This document discusses racial disparities in the treatment of cardiovascular disease. It provides an overview of health care disparities, noting they are differences in quality of care that are not due to access, clinical needs, or patient preferences. The document reviews literature finding racial minorities receive fewer cardiovascular procedures than whites. It also outlines federal programs and recommendations from the Institute of Medicine to address disparities through increased data collection, provider training, and health system changes. The role of perfusionists in efforts to eliminate disparities through education and data collection is discussed.
Ce document de la National Coalition for LGBT Health américaine est le fruit du travail de son "Eliminating Disparities Working Group", publié en 2004.
Il présente les chantiers identifiés de sorte à faire reconnaître et mieux prendre en compte les enjeux de santé des trans. Il balaie un large spectre de déterminants de santé : violences, VIH/sida et des autres IST, usage abusif de produits psychoactifs, santé et bien-être mental, couverture maladie, traitements hormonaux, modifications corporelles auto-réalisées, formation des professionnels de santé, tabac etc.
Black American women have higher rates of many risk factors for heart disease, including obesity, physical inactivity, metabolic syndrome, diabetes, and hypertension than white women
Ce document de la National Coalition for LGBT Health américaine est le fruit du travail de son "Eliminating Disparities Working Group", publié en 2004.
Il présente les chantiers identifiés de sorte à faire reconnaître et mieux prendre en compte les enjeux de santé des trans. Il balaie un large spectre de déterminants de santé : violences, VIH/sida et des autres IST, usage abusif de produits psychoactifs, santé et bien-être mental, couverture maladie, traitements hormonaux, modifications corporelles auto-réalisées, formation des professionnels de santé, tabac etc.
Black American women have higher rates of many risk factors for heart disease, including obesity, physical inactivity, metabolic syndrome, diabetes, and hypertension than white women
The Effect Race and Income on HIV AIDS infection in African-Americans - Sunil...Sunil Nair
Race and Income has a significant influence on susceptibility to HIV/AIDS infections; Afro-Americans (Blacks) are 1.33 times more likely to be infected than whites. A significant finding is that the income level didn't change race's effect on HIV infections. Race has a significant effect on HIV infections or is an important predictor of incidence of HIV infections independent of the income. In other words, irrespective of the income level being black and poor increases the changes of being infected with HIV/AIDS.
A academic reflection paper on agreements for and/or against using an individual or population approach to solving a public health concern. Written for a UNC-Chapel Hill public health foundations course in Fall 2015.
Global Medical Cures™ | Older Americans- Key Indicators of Well Being Global Medical Cures™
Global Medical Cures™ | Older Americans- Key Indicators of Well Being
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Bolivia’s mental health plan is not currently embedded in mental health legislation or a legal framework, though in 2014 legislative change was proposed that would begin to provide protection and support for the hospital admission, treatment and care of people with mental disorders in Bolivia. Properly resourced regulated and rights-based mental health practice is still required. Mental healthcare in the primary care setting should be prioritised, and safeguards are needed for the autonomy of all patients, including all those in vulnerable and
cared-for groups, including those in prisons.
A Community Survey of the Willingness, Perceptions and Practice of Blood Dona...Premier Publishers
Blood donation is the major way of acquiring blood in emergency situations, major surgeries and blood related obstetric complications. The disparity between willingness to donate and the real practice of blood donation has implication for the establishment of blood transfusion services in Nigeria. This community survey of the willingness, perceptions and practice of blood donation among adults in Kano metropolis identified factors associated with willingness to donate as well as perceptions and practice of blood donation. This was a descriptive cross-sectional survey of adults from four of the eight local Governments areas within Kano metropolis employing a mixed method of data collection; i.e. comprising a quantitative and qualitative component, using a multi-stage sampling method. Relevant history on the willingness, perceptions and practice of blood donation were obtained using a structured interviewer administered questionnaires and in-depth interviews. Data were entered and analyzed using the Statistical Package for Social Sciences (IBM SPSS) version 20. A total of 215 out of 216 respondents were surveyed, giving a response rate of 99.5%. Their ages ranged from 18years to 65years, with a mean age of 30.5 (± 10.5) years. There were 101 (46.8%) males and 113 (52.3%) females. Respondent’s willingness to donate blood was 94.9%, while practice of blood donation was 25.5%. All respondents had a good perception of blood donation and indicated that it was a way of saving other peoples’ lives. Willingness to donate blood was high in this study; however, this did not translate well to the practice of blood donation. Efforts should be made by government and organizations involved in blood donation to increase awareness and encourage people to donate blood voluntarily through efforts such as signing blood donation card.
