(HEPE) Introduction To Health Disparities 1antz505
Many youth leaders are compelled to do work with community based non-profit and local public health agencies as both a service learning and philanthropic component in their development as young professionals. However, despite invaluable experiential learning, students often don\'t comprehend key overarching issues such as health disparities, social determinants of health, health policy and community organizing. To address this gap and optimize their community based work, the Health Disparities Student Collaborative (HDSC), a Boston-based student group under Critical MASS for eliminating health disparities and the Center for Community Health Education Research and Service Inc. (CCHERS), developed a curriculum for students designed to broaden their perspectives while working with local public health, non-profit/community organizations and to develop their interest and ability to visualize the power of their collective voice as students and contributors to social justice work. The curriculum utilizes peer education and webinar software and covers three main topics: Current State of Health Disparities, Social Determinants of Health, and Youth Activism on Health Disparities/Social Determinants of Health. HDSC has collaborated with local partners CCHERS/Critical MASS and the Community Based Public Health Caucus (CBPHC) Youth Council to develop this comprehensive “Health Equality Peer Education” training.
(HEPE) Introduction To Health Disparities 1antz505
Many youth leaders are compelled to do work with community based non-profit and local public health agencies as both a service learning and philanthropic component in their development as young professionals. However, despite invaluable experiential learning, students often don\'t comprehend key overarching issues such as health disparities, social determinants of health, health policy and community organizing. To address this gap and optimize their community based work, the Health Disparities Student Collaborative (HDSC), a Boston-based student group under Critical MASS for eliminating health disparities and the Center for Community Health Education Research and Service Inc. (CCHERS), developed a curriculum for students designed to broaden their perspectives while working with local public health, non-profit/community organizations and to develop their interest and ability to visualize the power of their collective voice as students and contributors to social justice work. The curriculum utilizes peer education and webinar software and covers three main topics: Current State of Health Disparities, Social Determinants of Health, and Youth Activism on Health Disparities/Social Determinants of Health. HDSC has collaborated with local partners CCHERS/Critical MASS and the Community Based Public Health Caucus (CBPHC) Youth Council to develop this comprehensive “Health Equality Peer Education” training.
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
Presentation by Camara Jones, MD, MPH, PhD at the 2009 Virginia Health Equity Conference.
Dr. Jones presents the “Cliff Analogy” for understanding four levels of health intervention: medical care, secondary prevention, primary prevention, and addressing the social determinants of health. She described how health disparities arise on three levels (differences in quality of care, differences in access to care, and differences in underlying exposures and opportunities) and expand the “Cliff Analogy” to illustrate the relationship between addressing the social determinants of health and addressing the social determinants of equity, which is a fifth level of health intervention.
She identifies racism as one of the social determinants of equity and a fundamental cause of “racial”/ethnic health disparities in the United States, with racism defined as a system of structuring opportunity and assigning value based on the social interpretation of how one looks, which is what we call “race.” She described how racism impacts health on three levels (institutionalized, personally-mediated, and internalized) and animate understanding of these levels of racism with her “Gardener’s Tale” allegory.
Finally, using data from the “Reactions to Race” module on the 2004 Behavioral Risk Factor Surveillance System, she examined the relationship between responses to “How do other people usually classify you in this country?” and self-rated general health status to provide evidence of the impacts of racism on health. Dr. Jones challenges us to broaden the scope of our public health interventions by asking the question “How is racism operating here?” and then working to create a system in which ALL people are highly valued and ALL people are able to develop to their full potential.
On August 10, I had the wonderful opportunity to work with a group of amazing individuals to assess the biases present in our current healthcare system. This project was a part of a summer intensive program through MedSTEMPowered.
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
Presentation by Camara Jones, MD, MPH, PhD at the 2009 Virginia Health Equity Conference.
Dr. Jones presents the “Cliff Analogy” for understanding four levels of health intervention: medical care, secondary prevention, primary prevention, and addressing the social determinants of health. She described how health disparities arise on three levels (differences in quality of care, differences in access to care, and differences in underlying exposures and opportunities) and expand the “Cliff Analogy” to illustrate the relationship between addressing the social determinants of health and addressing the social determinants of equity, which is a fifth level of health intervention.
