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ELIMINATING HEALTH DISPARITIES IN AN URBAN AREA. VIRGINIA A. CAINE, M.D., DIRECTOR MARION COUNTY HEALTH DEPARTMENT INDIANAPOLIS, INDIANA May 1, 2002.

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slide1

ELIMINATING HEALTH DISPARITIES IN AN URBAN AREA

VIRGINIA A. CAINE, M.D., DIRECTOR

MARION COUNTY HEALTH DEPARTMENT

INDIANAPOLIS, INDIANA

May 1, 2002

slide2

“Racial and ethnic disparities in health care are unacceptable in a country that values equality and equal opportunity for all. And that is why we must act now with a comprehensive initiative that focuses on health care and prevention for racial and ethnic minorities.”

President Bill Clinton

February 21, 1998

president s initiative to eliminate racial and ethnic disparities in health
President’s Initiative to Eliminate Racial and Ethnic Disparities in Health

Target conditions

  • Infant mortality
  • Cancer screening and management
  • Cardiovascular disease
  • Diabetes
  • HIV infection/AIDS
  • Immunizations
slide4

Healthy People 2010

Two Overarching Goals:

  • Increase Quality and Years of Healthy Life
  • Eliminate Health Disparities
slide5

What Are Health Disparities?

  • Differences in the incidence, prevalence,mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.
why the interest in disparities
Why The Interest In Disparities?
  • The changing demography of the American population
  • The persistence of disparities in the health status of racial and ethnic minorities
slide7

Percent Distribution of U.S. Population by Race and Ethnicity, 2000

Source: U.S. Census Bureau, 2000

slide8

American

12.2%

Indian/Alaska Native

13.6%

11.4%

Asian/Pacific Islander

24.5%

Black/African American

71.8%

Hispanic/Latino

52.8%

White, not Hispanic/Latino

Percent of the Population by Race and Hispanic Origin, 2000 and 2050

3.9%

8.2%

2000

2050

Source: U.S. Bureau of the Census 2000

slide9

Emerging Majorities

Minority people are the majority in three states

  • California

(50.1%)

  • Hawaii

(71%)

(53%)

  • New Mexico

(71%)

  • District of Columbia
slide10

Emerging Majorities

Minority people are now at least 30% of the population in ten states:

  • Texas (45%)
  • Arizona (32%)
  • Mississippi (38%)
  • Florida (32%)
  • Maryland (36%)
  • New Jersey (32%)
  • New York (35%)
  • South Carolina (32%)
  • Georgia (34%)
  • Nevada (30%)
percent of the population by race and hispanic origin indiana
1990

White, not Hispanic: 90.1%

Black/African American: 7.8%

Asian/Pacific Islander: 0.2%

Hispanic/Latino: 1.7%

American Indian/Alaska

Native: 0.3%

2000

White, not Hispanic: 86.5%

Black/African American: 8.3%

Asian/Pacific Islander: 1.0%

Hispanic/Latino: 3.6%

American Indian/Alaska

Native: 0.7%

Percent of the Population by Race and Hispanic Origin, Indiana
life expectancy at birth 1900 1998

0

Life Expectancy at Birth, 1900-1998

Years

White

77.3

71.3

Black

47.6

33.0

1900

1950

1998

SOURCE: CDC/NCHS, National Vital Statistics Systems, 1900-98

infant mortality rates 1980 1998
Infant Mortality Rates, 1980-1998

22.2

14.3

10.9

6.0

Deaths <1 year/1000 live births

SOURCE: CDC/NCHS, National Vital Statistics System, 1980-1998

slide15

Infant mortality rates by race and Hispanic origin of mother

Total Hispanic

Non-Hispanic white

Non-Hispanic

black

Asian/Pacific Islander

Deaths <1 year per 1000 live births

SOURCE: CDC/NCHS, National Vital Statistics System, 1995

slide16

Infant mortality rates by Hispanic origin of mother

Total Hispanic

Mexican

Puerto Rican

Cuban

Central/South American

Deaths <1 year per 1000 live births

SOURCE: CDC/NCHS, National Vital Statistics Systems, 1995

slide17

Infant mortality rates by Asian/PacificIslander subgroup

Asian/Pacific Islander

Chinese

Japanese

Hawaiian

Filipino

Deaths <1 year per 1000 live births

SOURCE: CDC/NCHS, National Vital Statistics Systems, 1995

slide18

Coronary heart disease death rates

1990

White

1996

Black

A/PI

AI/AN

Hispanic

Per 100,000 population

NOTE: Death rates are age-adjusted to 1940 standard million age distribution.

