San Diego County Community Health
Rhonda Mohler
Western Governors University
Community Health and Population Focused Nursing
C228
Marc Gayol
June 30, 2014

San Diego County Community Health
San Diego California shares a border with Mexico and has an estimated population of 3,211,252. It is a diverse and multicultural population comprised of 32.7% Hispanics, 47.6% Whites, 11.6% Asians, and 5.6% are Blacks (State & County QuickFacts, n.d.). San Diego has a long history with the US Military; it has six Bases and one US Coast Guard Station ("San Diego Military Bases," n.d.). San Diego is the second largest city in California, is rapidly growing, and is known for its temperate year-round climate and sandy beaches. It has many parks with open space, lakes and reservoirs, recreation activities, senior citizens services, and community safety services. San Diego also has multiple public services, excellent public schools, state of the art hospitals and clinics, and public transportation which include trains and trolleys (Community Services, n.d.). Sam Diegans can go to a museum, an opera, and attend an NFL game all in the same day. San Diego is an amazing place to live and has a lot to offer its citizens, but steps need to be taken to identify and evaluate disease in the community in order to promote optimal health and ensure the well-being of all San Diegans.
Epidemiology is the study of disease in the community and then evaluating the reasons why the disease or condition happened. Evaluating the risks and safeguarding factors of a disease or condition helps identify the driving forces behind health abnormalities ("Epidemiology Program," n.d.). San Diego has many health needs and is at risks for high mortality and morbidity. Malignant neoplasms are the leading cause of death followed by heart disease and Alzheimer’s disease (Leading Causes of Death Among San Diego County Residents, n.d.). Poverty levels are on the rise and toddler immunization has not improved since 2002. Many school-aged children are obese and overweight, and adolescents are at risk for DUI, drug dependence, and suicide. Diseases and conditions in childhood can affect a person’s health and wellbeing their entire life. Eighty percent of obese children remain obese in adulthood which makes them at a higher risk for getting diseases such as hypertension, diabetes, and heart disease. Unfortunately healthcare coverage remains unsatisfactory in San Diego and domestic violence rates have not gotten better for years (San Diego County Report Card on Children & Families, 2011). Although San Diego County needs to address all the above concerns, some problems take priority and should be evaluated early.
San Diego has three problem areas in their community that need to be studied and evaluated in hopes of preventing disease and unhealthy outcomes. All three problems should be addressed according to Healthy People 2020 which have goals that are intended to improve the health and well-being of Americans ("Introducing Healthy People 2020," n.d.). Childhood obesity has tripled in the last 30 years and is a problem that has become an epidemic in the United States; these rats are even higher in San Diego. San Diego has been increasing awareness about childhood obesity since 2006 by creating the San Diego County Childhood Obesity Initiative (COI). Which is an action plan to end child obesity (Childhood Obesity Action Plan, 2010). Another problem facing San Diego is drug abuse, especially methamphetamine's and heroin; authorities are investigating the increasing number of deaths due to overdosing. The use of methamphetamine's had been declining the last few years but now methamphetamine usage is on the rise. Heroin usage has been increasing the past few years, and there is an increase in drug addicts switching from prescription opioids to heroin ("Drug Abuse Patterns and Trends in San Diego Update: January 2014," 2014). Malignant neoplasms is the third problem in San Diego, and it has the highest rate of mortality and morbidity.
Malignant neoplasms are the leading cause of death in San Diego County. There are several types of cancer, but for all cancers there is a 65% five-year survival rate. Skin cancer is the most common form of cancer and is four times as common as most other cancer; breast cancer is the second most common form of cancer (Leading Causes of Death Among San Diego County Residents, n.d.). Among racial/ethnic groups Blacks and Whites have the highest mortality rate followed by Asians and Hispanics. In regards to gender, Black men and White women have the highest mortality rate. San Diego County’s death rate in 2007 was 162.6 per 1000,000 people (Sampson, 2011). Cancer is the most costly chronic disease in San Diego, the annual cost estimated to be $10,436 per person. Medical costs are expected to increase, and if it continues at the same rate, in 2050, San Diego will be spending $25 billion dollars each year on preventable diseases. To reduce the costs of treating cancer and lowering the rate of morbidity and mortality, San Diego needs to encourage healthy behaviors by promoting cancer screening, providing information and having referral services and easy access to health care ("Chronic Diseases," 2010).