She identifies racism as one of the social determinants of equity and a fundamental cause of “racial”/ethnic health disparities in the United States, with racism defined as a system of structuring opportunity and assigning value based on the social interpretation of how one looks, which is what we call “race.” She described how racism impacts health on three levels (institutionalized, personally-mediated, and internalized) and animate understanding of these levels of racism with her “Gardener’s Tale” allegory.
Finally, using data from the “Reactions to Race” module on the 2004 Behavioral Risk Factor Surveillance System, she examined the relationship between responses to “How do other people usually classify you in this country?” and self-rated general health status to provide evidence of the impacts of racism on health. Dr. Jones challenges us to broaden the scope of our public health interventions by asking the question “How is racism operating here?” and then working to create a system in which ALL people are highly valued and ALL people are able to develop to their full potential.
On August 10, I had the wonderful opportunity to work with a group of amazing individuals to assess the biases present in our current healthcare system. This project was a part of a summer intensive program through MedSTEMPowered.
HIV/AIDS and Infectious Diseases: Prevalence and Attitudes Among U.S. Latinos
Dr Li Loriz, PhD, ARNP, BC, Director, School of Nursing, University of North Florida
July 22, 2005 - UNF Hispanic Health Issues Seminar
This is part 6 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.
Presented by
Salim Chowdhury, MD - Community Care
Curtis Upsher, Jr. MS - Director Community Relations - Community Care
Medicine, Culture, and Spirituality Conference
September 9, 2011
Cultural Competence Resources for GLBT Health. Delivered at the Diverse Students' Leadership Conference, St Mary's College, Notre Dame, IN. March 2011.
Understand what are the Social Determinants of Health, how are these tied to health equity and what you can do to make an impact for better outcomes and a more inclusive approach to healthcare.
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1Health Care DisparityBlack AmericansHispanicsLatinos.docxfelicidaddinwoodie
1
Health Care Disparity
Black Americans
Hispanics/Latinos
Demographics
45.7 million, which is 14.3% of USA population.
15% of the USA population
Cultural Norms
Strong kinship bonds, strong work orientation, strong religious orientation, take care of their own, seniors are highly respected, don’t like to admit they need help, poverty impacts education, self-esteem, quality of life and life style across.
Strong family ties, strong church and community orientation, male dominance, age dominance, negative view on asking for help, take care of their own majority are roman catholic, distrust of government, modesty is important and very proud of heritage
Religious and Spiritual Beliefs
Have strong religious affiliation with Christian denominations and also Islam.
Have strong belief in the spirit world. Majority are roman CatholicsS
Primary Insurance Coverage
Most of them are not insured, but the affordable care act provision target at improving provisions that will highly improve their lives.
Six in ten Hispanic adults in USA lack health insurance.
Education
17% have attained bachelor’s degree
11% have attained bachelor’s degree
Medical Conditions
They reside at disadvantaged neighborhoods with increased risks for health disparities. Obesity in children is enormous
More than a quarter of its population lack usual health care provider. Hispanic adults have a low prevalence for many chronic diseases and a high prevalence for diabetes.
Outreach
Foundation of African American outreach program to provide assistance to Africa-Americans
Action plan to reduce racial and ethnic health disparities
Introduction
The health of a population is influenced by both its social and its economic circumstances and health care services it receives. The health care services provided to Hispanics and black in United States of America is low. Throughout the years we have seen advancements in the health care quality received by ethnic minorities groups. But there is still a large gap when comparing minorities with their white counterparts (Vicini, 2015). This has affected the two groups which have low income families and experience poor quality care. Hispanic and blacks are less likely to have a high school education. Disparities in quality of care are common among the blacks and Hispanics in USA. For instance adults of 65 years and above receive worse care than adults with 18-44 years. Poor people have worse access to care than the high income people (Lee et al., 2003).
Healthcare Disparities between the Blacks and the Latinos in USA
The healthcare insurance status for the blacks and Latinos is low and as a result it forms barriers to access to quality health care utilization. Language barriers in health care are associated with decrease in quality of care, safety, patient and clinical satisfaction and contribute to health disparities even among people with insurance. Statistics have shown when comparing blacks and Latinos to their whi ...
