Question 1Washington D.C. fares better than other states and territories in terms of public health. Still, excess and binge drinking remains a subject of ongoing concern. According to County Health Rankings & Roadmaps (2017), 25 percent of the district population engage in excess or binge drinking, as compared to only 12 percent in the top performing states. American Health Rankings (2015) have shown that in District of Columbia excessive drinking is particularly prevalent among middle- and high-income white Americans aged between 18 and 44 years. Men are more likely to be affected by binge drinking than women, and college graduates are also more susceptible to the risks of developing alcohol dependence than those without a degree (American Health Rankings, 2015).

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Researchers say that the drivers behind this geographic disparity are unknown. Chandra, Blanchard, and Ruder (2013) suggest that high rates of unemployment, the growing number of college graduates, and other demographic transitions could increase the proportion of men and women who engage in binge drinking. The uniqueness of the binge drinking disparity is that it affects primarily the white better-off majority, although representatives of ethnic and racial minorities are not secured from its risks. The best strategy for closing the existing disparity is by increasing the availability of community programs to reduce the scope of binge drinking in Washington D.C. (Department of Health & Human Services, 2013). Community nurses should work collaboratively with local authorities to implement broad programs that will educate the affected community about the risks and negative consequences of binge drinking, as well as propose new policies to limit the availability of alcoholic drinks in Washington, D.C.

  • America’s Health Rankings. (2015). District of Columbia. Retrieved from
  • Chandra, A., Blanchard, J.C., & Ruder, T. (2013). District of Columbia community health needs assessment. The RAND Corporation.
  • County Health Rankings & Roadmaps. (2016). District of Columbia. Retrieved from
  • Department of Health and Human Services. (2013). A nation free of disparities in health and health care. HHS.

Question 2
Not all nurses can easily demonstrate their cultural competence in clinical settings. Kodjo (2009) writes that cultural competence begins with self-awareness. As a nurse, I bear in mind the principles, values, and cultural priorities that guide my clinical decisions. I always evaluate the extent to which these principles and values align with those of individual patients I encounter in my practice. My place of employment is sensitive to language and cultural barriers that may prevent patients from obtaining high-quality nursing care. At the same time, cultural competence could reduce the existing disparities, by providing a deeper insight into the cultural factors behind these disparities and their effects on target populations. It could also inform the development of culturally sensitive initiatives to put an end to various health and wellness disparities in the U.S.

  • Kodjo, C. (2009). Cultural competence in clinical communication. Pediatrics in Review, 30(2), 57-64.