HEALTH IMPACT FRAMEWORK/RESEARCH PAPER 1

Health Impact Framework/Research Paper

Introduction
The topic I chose for my Health Impact Pyramid is safe water sanitization/hygiene in

Africa. I found that it is important to bring to light the ongoing issue of water contamination in

an underdeveloped country such as Africa. It is incredible to me, despite the years of progress in

the 20th century, the number of citizens around the world who still struggle to have access to safe

drinking water. Still, more than 900 million people worldwide have no access to clean drinking

water and about 2.5 billion have to adequate water sanitation (Frieden, 2010). Africa struggles

with communicable disease that originated from unsafe water. Contaminated water can transmit

diseases such diarrhea, cholera, dysentery, typhoid, and polio. Contaminated drinking-water is

estimated to cause 502,000 diarrheal deaths each year (WHO Africa, 2022). Nonetheless,

applying the current water conditions to the Health Impact Pyramid was appropriate to address

the issue as well as addressing actions that can be taken to reach safer water levels in Africa.

The Health Impact Pyramid

The health impact pyramid is a 5-tier structure that describes different types of public

health interventions with a given framework to improve health. At the base of the pyramid are

socioeconomic factors which are factors that make the greatest impact to society as a whole

population. Continuing in ascending order follows interventions that change the individual’s

environment in efforts to only choose the healthiest option, regardless of education, income,

service provision, or other societal factors (Frieden, 2010). After that follows long-lasting

protective interventions, which are infrequent interventions that do not require routine care, such

as immunizations at infancy. Next on the pyramid are clinical interventions, which are

preventative/maintenance interventions. An example can be an individual who has diabetes who

goes to check ups regularly to check blood sugar levels, or an individual who was told has high
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cholesterol levels and is now prescribed medications to keep cholesterol levels low. Lastly on the

pyramid are counseling and education interventions, which represents health education.

Essentially, the higher in the pyramid the poorer the impact will be. Interventions that are

focused toward the base will create a greater impact because these interventions reach the public

in a much larger number than individually.

Socioeconomic Factors

Africa is one of the poorest countries in the world and it is no doubt that this country will

have a poor socioeconomic status. Being an underdeveloped region, it is hard to simply obtain a

better socioeconomic status. Water sanitation is one of the many struggles the people of Africa

face. To create a better socioeconomic status, a place must have a good foundation. Elements the

foundation may include are having the financial budget to help fund facilities to distribute safe

drinking water, having the federal members of the country support the effort to provide safe

water, etc. Sadly, Africa lacks the largest part of the health impact pyramid because the country

does not have a good socioeconomic status to begin with and requires a fundamental societal

transformation.

Changing Context to Make Individual’s Decision Healthy

Changing the context to make an individual choose the default option is next on the

pyramid. In other words, the environment is being changed to only healthy choices. In this case,

Africa could have no option but to supply their citizens with only clean drinking water to all

households. If it was made a law to only provide safe drinking water to households, it could

promote a healthier lifestyle and prevent an abundance of illnesses. In 2019, the share of annual

deaths attributed to unsafe water across the world ranged from a high of 10.1% in Chad, about
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100:1000, to about 0.3% on average in the Americas to less than 0.02% across most of Europe

(Staff, 2022). Clean water will prevent trips to the clinic and avoid the burden of trying to

coordinate transportation for an individual in Africa who does not have close access to a medical

facility. The people of Africa will also have a longer life expectancy and will be properly

hydrated. If it was made a policy to provide safe water to the people, it would automatically be

promoting health to all.

Long-Lasting Interventions

A 1-time protective intervention to promote safe water conditions to the people of Africa

could be creating a water filter for the water supply of each household or water supply facility.

One device was already created from an organization whose goal is to fight the struggle of

unpurified water in the country of Kenya. Called Just One Africa, the gravity-operated filter and

fast flow rate mean that anyone anywhere can have clean water in a matter of seconds. Just 4-

inches long and less than 8 ounces, the filter can deliver 20 liters (5 gallons) of clean water in

about 30 minutes (Just One Africa, 2021). JOA states “We have distributed thousands of water

filters throughout Kenya and have trained the recipients on WASH (Wash, Sanitation and

Hygiene) sanitation best practices and simple ways to keep families healthy... Entire villages are

seeing the benefits of having clean water and hope for a healthy future is expanding”. This

intervention is great news and implies that a one-time health promoting intervention can be done

by installing a water purifier device in homes/facilities to provide clean drinking water.

