The Elimination of Racial and Ethnic Disparities A Public Health Priority

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1 Massachusetts Department of Public Health The Elimination of Racial and Ethnic Disparities A Public Health Priority September, 2009

2 The Elimination of Racial and Ethnic Disparities is a Core Public Health Goal Data clearly indicate that it needs to a priority to address a wide range of health issues There is unevenness within public health with regard to whether this is a top priority Positive examples exist that demonstrate what public health can do to have an impact on disparities even in difficult economic ties 2

3 Why Should this be a Priority?

4 Racial Disparities in Boston Health Indicator Black White Black vs. White Asthma (< 5, hosp) 12.5 per x Birth Weight (Less than 3.3lbs) 3.4% of births x Body Weight (Overweight or 65% 47% 1.4 x Breast Cancer (Morality) 33.9 per 100, x Cervical Cancer (Mortality) 2.4 per 100, x Death Rate (Mortality) per 100, x Diabetes (Mortality) 41.1 per 100, x Drug Related Mortality 27.9 per 100, (1.3x) Heart Disease (Mortality) per 100, x High Blood Pressure 27% 20% 1.4 x HIV / AIDS (Mortality) 20.9 per 100, x Homicide 31.3 per 100,000 n<5 >8 x Hospitalization per 1, x Infant Mortality (Mortality) 11.3 per 1, x Lung Cancer (Mortality) 57.5 per 100, x Prostate Cancer (Mortality) 80.5 per 100, x Smoking during pregnancy 3.4% 4.9% (1.4 x) Suicide (Mortality) (1.7 x) Teen Birth Rate (15-17) 26.2 per 1, x Uninsured 11.1% 5.8% 1.9 x 4

5 Ratio of All Cause Mortality Rates Compared to White non-hispanics Massachusetts: Ratio of Rates Worse Off Better Off %* APC Blacks to Whites -1.5%* APC Hispanics to Whites -1.0%* APC Asians to Whites * Statistically Significant (p.05) APC = Annual Percentage Change 5

6 Infant Mortality Rates by Race/Ethnicity Western Region and Massachusetts: * White^ Black^ Hispanic Asian^ 14 Deaths per 1000 live births * State Overall: * 11.3 * 7.0 * 3.0* 2 NA 0 Western Region Massachusetts NA= Calculations based on less than 5 events are excluded (*) Statistically different from State (p.05) ^ = Non-Hispanic Source: MDPH, Bureau of Health Information, Statistics, Research, & Evaluation Bureau, Division of Research & Epidemiology 6

7 HIV/AIDS Death Rate by Race/Ethnicity Western Region and Massachusetts: White non-hispanic Hispanic 29 * Black non-hispanic Asian non-hispanic Deaths per 100, NA 2 Western Region Age-adjusted to the 2000 US standard population. Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program Massachusetts 1 Source: MDPH, 7

8 Asthma Emergency Department Visit Rates Children Ages 0-14 Western Region and Massachusetts: 2005 White non-hispanic Hispanic Black non-hispanic Asian non-hispanic 2,500 2,196 * 2,096 Visits per 100,000 2,000 1,500 1, ,683 ** , Western Region Massachusetts Statistically different from State (p.05) Red (*) = Statistically higher; Green (**) = Statistically lower Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year Emergency Department Visits 8

9 Diabetes An Example of a Growing Health Problem with Racial and Ethnic Disparities 9

10 Prevalence of Diabetes in Massachusetts Varies Significantly by Race/Ethnicity Age adjusted rate per Asian Hispanic Black (NH) White Total SOURCE: Mass DPH. 10

11 Diabetes Hospital Discharges, MA White Black Hispanic Asian Rate per 100, Hospital discharge rate Source: Division of Health Care Finance and Policy, Inpatient Hospital Discharge Database 11

12 Mortality Rates are Much Higher for Blacks and Hispanics Mortality Rates for Diabetes as the Primary Cause of Death, by Race, Rate p er 100, Years Source: Mass Dept of Public Health White, NH Black, NH Hispanic Asian/Pacific Islander, NH 12

13 And then there is H1N1

14 Race/Ethnicity of Novel H1N1 Cases Compared to the Boston Population 14

15 Race/Ethnicity of Hospitalized Novel H1N1 Influenza Cases 77% of cases vs. 51% of population Black 35 (49%) Hispanic 20 (28%) Other 5(7%) White 11 (15%) 15

16 What Causes These Disparities? 16

17 Substantial Variation in Diabetes Rates by Household Income <$25, fold variation $75,000 + Source: NEHI/Boston Foundation: Boston Paradox 17

18 Diabetes by Education, Percent < HS HS grad 1-3 years college 4+ years college MA Statistically different from state (p.05) Red (*) Statistically worse than state- Green (**) statistically better than state Source: MDPH, Bureau of Health Information, Statistics, Research and Evaluation, Health Survey Program 18

Racial & Ethnic Disparities Infant Mortality & Education, 2003 10.2 6.

19 Racial & Ethnic Disparities Infant Mortality & Education, DATA SOURCE: Infant Mortality Statistics from the 2003 Period Linked Birth/Infant Death Data Set, National vital statistics reports; vol. 54, no. 16. Hyattsville, MD; National Center for Health Statistics,

20 The Experience of Racism and Discrimination Boston Adults Who Report Having Been Treated Worse Than People of Other Races When Seeking Health Care During the Previous Year, By Race/Ethnicity Percentage of resp ondents 40.0% 30.0% 20.0% 10.0% 0.0% 8.3% 4.0% 1.9% Black Latino White 20

Leading Occupations in Massachusetts by Race/Ethnicity HISPANIC ASIAN Nursing

drivers drivers BLACK Nursing aides aides Janitors & cleaners RNs RNs Cashiers

Physicians Cashiers WHITE Secretaries Managers & admin.

