1. Country is Egypt2. Review the grading rubric carefully prior

1. Country is Egypt
2. Review the grading rubric carefully prior to beginning to
work, and frequently throughout the process.
3. Professional grammar, mechanics, and APA format and style
are expected. Maintain a professional and academic tone.
4. Create a proposal for an evidence-based practice project that
fully conforms to APA guidelines and uses the following level
one headings (in the order provided and without the page
numbers or clarifying information below). Additional headings
are not permissible. A title page is required. The provided page
limits must be adhered to. The total paper will be 8 pages not
counting the title page or references. Identify an
interprofessional healthcare disparity related to that country and
develop an EBP project proposal to improve that disparity in the
identified country. Do not create a research project--use
appropriate EBP terminology.
5. Per APA guidelines, repeat the title of the paper on the first
line of the first page of the body of the paper, followed by the
introduction. (1/2 page)
6. Overview of Country (1/2-1 page). This sections provides an
overview of/introduction to the country
7. Description of Healthcare System (1/2-1 page). This section
provides a detailed description of the type of healthcare system,
it's strengths and weaknesses, and pertinent additional
information.
8. Identification of Healthcare Disparity (interprofessional)
(1/2-1 page). This section identifies a healthcare disparity faced
by this country. The disparity must be amenable to improvement
through an evidence-based practice (EBP) project.
9. PICOT Question (1/2 page). This section states the PICOT
question that will guide the evidence review for your EBP
project. The PICOT must be in full PICOT format (the P before
the I before the C, etc). State the PICOT in a single sentence
and then provide operational definitions for each of the PICOT

elements. Ensure the writing conforms to APA guidelines and
flows well.
10. Evidence-Review (1-2 pages of at least 5 research studies).
Provide a synthesis of the evidence review. This is not a study
by study summary, but instead an integrative synthesis of the
findings that seeks to answer the PICOT question. Provide the
answer to the PICOT question in the final paragraph of this
section.
11. Interprofessional Approach to Improve the Healthcare
Disparity (1-2 pages). How will this EBP project focus on an
interprofessional approach to improve the healthcare disparity
to be improved? Be specific? Include at least three different
healthcare disciplines that will be involved and state how the
healthcare disparity benefits from each disciplines expertise.
12. Stakeholders & Overcoming Barriers (1 page). Who are the
major stakeholders in this EBP project? How will their support
be gained? What barriers must be overcome to make the project
a reality?
13. Funding and Sustainability (1/2 page). What are the costs
associated with this EBP project and how will funding be
gained? How will sustainability for the project into the future
be created?
14. Evaluation and Analysis Plan (1/2-1 page). What data must
be collected to evaluate if this EBP project was effective in
addressing the healthcare disparity identified? How will the
data be analyzed once it is collected?
15. Lessons Learned (1 page). What is the most important thing
learned about this country or the identified healthcare disparity
in planning this EBP project? How will the information learned
help someone become a more effective interprofessional team
member, evidence-based practitioner, or global citizen in the
future?
16. Conclusion (1/2 page). Provide a summary of the major
points made in this paper. Do not introduce new information.
17. References (at least 10). Ensure references are in APA
format

Introduction to Population Health
Population Health refers to the health status, health
outcomes and health distribution of a group of people as
opposed to a single individuals health status (Keyes & Galea,
2014). Factors that can influence population health include
social determinants of health (SDOH) such as housing,
education and poverty.
Social Determinants of Health Overview
Social determinants of health (SDOH) can be divided into
five domains that describe the conditions that affect a person’s
quality of life outcomes and risks. The five domains are
economic stability, health care access and quality, social and
community context, education access and quality, and
neighborhood and built environment. These domains include all
conditions or environments where people may live, learn, work,
play, worship, and their age that may affect their health. (Social
Determinants of Health - Healthy People 2030 | Health.Gov,
n.d.)
Healthy People 2030, U.S. Department of Health and Human
Services, Office of Disease Prevention and Health Promotion.
Retrieved [June 19, 2022],
from https://health.gov/healthypeople/objectives-and-
data/social-determinants-health
Domain:
Economic Stability
Health Care Access and Quality
Social and Community Context
Education Access and Quality
Neighborhood and Built Environment
Goal:
To help people earn steady incomes to help them meet their
health needs

