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Module 5 Final Presentation
- 1. Module V: Discrimination& Stigma Rev 1/27/2016 1 County of Riverside Department of Public Health Health Equity Committee
- 2. Review trainingpacket Sign-in sheets Continuing education units Cell phone policy ◦ Disable, silence, or place on vibrate all communication devices Restrooms and exits 2 Housekeeping
- 3. Remember: THINK BIG!!! Listenfor Understanding Confidentiality ◦ Sharing is encouraged ◦ What is said here, stays here Safe Zone ◦ We all come from different backgrounds, and have different opinions ◦ We expect respectful participation 3 Standards & Expectations
- 4. 4 Name Branch Location ICEBREAKER Tell us about the best vacation you’ve EVER taken. Share with us a fun experience you’ve had recently. Introduction
- 5. 5 Agenda • Review ofModules I-IV • Perceived Discrimination and Stigma • Lesbian, Gay, Bisexual and Transgender Populations • Boomer and Elder Populations • People with Disabilities • Discussion & The ASK Model
- 6. Our discussion todaywill be focused on three groups: o LGBT o Aging o People with Disabilities By the end of this session, participants will be able to recognize and address the perceived discrimination and stigma among these three groups. Participants will discuss ways we can avoid and undo discrimination among the groups discussed today. 6 Objectives
- 7. How doesstigma operate where you live, work, play or go to school? Who constitutes the “us” and the “them”? 7 Things to Think About
- 8. Module I ◦ PublicHealth History & System ◦ Core Functions and Essential Services of Public Health Module II ◦ Cultural Competency & Acceptance Module III ◦ Deconstructing Racism Module IV ◦ Social Determinants of Health Module V ◦ Discrimination & Stigma Module VI ◦ Community Capacity Building 8 Public Health: Improving Health for All
- 9. 9 There are3 core functions of Public Health ◦ Assessment ◦ Policy Development ◦ Assurance There are 10 essential services in Public Health One or more of the essential services fit into your job Module I - Recap
- 10.
- 11. Historic and institutionalizedracism has greatly contributed to negative social determinants. 11 Module III: Deconstructing Racism These determinants limit access to the services illustrated in Module I and highlight the need for cultural competency (Module II) in the provision of services.
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- 13. NEIGHBORHOOD CONDITIONS Crime Social Relationships SEGREGATION FoodAccessAir Quality Access to Healthcare Housing INCOME EDUCATION Transportation Racism Module IV - Recap
- 14. “In Sickness andIn Wealth” ◦ Ch.7 Biology of Stress ◦ Ch.8 Monkeys/Cold Virus ◦ Ch. 9 Demands & Control 14 “Unnatural Causes” Video Clips
- 15. 15 Perceived Discrimination Stigma Health Behaviors HeightenedStress Response Mental & Physical Health Adapted from Pascoe and Richman, 2009 Perceived Discrimination & Stigma as Social Determinants of Health
- 16. Stigma has beenassociated with elevated risk for many mental & physical health problems, including: 16 Alcohol, drug, and tobacco dependence Depression Anxiety Disorders Suicide ideation and attempts Obesity Heart Disease & Stroke Health Affects of Stigma
- 17. 1/27/2016DRAFT 17 Adapted from:Making Partners: Intersectoral Action for Health, 1988 Proceedings and outcome of a WHO Joint Working Group on Intersectoral Action for Health. The Netherlands. HealthEquity Public Health’s Job Personal Health Burden Public Health Responsibility vs. Personal Responsibility
- 18. Many people belongto multiple stigmatized groups, adding to their daily levels of stress. These can include: 18 • Ageism • Sexism • Homophobia • Transphobia • Racism • Classism • Ableism • Anti-Semitism and other forms of religious oppression Intersections of Oppression
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- 20. We needtwo volunteers to act as outside observers for this activity the observers will report to the group what you witnessed. Everyone else: The facilitators will place a “label” on your shoulder so you can’t see it (please don’t peak). After everyone has been “labeled” you will move around the room and engage in conversation with other participants. With each participant, react as a member of society might react to a person with the label the participant is wearing. It is important to talk with other participants clearly, conveying societal attitudes toward the label they are wearing without telling them what their labels are. 1/27/2016DRAFT 20
- 21. Were youable to correctly identify your label? How did it feel to be treated in a stereotyped way? What was the experience like for you? Were you puzzled or surprised by how you were treated? 1/27/2016DRAFT 21
- 22. 1/27/2016DRAFT 22 “While manyminority groups are the target for prejudice... and discrimination... in our society, few persons face this hostility without the support and acceptance of their family as do many gay, lesbian, and bisexual youth.” Virginia Uribe and Karen Harbeck “The barriers that LGBT people face in accessing health services- ranging from disrespectful treatment to denial of care – contribute to poor health outcomes” Nils Daulaire, Assistant secretary for global affairs, U.S. Department of Health and Human Services
- 23. What dothe initials LGBT stand for? What does gender identity mean? What is the difference between… sexual orientation and gender identity? 23 Who are L, G, B, T people?