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
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is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
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from mild to severe. A diagnosis of AUD requires that at least two of
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AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
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drinking, negative social consequences, risky use, and altered physiological
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of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Are There Any Natural Remedies To Treat Syphilis.pdf
Racial and LGBT Health Inequities
1. Racial and LGBT Health
Inequities
Louisiana Office of Public Health
STD-HIV/AIDS Program
Kathleen Welch
2. What are Health Inequities?
Differences in health status and in the distribution of
health determinants between different population
groups.
External determinants of health
Differences in social conditions outside the control of the
individuals concerned
Differences are avoidable and rooted in social justice
3. What are Health Inequities?
•Equality = SAMENESS
•Only works if everyone
starts from the SAME
place
•Equity = FAIRNESS
•Making sure people get
access to the same
opportunities
4. Racial Inequities in the US
Racial inequities in health in the U.S. are large and
pervasive.
Almost 100,000 black persons die prematurely each year
who would not die if there were no racial inequities in
health
For some health outcomes, the inequities are
worsening.
Pathogenic factors linked to race continue to affect
health even when socioeconomic status (SES) is
controlled.
5. Rates of Black & White Persons Living with
an HIV Diagnosis, by County, 2010
Black Rates White Rates
* Data are not shown to protect privacy. ** State health department requested not to release data.
6. Rates of Persons Living with an HIV
Diagnosis & Poverty Rates, by County, 2010
Persons Living with an HIV diagnosis Poverty Rates
* Data are not shown to protect privacy. ** State health department requested not to release data. † Data not available because the data source does not publish these data for this jurisdiction.
7. Racial Inequities in Louisiana
Whites Blacks Hispanics
Poverty Rate 17% 45% 40%
Males/No High School Diploma 2.5% 17.7% 11.8%
Incarceration Rate 4.25 1657.5 745.3
Life Expectancy 76.5 72.1 78.6
Death Rate 832.8 1057.4 384.9
Infant Mortality Rate 6.6 13.9 3.9
Heart Disease Death Rate 211.4 262.4 99.4
Cancer Death Rate 189.9 239.5 87.8
Cerebrovascular Death Rate 40.8 61.3 NSD
Diabetes Death Rate 21.6 46.1 NSD
Breast Cancer Death Rate 22.0 35.3 NSD
Firearms Death Rate 13.2 26.8 NSD
Adult Overweight/Obesity Rate 64.7% 74.3% 72.3%
Uninsured for Nonelderly 18% 30% 51%
Kaiser Family Foundation.(2012). State Health Facts. Retrieved from
http://www.statehealthfacts.org/index.jsp
8. Racial Inequities in Louisiana:
HIV/AIDS (2012)
Louisiana ranked 4th highest in HIV case rates and 3rd
highest in AIDS case in the US.
Baton Rouge ranked 2nd and New Orleans 4th in AIDS case
rates for MSAs.
Blacks account for only 32% of Louisiana’s population yet:
67% of people living with HIV in LA are black.
HIV diagnosis rate for blacks is more than 7 times higher than
for whites. (Whites: 7.1/100,000; Blacks: 56.7/100,000)
AIDS diagnosis rate for blacks is more than 12 times higher
than for whites
9. Racial Inequities in Louisiana: STDs
In 2013, Louisiana ranked 1st for gonorrhea, 2nd for
Chlamydia and 3rd for P&S syphilis case rates in the
nation.
Blacks accounted for 78% of P&S syphilis cases, 85% of
gonorrhea cases, 75% of Chlamydia cases.
10. How can Racism Affect Health
Status?
Direct Effects
Physiologic stress –allostatic load (McEwen and
Seeman, 1999. A cumulative physiologic “wear and tear”.
Can affect multiple biological systems (nervous, endocrine,
immune, cardiovascular…) and lead to premature illness and
mortality (Seeman, 2004).
