Racism, Stress, and Health Inequity

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Racism, Stress, and Health Inequity

• Connecting the Dots

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A Tale of Two Babies
Elijah
Joseph
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The Cycle Begins
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Pre-term Delivery
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Low Birth Weight
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Infant Mortality
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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)
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Health Status by Race
Fair or Poor Reported Health Status by Age Group
and Race Adults 18, Monroe County, 2006
Percent
(N2,545)
African Americans are twice as likely to rate
their health as fair or poor than whites.
Monroe County Adult Health Survey Report, 2006
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Health Status by Hispanic Origin
Fair or Poor Reported Health Status by Age Group
and Race Adults 18, Monroe County, 2006
Percent
(N2,545)
Significantly fewer non-Latinos rate their health
status as fair or poor than Latinos.
Monroe County Adult Health Survey Report, 2006
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Adult Health Insurance Coverage Monroe County

• The majority of individuals reported job-related
  reasons for not having health insurance.
• Couldnt afford premiums (36)
• Lost or changed jobs (22)
• Employer doesnt 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
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Access to a Primary Care Provider
Could Not Afford Medical Care in the Past Year
Do Not Have a Health Care Provider
Percent
Percent
(N2,545)
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
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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
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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.
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Low Birth Weight Rates by Maternal Education and
Race(Chicago, IL)
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Connecting the Dots

• Relationship between health status and
  race/ethnicity
• Relationship between perinatal health and
  lifetime health

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Nurses Health Study
Curhan et al., Rich-Edwards et al.
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Birth weight and CVD OutcomesNurses Health Study
Curhan et al., Rich-Edwards et al.
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LBW Cause and Consequence
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Adverse childhood events and adult ischemic heart
disease
Odds Ratio
Adverse Events
Dong et al, 2004
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Connecting the Dots

• Relationship between health status and
  race/ethnicity
• Relationship between perinatal health and
  lifetime health
• Relationship between health conditions and
  causes

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Is There a Common Link?

• Contributors to
• Diabetes
• Hypertension/Cardiovascular Disease
• Inflammatory Disease and Infection
• Low Birth Weight

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The common theme Stress
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• 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

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Epigenetics
Scientific American 2003
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Connecting the Dots

• The Source of the Stress

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Carnage of Racism
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Racism and Stress
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Racism and Stress
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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

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MATERNAL CHRONIC EXPOSURE TO INTERPERSONAL
RACISM IN THE WORKPLACE AND INFANT BIRTH WEIGHT
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Racism and Stress
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Connecting the Dots

• From the Past to the Future

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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
0
5
Puberty
Pregnancy
Age
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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

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

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What is Your Role?

• Knowing is not enough we must apply.
• Willing is not enough we must do.
• Goethe