- 24. From allracial/ethnic groups From all religions and spiritual traditions From all geographic regions Across the entire lifespan Of all abilities Across the entire political spectrum From all levels of health and illness 24 Who are L, G, B, T people?
- 25. In Riverside County ◦At least 92,000 people (~4.2% of population) are LGB ◦ Between 2,358 - 7,075 people (0.1% - 0.3% of population) are transgender ◦ 3rd largest minority group in Riverside County 25 At a glance…
- 26.
- 27.
- 28. 28 The Cost ofStigma
- 29. 29 The Cost ofStigma ***Rates of attempted suicide among Gay, Lesbian, Bisexual and Transgender men and women are 2 to 8 times that of heterosexual and gender conforming people.
- 30. ◦ Real andfeared rejection and discrimination at home, work, school. ◦ Plagued by hetero-normativity and gender-normativity ◦ HIV/AIDS stigma ◦ Internalized oppression ◦ Medical classification as a disease ◦ Religious beliefs that link sex and sin The Cost of Stigma Robs LGBT people from genuine authenticity. “Coming out” is a life-long, constant challenge.
- 31. Heaped ontop of typical stressors of living and coping in the world All LGBT belong to at least one other culture All other cultures/groups include some LGBT Chronic, persistent and in many cases, lifelong. Arises from mutable social and cultural structures and processes rather than from individual risk factors or choices Minority Stress
- 32. 32 “ I don’tthink it was in the dictionary when I was young” − Anna from Project Visibility LGBT and Aging
- 33.
- 34. 1/27/2016DRAFT 34 Our societymust make it right and possible for old people not to fear the young or be deserted by them, for the test of a civilization is the way that it cares for its helpless members. Pearl S. Buck
- 35. In the mostgeneral sense, persons 65+ tend to be considered the “senior” population. People who were born during the post World War II baby boom between the years 1946 and 1964. Older, old adults are 85+ Younger, old adults are 55+ Baby Boomers (Younger, old adults) 35 How do we define Aging?
- 36. From allracial/ethnic groups From all religions and spiritual traditions From all geographic regions Of all abilities Across the entire political spectrum From all levels of health and illness 36 The Aging Community
- 37. Riverside County projectedgrowth rate of 100.0-149.9% ! The elderly population is expected to grow more than twice as fast as the total population and this growth will vary by region. The older adult age group will have an overall increase of 112% during the period from 1990 to 2020. More than half of California’s counties will experience over a 100% increase in this age group. 37 At a glance
- 38. Demographic changes createan urgent need Two factors—longer life spans and aging baby boomers—will combine to double the population of Americans aged 65 years or older during the next 25 years to about 72 million. By 2030, older adults will account for roughly 20% of the U.S. population. - The CDC Chronic conditions present a strong economic incentive for action More than a quarter of all Americans and two out of every three older Americans have multiple chronic conditions, and treatment for this population accounts for 66% of the country’s health care budget. - The CDC 38 Why might this be an issue?
- 39. More and moreAmericans are living to be age 100 and over. The Times, published an article stating that health officials predict by 2050, more than 800,000 Americans would be pushing into their second century of life. 39 Health and Social Support System
- 40. Job discrimination Harassment “Suddenly Stupid” Suddenly weak Sexless/asexual Abuse Built and social environment “Going to crash the healthcare system” Social isolation 40 Stigma and Aging
- 41. Suddenly Stupid Sexless/asexual Abuse Social Isolation 1/27/2016DRAFT 41
- 42. Four factors foundto determine the “Boomer impact” on healthcare: 42 Chronic Illness, Injury and Healthcare Needs 1. An increase in utilization of the healthcare system 2. Increased prevalence of chronic disease 3. Different needs and patient expectations 4. More services and technologies available to them as compared to previous generations.
