This document discusses health disparities faced by racial and ethnic minority populations in the United States. It provides an overview of programs at the Cleveland Clinic aimed at addressing multifaceted health disparities. It highlights that racial and ethnic minorities experience higher rates of disease and poorer health outcomes for conditions like cancer, heart disease, stroke, diabetes and kidney disease when compared to white populations. The document also discusses social and economic factors that contribute to these disparities.
Cardiovascular Disease: Hispanic Perspective
Max Solano M.D., St. Vincent’s Family Medicine Center – Coordinator of Healthy LifeStyle Initiatives Project
June 24, 2005 - UNF Hispanic Health Issues Seminar
This is part 5 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.
This document provides cancer statistics for African Americans, including information on leading cancer sites, death rates, and risk factors. Some key points:
- Cancer remains a leading cause of death for African Americans, though overall racial disparities are decreasing.
- Lung cancer is the top cause of cancer death in African American males and females. Prostate cancer is the most commonly diagnosed cancer in African American males.
- African Americans have higher cancer death rates than whites for most major cancers, due in part to socioeconomic inequalities that impact access to care and screening.
Gregory Galloway Health Care Inequality PresentationGregory Galloway
Racial disparities exist in health care treatment and outcomes. Minorities are less likely to receive adequate pain treatment and newer cardiac treatments compared to whites. Socioeconomic status is a strong predictor of health, and racial minorities face more health risks at all income levels. Neighborhood and geographical factors also influence health, as racial minorities often live in poorer areas with less access to healthy options and quality providers. Options to address these disparities include increasing data collection and analysis, raising public and provider awareness, and improving healthcare access in underserved communities.
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.
Latinos in the U.S. and Northeast Florida: A Health Overview
Feb. 25, 2005
This is part 1 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.
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
Bank of America is hosting a golf tournament called Swing for the Cure to raise money and awareness for prostate cancer research. Proceeds will support the North Texas Prostate Cancer Coalition to develop a more accurate, less invasive prostate cancer test. The goal is to detect prostate cancer earlier when survival rates are nearly 100%. Bank of America employees will volunteer at the event to help raise funds and educate attendees about prostate cancer risks, symptoms, and the importance of early detection.
Coronary heart disease (CHD) involves damage to the heart's major blood vessels as plaque builds up, narrowing the arteries and reducing blood flow. It is the leading cause of death for those over 65. Risk factors include obesity, high cholesterol, poor diet, smoking, and limited access to healthcare. African Americans have higher rates of heart disease than Caucasians. Those in low-resource communities and with low socioeconomic status also face greater risks due to less access to care, poverty, unemployment, and lack of insurance. In 2015, CHD caused over 365,000 deaths in the US, with African Americans making up 26% despite being only 13% of the population.
Cardiovascular Disease: Hispanic Perspective
Max Solano M.D., St. Vincent’s Family Medicine Center – Coordinator of Healthy LifeStyle Initiatives Project
June 24, 2005 - UNF Hispanic Health Issues Seminar
This is part 5 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.
This document provides cancer statistics for African Americans, including information on leading cancer sites, death rates, and risk factors. Some key points:
- Cancer remains a leading cause of death for African Americans, though overall racial disparities are decreasing.
- Lung cancer is the top cause of cancer death in African American males and females. Prostate cancer is the most commonly diagnosed cancer in African American males.
- African Americans have higher cancer death rates than whites for most major cancers, due in part to socioeconomic inequalities that impact access to care and screening.
Gregory Galloway Health Care Inequality PresentationGregory Galloway
Racial disparities exist in health care treatment and outcomes. Minorities are less likely to receive adequate pain treatment and newer cardiac treatments compared to whites. Socioeconomic status is a strong predictor of health, and racial minorities face more health risks at all income levels. Neighborhood and geographical factors also influence health, as racial minorities often live in poorer areas with less access to healthy options and quality providers. Options to address these disparities include increasing data collection and analysis, raising public and provider awareness, and improving healthcare access in underserved communities.
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.
Latinos in the U.S. and Northeast Florida: A Health Overview
Feb. 25, 2005
This is part 1 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.
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
Bank of America is hosting a golf tournament called Swing for the Cure to raise money and awareness for prostate cancer research. Proceeds will support the North Texas Prostate Cancer Coalition to develop a more accurate, less invasive prostate cancer test. The goal is to detect prostate cancer earlier when survival rates are nearly 100%. Bank of America employees will volunteer at the event to help raise funds and educate attendees about prostate cancer risks, symptoms, and the importance of early detection.
Coronary heart disease (CHD) involves damage to the heart's major blood vessels as plaque builds up, narrowing the arteries and reducing blood flow. It is the leading cause of death for those over 65. Risk factors include obesity, high cholesterol, poor diet, smoking, and limited access to healthcare. African Americans have higher rates of heart disease than Caucasians. Those in low-resource communities and with low socioeconomic status also face greater risks due to less access to care, poverty, unemployment, and lack of insurance. In 2015, CHD caused over 365,000 deaths in the US, with African Americans making up 26% despite being only 13% of the population.
F - Improving Cardiovascular Health In African AmericansNathan Banda
The document discusses improving cardiovascular health in African Americans. It aims to increase awareness of genetic and behavioral risk factors for hypertension in this population. Hypertension is one of the biggest challenges to cardiovascular health for African Americans. The presentation reviews risk factors for hypertension such as age, race, family history, obesity, diet, stress, alcohol, and tobacco use. It also discusses the high prevalence of hypertension in African Americans and the impact of diet, exercise, weight control, and lifestyle changes on reducing hypertension risk and improving cardiovascular health.
Cancer and US Latinos
Daniel Santibanez, MPH, University of North Florida
June 24, 2005 - UNF Hispanic Health Issues Seminar
This is part 5 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.
What is our collective responsibility in addressing global health challenges? Over
the last 4 years, World Health Day has successfully highlighted some of the most
pressing global health issues that impact us every day. How we will continue to
respond to climate changes that threaten vulnerable populations such as the very
young, elderly, and the poor? How will we increase international health security
and defend ourselves against public health emergencies such as the bird flu
and humanitarian diseases that can devastate people, societies and economies
worldwide? How can we build our healthcare workforce in response to a continued
chronic shortage? Around the world, it is our collective responsibility to answer
these questions and increase our investment of time, resources, and education to
protect our greatest assets…our health, our children, and our global environment.
Join us as we work together to increase global health awareness and contribute to
a more promising future.
Learning Outcomes: Participants will explore World Health Day global health
issues highlighted over the last 4 years and examine strengths, weaknesses, opportunities,
and threats in global health.
This document presents health disparity data for African American women in Los Angeles County across several metrics. It shows that African Americans have higher rates of poverty, lower life expectancy, higher rates of obesity, hypertension, and infant mortality compared to other racial/ethnic groups in the county. Data on potential years of life lost and causes of mortality also demonstrate greater health burdens for African Americans.
The document discusses findings from the National Survey of American Life (NSAL) regarding mental health differences among racial and ethnic groups in the United States. It finds that while race is an important factor, there are also differences between ethnic groups like African Americans, Afro-Caribbeans, and whites. Immigrant status and ancestry were found to impact mental health outcomes for Afro-Caribbeans. The study also looked at multigenerational families and found mental health disparities are influenced by multiple social and biological factors over the life course, not any single cause.
