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Ellie O’Brien & Clare Dearing May 13th, 2014 The Challenges of Communicable Disease Control
Objectives • Prevalence of Influenza, Varicella, Tuberculosis, HIV, & STI’s • The Social Determinants of Health • Controlling Infectious Diseases • Vulnerable populations • Policy changes & The Community Health Nursing Standards of Practice
Influenza • “Canadian first nations are known to have a disproportionately higher rate of health disparities in general” (Boggild, A. K., Yuan, L., Low, D., McGeer, A. J., 2011). • They are also found to have a lower life expectancy. • Vulnerable populations were found to have higher incidence rates of H1N1, the Varicella virus and TB. • In 2009, for 588 infections of H1N1 where ethnicity was known, First Nations accounted for 54% of hospitalized cases and 60% of ICU cases (Boggild et. al, 2011).
Varicella • Since the introduction of the Alberta Varicella vaccination program in 2001, a steep decline has been noted in Albertan children. However, less of a decline was noted in First Nation children, as well as children of lower socioeconomic status. • Shingles is the reactivation of the dormant Varicella virus in the body. Reactivation is due to depleted cell mediated immunity. Consistent with rates of chickenpox; rates of shingles was seen highest in people of lower SES (Russell, M.L., Schopflocher, D.P. & Svenson, L.W., 2008).
Tuberculosis • 1/3 of the world’s population is infected with TB. • “In 2007, there were a reported 9.3 million new TB cases and about 2 million TB-related deaths.” • “In 1993 the WHO declared the dramatic increase in TB to be a global health emergency.” • The social determinants of health play a predominant role in the reappearance of TB world wide (Reitmanova, S., & Gustafson, D., 2012).
HIV & Sexually Transmitted Infections • Sexually transmitted diseases are on the rise and can be prevented and treated. • Testing is the first step in doing so, however there are many barriers to STI testing that individuals experience (Goldenberg, S., Shoveller, J, Koehoorn, M., & Ostry, A., 2008). • “HIV is a risk factor for TB reactivation, as well as a major contributor to the global reoccurrence of TB” (Long, R., 2010).
Social Determinants of Health • Social determinants of health disparities put vulnerable populations at a higher risk of contracting communicable diseases such as Influenza, Varicella, TB, HIV, & STI’s. • “Smoking, smoking during pregnancy, exposure to second-hand smoke, breastfeeding practices, and socio-economic factors are all risk factors that increase the risk of acute respiratory infections in Aboriginal populations” (Boggild, et. al, 2011). • Homelessness also plays a big part in the spread of these infectious diseases (Hwang, S.W., Kiss, A., Ho, M.M., Leung, C.S., & Gundlapalli, A.V., 2008).
Controlling Infectious Diseases • “Infectious diseases have undoubtedly been the greatest killer in human history (Brunham, R.C., 2009). • The first step in solving the spread of infectious diseases is recognizing the underlying causes related to the social determinants of health and the inequities among vulnerable populations. • Child immunization programs have been one of the most successful efforts in controlling and eradicating common infectious diseases. • Societal change is also a major contributor in controlling the spread of infectious diseases.
The Need for Change:Influenza • Public Health Nurses need to focus on the needs of vulnerable populations. When it comes to infectious diseases, education on the importance of vaccinations should be a top priority. • During an influenza outbreak these populations should be high on the priority list and extra efforts should be implemented in order to provide access to vaccination clinics for these populations.
The Need for Change: Sexually Transmitted Infections • Here are some of the barriers youth experienced related to STI testing: 1) Limited opportunity for testing 2) Geographic barriers 3) Social norms 4) Lack of information 5) Negative interactions with service providers
The Need for Change: Tuberculosis • It is said that Immigrants often represent the highest proportion of TB cases in the countries they reside in due to risk factors such as low income, limited access to health services, malnutrition, poverty, and overcrowded housing (Reitmanova, S., & Gustafson, D., 2012). • Another factor that may account for the higher rates of TB among immigrant populations are the social determinants of health which produce health inequalities.