- 43. Redefining SeniorCenters Livable Communities Transportation- Ability to get around on their own (adaptive devices) Independence- Minimal assistance from loved ones or professionals Health and Longevity- Manage illness and chronic disease Affordable Care/Coverage Age in Place- Remain at home and in community for as long as possible 43 Future Needs of Aging Boomers
- 44. 44 “It is vitallyimportant to distinguish between disability as a natural part of the human condition and disability-related health disparities that can lead to compromised care, ill health, institutionalization and premature death.”
- 45. Hearing Vision Movement Thinking Remembering Learning Communicating Mental Health Social Relationships 45 Disabilities
- 46. Medical modelsview disability as an extension of a physiological condition requiring treatment or therapy. Social models view disability as the result of societal forces on impairment, and suggest that changes to social norms and practices would reduce restrictions. As a demographic category, disability is an attribute with which individuals may broadly identify, similar to race or gender. Certain federal programs narrowly define disability as the impairment or limitation that leads to the need for the program’s benefit 46 Who are people with Disabilities? There is no one single definition Adapted from: Brault, M.W., 2012
- 47. From allracial/ethnic groups From all religions and spiritual traditions From all geographic regions Across the entire lifespan Across the entire political spectrum From all levels of health and illness 47 Disabilities
- 48. Think Back toModule 4 48 Disabilities – Shift in Paradigm Requiring medical management with the goal of “fixing” the problem (medical model) Moved from a paradigm that viewed disability as a medical problem Between multiple individual characteristics (social model) to a paradigm that views disability as a product of interactions
- 49. Overall, adults witha disability were: Less likely than those without disabilities to report excellent or very good health (27.3% vs. 60.3%) More likely to report being in fair or poor health (40.1% vs. 9.8%). 49 Disability No Disability College 18 - 34 13.9 21.8 Employed 35.4 74.5 Living in poverty 21.1 11.3 Disabilities – Local Data
- 50. 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% All <18 18-6465+ Riverside California U.S 50 Disabilities – At a glance - U.S. Census Legally Disabled 2012 Disability Rates 2012
- 51. Disabled studentsalmost twice as likely to be suspended Proportion of missing teeth to filled teeth higher among persons with intellectual disabilities. Diagnostic overshadowing Professional misconceptions 51 Disabilities Barriers to Good Health
- 52. Social Determinants: Inaccessiblephysical environments Social assumptions and prejudices Inflexible policies and procedures 52 Hint: Not from the disability! Where do health disparities among people with disabilities arise from?
- 53. Listen toand respect the wishes of the person/family being helped. Provide assistance in ways that lead to less dependence (more autonomy) 53 Competence vs. Incompetence Offer empowerment to obtain the information needed to take control and actively participate in their own health. Remove barriers to participation by people with disabilities Millie’s Story
- 54. KEEP THINKING! THERE AREMANY MORE FACTORS WE NEED TO CHANGE ! SAY: 1. People with disabilities 2. Brain injury 3. Congenital disability 4. He has a mental health condition/diagnosis 5. She has a learning disability 6. He receives special ed. services 7. Children without disabilities INSTEAD OF: 1. The handicapped or disabled 2. Brain Damaged 3. Birth defect 4. He’s emotionally disturbed/mentally ill 5. She’s learning disabled 6. He’s in special ed. 7. Normal or healthy kids 1/27/2016DRAFT 54
- 55. 55 A Day inthe Life of Richard Devylder
- 56.
- 57. 57 Do these peoplefit your stereotype?
- 58. When health professionalsknow about many different populations they can provide better care, make better decisions, and make better referrals. ◦ Each health professional is responsible to learn about the populations for whom they provide services or develop policies. ◦ Background knowledge about population health issues can assist both people who receive services and their service providers to focus their questions for each other. ◦ Dialogue from a position of mutual understanding is necessary to bring about equitable health care. Public Health Culture
- 59. Awareness Sensitivity Knowledge Lipson, Juliene G.& Dibble, Suzanne L. (2005) Culture & Clinical Care, San Francisco, UCSF Nursing Press The ASK Model
- 60. List 3 things youare personally ready and willing to do to assure that your care for the LGBT, Aging and Disabled communities is the BEST it can be. 60 Are you ready?