Red blood cell oxidative stress
Can accelerate cellular aging, telomere shortening in response
to life stress
Psychological Stress
11. Differences in Access to Care
Closure, relocation or privatization of hospitals that
primarily serve the minority community
Transfer of unwanted patients (“patient dumping”) by
hospitals and institutions
Limiting the access of Medicaid patients to the full
array of providers by sending these patients provider
lists that contain only providers that accept Medicaid
Targeting specific areas for managed care enrollment
while ignoring inner-city areas or other less desirable
districts
12. Differences in Quality of Care
Less aggressive treatment of minority patients
Minorities more likely to be treated by providers with
worse performance records or those who are less well
trained
Found across a wide range of disease areas and clinical
services
Found even when clinical factors, such as stage of disease
presentation, co-morbidities, age, and severity of disease
are taken into account
Found across a range of clinical settings, including public
and private hospitals, teaching and non-teaching hospitals,
etc.
13. Scope and Relevance of Care
Lack of stable relationships with primary care
providers
Minority patients, even when insured at the same level
as whites, are more likely to receive care in emergency
rooms and have less access to private physicians
Financial incentives to limit services –may
disproportionately and negatively affect minorities
“Fragmentation” of healthcare financing and delivery
17. LGBT Health Inequities
Individuals of the LGBT community are more likely to:
Rate their health as poor
Have chronic conditions (i.e., cancer diagnoses, obesity,
cardiovascular disease, chronic headaches)
Have higher prevalence of earlier onset of disabilities
Have higher prevalence of HIV/STDs
Experience psychological distress and have higher rates
of binge drinking and substance use
Differences in health inequities depending on LGBT
subgroup
18. HIV/AIDS in the LGBT Community
In 2010, gay and bisexual men and other MSM, represented
2% of the US population but accounted for:
56% of all people in the US living with HIV
66% of new HIV infection
Black MSM accounted for 36% of new HIV infections in
2010 and saw the highest increase in HIV rates among all
sub-populations between 2008 and 2010
1 in 4 transgender women of color are estimated to be HIV
positive (28%), most of which do not know their status
19. HIV/AIDS in the LGBT Community:
Louisiana
The percentage of adult HIV diagnoses in LA that are
attributed to MSM increased from a low of 40% in 2002 to
a high of 53% in 2011
The majority of new diagnoses among MSM in LA are
black and under the age of 35
20. HIV/AIDS in the LGBT Community:
Louisiana
Men and Women Men Only
21. STDs in the LGBT Community
STD rates are higher among some LGBT groups and
rates have been increasing for some infections
MSM account for more than 7 in 10 (72%) new syphilis
cases in the US and 15% -25% of all new Hepatitis B
infections
MSM are 17 times more likely to develop anal cancer
(commonly caused by HPV) than men who only have
sex with women
22. LGBT Stigma and Discrimination
History of discrimination and stigma is related to
negative mental health and behavioral health
conditions
LGBT members are 2.5 times more likely to experience
depression and anxiety, and substance misuse
Lack of acceptance from family members is correlated
with higher rates of mental illness and substance use
23. LGBT Stigma and Discrimination
Laws reinforce discrimination, stigma, and health
inequities
LGBT Rights in Louisiana
Statewide employment discrimination law on basis of
orientation allowed to expire in 2008
Hate crime law does not cover transgender individuals
No recognition of marriage among same-sex couples
No statewide recognition of partner health insurance benefits
Same-sex partners treated as legal strangers in medical
decision making
Medical leave under the Family and Medical Leave Act
24. Homophobia and Transphobia in
the Healthcare System
Individuals in the LGBT community are less likely to seek
treatment and preventative care due to stigma and
discrimination faced in healthcare settings
Less likely to regularly seek care from the same provider;
more likely to seek care in the emergency room
LGBT individuals are more likely to be:
Refused care
Denied insurance coverage
Face harassment and unequal treatment
Experience blaming of ones orientation or gender identity for
the cause of an illness
25. Homophobia and Transphobia
effects on the Healthcare System
LGBT-specific or gender-specific health issues may not
be addressed competently or at all
Physicians uncomfortable with sexuality issues
Only 11 to 37 percent take sexual history on new adult patients
Stigma compounded
Only 18 to 49 percent disclose sexual orientation to physician
26. Homophobia and Transphobia
effects on the Healthcare System
Most health professionals have not undergone any
