SOC

1. Chapter 2Chapter 2
Systematic Attention to HealthSystematic Attention to Health
Care DisparitiesCare Disparities

2.  To appreciate the difference between health care disparities
that are inequitable and those that are not
 To become familiar with the data and data sources for
describing health care disparities
 To become aware of the different roles played by the public,
private, and philanthropic sectors as they pertain to reducing
health care disparities
 To understand how legislation, accreditation, and advocacy
are mobilizing action to reduce disparities
 To understand how data, evidence-based health care, cultural
competence, and comparative effectiveness research are all
part of a systems approach to reducing disparities
 To become familiar with how a variety of health care
organizations are systematically addressing disparities
Chapter ObjectivesChapter Objectives

3. The National Institutes of Health (2000)
defines health care disparities as
“differences in the incidence, prevalence,
mortality, and burden of diseases and other
health conditions that exist among several
populations in the United States” (p. 4).
Review from Chapter 1Review from Chapter 1

4.  Definition - Study of the onset, course,
outcomes, incidence, and prevalence of
diseases and disorders in populations.
 Epidemiological studies provide data for
determining disparities in health care.
 Sources of disparities – biological,
environmental, social, idiosyncratic
EpidemiologyEpidemiology

5.  Biological – gender differences, natural aging
process, genetic risk for disease/disorders across
ethnic and racial groups (unavoidable
differences)
 Environmental-pollution, toxic exposure
 Social-crowding, stress violence
 Idiosyncratic-lifestyle, dietary, religious
practices, cultural practices and personal choice
Interacting Variables that Produce HealthInteracting Variables that Produce Health
Care DisparitiesCare Disparities

6.  Differences become disparities when the
effect on health care is ignored or not
considered in health care delivery to
specific groups
DisparitiesDisparities

7.  Differences in health access and status that are
the result of discrimination, neglect, or
socioeconomic discrimination
 Largest health disparity (inequitable) –
interaction between socioeconomic class, race,
and ethnicity
 Other disparities include those associated with
gender, LGBT, age
Inequitable DisparitiesInequitable Disparities

8.  Equitable health care – “care that does not
vary in quality be personal characteristics
such as ethnicity, gender, geographic
location and socioeconomic status”
(Disparity Solutions Center, 2010, p. 6)
Equitable Health CareEquitable Health Care

10.  In health issues, broad categories (e.g.
Hispanic/Latino) encompass subgroups
with significantly different health issues
 National figures are less useful at the local
level, where health care is delivered
 New data standards from OMH (Table
2.2) permit study of more granular
categories
Race and Ethnic Disparities in HealthRace and Ethnic Disparities in Health
StatusStatus

12.  Agency for Health Care Quality and Research (AHRQ)
 Centers for Medicaid and Medicare Services (CMS)
 Centers for Disease Control (CDC)
 Institute of Medicine (IOM)
 Kaiser Family Foundation
 National Institutes of Health (NIH)
 National Center for Health Statistics (NCHS)
 Office of Minority Health (OMH)
 Society for Women’s Health Research
 US Census Bureau
Common Sources of Health Care DisparitiesCommon Sources of Health Care Disparities
DataData

13. Health Status Differences Across Racial andHealth Status Differences Across Racial and
Ethnic GroupsEthnic Groups
 Asian Americans
 Whites
 Hispanics
 American Indians/Alaska Natives
 African Americans

14.  Greater incidence of diabetes, congestive
heart failure (CHF), obesity, HIV
 Lowest life expectancy
 Highest age-adjusted death rates
 Highest death rates from heart disease,
stroke, cancer, influenza, diabetes,
pneumonia, and HIV
Health Issues for African AmericansHealth Issues for African Americans

15. Preventive Services:
• Prenatal care
• Flu and pneumonia vaccines
• Women’s health screenings (Pap tests)
• Cancer screenings
• Mental health services – language barriers are
particularly problematic
Other Health Status DisparitiesOther Health Status Disparities

16.  Social determinants of health – socioeconomic situations of
persons and where they live and work strongly influence
health status
 Risk for mortality, morbidity, limited access to care, and
inferior quality of care increases with decreasing
socioeconomic level
 Health insurance inequities – lack of funds for private
insurance, lower quality care, less preventive care
 No medical home translates into fragmented health care
that lacks continuity
 The Patient Protection and Affordable Care Act of 2010 –
unique opportunity to reduce disparities
Socioeconomic Sources – Racial andSocioeconomic Sources – Racial and
Ethnic DifferencesEthnic Differences

17.  Health care disparities are seen as both an
economic and quality of care issue
 Many agencies charged with developing
strategies to reduce ethnic and racial disparities
with little progress in the past decade
 National Institute on Minority Health and
Health Disparities (2010) – responsibility for
planning, coordinating, and evaluation of all
disparities research activities conducted by NIH.
Racial and Ethnic Disparities – NationalRacial and Ethnic Disparities – National
AttentionAttention

18.  Biochemical differences are found at the
system, organ, tissue, cellular and
subcellular levels
 Major differences in disease incidence and
symptoms, i.e. heart disease/stroke
 Reproductive system
 Access issues
Disparities Across Other DimensionsDisparities Across Other Dimensions
- Gender- Gender

19.  Social stigma
 Paucity of research data, except in sexual
behavior and IV drug use (HIV/AIDS) –
demographic information still not being
collected
 Health status and risk factors differ in
lesbian, gay and bisexual adults
Disparities Across Other Dimensions –Disparities Across Other Dimensions –
Sexual OrientationSexual Orientation

20.  Increased life expectancy – US population
> 65 will double by 2033
 Chronic health conditions – heart
diseases, malignant neoplasms,
cerebrovascular disease, COPD, diabetes,
Alzheimer’s
 Continuity of care, research, prevention
Disparities Across Other DimensionsDisparities Across Other Dimensions
- Age- Age

21.  US lost $1.24 trillion between 2003-06
through disparities in minority care (The
Joint Center for Political and Economic
Studies)
 Minority populations are increasing faster
than whites in US
Stakeholder AttentionStakeholder Attention

22.  Growing awareness but limited
commitment of resources
 Disjointed leadership with plans to reduce
disparities diffuse and efforts fragmented
 Absence of key stakeholders such as
consumers and communities from the
discussion
Disparities Reduction Activities – ThemesDisparities Reduction Activities – Themes
(NCQA, 2011)(NCQA, 2011)

23.  Develop a sound evidence base –
systematic entry of racial and ethnic data
 Evaluation of a patient’s quality of care by
race and ethnicity
 Collection of race, ethnicity, language, and
sexual orientation data can measure
trends, health care delivery, needs,
interventions, and quality of care
Data CollectionData Collection

24. Using a systems approach:
1.Altering the structure of health care
systems;
2.Changing the way health care is delivered;
3.Training health care personnel in culturally
competent care;
4.Measuring results of these interventions.
How Can Disparities Be Reduced?How Can Disparities Be Reduced?

25.  Comparative effectiveness research
 Demographic data sets
 Epidemiology
 Evidence-based medicine
 Genetic risk
 HEDIS – Health Care Effectiveness Data and Information Set
 Inequitable health care disparities
 Outcome measures
 Patient Protection and Affordable Care Act of 2010
 Social determinants of health
Key TermsKey Terms