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(HEPE) Introduction To Health Disparities 1
- 1. Introduction to Health Disparities Health Equality Peer Educator Training (HEPE) By: Travis Howlette B.S., Jeff Wisniowski B.S., MPH and Kelsey Anilionis B.S.
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- 3. OUR OTHER HOSTSKelsey Anilionis Bachelors Of Health Science 11’ Travis Howlette Bachelors Of Health Science 11’
- 4. STUDENT SPEAKER Introductionto Health Disparities Jeff Wisniowski Health Science 11’/MPH 12’ Candidate at NEU
- 5. TIME LINE OFPOWER POINT PRESENTATIONS Introduction to Health Disparities March 13 th Introduction to Social Determinants March 20 th Of Health Youth Activism on Health Disparities March 27 th /Social Determinants of Health Each webinar time is 8-9pm (EST) 5-6 (PST)
- 6. Aim and Purposeof This Lecture Series Be able to define health disparities and identify current trends in disparities among populations Understand what social determinants are and how they can impact your health Feel empowered as students who can do something about these injustices
- 7. Goals of: Introductionto Health Disparities Be able to define health disparities and understand the difference between inequity and inequality Learn how multiple systems impact health disparities Identify current trends in health disparities
- 8. Types of HealthProfessionals Allied Health Public Health Complimentary Health Primary Care Providers
- 9. Who is themost responsible for your individual health? Allied Health Professionals Physical Therapists, Radiologist Technicians Public Health State Health Department Workers, Health Policy Makers Complimentary Health Providers Acupuncture Specialists, Message Therapy Primary Care Doctors Family Physicians, General Practitioners You/The Individual
- 10. History of Disparitiesin the US Tuskegee Experiment (1932-1972) Puerto Rico Sterilization Campaign (1930 ’s-1970’s) Red-lining of poor neighborhoods (1960 ’s) Secretary ’s Task Force on Black and Minority Health (1985) DHHS establishes Office of Minority Health (1985) 2010 Healthy People introduces goals on reduction of health disparities (2000) Shifting the framework of health disparities research from an epidemiological approach to a human rights inspired paradigm (James, 2009)
- 11. The “Un”Populations Underserved Undeserved Underprivileged Unemployed Underclass Uninsured Underinsured Undocumented Undereducated Uniformed
- 12. What are HealthDisparities? “ Differences in health status between advantaged and disadvantaged populations that are considered unfair and avoidable.” “ A difference in health among segments of the population that occur by gender, race, ethnicity, education, income, disability, geography or sexual orientation.”
- 13. Health Disparities TermsInequality The quality of being unequal or uneven, disparity of distribution or opportunity Unavoidable
- 14. HEALTH DISPARITIES TERMSInequity Favoritism or bias, an unfair circumstance Unfair and unjust
- 15. Disadvantaged Groups /Questions
- 16. Classification of Race/EthnicityAmerican Indian/Alaska Native (AI/AN) Asian American Black or African American Hispanic or Latino White/Non-Hispanic Native Hawaiian or Other Pacific Islander (NHOPI)
- 17. Income Exercise: MinimumWage Hispanic Mother with One Child Salary: 15,000
- 18. Income Exercise: SingleBlack Mother with Two Children Salary: 30,000
- 19. Income Exercise: TheWhite College Grad Salary: 50,000
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- 21. Break Down ofAverage Health Care Spending Minimum wage with one child Secretary with two children College Graduate 5.7% Per Year $855 1,710 2,850 Per Month $71.25 $142.5 $237.5
- 22. Exercise: Given thisamount of money… Who are you supporting? Where do you come up with money for co-pays, prescriptions? What health products do you purchase eg.vitamins, toothpaste? What if you have a surgery or costly medical bill?
- 23. FAIR OR POORHEALTH STATUS BY RACE/ETHNICITY AND INCOME, 2007 NOTES: Respondents assessed their health status as excellent, very good, good, fair, or poor. The federal poverty level for a family of four in 2007 was $21,203 (http://www.census.gov/hhes/www/poverty/threshld/thresh07.html). DATA: Centers for Disease Control and Prevention/National Center for Health Statistics, National Health Interview Survey. SOURCE: Health, United States, 2009 , Table 57. Share reporting fair or poor health:
- 24. How does incomeinfluence the following… Education level One’s ability to continue school Jobs opportunities Job vs. career stability Access to care Do you use a primary care physician or the ED? Dependents What if your children get sick? How do you pay for child care while you must work? Ability to afford care What quality of care can you purchase?