Increase access to comprehensive, high-quality health care
services
Increase social and community support
Increase educational opportunities and help children and
adolescents do well in school
Create neighborhoods and environments that promote health and
safety
Methods of improvement:
Employment programs
Strategies to increase insurance coverage
Encouraging positive relationships
Tutoring programs
Policy changes to reduce neighborhood violence
Career counseling
Improve communication
Offering support programs in communities
Financial assistance for college
Adding sidewalks and bike lanes in neighborhoods
Child care opportunities
Provide transportation
Support for children with disabilities in school
Increasing safety
Wellfare Policies to help with funding
Reducing unsafe air or water
Education

Citation:
(Social Determinants of Health - Healthy People 2030 |
Health.Gov, n.d.)
“The longer people live in stressfull economic and social
circumstances, the greater psychological wear and tear they
suffer, and the less likely they are to enjoy a healthy old age
(“Social Determinants of Health: The Solid Facts, 2nd Ed,”
2004).” SDOH has a major impact on people’s health and well-
being and can act affect them in multiple different ways. For
example, if a person does not have access to good education, it
reduces their likelihood of graduation, which reduces their
ability to get a job that can fund their needs. Without
appropriate funds, they will not have access to appropriate
health care, healthy food, physical activity opportunities etc.
These instances will decrease a person's overall health and can
lead to malnutrition, diabetes, heart disease and obesity. This is
just one example of how SDOH can impact a person’s life.
(Social Determinants of Health - Healthy People 2030 |
Health.Gov, n.d.)
Countries Reviewed
Egypt-
· Egypt is a developing country. Civilization is molded around
religious concepts. Uses Hieroglyphics as a form of written
word. The afterlife was more of a consideration than the
present, pyramids are shrines to the dead so they can be
prepared for the afterlife. (CIB, 2021)
· Egypt demographics are 1/3 made up of people aged 15 and
younger. Egypt will be implementing the family planning act to
help decrease birth rates currently in the country. (CIB, 2021).
· Healthcare beds have increased along with the budget from the
Ministry of Health to cover public health. Most healthcare
offered to the public is of low status. There is no shortage of

healthcare workers in larger cities. Preventative medicine is
becoming a widespread topic. Mandatory vaccination for
smallpox, TB, polio, diphtheria, and other fatal diseases i s
enforced for infants. Public mosquito control by spraying
houses is a common task. (Encyclopedia Britannica, n.d.)
· Strengths include the longevity of the healthcare governing
system has good reputation, plenty of local health facilities
allowing around 95% of residents to live within 5km, longevity
of the insurance and social health program, large
pharmaceutical industry, and a focus on immunizations. (Dept
of Health, 2022).
· Weaknesses include increased out of pocket spending, lack of
integrated services and multigravida communication, low
quality of healthcare, fragmented policy to regulate facilities,
and lack of workforce demotivation and dual practice. (Dept of
Health, 2022).
· Healthcare has been attempted to become socialized by the
government. This would regulate big pharma and insurance
boundaries. There is mandatory insurance for companies with
greater than 100 workers, people who work for the public
offices as well as government agencies also fall in this
insurance category. (Encyclopedia Britannica, n.d.)
ACEs
Adverse Childhood Experiences or “ACEs” are potentially
traumatic events that occur between the ages of 0 and 17 years,
during childhood. ACEs have been linked to chronic health
problems throughout adolescence and adulthood. These
experiences are preventable.
One of Egypt's more notable disparities is child and maternal
survival and health. Mortality rates have declined in the last
decade but still remain substantial in the most disadvantaged
areas of the country. Under the age of 5 mortality rates have
declined from 108 to 27 per 1,000 live births. By 2014 only
around 92 percent of births were attended by a skilled birth
attendant. (Health UNICEF Egypt, n.d.) Improvement requires
the country to address geographical inequalities, and improve