- 61. Module I:An Overview of Public Health Module II: Cultural Competency & Acceptance Module III: Deconstructing Racism Module IV: Health Inequities & Social Determinants of Health Module V: Discrimination & Stigma Module VI: Community Capacity Building 61 Next Steps for Public Health: Improving Health for All
- 62. To enroll ina module or if you have an interest in facilitating please contact: DOPH Staff Development Office 951-358-7141 If you have questions about content please contact: Epidemiology & Program Evaluation Branch 951-358-5557 62 Contact Information
Editor's Notes
- #3 Facilitator Notes: Announce location of the restrooms, exits, etc. Instruct everyone to sign in (regular and CEUs) Remind them water is available Instruct them to turn off cell phones or place on vibrate If participants must take calls, step outside of the training room Mention where to obtain refreshments; location of vending machines, etc.
- #4 If you normally don’t speak up much, try to offer your ideas and thoughts. Throughout this training series sensitive topics are discussed so you want to convey to participants that it is 1) an important part of moving forward in achieving our mission of optimal well-being for all Riverside County residents; 2) take care of yourself. The facilitators can talk to you during breaks if you need to talk. Since we will be spending several hours together and talking about sensitive issues, we want to make sure we have some ground rules in place so that everyone feels more comfortable. Think back to some teams you have worked with that have worked well together. What ground rules did they follow? Let the participants know that if needed, they can propose additional ground rules throughout the day. If someone is violating a ground rule (such as having side conversations), gently remind them that the group put forth the ground rules and that we should all try to respect them.) Let participants know that they are able to step out for a few minutes if needed. Step up; step down (if you are normally talkative, give others room to talk). If you are usually quiet, try to offer your ideas and thoughts Under Other: Breaks are scheduled, but if there is a pressing need, feel free to step out for a few minutes and then return. Remember, everyone in the room today has been uniquely affected by these topics and may have very different perspectives regarding them. It is important that each participant respects these differences even if you disagree with them. Each person in this room is unique based upon their own personal history. Let the participants know that no we are not going to undo racism today but we will take steps at understanding its roots and its affects today.
- #7 By the end of the session participants will be able to: define/describe stigma and perceived discrimination Describe how stigmatization impacts community health Contribute ideas on what DOPH can do to reduce barriers faced by stigmatized groups
- #15 About 20 minutes. Notes from Monday February 3rd 2014: Look at studies about control and stress. Discuss from the video control and threat (CEO/Custodian)
- #16 Although the expression of outright discrimination has been greatly reduced in recent decades, more subtle and chronic forms of discrimination are still very real for certain groups in our society. A number of comprehensive literature reviews find substantial evidence—from both laboratory and community studies— for the harmful health effects of discrimination across a range of mental health outcomes including depression, psychological distress, anxiety, and well-being (e.g., D. R. Williams, Neighbors, & Jackson, 2003; Paradies, 2006). Perceived discrimination has also been linked to specific types of physical health problems, such as hypertension, self-reported poor health, and breast cancer, as well as potential risk factors for disease, such as obesity, high blood pressure, and substance use (see, e.g., D. R. Williams & Mohammed, 2009, for a review). – [cut and paste from Pascoe and Richman, 2009] Stigma/Invisibility Perceived discrimination leads to psychological and physiological stress responses and health behaviors. Perceived discrimination also produces significantly heightened stress responses and is related to participation in unhealthy and nonparticipation in healthy behaviors In addition, evidence suggests that this relationship may occur through the mechanisms of stress responses and health behaviors.
- #17 External sources: e.g., negative attitudes of health care professionals and others in society may affect accessing health services Internal sources: e.g., internalized oppression, may increase use of unhealthy coping strategies and accumulated stress.
- #18 Who here knows the story of Sisyphus? Greek King punished by the gods. Forced to roll a boulder up a hill forever. On this slide our personal health burden is our personal boulder. You still need to push your rock (your own health burden) but public health’s job is to reduce the slope as much as possible and reduce it for everyone not just for some. As the note indicate accordion effect to reduce slope of the angle
- #19 Ageism Sexism Homophobia Transphobia Racism Classism Ableism Anti-Semitism and other forms of religious oppression NPR story – RWJ and Havard School PH joint study on Latinos
- #23 In Riverside County, especially outside of the Palm Springs region we often need to go back to basics by first describing what is LGBT? Riverside County has one of the largest LGBT populations in the country (Gates, 2006; Gates & Cooke, 2011). Members of the lesbian, gay, bisexual and transgender (LGBT) community are our neighbors, co-workers, friends and family and they experience disproportionately poor health outcomes and poor health status. Despite progress gained in equality for LGBT people over the last four decades, national data suggest that members of the LGBT population continue to experience poorer health outcomes than their heterosexual counterparts (Harcourt, 2006). To understand these health disparities it is important to look at the social determinants of health. Social determinants of health are the economic and social conditions under which people live, work and play that affect their health (U.S. Department of Health and Human Services, 2009; Centers for Disease Control and Prevention, 2012a; Lick et al., 2013). Stress from societal stigmatization, systematic harassment and discrimination, and a lack of cultural competency in the health care system place LGBT people at higher risk for violence and illnesses such as cancer, mental illness, and other diseases. They are more likely to smoke, drink alcohol, use illicit drugs, and engage in other risky behaviors (Table A). We cannot estimate the full extent of LGBT disparities due to a lack of data collection on sexual orientation and gender identity at national, state, and local levels (IOM, 2011; Lick et al., 2013).