LGBT-inclusive culturally competency training
More than 2/3 of health care organizations offering
cultural competency trainings on LGBT issues do not
require physicians to attend
The average medical student spends about 5 hours
learning about LGBT issues, the majority of which is
focused on HIV/AIDS
27. Issues for Adolescents
Suicide and Depression
Leading cause of death in questioning/gay males
LGBT youths that experience family rejection are 8 times
more likely to attempt suicide than LGBT peers not
experiencing family reject
“Rites of Passage” denial
Stifles normal social development
Violence
Average HS student hears 25.5 anti-gay slurs daily
58% of homeless LGBT youths reported being sexually
assaulted compared to 33% of homeless non-LGBT youths
28. Issues for Adolescents
Most Important Problems
Identified by Non-LGBT Youth
1. Class/exams/grades (25%)
2. College/career (14%)
3. Financial pressures related to
college or job (11%)
Most Important Problems
Identified by LGBT Youth
1. Non-accepting families (26%)
2. School bullying problems (21%)
3. Fear of being out or open (18%)
Human Rights Campaign, “Growing Up LGBT in America:
HRC Youth Survey Report Key Findings,” HRC, June 2012.
29. Health Issues for Women
In the United States there are an estimated 6 -11
million lesbians that:
Access health care less frequently than heterosexual
women
Are less likely to receive routine gynecological exams
Have an increased risk of cancers, tobacco use, sexually
transmitted disease, chronic diseases
31. Health Issues for Men
In the United States there an estimated 9 –18 million
gay men that:
Access health care less frequently than heterosexual
men
Have an increased risk of HIV, sexually transmitted
disease, tobacco use, cancers (anal cancers and
colorectal cancers)
17 to 20 times more likely to develop anal cancer, which has
been linked to HPV
Anal pap screening is rare
May have an increased prevalence of anorexia and
bulimia
32. Health Issues for Transgender
Persons
Many barriers to healthcare for transgender
individuals
More likely to live in poverty and not access or delay care
and treatment because of costs
More likely to be refused care in the healthcare setting
Barriers to insurance coverage exist in Medicare,
Medicaid, private insurance and veterans’ health care.
Deny coverage on gender-specific routine care
Not cover transition surgery or transition-related care
33. Health Issues for Transgender
Persons
Transgender individuals experience lower rates of cancer
screenings, particularly for cancer in reproductive organs
May be not be given or refused screenings or treatment specific
to reproductive organs
MTF Transsexuals
Prostate cancer - prostate gland not removed
High risk of HIV and STDs
FTM Transsexuals
Breast cancer - risk still present though breast reduction surgery was
performed
Ovarian cancer - ovaries may not have been removed
Cervical Cancer - cervix may still be present
35. Intersection of Racial and LGBT
Inequities
Inequities are compounded for racial minorities in the
LGBT community
Possible cultural aspects impact family support
36. National HIV/AIDS Strategy
The United States will become a
place where new HIV infections
are rare and when they do occur,
every person, regardless of age,
gender, race/ethnicity, sexual
orientation, gender identity or
socio-economic circumstance,
will have unfettered access to high
quality, life-extending care, free
from stigma and discrimination.
37. What Does It Take…….
Commitment to social justice
Ability to collect and use data to demonstrate racial
inequities in health
Willingness to ask questions and listen to answers
Tools for understanding and assessing how racism is
manifested
38. What Does It Take…….
Ability to shift from a focus on individual personal
health behaviors to a focus on institutions and systems
(requires “training” and “skill building”)
Community leadership/coalitions addressing racism
Desire to work “across issues”
Willingness to shift existing resources to support anti-
racism work
Editor's Notes
Health inequities can be defined as differences in health status or in the distribution of health determinants between different population groups. For example, differences in mobility between elderly people and younger populations or differences in mortality rates between people from different social classes. It is important to distinguish between inequality in health and inequity. Some health inequalities are attributable to biological variations or free choice and others are attributable to the external environment and conditions mainly outside the control of the individuals concerned. In the first case it may be impossible or ethically or ideologically unacceptable to change the health determinants and so the health inequalities are unavoidable. In the second, the uneven distribution may be unnecessary and avoidable as well as unjust and unfair, so that the resulting health inequalities also lead to inequity in health.
