Chapter 7 Maternal, Infant, and Child Health Chapter Objectives (1 of 2) After studying this chapter, you will be able to: Define maternal, infant, and child health. Explain the importance of maternal, infant, and child health as indicators of a society’s health. Define family planning and explain why it is important. Identify consequences of teenage pregnancies. Define legalized abortion and discuss Roe v. Wade and the pro-life and pro-choice movements. Define maternal mortality rate. Define preconception and prenatal care and the influence this has on pregnancy outcome. List the major factors that contribute to infant health and mortality. Chapter Objectives (2 of 2) Explain the differences among infant mortality, neonatal mortality, and postneonatal mortality. Identify the leading causes of childhood morbidity and mortality. List the immunizations required for a 2-year-old child to be considered fully immunized. Explain how health insurance and healthcare services affect childhood health. Identify important governmental programs developed to improve maternal and child health. Briefly explain what WIC programs are and who they serve. Identify the major groups that are recognized as advocates for children. Introduction Using age-related profiles helps identify risks and target interventions Infants <1 year Children 1-9 years Maternal, infant, and child health (MIC) encompasses health of women of childbearing age from pre-pregnancy through pregnancy, labor and delivery, and the postpartum period, and the health of the child prior to birth through adolescence MIC Health (1 of 4) MIC statistics are important indicators of effectiveness of disease prevention and health promotion services in a community Decline in US MIC mortality in recent decades, but challenges remain Significant racial disparities Modified from: Mathews T.J., M.F. MacDorman, and M.E. Thoma. (2015). "Infant Mortality Statistics from the 2013 Period Linked Birth/Infant Death Data Set." National Vital Statistics Reports, 64(9). Hyattsville, MD: National Centers for Health Statistics. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_09.pdf. Accessed December 5, 2015. MIC Health (2 of 4) Infant mortality rates, by race and Hispanic origin of mother; United States, 2005and 2013. Data from: Child Trends DataBank (2015). “Infant, Child, and Teen Mortality.”Available at http://www.childtrends.org/wp-content/uploads/2012/11/63_Child_Mortality.pdf Accessed December 6, 2015. MIC Health (3 of 4) Death rates for infants (deaths per 100,000): selected years, 1980–2013. Data from: Child Trends DataBank (2015). “Infant, Child, and Teen -Mortality.”Available at http://www.childtrends.org/wp-content/uploads/2012/11/63_Child_Mortality.pdf MIC Health (4 of 4) Death rates among children ages 5 to 14 by race and Hispanic origin: 1980–2013. Family and Reproductive Health Families are the primary unit in which infants and children are nurtured and suppo ...

1. Chapter 7
Maternal, Infant, and Child Health
Chapter Objectives (1 of 2)
After studying this chapter, you will be able to:
Define maternal, infant, and child health.
Explain the importance of maternal, infant, and child health as
indicators of a society’s health.
Define family planning and explain why it is important.
Identify consequences of teenage pregnancies.
Define legalized abortion and discuss Roe v. Wade and the pro-
life and pro-choice movements.
Define maternal mortality rate.
Define preconception and prenatal care and the influence this
has on pregnancy outcome.
List the major factors that contribute to infant health and
mortality.
Chapter Objectives (2 of 2)
Explain the differences among infant mortality, neonatal
mortality, and postneonatal mortality.
Identify the leading causes of childhood morbidity and
mortality.
List the immunizations required for a 2-year-old child to be
considered fully immunized.
Explain how health insurance and healthcare services affect
childhood health.
Identify important governmental programs developed to
improve maternal and child health.
Briefly explain what WIC programs are and who they serve.
Identify the major groups that are recognized as advocates for

2. children.
Introduction
Using age-related profiles helps identify risks and target
interventions
Infants <1 year
Children 1-9 years
Maternal, infant, and child health (MIC) encompasses health of
women of childbearing age from pre-pregnancy through
pregnancy, labor and delivery, and the postpartum period, and
the health of the child prior to birth through adolescence
MIC Health (1 of 4)
MIC statistics are important indicators of effectiveness of
disease prevention and health promotion services in a
community
Decline in US MIC mortality in recent decades, but challenges
remain
Significant racial disparities
Modified from: Mathews T.J., M.F. MacDorman, and M.E.
Thoma. (2015). "Infant Mortality Statistics from the 2013
Period Linked Birth/Infant Death Data Set." National Vital
Statistics Reports, 64(9). Hyattsville, MD: National Centers for
Health Statistics. Available at
http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_09.pdf.
Accessed December 5, 2015.
MIC Health (2 of 4)
Infant mortality rates, by race and Hispanic origin of mother;
United States, 2005and 2013.