A/PI is Asian American or Pacific Islander; AI/AN is American Indian or Alaska Native.

SOURCE: CDC/NCHS, National Vital Statistics System, 1990 and 1996

slide20

Racial and Ethnic Disparities: Morbidity and Mortality

  • African American men have a 40 percent higher heart disease rate than White men
  • Women of Vietnamese origin in the United States suffer from cervical cancer at nearly five times the rate than White women
slide21

Racial and Ethnic Disparities: Morbidity and Mortality

  • Native Americans have a diabetes rate that is nearly three times the rate of Whites. The Hispanic rate is nearly double that of Whites
  • African American women are 28% more likely to die from breast cancer, although the incidence is greater in White women
slide23

Several Causal Factors

  • Socioeconomic status (SES)
  • Health risk behaviors
  • Psycho-social factors
  • Acculturation
  • Biologic/Genetic factors
  • Health care
socioeconomic status
Socioeconomic Status
  • Education
  • Occupation
  • Income
  • Environment
  • Culture
slide27

Infant Mortality Rates in the United States

Deaths/1000 Live births

Education in years

SOURCE: CDC/NCHS/NVSS

health risk behaviors29

Female

Health Risk Behaviors

White

Current smokers

Black

Hispanic

>1 oz. alcohol

per day

Regular exercise or sports

percentage engaging in activity

SOURCE: CDC/NCHS, National Health Interview Survey, 1990

slide30

Health Risk Behaviors

Male

White

Black

Current smokers

Hispanic

>1 oz. alcohol

per day

Regular exercise or sports

percentage engaging in activity

SOURCE: CDC/NCHS, National Health Interview Survey, 1990

age adjusted prevalence of obesity bmi 30 0

>

Age-adjusted Prevalence of Obesity (BMI 30.0)

Female

NHANES II

Non-Hispanic Whites

NHANES III

Non-Hispanic Blacks

Mexican Americans

Percent

SOURCE: CDC/NCHS, Second National Health and Nutrition Examination Survey, 1976-80 Third National Health and Nutrition Examination Survey, 1988-94

slide32

>

Age-Adjusted Prevalence of Obesity

(BMI 30.0)

Male

NHANES II

NHANES III

Non-Hispanic Whites

Non-Hispanic Blacks

Mexican Americans

Percent

SOURCE: CDC/NCHS, Second National Health and Nutrition Examination Survey, 1976-80 Third National Health and Nutrition Examination Survey, 1988-94

psychosocial factors34
Psychosocial Factors
  • Large complex literature relating factors such as stress and discrimination with racial/ethnic differences in hypertension
slide36

Acculturation

Some health behaviors “worsen” with acculturation

slide39

Percentage Uninsured Under Age 18

United States

Percent of Population

Source: CPS, USCB

health care coverage of persons under 65 age adjusted
Health Care Coverage of Persons Under 65 (Age-adjusted)

Private

All Hispanic

Medicaid/

Public Assistance

NH White

NH Black

Not covered

Asian/PI

Percent

SOURCE: CDC/NCHS, National Health Interview Survey, 1996

health care42
Health Care

Extensive evidence of racial and/or ethnic

Differences in utilization of health care

  • Diagnostic tests and procedures
  • Therapeutic procedures
  • Intensity of care
  • Pain control
  • Transplants
  • Preventive services
possible explanations for the racial and ethnic differences in utilization
Possible Explanations for the Racial and Ethnic Differences in Utilization
  • Socioeconomic status
  • Language
  • Insurance status
  • Severity of illness
  • Patient health behaviors
  • Provider bias
iom report findings
IOM Report Findings

Racial and ethnic disparities in healthcare exist and, because they are associated with worse outcomes in many cases, are unacceptable.

iom report findings58
IOM ReportFindings

Factors contributing to racial and

ethnic disparities in healthcare:

  • Health systems
  • Healthcare providers
  • Patients and utilization managers
  • Bias, stereotyping, prejudices
  • Clinical uncertainty on the health of care providers
iom report recommendations
IOM ReportRecommendations
  • Increase awareness of racial and ethnic disparities among the general public, key stakeholders, and healthcare providers
  • Legal, regulatory, and policy interventions
  • Health systems interventions
factors influencing optimal medical care
Factors Influencing Optimal Medical Care
  • Effective patient-physician communication
  • Overcoming cultural and linguistic barriers
  • Access to affordable health insurance
  • Alternatives to hospital emergency rooms
  • Improvement in continuity of care
  • Improving information for patients
  • Participate in the latest quality improvement innovations
slide61

Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.

-- Dr. Martin Luther King, Jr.