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Eliminating Health Disparities: Challenges and Opportunities. Marsha Lillie-Blanton, Dr.P.H. Vice President in Health Policy The Henry J. Kaiser Family Foundation Centers for Disease Control and Prevention 19th National Conference on Chronic Disease March 3, 2005 Atlanta, GA. Figure 1.

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eliminating health disparities challenges and opportunities

Eliminating Health Disparities:Challenges and Opportunities

Marsha Lillie-Blanton, Dr.P.H.

Vice President in Health Policy

The Henry J. Kaiser Family Foundation

Centers for Disease Control and Prevention

19th National Conference on Chronic Disease

March 3, 2005

Atlanta, GA

health determinants

Figure 1

Health Determinants
  • Social and Environmental Conditions of Life
  • Family History
  • Health Infrastructure of Local Community
  • Health Coverage and Quality of Care
challenges opportunities

Figure 2

Challenges & Opportunities
  • Increasing Awareness and Knowledge
  • Assuring Adequate and Meaningful Insurance Coverage
  • Improving Healthcare Quality
slide5

Figure 3

“How Do You Think the Average African AmericanCompares to the Average White Person in Terms of…?”

LIFE EXPECTANCY

INFANT MORTALITY

Aware

of the

differ-

ences

Not aware of the

differences

Not aware of the

differences

Aware

of the

differ-

ences

43%

45%

57%

54%

say...

say...

say ”worse off”

say “worse off”

“just as well off” (43%)

“better off” (5%)

“don’t know” (9%)

“just as well off” (39%)

“better off” (6%)

“don’t know” (9%)

Whites Say

Whites Say

Aware

of the

differ-

ences

Not aware of the

differences

Aware

of the

differ-

ences

Not aware of the

differences

46%

42%

53%

58%

say...

say...

say “worse off”

say “worse off”

“just as well off” (42%)

“better off” (8%)

“don’t know” (8%)

“just as well off” (36%)

“better off” (10%)

“don’t know” (7%)

African Americans Say

African Americans Say

Facts: In 1997, black infant mortality was 2 ½ times higher than white (14.2 per 1,000 black infants born versus 6.0 per 1,000 white infants born), and blacks in 1996, on average, lived 6.6 years less than whites.

SOURCE: Kaiser Family Foundation Survey of Race, Ethnicity and Medical Care: Public Perceptions and Experiences, October 1999 (Conducted July - Sept, 1999.

heart disease death rates for adults 25 64 by income race and gender 1979 1989

Figure 4

Heart Disease Death Rates for Adults 25-64, by Income, Race and Gender, 1979-1989

Deaths per 100,000 person years

African American, Non-Latino

White, Non-Latino

Under $10, 000

Over $15, 000

NOTE: These data are the most recently available by race and income.

SOURCE: Health, United States, 1998, Socioeconomic Status and Health Chartbook, Data Table for Figure 27.

what more can be done to increase awareness knowledge

Figure 5

What More Can Be Done To Increase Awareness/Knowledge
  • Outreach and informational efforts to make the facts known
  • Education and training of health providers through professional associations & credentialing organizations
  • Expand Knowledge Base (Collection and Reporting of Data by Race& Social Class; Research on Interventions)
people of color are more likely than whites to be uninsured or covered by medicaid

Figure 6

People of color are more likely than whites to be uninsured or covered by Medicaid

Uninsured Medicaid and Other Public Private (Employer and Individual)

White,

Non-Latino

165.9 million

American Indian/

Alaska Native

1.5 million

Two Or More Races

3.9 million

Latino

38.2 million

African

American,

Non-Latino

32.0 million

Asian/

Pacific

Islander

11.2 million

Nonelderly Population 2003

NOTE: “Other Public” includes Medicare and military-related coverage.

SOURCE: Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2003 Data Update, 2004.

one quarter to nearly one half of nonelderly low income population groups are uninsured

Figure 7

One-quarter to nearly one-half of nonelderly low-income population groups are uninsured

Poverty Level

White, Non-Latino

Latino

African American, Non-Latino

Asian/Pacific Islander

American Indian/Alaska Native

<200%

White, Non-Latino

Latino

African American, Non-Latino

Asian/Pacific Islander

American Indian/Alaska Native

200%+

NOTE: Less than 200% of poverty level = $28,256 for family of 3 in 2001.

SOURCE: Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2001 Data Update, 2003.

what more can be done to improve coverage

Figure 8

What More Can Be Done To Improve Coverage
  • Simplify Medicaid Enrollment and Eligibility Process
  • Improve Medicaid Retention of Enrollees
  • Develop Private Sector Financial Incentives for Low-Wage Workers
  • Build Public Consensus on Viable Approaches
slide13

Figure 9

Equal Likelihood

Disparities Exist Among Insured Children: Underuse of Medication Among Medicaid Beneficiaries with Asthma

Odds Ratio of Underuse Given the Characteristic Below

+

+

* Difference is statistically significant after adjustment.

+ Compared to whites

‡ Compared to families in which the parent had graduated from high school, but had no additional education

NOTE: Model adjusted for socio-demographic factors, symptom level, and reports of processes of care. The children, ages 2-16, were enrolled in managed care plans located in California, Massachusetts, and Washington state.

SOURCE: Finkelstein et al., 2002.

disparities exist among insured adults reperfusion therapy in medicare beneficiaries with acute mi

Figure 10

Disparities Exist Among Insured Adults:Reperfusion Therapy in Medicare Beneficiaries with Acute MI

Men

Women

Source: Canto, JG et al. New England Journal Of Medicine. 2000 April 13; 342(15):1094-100.

what more can be done to improve health care quality and reduce disparities

Figure 11

What More Can Be Done To Improve Health Care Quality and Reduce Disparities
  • Collect and Report Data on Patterns of Care By Race
  • Research on Interventions
  • Leadership from Professional Societies in Implementing Practice Guidelines
  • CMS Peer Review/Quality Improvement Activities

Medicaid Specific

  • Cultural Competence Purchasing Guidelines for MCOs
  • CMS Quality Assurance Requirements for MCOs (42 DFR 438.240)
what can you do

Figure 12

What can you do?
  • Get to know the evidence
  • Engage colleagues in discussions about observed differential practices
  • Support data collection and analysis efforts in your clinical practice settings
  • Review your own practices to ensure that standards of care are followed across groups
  • Encourage 4T’s: talent, technology, trust, tracking