3. Data from: Child Trends DataBank (2015). “Infant, Child, and
Teen Mortality.”Available at http://www.childtrends.org/wp-
content/uploads/2012/11/63_Child_Mortality.pdf Accessed
December 6, 2015.
MIC Health (3 of 4)
Death rates for infants (deaths per 100,000): selected years,
1980–2013.
Data from: Child Trends DataBank (2015). “Infant, Child, and
Teen -Mortality.”Available at http://www.childtrends.org/wp-
content/uploads/2012/11/63_Child_Mortality.pdf
MIC Health (4 of 4)
Death rates among children ages 5 to 14 by race and Hispanic
origin: 1980–2013.
Family and Reproductive Health
Families are the primary unit in which infants and children are
nurtured and supported regarding healthy development
Various definitions of “family”
Concept has changed over time, depends on social and cultural
norms and values, may be conceptualized differently on an
individual basis
Research Indicators
Unmarried women are more likely than married women to
experience negative birth outcomes
Married women are more likely than unmarried, non-
cohabitating women to initiate prenatal care early in pregnancy
Married women are less likely than unmarried, non-cohabitating
women to rely on government assistance to pay for prenatal care

4. Teenage Births (1 of 2)
Teenage pregnancies more likely to result in serious health
consequences for mother and baby
Teen mothers less likely to receive early prenatal care
Teen mothers more likely to
Smoke during pregnancy
Have preterm birth
Have low-birth-weight babies
Have pregnancy complications
1/4 teenage girls get pregnant at least once before age 20
Teenage Births (2 of 2)
Teens who become pregnant and have a child are more likely to
Drop out of school
Not get married or have a marriage end in divorce
Rely on public assistance
Live in poverty
Substantial economic consequences for society
Family Planning
Determining the preferred number and spacing of children and
choosing the appropriate means to accomplish it
Community involvement in family planning and care includes
governmental and nongovernmental organizations
Unintended Pregnancies
~½ of pregnancies in U.S. are unintended

5. 43% of those end in abortion
Unintended pregnancy
Mistimed or unwanted
Unintended pregnancy associated with negative health behaviors
Delayed prenatal care, inadequate weight gain, smoking, alcohol
and other drug use
Title X – Family Planning Act
Federal program that provides funds for family planning
services for low-income people
Aims to reduce unintended pregnancy by providing
contraceptive and other reproductive healthcare services to low -
income women
Supports 4,000+ family planning clinics in U.S.
Approximately 4 million women receive care at clinics funded
by Title X
“Gag rule” – enacted in 1984, rescinded as of 2015
Evaluating the Success of Community Health Family Planning
Programs
Clinics have improved MIC health indicators
Have shown large reductions in unintended pregnancies,
abortions, and births
Each year, publicly subsidized family planning clinics help
prevent 1.9 million unplanned pregnancies that would result in
860,000 unintended births, 810,000 abortions, and 270,000
miscarriages
Each public health dollar spent saves $3.74 in Medicaid costs
Abortion
Legal in early stages of pregnancy since 1973 (Roe v. Wade)
Majority of abortions
Unmarried women (85.3%)

6. Women aged 20-29 (58.2%)
Rates highest among Non-Hispanic black women
Pro-life vs. pro-choice
Maternal Health
Effect of pregnancy and childbirth on women important
indicator of health
Pregnancy and delivery can lead to serious health problems
Maternal death
Maternal mortality and morbidity rates
Causes include poverty and limited education
Preconception and Prenatal
Health Care (1 of 2)
Preconception care – medical care provided to women of
reproductive age to promote health prior to conception
Prenatal health care – medical care from time of conception
until birth process
Early and continuous preconception and prenatal care leads to
better pregnancy outcomes
Less likely to give birth to a low-birth-weight infant
Preconception and Prenatal
Health Care (2 of 2)
Modified From: U.S. Department of Health and Human
Services, Health Resources and Services Administration,
Maternal and Child Health Bureau (2015). "Child Health USA
2014." Rockville, Maryland: U.S. Department of Health and
Human Services. Available at
http://mchb.hrsa.gov/chusa14/dl/chusa14.pdf. Accessed January
24, 2016.
Timing of prenatal care initiation, by maternal education, 2012.