- #24 We have chosen to use the shorthand LGBT when talking about the shared influences of stigma among lesbian, gay, bisexual, and transgender people. It is important to be explicit in what is meant by LGBT people or the LGBT community. The acronym LGBT refers to Lesbian, Gay, Bisexual, and Transgender. Although all of the different identities within “LGBT” are often grouped together (and share the commonality of discrimination based on sexism), there are speciic needs and concerns related to each identity. Defined as “not exclusively heterosexual” lesbians, gay men, and bisexual men and women (LGB) include people who openly identify as LGB, among other terms, and those who don’t use such labels but experience same-sex attraction or engage in same-sex sexual behavior. LGB people come from every culture, ethnicity, education and income level, health status, and lifestyle (IOM 2011 page 12; Meyer 2001). Transgender people are defined according to their gender identity and presentation, not their sexual orientation. Transgender people are individuals whose gender identity differs significantly from what is traditionally associated with their birth sex. Transgender individuals can have different sexual orientations (IOM 2011, page 12; Mayer, et al., 2008). Though the experiences of transgender persons are substantially different from cis-gender (gender-conforming) lesbians, gay males, or bisexual women and men, they are subject to many of the same discriminatory practices, harassment, and violence, as lesbians, gay men, and bisexual men and women. Further, fear of rejection by family and friends makes the “coming out” process similar for all these groups (Hughes & Eliason, 2002). LGBT stands for lesbian, gay, bisexual and transgender. The initials LGBT or GLBT are not agreeable to everyone that they encompass. These definitions are meant to be used as reference to better understand the populations under discussion and should not be used to assume another person’s identity. It is important to respect an individual’s self-identification. Self-concept related to gender: how well do I fit into male/female, and feminine/masculine expectations for my culture? Gender identity is established early in life, as children identify their own gender around age 3, and the gender of others around 6. Transgender is an umbrella term that describes people whose gender identity is not congruent with their physical bodies or sex assigned at birth. Transgender: Describes people who identify with or express a gender different from the sex assigned to them at birth. Sexual orientation: A person’s emotional, physical and sexual attraction and the expression of that attraction with other individuals. Some of the better-known labels or categories include “bisexual” (or “multisexual”, “pansexual”, “omnisexual”), “lesbian”, “gay” “homosexual” , or “heterosexual”. Queer: Used as an umbrella identity term encompassing lesbian, questioning people, gay men, bisexuals, non-labeling people, transgender folks, and anyone else who does not strictly identify as heterosexual. “Queer” originated as a derogatory word. Currently, it is being reclaimed by some people and used as a statement of empowerment. Some people identify as “queer” to distance themselves from the rigid categorization of “straight” and “gay”. Some transgender, lesbian, gay, questioning, non-labeling, and bisexual people, however, reject the use of this term due to its connotations of deviance and its tendency to gloss over and sometimes deny the differences between these groups. [http://internationalspectrum.umich.edu/life/definitions] Same-gender-loving: A cultural (particularly among African Americans) term that affirms the same sex attraction between men and women. [Healthy Black Communities, http://www.hbc-inc.org] Genderqueer: A term which refers to individuals or groups who “queer” or problematize the hegemonic notions of sex, gender and desire in a given society. Genderqueer people possess identities which fall outside of the widely accepted sexual binary. Genderqueer may also refer to people who identify as both transgender AND queer, i.e. individuals who challenge both gender and sexuality regimes and see gender identity and sexual orientation as overlapping and interconnected. [http://internationalspectrum.umich.edu/life/definitions] Homosexual: A person who is primarily and/or exclusively attracted to members of what they identify as their own sex or gender. A clinical term that originated in the late 1800s. The terms “lesbian, bi and gay” are preferred by many in the LGBT community. LGBT, LGBTQ, LGBTQA, TBLG: These acronyms refer to Lesbian, Gay, Bisexual, Transgender, Queer, and Ally. Although all of the different identities within “LGBT” are often lumped together (and share sexism as a common root of oppression), there are specific needs and concerns related to each individual identity. [http://internationalspectrum.umich.edu/life/definitions] Bisexual: People who are romantically and/or sexually attracted to, and/or partner with people of more than one gender. Gay and Lesbian: Refers to individual people who are romantically and/or sexually attracted to, and/or partner with people of the same gender; lesbians partner with women and gay men partner with men. I think image stolen from Press Enterprise
- #25 It may seem obvious but people often need to be reminded.