This presentation focuses on the experiences of African Americans and the unique difficulties that African Americans face. The author provides statistics to support her positions as well as at depth analysis.
Perceived Discrimination and Cardiovascular Risk FactorsMichael John
This study examined the relationship between perceived ethnic discrimination and cardiovascular risk factors in a multi-ethnic sample of 360 adults and university students. The researchers found that lifetime experiences of racism were positively associated with smoking, but not with binge drinking or BMI. Specifically, logistic regression revealed that experiences of lifetime discrimination significantly increased the likelihood of current smoking. However, lifetime discrimination was not significantly related to binge drinking in logistic regression and was unrelated to BMI in multiple regression. Latino individuals were over 11 times more likely to smoke and over 2 times more likely to binge drink compared to white/other individuals.
This document discusses disparities in heart disease among women of different ethnicities. It summarizes that Native American, Hispanic, and African American women have higher rates of heart disease mortality compared to Asian American and white women. It then discusses various risk factors for heart disease like high cholesterol, diabetes, obesity rates, exercise levels, and smoking rates among different ethnic groups of women. It also addresses biases in referral to certain cardiac procedures and treatments among African American patients.
A Quantitative Analysis of Perceptions of Health, Family History and Health O...PhD Dissertation
This presentation is about a quantitative analysis of perceptions of health, family history and health outcome associations in African American Men at risk for CVD. To get full text check this site https://www.phddissertation.info/
Genetics and Genomics in African American Womenbkling
This webinar will provide an overview of genetic risk and gene signatures that have been uncovered in recent years, which established unique molecular underpinnings of cancer growth that are specific to ancestry groups. Melissa B. Davis, PhD, Scientific Director of the International Center for the Study of Breast Cancer Subtypes, Weill Cornell Medical College, will go over a few examples and discuss the pending impact these have on cancer treatment and survival.
Community stroke prevention_programs__an_overview.6สปสช นครสวรรค์
This document summarizes a journal article about community stroke prevention programs. It finds that while healthcare providers understand stroke risk factors, prevention and risk factor control remain poor. The general public also lacks knowledge about stroke warning signs and their own risk. The document reviews the human and economic costs of stroke and discusses disparities. It outlines modifiable risk factors like hypertension and the need to increase public awareness and reduce those risks through community programs.
This document provides a draft Master's of Public Health (MOP) proposal for a study examining cardiovascular disease (CVD) risk factors and premature heart disease mortality among Native Americans aged 45-64 living in North and South Dakota from 2010-2013. The study would use a nested case-control design within the Strong Heart Study cohort to examine the association between exposures like diabetes, hypertension, smoking and outcomes like premature heart disease mortality. The goal is to better understand high rates of premature heart disease in Native American populations and inform prevention programs. Ethical considerations around working with vulnerable populations and obtaining informed consent are discussed.
Cancer Disparities in the 21st Century - Otis W. Brawley, M.D.bkling
Otis W. Brawley gave a presentation on the evolution of our concept of cancer and disparities in cancer outcomes. Some key points:
- Our understanding of cancer has advanced from the 19th century definition to incorporating genomics and personalized medicine. Screening and diagnostic tools have also improved greatly over time.
- However, an estimated 10-20% of cancers detected through screening are overdiagnosed and do not need treatment. Screening also has harms like unnecessary biopsies and treatments.
- Disparities exist in cancer outcomes based on factors like race, income, education level, geography. An estimated 152,000 cancer deaths per year could be prevented in the US if all Americans
This document summarizes an aggregate study on reducing hypertension in Hispanic men aged 50-80 in Orange County, Florida. It provides background on hypertension, risk factors, statistics on its prevalence among Hispanic populations both nationally and locally. It also discusses cultural health beliefs and socioeconomic challenges facing this group. The study aims to address this issue through primary, secondary and tertiary prevention strategies such as education, screening, treatment and community resources.
Counseling African-Americans Graduate Research PowerpointShanika Robinson
Fall 2018 Research Project from my Multicultural Class. The presentation talks on historical and current events which has caused mistrust among the Black Community in regards to the medical, mental health and overall health fields. At the end of the presentations are important key tips counselors should take in to consideration when working with Black clients. My partner for the project is Shaletha Robinson. Inside the presentation are reference links to the Henrietta Lacks case.
This document provides updated guidelines from the American Heart Association for preventing cardiovascular disease in women. Some key points:
- Cardiovascular disease remains the leading cause of death among women in the United States, causing over 420,000 deaths annually.
- While awareness and treatment of heart disease in women has improved, challenges remain such as increasing rates of obesity and diabetes that contribute to cardiovascular risk.
- The guidelines provide recommendations for preventing cardiovascular disease through control of major risk factors like hypertension and through evidence-based medical therapies.
- The vast majority of recommendations for prevention are now similar for women and men, with a few exceptions like the use of aspirin for primary prevention of heart attacks in younger women.
From Queens Library's expert-led panel, Cancer Awareness: What You Need to Know, featuring professionals from New York Hospital Queens, North Shore LIJ, the American Cancer Society, and the Leukemia and Lymphoma Society
US Ethnicity and Cancer, Learning from the World (B Blauvelt Innovara)Innovara, Inc.
A presentation on cancer and ethnicity in the United States, and how the US can learn from other countries in regards to cancer control. - by Barri Blauvelt, CEO, Innovara, Inc.
The document discusses care considerations for older adults and pregnant patients. It notes that the aging population is growing rapidly and will be more ethnically diverse. Nurses must adapt care to address the specific needs of older patients, including common chronic illnesses. When triaging pregnant patients, nurses should consider red flags, choose the appropriate pregnancy protocol, and understand the difference between true and false labor. Safety is a top priority, and medications should only be recommended if on the patient's approved list.
What do Heart Disease, Cancer, and Obesity have in common? They are all huge threats to women’s health and also all preventable.
We would be amiss if we gathered at this conference to talk about success, power, and vitality without including a candid
discussion about the most critical part of long term Success. HEA LTH!
Learning Objective: This workshop will explore top areas of health concerns and review small changes in daily lifestyle and be
a part of a collective movement to reduce risk and live a longer, healthier life.
Outcome-At the end for this workshop, participants will:
a. Explore new trends, issues, and health concerns specific to women
b. Examine specific health issues common among various age groups and ethnicities
c. Discuss solutions, lifestyle changes, and other health related solutions
d. Explore and assess several natural health remedies and other vitamin supplementation
e. Review and rate top weight loss and exercise plans for women
The document discusses sudden cardiac arrest, noting that it claims more lives annually in the US than other major causes of death but that rates vary between racial and ethnic groups. Risk factors for sudden cardiac arrest like heart disease, diabetes, and obesity also disproportionately impact some populations. Effective prevention programs require understanding health disparities, identifying at-risk communities, and collaborating across sectors.
This document discusses sudden cardiac arrest (SCA) and strategies for preventing SCA in high-risk populations. It notes that cardiovascular disease is a leading cause of death and that SCA claims more lives each year than lung cancer, breast cancer, and AIDS combined. It reviews data showing higher rates of SCA and associated risk factors like diabetes and hypertension in certain racial/ethnic groups. The document proposes models to explain health disparities and discusses the role of genetics, behaviors, socioeconomic status, and stress in influencing cardiovascular disease risk. It advocates for identifying at-risk populations and implementing community-based prevention programs, education, and healthcare system improvements to reduce SCA.
