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Racism, Stress, and Health Inequity

Connecting the Dots. Racism, Stress, and Health Inequity. A Tale of Two Babies. Elijah. Joseph. The Cycle Begins. Pre-term Delivery. Low Birth Weight. Infant Mortality. What are Health Disparities?. “Differences that occur by gender, race or ethnicity, education or income, disability,

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Racism, Stress, and Health Inequity

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  1. Connecting the Dots Racism, Stress, and Health Inequity

  2. A Tale of Two Babies Elijah Joseph

  3. The Cycle Begins

  4. Pre-term Delivery

  5. Low Birth Weight

  6. Infant Mortality

  7. What are Health Disparities? “Differences that occur by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation.” Inequity and inequality in… • Access, utilization and quality of care • Specific health outcomes • Health status US Dept. of Health and Human Services (2000) Carter-Pokras and Baquet (2002)

  8. Health Status by Race Fair or Poor Reported Health Status by Age Group and Race – Adults 18+, Monroe County, 2006 Percent (N=2,545) African Americans are twice as likely to rate their health as fair or poor than whites. Monroe County Adult Health Survey Report, 2006

  9. Health Status by Hispanic Origin Fair or Poor Reported Health Status by Age Group and Race – Adults 18+, Monroe County, 2006 Percent (N=2,545) Significantly fewer non-Latinos rate their health status as fair or poor than Latinos. Monroe County Adult Health Survey Report, 2006

  10. Adult Health Insurance Coverage – Monroe County The majority of individuals reported job-related reasons for not having health insurance. • Couldn’t afford premiums (36%) • Lost or changed jobs (22%) • Employer doesn’t offer or stopped offering coverage (12%) According to recent studies, insurance coverage reduces disparities among low-income and minority adults Uninsured Adults Aged 18-64 Years Old Percent Do Not Have Health Insurance Monroe County Adult Health Survey Report, 2006

  11. Access to a Primary Care Provider Could Not Afford Medical Care in the Past Year Do Not Have a Health Care Provider Percent Percent (N=2,545) Lack of primary care provider and being unable to afford medical care in the last year were cited as the main barriers to accessing primary care. These mostly affected African Americans and Latinos. Monroe County Adult Health Survey Report, 2006

  12. All PQI Hospitalizations – Discharges, 2006 Patient Days – 597,787 Charges (not costs) - $1,628,488,166 All Discharges 106,801 PQI Discharges 9,419 9% of all discharges Patient Days 62,595 Charges (not costs) $133,494,396 Beds 171.89 In 2006, preventable hospitalizations filled 172 beds and accounted for 9% of all charges in Monroe County hospitals. AHRQ Prevention Quality Measures, 2006 *Includes HH, RGH, Unity, SMH, Lakeside

  13. Probability of Hypertension Among U.S. Women, 1999-2002 Geronimus et al. In Press. Black-White Differences in Age Trajectories of Hypertension Prevalence Among Adult Women & Men, 1999-2002. Ethnicity and Disease.

  14. Low Birth Weight Rates by Maternal Education and Race(Chicago, IL)

  15. Connecting the Dots Relationship between health status and race/ethnicity Relationship between perinatal health and lifetime health

  16. Nurses’ Health Study Curhan et al., Rich-Edwards et al.

  17. Birth weight and CVD OutcomesNurses’ Health Study Curhan et al., Rich-Edwards et al.

  18. LBW: Cause and Consequence

  19. Adverse childhood events and adult ischemic heart disease Odds Ratio Adverse Events Dong et al, 2004

  20. Connecting the Dots Relationship between health status and race/ethnicity Relationship between perinatal health and lifetime health Relationship between health conditions and causes

  21. Is There a Common Link? • Contributors to • Diabetes • Hypertension/Cardiovascular Disease • Inflammatory Disease and Infection • Low Birth Weight

  22. The common theme: Stress

  23. Stressed • Increased cardiac output • Increased available Glucose • Enhanced immune Functions • Growth of neurons in hippocampus & prefrontal cortex Stressed Out • Hypertension & cardiovascular diseases • Glucose intolerance & insulin resistance • Infection & inflammation • Atrophy & death of neurons in hippocampus & prefrontal cortex

  24. Epigenetics Scientific American 2003

  25. Connecting the Dots The Source of the Stress

  26. Carnage of Racism

  27. Racism and Stress

  28. Racism and Stress

  29. National Community Reinvestment Coalition Study • Brokers spent 39 minutes with white testers, 27 minutes with African American and Latino testers. • African Americans and Latinos were questioned about their credit over 32% of the time; white shoppers 13% of the time. • White testers received two rate quotes for every one quoted to African American and Latino testers. • Fees were discussed 62% of the time with white testers 35% of the time with “protected testers.” • Fixed rate loans were discussed 77% of the time with white testers, 50% of the time with African American and Latino testers. Study conducted in 2007

  30. MATERNAL CHRONIC EXPOSURE TO INTERPERSONAL RACISM IN THE WORKPLACE AND INFANT BIRTH WEIGHT

  31. Racism and Stress

  32. Connecting the Dots From the Past to the Future

  33. Life Course Health Development White Poor Nutrition Stress Abuse Tobacco, Alcohol, Drugs Poverty Lack of Access to Health Care Exposure to Toxins African American Poor Birth Outcome Age 0 5 Puberty Pregnancy

  34. The Conversation Has Begun • PNMC and FLHSA partnership • Racial Disparities in Health: A Life Course Perspective • Actionable Ideas • Nearly 100 participants • Open discussion of the impact of race • Over 20 projects – concrete, actionable steps

  35. A Community Action Plan • Public Policy • Community Capacity Building • Neighborhood Health • Only the Beginning • Related projects • New initiatives

  36. What is Your Role? “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe

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