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Citizens’ Health Care Working Group

This working group reviews the approaches taken by the Health Disparities Task Force and Department of State Health Services to address health disparities, with a focus on Hispanic health disparities. The group highlights best practices and lessons learned, and discusses priority health areas such as infant mortality, cancer, cardiovascular disease, diabetes, HIV/AIDS, and immunizations. The group also addresses the burden of chronic diseases and racial/ethnic disparities, including obesity trends and tobacco prevention.

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Citizens’ Health Care Working Group

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  1. Citizens’ Health Care Working Group Adela S. Valdez M.D. Past Presiding Officer Health Disparities Task Force Asst. Dean for Education, UTHSCSA-RAHC

  2. Citizens’ Health Care Working Group • Objectives Review how HDTF and DSHS approached Health Disparities with overview of Hispanic Health Disparities Review organizational processes utilized to address Health Disparities Highlight best practices Lessons learned

  3. Review HDTF and DSHS approach to Health Disparities

  4. Priority Health Areas - USDHHS • Infant mortality • Cancer • Cardiovascular disease • Diabetes • HIV/AIDS • Immunizations

  5. OMH AND HDTF Initiatives • Immunizations • Obesity and Diabetes Prevention( CA, CV disease) • Physical Activity and Fitness (CV disease) • Tobacco Use (Cancer prevention) • Responsible Sexual Behavior (HIV/AIDS) • Prenatal Care (Infant mortality)

  6. Burden of Chronic Diseases andRacial/Ethnic Disparities

  7. Causes of Death in United States-2000

  8. Obesity

  9. Obesity Trends* Among U.S. AdultsBRFSS, 2002

  10. America’s Fattest Cities - 2004

  11. The Perfect Storm

  12. Lifestyle Changes that Promote Sedentary Behavior

  13. Tobacco Prevention and Control • Tobacco remains the single most preventable cause of death and disease in Texas and the US • Over 24,000 Texans Die each year • Cost of over $10 Billion dollars • In 1998, about 15% of all Texas Medicaid expenditures

  14. Success of Tobacco Intervention

  15. Trends in Cigarette Smoking Prevalence

  16. Plan to resolve the problem • Appropriate Funds allocated into six main components: • Community and School based • Public Awareness • Cessation efforts with Quitline • Efforts targeting specific populations • Youths in alternate settings • Enforcement of tobacco control policies • Pilot initiatives in four East Texas Counties • Jefferson, Harris, Fort Bend, and Montgomery

  17. Results • After first two years of implementation • 36% reduction in 6th-12th grade tobacco users in East Texas • ~ 55,000 fewer 6th – 12th graders using tobacco products as result of the comprehensive program • 18.6 % reduction in adult smoking rates which translates to 90,000 fewer adult smokers in the area

  18. Overview of Hispanic Health Disparities

  19. CHANGING POPULATION DEMOGRAPHICSEDUCATION • Hispanics and Blacks, in general, are disproportionately undereducated. • School drop-out rates are excessively high. • SAT scores for Hispanic and Black students are relatively low. • Enrollment in early childhood education programs (Head Start, kindergarten) disproportionately low.

  20. HEALTH PROFESSIONALSGENERAL • Hispanics and Blacks are disproportionately underrepresented in virtually ALL the health professions. • The underrepresentation involves those in practice, academia, research fields, post-baccalaureate degrees.

  21. HISPANICS IN DECISION-MAKING POSITIONS • Major disparity in the number/proportion of Hispanics and Blacks in decision-making positions in the health professions, state/national bodies, business sector, educational sector, governmental sector, etc.

  22. HEALTH INSURANCE • Hispanics and Blacks in U.S. and Texas are disproportionately underinsured and uninsured. • This problem is greater among Hispanics in the Southwest and even greater still in communities closer to the U.S.-Mexico border.

  23. Texas Has the Highest Uninsured Rate in the Nation

  24. Majority of Uninsureds Are Employed Percent Texas Uninsured by Labor Status Not in Labor Force 80% of Uninsured Hispanics Are Employed Unemployed Employed

  25. HEALTH INSURANCE • Texas ranks 2nd among states in the percentage of children 0-17 years old who do not have public or private health insurance. • 44 % of the uninsured children in Texas are Hispanic. Source: Office of Public Insurance Counsel

  26. HEALTH INSURANCE • For migrant children who are actually enrolled in the Texas Medicaid program, the coverage becomes moot as soon as they leave the state. • Lack of health insurance affects access to health services, contributes to poorer health, higher hospitalization rates and more advanced disease state by time health services finally received.