F - Improving Cardiovascular Health In African AmericansNathan Banda
The document discusses improving cardiovascular health in African Americans. It aims to increase awareness of genetic and behavioral risk factors for hypertension in this population. Hypertension is one of the biggest challenges to cardiovascular health for African Americans. The presentation reviews risk factors for hypertension such as age, race, family history, obesity, diet, stress, alcohol, and tobacco use. It also discusses the high prevalence of hypertension in African Americans and the impact of diet, exercise, weight control, and lifestyle changes on reducing hypertension risk and improving cardiovascular health.
Cancer and US Latinos
Daniel Santibanez, MPH, University of North Florida
June 24, 2005 - UNF Hispanic Health Issues Seminar
This is part 5 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.
What is our collective responsibility in addressing global health challenges? Over
the last 4 years, World Health Day has successfully highlighted some of the most
pressing global health issues that impact us every day. How we will continue to
respond to climate changes that threaten vulnerable populations such as the very
young, elderly, and the poor? How will we increase international health security
and defend ourselves against public health emergencies such as the bird flu
and humanitarian diseases that can devastate people, societies and economies
worldwide? How can we build our healthcare workforce in response to a continued
chronic shortage? Around the world, it is our collective responsibility to answer
these questions and increase our investment of time, resources, and education to
protect our greatest assets…our health, our children, and our global environment.
Join us as we work together to increase global health awareness and contribute to
a more promising future.
Learning Outcomes: Participants will explore World Health Day global health
issues highlighted over the last 4 years and examine strengths, weaknesses, opportunities,
and threats in global health.
This document presents health disparity data for African American women in Los Angeles County across several metrics. It shows that African Americans have higher rates of poverty, lower life expectancy, higher rates of obesity, hypertension, and infant mortality compared to other racial/ethnic groups in the county. Data on potential years of life lost and causes of mortality also demonstrate greater health burdens for African Americans.
The document discusses findings from the National Survey of American Life (NSAL) regarding mental health differences among racial and ethnic groups in the United States. It finds that while race is an important factor, there are also differences between ethnic groups like African Americans, Afro-Caribbeans, and whites. Immigrant status and ancestry were found to impact mental health outcomes for Afro-Caribbeans. The study also looked at multigenerational families and found mental health disparities are influenced by multiple social and biological factors over the life course, not any single cause.
This presentation focuses on the experiences of African Americans and the unique difficulties that African Americans face. The author provides statistics to support her positions as well as at depth analysis.
Perceived Discrimination and Cardiovascular Risk FactorsMichael John
This study examined the relationship between perceived ethnic discrimination and cardiovascular risk factors in a multi-ethnic sample of 360 adults and university students. The researchers found that lifetime experiences of racism were positively associated with smoking, but not with binge drinking or BMI. Specifically, logistic regression revealed that experiences of lifetime discrimination significantly increased the likelihood of current smoking. However, lifetime discrimination was not significantly related to binge drinking in logistic regression and was unrelated to BMI in multiple regression. Latino individuals were over 11 times more likely to smoke and over 2 times more likely to binge drink compared to white/other individuals.
This document discusses disparities in heart disease among women of different ethnicities. It summarizes that Native American, Hispanic, and African American women have higher rates of heart disease mortality compared to Asian American and white women. It then discusses various risk factors for heart disease like high cholesterol, diabetes, obesity rates, exercise levels, and smoking rates among different ethnic groups of women. It also addresses biases in referral to certain cardiac procedures and treatments among African American patients.
A Quantitative Analysis of Perceptions of Health, Family History and Health O...PhD Dissertation
This presentation is about a quantitative analysis of perceptions of health, family history and health outcome associations in African American Men at risk for CVD. To get full text check this site https://www.phddissertation.info/
Genetics and Genomics in African American Womenbkling
This webinar will provide an overview of genetic risk and gene signatures that have been uncovered in recent years, which established unique molecular underpinnings of cancer growth that are specific to ancestry groups. Melissa B. Davis, PhD, Scientific Director of the International Center for the Study of Breast Cancer Subtypes, Weill Cornell Medical College, will go over a few examples and discuss the pending impact these have on cancer treatment and survival.
Community stroke prevention_programs__an_overview.6สปสช นครสวรรค์
This document summarizes a journal article about community stroke prevention programs. It finds that while healthcare providers understand stroke risk factors, prevention and risk factor control remain poor. The general public also lacks knowledge about stroke warning signs and their own risk. The document reviews the human and economic costs of stroke and discusses disparities. It outlines modifiable risk factors like hypertension and the need to increase public awareness and reduce those risks through community programs.
This document provides a draft Master's of Public Health (MOP) proposal for a study examining cardiovascular disease (CVD) risk factors and premature heart disease mortality among Native Americans aged 45-64 living in North and South Dakota from 2010-2013. The study would use a nested case-control design within the Strong Heart Study cohort to examine the association between exposures like diabetes, hypertension, smoking and outcomes like premature heart disease mortality. The goal is to better understand high rates of premature heart disease in Native American populations and inform prevention programs. Ethical considerations around working with vulnerable populations and obtaining informed consent are discussed.
Cancer Disparities in the 21st Century - Otis W. Brawley, M.D.bkling
Otis W. Brawley gave a presentation on the evolution of our concept of cancer and disparities in cancer outcomes. Some key points:
- Our understanding of cancer has advanced from the 19th century definition to incorporating genomics and personalized medicine. Screening and diagnostic tools have also improved greatly over time.
- However, an estimated 10-20% of cancers detected through screening are overdiagnosed and do not need treatment. Screening also has harms like unnecessary biopsies and treatments.
- Disparities exist in cancer outcomes based on factors like race, income, education level, geography. An estimated 152,000 cancer deaths per year could be prevented in the US if all Americans
This document summarizes an aggregate study on reducing hypertension in Hispanic men aged 50-80 in Orange County, Florida. It provides background on hypertension, risk factors, statistics on its prevalence among Hispanic populations both nationally and locally. It also discusses cultural health beliefs and socioeconomic challenges facing this group. The study aims to address this issue through primary, secondary and tertiary prevention strategies such as education, screening, treatment and community resources.
Counseling African-Americans Graduate Research PowerpointShanika Robinson
Fall 2018 Research Project from my Multicultural Class. The presentation talks on historical and current events which has caused mistrust among the Black Community in regards to the medical, mental health and overall health fields. At the end of the presentations are important key tips counselors should take in to consideration when working with Black clients. My partner for the project is Shaletha Robinson. Inside the presentation are reference links to the Henrietta Lacks case.
This document provides updated guidelines from the American Heart Association for preventing cardiovascular disease in women. Some key points:
- Cardiovascular disease remains the leading cause of death among women in the United States, causing over 420,000 deaths annually.
- While awareness and treatment of heart disease in women has improved, challenges remain such as increasing rates of obesity and diabetes that contribute to cardiovascular risk.
- The guidelines provide recommendations for preventing cardiovascular disease through control of major risk factors like hypertension and through evidence-based medical therapies.
- The vast majority of recommendations for prevention are now similar for women and men, with a few exceptions like the use of aspirin for primary prevention of heart attacks in younger women.
From Queens Library's expert-led panel, Cancer Awareness: What You Need to Know, featuring professionals from New York Hospital Queens, North Shore LIJ, the American Cancer Society, and the Leukemia and Lymphoma Society
US Ethnicity and Cancer, Learning from the World (B Blauvelt Innovara)Innovara, Inc.
