. 18). 36% are high school graduates, 29% have Bachelor’s degree, 16% have no degree, 11% have no high school diploma, and 8% have an Associate’s degree (Pennsylvania Department of Health, 2017, p. 20). Mortality rate per 100 000 residents is 826.59 from health-related causes (Philadelphia Department of Health, 2020).
Citizens are employed in leisure and hospitality industry (over 40%), business services (25%), trade, transportation, and utilities (around 20%), education and healthcare (near 20%), while the remaining population is employed in other areas (U.S. Bureau of Labor Statistics, 2022).
Comparison of Sentinel City Data
In comparison, with Sentinel City, Philadelphia has more people under 18 years (216,00 vs. 188,348), significantly more people between 18 and 65 years old (1,228,064 vs. 455,234), and more elder people (140,000 vs. 83,629) (Pew Research Center, n.d.). White population of Philadelphia constitutes only 44$, which is a stark contrast to Sentinel City, where it is up to 76,1%. Similarly, the proportion of African American is 43,6% in Philadelphia, while Sentinel City has only 9,2% (Sentinel U, 2021). The comparison of Asian population is also similar – 8,0% to 3,7%. The only category that is more prevalent in Sentinel City than in Philadelphia is Hispanic population – 3,7% to 8,0% (Philadelphia Department of Health, 2020). Median household income indicators are also similar – $47,474 in Philadelphia compared with $49,091 in Sentinel City.
Key Health Concerns
The first health concern for Philadelphia is diabetes. According to Philadelphia Department of Public Health, “diabetes has increased by more than 50% in the past 15 years” (Farley, 2019, p. 1). In 2002, 7,4 % of adults had diabetes, while in 2018, the proportion increases up to 14%. Furthermore, the same study notes that diabetes “is the sixth leading cause of death in Philadelphia” (Farley, 2019, p. 12). The corresponding Healthy People 2030 objective is to promote formal diabetes education, which will encourage people to adopt healthy eating habits (U.S. Department of Health and Human Services, n.d. b). The more conscious of diabetes-related risks people will be, the better they can control the progression of the disease, as well as their response to it.
The second health concern is dementia. Dementia prevalence among people older than 65 years old in Philadelphia is 11,9% (Bennett et al., 2021, p. 4). As the proportion of elder population is likely to increase, the incidence of dementia is also likely to surge. The corresponding Healthy People 2030 objective is to increase the number of people with dementia who are aware of their diagnosis (U.S. Department of Health and Human Services, n.d. a). Although dementia is not curable, early diagnosis can substantially ease the progression of the disease, which is why it is important that people at risk know how to spot it.
The third health concern is obesity. According to CDC, 67,9% of adults and 41% of young people have at some point experienced excessive weight (Centers for Disease Control and Prevention, n.d.). Considering the overall popularity of fast food and sugar consumption, this trend is likely to become worse. The corresponding Healthy People 2030 objective is to reduce the proportion of obese adolescents and children (U.S. Department of Health and Human Services, n.d. c). Unless the younger generation starts adopting healthier habits, the future statistics will also contain a severe percentage of adult obesity.
Community Health Nursing Diagnosis
The most appropriate community health nursing diagnosis would be as follows: increased risk of diabetes among Philadelphia residents related to obesity as demonstrated by the rising fat and sugar consumption among young people and adolescents. People are daily exposed to thousands of opportunities to buy and consume food rich with sugar and unhealthy fats (Farley, 2019). Ranging from numerous fast food outlets to intermediate goods in groceries, the allure is too strong to be managed by personal self-control. The more residents of Philadelphia consume fast food, the more likely they are to become obese and be diagnosed with diabetes at some point in their life.
Existing Community Health Intervention
Task Force on Community Preventive Services has already developed an intervention aimed at addressing the issue of diabetes (The Community Guide, n.d.). It proposes to gather teams that would help patients manage diabetes on their own. The reason why this is effective for the middle-aged people of Philadelphia is that they are financially and emotionally mature enough to recognize the importance of healthy living and following it. The main advantage is that diabetes patients will be able to recover from the disease on their own. The population fit is virtually any middle-aged diabetic willing to overcome the disease. The main barrier is finding people for teams that would work with the target population.
Proposed Community Health Intervention
The long-term goal is to reduce the incidence of diabetes-related complications. The first short-term objective is to ensure that all patients are able to identify signs of deterioration by measuring blood glucose levels. The second objective is to “promote patients’ adoption of healthy behaviors and lifestyle choices”, such as dieting and physical exercises (Community Preventive Services Task Force, n.d., p. 2). One day is necessary to teach the patients to measure blood glucose, while adoption of healthy habits can take as long as six months. Glucometers are the major items of the required equipment. The entire initiative should take no more than $10 000, including the price of glucometers and compensation of team members.
