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Racism, Stress, and Health Inequity

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Connecting the Dots. Racism, Stress, and Health Inequity. A Tale of Two Babies. Elijah. Joseph. The Cycle Begins. Pre-term Delivery. Low Birth Weight. Infant Mortality. What are Health Disparities?. “Differences that occur by gender, race or ethnicity, education or income, disability,

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Presentation Transcript
what are health disparities
What are Health Disparities?

“Differences that occur by gender, race or

ethnicity, education or income, disability,

geographic location, or sexual orientation.”

Inequity and inequality in…

• Access, utilization and quality of care

• Specific health outcomes

• Health status

US Dept. of Health and Human Services (2000)

Carter-Pokras and Baquet (2002)

health status by race
Health Status by Race

Fair or Poor Reported Health Status by Age Group and Race –

Adults 18+, Monroe County, 2006

Percent

(N=2,545)

African Americans are twice as likely to rate their health as fair or poor than whites.

Monroe County Adult Health Survey Report, 2006

health status by hispanic origin
Health Status by Hispanic Origin

Fair or Poor Reported Health Status by Age Group and Race –

Adults 18+, Monroe County, 2006

Percent

(N=2,545)

Significantly fewer non-Latinos rate their health status as fair or poor than Latinos.

Monroe County Adult Health Survey Report, 2006

adult health insurance coverage monroe county
Adult Health Insurance Coverage – Monroe County

The majority of individuals reported job-related reasons for not having health insurance.

  • Couldn’t afford premiums (36%)
  • Lost or changed jobs (22%)
  • Employer doesn’t offer or stopped offering coverage (12%)

According to recent studies, insurance coverage reduces disparities among low-income and minority adults

Uninsured Adults Aged 18-64 Years Old

Percent Do Not Have Health Insurance

Monroe County Adult Health Survey Report, 2006

access to a primary care provider
Access to a Primary Care Provider

Could Not Afford Medical Care

in the Past Year

Do Not Have a Health Care Provider

Percent

Percent

(N=2,545)

Lack of primary care provider and being unable to afford medical care in the last year were cited as the main barriers to accessing primary care. These mostly affected African Americans and Latinos.

Monroe County Adult Health Survey Report, 2006

all pqi hospitalizations discharges 2006
All PQI Hospitalizations – Discharges, 2006

Patient Days – 597,787

Charges (not costs) - $1,628,488,166

All Discharges

106,801

PQI Discharges

9,419

9% of all discharges

Patient Days

62,595

Charges (not costs)

$133,494,396

Beds

171.89

In 2006, preventable hospitalizations filled 172 beds and accounted for 9% of all charges in Monroe County hospitals.

AHRQ Prevention Quality Measures, 2006

*Includes HH, RGH, Unity, SMH, Lakeside

probability of hypertension among u s women 1999 2002
Probability of Hypertension Among U.S. Women, 1999-2002

Geronimus et al. In Press. Black-White Differences in Age Trajectories of Hypertension

Prevalence Among Adult Women & Men, 1999-2002. Ethnicity and Disease.

connecting the dots1
Connecting the Dots

Relationship between health status and race/ethnicity

Relationship between perinatal health and lifetime health

slide16

Nurses’ Health Study

Curhan et al., Rich-Edwards et al.

birth weight and cvd outcomes nurses health study
Birth weight and CVD OutcomesNurses’ Health Study

Curhan et al., Rich-Edwards et al.

adverse childhood events and adult ischemic heart disease
Adverse childhood events and adult ischemic heart disease

Odds Ratio

Adverse Events

Dong et al, 2004

connecting the dots2
Connecting the Dots

Relationship between health status and race/ethnicity

Relationship between perinatal health and lifetime health

Relationship between health conditions and causes

is there a common link
Is There a Common Link?
  • Contributors to
    • Diabetes
    • Hypertension/Cardiovascular Disease
    • Inflammatory Disease and Infection
    • Low Birth Weight
slide23

Stressed

  • Increased cardiac output
  • Increased available

Glucose

  • Enhanced immune

Functions

  • Growth of neurons in

hippocampus &

prefrontal cortex

Stressed Out

  • Hypertension &

cardiovascular diseases

  • Glucose intolerance &

insulin resistance

  • Infection & inflammation
  • Atrophy & death of

neurons in hippocampus

& prefrontal cortex

epigenetics
Epigenetics

Scientific American 2003

connecting the dots3
Connecting the Dots

The Source of the Stress

national community reinvestment coalition study
National Community Reinvestment Coalition Study
  • Brokers spent 39 minutes with white testers, 27 minutes with African American and Latino testers.
  • African Americans and Latinos were questioned about their credit over 32% of the time; white shoppers 13% of the time.
  • White testers received two rate quotes for every one quoted to African American and Latino testers.
  • Fees were discussed 62% of the time with white testers 35% of the time with “protected testers.”
  • Fixed rate loans were discussed 77% of the time with white testers, 50% of the time with African American and Latino testers.

Study conducted in 2007

connecting the dots4
Connecting the Dots

From the Past to the Future

life course health development
Life Course Health Development

White

Poor Nutrition

Stress

Abuse

Tobacco, Alcohol, Drugs

Poverty

Lack of Access to Health Care

Exposure to Toxins

African

American

Poor Birth Outcome

Age

0

5

Puberty

Pregnancy

the conversation has begun
The Conversation Has Begun
  • PNMC and FLHSA partnership
  • Racial Disparities in Health: A Life Course Perspective
  • Actionable Ideas
    • Nearly 100 participants
    • Open discussion of the impact of race
    • Over 20 projects – concrete, actionable steps
slide39

A Community Action Plan

    • Public Policy
    • Community Capacity Building
    • Neighborhood Health
    • Only the Beginning
    • Related projects
    • New initiatives
what is your role
What is Your Role?

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

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