Clinical Interventions

Clinical interventions that can be done in efforts for water hygiene could be by supplying

homeowners in Africa with water sanitation level kits to monitor for any contaminants present in
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their drinking water. These kits could test for bacteria or pathogens present in their water at

home. Frieden explains that though actions like these may be in place, the aggregate impact of

these interventions is limited by lack of access, erratic and unpredictable adherence, and

imperfect effectiveness (2010). I agree with what Frieden explains because realistic problems

that this intervention may face is the supply of water kits that will be available, questioning if

homeowners will be checking their water regularly, or what will the next steps be if the home

does have poor water quality, etc. In theory a home water sanitization kit promotes health safety,

but the reality is questioning if adherence will be maintained in efforts toward routine monitoring

of the people’s drinking water.

Counseling and Education

Counseling and education for safe water levels can be conducted to individuals of Africa.

Though this element of the tier is the least effective type of intervention, putting maximum effort

may make a difference. A health professional can conduct meetings in a public facility on

awareness of poor water hygiene that exists in Africa. Nurses can distribute educational

pamphlets to the public. The topic of poor water sanitation can be brought to city hall meetings

to spread awareness and share ideas. The goal here is reaching the individual and hoping that the

person will absorb some information given.

Future interventions that I may promote are by creating awareness to the ongoing

problem in Africa, and as mentioned previously by distributing education pamphlets and flyers

on organizations that are accepting donations. The organization Just One Africa seemed

confident in their water filter purifier. I would share with the public what this foundation is and

the impact they are making. As a nurse, though does not apply to water hygiene in Africa, I could

continue to promote education on water safety in efforts towards preventing waterborne diseases.
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I could advise people to always wash their hands before preparing or eating food and after

visiting the toilet, cleaning a child, or handling animals (Staff, 2022).

Culture and Health Beliefs

Though not ruled out, the water contamination issue could possibly be related to a

regional belief or religion. What others may see as a problem, they may see as perfectly normal.

As a nurse it is important to have cultural awareness when working with a diverse population.

Nurses must remember that patients come from different cultures and traditions and must respect

their beliefs when providing care. The Transcultural Nursing Society (TCNS) is a nursing

organization whose mission is to enhance the quality of culturally congruent, competent, and

equitable care that results in improved health and well being for people worldwide (TCNS,

2023). Beginner nurses such as myself should become more culturally aware of the population

around them, and learn about what a transcultural nurse is. The TNCNS explains that

transcultural nurses are academically prepared to serve many cultures by respecting the worth,

dignity and rights of individuals, families, groups and communities. Most important,

transcultural nurses are prepared to assess the cultural care needs of people and to skillfully

integrate the values, beliefs and lifeways of cultures for the health and well-being of those served

as a human rights imperative (TCNS, 2023). A nurse who is informed on the beliefs from an

individual from Africa, for example, will promote an even greater level of patient-centered care.

Personal Opportunities in the Global Health Field

Nurses can make a career out of bringing awareness and promoting change in the global

health field. Nurses can join committees that are devoted to environmental safety such as the

Alliance of Nurse for Healthy Environments. ANHE is a transformational alliance preparing and
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engaging nurses to assure the environmental health of all people, overcome environmental health

disparities, and to heal our communities and the earth for present and future generations (ANHE,

n.d.). As previously discussed, the Transcultural Nursing Society is a group that stands for global

health quality for the human rights of all people. TCNS members believe that nurses and other

health care practitioners should provide and maintain humanistic care for people worldwide.

Transcultural healthcare practitioners are focused on preserving and maintaining the human

rights of all people. These human rights should not be denied, neglected, or violated and deserve

protection from acts of injustice (TCNS, 2023). These are only a few committees that nurses can

join to create a career for global health. Nurses must also have the motivation and passion to

make a difference.

The Health Impact Pyramid illustrated the example of applying safe water conditions in

Africa. Each element from the 5 tiers in the pyramid demonstrated an impact it can make to the

region. Each tier focused on ways to optimize actions for each intervention whether it was big or

small. In correlation to helping citizens from Africa, nurses must recall their awareness on

different cultures and beliefs when tending to a vast population and treat each individual with

respect. This framework for public health action demonstrated how one issue could be changed,

and nurses have the potential to make an impact in any global health issue.
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References

Alliance of Nurses for Healthy Environments. About ANHE (n.d.) Retrieved April 19, 2023, from

https://envirn.org/about/

Frieden, T.R. (2010). A framework for public health action: The health pyramid. 100(4), 590-

595.

Just One Africa. (2021, February 5). About us - who we are and why we do what we do.

Retrieved April 22, 2023, from https://www.justoneafrica.org/about-us/

Staff, A. J. (2022, March 22). Infographic: Which countries have the safest drinking water?

Infographic News. Al Jazeera. Retrieved April 19, 2023, from

https://www.aljazeera.com/news/2022/3/22/infographic-which-countries-have-the-safest-

drinking-water-interactive

Transcultural Nursing Society. (2023, February 28). Retrieved April 22, 2023, from

https://tcns.org/

World Health Organization Africa (2022). Drinking-water. Retrieved April 21, 2023, from

https://www.who.int/news-room/fact-sheets/detail/drinking-water