More young people in Canada are visiting EDs because of drinking alcoholΔρ. Γιώργος K. Κασάπης
More people are visiting emergency departments after drinking alcohol, a new study finds. Researchers looked at more than 765,000 ED visits in Ontario, Canada’s largest province, and found a 175% increase in such visits between 2003 and 2016 among 25- to 29-year-olds. That spiked to a 240% increase in alcohol-related ED visits for young women, who were also more likely than men to be under Canada’s legal drinking age of 19. For both young men and women, visiting the ED for alcohol-related problems also led to more hospital admissions than other types of ED visits. Other countries, including the U.S., have experienced similar increases in alcohol-related visits to the ED, the authors behind the new study write, urging more research into the reasons behind the growing trend.
The Effect Race and Income on HIV AIDS infection in African-Americans - Sunil...Sunil Nair
Race and Income has a significant influence on susceptibility to HIV/AIDS infections; Afro-Americans (Blacks) are 1.33 times more likely to be infected than whites. A significant finding is that the income level didn't change race's effect on HIV infections. Race has a significant effect on HIV infections or is an important predictor of incidence of HIV infections independent of the income. In other words, irrespective of the income level being black and poor increases the changes of being infected with HIV/AIDS.
A academic reflection paper on agreements for and/or against using an individual or population approach to solving a public health concern. Written for a UNC-Chapel Hill public health foundations course in Fall 2015.
Global Medical Cures™ | Older Americans- Key Indicators of Well Being Global Medical Cures™
Global Medical Cures™ | Older Americans- Key Indicators of Well Being
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Bolivia’s mental health plan is not currently embedded in mental health legislation or a legal framework, though in 2014 legislative change was proposed that would begin to provide protection and support for the hospital admission, treatment and care of people with mental disorders in Bolivia. Properly resourced regulated and rights-based mental health practice is still required. Mental healthcare in the primary care setting should be prioritised, and safeguards are needed for the autonomy of all patients, including all those in vulnerable and
cared-for groups, including those in prisons.
A Community Survey of the Willingness, Perceptions and Practice of Blood Dona...Premier Publishers
Blood donation is the major way of acquiring blood in emergency situations, major surgeries and blood related obstetric complications. The disparity between willingness to donate and the real practice of blood donation has implication for the establishment of blood transfusion services in Nigeria. This community survey of the willingness, perceptions and practice of blood donation among adults in Kano metropolis identified factors associated with willingness to donate as well as perceptions and practice of blood donation. This was a descriptive cross-sectional survey of adults from four of the eight local Governments areas within Kano metropolis employing a mixed method of data collection; i.e. comprising a quantitative and qualitative component, using a multi-stage sampling method. Relevant history on the willingness, perceptions and practice of blood donation were obtained using a structured interviewer administered questionnaires and in-depth interviews. Data were entered and analyzed using the Statistical Package for Social Sciences (IBM SPSS) version 20. A total of 215 out of 216 respondents were surveyed, giving a response rate of 99.5%. Their ages ranged from 18years to 65years, with a mean age of 30.5 (± 10.5) years. There were 101 (46.8%) males and 113 (52.3%) females. Respondent’s willingness to donate blood was 94.9%, while practice of blood donation was 25.5%. All respondents had a good perception of blood donation and indicated that it was a way of saving other peoples’ lives. Willingness to donate blood was high in this study; however, this did not translate well to the practice of blood donation. Efforts should be made by government and organizations involved in blood donation to increase awareness and encourage people to donate blood voluntarily through efforts such as signing blood donation card.
More young people in Canada are visiting EDs because of drinking alcoholΔρ. Γιώργος K. Κασάπης
More people are visiting emergency departments after drinking alcohol, a new study finds. Researchers looked at more than 765,000 ED visits in Ontario, Canada’s largest province, and found a 175% increase in such visits between 2003 and 2016 among 25- to 29-year-olds. That spiked to a 240% increase in alcohol-related ED visits for young women, who were also more likely than men to be under Canada’s legal drinking age of 19. For both young men and women, visiting the ED for alcohol-related problems also led to more hospital admissions than other types of ED visits. Other countries, including the U.S., have experienced similar increases in alcohol-related visits to the ED, the authors behind the new study write, urging more research into the reasons behind the growing trend.
Public health week conference racism and healthcareAntoniette Holt
This is an older presentation from Public Health Conference in 2016, but still has some really helpful points to address racism, health disparities, and the need for health equity. There are scenarios to help encourage discussion. Also some helpful next steps.
