ELIMINATING HEALTH DISPARITIES IN AN URBAN AREA. VIRGINIA A. CAINE, M.D., DIRECTOR MARION COUNTY HEALTH DEPARTMENT INDIANAPOLIS, INDIANA May 1, 2002

Transcription

1 ELIMINATING HEALTH DISPARITIES IN AN URBAN AREA VIRGINIA A. CAINE, M.D., DIRECTOR MARION COUNTY HEALTH DEPARTMENT INDIANAPOLIS, INDIANA May 1, 2002

2 Racial and ethnic disparities in health care are unacceptable in a country that values equality and equal opportunity for all. And that is why we must act now with a comprehensive initiative that focuses on health care and prevention for racial and ethnic minorities. President Bill Clinton February 21, 1998

3 President s Initiative to Eliminate Racial and Ethnic Disparities in Health Target conditions Infant mortality Cancer screening and management Cardiovascular disease Diabetes HIV infection/aids Immunizations

4 Healthy People 2010 Two Overarching Goals: Increase Quality and Years of Healthy Life Eliminate Health Disparities

5 What Are Health Disparities? Differences in the incidence, prevalence,mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.

6 Why The Interest In Disparities? The changing demography of the American population The persistence of disparities in the health status of racial and ethnic minorities

7 Percent Distribution of U.S. Population by Race and Ethnicity, 2000 African American/ Black 12.2% Asian/Pacific Islander 3.8% White, not Hispanic/ Latino 71.4% Hispanic/ Latino 11.9% American Indian/Alaska Native 0.7% Source: U.S. Census Bureau, 2000

8 Percent of the Population by Race and Hispanic Origin, 2000 and % 12.2% 11.4% 8.2% 13.6% 24.5% American Indian/Alaska Native Asian/Pacific Islander Black/African American 71.8% 52.8% Hispanic/Latino White, not Hispanic/Latino Source: U.S. Bureau of the Census 2000

9 Emerging Majorities Minority people are the majority in three states California (50.1%) Hawaii (71%) New Mexico (53%) District of Columbia (71%)

10 Emerging Majorities Minority people are now at least 30% of the population in ten states: Texas (45%) Mississippi (38%) Maryland (36%) New York (35%) Georgia (34%) Arizona (32%) Florida (32%) New Jersey (32%) South Carolina (32%) Nevada (30%)

11 Percent of the Population by Race and Hispanic Origin, Indiana 1990 White, not Hispanic: 90.1% 2000 White, not Hispanic: 86.5% Black/African American: 7.8% Black/African American: 8.3% Asian/Pacific Islander: 0.2% Asian/Pacific Islander: 1.0% Hispanic/Latino: 1.7% Hispanic/Latino: 3.6% American Indian/Alaska Native: 0.3% American Indian/Alaska Native: 0.7%

12

13 Life Expectancy at Birth, Years White Black SOURCE: CDC/NCHS, National Vital Statistics Systems,

14 Infant Mortality Rates, White Black Deaths <1 year/1000 live births SOURCE: CDC/NCHS, National Vital Statistics System,

15 Infant mortality rates by race and Hispanic origin of mother Total Hispanic Non-Hispanic white Non-Hispanic black 14.3 Asian/Pacific Islander SOURCE: CDC/NCHS, National Vital Statistics System, Deaths <1 year per 1000 live births

16 Infant mortality rates by Hispanic origin of mother Total Hispanic Mexican Puerto Rican 8.9 Cuban Central/South American SOURCE: CDC/NCHS, National Vital Statistics Systems, 1995 Deaths <1 year per 1000 live births

17 Infant mortality rates by Asian/Pacific Islander subgroup Asian/Pacific Islander 5.3 Chinese 3.8 Japanese 5.3 Hawaiian 6.6 Filipino 5.6 SOURCE: CDC/NCHS, National Vital Statistics Systems, Deaths <1 year per 1000 live births

18 Coronary heart disease death rates White Black A/PI AI/AN Hispanic Per 100,000 population NOTE: Death rates are age-adjusted to 1940 standard million age distribution. A/PI is Asian American or Pacific Islander; AI/AN is American Indian or Alaska Native. SOURCE: CDC/NCHS, National Vital Statistics System, 1990 and 1996