7. Infant Health
Depends on many factors
Mother’s health and her health behavior prior to and during
pregnancy
Genetic characteristics
Mother’s level of prenatal care
Quality of delivery
Infant’s environment after birth (home and family, medical
services)
Nutrition
Immunizations
Infant Mortality
Measure of a nation’s health
Decline in infant mortality due to
Improved disease surveillance
Advanced clinical care
Improved access to health care
Better nutrition
Increased education
Leading causes of infant death: congenital abnormalities,
preterm/low birth weight, SIDS
Improving Infant Health
Premature births
Low birth weight
Cigarette smoking
Alcohol and other drugs
Breastfeeding
Sudden Infant Death Syndrome (SIDS)

8. Child Health
Good health during childhood years essential to child’s optimal
development
Medical home recommended
Childhood Mortality (1 of 2)
Most severe measure of health in children
Rates have generally declined in past few decades
Unintentional injuries are leading cause of death in children
Specifically, motor vehicle deaths, especially those not wearing
seat belts/restraints
Childhood Mortality (2 of 2)
Unintentional injuries
Significant economic, emotional, and disabling impact
Child maltreatment
Strong community response needed
Infectious diseases
Importance of immunization schedule
Community Programs for Women, Infants, and Children
Federal government has over 35 programs in 16 different
agencies to serve needs of nation’s children
Many are categorical programs
Only available to people who fit into a specific group
Many fall through the cracks
Maternal and Child Health Bureau
Title V
Only federal legislation dedicated to promoting and improving

9. health of mothers and children
Maternal and Child Health Bureau (MCHB)
Established in 1990 to administer Title V funding
Accomplishes goals through four core public health services
Infrastructure building, population-based, enabling, and direct
healthcare services
Women, Infants, and Children (WIC) Program
Clinic-based program designed to provide nutritional and
health-related goods and services to pregnant, postpartum, and
breastfeeding women, infants up to 1 year of age, and children
under age 5
Sponsored by the USDA; established in 1974
Eligibility requirements
Residency in application state, income requirements, at
“nutritional risk”
2014: over 9 million participants
WIC Enrollees
Modified from: Thorn, B., C. Tadler, N. Huret, E. Ayo, and C.
Trippe. (2015). “WIC Participant and Program Characteristics
Final Report.” U.S. Department of Agriculture, Food and
Nutrition Service, Office of Policy Support. Available at
http://www.fns.usda.gov/sites/default/files/ops/WICPC2014.pdf
Breastfeeding initiation rates by state for WIC infant
participants, ages 6 to 13 months; April 2014.
Providing Health Insurance for Women, Infants, and Children
Children without insurance more likely to have necessary care
delayed or receive no care for health problems
Medicaid – low-income individuals and families; children are
slightly more than half of all Medicaid beneficiaries

10. CHIP – targets uninsured children whose families don’t qualify
for Medicaid
Providing Child Care
FMLA – Family and Medical Leave Act
Grants 12 weeks unpaid job-protected leave to men or women
after birth of child, adoption, or illness in immediate family
Only affects businesses with 50+ employees
Cost of child care
Child Care and Development Block Grant
Other Advocates for Children
Numerous groups advocate for children’s health and welfare
Children’s Defense Fund (CDF)
United Nations Children’s Fund (UNICEF)
American Academy of Pediatrics (AAP)
Discussion Questions
What are ways community programs can increase participation
in early prenatal care services?
What kind of impact do programs such as WIC have on
community health outcomes?
Adolescents, Young Adults, and Adults
Chapter 8
Chapter Objectives (1 of 2)
After studying this chapter, you will be able to:
Explain why it is important for community health workers to be