This essay gives the descriptive account of how Paratransit services are in need of better assessment criteria but it also highlights the expense of managing a program that caters to people who are disabled.
Carlos Pellegrini: From Success to SignificanceNIHACS2015
Carlos Pellegrini, MD, is Past President of the American College of Surgeons and Chairman of the Department of Surgery at the University of Washington in Seattle, where he developed the Center for Videoendoscopic Surgery, the Center for Esophageal and Gastric Surgery, and the Institute for Simulation and Interprofessional Studies (ISIS).
He delivered a keynote presentation entitled, “From Success to Significance."
Anne C. Beale, MD, MPH, the president of the Aetna Foundation speaks about disparities in child health care, the causes behind those disparities, and policies that can reduce them.
Health and health care inequalities
Name
Institution
Racial inequalities and discrimination
African Americans bear disproportionate burden in injury, disease morbidity, disability and mortality. This disadvantage is mostly related to age-related mortality. African Americans are significantly at risk for early death compared to the native community. The overall death rate of death among the African Americans in the US is equivalent to that of the natives thirty years ago (Dreyer, Brettle, & Roderick, 2020). The premature death is caused by various disorders such as obesity, cardiovascular heart disease, and hypertension. For example, the cases of death due to heart-related diseases is higher among the African Americans than any other race group in the United States. These health challenges occur in the context of increasing inequalities in the rate of disease infection.
Economic differences cannot explain the difference in health inequalities even when socioeconomic status is controlled. Differences in skin tone may be the basis of the discrimination in health status. The health disparities that negatively affect the African Americans arise from many sources including social inequalities, inherited health risks, and lifestyle patterns. Health disparities could also be caused by race-based discrimination. The concept of place or geographical location is important in explaining contribution of social injustice to health risks. Various studies shows that neighborhood is important in mediating access to social connections and opportunities, all which are factors that affect health status. When neighborhood is characterized by segregation, often linked to racial concentration, then African Americans have higher rates of mortality and morbidity. Residential segregation and discrimination that creates concentrated neighborhoods where residents are poor are social spaces with concentrated health-related problems. African Americans have higher exposure to stressful environments because of fewer resources.
African American, a poor racial minority has poorer health status. The poor community is less likely to have sufficient health and social services and this create a problem of timely access to medical services. Second, the community environment expose the African American to health hazards such as air pollution, dirt, and water contamination (Barsanti & Salmi, 2017). Moreover, concentration of social inequalities and poverty and it related characteristics such as substance abuse, anxiety, unemployment, and crime often creates social environment that lessen social connectedness. Researchers link the idea of biological responses that may be triggered by neighborhood stressors. There is correlation between residential segregation and social inequality. There are different factors that concentrate social stressors which trigger risks of heart disease, cognitive impairment, and chronic inflammation. African Americans who mostly live in unhealthy ...
Global Medical Cures™ | Women of Color- Cardiovascular Disease
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Achieving Health Equity Closing The Gaps InHealth Care Di.docxdaniahendric
Achieving Health Equity: Closing The Gaps In
Health Care Disparities, Interventions, And
Research
Purnell, Tanjala S; Calhoun, Elizabeth A; Golden, Sherita H; Halladay, Jacqueline R; Krok-Schoen, Jessica
L; Appelhans, Bradley M; Cooper, Lisa A . Health Affairs ; Chevy Chase Vol. 35, Iss. 8, (Aug 2016): 1410-
1415.
ProQuest document link
ABSTRACT (ENGLISH)
In the United States, racial/ethnic minority, rural, and low-income populations continue to experience suboptimal
access to and quality of health care despite decades of recognition of health disparities and policy mandates to
eliminate them. Many health care interventions that were designed to achieve health equity fall short because of
gaps in knowledge and translation. We discuss these gaps and highlight innovative interventions that help address
them, focusing on cardiovascular disease and cancer. We also provide recommendations for advancing the field of
health equity and informing the implementation and evaluation of policies that target health disparities through
improved access to care and quality of care.
FULL TEXT
Headnote
ABSTRACT In the United States, racial/ethnic minority, rural, and low-income populations continue to experience
suboptimal access to and quality of health care despite decades of recognition of health disparities and policy
mandates to eliminate them. Many health care interventions that were designed to achieve health equity fall short
because of gaps in knowledge and translation. We discuss these gaps and highlight innovative interventions that
help address them, focusing on cardiovascular disease and cancer. We also provide recommendations for
advancing the field of health equity and informing the implementation and evaluation of policies that target health
disparities through improved access to care and quality of care.
