: Why Zip Code Matters Christy Eskes, DHSc, MPA, PA-C October 12, 2014 Differences in health outcomes across segments of the population Substantial disparities in health, life expectancy, and quality of life Majority due to the social determinants of health The conditions in which a person is born, grows, lives, works, and ages Health system factors Complexity of the healthcare system Unfamiliarity with the Western model Referrals Instructions for procedures Medication instructions Quality of hospitals/clinics located in areas with high percentages of minority groups Initial study in 1985: 60,000 excess deaths occur each year in minority populations Six causes = >80% of these deaths: Cancer Cardiovascular disease and stroke Cirrhosis Diabetes Homicide and accidents Infant mortality 1
How far have we come since 1985? In 2004, the CDC identified significant racial/ethnic disparities among the 10 leading health indicators Socioeconomic factors (education, employment, poverty) Lifestyle behaviors (physical activity, alcohol intake, tobacco use) Social environment (educational and economic opportunities, neighborhood and work conditions) Access to clinical preventive services (cancer screening, vaccination rates) National goals have evolved over time Healthy People 2000 Reduce health disparities Healthy People 2010 Eliminate health disparities Healthy people 2020 Achieve health equity, eliminate disparities, and improve the health of all groups In 2010, President Obama created the Institute on Minority Health and Goal to define the agenda and provide better funding for reducing disparities Disparities defined as differences in the incidence, prevalence, mortality, and burden of disease and other adverse health conditions that exist among specific population groups CDC and Inequalities Report 2013 Some improvement in diabetes prevalence for some groups but worsening in others Highest in males, blacks, Hispanics, undereducated, low income, and those with a disability HIV infection rates higher in all non- Asian racial/ethnic minorities Lower percentage of blacks given antiretroviral therapy Lower percentage of blacks and Hispanics with suppressed viral loads CDC and Inequalities Report 2013 Infant mortality rates more than double in black populations Premature death rates from CVA and CHD higher in blacks than whites Asthma attacks more frequent in low income populations Uncontrolled HTN more prevalent among Mexican-Americans and the uninsured 2
Human The first HDI presented in 1990 and has been provided in an annual Human Development Report on a global level An official government statistic in many countries MeasureofAmerica created a modified version with more specific indicators to reflect U.S. context and maximize use of available data Founded in 2006, became an initiative of the Social Science Research Council in 2008 Goal to provide data to support people-centered policies to improve well-being American Human Developed as an alternative measure of wellbeing across the U.S. versus using GDP All 50 states, broken down by congressional districts, counties, gender, and racial/ethnic groups 2014MeasureofAmerica,AProjectoftheSocialScienceResearchCouncil American Human 2014MeasureofAmerica,AProjectoftheSocialScienceResearchCouncil Views capabilitiesas the tools a person has to be able to pursue a life of value what people cando, and what they can becom e. Defined by both individual effort and societal conditions. Breaking Down the AHDI Breaking Down the AHDI A Long and Healthy Life Life expectancy at birth Access to Knowledge School enrollment for population age 3 and older (1/3 weight) Educational degree attainment for age 25 and older (2/3 weight) A Decent Standard of Living Median earnings of all full- and part-time workers age 16 and older (personal, not household) Each indicator ranges from 0-10, with 10 being the highest Further evaluated by geography, race and ethnicity, gender, and nativity 3
AHDI Historical Trends AHDI by Race and Ethnicity 2014MeasureofAmerica,AProjectoftheSocialScienceResearchCouncil 2014MeasureofAmerica,AProjectoftheSocialScienceResearchCouncil California Human Development Project 2011 Highlighted because of the vast differences across the state in American HDI scores Five of the country s top 10 congressional districts Lowest ranked congressional district So goes California, so goes the nation The Five Californias Represent disparities among various populations Silicon Valley Shangri-La Metro-Coastal Enclave California Main Street California Struggling California The Forsaken Five Percent 2011MeasureofAmerica,AProjectoftheSocialScienceResearchCouncil 4
