Public health is the science and art of promoting and protecting the life and well being of the population as a whole, by preventing the ill – health and prolonging the life through the organized efforts of the state and the society.
This assessment aims to discuss and present the health status indicators for diverse groups in the National and International perspectives. It also includes the causative factors in health.
- Current Health Status indicators for Three Diverse Groups from National and international perspectives.
New Zealand is located in the South Pacific. It is a multi-cultural country and a very supportive on health of the society and its program. There are several diverse groups that living in New Zealand namely: the Maori, The Pacific people, the Pakeha or Europians and the Asian migrants.
a. The Maori
Maoris are the most important ethnic groups in New Zealand. They are the original settlers of the country. One indicator that compromises the health of the Maori is smoking. Smoking was identified as the most prevalent health status indicator and it is significantly observed in areas inhabited by the Maori.
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Broughton (1996) stated that traditionally the Maori society was tupeka kore (tobacco free). Maoris’ first encounter with tobacco was through the British, it was used as a tool of colonization by gifting or trading it in return for land and other resources.
Currently, 32.7 per one hundred of Maori identified as being regular smoker, more than twice the smoking rates of European and Asian ethnic groups. Among Maori males the regular smoking rate is 30.5 percent and among females it is 34.7 percent. For Maori women of childbearing age (20-44 years), 40.5 percent smoke regularly. (Statistics New Zealand, 2014)
Moreover, the Maori youth aged 15 – 19 years has higher smoking rate than non-Maori. In this age group, 38.8 percent (CI 29.3–48.3%) of Maori were current smokers compared with 13.7 percent (CI 10.4–17.1%) of non-Maori. There were some findings that there were notable difference in the average of the Maori and non-Maori’s initial taste of cigarette. On average Maori youth, their first cigarette was as early as 11.5 years compared to non-Maori youth at 12.7 years.
As a result, tobacco smoking is the primary cause of the preventable death for Maori in New Zealand. Approximately, three times as many Maori died from Lung cancer and other smoking related diseases as Non-Maori each year.
Maoris’ current smokers are more likely to prefer on smoking a roll-your-own-cigarette than non- Maoris smokers. The frequency of roll-your-own-cigarette was 70.3 percent for Maori and 57.4 percent compared to non-Maori.
The most common reason of Maori and non-Maori for using the roll-your–own-cigarette was that, it has less expense than the manufactured cigarettes. The other reason for Maori and non-Maori they gave was, it last longer and taste better.
Another health indicator among Maori is the Life Expectancy. The life expectancy of Maori men is 73 years while the Maori women is 77.1 compared to the non-Maori men which is 80.3 years and 83.9 years for the non-Maori women. The life expectancy at birth has narrowed the gap to 7.1 years between Maori and non-Maori people. In comparison with 8.2 years in 2005-07, 8.5 years in 2000-02, and 9.1 years in 1995-97 based on death rates of New Zealand in 2012-2014 (Statistics New Zealand, 2014).
The differences in the life expectancy rate of Maori people compared to non-Maori are due to the number of factors including rates of smoking and socioeconomic status.
b. The Pacific people
The Pacific community in New Zealand are consist of different ethnic groups like the Samoans who are the largest group with 50% of the population, the Cook Islanders, 20%, the Tongan, 18%, the Niuaen, 8% and the Fijans who have the smallest group of 4%. (Ministry of Public Island Affairs, 2013)
Obesity is one of the biggest issue in health for the Pacific Islanders. Among the New Zealand diverse groups, the Pacific adults had the highest rate of obesity with 67 percent followed by 46 percent Maori adults. Contrasting to, only one in seven Asian adult is obese, with a rate of 14 percent. On the other hand, Pacific children aged 2-14 are 55 percent obese or overweight, compared to 29 percent of the total child population in New Zealand.
Based on body mass index, it was found out that almost one out of three adults from age 15 years and above were obese with a rate of 31 percent while about 34 percent were overweight. In ages 2-14 years, one in nine children were obese or 11 percent. Furthermore, high rate of overweight children of the Pacific people were also found, which was 22 %.
c. The Asian group
The Asian adults are generally in good health. They have the positive focus on health and well-being. In fact, Asian adults have comparatively low rates of smoking, hazardous drinking, asthma, arthritis, chronic pain, diagnosed mood or anxiety disorders (Asian Health, 2006).
However, Asian adults are about 1.8 times as likely to have been diagnosed of type 2 diabetes as non-Asians. Self noted diabetes rates are common among Indian people, more than three times than the normal average. Asian adults generally report lower use of primary health center because of the language and cultural barriers that affect the access to health services (source).
