The research need to generate qualitative and quantitative data regarding a particular community health need is directly proportionate to the impact that the particular health need has on the community and sometimes even the mortality/morbidity generated by the particular health problem. In this regard, in this current assessment we review the health needs of coal mining workers in West Virginia, USA to identify hazards and risk factors pertaining to their health, by virtue of their designated profession.
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Community health needs assessment is a rigorous project that serves the population under study by elucidating the current needs, reflecting the situation which is often not balanced between health providers, insurance schemes, health administration and/or community leaders. It also serves at identifying particular needs that are overlooked by healthcare officials that are either novel or problematical by elucidating perceived and expressed health and wellbeing needs. In other words, it can be a useful means to depict the selected community’s horizon in respect to health needs, healthcare shortfalls and aetiology, all useful areas for the facilitation of better public health management.
In order to perform an accurate community health needs assessment, research should be grounded on an up to date background study of the selected population’s demographics and census (socioeconomic, workforce and other) data, where available. Moreover, particular health factors should be taken into account by managing information currently disseminated through healthcare officials (such as mortality, disease prevalence, risk factors analysis).
This research would also benefit from an on-site review of environmental and work related conditions, if possible.
The most useful and widely used instrument to conduct a community health needs assessment and subsequent analysis is by means of a structured questionnaire based survey that will employ cross sectional and population specific items targeted at the current health need. Moreover, the instrument should be designed with attention to environment and state specific conditions, such as regulations and laws, insurance coverage and even so, local traditions and unwritten codes of conduct.
For the above reasons, in this essay we will conduct a review of available information on the community of Coal Mining Workers in West Virginia, USA. After the acquisition and analysis of the pertaining data, we will present a structured survey instrument, aiming to identify health needs with respect to existing health problems and patient satisfaction.
BACKGROUND-RESEARCH
We searched a wide array of online databases and organisations providing demographic and other information for the population in question. We also conducted a MEDLINE search, to draw the picture of already identified health needs and/or needs assessments already conducted in this population. Search terms employed were “coal workers”, “west Virginia”, “health needs”, “pneumoconiosis’, “interstitial lung disease”, “occupational hazard” alone or in combination.
West Virginia is a state in the Mid-Atlantic section of the USA, capital Charleston. The state is notorious for its mountain composition and significant coal mining industries. The mineral and coal resources in the area are vast, and West Virginia has been considered to have fuelled a great part of the industrial revolution of the developed world. Moreover, coal mining and related work constituted major part of the employment activities of the state, while still in the 21st century, it is believed that mining safety and environmental concerns are amongst the most challenging issues facing the state.
In 2009, West Virginia was inhabited by 1,819,777 people. 5.6% of West Virginia’s population were reported as under 5, 22.3% under 18, and 15.3% were 65 or older. Females made up approximately 51.4% of the population (United States Census Bureau, 2010). Moreover, according to US Census Bureau Data, West Virginia is the third lowest in per capita income state. It also ranks last at median household income. Virginia’s adult population with a bachelor’s degree is the lowest in the U.S. At 17.3%.
The main economy is coal, and the state is the lead in coal production, second only to Wyoming.From the West Virginia Office of Miners’ Health, Safety and Training we find that the West Virginia Coal Industry provides about 30,000 direct jobs in WV, including miners, mine contractors, coal preparation plant employees and mine supply companies. In particular 20,715 are registered as employees in the 188 active coal mines in WV, while an additional 4,842 work as an independent contractor.
From the same source we read that for 2009, fatal accidents were 3, non fatal accidents 1,164 and the accident frequency was estimated to be 2.79%. Involved in accidents are mainly high voltage equipment, and areas in and around river load outs. But apart from fatalities, a major health problem for VW coal mining workers is pneumoconiosis, or ‘black lung’. The CDC has implemented a safety and health chapter regarding occupational Respiratory Disease Surveillance, and especially for coal miners, the Enhanced Coal Workers’ Health Surveillance Program (ECWHSP).