- 25. How does povertyeffect health?
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- 27. Poverty > Obesity> Diabetes
- 28. Yet Income DoesNot Exist In A Vacuum These factors are additive not just interactive
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- 30. Key Drivers ofHealth Disparities: Social, Institutional, Environmental Institutional Laws and Policies Workplace Hospital settings Social Racism Education level Poverty Environment Air quality Housing Food Safety
- 31. Behavioral and BiologicalRisk Factors Genetic Attributes and Gene Expression Family Histories Sedentary Lifestyle Physical activity Rates of Cigarette Smoking Nutrition Choices Alcohol and Drug Consumption Risk Taking Behaviors Seat belts, injury, accidents
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- 36. DEATH RATE DUETO HEART DISEASE BY RACE/ETHNICITY, 2006 White, Non- Hispanic Hispanic African American Asian and Pacific Islander American Indian/ Alaska Native NOTES: Rates are age-adjusted. DATA: Centers for Disease Control and Prevention/National Center for Health Statistics, National Vital Statistics System. SOURCE: Health US, 200 9 Table 32. Deaths per 100,000 population: White, Non-Hispanic Hispanic African American Asian and Pacific Islander American Indian/ Alaska Native
- 37. INFANT MORTALITY RATEBY RACE/ETHNICITY, 2005 Infant deaths per 1,000 live births: NOTES: Births are categorized according to race/ethnicity of mother. DATA: Centers for Disease Control and Prevention/National Center for Health Statistics, National Vital Statistics System, Linked Birth/Infant Death Data Set. SOURCE: Health, United States, 2009 , Table 17.
- 38. HEALTH INSURANCE STATUS,BY RACE/ETHNICITY: CHILDREN, 2008 White, non-Hispanic 44.1 million African American, non-Hispanic 11.3 million Hispanic 17.2 million Asian/ Pacific Islander 3.3 million NOTES: “NSD” = Not sufficient data; “Other Public” includes Medicare and military-related coverage. The sample size for American Indian/Alaska Native was not large enough for reliable estimates. Totals may not add to 100% due to rounding. SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured analysis of the March 2009 Current Population Survey. Total Child Population 2008 Two or More Races 2.2 million Private (Employer and Individual) Medicaid and Other Public Uninsured
- 39. NO DOCTOR VISITIN PAST YEAR FOR NONELDERLY ADULTS BY RACE/ETHNICITY AND INSURANCE STATUS, 2005-2006 SOURCE: Kaiser Family Foundation and Urban Institute analysis of the National Health Interview Survey, 2005 and 2006, two-year pooled data.
- 40. Why Are DisparitiesImportant? Population Projections 2008-2050 Source: U.S. Census Bureau, 2008 National Population Projections, August 14, 2008 http://www.census.gov/Press-Release/www/releases/archives/population/012496.html
- 41. Take Home Messages:Introduction to Health Disparities Be able to define health disparities and understand the terms of inequity and inequality Understand that multiple systems impact health disparities from the larger social structures down to the individuals behavior Identify current trends in health disparities and understand the importance of health disparities as we look to the future of health care
- 42. Questions? For hewho has health has hope; and he who has hope, has everything. ~Owen Arthur Of all forms of inequality, injustice in health care is the most shocking and inhumane. ~Rev. Martin Luther King, Jr. Jeff Wisniowski: wisniowski.j@husky.neu.edu
- 43. Summary Of HealthDisparities Long history of disparities in US “ A difference in health among segments of the population that occur by gender, race, ethnicity, education, income, disability, geography or sexual orientation.” Disparities vs. Inequalities Diverse contributors dependent on several factor Social Condition and Behavioral Risk Factors
- 44. Overview Of HealthDisparities Growing Minority Populations Patient Accountability and Affordability Act Insuring the nation, shift to preventative care Health People 2020, looking forward CDC Interventions and How You Can Be Involved
Editor's Notes
- #3 Community Based Public Health Caucus of the APHA Center for Community Health Education Research and Service NCBON We’d also like to thank our mentors Kerone Anderson And Renee Bayer at the University of Michigan for all her help!
