NR 717 Week 7 Discussion

NR 717 Week 7 Discussion

Student Name

Chamberlain University

NR-717: Concepts in Population Health Outcomes & Health Policy

Prof. Name:

Date

NR 717 Week 7 Discussion

Identify

Greetings to the esteemed members of the Mississippi State Department of Health.

My name is Angelica Waller, MSN, BSN, RN, and I am currently enrolled in the Doctor of Nursing Practice (DNP) program in Healthcare Leadership at Chamberlain University. I have proudly served as a registered nurse for the past seven years, gaining extensive clinical experience across multiple healthcare facilities. Presently, I work as a nurse manager in the step-down intermediate care telemetry unit at Moore’s Park Memorial Hospital.

My career in nursing began as a floor nurse, where I actively volunteered at a local clinic providing healthcare services to uninsured and underserved individuals. Despite transitioning into a managerial position, I remain deeply engaged in community outreach by coordinating with interprofessional teams to establish mobile clinics and health education initiatives. My academic and professional interests focus on reducing disparities in healthcare access, promoting funding for public health services, and addressing chronic diseases such as hypertension and cardiovascular illnesses that disproportionately affect vulnerable populations.

Situation

Within Jackson, Mississippi, hypertension is alarmingly prevalent, particularly among African American residents. This condition often escalates into chronic cardiac disease, posing significant public health challenges.

Why is this issue important?

Hypertension within the African American community is not solely a clinical issue—it is heavily influenced by socioeconomic determinants. Individuals with lower income, limited educational opportunities, and inadequate health insurance coverage face heightened risks of developing and poorly managing hypertension. These disparities often translate into reduced quality of life and increased risk of premature death.

This concern reflects the principles of H. Res. 238 (IH), 114th Congress (2015), which sought to address health inequities during National Minority Health Month by acknowledging disparities faced by African Americans, Hispanic Americans, Native Hawaiians, Alaska Natives, American Indians, Asian Americans, and Pacific Islanders.

In Jackson, the convergence of low health literacy, unaffordable healthcare, and structural inequities demands urgent system-based and community-driven interventions to prevent worsening cardiovascular outcomes.

Background

The Mississippi State Department of Health (MSDH) is central to advancing equity and addressing public health inequities. Alarmingly, Mississippi holds the second-highest mortality rate from heart disease in the United States (McCoy, 2024).

Although the Affordable Care Act (ACA) and Medicaid expansion have reduced uninsured rates nationwide, significant gaps remain within Mississippi. Adults living below the poverty line and without dependent children continue to lack feasible healthcare coverage (Raphael & Rudowitz, 2024). Consequently, many residents delay or avoid seeking medical attention, ultimately worsening chronic disease outcomes.

In my professional practice, I have observed firsthand how these inequities impact patient health. Many avoid care due to fear of medical costs, distrust of healthcare systems, or inadequate understanding of their conditions. These barriers further contribute to unmanaged hypertension, often resulting in preventable hospitalizations or fatalities.

Case Example: Jackie’s Story

An illustrative case is that of “Jackie,” a 52-year-old African American woman from Jackson. Jackie initially delayed seeking medical evaluation for swelling, cramps, nausea, and vomiting due to concerns about missing work and potential hospitalization. Eventually, after losing her job and health insurance, she was diagnosed with advanced kidney and heart disease.

Due to financial constraints and transportation barriers, Jackie frequently missed dialysis sessions. Tragically, she was later found deceased in her home, the result of complications from uncontrolled hypertension.

This heartbreaking story underscores the severe impact of systemic barriers, lack of accessible health insurance, and insufficient community-based support on African American patients within Jackson.

Assessment

Reducing hypertension disparities in Jackson requires a two-fold approach: expanding access to healthcare services and addressing the social determinants of health.