  27. Hispanics Typically Low Utilizers of Healthcare Services • Lower Utilization of Healthcare • Culture - Home remedies commonly first line of defense. • Reactive vs Proactive Healthcare • Women set the health agenda in the household. • Fewer Hispanic Physicians • Only 13% of the state’s 13,000 primary care physicians are Hispanic.

  28. DIABETES (ADULT-ONSET TYPE) • Higher rate of diabetes for Hispanics and Blacks • Higher rate of diabetic complications • Higher death rates for Hispanics and Blacks, 2 to 2.5 times higher than Anglos in 1990 and 2000 in Texas

  29. DISEASE/HEALTH DISPARITIESHOMICIDES • Homicide rate for Hispanic and Black males was 2 to 4 times higher than that for Anglo males in Texas in 1990 and 2000. (Rates among females are similar between Hispanics and Anglos.)

  30. Age-Adjusted Death Rates for Cervical Cancer by Race/Ethnicity, Texas: 1995-1998(Rate per 100,000 population) Source: Texas Department of Health, Vitalnet

  31. SCREENING FOR BREAST CANCER • Rates for breast examination by a clinician are lower in Hispanic and Black females.* 78.8% White, non-Hispanic 57.5% Hispanic 75.7% Black, non-Hispanic *Data for 1998-2000

  32. SCREENING FOR BREAST CANCER • Rates for mammography are lowest for Hispanic females 61.0% Hispanic 72.1% Black, non-Hispanic 71.5% White, non-Hispanic *Data for 1998-2000

  33. DISEASE/HEALTH DISPARITIESTEENAGE PREGNANCY • Hispanic and Black teenage pregnancy rate 2 to 3 times higher than that for White non-Hispanics. • Percent unmarried (2/3 of teenage pregnancies) is similar between Hispanics and White non-Hispanics. • Percent unmarried (about 94 percent of teenage pregnancies) much higher for Blacks. • Rates over the last decade relatively stable.

  34. DISEASE/HEALTH DISPARITIESOBESITY • Being overweight and obesity are disproportionately increased in Hispanics and Blacks, particularly females.

  35. DISEASE/HEALTH DISPARITIESMENTAL HEALTH • Need more frequency information, risk factors, mental health care access, outcomes in Hispanics and Blacks in Texas and in the U.S.

  36. SUMMARY • Rapidly growing numbers • Increased under-education, low income, language barriers • Greater lack of access, underutilization, mis-utilization of health care system • Greater uninsured, underinsured

  37. REPRESENTATIVE HEALTH POLICY IMPLICATIONS • Expansion of health insurance • Increased inclusion of Latinos and Blacks in medical/health research as consumers, researchers • Increased numbers of Latinos and Blacks in Academic Health institutions (administration, tenured faculty, researchers)

  38. REPRESENTATIVE HEALTH POLICY IMPLICATIONS • Enhancement of early educational opportunities. • Dramatic focus needed in eliminating disparities in access to care, utilization of care, and preventive services.

  39. CHALLENGES • Increasing health care costs • Lack of societal mandate for all to have sufficient access to the health system • Increased expectations of health with increasing technology • Improving health requires improving education, employment, decision-making capacity in a variety of community and organizational sector.

  40. SUMMARY • Major under representation in health professionals • Major under presentation in decision-making bodies in health, government, business, education, entrepreneurs—arenas that intersect with health and health care • Numerous health disparities (i.e., disproportionately greater disease burden) • Less health and research data available

  41. New Innovative Initiatives • State Program Initiatives • Regional Initiatives • Texas State Heath Strategic Partnership

  42. Strategies Eliminating health disparities in Texas requires an ability to identify and address the underlying causes of higher levels of disease…

  43. Strategies Research is needed to understand why vulnerable populations have disparate health outcomes…

  44. Strategies • Improved Access / Outreach • Enhanced public information • Community partnerships • Realignment of funding priorities

  45. Underlying Causes of Disparity • Race • Ethnicity • Gender • Age • Geography • Education

  46. Small Steps,BIG Impact

  47. Strategies • Linking potential external partners to SHS programs • Promoting SHS programs that improve the health of racial/ethnic minorities to the health care community, in addition to the public and private sectors • Each Region is addressing problems in their own communities

  48. Texas Public Health Regions

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