- #4 We also have both of our other hosts online who will be able to answer questions as I speak and assist me Kelsey Anilionis is a BS Health Science Student at NEU Travis Howlette is a BS Health Science Student and Leader of the Youth Council of the CBPH
- #5 My name is Jeff Wisniowski I am a combined Health Science/MPH student at Northeastern This is a photo of Travis and I at APHA Conference In Denver this year On the other side is a photo of me and my little Jymaal at an NEU hockey game, been doing Big Brothers Big Sisters in Boston for 2 years now Great Experience and Youth Caucus Member ’s I’m sure you guys enjoyed it
- #6 Just wanted to remind you of the timeline of our webinar lectures
- #7 It ’s always helpful to specifically outline what we want you to take away from this lecture series This is an introductory tool designed for students who are interested in all aspects of health care We want to show the importance of health disparities in the health care dialogue ----- Meeting Notes (3/11/11 20:30) ----- Take home messages with set up of last slide, Travis definition
- #8 I hope everyone took the pre-test and got a chance to read the Ghetto Miasma article from the New York Times Brings about a very compelling first hand look at how health disparities impact the individual The goal of this powerpoint is to introduce you guys to the general concept of health disparities and provide you with a basis of knowledge make changes in your local communities, now as students
- #9 Health care in the US is very diverse and there are a multitude of professionals who work in health care Allied Health professionals- Physical Therapists, Radiology Technicians, Respiratory Therapists ect. Public Health Professionals-working in community health centers and local or states health departments Complimentary health- acupuncture, alternative medicine therapies Primary Care Providers- your MD ’s/ and specialists Keeping disparities in mind as you develop professionally starts with you becoming active and outspoken about them now as students It ’s important to remember that each type of care contributes to the health of the larger population
- #10 Want to take a quick poll of what you guys think as an audience, test out your adobe soft ware skills and get your opinion Please choose who you believe is the most responsible for your health Also I want you guys to think about who contributes or takes away from the type of care you receive? What about the quality of care you receive?
- #11 Tuskegee Experiment where Blacks were exposed to syphilis and then had proven effective treatments with held from them Puerto Rican sterilization campaigns resulted in over 1/3 of women being sterilized and unable to bare children Red-lining of neighborhoods were practices taken by banks in the the 1960 ’s to identify failing neighborhoods and no longer invest money into them resulted in detrimental effects to the populations of people who lived in these neighborhoods many them minorities and persons or color. in 1985 president Reagan ordered a report on the status of Black and Minority Health the alarming information returned that same year the Department of Health and Human Services created the Office of Minority Health health disparities began to commonly appear in literature around 1995 the Clinton administration made the elimination of health disparities a top priority of the Health People 2010 goals current times health care has shifted modes from examining and reporting on health disparities to now using human rights principles to eliminate them as social injustices. Important to remember historical Recently their has been news coverage from a study on Guatemalan research subjects in the 1940 ’s where they knowingly infected them with syphilis This study was headed by John Cutler the same Dr. as the Tuskegee experiments This recent topic in the news prompted the president of the United States to publicly apologize
- #12 when talking about health disparities the “Un”populations are often mentioned these are the people who suffer the greatest debts and encounter the biggest barriers because of their positions in society Often the have limited power and little voice to over come the barriers they face and you will see this as we begin to frame health disparities
- #13 here we are presented with two definitions of health disparities that often come up in the literature key points of the definitions are “unfair and avoidable” there are differences between how portions of the population are effected we demonstrate this in various measures of health e.g. access to care, health outcomes, rates of chronic disease
- #14 Often in the literature Inequality is unavoidable, i.e. something that is put on by larger society, you don’t have control over Inequality in health is that females are shown to live longer than males Simple difference in span of life
- #15 Unfair and unjust, an example of an inequity would be a larger nuclear plant moves into a poor neighborhood, while their voice is not heard and they are too poor to move anywhere else Now you have environmental pollutants in the neighborhood that burdens the health of the community, While the community does not have the power, capacity or ability to effect their situation "differences in health which are not only unnecessary and avoidable, but, in addition, are considered unfair and unjust"
- #16 I ’d like to pause and take a moment for you guys to look at a cartoon that incorporates the concepts of Racism a way to frame advantaged groups vs. disadvantaged groups Also if you have any questions at this point please feel free to put them in the chat box
- #17 Race-category based on classification of country environment Ethnicity-Heritage, origins cultural background We cover these definitions because often this is how health disparities data is represented Dramatic and persistent health disparities have been described among -- original peoples of North and South America (including Central America), -- original peoples of the Far East, Southeast Asia, or the Indian subcontinent. -- People having origins in any of the black racial groups of Africa. -- A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. -White of non hispanic origin -- original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
