The community health nurse is working on creating nutrition initiatives for a community with a high incidence of heart disease and diabetes. Which of the following is a driving factor in the persistence of food deserts in areas of the United States?

Correct Answer: A

Rationale: The correct answer is A: Structural racism. Structural racism refers to the system in which policies, practices, and norms perpetuate racial inequalities. In the context of food deserts, structural racism leads to unequal access to healthy food options in marginalized communities, contributing to health disparities like heart disease and diabetes. Implicit bias (B) and explicit racism (C) are forms of individual prejudice, which, while harmful, do not fully explain the systemic issue of food deserts. Mass incarceration (D) is related to the criminal justice system and does not directly address the lack of access to nutritious foods in communities affected by structural racism.

Correct Answer: B

Rationale: With the rapid growth of technology and increased demands on the private and public health care subsystems, health care costs have become prohibitive. Cost-effectiveness and cost containment have become critical driving forces as health care delivery system changes are made; however, cost-effectiveness often conflicts with the provision of quality care.

Correct Answer: D

Rationale: Managed care has become a dominant paradigm in health care. This model has replaced fee for service by a physician in independent practice or physicians in a group practice, and care in a community health center.

Correct Answer: D

Rationale: Voluntary health agencies are committed to specific diseases, organ or body structures, health and welfare of special groups, or particular phases of health. Philanthropic groups support research and programs. These organizations provide major sources of help in preventing disease, promoting health, treating illness, consumer education, and advocacy and research. Unfortunately, there continue to be overlaps among private, voluntary, and public agencies, but without voluntary agencies, fewer services would be available.

Correct Answer: A

Rationale: The federal government has been assuming a larger role in the protection of the population through regulation and funding. Local health departments establish local health codes, fund public hospitals, and provide services to populations at risk who often lack health insurance. State health departments are highly dependent on the federal level of resources and guidance. Regional health districts are not used as a level of government in the United States.