Why does zip code matter? 2011MeasureofAmerica,AProjectoftheSocialScienceResearchCouncil Example: two men one born and raised in Palo Alto, one in Watts 14 years difference in life expectancy 3-fold difference in earnings 19-times more likely to have completed college The Watts score is similar to that of the nation in the mid-1960s 5
Must be a focused, deliberate effort by multiple stakeholders Healthcare system Federal State Local Healthcare system interventions Collect and report health care access and utilization data by race/ethnicity Encourage use of evidence-based guidelines and quality improvement Support the use of language interpretation services in the clinical setting Increase the proportion of underrepresented minorities in the healthcare workforce Federal Multiple stakeholder groups actively working to bring awareness to disparities Department of Health & Human Services Centers for Disease Control Commission to End Health Care Disparities (CEHCD) Etc Federal Enhance access to high-quality education, jobs, opportunities for healthy living Identify high-need areas that experience health disparities to align existing resources to meet these needs Support for placement of primary care providers in medically underserved communities Support and expand training programs to increase diversity in the healthcare workforce State Use data to identify populations at greatest risk, and work with these communities to implement programs to address the highest priority needs Create and support local libraries and literacy programs to increase the abilities of patients to find and use reliable health information Offer and expand preventive services for children and adults, particularly those at risk 6
Local Work with communities to implement policies and programs to address highest priority needs Improve collaboration with community leaders to ensure community health needs are identified Identify and address barriers to local care Health literacy, skill-building courses Ensure prevention strategies are culturally, linguistically, and age appropriate Self-awareness and cultural competency Knowledge of the local minority population Continual community needs assessment Supporting community through legislation Self-assessment Taking responsibility to understand and eliminate biased, disrespectful, and prejudiced attitudes, beliefs, behaviors, policies, and practices Cultural competence assessment http://www.aafp.org/fpm/2000/1000/p58.html Patient assessment Cultural assessment forms http://www.culturediversity.org/assmtform.htm Communication is key Conclusion Zip code matters! Health disparities are prevalent and extend beyond race/ethnicity Recognizing the challenges our patients face is an important aspect of their care Targeting disparities is everyone s responsibility 7
References and Resources Betancourt JR, Green AR. Chaptere4. Racial and Ethnic Disparities in Health Care. In: Longo DL, FauciAS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison'sPrinciplesof InternalMed icine. 18th ed. New York: McGraw-Hill; 2012. http://www.accessmedicine.com/content.aspx?aid=9106901. Kosoko-Laski S, Cook CT, O Brien RL. CulturalProficiencyin Ad d ressing HealthDisparities.Sudbury: Jones and Bartlett Publishers; 2009. Betancourt JR, Green AR, Carrillo JE. CulturalCom petence in HealthCare: Em erg ing Fram eworksand PracticalApproaches[Field Report]. The Commonwealth Fund, No. 576; 2002. Centers for Disease Control. Healthy People 2010: Disparities. Accessed from http://www.healthypeople.gov/2020/about/foundation-healthmeasures/disparities Centers for Disease Control. Experienced by Racial/Ethnic Minority Populations. MMW R W eekly. 2004Aug 27;53(33):755. National Instituteon Minority. Accessedfrom http://www.nimhd.nih.gov References and Resources U.S. Department of Health & Human Services: Surgeon General.gov. National Prevention Strategy: Elimination of. 2014May. Accessed from http://www.surgeongeneral.gov/initiatives/prevention/strategy/eliminationof-health-disparities.html The Providers Guide to Quality & Culture: Joint project by the Management Sciences for Health (MSH), Department of Health and Human Services (DHHS), Health Resources andservices Administration, andbureau of Primary Carehttp://erc.msh.org/mainpage.cfm?file=1.0.htm&module=provider&lang uage=english The Office of Minority Health http://www.minorityhealth.hhs.gov Centers for Disease Control National Prevention Information Network http://www.cdcnpin.org/scripts/population/culture.asp Diversity in Medicine www.amsa.org/div Resources for Cross-Cultural Health Care www.diversityrx.org National Center For Cultural Competence (NCCC)http://nccc.georgetown.edu/ Questions? 8