19

20 Racial and Ethnic Disparities: Morbidity and Mortality African American men have a 40 percent higher heart disease rate than White men Women of Vietnamese origin in the United States suffer from cervical cancer at nearly five times the rate than White women

21 Racial and Ethnic Disparities: Morbidity and Mortality Native Americans have a diabetes rate that is nearly three times the rate of Whites. The Hispanic rate is nearly double that of Whites African American women are 28% more likely to die from breast cancer, although the incidence is greater in White women

22 How Do We Explain Racial And Ethnic Disparities In Health?

23 Several Causal Factors Socioeconomic status (SES) Health risk behaviors Psycho-social factors Acculturation Biologic/Genetic factors Health care

24 Socioeconomic Status Education Occupation Income Environment Culture

25

26

27 Infant Mortality Rates in the United States Deaths/1000 Live births < Education in years NHW=Non-Hispanic White NHB=Non-Hispanic Black SOURCE: CDC/NCHS/NVSS

28 Health Risk Behaviors

29 Health Risk Behaviors Female Current smokers White Black Hispanic >1 oz. alcohol per day Regular exercise or sports percentage engaging in activity SOURCE: CDC/NCHS, National Health Interview Survey, 1990

30 Health Risk Behaviors Male White Current smokers Black Hispanic >1 oz. alcohol per day Regular exercise or sports percentage engaging in activity SOURCE: CDC/NCHS, National Health Interview Survey, 1990

31 Age-adjusted Prevalence of Obesity (BMI > 30.0) Female Non-Hispanic Whites NHANES II NHANES III Non-Hispanic Blacks Mexican Americans Percent SOURCE: CDC/NCHS, Second National Health and Nutrition Examination Survey, Third National Health and Nutrition Examination Survey,

32 Age-Adjusted Prevalence of Obesity (BMI > 30.0) Non-Hispanic Whites Male 12.0 NHANES II NHANES III 20.0 Non-Hispanic Blacks Mexican Americans Percent SOURCE: CDC/NCHS, Second National Health and Nutrition Examination Survey, Third National Health and Nutrition Examination Survey,

33 Psychosocial Factors

34 Psychosocial Factors Large complex literature relating factors such as stress and discrimination with racial/ethnic differences in hypertension

35 Acculturation

36 Acculturation Some health behaviors worsen with acculturation

37 Biological and Genetic Factors

38 Health Care

39 Percentage Uninsured Under Age 18 United States Percent of Population White Black Hispanic Source: CPS, USCB

40 Health Care Coverage of Persons Under 65 (Age-adjusted) All Hispanic NH White NH Black Private Medicaid/ Public Assistance Not covered Asian/PI Percent SOURCE: CDC/NCHS, National Health Interview Survey, 1996

41

42 Health Care Extensive evidence of racial and/or ethnic Differences in utilization of health care Diagnostic tests and procedures Therapeutic procedures Intensity of care Pain control Transplants Preventive services

43 Possible Explanations for the Racial and Ethnic Differences in Utilization Socioeconomic status Language Insurance status Severity of illness Patient health behaviors Provider bias

44

45

46

47

48

49

50

51

52

53

54

55

56

57 IOM Report Findings Racial and ethnic disparities in healthcare exist and, because they are associated with worse outcomes in many cases, are unacceptable.

58 IOM Report Findings Factors contributing to racial and ethnic disparities in healthcare: Health systems Healthcare providers Patients and utilization managers Bias, stereotyping, prejudices Clinical uncertainty on the health of care providers

59 IOM Report Recommendations Increase awareness of racial and ethnic disparities among the general public, key stakeholders, and healthcare providers Legal, regulatory, and policy interventions Health systems interventions

60 Factors Influencing Optimal Medical Care Effective patient-physician communication Overcoming cultural and linguistic barriers Access to affordable health insurance Alternatives to hospital emergency rooms Improvement in continuity of care Improving information for patients Participate in the latest quality improvement innovations

61 Of all the forms of inequality, injustice in health is the most shocking and the most inhumane. -- Dr. Martin Luther King, Jr.