- #18 The goal of this next exercise is to show you just how difficult it can be to afford quality health care It may seem oversimplified but in reality these figures are even more pressing Here we are going to take three hypothetical persons of different races education and income We have a Hispanic mother who never completed high school working a minimum wage job making 15,000 a year, She has one child and does not qualify for any federal assistance
- #19 Next we will pick a African-American mother with some college who works as a secretary making 30,000 a year She has two children
- #20 Last we have a white college graduate who lives on his own and makes 50,000 a year
- #21 Here is chart from visualeconomics.com that shows us where they average American spends their money each year Once again its an estimate of course as I know some of us may spend more on apparel and less on reading, or more on education 34.1% on housing, 17.6% on transportation, 10.8% on Insurance We see that just 5.7% goes to health care each year
- #22 If we use this figure to calculate just how much each individual has per month we see that A single mother with one child only has $70 a month to spend on healthcare A secretary with two children only has $140 to spend on the health of her and her children While the single college graduate has a rather abundant amount of money with less dependents
- #24 this is a slide showing a poor self reported health status by race Where those in the 100% of greater category make more than 21,203 for a family of four What is important to see from the trend in this graph is that as poverty level increases health status significantly decreases across all races Those below the poverty level experience poor health at nearly twice the rate
- #25 I want you to take a minute to read through these questions and think about how income can impact all of these things I would also like to open up the chat box for questions at this time
- #26 So that was a hypothetical exercise to get you guys thinking just how difficult it can be to afford healthcare and why some cannot access it This is a map taken from the 2009 Census that display poverty the highest rates being purple with the gradient shifting to the lowest in white. Here we are looking at the darkest purple areas highlighting the highest rates of poverty. Where people make significantly low incomes for the individuals they support this is our hispanic mother, our secretary or even Beverly from the NYT article Here we are looking at one single barrier, Income alone
- #27 This is a map taken from the CDC of rates of Adult obesity. The darkest shaded areas indicate the highest rates of obesity in the population What do you see from the map? Notice the overlap of obesity and the high rates of poverty from the previous rates.
- #28 Next we overlay a map of diabetes and see the darkest concentrations indicating the highest rates of a debilitating chronic condition I could do this for a map of heart disease and cancer too! It is important to emphasize that poverty is not the only indicator of health disparities. Even when income is taken into account health disparities still exist among races.
- #29 Other factors play a large in health disparities Income is not the only indicator and several forces are at play These factors are additive means that each piece adds to the burden placed on the individual
- #30 Now we began by our first way to demonstrate the fundamental causes of health disparities Here we see a chain that places larger factors out of the individuals control Narrowing down to behavior factors and genetics is the Individuals position, lUltimately effecting your health outcomes
- #31 Institutional Laws providing assistance to minorities Racial equity within the workplace Cultural competency at hospitals, understanding others values Certain cultures don ’ t let male Dr ’ s work with females Travis will cover these factors much more in depth during his socials determinants of health lecture Social-these are very difficult to measure or see the direct impacts of Racism and unfair treatment of individuals The level of education one attains and the quality of education Environment Air pollution, contaminants from various chemicals or agents Food quality, health inspectors at restaurants you go to Housing and urban development, the neighborhoods you live in and their condition Social, Institutional, and Environmental factors are everything from seatbelt laws to the condition of ones neighbor hood, like the safety of Juanita’s neighborhood in the NYT article and how that kept her worried
- #32 Things that are within the individuals control Genetics like Beverly in the Ghetto Miasma article many of her relatives died of heart disease and cancer which ran in her family Sedentary Lifestyles Lack of regular physical activity You may remember things like the Verb campaign, to get people out an playing Rates of Cigarette Smoking Tobacco use has been linked to a variety of negative health outcomes, heart disease, lung cancer ect. Nutrition Choices Culturally what does the individual eat and do they make healthy choices Kelsey Travis and I were just talking the other day about how when we would get out of middle school and go buy sugary drink and snacks While we drive by schools getting out and we see all the kids with blue red ect. Crazy colored sugary drinks Alcohol and Drug Consumption Risk Taking Behaviors Starting disparities exist in motorvehicle accidents when males die at 4 times the rate of females and use their seatbelts 3 times as less
