HEALTH DISPARITIES By Hana Koniuta November 19, 2010
"We need to focus on the uninsured and those who suffer from health care disparities that we so inadequately addressed in the past." Sen. Bill Frist (R-Tenn), Senate majority leader on his priorities for the 108th Congress
Health disparities are Gaps in the quality of health and health care among different groups of people.
CDC definition: Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. These disparities are inequitable and are directly related to the historical and current unequal distribution of social, political, economic, and environmental resources.
Populations can be defined by: o race or ethnicity o gender o age o education o income/socioeconomic status o disability o geographic location o sexual orientation
Factors that contribute to health disparities: Poverty Environmental conditions Access to (quality) health care Individual and behavioral factors Genetic predisposition Educational inequalities Occupational exposure Ethnic or familial factors Discrimination
Institute of Medicine study -In 1999 the U.S. government asked the Institute of Medicine to investigate disparities in health and health care among racial and ethnic minorities. -Results from the study, called Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, found that minorities had poorer health and were consistently getting lower-quality care even when factors such as insurance status and income weren't involved. - Minorities were less likely to get lifesaving heart medications, bypass surgery, dialysis, or kidney transplants. They were more likely to get their feet and legs amputated as a treatment for late-stage diabetes.
Despite continued advances in health care and technology, racial and ethnic minorities continue to have higher rates of disease, disability and premature death than non-minorities. Two major factors Inadequate Access to Care Barriers to care can result from economic, geographic, linguistic, cultural and health care financing issues. Even when minorities have similar levels of access to care, health insurance and education, the quality and quantity of health care they receive are often poor. Substandard Quality of Care Lower quality care has many causes, including patient-provider miscommunication, provider discrimination, stereotyping or prejudice. (Quality of care is usually rated on the four measures of effectiveness, patient safety, timeliness and patient centeredness).
Why is this important for us? Federally Qualified Health Centers are designed to provide services for medically underserved areas and populations. o Approximately two-thirds of health center patients are minorities o 9 out of 10 patients have incomes below 200% of the federal poverty line o 4 in 10 health center patients have no health insurance. These are people who are affected by health disparities
Examples of health disparities related to infectious diseases and diseases of the immune system: Asthma prevalence in Puerto Rican populations is estimated to be 80% higher than that of non- Hispanic whites. Prevalence of asthma in African-American and Native-American populations is estimated to be 30% higher than that of non-hispanic whites. African-American women are disproportionately affected by the chronic inflammatory disease lupus, compared to white women. Scleroderma, a disease characterized by hardening in the skin or other organs, is more prevalent in African-American women. African Americans account for approximately 13% of the U.S. population, but represent almost half of new AIDS diagnoses.
More stats Hispanics/Latinos comprise 15% of the U.S. population, yet account for approximately 17% of new HIV infections. The rate of Chlamydia among African Americans is estimated to be eight times higher than the rate among whites. Rates among Native Americans and Hispanics/Latinos are estimated to be five times and three times higher than whites, respectively. In 2006, African Americans accounted for 69% of reported cases of gonorrhea. In that same year, Native Americans had the second-highest gonorrhea rate, followed by Hispanics/Latinos. In 2006, of the 13,767 TB cases reported in the United States, 83% occurred in racial minorities.
Health Disparities in Connecticut Racial and ethnic diversity continues to increase in CT Hispanic/Latino population is rapidly increasing Racial and ethnic minority residents are more likely to be poor compared to Caucasians in CT Mortality data shows that compared with other racial and ethnic subgroups in CT African-Americans suffer disproportionately from major chronic diseases (heart disease, stroke, diabetes, cancer) and other causes of death such as HIV/AIDS and homicide Lack of health insurance is an urgent health problem facing many state residents In Connecticut, Hispanic residents are about 5.4 times more likely, and Black residents 2.7 times more likely, to be uninsured than White residents
More CT data Lower-income adults in CT are less likely to complete recommended screening tests for certain types of cancers such as Paps and colonoscopies compared with those of high income. Adult smokers in CT are more likely to be younger and have lower incomes and less education than non-smokers. Lower-income adults are more likely to be obese than higher-income adults. People without health insurance, and those with lower incomes and less education are more likely to report never having had their blood cholesterol checked. In CT cases of HIV/AIDS are most prevalent in persons of Hispanic and African-American origin.