For most of the 15 leading causes of death
including heart disease, cancer, stroke, diabetes, kidney
disease, hypertension, liver cirrhosis and homicide, African
Americans (or blacks) have higher death rates than whites
(Kung et al. 2008). These elevated death rates exist across
the life-course with African Americans and American
Indians having higher age-specific mortality rates than
whites from birth through the retirement years (Williams
2005). Other data indicate that almost 100,000 black persons
die prematurely each year who would not die if therewere no racial inequities in health (Levine et al. 2001).
For some health outcomes, the inequities are
worsening. Trend data for heart disease and cancer—the
two leading causes of death in the United States—indicate
that blacks and whites had comparable death rates for these
conditions in 1950, but African Americans now have
higher mortality rates than whites05; NCHS 2007).
Research also reveals that pathogenic factors linked to
race continue to affect health even when socioeconomic
status (SES) is controlled. In national data there are
residual racial differences in health at every level of SES
for multiple indicators of health status, including self-rated
health, heart disease mortality, hypertension and obesity
(Pamuk et al. 1998). This pattern exists for a broad range
of other outcomes. A striking example comes from national
data on infant mortality by mothers’ education for all
women age 20 years and older. African American women
with a college degree or more education have a higher rate
of infant mortality than white, Hispanic (or Latino), and
Asian and Pacific Islander women who have not completed
high school (Pamuk et al. 1998). Further evidence of the
markedly elevated disease risk for African Americans
comes from national data on chronic disease risk factors for
blacks, whites and Hispanics age 40 and over (Crimmins
et al. 2007). This study assessed indicators of blood pressure
risk (systolic, diastolic, and pulse rate), inflammation
risk (C-reactive protein, fibrinogen, albumin) and metabolic
risk (total cholesterol, HDL cholesterol, BMI and
glycated hemoglobin). A summary indicator of total risk
counted how many of these 10 risk factors were outside of
the normal range. This study found that even after adjustment
for income, education, gender and age, blacks had
higher scores on blood pressure, inflammation, and total
risk. Importantly, blacks maintained a higher risk profile
even after adjusting for health behaviors (smoking, poor
diet, physical activity and access to care).
Racial inequities in LA are even more extreme than in other parts of the US. This is true for the South. Of the 8 grantees selected for the CAPUS grant seven were from the South. The CDC and other federal agencies have made it a priority to allocate more funding for the South than other parts of the US—in regards to HIV prevention and treatment
The authors conclude: "This is a preliminary report of an association between racial discrimination and oxidative stress. It is a first step to understanding whether there is a relationship between the two. Our findings suggest that there may be identifiable cellular pathways by which racial discrimination amplifies cardiovascular and other age-related disease risks. If increased red blood cell oxidative stress is associated with experiencing racial discrimination in African Americans, this could be one reason that many age-associated chronic disease have a higher prevalence in this group."
*Oxidative stress is the process by which free radicals, or reactive oxygen species, damage cellular components including DNA, proteins and lipids.
Can accelerate cellular aging, telomere shortening in response to life stress (Epel, 2006)
Telomeres essential for protecting chromosome ends—marker for longevity and cellular health
“Nurture’s impact on nature”
Carol Greider at John Hopkins, “When the telomere gets to be very short there are consequences and an increased risk of age-related ailments.”
Positive behaviors can stave off telomere erosion.
A German study showed that people in their 40s and 50s had telomeres about 40% shorter than people in their 20s if they were sedentary, but only 10% shorter if they were dedicated runners.
Werner, C; Furster T, Widmann, T, et al. Physical Exercise Prevents Cellular Senescence in Circulating Leukocytes and in the Vessel Wall Circulation. 2009; 120: 2438-2447.
