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90110 pp tx_ch10
Here are some key discussion questions this chapter raises: - Racial and ethnic classifications have changed to better reflect the diversity of the U.S. population over time as understanding of these social constructs evolves. How can data collection continue improving to support equitable health outcomes? - What cultural factors most influence health behaviors and outcomes in different minority groups? How can health programs be designed to address each group's unique needs and beliefs? - Socioeconomic disparities like poverty, education and income strongly influence health, but do not fully explain differences. What other historical, political and social determinants must be addressed? - Empowering minority communities requires access to decision-making power. How can health programs foster social networks,
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90110 pp tx_ch10
- 1. Community Health andMinorities Chapter 10
- 4. Introduction • Strength ofAmerica lies in diversity of people • Race remains an issue in U.S. • U.S. population • Majority – white, non-Hispanic (66%) • Racial or ethnic minorities (34%) • Minority health – morbidity and mortality of ethnic minorities
- 5. • Define morbidity •Mortality?
- 6. U.S. Population byRace/Ethnicity, 2008
- 7. U.S. Population Projectionby Race/Ethnicity
- 8. • Projections innumbers of members of each ethnicity by 2050?
- 9. Introduction • Advances inhealth gains are not equal in U.S. • Secretary’s Task Force Report on Black and Minority Health • Initiative to Eliminate Racial and Ethnic Disparities in Health (Race and Health Initiative)
- 10. Disparity • Compare africanamerican • Hispanic…define native american
- 11. 6 causes ofdeath accounts for 80% of all in minorities • Infant mortality • Cancer • CVD and stroke • Diabetes • Homicide and accidents • Addictive drugs
- 12. Age adjusted deathrates for selected causes
- 13.
- 14. The index ofdisparity • Differences between rates of health status indicators between minoritities and non minorities • 5 HSIs went up • 17 went down
- 15.
- 16. Race and HealthInitiative • 1) to achieve health • 2) eliminate disparity • 3) improve all peoples’ health • It is part of healthy people 2010’s goals
- 17. Racial and EthnicClassifications • Classifications used to operationalize race and ethnicity • Challenges with classifications representing diversity of population • Categories of race are more social than biological • Self-reported data can be unreliable • Many nonfederal systems do not collect racial and ethnic data
- 18. Races • American indian or alaskan native • Asian or pacific islander • Black • White Ethnic groups g)Hispanic b) non hispanic
- 19. Health Data Sourcesand Their Limitations • Challenges in complete and accurate collection of racial and ethnic data • Bias analysis = numerator and denominator issues.. Numbers not exact • HHS has long-term strategy for improving collection and use of racial and ethnic data • Important to understand health beliefs of various groups • Heterogeneity within groups
- 20. 1997 expanded racedefinition • 5 categories: separated asian or Pacific islander into • Asian and Native Hawaiian or Pacific Islander • Also term latino or hispanic used • And negro used as well as black or african american
- 21. What is black? •In south africa? • In australia?
- 22. What is ajew? • In canada or usa ( Lennie Kravitz) • In germany WW2? (PARENTAGE)
- 23. Americans of HispanicOrigin • Hispanic origin is an ethnicity, not a race • Persons of Mexican, Puerto Rican, Cuban, Central American, or South American descent, or some other Spanish origin • Nearly all Hispanics (96%) in the U.S. are classified by race as white • Educational attainment: a major disparity • Income: a major disparity • Health beliefs
- 24. Hispanics • 2008 47million hispanics ( 15.4% usa) • Most rapidly growing • Especially mexican americans • Hispanics lowest high school achievement levels (57% in 1980 and 75% in 2008) • Poverty rates = 22%
- 25. Black Americans • Blackor African Americans • People having origins in any of the black racial groups from Africa ( 2008 =12.4% of USA) • More than ½ live in southern regions of U.S. • Educational attainment < whites> hispanics • Income is lowest of all groups!! (24% in poverty) • Health beliefs and culture
- 26. Asian Americans andPacific Islanders • Now two separate racial groups • Generally concentrated in the western states • Educational attainment well off • Income well off, a BIPOLAR Distribution • Health beliefs • Variations among the many groups • Generational differences • Asians 4.4% usa not “Model Community”
- 27. American Indians andAlaska Natives • Original inhabitants of America • Economically and socially disadvantaged • Relatively poor health status • Education: low achievment levels • Income poverty level 25.7% • Health beliefs • Various tribal groups have distinct customs, languages, and beliefs • Many share the same cultural values
- 28. Native Americans andHealth Care • Many tribes are sovereign nations • Tribes transferred land in U.S. to federal government in return for provision of certain services • Indian Health Services (IHS) within HHS • Responsible for federal health services to Native Americans and Alaska Natives • Goal to raise health status to highest possible level
- 29. Completed High Schoolby Race and Hispanic Origin, U.S.