The need to eliminate disparities in health and health care has long been recognized. Nonetheless, populations
such as racial/ethnic minority groups, rural residents, and adults with low incomes continue to experience
suboptimal access to and quality of health care.1-7 Disparities in health and health care are especially pronounced
in cardiovascular disease and cancer, which are the leading causes of death in the United States.1-7 In
cardiovascular disease, for instance, compared to non-Hispanic whites, African Americans and Hispanics have a
higher prevalence of hypertension and poorer blood pressure control, which contributes to greater morbidity and
mortality.1,3 Similarly, lowincome adults are more likely to have at least one cardiovascular disease risk factor,
compared to adults with higher incomes, and rural residents have poorer access to care and a greater burden of
risk factors, compared to nonrural residents.5,6 (For an additional discussion of racial/ethnic disparities in cancer
and cardiovascular disease in these populations, see online Appendix Exhibit 1.)8
Several intervention ...
Similar to An Introduction to CVD Racial Disparities (20)
Achieving Health Equity Closing The Gaps InHealth Care Di.docx
An Introduction to CVD Racial Disparities
1. An Introduction to Racial Disparities in the
Treatment of Cardiovascular Disease
Polishing our Lens of Research and Care
Dr. Anthony Shackelford DHA, CCP, CCT
Assistant Professor
Cardiovascular Perfusion Program
Medical University of South Carolina
2. Purpose
To help increase awareness within the
perfusion community of racial disparities in
the treatment of cardiovascular disease. by
providing:
a general overview of what health care
disparities are and are not
the processes and programs in place to reduce
and eliminate health care disparities
examples of evidence specific to the treatment
of heart disease in the context of racial
disparities
2
3. What are going to cover?
General overview of what health care
disparities are and are not
The processes and programs in place to
reduce and eliminate health care disparities
Examples of evidence specific to the
treatment of heart disease in the context of
racial disparities
Applicability to Perfusion
3
4. Disclaimer
I have no contractual or financial
affiliations with any of the
manufactures of any of the devices
mentioned in this presentation
4
6. Death Rate due to Heart Disease by
Race/Ethnicity, 2005
329.8
Deaths per 100,000
population:
262.2
228.3
192.4
173.2 170.3
141.1
129.1
115.9
91.9
White, Hispanic African-
Asian andAmerican White, NoHispanic African-
Asian andAmerican
Non- American Pacific Indian/ n- American Pacific Indian/
Hispanic Islander Alaska Hispanic Islander Alaska
Native Native
Men Women
NOTES: Rates are age-adjusted.
DATA: Centers for Disease Control and Prevention, National Center for Health Statistics, National
Vital Statistics System.
SOURCE: Health US, 2007, Table 36.
7. Starting Point: Health Status
Determined by a variation
of social and behavioral risk
factors among people of:
different race/ethnicity
socioeconomic status (SES)
gender
+/- effect on mortality
Blacks and American Indians >
Whites
Asian and Pacific Islanders <
Whites.
7
8. What are Health Disparities?
Racial or ethnic differences in the quality of
health care that is not due to:
access-related factors
clinical needs
preferences
appropriateness of intervention
8
10. Literature “skim” of Racial
Disparities in the Treatment of
Cardiovascular Disease
10
11. Trends of CVD mortality by race and
ethnicity
Findings: CHD mortality rates of black
men and women have declined
the rate has been slower than white men and
women since the mid 1980’s
11
12. 17,000 patients for differences with respect to
noninvasive procedures and invasive procedures
(e.g. CABG, CC, PTCA)
Findings:
Black men and women < white men and women
to undergo costly cardiovascular procedures
Hispanics < whites to have received CC / PTCA
(Am J Public Health. 2000;90:1128–1134) 12
13. 3,015 patients over a two year period
Statistically significant difference in the utilization rates
comparing Caucasians to African-Americans for CABG
Although not statistically significant, African-Americans
were less likely than Caucasians to receive a cardiac
catheterization and Percutaneous Transluminal Coronary
Angioplasty (PTCA).
No significant disparities for gender for the utilization of
invasive treatments for cardiovascular disease.
Journal of Cultural Diversity, 11(3), 80-87.
13
14. Found that DES use was influenced by demographic,
socioeconomic and hospital characteristics.
blacks and low-income groups were significantly less likely to receive a
DES than their counterparts and differences according to facility
procedural volumes
14
16. Why this is more important
to North Carolina?