11. aware of the different health concerns of the various age groups
in the United States.
Define by age the groups of adolescents, young adults, and
adults.
Briefly describe key demographic characteristics of adolescents
and young adults.
Explain what the Youth Risk Behavior Surveillance System
(YRBSS) and the Behavioral Risk Factor Surveillance System
(BRFSS) are and what type of data they generate.
Chapter Objectives (2 of 2)
Provide a brief behavioral risk profile for adolescents, young
adults (including college students), and adults.
Outline the health profiles for the various age groups—
adolescents, young adults, and adults—listing the major causes
of mortality, morbidity, and risk factors for each group.
Give examples of community health strategies for improving the
health status of adolescents, young adults, and adults.
Introduction
Adolescents and young adults (10-24)
Adolescence generally regarded as puberty to maturity
Adults (25-64)
Years between 10 and 64 some of the most productive years of
people’s lives
Most enjoy the best health of their lives
Shape health through lifestyle and health behavior for later
years
Adolescents and Young Adults
Represent the future of the nation
Adolescence is difficult stage; period of transition from
childhood to adulthood

12. Comfort and security to complex and challenging situations
Young adults complete physical growth; experience significant
life changes
Many health beliefs, attitudes, and behaviors are adopted and
challenged
Demography (1 of 2)
Number of adolescents and young adults
In 2010, over 1/5 of U.S. population
In 2012, ~54% of adolescents were non-Hispanic white
Living arrangements
In 2012, >1/4 lived in single-parent families
Variations by race and ethnicity
Demography (2 of 2)
Employment status and health care access
Participation in labor force has remained fairly constant in
recent decades
Disparities by race and ethnicity
Employment status has impact on access to health insurance,
health care
Mortality (1 of 2)
Significant decline in death rates over past several decades;
mostly due to advances in medicine and to injury and disease
prevention
Male mortality rate higher than female
Most threats stem from behavior rather than disease
Unintentional injuries (41%), homicide (17%), suicide (15%)
Significant racial disparities among race and leading causes of
death

13. National Center for Health Statistics. (2015). Health, United
States, 2014: With Special Feature on Adults Age 55-64.
Hyattsville, MD: Author.
Death rates for leading causes of death for ages 15 to 24, 1950–
2013.
Mortality (2 of 2)
Morbidity (1 of 2)
Communicable diseases
Measles immunizations important
Sexually transmitted diseases
This age group acquires nearly half of all new STDs in the U.S.
Some effects can last a lifetime
Data from: Centers for Disease Control. Morbidity and
Mortality Weekly Report: Annual Summaries, various years;
“Summary of Notifiable Diseases—United States, 2000.”
Morbidity and Mortality Weekly Report, 49(53): 23; and
“Summary of Notifiable Diseases—United States, 2008.”
Morbidity and Mortality Weekly Report, 57(54): 32-33.
"Summary of Notifiable Diseases - United States, 2010."
Morbidity and Mortality Weekly Report, 59(53): 39-40.
Morbidity (2 of 2)
Health Behaviors of High School Students
Unintentional injuries
Violence
Tobacco use
Alcohol and other drugs

14. Sexual behaviors – unintended pregnancies and STDs
Physical activity and sedentary behaviors
Overweight and weight control
Health Behaviors of College Students
Unintentional injuries
Violence
Tobacco use
Alcohol and other drugs
Sexual behaviors – unintended pregnancies and STDs
Protective Factors
Protective factors – individual or environmental characteristics,
conditions, or behaviors that reduce the effects of stressful life
events, increase the ability to avoid risks or hazards, and
promote social and emotional competence
Examples: school connectedness, community service
Community Health Strategies
Main factors affecting community health in age groups are
social and cultural factors and community organizing
Alcohol use a main problem
Adults
Ages 25-64
Represent more than half of U.S. population

15. Health Profile (1 of 3)
Mortality
Mainly from chronic diseases
Many associated with unhealthy behaviors and poor lifestyle
choices
Lifestyle improvements and public health advances have led to
decline in death rate for adults
Data from: Heron, M. (2016). “Deaths: Leading Causes for
2013.” National Vital Statistics Reports, 65(42). Hyattsville,
MD: National Center for Health Statistics.
Health Profile (2 of 3)
Data from: Heron, M. (2016). “Deaths: Leading Causes for
2013.” National Vital Statistics Reports, 65(42). Hyattsville,
MD: National Center for Health Statistics.
Health Profile (3 of 3)
Cancer
#1 cause of death for adults ages 45-54 and 55-64
Males – prostate, lung, and colorectal
Females – breast, lung, and colorectal
Cardiovascular Diseases
Age-adjusted mortality rates dropped over past 60 years
Mainly due to public health efforts related to smoking
cessation, increased physical activity, and nutrition