Relationship between health disparities and educational opportunities among youth: Higher levels of education are associated with more years of life Higher education = an increased likelihood of obtaining or understanding basic health information and services Less education = higher levels of health risks, such as obesity, substance abuse, and violence Good health is associated with academic success Health risks such as teenage pregnancy, poor dietary choices, inadequate physical activity, physical and emotional abuse, substance abuse, and gang involvement significantly impact how well students perform in school
Addressing Health Disparities Central focus of strategic plans for both the Dept. of Health and Human Services and the CDC CDC goals directly address the importance of reaching at-risk populations: Healthy People in Every Stage of Life All people, and especially those at greater risk of health disparities, will achieve their optimal lifespan with the best possible quality of health in every stage of life. Healthy People in Healthy Places The places where people live, work, learn, and play will protect and promote their health and safety, especially those at greater risk of health disparities. Culturally appropriate school programs that address risk behaviors among youth, especially when coordinated with community efforts, could improve the health of populations at risk for health disparities, and the health of the nation as a whole.
Healthy People 2010 o Department of Health and Human Services initiative o o Provides framework for health promotion and disease prevention Statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats. o Goal 1: Increase Quality and Years of Healthy Life o help individuals of all ages increase life expectancy and improve their quality of life o Goal 2: Eliminate Health Disparities o eliminate health disparities among different segments of the population
Current research Many governmental organizations study specific health disparities among minority populations in an effort to eliminate disparities and make improvements. Examples: National Cancer Institute, Cancer Health Disparities Centers for Disease Control and Prevention, Disparities in HIV/AIDS and STDs American Lung Association, Disparities in the Impact of Air Pollution National center on minority health and health disparities NCMHD CT Center for Eliminating Health disparities among Latinos
Disparities in the Impact of Air Pollution People of lower economic status and some racial and ethnic minorities face higher exposure to air pollution. Studies show that low socioeconomic status is associated with greater harm from air pollution. Reasons why disparities may exist: Groups may face greater exposure to pollution because of factors ranging from racism to class bias to the housing market and land costs. For example, pollution sources may be located near disadvantaged communities, increasing exposure to harmful pollutants. Air pollution levels are higher in major cities. Low social position may make some groups more susceptible to health threats because of factors related to their disadvantage. Lack of access to health care, fewer job opportunities, unsafe workplaces, or access to healthy food are among the factors that place groups at risk of harm. Existing health conditions, behaviors, or traits may predispose some groups to greater risk. For example, diabetics are among the groups most at risk from air pollutants and the elderly, Blacks/African Americans, Mexican Americans and people living near a central city have higher incidence of diabetes.
Solutions Community involvement is essential to successfully change policies, systems, and environments at the local level Developing effective, sustainable, community-based strategies and interventions requires recognizing the importance of key elements that respond to the specific needs of each community and its members 1. Trust: build a culture of collaboration with communities that is based on trust 2. Empowerment: give individuals and communities the knowledge and tools needed to create change by seeking and demanding better health and building on local resources 3. Culture and history: design health initiatives that acknowledge and are based in the unique historical and cultural context of racial and ethnic minority communities in the U.S. 4. Focus on Causes: Assessing and focusing on the underlying causes of poor community health and implementing solutions designed to remain embedded in the community s infrastructure
more solutions 5. Community Investment and Expertise: recognize and invest in community expertise and work to motivate communities to mobilize and organize existing resources 6. Trusted organizations: embrace and enlist community organizations valued by community members, including groups with a primary mission not related to health 7. Community leaders: help community leaders and key organizations to act as catalysts for change in the community. Forge unique partnerships 8. Ownership: develop a collective outlook to promote shared interest in a healthy future through widespread community engagement and leadership 9. Sustainability: make changes to organizations, community environments, and policies to help ensure that health improvements are long-lasting and community activities and programs are self-sustaining 10. Hope: foster optimism, pride, and a promising vision for a healthier future
Needs assessment Use needs assessment as a way to identify problems, match programs and solutions to these problems, and develop an action plan with the people they serve 4 steps Analyze the person/populations existing situation/problem Identify the importance of varying factors in the situation and set priorities among them Identify casues of performance problems/opportunities Identify possible solutions and growth opportunities
Sources: Stratton, A., M.M. Hynes, A.N. Nepaul. 2009. The 2009 Connecticut Health Disparities Report Hartford, CT: Connecticut Department of Public Health. http://www.communityhealthcorps.org/client/documents/prescr iption-1-health-disparities-member.pdf http://www.cdc.gov/healthyyouth/disparities/intro.htm http://www.cdc.gov/healthyyouth/healthtopics/disparities.htm American Lung Association. http://www.stateoftheair.org/2010/health-risks/health-risksdisparities.html Reaching across the Divide: Finding Solutions to Health Disparities.http://www.cdc.gov/reach/pdf/health_disparities_ 101607.pdf