- 30. Real Median Incomeby Race and Hispanic Origin, U.S.
- 31. Poverty Rates byRace and Hispanic Origin, U.S.
- 32. Refugees • Refugees • Immigrants • Aliens • Illegal aliens • Can be classified into existing racial/ethnic groups; as a single group, present special concerns • Education, health problems, injuries, employment, etc.
- 33. Race and HealthInitiative • Goal to eliminate disparities among racial and ethnic minority populations in six areas of health while maintaining progress of overall health of American people • Infant mortality • Cancer screening and management • Cardiovascular disease • Diabetes • HIV/AIDS • Adult and child immunization
- 34. Infant Mortality (before 1 year old) • Serious disparity in U.S. among racial and ethnic minorities • Black Americans infant death rate more than two times that of white Americans • Lack of prenatal care and low-birth-weight babies
- 36. Infant Mortality Ratesby Race and Hispanic Origin of Mother, U.S.
- 37. Babies of LowBirth Weight by Mother’s Race and Hispanic Origin, U.S.
- 39. Cancer Screening andManagement • Incidence and death rates highest among black Americans for various types of cancer • Many disparities attributed to lifestyle factors, late diagnosis, access to health care • Less primary and secondary prevention in various minority groups • 550,000 cancer deaths/year • Lung ,rectum, colon and prostate cancer
- 40. Examples of primaryprevention? • Hint…….lifestyle • Examples of secondary prevention? • Hint ……..screening tests
- 41. 50 to 75year old fecal occult tests or low endoscopy
- 42. Cancer Incidence andDeath Rates, U.S., by Cancer Site and Race
- 43. Cardiovascular Diseases (number 1 killer) • Death rates vary widely among racial and ethnic groups ( coronary and stroke) • Black Americans have higher rates from CHD and stroke • Hypertension prevalence as a risk factor varies according to race/ethnicity • Black American tend to develop hypertension earlier in life than whites; unknown reason
- 44. Heart disease per100000 2006
- 45. Diagnosed age adjustedprevalence of hypertension by race
- 46.
- 47. Diabetes • Overall prevalencehas risen in U.S. in recent years • Prevalence in those 20 and older varies in minority groups • Increase in age-adjusted death rates in all racial and ethnic groups • Significantly higher in minority groups • American indians>black>hispanic
- 48. Diabetes Age-Adjusted Prevalenceby Race/Ethnicity, U.S.
- 49. HIV Infection/AIDS • Proportionaldistribution of AIDS cases has increased in black Americans and Hispanics and decreased in white Americans • Attributed to higher prevalence of unsafe or risky health behaviors, and lack of access to health care to provide early diagnosis and treatment • Since 1981, ½ all AIDS cases are in minorities
- 50. Percentages of AIDSby Race/Ethnicity and Year of Diagnosis, U.S.
- 51. % HIV/AIDS casesby race 2007
- 52. Child and AdultImmunization Rates • Early childhood immunizations do not vary significantly by race or ethnicity • Older adult immunization rates are substantially lower in minority groups, even though an overall increase has occurred
- 53. Socioeconomic Status andRacial and Ethnic Disparities in Health • Many factors contribute to health disparities – economic, educational, behavioral, cultural, legal, and political • Socioeconomic status (SES) considered the most influential single contributor to premature morbidity and mortality • Association between SES and race/ethnicity is complicated and cannot fully explain all disparity
- 54. Indirect causal associations •Poverty leads to morbidity and mortality • Circumstances explain most of morbidity issues • Education • Income • Social status
- 55. % adults 65and over with pneumococcal vaccine
- 56. Relationship Between Raceand Health
- 57. Equity in MinorityHealth • Simple solutions unlikely • Solutions to problems for one group may not work for another • Solutions must be culturally sensitive
- 58. Cultural Competence • Aset of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals, that enables effective work in cross-cultural situations • Culture is vital in how community health professionals deliver services and how community members respond to programs and interventions
- 59. Empowering the Selfand the Community • To enable people to solve their community health problems • Three kinds of power associated with empowerment • Social – access to “bases”; needed to gain political power • Political – power of voice and collective action • Psychological – individual sense of potency
- 61. Discussion Questions • Whyhave there been so many changes to racial and ethnic classifications in the United States in recent decades? • How can community health programs empower minority groups?