Minority Health and Health Disparities

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Minority Healthand Health Disparities
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Objectives

• List some populations that might require the
  health educator to prepare material differently
  for presentation
• Describe ethnic and racial disparities in
  selected areas of health
• Describe the extent of research related to health
  and minority populations.
• Explain the research concerns and difficulties in
  studying minority health.
• Describe the legacy of suspicion and concern
  among ethnic and racial minorities in the wake of
  the Tuskegee study.

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Factors That Affect the Health of a Community
Physical Factors
Social/Cultural factors
Health of The Community
Community organization
Individual behaviors
Source McKenzie, Pinger, Kotecki (2006)
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How do we approach a community?
What you see is not what you get!
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Culture
Past - Present Culture changes everyday
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Navigational Tool?
Cultural Competency
Who's more diverse?
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Diversity
External Internal
Gender
Race
region of origin
SES
Color
Ethnicity
politics
Ability
language
resident status
sexual orientation
Class
Experience
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Health practices - Smoking - Alcohol -
Nutrition
Race Health
Biological
Cultural
Psychosocial stress - Smoking - Alcohol -
Nutrition
Socioeconomic
Environmental stress - Residential -
Occupational
Biological processes
Race
Racism
Political
Health outcomes
Psychosocial resources - Social ties -
Perceptions of control - Coping patterns
Historical
Medical care - Need - Access - Quality
Legal
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Overview of Diversity

• The strength and greatness of America lies in the
  diversity of its people
• melting pot
• 1997 President Clinton
• One America in the 21st Century

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U.S. Population 2000
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U.S. Population 2050 projected
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Racial and Ethnic Classifications

• U. S Office of Management and Budget
• operationalize race and ethnicity
• Five racial categories
• White
• African American
• American Indian, Eskimo
• Asian, Pacific Islander
• Hispanic

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Six Health Areas

• Infant mortality
• Cancer Screening and Management
• Cardiovascular Disease
• Diabetes
• HIV Infections/AIDS
• Child and Adult Immunization

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Documents

• Healthy People 2010
• Initiative to Eliminate Racial and Ethnic
  Minorities in Health
• 2/21/98 Clinton declared that by the year 2010
  the US would eliminate the disparities in six
  health areas experienced by racial and ethnic
  minority populations by
• prevent disease
• promote health
• delivering care to racial and ethnic minority
  communities

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(No Transcript)
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Health data sources and their limitations

• Gaps in the information system
• bias analysis
• self-reported data
• reliability

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Refugees New Immigrants

• Refugees a person who flees one area or country
  to seek shelter or protection from danger is
  another
• Immigrants individuals who migrate from one
  country to another for the purpose of seeking
  permanent residence
• Aliens a person born in and owing allegiance to
  a country other than the one in which he/she
  lives
• Illegal aliens an individual who entered this
  country without permission
• Special Concerns
• poor
• lower levels of education
• few work skills
• serious health problems

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Socioeconomic Status Racial and Ethnic
Disparities in Health

• Indirect causal associations
• level of education
• level of income
• poverty
• Group living circumstances

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Community Health Strategies for Achieving Equity
in Minority Health

• Cultural Competence
• A set of congruent behaviors, attitudes, and
  policies that come together in a system, agency,
  or among professionals that enables effective
  work in cross cultural situations.
• Empowering the Self and the Community
• social power
• political power
• psychological power

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President Clinton recounted the injustice done to
the study participants and concluded, "what was
done cannot be undone but we can end the silence.
We can stop turning our heads away. We can look
at you in the eye, and finally say, on behalf of
the American people, what the United States
government did was shameful and I am sorry.
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Tuskegee Syphilis Study

• Research study from 1932-1972
• United States Public Health Service
• African American Community
• 399 Black men late stages of syphilis
• Study the testing and treatment of syphilis in 5
  rural counties in the south
• They were never told what disease they were
  suffering from or of its seriousness

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Research

• Informed that they were being treated for bad
  blood
• PHS had no intention of curing them of syphilis
• Data for the experiment was to be collected from
  autopsies of the men
• Died from tumors, heart disease, paralysis,
  blindness, insanity, and death

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Tuskegee cont

• Five counties
• Albemarle County, Va
• Glynn County, GA
• Pitt County, NC
• Macon County, AL
• Tipton County, TN

We have no further interest in these patients
until they die.
PHS Physician
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Tuskegee cont

• By the end of the experiment, 28 of the men had
  died directly of syphilis, 100 were dead of
  related complications, 40 of their wives had been
  infected, and 19 of their children had been born
  with congenital syphilis.

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Textbook Approach

• Black institutions cooperated
• Black churches added credibility
• Black community leaders ensured participation

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Tuskegee Summary

• Treatment was not provided
• Education was not provided
• Referred to as bad blood
• Persons were not told that the disease was a STD
  or that infants could be born infected
• WWII 1941 these men were not drafted
• 1943 penicillin was being used to treat syphilis
• This treatment was withheld from the men in the
  study (treatment would end the study)

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Tuskegee

• The study continued until 1972
• The Washington Star broke the story

In 1972, news anchor Harry Reasoner described it
as an experiment that used human beings as
laboratory animals in a long and inefficient
study of how long it takes syphilis to kill
someone.
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Tuskegee

• In a White House ceremony 5/16/97 Clinton
  apologized for the 40-year government study
• Only eight survivors of the Tuskegee experiment
  were still alive
• Five attended the ceremony accompanied by family
  members of some of the deceased

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Implications of the Study

• What are the implications of the Tuskegee study
  for health educators?
• What can we learn from this obviously inhumane
  and unethical research?
• Is there a connection between the Tuskegee study
  and the current AIDS epidemic?

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Cultural Competency

• Develop better access to services by hiring
  bilingual and bicultural staff members.
• Tailor interventions by learning about other
  cultures.
• Modify services by integrating traditional
  medicine with Western medicine.
• Develop a specialized program model

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Strategies for Diverse Cultures

• Channel efforts through minority communities
• Tailor health messages
• Involve family, churches, employers and other
  community organizations
• Provide culturally sensitive materials to reduce
  language barriers, cultural differences, etc.
• Assess suitability of existing materials
• Develop minority support networks, clubs, etc.

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Points To Consider Before Presenting

• What is the precise mix of the class or audience?
• Find out more about the demographics of the
  group. Where do they live urban, suburban,
  rural?
• Educational level?
• SES level?
• Language proficiency of classes/groups?
• Immigrant who speak little English?
• Translator needed?
• Any health problems?

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References

• Gilbert, G.G., Sawyer, R.G. (2000). Health
  education Creating strategies for school and
  community health (2nd ed.) Boston Jones and
  Bartlett.
• McKenzie, J.F., Pinger, R.R., Kotecki, J.E.
  (2005). An introduction to community health
  (5th ed.) Boston Jones and Bartlett.
• http//www.cdc.gov/hiv/topics/surveillance/resourc
  es/slides/race-ethnicity/index.htm
• http//www.omhrc.gov/