Nurses can play a big care role across all ZIP codes
The focus on ZIP code and neighborhood in the Aug. 27 and 28 Post-Gazette (“Want to Live Longer? Lifespan Can Depend on Where You Live”) as a critically important determinant of health disparity is applauded.
While these disparities are evident across the lifespan and health continuum, they are particularly evident in the management of chronic, often progressive disease such as cancer. Our clinical and research work over the past years finds worse survival and higher levels of distress among poor and/or minority patients, particularly with advanced cancers. Even with world-class cancer care in our wonderful community, these disparities are evident according to ZIP code.
We can do better. We advocate recognizing the cost-effective and efficacious role of nursing for the mitigation of health disparities in cancer and other chronic illness. Nurses in traditional and expanded roles serve in schools, community health centers, the home, shelters, public health and acute and long-term settings providing tailored, patient-centered care. They serve as direct providers or conduits to critically needed resources and support for cancer prevention, detection, navigation, state-of-the-art treatment and end-of-life care.
This same effective model of cancer care nurse utilization could be applied to the prevention and treatment of many chronic illnesses across all ZIP codes. To reduce disparity across the illness continuum, nurses as key community partners should be considered. MARGARET QUINN ROSENZWEIG, Ph.D. CATHERINE M. BENDER,
Ph.D. Professors University of Pittsburgh School of Nursing
Oakland
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As reported in the Aug. 28 PG, strong associations exist between mental and physical health, longevity and the demographics of the ZIP code where one is born and resides (“Give Health Info to Poor in Gathering Spots, Expert Tells Forum”). Documented contributions to impaired health include inadequate prenatal care, inadequate nutrition, limited physical activity and access to health care.
However, what was not mentioned is the effect of early-life physical, mental and sexual abuse as significant risk factors for altering behavior, learning ability, physical and mental health, and longevity, regardless of ZIP code. This was recognized by the 21st Heinz Awards, which honored Dr. Nadine Burke Harris. Dr. Harris, among others, has shown the significant harmful effect of adverse childhood experiences on long-term mentaland physical health.
In our community it would be beneficial to pay more attention to the work of Dr. Harris. Education and training in the use of techniques to reduce impulsive behavior should be available in barber shops, beauty parlors, libraries and community centers. Through education about the effects of early-life abuse on the mental and physical health of children, it is anticipated that adults will be motivated to decrease the likelihood of their engaging in such behaviors.
Adults can be taught how to gain control when they lose their ability to think clearly when interacting with children. Something as simple as taking a few deep breaths is highly effective for lowering the risk of abusing young children by helping to lower the likelihood of detrimental impulsive behavior. It is not complicated. BRUCE S. RABIN, M.D.,
Ph.D. Emeritus Professor University of Pittsburgh
Oakland