21 Leading Occupations in Massachusetts by Race/Ethnicity HISPANIC ASIAN Nursing aides aides Janitors & cleaners Grounds maintenance Maids Maids Truck Truck drivers drivers BLACK Nursing aides aides Janitors & cleaners RNs RNs Cashiers Maids Maids ASIAN Computer engineers Medical scientists Waiters & waitresses Physicians Cashiers WHITE Secretaries Managers & admin. admin. Supervisors in in retail retail sales sales RNs RNs Salespersons 21 Source: Current Population Survey:

22 Hispanic workers are at high risk of fatal occupational injury in Massachusetts 5 Deaths per 100,000 workers White Hispanic Source: Massachusetts Census of Fatal Occupational Injuries,

23 Minority workers experience higher rates of hospitalizations for some work-related injuries White Black Hispanic Asian Hospitalizations per 100,000 workers Amputations Burns 5.3 Source:: DHCFP Hospital Discharge Data Set: ; Hospitalization Rates for Work-Related Injuries 23

24 What Can be Done in Public Health to Address the Issue?

25 Leadership at the Highest Levels Helps The Elimination of Disparities is an Explicit Priority of the Patrick Administration 25

26 Hire Diverse Leadership After years of little diversity in leadership 26

other grants Involvement in senior policy inside and

27 Focus Attention at the Highest Levels Creation of DPH Health Equity Office Management of disparities and other grants Involvement in senior policy inside and outside of DPH Use of the position as a bully pulpit 27

28 Provide Information on Disparities Regulatory mandate that hospitals collect and report accurate, consistent patient race and ethnicity data 28

Guarantee Interpreter Services Chapter 66 of the Acts of 2000 Emergency Room Interpreters Law (ERIL) every acute care hospital shall provide competent interpreter services in connection with all

29 Guarantee Interpreter Services Chapter 66 of the Acts of 2000 Emergency Room Interpreters Law (ERIL) every acute care hospital shall provide competent interpreter services in connection with all emergency room services provided to every non-english speaker who is a patient or who seeks appropriate emergency care or treatment. DPH Releases the 1 st Annual Hospital Interpreter Services Report 1.2 million interpreter sessions completed in Massachusetts in over 100 different languages in a one year period. 29

30 Issue Special Reports 30

Promote Higher Quality Services Making CLAS Happen CLAS (Culturally and Linguistically Appropriate Services) Standards (US DHHS, 2001) contribute to the elimination of racial and ethnic health

31 Promote Higher Quality Services Making CLAS Happen CLAS (Culturally and Linguistically Appropriate Services) Standards (US DHHS, 2001) contribute to the elimination of racial and ethnic health disparities make services more responsible to the individual needs of clients are inclusive of all cultures, while specifically designed to address the needs of racial, ethnic, and linguistic minority groups. 31

32 Provide Specialized Funding Release of $1M dollars to support innovative efforts throughout the state *42 grantees across the state *Workforce development, quality improvement, social determinants 32

33 Work with Local Communities Supporting local screenings of Unnatural Causes* to build awareness about health disparities. Working with communities to develop goals to eliminate disparities in health. *Unnatural Causes Produced by California Newsreel 33

34 Change Internal DPH Efforts Increase programming for health issues affecting communities of color ($2 M in violence prevention) Adapt existing DPH programs to reflect focus on racial and ethnic disparities (new RFP criteria) 34

35 Develop Targeted Campaigns 35

36 36

37 Wellness Promotion/Obesity Prevention Initiative Mass In Motion 37

restaurants to post the calorie content of their food Such

38 Consider Needed Policy Changes Example: Passage of Menu Labelling Regulation New regulations require fast food chain restaurants to post the calorie content of their food Such restaurants are more likely to be located in neighborhoods of color 38

39 Example of disproportionate impact low income residents of color 39

40 Low income neighborhoods are less likely to have Supermarkets with large produce sections Farmers markets Accessible recreational facilities Safe, walkable neighborhoods 40

41 An Example of the Adaptation Process Support the Successful Implementation of Health Care Reform

42 42

43 Percentage of males who reported that they did not have Health Insurance, by Race/Ethnicity, % per. Mov. Avg. (Black NH) 2 per. Mov. Avg. (Hispanic) 2 per. Mov. Avg. (White NH) 43

44 Latinos and other people of color less likely to have health insurance 44

45 45

46 Additional Areas of Health Disparity Often intensifying racial and ethnic disparities

47 Income 47

48 Education : Prevalence of serious mental health distress *Significant at the p<.05 level 48

49 Disabilities 49

50 Age Suicides by Gender and by Age Massachusetts: Female Male 120 Number of Deaths

Gender Men s Health: Life Expectancy by Gender and Age Massachusetts: 2007 100 Life Expectancy in

51 Gender Men s Health: Life Expectancy by Gender and Age Massachusetts: Life Expectancy in Years Male 21.1 Female At Birth At Age 65 At Age 75 51

52 Sexual Orientation 52

disabilities 12,000 inpatient admissions per year in

53 Jobs Soldiers and Veterans Face Higher Health Risks 441,000 veterans in Massachusetts 53,000 with disabilities 12,000 inpatient admissions per year in Mass. to VA hospitals Physical injuries and post traumatic stress disorder 53

54 The Common Occurrence: Racial/Ethnic Disparities combined with others disparities 54

Diabetes Prevention and Control A Comprehensive Process. Commissioner John Auerbach Massachusetts Department of Public Health

Diabetes Prevention and Control A Comprehensive Process Commissioner John Auerbach Massachusetts Department of Public Health Like everywhere else, Massachusetts has a growing diabetes problem Diabetes