In a study of over 4800 residents of Maastricht who screened negative for mental illness and paranoid traits at baseline, those who said that they had suffered from discrimination/racism were twice as likely to develop psychotic symptoms in the following three years.10
There is still not a well understood mechanism of action, racism is difficult to quantify and measure, Thus whether for political or analytical expediency researchers tend to avoid studying direct influences of racism on health in favor of indirect pathwaysFor example, is the poorer response to antihypertensive treatment in African-Caribbeans due to biology or is it a reflection of the role of perceived racism in its development and persistence? Investigation of racism's pathophysiological, cognitive, or psychophysiological correlates may offer new avenues for treatment and more efficacious management. Developing a deeper understanding of possible links between racism and health is a prerequisite for initiatives to decrease impact at a community and individual level.
Disparity in clinical care persists among older LGBT adults age 65 and above, despite universal availability of similar care through Medicare
Important for providing a safe space for disclosing one’s sexual orientation and gender identity. Also important for reducing personal biases and providing equal level of care and treatment.
Suicide and Depression
Suicide is a leading cause of death, especially of questioning/gay male adolescents - physicians are urged to consider sexual orientation as a risk factor.
Nearly one third of all adolescent male suicide attempts are linked to a crisis over sexual orientation.
LGBT Youth are denied many “Rites of Passage” unique to Adolescence
“Rites of Passage” unique to adolescence include:
o Classroom romances, first date, first kiss, Senior Prom
o No role models or relationship models to identify with
o Lack of healthy outlets for sexual exploration/experimentation
Failure to experience these activities stifles the normal Social Development of LGBT Youth.
Violence against Youth is frequent and has significant impact
Average High School student hears 25.5 Anti-Gay Slurs each day.
1 in 3 LGBT Youth in a Chicago had an object thrown at them and 1 in 5 had been kicked, punched, or beaten because of their Sexual Orientation.
Seattle study found LGBT Youth were 6 times more likely to be targets of offensive comments or attacks and 3 times more likely to be injured in a fight.
Significant number of victims of Anti-Gay Violence are actually Straight.
Evidence for a greater incidence of
Breast cancer
Cervical cancer
Cancers due to HPV
Lung cancer
Lesbians have double to triple the risk compared to heterosexual women
Greater prevalence of risk factors (obesity, alcohol consumption, nulliparity, lower screening rates)
Stated risk factors aren’t exclusive to lesbians, but the possible concentration of risks within a single group is unique
Individuals don’t know their risk is higher
In one study, the average time between pap smears for:
Heterosexual women was 8 months
Lesbian women was 21 months
Lower screening rates may result in later detection, increasing morbidity and mortality
Lower incidence of birth control pill use
BC decreases risk of ovarian cancer
Documented higher rates of smoking for LGBT populations - especially adolescents & those with lower SES
Probable increased exposure to second hand smoke – smoking is cultural norm in many LGBT social settings (bars, dance clubs, youth centers)
Known to be transmitted between women
Human papillomavirus
Can result in tissue changes leading to cervical cancer
Bacterial vaginosis
Candidasis
Trichimonas
Lesbians – more likely to be overweight/obese; higher BMI, more smokers, lower preventive health care visits increase risk of heart disease, diabetes, and cancer
Assessing CVD risk
Study compared lesbian women to heterosexual sisters
Ages 40 and up
Findings in lesbian women
Higher BMI
Greater waist circumference
Larger waist-to-hip ratio
More likely to have ever smoked
More likely to have weight cycling history
2001 Harvard study of 122 men - 14% gay men suffer from bulimia; 22% from anorexia; social pressure to conform to physical ideals is common
Cancers due to HIV/AIDS
Kaposi’s sarcoma
Non-Hodgkin’s lymphoma
Anal cancer
Hodgkin’s disease
Known to be transmitted between men
HIV/AIDS
Hepatitis A and B Virus
Gonorrhea
Syphilis
Chlamydia
Human Papilloma Virus
Gay men – subfactor group “Bears” more likely to be overweight/obese
As noted by President Barack Obama, the vision for the National HIV/AIDS Strategy
In order for our country to “become a place where new HIV infections are rare” we must ensure that every person has “unfettered access to high quality, life-extending care, free from stigma and discrimination.“
It is with those marching orders that we move forward our stigma work at NASTAD and NCSD.