the quality of health care servcies. Other areas of need to
improve are improving resources available, and decreasing
pollution. (Health UNICEF Egypt, nd.) The discipline that is
making an impact would be primary care in the country. There
is a primay care facilitiy available within five kilometers for
95% of the population. (WHO EMRO, Egypt, 2015)
In Egypt nutrition is the second largest contributer to
poverty in Egypt for children under the age of five. The figure
below, from the Unicef child malnutrition snapshot infographic
depicts the puzzle pieces that affect a child's well being. (Data
Snapshots | UNICEF Egypt, n.d.)
A very preventable adverse childhood experience in Egypt is
female gential mutilation (FGM). Although efforts have been
made to decrease FGM drastically, there are still girls at risk of
undergoing FGM, and it has already undergone the mutilation.
As of a report in 2015, 78% of girls ages 1-14 were mutilated
between the ages of one and fourteen. SDOH affect the chances
and outcomes of FGM. For example the higher the mother's
education level, the lower the chances a girl will be forced to
undergo the procedure. FGM can cause long term psychological
and health complications that are often irreversible. It is also
more prevalent in the rural areas of the country. (Data
Snapshots | UNICEF Egypt, n.d.)
Gerontology
Egypt
Less than one in twenty Egyptians are 65 years of age or older
(Salama and Roe, 2020). Dementia is a growing issue in this
smaller population, but there is little treatment guidance for
practitioners to follow. Additionally, depression is an
increasing issue in this population that is not widely discussed
and is associated with shame (El-Gilany, Elkhawaga, & Sarraf,
2018). Despite the small population, there are social services
and services available to the elderly. The Egyptian government
provides institutional homes, elder people clubs, social training

programs, and discounts for many recreational activities.
Gerontological research does predict an incrrease in the elderly
population in the upcoming years. Nursing and physician
programs also include training modules for improving and
caring for the elderly population.
Economics
In Egypt, one of the largest social determinants of health
involved the sex differences in access to care (Assai et al.,
2006). Poverty is also a large social determinant of health in
Egypt with one third of the population below the poverty line
and a low economic freedom at 49.1 (Egypt, 2022) in
comparison to Japan's score of 69.9 (Japan, 2022). Similarly
both countries have a low participation of female inclusion in
the workforce.
Egypt
· Population
1. 102.3 million
1. Unemployment rate
2. 10.5%
1. Economic Growth
3. Has accelerated over last 5 years
3. Top Exports
· Oil & Mineral Fuels, Precious Stones & Metals, and Plastics
3. Top Trade Partners
· China, United States, and Saudi Arabi
1. Economic Weakness
4. 1/3 of population in poverty
4. low female labor participation
1. Government
5. Republic
5. 49.1 economic freedom
5. (Egypt, 2022)
Societal Norms/Intolerances
Egypt
· Relaxed attitudes toward time and punctuality

· The social class an Egyptian is born into tends to dictate many
aspects of their everyday life and access to opportunities.
· The concept of honor or "sharaf" is held to a high regard and
regularly influences daily interactions.
· Family loyatly is highly valued and the society is collectivitist
where people do what's best for their family and not
themselves.
· Islam is the predominant religion that guides the social rules,
actions, and laws.
Culture
Culture: “the combination of a body of knowledge, a body of
belief, and a body of behavior”
(Cultural Respect | National Institutes of Health (NIH), n.d.)
Culture includes several elements that are specific to a
particular culture including but not limited to, racial, religious,
geographic, and social groups, including language, thoughts and
beliefs. These elements can influence the beliefs and belief
systems surrounding health and the delivery of health
services. (Cultural Respect | National Institutes of Health
(NIH), n.d.) Culture respect is important in delivering high
quality health care. Showing respect towards diverse patients
and the provider’s willingness to understand the
patient’s cultural background increases the responsiveness and
understanding. (Cultural Respect | National Institutes of Health
(NIH), n.d.)
Eqyptian Culture and Healthcare
The Egyptian Culture today combines traditional and modern
health practices. Including herbal medications, seers and spirit
healers. They also believe in naturalistic and social causes of
sickness, like bad luck, stress and bereavements. Therefore,
they may not wish to know the possible potential complications
of a procedure thinking it may be bad luck. (Egyptian - Cultural
Approaches to Pediatric Palliative Care in Central
Massachusetts - Resource Guides at University of
Massachusetts Medical School, n.d.)