A presentation on cancer and ethnicity in the United States, and how the US can learn from other countries in regards to cancer control. - by Barri Blauvelt, CEO, Innovara, Inc.
The document discusses care considerations for older adults and pregnant patients. It notes that the aging population is growing rapidly and will be more ethnically diverse. Nurses must adapt care to address the specific needs of older patients, including common chronic illnesses. When triaging pregnant patients, nurses should consider red flags, choose the appropriate pregnancy protocol, and understand the difference between true and false labor. Safety is a top priority, and medications should only be recommended if on the patient's approved list.
What do Heart Disease, Cancer, and Obesity have in common? They are all huge threats to women’s health and also all preventable.
We would be amiss if we gathered at this conference to talk about success, power, and vitality without including a candid
discussion about the most critical part of long term Success. HEA LTH!
Learning Objective: This workshop will explore top areas of health concerns and review small changes in daily lifestyle and be
a part of a collective movement to reduce risk and live a longer, healthier life.
Outcome-At the end for this workshop, participants will:
a. Explore new trends, issues, and health concerns specific to women
b. Examine specific health issues common among various age groups and ethnicities
c. Discuss solutions, lifestyle changes, and other health related solutions
d. Explore and assess several natural health remedies and other vitamin supplementation
e. Review and rate top weight loss and exercise plans for women
The document discusses sudden cardiac arrest, noting that it claims more lives annually in the US than other major causes of death but that rates vary between racial and ethnic groups. Risk factors for sudden cardiac arrest like heart disease, diabetes, and obesity also disproportionately impact some populations. Effective prevention programs require understanding health disparities, identifying at-risk communities, and collaborating across sectors.
This document discusses sudden cardiac arrest (SCA) and strategies for preventing SCA in high-risk populations. It notes that cardiovascular disease is a leading cause of death and that SCA claims more lives each year than lung cancer, breast cancer, and AIDS combined. It reviews data showing higher rates of SCA and associated risk factors like diabetes and hypertension in certain racial/ethnic groups. The document proposes models to explain health disparities and discusses the role of genetics, behaviors, socioeconomic status, and stress in influencing cardiovascular disease risk. It advocates for identifying at-risk populations and implementing community-based prevention programs, education, and healthcare system improvements to reduce SCA.
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,
This document summarizes surveillance data on heart disease and stroke prevention from a clinician educator's perspective. It includes data from several sources on topics like age-adjusted death rates by race and sex, percentage breakdown of cardiovascular disease deaths, trends in cardiovascular procedures, prevalence of risk factors like high blood pressure and diabetes, and projections on the growing racial and ethnic diversity of the US population. The document emphasizes the importance of considering social and economic factors that influence cardiovascular health outcomes between demographic groups.
This document discusses how racism and racial inequalities impact health. It finds that racial disparities in health persist even after accounting for socioeconomic status. Black Americans have higher rates of disease, worse health outcomes, and shorter life expectancies than white Americans. Discrimination operates through multiple pathways like restricting socioeconomic attainment, segregating communities, and directly impacting stress levels. Both chronic everyday discrimination and acute major discriminatory experiences are associated with worse health. Place and environment also matter - segregated communities tend to be more disadvantaged and have worse health outcomes. Discrimination within the medical system also negatively impacts health. Overall, racism appears to be a major driver of the significant and persistent racial inequalities seen in health.
Here are 3 potential discussion questions:
1. What are some challenges to collecting accurate racial and ethnic health data in the U.S.?
2. How do socioeconomic factors like income and education contribute to health disparities among racial and ethnic groups?
3. In what ways can cultural competence help address inequities in health outcomes for minority populations?
Prostate Cancer in Africa, NCI Summer Fellowshipjamieritchey
The document summarizes a population-based study of Ghanaian men aged 50-74 that investigated the prevalence of risk factors for chronic diseases. Some key findings were: smoking and drinking were common, but obesity was low. Hypertension was common but diabetes was less so. Access to healthcare was limited. The study provides insights into differences from African American men that could help explain their higher disease rates.
UCB Causes of health problems among African and Indian Americans.docxwrite5
1) African Americans and American Indians face similar health issues like diabetes and cardiovascular disease, but the causes and challenges differ. For diabetes, the rates are higher for African Americans, Native Americans, and Hispanic Americans.
2) Talking circle interventions could be used to address health problems in these communities. Talking circles allow for open discussion and sharing of experiences in a supportive environment.
3) Hypertension disproportionately impacts African Americans and is linked to cultural and social factors like racism and stress in addition to genetics. High blood pressure is much more common among African American males and females compared to other groups.
HIV/AIDS in the United States: Epidemiology and an Overview of High-Impact Prevention Measures
By Melody Lehosit, Kaplan University School of Health Sciences
A presentation for National Public Health Week.
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."
Improving Race and ethnicity data quality to advance health equityAccelerate Utah
The document discusses improving race and ethnicity data collection to advance health equity. It will expand categories from 10 to 81 and simplify collection for new Americans. Patients will be prompted to update their race/ethnicity starting in February 2023 via online portals, check-ins, and annual confirmations. Accurate data is needed to provide inclusive care, reduce disparities, and improve outcomes. The expanded categories were developed through research and partnerships to better represent the community's diversity.
Understand why hospitals must take the lead in eliminating disparities in care
Learn about the various dimensions of health care disparities. This presentation provides a background on the factors contributing to health care disparities, the ways in which race, ethnicity and language (REaL) data may be applied to improve health equity, as well as strategies through which to enhance the collection of REaL data.
Authors: Bohr D, Bostick N
African Americans in Wisconsin have significantly higher rates of poverty, lower education levels, and younger median age compared to the total Wisconsin population. The top three leading causes of death for African Americans are cancer, heart disease, and unintentional injury. However, the death rate for diabetes is over two times greater and for homicide is 14.7 times greater for African Americans compared to whites. Risk factors such as smoking, physical inactivity, and obesity are also higher among African Americans. Environmental and socioeconomic factors like living in urban areas with more exposure to pollution, lower SES, and lack of access to healthcare all contribute to the health disparities seen between African Americans and whites in Wisconsin.
Improving Breast Cancer outcomes in Communities of Color Steps Towards Equitybkling
Hayley Thompson, Ph.D., Faculty Director of the Office of Cancer Health Equity and Community Engagement at Karmanos Cancer Institute and leader of Population Studies and Disparities, gives an overview of recent efforts to improve health equity for women of color with breast cancer and make suggestions about how to make breast cancer outcomes more equitable.
The document discusses the controversial history of blood donation policies in the US, which have at times discriminated against African Americans and gay/bisexual men. During WWII, black and white blood was separated due to a racist military policy, despite evidence that blood does not differ by race. During the AIDS crisis in the 1980s, many doctors were reluctant to investigate the disease because it initially affected gay men. The FDA instituted a lifetime ban on blood donations from gay and bisexual men in 1983 due to homophobia and unfounded fears, even as other countries have since reformed similar discriminatory policies. Critics argue the ban is an ineffective and discriminatory way to screen donors compared to assessing individual risk behaviors.
The document discusses the controversial history of blood donation policies in the US, which have at times discriminated against African Americans and gay/bisexual men. During WWII, black and white blood was separated due to a racist military policy, despite evidence that blood does not differ by race. During the AIDS crisis in the 1980s, many doctors were reluctant to investigate the disease because it initially affected gay men. The FDA instituted a lifetime ban on blood donations from gay and bisexual men in 1983 due to homophobia and unfounded fears, even as other countries have since reformed similar discriminatory policies. Critics argue the ban is an ineffective and discriminatory way to screen donors compared to assessing individual risk behaviors.