16. Health Behaviors
Risk factors for chronic disease
Most significant for adults – smoking, lack of exercise, BMI,
alcohol
Awareness and screening of certain conditions
Hypertension, diabetes, cholesterol
Community Health Strategies
Role of individual behavior, social factors, environmental
factors, and previous influences on their health across lifespan
Primary, secondary, and tertiary prevention efforts for adults
Primary – exercise and nutrition programs
Secondary – self and clinical screenings to identify and control
disease processes
Tertiary – medication compliance
Discussion Questions
Why are lifestyle and health behaviors significant for the adult
age group compared to other age groups?
How can community health efforts affect leading causes of
death for the adolescent and young adult age group?
Chapter 9
Older Adults
Chapter Objectives (1 of 2)
After studying this chapter, you will be able to:
Identify the characteristics of an aging population.

17. Define the following groups—old, young old, middle old, and
old old.
Refute several commonly held myths about the older adult
population.
Describe the factors that affect the size and age of a population.
Define fertility and mortality rates and explain how they affect
life expectancy.
Explain the difference between dependency and labor-force
ratios.
Describe older adults with regard to marital status, living
arrangements, racial and ethnic background, education,
economic status, and geographic location.
Chapter Objectives (2 of 2)
Describe the effects of chronic conditions and physical
impairments on older adults.
Explain how health behaviors can improve the quality of later
life.
Briefly outline elder abuse and neglect in the United States.
Identify the six instrumental needs of older adults.
Explain the role of caregivers with older adults in the United
States.
Describe different housing options available to older adults.
Briefly summarize the Older Americans Act of 1965.
List the commonly provided services for older adults in most
communities.
Explain the difference between respite care and adult day care.
Introduction
Number of older adults and their proportion in the total
population increased significantly in the 20th and early 21st
century
Represent 13.1% of population
1 in every 8 Americans

18. Young old – 65-74
Middle old – 75-84
Old old – 85+
Aging Myths
Ageism – prejudice and discrimination against older adults
Common myths not accurate representation of older adults
Reality
Majority of older adults today are active and well
Many still working
Many strongly engaged in community, volunteer, and advocacy
programs
Demography of Aging (1 of 3)
Size and growth of the older adult population
Number and proportion of older adults grew significantly
Older adult population projected to continue growing; baby
boom generation
85+ fastest-growing segment of older population
Growth in median age
Data from: U.S. Census Bureau, Population Division, Interim
State Population Projections.
www.census.gov/population/projections/files/natproj/pyramids/
mp_p2.pdf
Demography of Aging (2 of 3)
Projected resident population of the United States: July 1, 2000
Data from: U.S. Census Bureau, Population Division, Interim
State Population Projections.

19. www.census.gov/population/projections/files/natproj/pyramids/
mp_p4.pdf
Projected resident population of the United States: July 1, 2050
Demography of Aging (3 of 3)
Factors Affecting Population Size and Age
Fertility rates
Baby boomers: 1946-1964
Mortality rates
Life expectancy has continued to increase; significant increase
in 20th century
Dependency and Labor Force Ratios (1 of 2)
Dependency ratio – economically unproductive to economically
productive
Traditionally defined by age
Can be used for social policy decision making
Labor force ratio – number of people actually working and those
who are not, independent of their ages
Ratio of workers to dependents will be lower in the future than
today
Data from: U.S. Census Bureau. (2010). "The Next Four
Decades, The Older Population in the United States: 2010 to
2050, Current Population Reports" Current Population Reports
(#P25-1138). Available at
http://www.census.gov/newsroom/releases/archives/aging_popul
ation/cb10-72.html. Accessed November 30, 2010
Dependency and Labor Force Ratios (2 of 2)
Dependency ratios for the United States:
2010 to 2050.