Marriage and childbirth are important focuses of the
Egyptian culture. Pregnancy is natural and expected, which has
led to extremely high birth rates and poses risks for mothers
who do not deliver in proper facilities. (Health | UNICEF Egypt,
n.d.) Also, all boys are circumcised and 97% of girls experience
female genital mutilation. (Egyptian - Cultural Approaches to
Pediatric Palliative Care in Central Massachusetts - Resource
Guides at University of Massachusetts Medical School, n.d.)
Egyptian families may prefer to relay negative prognosis to
the patient themselves, in a gradual and prolonged manner.
Unlike the Japanese culture, verbal permission is more
acceptable than written consent as it is based on trust. (Egyptian
- Cultural Approaches to Pediatric Palliative Care in Central
Massachusetts - Resource Guides at University of
Massachusetts Medical School, n.d.)
Because Egypt is a developing country, major efforts have
been made to improve outcomes for mothers and babies, and in
reducing female genital mutilation. (Data Snapshots | UNICEF
Egypt, n.d.; Health | UNICEF Egypt, n.d.) It may not be the
case if these efforts had not come from elsewhere. Overall, the
country of Egypt needs to be prepared for the increased
population and the need to increase hospital beds and facilities
in the future.
Societal Goals
Egypt
The developing country of Egypt started a bold legislative
framework in 2016 with the hopes of goal achievement by 2030.
Egypt Vision 2030 was created to align with the G20 SDG's.
Under this new vision, some of the key areas of growth can be
found in health and education. These goals would have the
potential to decrease the significant social disparities occurring
within the country and help combat social determinants of
health. Egypt goals in education include ensuring all children
can complete free primary and secondary education and
reducing the currently 7% illiteracy rate of children and

adolescents (Sustainable development, 2021). Health goals are
centered around reducing infant mortality rates by 50%,
decreasing maternal mortality by 60% and the ability for
citizens to have increased equitable healthcare access
(Sustainable development, 2021).
Egypt Vision 2030
I. Environment
i. Reduce greenhouse gas emissions by 10%
II. Economic Growth
i. New wage system
III. Education
i. Reduce current illiteracy rate
IV. Health
i. Reduce infant & maternal mortality rates
Health Literacy
Health literacy is a term used to describe the ability to
understand, analyze, interpret, and access healthcare and health
services. People with a well-developed health literacy are
knowledgeable about preventative health services and can
successfully question their healthcare providers about issues
related to their health. Furthermore, invidiuals with health
literacy can understand a diganosis being given to them and are
able to navigate treatment options moving forward. As Japan
and Egypt are vastly different countries in terms of
development, health literacy varies as well as it is related to
education level, access to resources, and financial constraints,
among other things.
· Egypt
. Recent research has found that around 75% of the population
in this developing country have limited health literacy (Anwar,
Mostafa, Hakim, Sos, Abozaid, & Osborne, 2020). There is a
small percentage of the population in this country that
understands healthcare terms, leading to an increase in
hospitalizations and longer hospital stays. Much of this lack of

health literacy is strongly correlated with lower education
levels, specificially those associated with reading
comprehension. Egyptians have greater instances of poor
reading skills, poor reading comprehension skills, and poor
writing ability. Another challenging part of health literacy in
Egypt is the fact that there has not be extensive research on this
concept and the current numbers are indicative of the population
near cities. Many Egyptians live in rural areas and work in
hazardous conditions. The level of health literacy in these areas
is much worse, necessitating increased awareness and
appropriate interventions.
.
Policy
· Egypt
. There has been a huge impact on Egyptian healthcare system
as of late due to the Syrian Conflict. There is an influx of
refugees coming to Egypt looking for solace. With this increase
of residents that have the same access to health services as the
Egyptian residents this has greatly strained the Healthcare
system. (Fares et al., 2021). Egypt policy is an all-inclusive
view as well called Universal Health Coverage (UHC). This
allows healthcare access to everyone without causing devasting
difficult financially from the patient. In many cases these
benefits are paid by taxes on items such as tobacco, copays,
donations, and other financial sources. There are some flaws to
this system. Too much access causes an influx of unnecessary
medical visits, to help reform this Egypt is placing a minimum
of co-payments, The health program reform is planning to be
released in 2032. The hope is that this will help combat some of
the issues with the lower classes of citizens of Egypt by helping
to educate and care for the prevention of many diseases.
Awareness campaigns to help spread the word of disease that
can be prevented, and detection and screen availability will all
see a reform with this new policy. (Salama, 2022).
Urbanization