According to the Centers for Disease Control and Prevention (CDC), “Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations” ("Health disparities," n.d.). Health disparities can be caused by many things such as age, gender, education, race, income, housing, and occupation (Sampson, 2011). San Diego has some troubling statistics that suggest that health disparities may exist in some cancer patients. San Diego’s unemployment rate is 9.6%, 17.1% of the population has no health insurance, 10% of families are below the poverty level, 18.2% under 18 years old are under the poverty level, and 7.5% have an education less than 9th grade. There are 1.067,462 total households in San Diego County. 12.1% are a female householder with no husband present and 23.2% households have one or more people that are 65 years and over. 37.1% speak a language other than English at home; 45.5% of houses are renter occupied and 6.1% have no vehicle. Females’ makeup 50.3% of the population, and 9.3% of the population have a disability (State & County QuickFacts, n.d.) According to The Center on Policy Initiatives (CPI), 38% of all San Diegans employed do not make enough money to make ends meet ("Cost of Living," 2014). San Diego’s Healthy People 2010 is trying to overcome these statistics, and prevent disease. They created objectives which are to “increase quality and years of healthy life for individuals of all ages, and eliminate health disparities between different groups of the population” (Healthy People 2010 San Diego: A decade in process, 2010, p. 4).
San Diego has not met 6 out of 12 Healthy People 2010 Cancer objectives and the first one not met is to reduce the breast cancer death rate among females to 21.3 per 100.000 but its rate is higher at 23.3 per 100,000. The second objective not met is to reduce the death rate from cancer of the uterine cervix among females to 2.0 per 100,000 but its rate is higher at 2.1 per 100,000. The third objective not met is to reduce oropharyngeal cancer death rate to 2.4 per 100,000 but is still higher at 2.5 per 100,000. The fourth objective not met is to reduce the melanoma cancer death rate to 2.3 per 100.000 but is higher at 2.8 per 100.000. The fifth objective not met is to increase the proportion of women who have ever received a Pap test, 18 years and older to 97% but it is currently lower at 93.6%. The sixth objective not met is to increase the proportion of women who received a Pap test within the preceding years, 18 years and older to 90% but it is currently higher at 93.6% (Healthy People 2010 San Diego: A decade in process, 2010). San Diegans can overcome these statistics by living a healthy lifestyle and having assessable high quality primary healthcare. Healthy living by maintaining a healthy diet, doing moderate exercise, and not using tobacco could prevent cancer. According to Healthy People 2010, San Diego did not meet any of the Nutrition and Overweight objectives. One of the objectives was to increase the proportion of adults who are at a healthy weight to 60%, but it is currently only 41.6%. Another objective was to reduce the proportion of adults who are obese to 15%, but it is higher at 22.1%. The third objective not met was to reduce the proportion of children aged 6 to 11 years who ae overweight or obese to 5%, but it is high at 11.5%. The fourth objective not met was to reduce the proportion of adolescents aged 12 to 19 years who are overweight or obese to 5%, but it is still high at 17.1%. The fifth objective not met is to increase the proportion of persons aged 2 years and older who consume at least two daily servings of fruit to 75% but it is currently low at 59.7%. The last objective not met is to increase food security among U.S. households and, in so doing, reduce hunger to 94% but it is only 64%. One Occupational Safety and Health objective out of three was not met, and that was to increase the proportion of adolescents who participate in daily school physical education to 50%, but it is low at 37.8%. And lastly, two out of 5 Tobacco Use objectives were not met. The first one was to reduce tobacco use by adults to 12% but it is higher at 12.9%. Another objective not met was to increase tobacco use cessation attempts by adolescent smokers to 64% but it is lower at 51%. Even though San Diego County did not meet all the Healthy People 2010 objectives, it still did better than the state of California in 62 of the 141 objectives by five percent (Healthy People 2010 San Diego: A decade in process, 2010).
