Health Disparities From knowledge to action

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Health Disparities From knowledge to action
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Overview of Disparities
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Overview of Disparities

• Minority Americans report widespread
  patient-physician communication differences
• Minority Americans are more likely to feel
  treated with disrespect when obtaining health
  care
• Though the gap is closing disparities persist in
  satisfaction with primary and secondary care

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Overview of Disparities
From Unequal Treatment Confronting Racial and
Ethnic Disparities in Health care IOM 2003
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Overview of Disparities

• Minority Americans have worse health status and
  more chronic conditions
• Minority Americans have lower rates of insurances
  coverage and less access to care

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Overview of Disparities

• Disparities are found across a range of clinical
  settings, including public and private hospitals,
  teaching and non-teaching hospitals, etc.
• Disparities in care are associated with higher
  mortality among minorities (e.g., Bach et al.,
  1999 Peterson et al., 1997 Bennett et al.,
  1995)

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Overview of Disparities

• Disparities consistently found across a wide
  range of disease areas and clinical services
• Disparities are found even when clinical factors,
  such as stage of disease presentation,
  co-morbidities, age, and severity of disease are
  taken into account

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Potential sources of healthcare disparities

• Health systems-level factors financing,
  structure of care cultural and linguistic
  barriers.
• Patient-level factors including patient
  preferences, refusal of treatment, poor
  adherence, biological differences.
• Disparities arising from the clinical encounter.

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Causes of Death (2000) USA
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Mortality Rates (All causes) 2000
From National Center for Health Statistics -
rates reported per 100,000 individuals
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Cardiovascular/Cerebrovascular

• Leading cause of death in African American men
  (33.5) and women (40.6)
• More than twice as likely to die from
  hypertensive heart disease
• Prevalence of high blood pressure one of the
  highest in the world ( worse in the southeastern
  US)
• 45 have blood cholesterol levels of gt 200 mg/dl

• 36of African Americans have hypertension
• African Americans at greater risk than whites
  for death from both
• Two to three times greater risk to have an
  ischemic stroke
• Higher death rates from stroke Americans

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Diabetes

• 2.7 million or 11.4 of all African Americans
  more than twenty years old have DM.
• African Americans and Hispanics are twice as
  likely to have DM than non-Hispanic whites.
• There is twice the risk of developing heart
  disease and stroke.
• 2 to 4 times the risk of dying from heart
  disease.
• One in every four African American women over 55
  years has DM.

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HIV/AIDS

• Problem of EPIDEMIC proportion.
• African Americans accounted for half of the new
  cases in 2001.
• More than 168,000 African Americans died of AIDS
  in 2001. Leading cause of death in African
  American men aged 35-44.
• Approximately 78 of HIV infected women are
  minorities.
• African-American and Hispanic children accounted
  for more than 80 of pediatric AIDS cases in 2000.

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Aids Infection by Gender and Race
Females
Males
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20
43
64
17
35
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Cancer Death Rates, by Race and Ethnicity,
1996-2000
Per 100,000, age-adjusted to the 2000 US
standard population. Hispanic is not mutually
exclusive from whites, African Americans,
Asian/Pacific Islanders, and American
Indians. Source Surveillance, Epidemiology, and
End Results Program, 1975-2000, Division of
Cancer Control and Population Sciences, National
Cancer Institute, 2003.
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Cancer Sites in Which African-American Death
Rates Exceed White Death Rates for Men, US,
1996-2000
Site
African American
Ratio of African American/White
White

• All sites
  356.2 249.5 1.4
• Larynx 5.7 2.4
  2.4
• Prostate 73.0 30.2 2.4
• Stomach 14.0 6.1 2.3
• Myeloma 9.2 4.5 2.0
• Oral cavity and pharynx 7.9
  4.0 2.0
• Esophagus 12.2 7.3 1.7
• Liver 9.3 6.0 1.6
• Lung bronchus 107.0
  78.1 1.4
• Pancreas 16.4 12.0 1.4
• Small intestine 0.7
  0.5 1.4
• Colon rectum 34.6 25.3 1.4

