1.

Describe two things you learned about how environment affects health that
surprised you by watching the video.
When we think about health, most people think about health care, access to
care, and quality of care. However, what the research clearly shows is that health
is embedded in the larger conditions in which we live and work, the quality of
housing and the neighborhoods we live and have a dramatic impact on our
health.
I wasnt so much surprised, as struck by the truth of this statement from the film.
The cumulative stress of dangerous, disconnected neighborhoods with poor
access to services, parks, fresh air and beauty are directly correlated to overall
health. Its intuitive and it validates what everyone understands on a very basic
level: poverty kills and not just because of the personal choices that a person
makes each day. I also wasnt so much surprised, but reminded anew that after
WWII, white families were given government-backed mortgages that lead to the
white flight into the suburbs. This was a policy-driven change that was racial
discrimination, pure and simple. It is what lead to the creation of ghettos and
drives the economic disparities that we all see and experience as a modern
norm, today.
I have a poignant memory of my grandma describing the white flight from her
neighborhood in the central district of Seattle during the late 60s and early 70s.
She realized that by staying, she was losing value in her house, but she was a
stubborn woman. Her previously white neighbors were replaced with black
neighbors and then subsequent sales in the neighborhood sold for less than
previous market value. She had an ugly look of distaste on her face as she
described the way her new neighbors, destroyed the neighborhood and
ultimately drove her away, too. I knew at the time that her offensive language
(which I omitted) toward minorities was bigotry, but I didnt understand the
underlying forces that were at play. In fact, Im not sure that she understood it,
either. I do know that I have fond memories of her old house and what a lovely
neighborhood it was, even in the 70s. But now it is a bleak, derelict
neighborhood and I find myself locking my doors when I drive through it. I know
on a visceral level that it isnt safe there for anyone.

I am becoming increasingly aware of the invisible driving forces that effect society
today. Like the film described, I used to assume that the health disparities
between classes were a result of bad personal choices, rather than racially
discriminatory policies and environmental differences. Based on observations
and the news, I understood that the short term rewards of cheap, fast food, was
to blame for some of the health problems and there were food deserts in cities,
limiting access to better food choices. I listened to reports that described toxic
loads that were higher in poor neighborhoods and that those same
neighborhoods had few green outdoor spaces and limited access to decent
health care. What I didnt understand, or put all together is that the sum total of all
of these individual differences could be blamed on the government in a very real,
tangible decision, that ultimately created not only poor neighborhoods, but
caused much of the chronic health problems of the poor today. I didnt realize that
all of the chronic health conditions such as obesity, asthma, hypertension, low
birth weights and other conditions are all clustered in specific low income
neighborhoods that are not of their own choosing, but is their burden,
nonetheless. They are victims, not people making bad choices.
2. Describe how you could use what you learned from watching this video to improve
patient care. Provide at least two examples.
I can implement some of these lessons into my nursing by first, not blaming or
judging the victims of low socio-economic circumstances. It is subtle, but
assumptions and attitude on my part, can make a difference in my delivery of
care as a nurse. If I assume that a patient is simply the product of poor decision
making, I will treat that individual much differently than if I assume that the person
is a product of environmental forces that drove their current circumstances. Its
the difference between me advocating for the patient and not. Its the difference
between sensitive management and neglectful management of care. And it is
huge. Another way that I can use what Ive learned, is by using my power to
effect change, as an educated professional in the nursing field. Im not sure what
that might look like on a daily basis, but it can be subtle, such as how I address
problems that arise, vs. dramatic like political reform. Im sure that actionable
steps on what I can do, will be discussed more in our program. Im sure that I can
be an agent of change, if I decide to.