20. Other Demographic Variables
Affect community health programs for older Americans
Marital status
Living arrangements
Racial and ethnic composition
Geographic distribution
Economic status
Education
Housing
Marital Status
Almost ¾ of older men are married; just over half of older
women are married
Older women are three times more likely to be widowed
Number of divorced older adults continues to rise
New concerns: lack of retirement benefits, insurance, lower net
worth assets
Living Arrangements
Closely linked to income, health status, and availability of
caregivers
Over ½ non-institutionalized older adults live with someone
else
Women more likely to live alone
Only 3.4% of older adults live in nursing homes
¾ of nursing home residents are women
More than half of nursing home residents are 85+
Racial and Ethnic Composition

21. U.S. older population growing more diverse
2013 older adults:
78.8% white, 8.6% African American, 7.5% of Hispanic origin,
3.9% Asian
Coming decades:
Percentage of white older adults will decline and older
Americans of Hispanic origin will become largest minority
group in the U.S.
Geographic Distribution
More than 60% live in 13 states: CA, FL, TX, NY, PA, OH, IL,
MI, NC, NJ, GA, VA, AZ
CA greatest number; FL greatest proportion
Reasons some states “age”
Inward migration (FL), young people leave (farm belt states)
~81% of older adults age 65+ live in metropolitan areas
Economic Status
1970 – 25% of older adults lived in poverty
2013 – 9.5% lived in poverty
Major sources of income
Social Security (reported by 86% of older adults)
Income from assets (reported by 51%)
Private pensions (reported by 27%)
Gov’t employee pensions (reported by 14%)
Earnings (reported by 28%)
Education
Percentage of older adults who completed high school rose from
28% in 1970 to 84% in 2014
25% of older adults had a bachelor’s degree or higher in 2014
Differences by race and ethnicity

22. Baby boomers most educated cohort in U.S. history
Housing
Most live in adequate, affordable housing
81% own, 19% rent
Older adults’ homes tend to be older, of lower value, and in
greater need of repairs than the homes of younger counterparts
For most older adults, housing represents an asset
Health Profile of Older Adults
Health status of older adults has improved over the years (living
longer and functional health)
Chronically disabled has been decreasing
Health status usually not as good as younger counterparts
Morbidity (1 of 2)
Top causes of death for older adults (responsible for almost 2/3
of deaths)
Heart disease
Cancer
CLRD
Stroke
Alzheimer’s disease
Morbidity (2 of 2)
Activity limitations increase with age
Chronic conditions
Substantial burden on health and economic status of individuals,
families, and nation
Impairments
Very prevalent in older adults

23. May be sensory, physical, memory
Health Behaviors and Lifestyle Choices
Generally have more favorable health behaviors than younger
counterparts
Less likely to consume large amounts of alcohol, smoke
cigarettes, or be overweight
Areas for improvement
Physical activity, immunizations
Physical Activity
Older adults are least physically active of any age group
Loss of physical fitness due to aging, chronic conditions
Physical activity recommendations for older adults are the same
as other adults
But only about 11% of older adults meet physical activity
guidelines
Nutrition
Dietary concerns for older adults include:
Reduced sodium intake
Reduced caloric needs
Increased vegetable consumption
Increased water consumption
Obesity
Number of obese older adults has increased
In 2010, 38% of those 65+ were obese
Only 26% of older adults are in healthy weight range

24. Cigarette Smoking
Just over 9% of older adults are cigarette smokers
Number has decreased significantly over past few decades
Special concern: older adults who are former smokers
Vaccinations
Immune systems tend to weaken with age
Recommended immunizations for older adults
In 2014-2015 flu season, 66.7% of older adults received flu
vaccination
Only about 60% have ever received pneumococcal vaccination
Vaccination rates among older adults have improved over time
But racial disparities exist
Mistreatment of Older Adults
Reports have increased greatly in recent years
All states have set up reporting systems
Special problem for older adults
Dementia and cognitive impairment
Past experience with domestic violence
Frailty
Social isolation
Instrumental Needs of Older Adults
Six instrumental needs that determine lifestyle for people of all
ages; aging process can alter needs in unpredictable ways
Income
Housing
Personal care
Health care
Transportation
Community facilities and services