It was noted that after migration, Asian people may have increased risk of diabetes and cardiovascular diseases due to the lifestyle changes, physical activity and change in diet.
United States of America
United States of America is among the world’s good provider on health for its people. The total population of America as of 2013 is 320,051,000, with a gross national income per capita of 53,960. The allocations for health per capita is 8,895 international dollar in 2012 and the total expenditures for health as percentage of GDP as of 2012 is 17.9. (WHO, 2015) United States of America is a multicultural country and they have several diverse groups namely: the Whites Americans, the African Americans, the Asian Americans, the Native Americans/ American Indians and Alaska Natives, the Native Hawaiians and other Pacific Islanders and Hispanic and Latino Americans.
a. American Indians and Alaska Natives
Tobacco remains the largest preventable cause of disease and death in the United States. Every year 480,000 of Americans are killed through cigarette smoking, and 41,000 of these deaths were due to the second hand smoking. (U.S. Department of Health and Human Services, 2014).
Cigarette Smoking is the most prevalent case for the American Indians and Alaska Natives in the United States of America with significantly the highest percentage rate among other racial groups, of 26.1 percent compared to 19.4 percent of the White Americans, the African Americans with 18.3 and the Hispanics has 12.1 percentage respectively. The Asian American has the lowest percentage of smoking with 9.6 percent.
Men in the United States are the most frequent smokers with 20.5 percent compared to women who has 15.3 percent. Among the adults in America, ages 25 to 44 years are the most habitual smokers with a 20.1 percent, followed by the ages 45 to 64 years with 19.9 percent and 18.7 percent for ages 18 to 24. The least frequent smokers are at the age of 65 years and older with 8.8 percent. (Centers for Disease Control and Prevention, 2015).
b. The African American
Obesity is based on the body mass index(BMI) of a person of 30 or higher. The body mass index is measured of an adult’s weight in relation to his or her height, calculated by the adults weight in kilograms divided by the square root of his or her height in meters.(U.S. Center for Disease Control and Prevention,2014).
In the United States more than one-third or 34.9% or 76.8 million of adults are obese. The African American have the highest rates of obesity with 47.8 percent, followed by the Hispanic with the rate of 42.5 percent, the White comes third with a percentage of 32.6 percent, and for the American Asian has the lowest rate of obesity with a rate of 10.8 percent. (Journal Of American Medicine, 2014)
Obesity are more prevalent among middle age group from 40 tp 59 year old with a rate of 39.5% compared to the younger adults, the 20-39 years age group with a percentage rate of 30.3%, and the adults of over 60 years and above has a percentage rate of 35.4 percent. (Journal of American Medicine, 2014)
Another indicator among African American is Diabetes. Diabetes is the sixth leading cause of death in the United States of America, killing 71.5 thousand people in 2012. (WHO, 2012)
Diabetes is a chronic disease characterized by hyperglycemia or high glucose levels in the blood. In a healthy person the blood sugar level are kept in an acceptable range by insulin. Insulin is a hormone, that is produced in the pancreas, that will help the body absorb excess sugar from the blood stream. Among diabetic people, blood sugar levels are not adequately controlled by insulin. (Agency for Healthcare Research and Quality, 2010).
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Diabetes is most prevalent among African American adults, from ages 18 and over, with a percentage rate of 13.2 percent compared to the Hispanics with 12.2 percent, while, 7.3 percent for both White Americans and Native Hawaiians.(CDC, 2014)
In 2012, 44.2 per 1000 population of African American adults were hospitalized for lower extrimity amputation in contrast with 12.5 per 1000 population of the White and 25.4 of the Hispanics. (National Healthcare Quality and Disparities, 2014)
c. White Americans
The Center for Disease Control and Prevention(CDC)2014, gathered the information about the mortality in the U.S., including the death by suicide. In 2013, there were 41,149 suicide cases reported. This makes the suicide, as the tenth primary cause of death in America.
The CDC calculates the suicide rate each year by the number of the accounted suicide deaths that occur for every 100,000 people in the population.
White americans got the highest rate of suicide death with 14. 2%, followed by the American Indians and Alaska natives with a rate of 11.7%. Much lower and nearly the same rates are common among Asians and Pacific Islanders with 5.8%, Hispanic with 5.7%, and African American with 5.4% respectively.(Centers for Disease Control and Prevention, 2014)
In 2013, Men were most likely to commit suicide compared to women with a significant rate of 20.2, and women had a rate of 5.5, that is four times higher in men. It was noted in in 2013 that 77.9% of males died in suicide in comparison to much lower rate in female for only 22.1%.