- #26 Riverside County has one of the largest LGBT populations per capita in the nation. Estimates place the size of the Riverside County lesbian, gay and bisexual (LGB) population between 70,747 - 235,822 people. The most recent population based survey places the (LGB) population at 4.2% of the general population or over 92,000 individuals. The transgender population of Riverside County is estimated to be between 2,358 and 7,075 individuals. Throughout California LGBT smoke at significantly greater rates than heterosexuals (21.8% vs. 14.3%). Across California LGB report binge drinking in the past year at greater rates than their heterosexual peers (41.2% vs. 33.7%). In California, nearly 1 in 10 lesbians (9.1%), and gay men (8.7%) self-reported a cancer diagnosis. In California, lesbians and bisexual women 30 years old and older receive mammograms and Pap tests less often than heterosexual women. In California, nearly a quarter of all lesbians (24.1%) and bisexual women (24.8%)report having an asthma diagnosis. In the Inland Empire, a higher percentage of bisexual men (45%) and women (42.1%) report that they are disabled than heterosexual men and women (27.7% and 30.5%) or gay men and lesbians (30.1% and 22.4%). This disparity is seen throughout the state.
- #27 Notes from Monday February 3rd 2014: Looks at lifetime experience. Top graph is National data. This slide may have too much information in it, possibly break into two slides?
- #29 High rates of: Alcohol, tobacco and drug use Depression, anxiety, suicide Body image and eating disorders (men more than women) Domestic violence Specific risks for disease among certain sub-groups (e.g. higher risk of breast cancer among lesbians, anal cancer among gay men) Notes from Monday February 3rd 2014: Define binge drinking Binge drinking used to mean drinking heavily over several days. Now, however, the term refers to the heavy consumption of alcohol over a short period of time. Men 5 or more drinks in a “short period of time” Women 4 or more drinks in a “short period of time”
- #30 Perceptions of discrimination and whether one can access quality health services have been shown to not only affect whether and how individuals seek medical care and interact with medical professionals but affect health outcomes as well (Harcourt, 2006; When Health Care Isn’t Caring, 2010). Societal discrimination has a direct impact on the mental health of LGBT men and women. A social context of oppression leads to social and family alienation, reduced levels of social support, low self-esteem, and symptoms of psychological distress. For racial/ethnic minority LGBT the social impact on mental health is amplified due to the intersection of racism and heterosexism (Hatzenbuehler 2010). Hatzenbuehler and colleagues (2010), studying the impact of institutional discrimination such as bans on marriage equality on the mental health of LGB populations, found that the prevalence of mood, anxiety and substance use disorders increased in states enacting such bans and decreased in states that did not. They conclude “living in states with discriminatory policies may have pernicious consequences for the mental health of LGB populations.” Other studies have highlighted the detrimental effects of discrimination on health (McLaughlin et al, 2010; Diaz et al, 2001; Lick et al., 2013). In another study examining the impact of homophobia, poverty and racism on the mental health of Latino gay and bisexual men Diaz et al (2001) found high prevalence rates of psychological symptoms of distress including suicidal ideation (17%), anxiety (44%), and depressed mood (80%).
- #31 Notes from Monday February 3rd 2014: Remove QI Possibly give examples of personal experience… When someone asks “Does your husband/wife…” Response to “I’m a Christian…or I don’t believe in…, but”: The issue/concern/point is that it does not matter if you agree/disagree; it has an impact on the person/s
- #32 Notes from Monday February 3rd 2014: Possibly move this definition to slide 13.