Per 100,000, age-adjusted to the 2000 US
standard population. Source Surveillance,
Epidemiology, and End Results Program, 1975-2000,
Division of Cancer Control and Population
Sciences, National Cancer Institute, 2003.
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Cancer Survival() by Site and Race,1992-1999
African American
White
Difference
Site
All Sites 64 53 11 Breast (female) 88 74 14 C
olon rectum 63 53 10 Esophagus 15 9
6 Leukemia 48 39 9 Non-Hodgkin
lymphoma 57 47 10 Oral cavity 60 36 24 Prostate
99 93 6 Urinary bladder 83 64 19 Uterine
cervix 73 61 12 Uterine corpus 86 60 26
5-year relative survival rates based on cancer
patients diagnosed from 1992 to 1999 and followed
through 2000. Source Surveillance,
Epidemiology, and End Results Program, 1975-2000,
Division of Cancer Control and Population
Sciences, National Cancer Institute, 2003.
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Causes of Death in African Americans (2000) -
Georgia
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Health Status in Georgia
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Disparities in Georgia

• Outcomes in Georgia
• Infant mortality rates in African Americans is
  more than twice that in Whites.
• Prostate Cancer death rates are gt 50 higher in
  African Americans.
• African Americans are more than twice as likely
  to die from Hypertensive Heart Disease.
• Hispanics are twice as likely to die from
  Diabetes than whites.

From Georgia Division of Public Health Vital
Statistics 2001
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Disparities in Georgia

• Coverage in Georgia
• More likely to use emergency room as main source
  of medical care.
• 4 to 5 times less likely to have had BP check in
  last 2yrs.
• 3 to 4 times less likely to have had a mammogram
  in last 2yrs.
• Children 2 times less likely to have seen a
  doctor in last 2 years.

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Uninsured by Ethnicity (2002) - GA.
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6.8
20.3
13.8
From Georgia Healthcare Coverage Project (
Custer Ketsche 2003)
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Uninsured by Ethnicity (2002) - USA
10.7
18.2
20.2
32.4
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Uninsured by race and income
From Georgia Healthcare Coverage Project (
Custer Ketsche 2003)
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I.O.M Report
In unassailable terms, the report found that
even when their insurance and income are the same
as those of whites, minorities often receive
fewer tests and less sophisticated treatment for
a panoply of ailments, including heart disease,
cancer, diabetes and HIV/AIDS. By stripping away
the pretense that the differences can be
explained by minorities' lack of access to timely
care, the report should spur doctors and patients
to question why racial disparities are tolerated
in medicine. USA Today, March 22
Racial Bias in Health Care
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I.O.M. Recommendations

• Policy Regulatory
• Avoid fragmentation of health plans along
  socioeconomic lines.
• Strengthen the stability of patient-provider
  relationships in publicly funded health plans.
• Increase the proportion of under-represented US
  racial and ethnic minorities among health
  professionals.

From Unequal Treatment Confronting Racial and
Ethnic Disparities in Health care IOM 2003
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I.O.M. Recommendations

• Policy Regulatory
• Apply the same managed care protections to
  publicly funded HMO enrollees that apply to
  private HMO enrollees.
• Provide greater resources for the DHHS Office for
  Civil Rights to enforce civil rights laws.

From Unequal treatment Confronting Racial and
Ethnic Disparities in Health care IOM 2003
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I.O.M. Recommendations

• Health Systems
• Promote the consistency and equity of care
  through use of evidence based guidelines.
• Structure payment systems to ensure adequate
  supply of services to minority patients and limit
  provider incentives that promote disparities.
• Enhance patient-provider communications and trust
  by providing financial incentives for practices
  that decrease barriers and encourage evidence
  based practices.

From Unequal treatment Confronting Racial and
Ethnic Disparities in Health care IOM 2003
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I.O.M. Recommendations

• Health System
• Support the use of interpretation services where
  community need exists.
• Support the use of community health workers
• Implement multi-disciplinary treatment and
  preventive care teams.

From Unequal treatment Confronting Racial and
Ethnic Disparities in Health care IOM 2003
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I.O.M. Recommendations

• Education
• Implement patient education programs to increase
  patients knowledge of how to best access care
  and participate in treatment decisions.
• Integrate cross cultural education into the
  training of all current and future health
  professionals.

From Unequal treatment Confronting Racial and
Ethnic Disparities in Health care IOM 2003
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Federal Action

• DHHS Initiative to Eliminate Racial and Ethnic
  Disparities in Health
• NIH Strategic Research Plan to Reduce and
  Ultimately Eliminate Health Disparities
• NLM Strategic Plan to Reduce Racial and Ethnic
  Disparities
• Healthy People 2010
• 100 access, Zero Disparities - BPHC

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Community Action

• Hispanic Health Care Outreach
• North West Georgia Healthcare Partnership Vision
• Promotora Community health worker
• Improved access
• Focus on Men's Health
• Network of South-central counties
• Screening ( PSA, Cholesterol and BP)
• Early detection

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Knowledge is Key
Action is Power