Evaluation Plan
As team work is at the core of the proposed intervention, evaluation of the result should also be team-based. Health professionals gather the essential data, such as patients’ habits and current measures of blood glucose and other diabetes related problems. Each time the team meets, health professionals complete a survey based on their observations of patients’ behavior. The items in this survey should consist of general questions, such as “Does the patient smoke?” or “Does the patient exercise?”. These entries are valuable because they provide a measurable indication of progress. Once the Yes/No responses cease being relevant, it is reasonable to add more in-depth entries, which would detail the number and frequency of certain activities, such as exercising. The goal and objectives in the existing plan apply to the proposed plan as well.
Sentinel City Summary
The physical environment of Sentinel City is dense, with many modern buildings being located in close proximity to each other. The most evident sign of environmental degradation is the presence of the plant that can be seen in Lake View (Sentinel U, 2021). Sulfur dioxide emissions spoil the atmosphere and force residents to breathe intoxicated air. Another aspect is the presence of uncollected waste in some areas. Although probably nothing can be done about the plant’s emissions on the nurse level, the issue of trash pickup can be addressed by launching a social campaign that would raise awareness of the litter. Furthermore, it is possible to initiate a volunteer-based effort to pick-up trash. All such steps will draw the attention of the city’s authorities, which will lead to actions regarding waste problem.
Transportation in the city is implemented via three means – bicycles, cars, and buses. One particular type that is notably missing is tram lines. Adding trams will make traffic less risky and offer more alternatives to residents. Public health department is extremely sensitive regarding any vulnerable population, including elderly and handicapped. Both these groups have a special range of services, although the absence of pathways for handicapped complicates their movement through the city. Adding delineated zones for people with disabilities can easily solve this problem. Regarding education, Sentinel City has an urgent problem of high dropout and student underperformance. Both of them can be approached by greater involvement of parents and families in the learning process of their children.
Sentinel City has numerous recreational places, such as parks, Lake View, and numerous playgrounds. However, the presence of dogs without leashes and owners endangers citizens. Ensuring that dogs can only be present with owners is the most evident solution. Politically active individuals can be seen protesting in front of the City Hall even though there are too few of them. Using viral hashtags can help them attract attention and public support to urgent issues. Most of the mass communication in the city is done via radio Buzz radio. Using it to stream health-related advice may promote health awareness among the residents. The major economic problem of the city is unemployment, which precipitates homelessness. The corresponding recommendation is to stimulate the creation of small businesses, thus increasing employment rates.
Conclusion
Altogether, it should be evident that although there are differences in population size and demographic proportions, there are some similarities between the two cities. Both have a relatively similar medium income and similar health problems. The main identified concerns for Philadelphia are diabetes, obesity, and dementia. Diabetes and obesity are also important issues for Sentinel City that could also benefit from a community health intervention plan. The plan for Philadelphia presupposes building team to help patients overcome diabetes. The proposed intervention is to teach diabetics to measure their blood sugar level and encourage them to change their lifestyle habits. In six months, the results of the intervention should become evident. The same approach can be used with Sentinel City that also has a plethora of issues. Ultimately, every individual is personally responsible for overcoming their own diseases, as well each community is responsible for solving its urgent problems.
References
Bennett, E. E., Kwan, A., Gianattasio, K. Z., Engelman, B., Dowling, N. M., & Power, M. C. (2021). Estimation of dementia prevalence at the local level in the United States.Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 7(1), 1-10.
Farley, T. (2019). Diabetes Prevalence and Impact on Philadelphia. Philadelphia Department of Public Health, 4(5).
Centers for Disease Control and Prevention. (n.d.).Community Profile: Philadelphia, Pennsylvania.
Community Preventive Services Task Force. (n.d.) Diabetes management: team-based care for patients with Type 2 Diabetes.
Pennsylvania Department of Health. (2017). The Context of Health.
Pennsylvania Department of Health. (2019). Philadelphia | Pennsylvania County Health Profiles.
Pew Research Center. (n.d.). Adults in the Philadelphia metro area.
Philadelphia Department of Health. (2020). PhilaStats.
Sentinel U. (2021). Sentinel City® Community Health Simulation Demographics. Web.
The Community Guide. (n.d.).Diabetes Management: Team-Based Care for Patients with Type 2 Diabetes.
U.S. Department of Health and Human Services. (n.d. c). Increase the proportion of older adults with dementia, or their caregivers, who know they have it — DIA‑01.
U.S. Department of Health and Human Services. (n.d. a).Increase the proportion of older adults with dementia, or their caregivers, who know they have it — DIA‑01.
U.S. Department of Health and Human Services. (n.d. b). Increase the proportion of people with diabetes who get formal diabetes education — D‑06.
U.S. Bureau of Labor Statistics. (2022). Philadelphia Area employment — February 2022.