This is a training intended to help health workers with understanding the literacy issues in working with a diverse group of clients. The training was presented to Americorps staff who work as patient navigators in Seattle.
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Dr. charles modlin nma new orleans urology presentation july 30 2012
1. Charles Modlin, M.D., MBA
Overview & Examples
Health Disparities in
• Staff Urologist Racial/ Ethnic Minority
• Kidney Transplant Populations
Surgeon
Discuss Causes of
• Founder & Health Disparities
Director, Minority
Men’s Health Health Disparities
Center Prevention
• Cleveland Clinic
Highlight Cleveland
Clinic Programs
Designed to Address
Multifaceted Health
Disparities
2. Disclosures
• I do not have any significant financial
interest or other relationship with the
manufacturers of any products or
providers of services I intend to
discuss.
•
4. Cleveland Clinic Minority Men’s
Health Center/ Health Fair
Established 2003
Special Health Concerns in
Minority Males
5. Health
• In 1947, The World Health Organization
defined health as:
• “a state of complete
- physical,
- mental, and
- social well-being and
- not merely the absence of disease and
infirmity”
6. U.S. Minorities Increasing in
Numbers & Percentage Population
• Minorities:
- African Americans (Blacks), AA
- Hispanic/ Latinos, H/L
- Asian, A
- Native American, (American Indians), NA
- Pacific Islander, PI
• 1970: All U.S. Minorities 12.3% population
• 2003: All U.S. Minorities 25%
• 2006: All U.S. Minorities 30%
• 2050: Projected 50%
7. Population of the United States by Race and
Hispanic/Latino Origin, Census 2000 and 2010
Census Census
2010, Percent of 2000, Percent of
Race and Hispanic/Latino origin population population population population
Total Population 308,745,538 100.0% 281,421,906 100.0%
Single race
White 196,817,552 63.7 211,460,626 75.1
Black or African American 37,685,848 12.2 34,658,190 12.3
American Indian and Alaska Native 2,247,098 .7 2,475,956 0.9
Asian 14,465,124 4.7 10,242,998 3.6
Native Hawaiian and other Pacific
481,576 0.15 398,835 0.1
Islander
Two or more races 5,966,481 1.9 6,826,228 2.4
Some other race 604,265 .2 15,359,073 5.5
Hispanic or Latino 50,477,594 16.3 35,305,818 12.5
NOTE: Percentages do not add up to 100% due to rounding and because Hispanics may be of any race and are therefore counted
under more than one category.
Source: U.S. Census Bureau: National Population Estimates; Decennial Census.
Read more: Population of the United States by Race and Hispanic/Latino Origin, Census 2000
and July 1, 2005 — Infoplease.com http://www.infoplease.com/ipa/A0762156.html#ixzz1yins01sM
8. Race in Medicine & Research
• Active debate about meaning, importance
• Possibility of improving prevention and
treatment of diseases by predicting hard-to-
ascertain factors on the basis of more easily
ascertained characteristics
• Race: surrogate marker of increased
likelihood of certain medical conditions
9. Health Disparities in AA’s
• Compared to general
population, each year:
• 44% more AA’s die from cancer
• 30% more die from heart
disease
• 180% more die from stroke
http://www.cdc.gov/cancer/dcpc/data/race.htm
http://www.kff.org/minorityhealth/index.cfm
10. African Americans Life
Expectancies
• AA’s 6-8 year shorter life expectancy
than whites
• AA’s have not benefited equally from
medical advances
• AAs economically advantaged do not
enjoy in equal measure with whites
expected +++ influence of affluence on
their health.
11. Life Expectancy at Birth (in
years), by Race/Ethnicity, 2007
U.S. Ohio
White 78.7 78.0
AA 74.3 73.3
H/L 83.5 80.4
Asian 87.3 83.4
NA 75.1 NSD
12. Life Expectancy at Birth Among Black and White Males and Females in the
United States and the Black-White Life Expectancy Gap, 1975-2003
Harper, S. et al. JAMA 2007;0:297.11.1224-1232.
Copyright restrictions may apply.
13. Number of Deaths per 100,000
Population by Race/Ethnicity,
2005
United States Ohio
• White 785.3 White 850.4
• Black 1,016.6 Black 1,078.1
• Other 476.5 Other 291.2
2008
United States Ohio
White 750.3 White 828.0
Black 934.9 Black 1,029.2
Other 445.8 Other 325.7
14. Infant Mortality Rate (Deaths per 1,000 Live
Births) by Race/Ethnicity
2003-2005
• United States Ohio
• Non-Hispanic White 5.7 6.4
• Non-Hispanic Black 13.6 15.6
• Hispanic 5.6 6.5
• 2007 Non-HW NH-Black Hispanic
• United States 5.7 13.4 5.5
• Ohio 6.4 15.3 6.6
15. Number of Deaths Due to Firearms
per 100,000 Population by
Race/Ethnicity, 2005
• United States Ohio
• White 8.9 White 7.7
• Black 19.4 Black 22.3
• Other 4.1 Other NSD
http://www.statehealthfacts.org/comparebar.jsp?ind=115&cat=2&sub=32&yr=63&typ=3
16. High Blood Pressure Levels Vary
by Race and Ethnicity
Race of Ethnic Men Women
Group (%) (%)
African
43.0 45.7
Americans
Mexican
27.8 28.9
Americans
Whites 33.9 31.3
All 34.1 32.7
http://www.cdc.gov/bloodpressure/facts.htm
17. Hypertension
African Americans
• HTN risk factor for:
- Kidney, eye, heart, vascular disease
- 7.5 million Blacks
- High salt diets, urban living, poverty,
psychosocial factors: stress, genetic
predisposition
- Greater likelihood of being untreated
18. Cardiovascular Disease and
Heart Failure in AA’s
• CVD leading cause of death in all U.S.
pts.
• Greater incidence in AA’s
• Race and ethnicity influence a patient's
chance of receiving many specific
procedures and treatments:
- AA 13% less likely to have coronary
angiography, 1/3 less to have bypass
19. Screening & Treatment
Differences by Race & Gender
• Blacks are less Paula A. Johnson, MD,
likely to receive MPH
major procedures Brigham and Women’s Hospital
diagnosing and
treating coronary
Sources: Schulman KA et al,
heart disease than N Engl J Med 1999;340(8);
whites Ayanian JZ et al, JAMA,
• Black women are 1993;269,20; Giles et al,
the least likely to Arch Intern Med
have such 1995;155(3); Johnson PA
procedures et al, Ann Intern Med
recommended 1993;119(8))
20. Heart Disease in AA
• Heart failure from HTN is > in Blacks (40%) than
Whites (7%).
• Major risk factors: smoking, HTN, high
cholesterol, physical inactivity.
• AA’s:
- less knowledge about risk factors than whites,
even per age and education.
• AA diet consumption of meat, fried foods, high in
cholesterol and saturated fats.
• Physician Decision-making
21. Cerebrovascular Disease in AA
• Blacks higher incidence of and
>>mortality from stroke than whites
- Blacks more hemorrhagic vs.
ischemic (Stroke 1991^22:299-304)
• Race and ethnicity influence a patient's
chance of receiving many specific
procedures and treatments.
