Designing an effective public health program first requires a fuller understanding of the target population and the needs there represented. The essay here considers these characteristics in relation to the communities of Philadelphia. In doing so, it recognizes both the demographic and institutional obstacles that must be overcome to dispatch an effective program.
Health Program Assessment: Inequality in Philadelphia Communities
How long have you lived in your community?
I have been a Philadelphia resident for 23 years, during which time I have come face-to-face with a wide array of pressing public health issues. As a recent article by Melwert (2012) shows, Philadelphia is routinely ranked as the least healthy county in the State of Pennsylvania.
What do you believe are the greatest health issues that exist within your community and who are the populations you believe are most impacted by these health issues?
The population that concerns us most is the youth demographic. In Philadelphia, young people between the ages of 1 and 19 are at the highest risk for certain prevailing health challenges. Additionally, based on the findings from our interviews with local residents, the vast majority of youths in high-risk categories are of African-American or Hispanic ethnicity. There are yet further divisions within this risk population where different age groups must contend with different health risk indexes.
For instance, among younger community members, one of our greatest concerns relates to environmental health. Children between the ages of 1 and 7 are at a high risk for exposure to lead in our community. Additionally, environmental factors have contributed to a preponderance of emergent asthma cases in the community, impacting community members as young as one-year-old. There are yet additional health risks that are specific to the adolescent and teen members of the community. For those between the ages of 13 and 19, our public health program must concern itself with the growing issue of childhood obesity, the apparent frequency in cases of ADHD and the spread of sexually transmitted diseases.
What are two barriers that exist within your community that you feel could negatively influence these health issues (e.g., no public parks, pollution from a particular factory, no major hospitals or grocery stores)?
Two barriers seem to have the most determinant impact on health considerations for the selected population. These relate to housing and popular health beliefs. For the former, the issues of asthma and exposure to lead are mutually impacted by the permeation of air pollution in impacted neighborhoods. The age of many homes, which are frequently more than 60 years old, is a direct contributor to the spread of these health conditions. With respect to issues such as childhood obesity or the spread of STDs, the greatest obstacle to improving public health is a dearth of knowledge on how certain health behaviors induce a higher level of personal risk.
Why do you think those barriers exist?
Most research on the subject demonstrates that Philadelphia's public health issues are inextricable from its general rate of inequality. The demographics most impacted by the city's pressing public health issues are those who are equally impacted by prevailing economic challenges. As the text by Melwert indicates, while housing and schooling issues are found on the surface, these problems are rooted in a more entrenched economic hierarchy. According to his article, "higher-than-average rates of smoking, inactivity and obesity don't help. But, it's the socio-economic indicators -- like high drop-out rate, violent crime, and childhood poverty -- that really weigh it down." (Melwert, p. 1) This denotes that in spite of the behavioral challenges that our program will address, many barriers are formed at the institutional level and most also be confronted.
What kinds of resources exist within your community that could help influence the health of individuals within your community (i.e., hospitals, community clinics, non-profits, etc.)? Consider the resources available within the community to help address the public health issues.
One of the four overarching goals of the CDC's Healthy People 2020 initiative relates to the issue of health inequality. Indeed, as the health program assessment here shows, socioeconomic factors are likely to have a direct bearing on the way communities experience certain health issues. The objective here is to reduce the impact of these factors. According to the CDC (2011), it is incumbent upon us to "achieve health equity, eliminate disparities, and improve the health of all groups." (CDC, p. 1) This denotes that resources are being made available at the federal and state levels to help communities meet their various public health objectives. Given that the Philadelphia county is a hotbed for health inequality, it seems appropriate to tap the various grant programs and federal assistance initiatives in order to gain material support for a comprehensive youth health intervention program.
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