Understanding social influences on healthcare disparities
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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 l.jpg

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

Why racial ethnic disparities exist l.jpg
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

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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

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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)

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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

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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