25. Income
Change in types of expenses in elder years
Achieving older adult status often reduces income needs
Income has improved significantly in recent years
Social Security is major source of income
Unmarried women and minorities have highest rates of poverty
Housing
Major needs: appropriateness, accessibility, adequacy,
affordability
Changing residence can have negative effects
Variety of housing options available
Independent living
Assisted living
Continuing Care Retirement Communities
Nursing Homes/Skilled Nursing Facilities
Affordable housing
Personal Care
Four levels of tasks that may need assistance:
Instrumental tasks, expressive tasks, cognitive tasks, tasks of
daily living
Activities of daily living (ADLs): measure functional
limitations
Instrumental activities of daily living (IADLs): measure more
complex tasks
Caregivers
Caregivers for older adults face number of problems
Increased financial burden, lack of privacy, demands on time
and energy

26. Need for personal care and paying for long-term care services
for older adults is projected to increase in coming years
National Family Caregiver Support Program
Support for working caregivers is a growing concern
34
Health Care
Older adults heaviest users of healthcare services
Use of healthcare services increases with age
Most money spent on health care is in last years of life
Medicare primary source of payment for healthcare services of
older adults
Will see major changes in future years
Transportation
Transportation allows older adults to remain independent
Greatest influence on transportation needs:
Income and health status
Many public transportation challenges
Solution
s for transportation needs of older adults

27. Community Facilities and Services (1 of 2)
Older Americans Act of 1965 (OAA) to increase services and
protect rights of older adults
National nutrition programs for older adults
State Departments on Aging and Area Agencies on Aging
Other programs
Services can vary greatly across the country
Community Facilities and Services (2 of 2)
Meal service
Homemaker service
Chore and home maintenance
Visitor service
Adult day care
Respite care
Home health care
Senior centers
Other services
Discussion Questions
What can happen to increase the likelihood of older adults
utilizing community facilities and services?

28. How will the changing demographics of older adults affect
healthcare services?
Chapter 10
Community and Public Health and Racial/Ethnic Minorities
Chapter Objectives (1 of 2)
After studying this chapter, you should be able to:
Explain the concept of diversity as it describes the American
people.
Explain the impact of a more diverse population in the United
States as it relates to community and public health efforts.
Explain the importance of the 1985 landmark report, The
Secretary’s Task Force Report on Black and Minority Health.
List the racial and ethnic categories currently used by the U.S.
government in statistical activities and program administration
reporting.
Chapter Objectives (2 of 2)
List some limitations related to collecting racial and ethnic

29. health data.
Discuss selected sociodemographic characteristics of minority
groups in the United States.
List and describe the six priority areas of the Race and Health
Initiative.
Explain the role socioeconomic status plays in health disparities
among racial and ethnic minority groups.
Define cultural and linguistic competence and the importance of
each related to minority community and public health.
Introduction
Strength of America lies in diversity of people
Diversity
U.S. population
Majority – white, non-Hispanic (62.2%)
Racial or ethnic minorities (37.8%)
Racial and Ethnic Classifications
Classifications used to operationalize race and ethnicity
Race – “categorization of parts of a population based on
physical appearance due to particular historical social and
political forces”

30. Ethnicity – subcultural group within a multicultural society; six
main features
Health Data Sources and Their Limitations
Challenges to collection of race and ethnicity data
Unreliability of self-reported data
Classifications are social constructs that change over time and
vary across societies and cultures
Biased analysis
HHS – works to increase reliability of data and amount of data
collected
Americans of Hispanic Origin
Hispanic origin is an ethnicity, not a race
Largest minority group in U.S.
People of Mexican origin largest Hispanic group
Education
Income
Health beliefs

31. African Americans
People having origins in any of the black racial groups from
Africa
2nd largest minority group in U.S.
More than ½ live in southern states
Education
Income
Impact of slavery
Health beliefs
Asian Americans
Asian Americans – people of Asian descent who trace their
roots to more than 20 different Asian countries
Native Hawaiian and Other Pacific Islanders (NHOPI) – peoples
of Hawaii, Guam, Samoa, or other Pacific Islands and their
descendants
Immigration
Education
Income
Health beliefs
American Indians and Alaska Natives
Original inhabitants of America

