Question:
Discuss about the Determinants of Health for Nutrition, Health & Aging.
Many of the authors have indicated time and time again at the predominance of various health determinants associated with the health care scenario. And the impact of these determinants is profound on determining the health status of the vulnerable populations. In this assignment, the vulnerable population chosen are the visually impaired and in order to explore and evaluate the health determinants for this population, red lotus model of health is selected. In this structure, the stem and roots of the plant are considered to be the construct of values and principles within the health promotional system [1]. Now, the first layer of petal structures of the health model is representative of all the kinds of environmental health determinants, where as the second petal layer of the model is representative of needs assessment for the vulnerable population. The third, fourth and fifth petal layer represents planning, implementation and evaluation respectively. The leaves of the model are representative of sustainability practices, the stamens signify the biological and socio-economic status of the vulnerable population and lastly the pod represents the people and their health status.
Considering biological factors, there are three key determinants, age, sex and genetics. According to the recent statistics, visual impaired-ness associated disabilities have been observed to be intricately linked with aging. Close to 500,000 Australians over 40 have been identified to live with some or the other kind of visual disability[2]. And despite of vision loss preventable the rate of the vision loss as a direct result of aging processes in Australia continues to increase. Based on the recent data published, there are close to 50% of the adults aged 40 or higher have been observed to develop AMD with growing age, 16% have been observed to lead to glaucoma, 5% to diabetic retinopathy and 22% to other cataract problems, all with growing age. Considering the gender related influence, the rate of women suffering from visual impaired ness is 64% of the total number of visually disabled in the world and the statistics for this data is no exception for Australia. A contributing factor to this may be the fact that the men get twice as much accessibility to eye care services as women and it is heavily influenced by the social standing of the women in the rural and remote areas as well. Other, the genetic predisposition of visual loss is primarily for the aging population, whereas the children suffering from disabilities can also be influenced genetically. Both glaucoma and AMD have been identified as heavily genetically influenced visual disorders and the probability of this genetic disorders occurring also increases with growing age in the majority[3].
The next sector of determinants is the socio-economic influence of the visual disabilities; considering the income, the rate of vidual impaired- ness has been discovered to be higher than the high income background. In Australia, the socio-economic standing s crucially related with the percentage of visual disabilities, and it is reflected in the rate of prevalence of blindness in the aboriginal communities as compared to the non native individuals residing in Australia. According to the recent statistics, the native and economically background ethnic communities experience 6 times more vision loss and 3 times more visual impairment as compared to the rest of the populations[4]. A contributing factor to this might be the fact that low income is associated crucially with social status and accessibility to good lifestyle, healthy and hygienic living conditions and social privileges, the lack of a stable financial background therefore, interlinked with the rest of the variables limits the chances of healthy living and increases the possibility of visual disability.
Considering the last two sectors of determinants, cognitive determinants refers to the values, principles, thoughts and attitudes that affect the living conditions of visually impaired and how it contributes to the further deterioration of the their condition. It has to be mentioned in this context that there still is a significant level of discrimination and prejudices in society regrading the disabled and it restricts their right to good health and good living most times. There are various socio-cultural restrictions for the visually impaired population and their access to good health care, be it racial, gender or age-related or religious and ethnic prejudices[5]. As per the recent data, a vast majority of the visually impaired get inconsistent access to the Home and Community Care services for the visual aids and these socio-economic determinants are the major contributing factor leading to this. The last sector of determinants, the behavioural characteristics, physical, mental, and spiritual contribute significantly to the health and wellbeing of the visually impaired. The lack of compassion and support in the behaviours of the family, care environment and the rest of the society has been detected to be the underpinning reasons behind the lack of self worth and self esteem in the visually impaired individuals[6].
Considering the physical environment of the individuals, it has to be understood that the aging population dealing with visual disabilities are twice as likely to experience falls, and along with that they are much more likely to face lack of social independence and thrice as likely to develop depression. The lack of supportive care services in the demographic imparts a significant detrimental effect on their basic health and wellbeing. Considering the demographic data of build environment, it has to be mentioned that there is no certain national policy services or program dedicated to people older than 65 and dealing with visual impaired and this blatant negligence is also reflected on the restrictions that the visually impaired face, be it educational institution, occupational sector or residence area[7]. Considering the influence of the social determinants, it must not escape notice that the depression rates in the aging population with visual disabilities is thrice as higher in Australia as compared to the rest of the populations, and the rate of deoresion is even higher with people aged 65 and higher. The lack of societal support and compassion and the predominance of social rejection and discrimination is the most influential contributing factor.
Considering the impact of economic environment, the lack of financial stability affects the lifestyle, nutritional patterns and health literacy and awareness, the lack of which is heavily linked to the deteriorating visual impairments with growing age. Along with that, the cost for vision loss prevention an adequate health care services for the visually impaired as estimated in Australia is close to $16000, a out of pocket amount that the socio-economically backward classes cannot afford and hence the health condition continues to escalate for the visually disabled. Lastly, considering the political impact on the health status of the disabled, it has to be understood that there is a gaping lack of attention towards improving the life visually disabled, and that is reflected conspicuously in the lack of any national policy of the visually impaired over the age of 65. There are no considerable efforts from the government towards the implementation of advanced treatments like bionic eye treatments, laser therapies and furthermore, the costs for what basic treatment is available for the visually disabled is obstinately expensive and completely out of reach for the aging population who are the majority vulnerable population for visual impaired-ness.
The effect of the determinants on health cannot be denied and that is reason why a variety of different model of health have been Identified to overcome the detrimental effect of the determinants and facilities Health Promotion to improve the life of the vulnerable population. It has to be understood that Social Justice can only be implemented when is in every individual of the society has equal rights towards good health and wellbeing, However, unfortunately the disabled available population often restricted from these basic human rights[8]. According to the health promotional model of Ottawa charter that has been developed to address each and every Health Care needs on a global scale, a few strategies can be developed which can be the solution for rising discriminative and disparities for health and wellbeing in the vulnerable population of disabled.
It can be stated that success of the strategies discussed are circumstantial, due to the presence of the key external and internal variables that potentially alter the effect of the determinants. Therefore, the future implications of the strategies devised will also rely on honest effort and cooperative participation from all the key stakeholders involved with this condition[11]. We must not overlook the fact here that there are various environmental restrictions associated with visual disability; and it being a sensory disability the prejudices regarding the viability and validity of visually disabled are magnified as well. However, these strategies can be a strong initiatives attempted to improve the living standards and health status of visually impaired and tesetratgeies will be able to lay the foundation based on which the health status of visually impaired population can be improved drastically, regardless of age, gender or other socio-cultural variables[12].
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