22. 2005 Stroke Death Rates per
100,000 population
(Kaiser Family Foundation)
United States Ohio
Rate
White White
44.7 48.2
Black Black
65.2 60.3
Other Other
38 31.9
23. Cancer in African Americans
• Cancer 2nd leading cause of U.S.
deaths
• AA’s highest death rates in U.S.
• Contributing factors: Tob,
occupations, diet, knowledge, attitudes
and practices, health/medical
resources, biological factors,
socioeconomic status.
24. Smoking in African
Americans
• AA tend to start smoking later in life
and fewer cigarettes/day than Whites
• More likely smoke Tar and Nicotine
brands, 55% AA use only mentholated
form
• AA less likely than Whites to quit
• AA 30% higher Nicotine intake per
cigarette and differ in metabolism
• Clin Immunol Immunopathol. 1991 May;59(2):187-200.
25. Cancer in AA
By Race, AA more likely develop and
die of the 4 most common cancers:
Breast,
Prostate,
Colon,
Lung—
Cancer Incidence and Death Rates* by Site, Race, and
Ethnicity†, US, 2004-2008. American Cancer Society. Cancer
Facts & Figures 2012. Atlanta: American Cancer Society;
2012.
26. Cancer Incidence Rates by Race
(Kaiser Family Foundation)
2004 Rate Age-Adjusted per 100,000
• United States Ohio
• White 455.4 White 426.1
• Black 469.6 Black 453.6
• Hispanic 356.5 Hispanic 403.7
0.0 - 471.7
United States Rate
White 462.5
Black 471.7
Hispanic• 350.1
•
2007
27. Number of Cancer Deaths per
100,000 Population by
Race/Ethnicity, 2005 & 2007
U.S. 2005 2007 Ohio 2005 2007
White 182.6 174.7 Whites 194.2 190.5
Black 222.7 209.1 Blacks 249.2 238.1
Other 112.4 108.5 Other 66.0 91.3
28. Cancer Mortality Trends Among
Men by Race/Ethnicity: Progress
Among white men in the • Among black men in the
United States from 1999 to United States from 1999 to
2008, deaths from— 2008, deaths from—
- Colorectal cancer - Colorectal cancer
decreased significantly decreased significantly
by 3.0% per year. by 1.9% per year.
- Lung cancer decreased - Lung cancer decreased
significantly by 2.0% significantly by 2.8%
per year. per year.
- Prostate cancer - Prostate cancer
decreased significantly decreased significantly
by 3.4% per year. by 3.7% per year.
- Melanoma of the skin - Melanoma of the skin
increased significantly remained level.
by 1.0% per year.
29. Five-year relative survival by stage at diagnosis for
total cancers
in adults 20 years and older by race and gender
Source: SEER 1992-2001
Stage at
diagnosis Local Regional Distant All Stages
Distant All stages
Gender Race Diagnosed % Survival %Diagnosed % Survival % Diagnosed % Survival % Survival %
Men Black 54 92 20 31 26 16 56
White 58 95 20 43 22 20 64
Women Black 40 83 33 50 27 15 51
White 50 92 28 61 22 21 64
Local
30.
31. Lung Cancer Deaths
Total Population
Rate per 100,000
TOTAL 57.6
Race and ethnicity
American Indian or Alaska Native 38.2
Asian or Pacific Islander 29.3
Asian DNC
Native Hawaiian and other Pacific Islander DNC
Black or African American 66.7
White 57.5
Hispanic or Latino 22.7
32. Prostate Cancer Deaths
Males Rate per 100,000
TOTAL 32.0
Race and ethnicity
American Indian or Alaska Native 15.9
Asian or Pacific Islander 12.4
Asian DNC
Native Hawaiian and other Pacific Islander DNC
Black or African American 68.7
White 29.4
Hispanic or Latino 20.9
Data source: National Vital Statistics System (NVSS), CDC, NCHS.
33. Number of Diabetes Deaths per
100,000 Population by
Race/Ethnicity, 2005
United States Ohio
• White 22.5 White 28.4
• Black 47.0 Black 58.3
• Other 20.5 Other NSD
34. Kidney Disease and
African Americans
• The incidence of ESRD in AA is 4 times
greater than in whites.
• HTN and DM are the most commonly
identified causes of kidney failure
• National chronic kidney disease fact sheet, 2007.
http://www.cdc.gov/diabetes/pubs/factsheets/kidney.htm
35. New Cases of End-Stage
Total Population
Renal Disease
Rate per Million
TOTAL 289
Race and ethnicity
American Indian or Alaska Native 586
Asian or Pacific Islander 344
Asian DNC
Native Hawaiian and other Pacific Islander DNC
Black or African American 873
White 218
Gender
Female 242
Male 348
Data source: U.S. Renal Data System (USRDS), NIH, NIDDK.
36. Renal Transplantation:
Disparities
• Currently approx.
- 100,000 pts. on Kidney Tx
Waiting list
•35% AA; 19%H/L
•But AA’s only 12% U.S.
population; H/L 16%
• NIH News
http://www.nih.gov/news/health/mar2012/niddk-08.htm
• AA only get 26% of Deceased
Donor Kidney Tx
37. Renal Transplantation:
Disparities
• Among Appropriate Candidates for Tx, Blacks
are less likely: (UNOS Scientific Registry)
- referred for evaluation
- listed for Tx (account for only 28% new
listing)
- receive Tx
- Post Tx have higher rejection rates (50%
higher), lower patient and graft survival
Blacks wait 2-4 times as long as whites
38. Why Healthcare Disparities?
• Reasons:
• Multifactorial
• Patient and Provider Factors
• Culture/ Culture Competency/ Communication
• Education/ Health Literacy
• Historical Factors/ Distrust/ Racism/ Stereotyping/ Bias
• Socio-Economic
• Lack of health insurance
• Lack of Access
• Environment/ Nutrition
• Lack of Diverse Healthcare Workforce
• Genetics/ Biologic/ Diff. Response to Medications
• Lack of Minority Patients in Research Trials
• Sub-specialization in Medicine & Lack of Awareness of
Disparities
39. Health Disparities Solutions:
Multifaceted
- Based upon our Cleveland
Clinic MMHC Observations
and Research
- Examples of our Cleveland
Clinic Innovative Solutions/
Programs
40. Solutions: Step 1
Health Provider Recognition,
Acknowledgment of Existence,
Causes & Impact of Health Disparities
in Minority Populations
41. Doctors on Disparities in Medical
Care
• Doctors less likely than public to say
disparities are happening “very often”
or “somewhat often.”
• Kaiser Family Foundation Survey, March
2002. http://www.kff.org/minorityhealth/20020321a-index.cfm
44. Cleveland Clinic Journal Medicine
Special Series 2012:
Addressing Disparities in Health Care
Guest Editor: Charles Modlin, MD, MBA
• Modlin CS.
Addressing
Disparities in Health
Care Cleveland Clinic
Journal of Medicine
January 2012 vol. 79
(1): 44-45.
45. Disparities in prostate cancer in African American
men: what primary care physicians can do.