Urbanization is defined as the process of cities becoming more
industrialized and containing higher percentages of the
population. It's counterpart being rural areas of low
industrialization and smaller percentages of the population
(Urbanization, 2022).
Egypt
Egypt has an annual growth rate of 1.87% with currently
42.71% of the total population considered urban (Egypt: UN-
Habitat, 2022). Unfortunately Egypt has had problems with
keeping up with its expanding urban population. The rapid
urban growth of Egypt has not being able to efficiently provide
a safe infrastructure for the citizens of the expanding
metropolitan cities. Many people have faced unsafe living
conditions because of poor urban planning and service delivery
(Egypt-UN-Habitat, 2022).
Impacts of urbanization on social determinants of health
(SDOH)
Urbanization effects SDOH in many of the same fashions as
rural living. Transportation, access to care and housing can still
be just as inaccessible for urban living if proper care was not
taken in transportation logistics or housing availability.
Although well developed now, Japan has struggled in the past
with rapid urbanization expansion. The developing country of
Egypt can take a lesson from the issues Japan faced in the early
phases of urbanization.
Housing and transportation are two determinants in need of
restructure for Egypt's current urbanization model. Japan
learned early on that speed over quality was not the ideal choice
when setting up an urban city. Buildings that were too hastily
put together became more of a burden for the city in repair costs
and buildings that erupted without thought of logistics created
crowding and unsafe transportation routes for pedestrians (Hein
et al, 2007).
Urbanization has the potential to create positive change for
SDOH. Urban cities can allow individuals easier access to

healthcare facilities, increased economic growth and prosperity
and more efficient infrastructures (Social determinants of
health, 2021). For these positive changes to happen it is
important for leaders to understand the proper foundations that
must be created to protect and support the flocking population
that urban cities inspire.
Globalization:
Labonte and Shrecker (2022) identify globalization as, "a
process of greater integration within the world economy through
movements of goods and services, capital, technology and (to a
lesser extent) labour, which lead increasingly to economic
decisions being influenced by global conditions" (Labonte and
Shrecker, 2022, pg. 3).
EGYPT
Egypt has a large tourist population that positively effects the
more popular locations with their healthcare system. The more
visited the places are the better healthcare and more
accessibility there is. This leaves the lower income population
with less healthcare and more vulnerable to disease and
infection. Khalifa and Haley (2010) states, “Improving
standards of care within Egypt’s private health sector, relatively
lower health care costs, and an already popular tourism
destination have positively positioned Egypt for medical
tourism; particularly in such destinations as the Red Sea, Cairo,
Alexandria, and Giza” (Khalifa & Haley, 2010, pg. 3). Having
the tourist population allows for extra income to help fund
education and increase research for many of the highly
infectious diseases that are plaquing Egypt. The con to this
funding is that it is going to the areas where people already
have access to medical treatment instead of trying to fund the
lower income communities. There could be future policies that

decrease the availability for private practice physicians to
access government funded resources. (Khalifa & Haley, 2010).
Environmental Issues
Egypt
· The environment in this developing country has significant
issues that threaten the land. There is an abundance of
hazardous waste, high levels of air pollution, and rising cases of
water scarcity (Asiri, Khan, & Kend, 2020). Egypt is also
suffering from deteriorating resources and a lack of
governmental legislation regarding the use of resources and
protecting the environment. It is important to mention that
Egypt is located along the Nile River and can be described as a
patch of green that sits in between the desert. More than 50% of
its food is imported due to an abundance of people living on a
small piece of land that has a limited amount of land available
for agriculture (Sarant, 2017). It is also no surprise that living
in the middle of a desert results in decreased water supply as
Egypt is below the level of water scarcity with only 600m3 -
340m3 available per person. Additionally, Egypt has been
battling an increase in dust storms that has caused increasing
health issues and hospitalizations in the population (Akpinar -
Elci, Berumen-Flucker, Bayram, & Taiar, 2021). The increase in
hazardous waste is the result of a combination of poor
regulation and the increase in industrialization as private
coporations have been purchasing most of the available land.
Other Determinants of Health and Disease
Egypt
Education is the fourth goal in the United Nations
sustainable development goals. Egypt has been able to create a
solid foundation for sustainable development through good
leadership and governance appointed in 2014 by the people.
This government has a clear and coordinated vision toward

inclusive economic growth and sustainable development. This
provides a strong foothold for Egypt to take on the goals for
2030, including education as an essential role in reducing
poverty. Active policies that have been introduced “include
curriculum that integrates social justice, cultural diversity,
appropriate development and democracy as an inherent direction
of personal and social change and revitalizing the strengths of
individuals, communities, and entities.” Also providing values
and skills to enable students to become leaders. However, these
policies have been met with some resistance as there is still
some content that remains unclear. Raising public awareness
will be necessary to gain stakeholders support to implement
these objectives within the educational systems. (Singer, 2020)
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