- #33 This video will explore how stigma impacts the lives of older LGBT adults. Project Visibility Video 14 minutes
- #35 Change quote
- #38 Eleven of these counties, will have growth rates of over 150%. The Sandwich Generation Boomers are in their 40, 50, and 60’s Their children are in their late teens or early 20’s Their parents and in their 70’s, 80’s and older Parents are living longer, sometimes with health issues and children are taking longer to leave home. The number of parents living with their adult children increased 63% since 2000 1 in 8 middle-aged American is caring for at least one child and a parent under the same roof. Grandparents are raising grandchildren According to the 2010 Census, approximately 4.8 million live in their grandparents homes. In many cases, Boomers are shouldering the financial and emotional costs of care giving.
- #39 Demographic changes create an urgent need The growth in the number and proportion of older adults is unprecedented in the history of the United States. Chronic conditions present a strong economic incentive for action During the past century, a major shift occurred in the leading causes of death for all age groups, including older adults, from infectious diseases and acute illnesses to chronic diseases and degenerative illnesses Demographic changes create an urgent need The growth in the number and proportion of older adults is unprecedented in the history of the United States. Chronic conditions present a strong economic incentive for action During the past century, a major shift occurred in the leading causes of death for all age groups, including older adults, from infectious diseases and acute illnesses to chronic diseases and degenerative illnesses. These also cost us more to treat as they are usually maintained for a life time. Demographic changes create an urgent need Two factors—longer life spans and aging baby boomers—will combine to double the population of Americans aged 65 years or older during the next 25 years to about 72 million. By 2030, older adults will account for roughly 20% of the U.S. population. The CDC Chronic conditions present a strong economic incentive for action More than a quarter of all Americans and two out of every three older Americans have multiple chronic conditions, and treatment for this population accounts for 66% of the country’s health care budget. The CDC
- #40 This new population of centenarians are far from the frail, ailing, housebound people one may expect. The majority of them are mentally alert and relatively free of disability, and they remain active members of their communities. This may simply represent a new model of aging, one that health experts are hoping more of us can emulate, both to make our lives fuller and to ease the inevitable healthcare burden that our longer-lived population will impose in coming decades.
- #41 Richeson and Shelton article: A social psychological perspective on the stigmatization of older adults.
- #43 http://www.communitychoices.info/adrc/docs/riverside/RiversideADRCBOOMER%20REPORT_October2010.pdf The 2007 American Hospital Association (AHA) report states that Boomers will have more impact than ever on the United States healthcare system. The challenge is more patients will be added to an already underfunded system, with estimated costs running into billions of dollars.
- #47 Because health professionals, advocates, and other individuals use the same term in different contexts, disability does not often refer to a single definition. Medical models view disability as an extension of a physiological condition requiring treatment or therapy. In contrast, social models view disability as the result of societal forces on impairment, and suggest that changes to social norms and practices would reduce restrictions.4 As a demographic category, disability is an attribute with which individuals may broadly identify, similar to race or gender. In contrast, certain federal programs narrowly define disability as the impairment or limitation that leads to the need for the program’s benefit—such as the Social Security Disability Insurance program’s income support for individuals who are not able “to engage in any substantial gainful activity.”5 The agencies and organizations that provide benefits to, advocate for, or study these populations, each refer to their targeted group as people with disabilities; but because of the differences in definitions, an individual may be considered to have a disability under one set of criteria but not by another. (Brault, Matthew W., “Americans With Disabilities: 2010,” Current Population Reports, P70-131, U.S. Census Bureau, Washington, DC, 2012 How Does ADA Define Disability? The Americans with Disabilities Act (ADA) has a three-part definition of disability. Under ADA, an individual with a disability is a person who: (1) has a physical or mental impairment that substantially limits one or more major life activities; OR (2) has a record of such an impairment; OR (3) is regarded as having such an impairment. A physical impairment is defined by ADA as "any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological, musculoskeletal, special sense organs, respiratory (including speech organs), cardiovascular, reproductive, digestive, genitourinary, hemic and lymphatic, skin, and endocrine." Neither ADA nor the regulations that implement it list all the diseases or conditions that are covered, because it would be impossible to provide a comprehensive list, given the variety of possible impairments. http://www.ada.gov/pubs/adastatute08.htm#12102
- #49 See healthy people 2010 (2020). Because disability status has been traditionaly equated with health status, the health and wellbeing of people with disabilities has been addressed primarily in a medical care rehabilitation, and long-term care financing contexts. Four main problems from this approach 1, all people with disabilities automatically have poor health, 2, public health should focus only on preventing disabling conditions, 3, a standard definition of “disability” or “people with disabilities” is not needed for public health purposes, and 4, the environment plays no role in the disabling process.