Wu I, Modlin C. Cleveland Clinic Journal of Medicine
May 2012 vol. 79 5 313-320
46. SOLUTION: Step 2
Vision & Commitment
Institutional/Self-Belief that You
Can Make A Difference
47. Solutions: Step 3:
Health Provider Cultural Competency &
Sensitivity
• All providers need to become sensitive
to traditions, values, attitudes of ethnic
groups
- Mandated in some states, i.e. New
Jersey first state
• Cultural sensitiveness indicates how
culture can strongly influence the amount
and type of communication between
patients and their health providers
48. The African American Barber Shop, Beauty Salon
and Church Initiative
A Tool in Development of Medical & Nursing
Student & Health Provider
Cultural Competency/Sensitivity
49.
50. Step 4: Community Trust-Building
• Key Lesson:
Initiative
Barbershop, Salon, Church
• Trust is single most important
prerequisite necessary for healthcare
providers to have success in promoting
health in AA communities.
51. Solutions: Step 5
African American Physician Leadership,
Visibility & Availability:
Very Important To The African American Community
52. Become Part of the Community:
Build Trusting Relationships
53. Become Part of the Community:
Build Trusting Relationships
54. TEAMWORK & VOLUNTEERISM:
Step 6
• Dept. Urology
• Dept. Nephrology
• Medicine Institute
• Cleveland Clinic
Interdepartmental Clinical
Collaborations
• Wellness Institute
• Dept. Pastoral Care Services
• Dept. Social Work
• Pharmacy
• Division of Nursing
• Nutrition Services
• Institutional Services (Pt.
Education, OPSA, Sponsored
Research, etc.)
• Corporate Communications
• Governmental & Community
Relations
• Diversity
• Bioethics
• Biostatistics
• Cleveland Clinic Lerner College
of Medicine
• Lerner Research Institute
57. Cleveland Clinic
Financial Assistance Program
• Under Ohio Hospital Care Assurance Program (HCAP)
Cleveland Clinic offers basic, medically necessary
hospital-level services free of charge to individuals who
are residents of Ohio, and who are currently eligible
recipients of the General Assistance or the Disability
Assistance Programs or whose income is at or below the
Federal Poverty Income Guidelines.
• In addition, Cleveland Clinic provides financial
assistance on a sliding scale to patients who do not have
insurance at family income levels up to four (4) times the
Federal Poverty Income Guidelines, and to all patients,
including patients with insurance coverage, if there are
exceptional circumstances.
58. Financial Assistance Program
Family Size HCAP 2008 CC Financial
Federal Assistance
• 2008 Federal Poverty
Income Level
Program
(Family Income
up to 400% of
Poverty Income Federal Poverty
Level)
Guidelines
1 $10,400 $41,600
2 $14,000 $56,000
3 $17,600 $70,400
4 $21,200 $84,800
5 $24,800 $99,200
6 $28,400 $113,600
7 $32,000 $128,000
8 $35,600 $142,400
65. MMHC Health Fair Screenings 2007
600
500
422 439
400
400
e
l
t
i
T 300
s
i
217
x
A
200
200
153
120
100
0
Dental Screenings Blood Pressure Stress Urinalysis Reviewed DRE Blood draws
& Oral Hygiene Screening Management Medications
Instruction
Series1 120 153 200 217 400 422 439
66.
67.
68.
69.
70. Solutions: Step 10: Dedicated
Health Literacy Education
• Health Education/ Outreach
to Promote/ Improve Health
• Health Literacy
Literacy
Saves Lives
- Increase awareness of
preventive health
- Increase health
screenings
- Promote healthy
lifestyles
- Promote participation
in clinical trials by
minorities
- Promote awareness of
family medical history
71. Minority Men’s Health Center
Health Fair
Health Information You Need To
Know!
(With Pre & Post Test Options)
72. Kidney Disease and Kidney
Transplantation
• Diabetes and high-blood pressure
cause most kidney disease and kidney
failure.
• Control of your blood pressure and
blood sugar may prevent kidney
disease.
• Kidney transplantation is a way to treat
kidney failure. More AA are needed to
donate their kidneys while living or
after death.
73. Diabetes
• Risk factors for diabetes are:
- Genetics
- Obesity
- Lack of exercise
- Other predisposing factors
74. Solution: Step 11:
Communications
Health Disparities Public Media Campaign
• TV Media/ News
• Print Media
82. Response to Medications
African Americans
• Differences in genetics, environmental and cultural
factors may lead to racial differences in response to
medications.
• Studies and Examples:
• AA respond better to Calcium Antagonists
- Whites respond better to ACE and B-Blockers
- BiDil—New Med to treat CHF in AA
- RACE-BASED MEDICINE
- Immunosuppressive Medications in AA
83. Etiology of Heart Failure
in Black Patients
HTN CAD
LVH MI
HF
More common cause More common cause of
of HF cases in blacks HF cases in whites
LVH=left ventricular hypertrophy.
Adapted from Yancy CW. J Card Fail. 2003;9(suppl 5):S210-S215.
84. A-HeFT: Additional 43% Reduction in Mortality Beyond Current
Standard Therapies
100
BiDil + Standard Therapies
95
Survival (%)
90 Placebo + Standard Therapies Event rate=6.2%
43% Reduction*
P=.012 by Log-Rank Test
85 Event rate=10.2%
0 100 200 300 400 500 600
Time (days)
BiDil, n = 518 463 407 360 314 253 16
Placebo, n = 532 466 401 340 285 233 25
*Reduction refers to relative risk in mortality 1 – (hazard ratio) =1 – 0.57 =0.43. Reduction represents full length
of follow-up.
BiDil [prescribing information]. Lexington, MA: NitroMed, Inc.; 2005.
89. Bill Cobbs: Hollywood Actor
on Disease Prevention & Early Detection
• http://www.youtube.com/watch?v=-HE7I_J-q98&featu
90. Health Policy Advocacy:
Step 19:
United States Congressional Black Caucus,
U.S. Capital,
Washington, D.C.
91. Healthy People 2000: Priority Areas
• 1. Physical Activity and Fitness
2. Nutrition
3. Tobacco
4. Substance Abuse: Alcohol and Other Drugs
5. Family Planning
6. Mental Health and Mental Disorders
7. Violent and Abusive Behavior
8. Educational and Community-Based Programs
9. Unintentional Injuries
10. Occupational Safety and Health
11. Environmental Health
12. Food and Drug Safety
13. Oral Health
14. Maternal and Infant Health
15. Heart Disease and Stroke
16. Cancer
17. Diabetes and Chronic Disabling Conditions
18. HIV Infection
19. Sexually Transmitted Diseases
20. Immunization and Infectious Diseases
21. Clinical Preventive Services
22. Surveillance and Data Systems
92. Healthy People 2010
• Healthy People 2010 challenges individuals, communities,
professionals, and institutions—all of us— to take specific
steps to ensure that good health, as well as long life, are
enjoyed by all.