The ECWHSP includes surveys that include specifically designed standardized health questionnaires, work histories, spirometry testing, radiographic examinations, and collection of other relevant health information, which are gathered in a specially designed mobile examination unit by trained personnel on site.Results of the ECWHSP 2009 survey on mine workers in West Virginia are shown on table 1:
Finding
Examined
Rate
Total
Participation
1,884
20%
9,593
pneumoconiosis (>=1/0 or PMF).
93
5%
1,884
pneumoconiosis (>=2/1 or PMF).
43
2%
PMF
24
1%
advanced pneumoconiosis
35
2%
have a chronic cough.
624
34%
bring up phlegm from their chest.
690
38%
have chest sounds of wheezing.
613
34%
have had an attack of wheezing
738
41%
have experienced dyspnea on level
741
41%
have experienced dyspnea on a hill
1,119
62%
have chest tightness
672
37%
have chronic bronchitis.
142
8%
have emphysema.
79
4%
have had pneumonia
337
19%
have asthma
132
7%
have tuberculosis.
4
0%
never smoked.
954
53%
former smokers
455
25%
current smokers
393
22%
Although under a lot of argumentation, coal and in general volatiles (dust) have been proven by sufficient evident as causes of respiratory damage. In detail, in coal miners a significant association between the level of FEV1 and dust was found, even after adjustment for age, physique and smoking (Cowie ,1999; Soutar 1989).
Some more interesting figures arise from the State Health Facts website, shown in Table 2:
Measured index
WEST VIRGINIA
USA
Age-Adjusted Invasive Cancer Incidence Rate per 100,000 Population, 2005
484.2
458.4
Births of Low Birth weight as a Percent of All Births, 2006
9.7
8.3
Number of Deaths per 100,000 Population, 2007
951.7
760.31
Life Expectancy at Birth (in years), 2005
75.3
78.0
Percent of Adults Who Have Ever Been Told by a Doctor that They Have Diabetes, 2008
11,9
8,2
Number of Deaths Due to Diseases of the Heart per 100,000 Population, 2006
236,9
200,2
Asthma prevalence among adults
9.0
8,2
Percentage of Adult Population Aged 21-64 Years Who Reported a Disability, 2007
22,4
12,8
The above figures need to be assessed in caution regarding the high prevalence of “occupation of coal worker” in West Virginia. Apart from the apparent pathophysiology of dust entering the lungs and rendering them chronically inflammatory, with signs of fibrosis and atelectasia or other interstitial pneumonic disease or pneumonoconiasis, health needs of coal mining workers are extended to a variety of diseases that are not as commonly identifiable at the first look.
Although current screening methods and occupational policies do exist for these workers, they tend to be centred on respiratory diseases. Coal Mining however, is a demanding, time consuming manual labour that is often exigent and causes a variety of clinical manifestations. As such we can consider lower back pain, physical limitations (Galagher,2005) cervical spine degenerative changes, vibration-hazard related body changes, sudden coronary death (Kopytina et al, 1993), skin lesions (Begraca et al, 1991)and mental health changes (Lagunov,1991).
Moreover, the coal mining community often has unmet needs on the level of healthcare access and utilization, that different stakeholders are usually unaware. In a study by Smith et al,2005 a community health needs assessment was the means to the provision of a community nurse and a revision in healthcare provision among former miners in Kent.
Having reviewed the major components of community health needs assessment for mine workers in West Virginia and having conducted the appropriate background review, we propose the following questionnaire as a tool to conducting an effective and fruitful evaluation of perceived and actual health needs, in a community of mine workers.
This tool comprises of a health needs assessment part, where the answers are left open and views are encouraged for propositions in order to facilitate the analysis of expected health and participation to health concerns. The second part is a standardized demographics and health questionnaire that is used widely in this form, with minor alterations in assessing the perceived health and demographic information of the study population in question.
