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Understanding Social Influences on Healthcare Disparities

Understanding Social Influences on Healthcare Disparities. Akiko S. Hosler, Ph.D. New York State Dept of Health & University at Albany The 19 th National Conference on Chronic Disease Prevention and Control March 2005. Why Racial/Ethnic Disparities Exist?.

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Understanding Social Influences on Healthcare Disparities

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  1. Understanding Social Influences on Healthcare Disparities Akiko S. Hosler, Ph.D. New York State Dept of Health & University at Albany The 19th National Conference on Chronic Disease Prevention and Control March 2005

  2. Why Racial/Ethnic Disparities Exist? • Because racial/ethnic categories are socially constructed to reflect existing socioeconomic differences and inequalities • Race/ethnic categories are dependent on the society’s collective perception that such differences are important • Race/ethnic categories are not fixed • Change over time within the same society • Each society has its own unique way to differentiate people based on hereditary characteristics

  3. Examples of Race/Ethnicity as a Social Construct • “Hispanic” category appeared first time in the 1980 census • In the 1790 census (the first census), “free white males” “free white females” “other persons” and “slaves” were used • In Great Britain today, “Arabs” “(South) Asians” and “West Indians” are distinctive categories • U.S. categories are not scientific ( genetics) • Violate the basic principles of taxonomy • Rely self-reporting

  4. But Why Race/Ethnicity Still Important? • A representation of the structure and dynamics of our society • Functional purposes – to advocate needs, interests • Basis of self identity and group identity for some individuals • Governments are responsible for keeping track of historic changes of race/ethnic differences (OMB standards)

  5. Healthcare Disparities - Social Phenomena • Remind us that health has biomedical causes and social causes • Certain health-related processes and outcomes are better understood & dealt with on the population basis • Continuing effort to search for “social variables” that make sense • Beyond race/ethnicity, income & education • Beyond descriptive, cross-sectional analysis

  6. New York State’s Experience • Russian-speaking immigrants in NYS • High rates of obesity & diabetes, lack of knowledge on A1C (language, refugee status, economic & cultural issues)Ethnicity & Disease. 2004;14:372-377 • Puerto Rican adults with diabetesin NYC • Adequate healthcare access, but prevention for cardiovascular complications inadequate (language for older generations, perception for need)American Journal of Public Health. 2004;94:434-437. May/June 2005 issue the Diabetes Educator • Japanese residents in Westchester County • Low rates of obesity & diabetes, adequate preventive care, but men are at risk for diabetes (high socio-economic status, work-related inactivity and stress for men)Am J of Public Health. 2003:93:1279-1280

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