Johns Hopkins University Health Disparities Seminar Series. Eliminating Health Disparities in Maryland
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1 Johns Hopkins University Health Disparities Seminar Series Eliminating Health Disparities in Maryland Joshua M. Sharfstein, MD, Secretary Maryland Department of Health & Mental Hygiene and Carlessia A. Hussein, RN, DrPH, Director DHMH Office of Minority Health & Health Disparities September 12, 2011 Office of Minority Health and Health Disparities Maryland Department of Health and Mental Hygiene 1
2 Objectives of the Presentation Review Health Disparities Data Themes Review Selected Health Disparities Data for the United States, Maryland and Baltimore City Discuss Strategies in Maryland Disparities Plan Present Partnerships & Collaborations Discuss new initiatives 2
3 3
4 Maryland Population Data Maryland Population by Race and Hispanic Ethnicity, 2010 Census Maryland % of MD Total 5,773, % Race, regardless of Hispanic Ethnicity: White (one race) 3,359, % Black or African American (one race) 1,700, % American Indian/Alaska Native(one race) 20, % Asian (one race) 318, % Native Hawaiian/Pac Islander (one race) 3, % Other race (one race) 206, % Two or more races) 164, % Hispanic Ethnicity, regardless of Race: 470, % 4
5 Health Disparities Data Themes Health Status Disparities: Disease mortality and morbidity rates Disease frequency (incidence and prevalence Disease risk factor prevalence Social determinants of health (place matters) Health Care Disparities Health insurance rates Health care utilization rates Health care quality metrics 5
6 Mortality Rate Disparities Black and White Mortality Rates for Selected Conditions and Geographies Condition US Maryland Baltimore City Age-Adjusted Mort Rates / 100K population Heart Disease Black CDC Wonder White Cancer Black CDC Wonder White Diabetes Black CDC Wonder White HIV/AIDS Black CDC Wonder White Infant Deaths / 1000 live births Infant Mortality Black US: Health US 2010 White MD: 2009, 2010 IM Reports IMR IMR
7 Disease Prevalence Disparities US data: MD and Baltimore City data: Black vs. White Prevalence Rates for Selected Conditions and Geographies (NH = Non Hispanic) BRFSS 2005 BRFSS Condition Age Group Race Group US Maryland Baltimore City Diagnosed Hypertension Age NH Black 20.5% * 20.7% * NH White 11.6% 5.8% Age NH Black 50.6% * 53.8% * 60.4% * NH White 32.6% 33.7% 32.0% Age 65+ NH Black 72.7% * 75.6% * 76.8% * NH White 54.3% 57.9% 52.5% Diagnosed Diabetes Age NH Black 3.7% * 4.8% NH White 2.1% 2.7% Age NH Black 19.2% * 17.5% * 21.0% * NH White 9.1% 9.6% 11.9% Age 65+ NH Black 29.7% * 32.2% * 31.2% NH White 15.6% 17.3% 16.0% * means that NH Black rate is statistically different from corresponding NH White rate 7
8 Disease Risk Factor Disparities US data: MD and Baltimore City data: Black vs. White Prevalence Rates for Selected Risk Factors and Geographies (NH = Non Hispanic) BRFSS 2005 BRFSS Condition Age Group Race Group US Maryland Baltimore City Obesity Age NH Black 33.2% * 38.3% * NH White 21.7% 18.8% Age NH Black 40.2% * 40.1% * 42.7% * NH White 28.1% 28.0% 27.2% Age 65+ NH Black 33.8% * 35.0% * 36.3% * NH White 19.9% 22.1% 19.4% Physical Inactivity Age NH Black 53.8% * 57.6% * NH White 44.5% 44.8% Age NH Black 63.5% * 58.8% * 60.8% * NH White 51.6% 49.6% 49.2% Age 65+ NH Black 72.4% * 70.4% * 69.9% NH White 58.8% 59.0% 63.0% Smoking Age NH Black 17.0% * 31.7% * NH White 20.9% 21.0% Age NH Black 25.0% * 21.5% * 33.4% * NH White 20.8% 15.6% 24.3% Age 65+ NH Black 13.1% * 11.7% * 15.6% * NH White 8.7% 7.4% 8.4% * means that NH Black rate is statistically different from corresponding NH White rate 8