32. Many different American Indian tribal groups and Alaskan
villages, each with distinct customs, languages, and beliefs
Relatively poor health status
Indian Health Service
U.S. Gov’t, Native Americans, and Provision of Health Care
Many tribes are sovereign nations
Tribes transferred land in U.S. to federal government in return
for provision of certain services
Indian Health Services (IHS)
Responsible for federal health services to Native Americans and
Alaska Natives
Goal to raise health status to highest possible level
Immigrant and Refugee Health
Refugees
Immigrants
Aliens
Unauthorized immigrants
Can be classified into existing racial/ethnic groups; as a single
group, present special concerns

33. Minority Health and Health Disparities
Minority Health
Health Disparities
Federal efforts to eliminate health disparities
Race and Health Initiative
Goal: eliminate disparities among racial and ethnic minority
populations in six areas
Infant mortality
Cancer screening and management
Cardiovascular disease
Diabetes
HIV/AIDS
Adult and child immunization
Infant Mortality
Serious disparity in U.S. among racial and ethnic minorities
African American infant death rate more than two times that of
white Americans
Lack of prenatal care
Low-birth-weight babies

34. Data from Centers for Disease Control and Prevention, National
Center for Health Statistics.Mathews TJ, MacDorman MF.
Infant mortality statistics from the 2010 period linked
birth/infant death data set. Natl Vital Stat Rep 2013;62(8).
http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_08.pdf
Infant mortality rates by race and Hispanic origin of mother:
2000, 2005, and 2010.
Cancer Screening and Management
Incidence and death rates highest among black Americans for
various types of cancer
Many disparities attributed to lifestyle factors, late diagnosis,
access to health care
Less primary and secondary prevention in various minority
groups
Data from: Howlader, N., A. M. Noone, M. Krapcho, et al.
(eds.). SEER Cancer Statistics Review, 1975-2010, based on
November 2012 SEER data submission, posted to the SEER web
site, 2013. Bethesda, MD.
SEER cancer incidence and U.S. death rates, 2010, by cancer
site and race.

35. Cardiovascular Diseases
Death rates vary widely among racial and ethnic groups
Black Americans have higher rates from CHD and stroke
Hypertension prevalence as a risk factor varies according to
race/ethnicity
Black Americans tend to develop hypertension earlier in life
than whites; unknown reason
Diabetes
Overall prevalence has risen in U.S. in recent years
Prevalence in those 20 and older varies in minority groups
Increase in age-adjusted death rates in all racial and ethnic
groups
Significantly higher in minority groups
Data from Centers for Disease Control and Prevention. Age-
Specific Rates of Diagnosed Diabetes per 100 Civilian, Non-
Institutionalized Population, by Race and Sex, United States,
2014. 01 Dec. 2015
Age-specific rates of diagnosed diabetes
per 100 civilian, non-institutionalized
population, by race and sex, United States, 2014.

36. HIV Infection/AIDS
Proportional distribution of AIDS cases has increased in
African Americans and Hispanics
Attributed to higher prevalence of unsafe or risky health
behaviors and lack of access to health care to provide early
diagnosis and treatment
Centers for Disease Control and Prevention, 2013, April.
Rates of diagnosis of HIV infection among adults and
adolescents by race/
ethnicity: 2008–2012, United States.
Child and Adult Immunization Rates
Older adult immunization rates are substantially lower in
minority groups, even though an overall increase has occurred
Social Determinants of Health and Racial and Ethnic Disparities
in Health (1 of 2)
Many factors contribute to health disparities
Strong associations between social determinants of health
factors and health outcomes

37. Education, level of income, poverty
Data from: National Center for Health Statistics. Health, United
States, 2012: With Special Feature on Emergency Care.
Hyattsville, MD. 2013.
Data from Centers for Disease Control and Prevention. Use of
Race and Ethnicity in Public Health Surveillance. Summary of
CDC/ASTDR Workshop. Morbidity and Mortality Weekly
Report, 1993, 42(RR-10).
A framework for understanding the relationship between race
and health.
Social Determinants of Health and Racial and Ethnic Disparities
in Health (2 of 2)
Health status by race, ethnicity, and income in 2012.
Equity in Minority Health
Simple solutions unlikely