- #33 One way public health professionals often show these complex interactions is through the ecological model This model shows how each level of society effects someone's health, using the same concepts we just looked at but applying this to this circular effect from the individual your health behaviors like we just discussed, how much you exercise Interpersonal-social network what your peers do and influence you to do, statistics show that individuals who have peers that smoke are likely to smoke too Organizational-schools you attend, churches you belong too Community Public policy-seat belt laws and tobacco restrictions
- #34 This is a set of slides from Ichiro Kwachi Chair of the Department of Society , Human Development and Health at Harvard School of Public Health that shows a personal view of health disparities He used this because he said physicians are difficult to explain health disparities to, being so clinical, that ’ s why it ’ s important to learn about them now Pictured here is an obituary page taken from a New Orleans paper pre-hurricane Katrina. In 2002 Notice the different races pictured across the same page
- #35 As we zoom in further we notice Florence Kreller died at home at 87 Ned Beyhi did at 81 Hilda Lirocchi died at home at she was 95 Gerard Francis died at age 80 of cancer
- #36 Now as we zoom in on the same obituary page take a look at some of the black men and women on the page please type in the comment box what do you notice about the ages and causes of death? What do you notice again here So what does this mean in terms of disparities We Antoinette dying at 25 of a stab wound, violence and homicides are higher among youth especially in ethnic minorities Burnell died of cancer at 46 compared to Gerard from the previous page who died at 80 Brian died at age 40 of a stroke
- #37 Brian is just one individual here we examine the deaths form heart disease by race heart disease is the leading cause of death for people of most racial/ethnic groups in the United States, including African Americans, American Indians or Alaska Natives, Hispanics, and whites. African American men are 30% more likely to die from heart disease than non-Hispanic white males First we see the disparities between African Americans and the rest We also notice an inequality between males and females
- #38 I’d like to show you a few more graphs to introduce you to some of the most pressing disparities in health care In the follow-up e-mail I will provide you with a link to quick fact sheets that address a large list of health topics from sexual health/STI’s to chronic conditions like diabetes and heart disease Infant mortality is death of an infant per 1000 live births, here we see that 14 of every 1000 African American babies will not make it to their first birthday a rate almost 3 times as high as their white and hispanic counterparts We use infant mortality as a significant indicator of health because If babies are not making it through their first birthday what does that say about the health status of the ones who make it
- #39 Now we will take a step back to examine other early predictors of health outcomes here we have insurance coverage for children in the US by race A big predictor of the types of care one receives or when they access it is their insurance status Notice the disparities or significantly larger gaps in uninsured minorities with Hispanics at 18%Nearly three times the rate of whites for uninsured African Americans at 11% and Asain’s at 12% As well as the larger proportions of those on public assisted health care
- #40 Here is a graph of visit to a primary care provider by race and insurance status We know prevention is key and visits to your primary care provider can screen you for cancers and other conditions as well as refer you to other health services First notice the staggering difference between those who are insured vs. uninsured, people without insurance go to the Dr. nearly 3 times less than those with insurance This certainly highlights the importance of health insurance Next compare the rates between races notice that Hispanics and Asian’s have the highest rate of not going to the Dr.’s
- #41 Is their any questions before I get into the next slide? The graph on the left is the most current estimate of the US population while the graph to the right is the 2050 projected populations. when we being to look at health disparities and the populations that are affected the most it ’s important to think about the future growth of these populations. The importance recognizing health disparities and more importantly providing solutions to closing these disparities gaps is supported by the projection of our growing minority populations.
- #42 I hope everyone took the pre-test and got a chance to read the Ghetto Miasma article from the New York Times Brings about a very compelling first hand look at how health disparities impact the individual The goal of this powerpoint is to introduce you guys to the general concept of health disparities and provide you with a basis of knowledge make changes in your local communities
- #43 Immediately after this you will receive a follow-up email for a link to a post test and information on next weeks lecture Thank you everyone for your time Infants born to black women are 1.5-3 times more likely to die than infants born to other races The birth rate for Hispanic adolescents was approximately 3 times the rate for non-Hispanic white adolescents Current asthma prevalence was higher among Hispanics and non- Hispanic blacks than among non-Hispanic whites. Infants born to black women are 1.5-3 times more likley to die than infants born to other races A shift in the adolescent population of all races a reversal of the trends the situation 15-20 years ago African Americans had asthma-related emergency room visits 4.5 times more often than Whites in 2004. Homicide rates were highest among persons aged 15–34 years, and the overall rate for males was approximately 4 times that of females. For motor vehicle-related deaths males of all racial/ethnic groups had a rate 2–3 times higher than that of females.
- #44 Even a recently as President Obama’s address