9 Hospital Admission Rate Disparities Black vs. White Admission Rate Disparities (age-adj) for Selected Conditions (AHRQ Prevention Quality Indicators, AKA Ambulatorty Care Sensitive Conditions) Condition (2007 data) Metric United States Maryland Angina without procedure Rate ratio (age 18+) Rate diff / 100K Congestive Heart Failure Rate ratio (age 18+) Rate diff / 100K Hypertension Rate ratio (age 18+) Rate diff / 100K Diabetes with long-term comp Rate ratio (age 18+) Rate diff / 100K Diabetes, uncontrolled no com Rate ratio (age 18+) Rate diff / 100K Asthma Rate ratio (age 18+) Rate diff / 100K
10 Maryland Health Disparities Strategies AWARENESS: - Statewide Health Disparities Elimination Plan - Health Disparities Information Dissemination - Website with Resources & Promising Practices - Use of Health Literacy & Cultural Competency 10
11 Maryland Health Disparities LEADERSHIP: Strategies - Presentations to MD General Assembly Health Disparities Sub-Committee - Recommendations to Secretary of Department of Health and Mental Hygiene - Discussions with DHMH Deputies and Directors of Department s Administrations - Presentations to MD s Legislative Black Caucus - Presentations to Governor s Councils 11
12 Maryland Health Disparities Strategies HEALTH AND HEALTH CARE OUTCOMES: - Minority Outreach & Technical Assistance (MOTA) - Minority Infant Mortality Reduction Programs - Cardiovascular Mortality Reduction Programs - Local Health Disparities Committees (MOTA) - Health Disparities Data Highlights 12
13 Maryland Health Disparities Strategies CULTURAL & LINGUISTIC COMPETENCE: - Workforce Diversity Program (Federal Funds) - MD Health Professions Boards - Community Health Outreach Worker Model - Translating health information materials - Minority Health Roundtables - Maintain Relations with Race and Ethnic Groups - Work with Governor s Minority Commissions - Distribute Timely Emergency Information 13
14 Maryland Health Disparities Strategies DATA, RESEARCH AND EVALUATION: - Publication of Maryland Health Disparities Chartbook with 2009 Update - Dissemination of Subject-Matter Data Highlights - Dissemination of Geographic Area Highlights - Structured Collection & Analysis of Outreach - Monitoring Trends in Minority Mortality by Area - Researching Determinants of Health (Racism) 14
15 Success Stories & Promising Practices Reduced All-Cause Cancer Mortality by 50.3% Between Blacks and Whites from Established Maryland Health Disparities Network Database of over 4000 (unduplicated count) Reached 1.2 Million Minorities from with Health Disparities Prevention Information Published Two Health Disparities Plans and Distributed Widely Throughout the State Convened 7 Statewide Disparities Conferences 15
16 Health Disparities Partnerships Local Health Department Programs Hopkins Center to Eliminate Cardiovascular Health Disparities University of Maryland Medical School University of Maryland School of Public Health at College Park HHS Region III Health Equity Council Maryland Health Care Commission Federal HHS Office of Minority Health National Association of State Offices of Minority Health 16
17 Joint Efforts and Opportunities Maryland Health Disparities Centers Workforce Diversity MD Health Alliance and Allied Health Alliance (underdevelopment) Social Determinants of Health Rural Minority Health Birth-to-Prison Invisible Pipeline: Black Males Bring Together the State Health Disparities Centers Conduct Joint Research 17
18 New Initiatives Cost & Quality Council Disparities Workgroup Focus on health care disparities Public health and Prevention Focus on state policy initiatives E.g. Tobacco and nutrition State Health Improvement Process Accountability, local action, public engagement 18
19 Contact Information Office of Minority Health and Health Disparities Maryland Department of Health and Mental Hygiene 201 West Preston Street, Room 500 Baltimore, Maryland Website: Phone: Fax:
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