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ELIMINATING HEALTH DISPARITIES IN AN URBAN AREA

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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ELIMINATING HEALTH DISPARITIES IN AN URBAN AREA

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

  2. “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

  3. 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

  4. Healthy People 2010 Two Overarching Goals: • Increase Quality and Years of Healthy Life • Eliminate Health Disparities

  5. 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.

  6. 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

  7. Percent Distribution of U.S. Population by Race and Ethnicity, 2000 Source: U.S. Census Bureau, 2000

  8. 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

  9. Emerging Majorities Minority people are the majority in three states • California (50.1%) • Hawaii (71%) (53%) • New Mexico (71%) • District of Columbia

  10. 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%)

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. How Do We Explain Racial And Ethnic Disparities In Health?

  21. Several Causal Factors • Socioeconomic status (SES) • Health risk behaviors • Psycho-social factors • Acculturation • Biologic/Genetic factors • Health care

  22. Socioeconomic Status • Education • Occupation • Income • Environment • Culture

  23. Infant Mortality Rates in the United States Deaths/1000 Live births Education in years SOURCE: CDC/NCHS/NVSS

  24. Health Risk Behaviors

  25. 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

  26. 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

  27. > 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

  28. > 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

  29. Psychosocial Factors

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

  31. Acculturation

  32. Acculturation Some health behaviors “worsen” with acculturation

  33. Biological and Genetic Factors

  34. Health Care

  35. Percentage Uninsured Under Age 18 United States Percent of Population Source: CPS, USCB

  36. 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

  37. 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

  38. Possible Explanations for the Racial and Ethnic Differences in Utilization • Socioeconomic status • Language • Insurance status • Severity of illness • Patient health behaviors • Provider bias

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