Cancer can be detected through screening, such as a mammogram, breast exam, skin exam, and prostate exam; unfortunately, only fifty percent of cancers are detected through early screening (Healthy People 2010 San Diego: A decade in process, 2010). San Diego has many community resources to help and assist patients. It has clinical services that offer’s disease prevention, accessible primary care, emergency services, and long-term care and rehabilitative services. There are also many community resources that are state funded for eligible individuals that provide programs for cancer, such as breast and cervical cancer. They also have programs for cancer screening, medication cost, counseling, and support groups for patients and their families (2’1’1 San Diego, n.d.). San Diego’s goal is to provide all San Diegans access to high quality healthcare and to promote a healthy lifestyle which is essential to the well-being of every individual. In turn, it may help motivate San Diegans to improve their own health by getting primary care and living a healthy lifestyle through diet, exercise, and not using tobacco.
Several tools have been developed to help Community Health nurses assess San Diego County in formulating a community diagnosis. The Windshield Survey is a tool to help nurses create a basic description about San Diego County’s community, its health, and members.
For example, if a nurse drove around her community and visited an elementary school he/she might notice that there are overweight or obese children with no signs of activity; this observation might shape her nursing practice and interventions. The Community Disaster Preparedness Inventory tool can be used by nurses to assess San Diego County’s level of disaster preparedness. Because San Diego County has many resources to ensure a coordinated and effective response to emergencies and has activities that prepare for a disaster, a nurse might conclude that it has a high level of disaster preparedness ("Emergency Preparedness," n.d.). The Community and Population Health Scavenger Hunt tool can help a nurse to explore his/her community by visiting several facilities. After visiting several facilities, a nurse might conclude that San Diego has many community centers that provide caring, supportive, affordable, high quality healthcare services ("Welcome to Family Health Centers of San Diego," n.d.).
Another tool used by Community Health nurses when doing a community health needs assessment, is the Population Economic Status Assessment. This tool can be used to help a nurse evaluate San Diegans affordability and utilization of available health facilities. San Diego County’s poverty level is 15.3%, its unemployment rate is 5.9%, and the rate of people who have no health insurance is 16.9%, which are all lower than California’s statistics. Since a nurse needs to decide on priorities for taking action on the problems in San Diego County, he/she may decide that economics is not the priority when evaluating the entire population (State & County Quick Facts, n.d.). Neighborhood/Community Safety Inventory is a tool that can help nurses identify safety issues in the community and help plan nursing interventions to resolve identified problems. San Diego County has a San Diego County Air Pollution Control District which protects the public from the unsafe effects of air pollution, achieves and maintains air quality standards, and develops and implements cost effective programs to meet state and federal directives ("Air Pollution Control District," n.d.). A nurse assessing San Diego County might conclude that environmental safety is not its community diagnosis. The last tool used to assess San Diego County is the Cultural Assessment, which is a tool to assist a nurse in obtaining information in order to help the community and nurse formulate a mutually acceptable, culturally sensitive treatment plan. San Diego County’s largest minority group is Hispanics; a nurse doing a cultural assessment must remember that patients have a right to their cultural beliefs, values, and practices. In doing so, the nurse should recognize that many Hispanics may navigate between two cultures, American and Latin American. He/she might also notice that most Hispanics are satisfied with their lives, are hardworking, and optimistic about their futures ("Between Two Worlds: How Young Latinos Come of Age in America," 2009). After assessing the Hispanic culture the nurse might not choose to make a culture community diagnosis.
The above assessment tools can assist the Community Health nurse in providing exemplary nursing care for individuals, families, and population groups in San Diego County. Assessment tools guide nurses to assess the health status of San Diegans and provide direction for the development of nursing diagnoses, planning interventions, and evaluating the outcomes of care.

References
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