•
Healthy People is managed by the
Office of Disease Prevention and Health Promotion,
U.S. Department of Health and Human Services
93. Step 20:Promotion of & Celebration
of Family Support Systems and
Awareness of Family Medical History
94. Solutions: Step 21
Outcomes Research
• Look at health outcomes in your own
practice and at your own institution
• Know how you are doing
• Develop strategies to improve your
outcomes
95. Analysis of Disparities in Kidney
Transplantation by Race at
Cleveland Clinic
Section of Renal Transplantation
Minority Men’s Health Center
C. Modlin, C. Zaramo, J. Alster, L. Zhou, D.
Goldfarb, S. Flechner,
and A. Novick
96. Health Disparities in Renal Graph
Survival in Tx Patients by Race and
Source of Allograft
Cadaveric (CAD) Living Related (LR)
97. Dialysis 1st Week Post-Tx
Significant Disparities in Dialysis following the First
Week of Post Renal Transplantations (Post-Tx, p<0.001*)
100
*p< 0.0001
Percentage (%)
80
52.14%
60
40 15%
20 8.16% 5.14%
0
African Caucasian African Caucasian (L)
American (CAD) (CAD) American (L)
Race/ Ethnicity
98. Post-Tx Serum Creatinine (CAD)
Creatinine Levels from Cadaveric Donors, Significant Difference at 7
Days
(p<0.0001), 1 month (p=0.005) and 2 Months (1 Year ) (p< 0.004)
*
7
African American (CAD)
p=0.0001
White (CAD
6
5
P<.0001 @ 7 days
P<.008 @ 12 mos.
4
3
* p=0.005
2
1
* p=0.004
0
Day 7 1 3 6 12 36
Time
99. STEP 22:
Putting it all together:
Develop and Implement
Multifaceted Innovative
Programs to Address Health
Disparities
111. Solutions:
Innovations in Healthcare:
Look to see how you can innovate
to improve outcomes
• Utilization of Expanded Criteria Donor Kidneys for
Transplantation:
- Single Pediatric Deceased Donor Allografts
- Pediatric Enbloc Deceased Donor Allografts
- Kidneys with multiple arteries
- Dual Deceased Donor Allografts
- Kidneys with capsular injuries
- Kidneys with renal artery aneurysms
112. Expanded Criteria Donor
Kidneys for Transplantation
• Modlin CS,
Goldfarb DA, Novick
AC. The use of
expanded criteria
cadaver and live
donor kidneys for
transplantation. Urol
transplantation
Clin North Am. 2001
Nov;28(4):687-707.
113. Issues and Techniques Available to Expand
the Pool of Kidneys Available For
Transplantation. MODLIN
• Chapter 10. In Kidney
and Pancreas
Transplantation: A
Practice Guide.
This definition implies that health is a complex mechanism involving more components than freedom from physical disease and pain. It is an evolving process involving social, spiritual, emotional, physical and intellectual considerations.
Black Americans who are economically advantaged do not enjoy in equal measure with whites the expected positive influence of affluence on their health. One possible explanation relates to the high stress levels that middle class AA’s experience (relative to whites). Prolonged High-effort mental coping mechanisms among African Americans who succeed in white-collar work environments contributes to hypertension and increased heart rate.
Heart disease. Race and ethnicity influence a patient's chance of receiving many specific procedures and treatments. African Americans are 13 percent less likely to undergo coronary angioplasty and one-third less likely to undergo bypass surgery than are whites. Heart failure due to hypertension is more common in Blacks (40%) than whites (7%). The major risk factors are smoking, htn, high cholesterol, and physical inactivity. AA’s have less knowledge about risk factors than do whites, even when taking age and education into consideration. The AA diet stresses the consumption of meat, esp. pork, fried foods and eggs, and is high in cholesterol and saturated fats. Physician Decisionmaking A small study of physicians' decisions about whether to refer patients for cardiac catheterization, a diagnostic procedure for heart disease, provides supportive evidence that factors other than insurance and income can influence the quality of care people get. This study, which used actors portraying similar economic backgrounds, found that black women were significantly less likely than white men to be recommended for referral, despite reporting the same symptoms.
Some risk factors for stroke—age, male sex, black race and family history of stroke, are non-modifiable. Hypertension is the most important modifiable risk factor in all populations. Other important modifiable factors include diabetes, afib, tia, alcoholism, smoking, obesity, low physical exercise, poor nutrition, hypercoagulable states, and use of illicit drugs, oral contraceptives and hormone replacement therapy.
Cancer is the 2 nd leading cause of death in the U.S. and significant burden to AA’s, who have the highest death rates. The incidence of cervical cancer in AA is double that of whites. Contributing factors: tobacco, occupations, diet, knowledge, attitudes and practices, health/medical resources, biological factors, and socioeconomic status. 55% of deaths in AA are caused by smoking-related diseases.
The prevalence of smoking among young black males doubled from 14.2 to 28.2% from 1991-1997. A smoking cessation study examined the effects of physician recommendation to quit smoking and noted that people who were told by physicians to stop smoking did so twice as often successfully as those not told by a physician.
More research is needed on the identification, prevention, treatment, and care cancer in the minority population.
Approx. 37% of all internal cancers diagnosed in AA men are prostate cancer. This translates to about 225 per 100,000 new AA cases of cancer, which is more than the combined projections for the next 5 leading cancer sites. The incidence of prostate cancer in the age group 45-49 for blacks is 12.6/100,000 compared to whites 7.4/100,000
The incidence of ESRD in AA is 4 times greater than in whites. HTN and DM are the most commonly identified causes of kidney failure, but regardless of the diagnosis, AA are at greater risk than whites of requiring dialysis or transplantation.
The number of cadaveric transplants is roughly 4 per 100 dialysis patient-years among white men, 3 per 100 dialysis years among white women and black men and 2 per 100 dialysis years among black women. The demand for organs has outpaced supply. Whites are more than 2 times as likely as blacks to be wait-listed before dialysis. Factors believe to account for some of the disparities: AA once referred do not advance through the process as quickly: some reasons are related to place of recidence, educational level, functionality on dialysis, and associated medical comorbidity.
Poverty is the most important factor and affects the ability to afford preventive and routine health services. Other barriers to health are: transportation, long waiting times, inconvenient hours of service and confusion at the clinic or hospital atmosphere and other factors. These barriers cause AA’s to revert to public medical facilities with distant appointments, contribute to the advancement of illnesses and the high use of costly ER services. Limited education and illiteracy obstruct the ability to interpret and comprehend health-related information. The persistent association between race and lack of health care utilization, even with the same socioeconomic stratum, suggests that discrimination and physician bias is still a plausible explanation.
Many white health care professionals have difficulties understanding the African American culture, beliefs, and expectations. The body language between African Americans and Whites can also be a barrier. Most providers are not educated and trained to be culturally sensitive. The cultural barriers are built into the very fabric of the U.S. health system model, which emphasizes isolating and treating different ailments through specialized practitioners, rather than a holistic approach. Beware, not all African Americans think or act or react the same way. The provider needs to interact with each patient to develop his/her holistic, culturally competent plan of care. With this approach, quality is maximized, and outcomes are more successful.
Etiology of Heart Failure in Black Patients Retrospective analyses of V-HeFT-I, V-HeFT-II, SOLVD, US Carvedilol, BEST, and MERIT-HF have reported subgroup data demonstrating that black patients have a higher incidence of HTN as a cause of LVD than do non-blacks. HF in non-black patients is more likely to be caused by CAD than by HTN. 40%-80% of HF cases in blacks are caused by HTN. 50%-80% of HF cases in whites are caused by CAD. Reference Yancy CW. Heart failure in African Americans: pathophysiology and treatment. J Card Fail. 2003;9(suppl 5):S210-S215.
A-HeFT: Additional 43% Reduction in Mortality Beyond Current Standard Therapies This Kaplan-Meier curve shows an additional 43% decrease in mortality among those patients treated with BiDil plus standard therapies. This result led to the Data Safety and Monitoring Board’s recommendation to terminate the trial early. Reference BiDil [prescribing information]. Lexington, MA: NitroMed, Inc.; 2005.