Among the age group, 45 to 64 years had the highest suicide rate of 19.1%, followed by 85 years and older with 18.6%. The younger groups aged 15 to 24 years had lower suicide rate of 10.9%.(CDC,2014).
a. National Causative Factors
The influence of the family members or growing up in the house or environment where people regularly smoke has a great impact for the prevalence of smoking among Maori people. The total lack of discouragement since some or all of the family members are smoking.
In general, the peer pressure for the teen agers that caused them to start smoking at an early age and the feeling of relief from stress and fatigue. Lastly, the use of the roll-your–own-cigarette which has cheaper cost. (The Buzzle, 2015)
The factors that influence the obesity of the Pacific people are, there lifestyle, habits and food consumption. For age fifteen years and above, less than half or about 40.9% of the Pacific males and Pacific females (48.9%) met the recommended vegetable intake that was notably lower than non-Pacific group.
In addition, Pacific males and females consumed more servings of soft drinks or energy drinks per week. In particular, Pacific female, were three times as likely to eat fast food and takeaways in comparison to non-Pacific people. Children aged 2-14 years were less likely to have eaten breakfast at home compared to non-Pacific. (The Pacific People’s Health, 2014)
One causative factor of Diabetes is obesity. Atleast 80% of Type 2 diabetes are overweight. Due to today’s sedentary and westernised lifestyle, people will become overweight and eventually become obese. Obesity causes insulin resistance, meaning that the fats and muscle cells of obese people do not seem to react to the insulin, so there is an uncontrollable blood glucose level in the body, thus, leading to Type 2 diabetes. (Diabetes Info NZ, 2014)
b. International Causative Factors
The factor that triggers the prevalence of smoking among American Indians and Alaska Natives is that, it is included in a sacred tobacco ceremonial rights, religious practices and as medicinal roles for native culture. In addition, tobacco sold in tribal lands are exempted from state and national taxes, thus, it is cheaper and affordable. (U.S. Department of Health and Human Services, 2015)
The causative factor of obesity of the African American is the limited access to safe places for outdoor physical activities. In order to carry out a a good and a balance healthy living, one must participate in a sufficient physical activity. In addition, lower incomes and poverty contributes to the increasing obesity, since less nutritious foods or calorie-loaded foods are often less expensive and affordable than healtier foods. (Racial and Ethnic Disparities in Obesity, 2014)
The risk factor of diabetes which is prevalent among African Americans are due to lifestyle choices. The lesser chance of regular physical activity and consuming high-calorie foods in larger amount than necesarry will have the high risk of devloping type 2 diabetes. Another factor is heriditary, if someone in close family has diabetes, other members might also develop diabetes.(Endocrineweb, 2014).
Based from the causative factors of the different health problems encountered from the national and international aspects, it is observed that they have almost the same common factors that triggers the prevalence of diseases. Lower incomes and living in more deprived areas are more prone to such diseases. Regular physical activities and proper nutrition is the key to have a healthy life.
Smoking is one of the major problem that the government of New Zealand is facing especially with the Maori group who is the leading cigarette or toabcco smoker than other ethnic groups.
It is further noted, that there is a strong relationship between smoking and neighborhood deprivation. It means that there are more people who are engaged in smoking in most deprived areas than the least deprived areas.
The government should continue to dessiminate information and awareness for the effects of smoking for the active and passive smokers most especially to the deprived areas where smoking is rampant. Conduct counselling for the addictive smoker and the family. Create programs or provide facilities that promotes physical activities to different groups.
There should be a thorough emphasis and education for the tremendous effect of smoking like: smoking can harm every organ and systems in the body, cause 80% of lung cancer, and respiratory condition like emphysema and chronic bronchitis. Smoking is also a major cause of heart disease, stroke and other cancers. In addition, smoking around children increases the risk of lung infection like croup, bronchitis and peumonia.
There are a lot of health problems that the United States of America is facing, one of them is obesity and it is quite alarming that more than one-third of the population in America are obese. Among the diverse groups, Afrian Americans has the highest percentage of obesity.
One factor of obesity for Black Americans is that they have limited access to
safe areas for outdoor activities. To carry out a balance and healthy living one must indulge in a regular physical activitivities. It is also observed that lower income and poverty contributes to the increasing obesity since they will opt to consume the cheaper, less nutritious and high calorie foods.
Being obese increases the persons risk to developing heart diseases (cardiovascular heart disease, stroke), type 2 diabetes and and other forms of cancer.
In order to prevent obesity and the risk of developing long term diseases the government should continue to support programs that involves physical activities. Provide facilities for indoor and outdoor sports and a safe playground for children.
The government should also provide a team that will monitor the intake of nutritious foods especially in the deprived areas where obesity is common. A quarterly checks of the blood for blood sugar, lipid profile and blood pressure for the obese persons.
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