Pathways to Health Equity: Challenges

1
Pathways to Health EquityChallenges
Opportunities

• Moon S. Chen, Jr., Ph.D., M.P.H.
• Professor, Internal Medicine, UC Davis
• Associate Director for Population Research
  Cancer Disparities,
• UC Davis Cancer Center
• Sacramento, CA

2
Presentation Objectives

• What is health equity and what are its
  determinants? The historical example.
• What do we need to do to achieve health equity?
  The challenges.
• What do we need to eliminate a health disparity?
  The opportunities.

3
Pathways
Photo author enUserAaronsnet
4
(No Transcript)
5
(No Transcript)
6
(No Transcript)
7
Answer Eliminate health disparities and its
determinants
What is health equity what are its
determinants?
8
(No Transcript)
9
December 1979
WHO Announces Global Eradication of Smallpox !
10
What do we need to do to eliminate health
disparities?

• Disease that is worth the effort
• Evidence base to prevent control
• Professional endorsement
• Universal implementation
• Legal backing social acceptance
• Economic feasibility
• Commitment and tracking

11
A Disease worth the effort liver cancer
SEER INCIDENCE Rates Among Men, 1988-1992
Miller et al., 1996 Racial/Ethnic Patterns of
Cancer in the United States 1988-1992 National
Cancer Institute
12
PERSPECTIVECompare AIDS with HCC

• Etiology both viral Treatment anti-viral
• Transmission vertical horizontal sexual IVD
• Detection blood test
• Disparity
• AIDS Blacks Whites151
• HCC Foreign-born Asian White681
• US-born Asian White111

13
Top Global Cancer Mortality-to-Incidence
Ratio (Age-Standardized, 1993 2001)
Source GLOBOCAN 2002 Software and Database
Version 2.0, built September 2005
14
The Contribution of Individual Cancer Sites to
the Decrease in Cancer Death Rates in Males,
1990-2004
15
The Contribution of Individual Cancer Sites to
the Decrease in Cancer Death Rates in Females,
1990-2004
16
Evidence base for prevention control

• 1970s Hepatitis B surface antigen discovered
  linked to liver cancer. Serological testing was
  developed. Epidemiological studies conclusively
  proved that hepatitis B virus (HBV) is the
  principal risk factor for primary liver cancer.
• 1980s HBV vaccine was developed and used.
  Serological testing to determine carrier status
  was recommended.

17
(No Transcript)
18
(No Transcript)
19
Universal Implementation
20
(No Transcript)
21
Legal Backing Social Acceptance
22
Hepatitis B Vaccination is both Cost-effective
and cost-beneficial in in lives saved.
- Zhou et al, Pediatrics,
2003 Screen treat AND screen, treat, ring
vaccinate---cost-effective. --Hutton et al, Ann
Int Med, 2007
Economic Feasibility
23
Reported Acute Hepatitis B United States,
1980-2006
Universal vaccination of infants recommended
2006 rate 1.6/100,000
Source National Notifiable Diseases Surveillance
System (NNDSS)
24
Evidence for the Effectiveness of Universal HBV
Vaccination on HBV Infection and HCC in Taiwanese
Children
Incidence of HCC
Source Beasley RP, et al., Lancet 1981 Lok ASF,
Gastroenterology 2004
25
(No Transcript)