% of Population Black 1990 ->2000
United States
248,709,873 -> 281,421,906
29,980,996 (12.1%) ->34,658,190 (12.3%)
North Carolina
6,628,637 -> 8,049,313
1,456,323 (22.0%) -> 1,737,545 (21.6%)
South Carolina
3,486,703 -> 4,012,012
1,039,884 (29.8%) -> 1,185,216 (29.5%) 16
17. Federal Policy Actions Taken to
Eliminate & Reduce Disparities
The Healthcare Research and Quality Act of 1999
Directed Agency for Healthcare Research and Quality
(AHRQ) to develop 2 annual reports:
National Healthcare Quality Report (NHQR)
National Healthcare Disparity Report (NHDR)
Focus: a more comprehensive snapshot of the
performance of our health care system’s strengths
and areas for future improvement
17
18. Congress Charges
Institute of Medicine
Assess the extent of racial and ethnic differences in
healthcare
Evaluate potential sources of racial and ethnic
disparities
including the role of bias, discrimination, and stereotyping
At the individual (provider and patient), institutional, and
health system levels **
Provide recommendations regarding interventions
to eliminate healthcare disparities.
18
20. Sources of Disparities in Healthcare
Complex
Rooted in historic and
contemporary
inequities
Involve many
participants at several
levels
health systems
processes
health care professionals
patients
20
21. IOM’s Unequal Treatment
www.nap.edu
Recommendations
Increase awareness of existence of disparities
Address systems of care
Support race/ethnicity data collection, quality improvement, evidence-
based guidelines, multidisciplinary teams, community outreach
Improve workforce diversity
Facilitate interpretation services
Provider education
Health Disparities, Cultural Competence, Clinical Decisionmaking
Patient education (navigation, activation)
Research
Promising strategies, Barriers to eliminating disparities
22. Goal: Control the System
1. How care is delivered with
respect to the varying patient
demographics.
2. At minimum our healthcare
system and its processes
should not independently
contribute to lesser/negative
outcomes in care.
22
23. So how are we doing?
Results form the 2011
Health care quality and access are suboptimal, especially for minority and
low-income groups.
Quality is improving; access and disparities are not improving.
Progress is uneven with respect to eight national priorities:
Two are improving in quality:
(1) Palliative and End-of-Life Care and (2) Patient and FamilyEngagement.
Three are lagging: (3) Population Health, (4) Safety, and (5) Access.
Three require more data to assess:
(6) Care Coordination,
(7) Overuse, and
(8) Health System Infrastructure
All eight priority areas showed disparities related to race, ethnicity, and
socioeconomic status.
23
24. Federal Efforts to Address
Health Disparities
Federal Office of Minority Health
Efforts within HHS
Department of Health and Human Services (DHHS)
Interagency Working Group on Health Disparities
Health Disparities Collaboratives
Healthy People 2020
Data Collection
Legislation
Reimbursement rates to providers
Language access laws
Title VI of the Civil Rights Act of 1964
Medical malpractice
25. Potential Policy Levers for
Eliminating Health Disparities
Coverage
Piecemeal efforts vs. comprehensive efforts
Fragmentation of the health care system
Language access (who should pay?)
Reimbursement rates and other incentives
Provider training for cultural competence
Social policies (education, job training,
housing)
Health information technology
26. Examples of System-Level
Efforts to Eliminate Disparities
Insurance Companies
National Health Plan Collaborative (NHPC)
Pay-for-Performance (P4P)
Disease registries
Massachusetts General Hospital –
Disparities Solutions Center
Johns Hopkins Center for Health
Disparities
27. We are including the
Core Measures for Heart
Attack, Heart Failure and
Pneumonia.
28. Where Does Perfusion Fit In?
Provider education:
Increase awareness of existence of disparities
Health Disparities, Cultural Competence, Clinical Decision-
making
Improve workforce diversity
Support race/ethnicity data collection,
quality improvement,
evidence-based guidelines,
multidisciplinary teams
28
29. Take Home Messages
1. Disparities exist 5. A myriad of efforts
2. Regardless of how are underway to
they fair in the address disparities.
aggregate, all racial
groups have 6. Overall, we still have
problems. a long way to go to
3. Racial groups are eliminate
not monolithic. disparities.
4. Many factors aside
from race impact
health and health
care.
However one variation in the health care system that can be controlled and improved upon is how care is delivered with respect to the varying patient demographics. The minimum performance level of our healthcare system and its processes should be that the system does not independently contribute to lesser/negative outcomes in care.