Emphasis is given on other diseases that might affect the coal mining community ( participants are requested to count five-5 major health concerns) and on perceived level of attention and care this community is receiving or should be receiving according to its needs. A question regarding their sibling’s health is put in the end to elucidate concerns that are also documented in the literature regarding out of site contamination with dust by coal workers that bring their occupational hazard in the family home or by dispersion in neighbourly areas (Pless-Mulloli et al, 2001).
QUESTIONNAIRE:
We are conducting a review of the Health Needs within the WV coal mining community. Along with statistical data and analysis we are also interested in your viewpoints.
Instructions
Part One: Health Problems
There are several factors that influence or determine whether the people in your coal miner’s community are healthy.
From the following list, please rank from 1-5 (1 being the highest priority) what you think are the top five health and disability issues affecting your community?
Health Issue
Your Ranking (1-5)
Asthma / Respiratory Disease / Pneumoconiasis
Cancer
Cardiovascular Disease
Depression / Psychiatric Disorders
Diabetes
Disability
Drug and Alcohol use
Nutrition
Obesity
Oral Health
Physical Injury (including violence and accidents)
Self harm / Suicide
Sexual Health
Smoking
Other (please specify below)
What do you think is needed to address the top three priority issues identified above and what difference will this make?
Issue 1:
Issue 2:
Issue 3:
What is needed?
What is needed?
What is needed?
What difference will this make?
What difference will this make?
What difference will this make?
How much influence do you think the following have as to whether people in your coal mining community are healthy?
Please mark each factor with an X, ranking “influence” from 1-5 following with an X
Influence (1 is most, 5 is least)
Factors
1
2
3
4
5
Cost of services
Ease of access to health services
Education
Employment
Family support
Housing
Income
Social Isolation
Transport
Community support
Insurance status
Other (please specify below)
Your details
Please provide us with some information about yourself. This will assist us with the analysis of the questionnaire results.
Please mark the following that applies to you with an X
Name (optional)
Ethnic Group
American
German decent
Hispanic
Other
Gender
Male
Female
Age Range
Children (aged 0 – 14)
Adults (aged 25 – 64)
Youth (aged 15 – 24)
Older People (aged 65+)
Where do you live?
metropolitan area
county
How many years have you worked in the coal mining sector?
( number of years)
Do you consider your self healthy?
Yes
No
What is your principal concern?
How often do you visit a doctor?
List one preventive diagnostic test that you had the previous 6 months: ( colorectal screening, pap test, ECG, CXR, ultrasonogram etc):
Does your employer offer health promotion/wellness programs?
Yes
No
Type of health insurance( state) :
In the following section, select which answer describes you. *Note that N/A stands for not applicable
Always
Sometimes
Never
N/A
You wear a seat belt:
You wear a helmet when riding a bicycle, rollerblading or skateboarding:
You drive the posted speed limit:
You eat at least 5 servings of fruits and vegetables each day:
You eat fast food more than once a week:
You exercise at a moderate pace at least 30 minutes per day, 5 days per week:
You consume more than 3 alcoholic drinks per day (female) or more than 5 per day (male):
You smoke cigarettes:
You chew tobacco:
You are exposed to secondhand smoke in your home or at work:
You use illegal drugs (marijuana, cocaine, methamphetamine, etc.):
You perform self-exams for cancer (breast or testicular):
You wash your hands with soap and water after using the restroom:
You undergo physiotherapy for lower back pain
You apply sunscreen before planned time outside:
You get a flu shot each year:
You practice safe sex (condom or other barrier method, etc.):
You take vitamin pills or supplements daily:
You spend money on gambling more than once a month:
You attend religious services regularly:
You volunteer in your community (church, schools, civic organizations, etc.):
You donate money to community based organizations (churches, non profit organizations, etc.):
You get enough sleep each night (7-9 hours):
You feel stressed out:
You feel happy about your life:
You feel lonely:
You worry about losing your job:
You feel safe in your community:
You are afraid for your children’s health
You feel that the government is liable for your health
You feel that the government is liable for your children’s health
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