- #51 Notes from Monday February 3rd 2014:
- #53 Notes from Monday February 3rd 2014: FOR EXAMPLE -Assuming that everyone must be able to independently fill out forms, undress unaided, transfer to high examination tables, and communicate in spoken English to receive standard health care services. Often invisible in health disparities conversations (see Nosek & Simmons 2007) Disproportionately prevalent among people wit disabilities: diabetes, hypertension, depression, and sleep disorders. Health disparities versus secondary conditions
- #54 Notes from Monday February 3rd 2014: Kathy Snow Millie’s Story It was difficult to understand Millie. Her speech was laborious because of cerebral palsy and even worse because calcium deposits on her vertebra affected her neck muscles. The staff at Rehab was kind, but in a hurry. Many had been trained in another country and spoke English as a second language. However, the language difference was less important than the attitudes the caregivers brought with them. Their previous experiences and expectations led them to think that anyone with difficulty communicating had significant cognitive limitation. Millie tried to ask them to warn her before they lifted her stiff hands so she could prepare herself. They smiled and nodded but didn’t understand. So they picked up her hands without warning. Millie yelled loudly. Millie’s mom would visit and the nurses would ask her how Millie felt. Mom reassured the nurses they were doing a good job, but she didn’t tell them to listen to Millie. Even Millie’s mother was a part of the cultural divide; her own culture discouraged being critical of caregivers and sought to avoid confrontation. So Millie yelled. Finally Millie complained to a friend, “They only see the physical, not inside you.” They decided to provide a little education. They wrote down all the words Millie had to say and posted them on the walls of Millie’s room. They wrote ideas like, “When you don’t understand, ask me to repeat. Two or more times if necessary.” They wrote, “No pureed food!” They wrote, “Millie is not deaf or dumb. She respects your intelligence, please respect hers.” Over time, her room was covered in words. The staff was amazed. They began to respect her, and working together Millie finally left the hospital. She never reached her goal of walking again, but she did regain her self-respect and dignity. Adapted from: Johnson, J., Guinan M., Brown, S.E., and Shearer, V. (2011). Disability, Culture, and Health Disparities. Impact Newsletter.
- #56 11:28 minutes
- #57 Skill Building ??
- #58 Assume competence. Fallen Fox, MMA Fighter (M to F Transgender) Stephen Hawking, Former Professor of Mathematics at the University of Cambridge (1979 – 2009). Now Director of Research at the Center for Theoretical Cosmology at Cambridge. (he is also 71) Jason Collins, First openly gay NBA player. Ruth Flowers aka “Mamy Rock” 73 year old from the UK. She is one of Europe's top DJs. Erik Weihenmayer, first (only so far) blind person to have reached the summit of Mount Everest (2001) and the tallest peak on each continent.
- #59 Talking Points: Bullet One: When health professionals know about many different populations they can provide better care, make better decisions, and make better referrals. Bullet Two: Each health professional is responsible to learn about the populations for whom they provide services or develop policies. Bullet Three: Background knowledge about the health issues facing LBGT, elder and people with disabilities can assist both people who receive services and their service providers to focus their questions for each other. Bullet Four: Dialogue from a position of mutual understanding is necessary to bring about equitable health care.
- #60 ASK REFLECTION QUESTIONS: adapted from Lipson, Juliene G. & Dibble, Suzanne L. (2005) Culture & Clinical Care, San Francisco, UCSF Nursing Press Awareness 1. Think about your health care setting from the perspective of a new LGBT, elder or disabled patient or client. . . . Would the new client find welcoming signs? What are they? Are there potential barriers to creating a welcoming environment? 2. What did you learn about LGBT, elder or disabled cultures in your youth? How about college? Your health care training program? What gaps in knowledge do you have, if any? 3. What LGBT, elder or disabled issues make you uncomfortable? Sensitivity 1. How could you alter the health care environment in which you work to convey a more welcoming message to LGBT, elder or disabled clients? 2. Think of a time when you thought someone you took care of was LGBT, elder or disabled. Write a short description of what you recall about your interactions with this person. How might your interaction have changed if you knew more about LGBT, elder or disabled issues and cultures? 3. Think of a joke that you have heard about LGBT, elder or disabled people. What would be a sensitive and appropriate response if you heard this joke told in a group at work? Knowledge 1. What have you learned today that you did not already know? How can you use the information in this chapter in your work setting? 2. What questions do you have about LGBT, elder or disabled cultures that this module did not answer? Make a list of these questions, and check for resources to find the answers to the remaining questions. Show your facilitators your questions.