Table: Issues, Impacts, and Proposed Interventions

Issue Identified	Impact on Community	Proposed Intervention
Lack of affordable insurance	Delayed or forgone care; worsening of chronic illness	Expand Medicaid coverage and provide subsidies for uninsured adults without dependents
Poor health literacy	Mismanagement of hypertension and related conditions	Develop culturally tailored, community-based health education and literacy programs
Economic instability	Limited access to medication, healthy food, and care	Create workforce development programs, improve employment opportunities, and deploy CHWs
Structural racism in healthcare	Inequitable diagnosis, treatment, and outcomes	Introduce implicit bias and cultural competency training for all healthcare providers
Limited preventive care access	Higher rates of late-stage disease diagnosis	Increase availability of free or low-cost hypertension and cardiovascular risk screenings

Research highlights that community health workers (CHWs) integrated into care teams improve chronic disease management, particularly hypertension, while also building trust among underserved populations (Williams & Cooper, 2019). Addressing multiple determinants simultaneously—insurance coverage, employment, and education—creates a comprehensive framework for sustainable health improvements.

Recommendations

The Mississippi State Department of Health should consider the following key strategies:

• Expand insurance accessibility by supporting Medicaid expansion and advocating for policy reforms that cover low-income adults without dependents.

• Invest in community engagement by establishing mobile health clinics, education programs, and preventive screenings in underserved neighborhoods.

• Integrate community health workers into care delivery models to bridge trust gaps and support disease self-management.

• Promote health literacy initiatives tailored to cultural and community needs, empowering individuals to manage hypertension effectively.

• Address systemic inequities by requiring healthcare providers to undergo training on implicit bias and cultural sensitivity.

• Enhance preventive services by offering free or subsidized cardiac and hypertension screenings.

• Strengthen intersectoral collaboration between healthcare providers, policymakers, and community organizations to create holistic support systems.

Request

I respectfully urge the Mississippi State Department of Health to collaborate on implementing these interventions. Specifically, I propose the following actions:

• Educational initiatives: Create and deliver community programs addressing hypertension prevention and management.

• Mobile and community clinics: Establish accessible screening locations for early detection of hypertension and cardiac risks.

• Pilot intervention program: Launch a 12-month initiative focused on reducing disparities, followed by evaluation and community feedback to guide long-term improvements.

Collectively, these measures will improve health outcomes for African American residents in Jackson, reduce preventable hospitalizations, and enhance equity in healthcare delivery.

Salutation

Thank you for your dedication to improving healthcare outcomes for disadvantaged populations. I look forward to opportunities for further collaboration and discussion.

Sincerely,
Angelica Waller, MSN, BSN, RN

References

Chelak, K., & Chakole, S. (2023). The role of social determinants of health in promoting health equality: A narrative review. Cureus. https://doi.org/10.7759/cureus.33425

Ercia, A. (2021). The impact of the Affordable Care Act on patient coverage and access to care: Perspectives from FQHC administrators in Arizona, California and Texas. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-06961-9

Erlangga, D., Suhreke, M., Ali, S., & Bloor, K. (2019). The impact of public health insurance on health care utilization, financial protection, and health status in low- and middle-income countries: A systematic review. PLOS One, 14(8), e0219731. https://doi.org/10.1371/journal.pone.0219731

NR 717 Week 7 Discussion

Jurns, C. (2019). Using SBAR to communicate with policymakers. Online Journal of Issues in Nursing, 24(1), 13. https://doi.org/10.3912/OJIN.Vol24No01PPT47

McCoy, M. (2024, February 22). Mississippi has the 2nd-highest heart disease mortality rate in the US. WJTV 12 News. https://www.wjtv.com/living-local/focused-on-health/mississippi-has-2nd-highest-heartdisease-mortality-rate-in-us/

Raphael, J., & Rudowitz, R. (2024, March 12). A closer look at Medicaid expansion efforts in Mississippi. KFF. https://www.kff.org/policy-watch/a-closer-look-at-medicaidexpansion-efforts-in-mississippi/

Williams, D. R., & Cooper, L. A. (2019). Reducing racial inequities in health: Using what we already know to take action. International Journal of Environmental Research and Public Health, 16(4), 606. https://doi.org/10.3390/ijerph16040606