Health Disparities in Arizona

1
Health Disparities in Arizona
Zipatly Mendoza, Arizona Health Disparities
Center Janey Pearl, ADHS PIO, Human Relations
CommissionRJ Shannon, ADHS HIV/STD/Hep C Program
Arizona Health Disparities Center www.azminorityh
ealth.gov
2
Health Disparities

• What are they?
• What do they look like for us?
• What causes them?
• What are we doing about it?

3
Is it fair that

• Poor people die younger than rich people?
• Lower social class infants have lower birth
  weight outcomes?
• Working poor are not able to afford health
  insurance?
• Minority groups repeatedly score worse on various
  health rankings?

Source Measuring Health Disparities Center for
Social Epidemiology and Population University of
Michigan, 2003.
4
Health Disparities

• Differences in health outcomes exist among
  specific population groups
• Occurrence of disease
• Number of cases of disease
• Burden of disease
• Death rates

Source National Institutes of Health (NIH)
Strategic Plan to Reduce and Ultimately Eliminate
Health Disparities, 2001.
5
Arizona Population by Race and Ethnicity
Source Differences in the Health Status Among
Race/Ethnic Groups, Arizona 2005. Bureau of
Public Health Statistics, ADHS.
6
Arizona Tribal Nations

• Pascua Yaqui
• Quechan
• Salt River
• San Carlos
• San Juan Southern Paiute
• Tohono Oodham
• Tonto Apache
• White Mountain Apache
• Yavapai Apache
• Yavapai Prescott
• Zuni

• Ak-Chin
• Cocopah
• Colorado River Indian Tribe
• Ft. McDowell
• Ft. Mojave
• Gila River
• Havasupai
• Hopi
• Hualapai
• Kaibab Paiute
• Navajo Nation

7
Languages Spoken at Home

• Source 2006 American Community Survey, US Census
  Bureau.

8
Who do health disparities affect?

• Us!
• Arizona Communities
• Businesses, schools, churches, etc.
• Health care systems
• Hospitals, clinics, insurance co., etc.
• Arizona Economy
• Prevention vs. cost of treatment

9
Why do health disparities exist?

• Social Determinants of Health
• Systems of Care
• Historical Factors

10
What are Social Determinants?
Community conditions that have an effect on a
persons health

• Early childhood care
• Proper development is crucial during early years
• Education
• Low income schools often lack resources
• Food security
• Access to healthy, nutritional food
• Housing
• Access to safe housing, free from harmful
  substances

11
Social Determinants (cont.)

• Income inequality
• More higher incomes, higher poverty rates ?
  bigger gap
• Social inclusion and exclusion
• Geographical differences between classes ?
  resources
• Employment and job security
• High unemployment, More part-time employees ?
  lack of insurance/benefits
• Working conditions
• Hazards, environment, stress

12
Social Determinants of Health
POVERTY

VIOLENCE
13
What are we talking about?

• Meet Jason.
• He is currently in the hospital.
• Why is Jason in the hospital?
• Because he has a bad infection in his leg.
• But why does he have an infection?
• Because he has a cut on his leg and it got
  infected.
• But why does he have a cut on his leg?
• Because he was playing in the junk yard next to
  his apartment building where there was some
  sharp, jagged steel that he fell on.
• But why was he playing in a junk yard?

14

• Because in his neighborhood there is nowhere
  else for kids to play, and parents are
  at work so there is no one to
  supervise them.
• But why does he live in that neighborhood?
• Because his parents can't afford another place
  to live.
• But why can't his parents afford another place
  to live?
• Because his Dad doesnt make much money and his
  Mom is sick.
• But why doesnt his Dad make much money?
• Because he doesnt have much education, and
  hasnt been able to find another job.
• But why ...?
• Source Toward a Healthy Future Second
  Report on the Health of Canadians. Found on
  http//www.phac- aspc.gc.ca/ph-sp/phdd/determinant
  s/index.htmldeterminants

15
Systems of care
16

• "Health inequalities are produced by the
  clustering of disadvantage - in opportunity,
  material circumstance, and behaviors related to
  health across people's lives."
• Shaw M., Darling D., Gordon D. and Davey Smith G.
  (1999). The Widening Gap Health Inequalities and
  Policy in Britain. Bristol The Policy Press.

17
History

• Discrimination
• Barriers
• Trust
• Cultural/Family norms
• Cultural beliefs
• Communication within families
• Your genes load the gun
• .but your lifestyle pulls the trigger!
• -Grant Jones

18
Health Rankings
Number of Times Each Group Ranked Better
Than Average, Average, and Worse Than Average on
70 Indicators, Arizona, 2005



56
5
9
Asian
Better than average
White non-Hispanic
46
9
15
Average
Worse than average
18
27
25
Hispanic
15
16
39
American Indian
African American
8
14
48
Source Differences in the Health Status by
Race/Ethnic Groups. Bureau of Public Health
Statistics, ADHS 2005
19
Top 5 Causes of Death in AZ

• 1. Diseases of the Heart
• 2. Cancer
• 3. Accidents (Unintentional injury)
• 4. Chronic lower respiratory diseases
• 5. Stroke, Alzheimer's, Dementia
  (Cerebrovascular)

20
Top 5 Causes of Death by Ethnicity
21
This is a social justice issue !
22
Cardiovascular Disease
Number of deaths per 100,000 population
(age-adjusted to the 2000 standard)
Source Differences in the Health Status by
Race/Ethnic Groups. Bureau of Public Health
Statistics, ADHS 2005
23
Cancer
Number of deaths per 100,000 population
(age-adjusted to the 2000 standard)
Source Differences in the Health Status by
Race/Ethnic Groups. Bureau of Public Health
Statistics, ADHS 2005
24
Cervical Cancer
Number of deaths per 100,000 population
(age-adjusted to the 2000 standard)
Source Differences in the Health Status by
Race/Ethnic Groups. Bureau of Public Health
Statistics, ADHS 2005
25
Colorectal Cancer
Number of deaths per 100,000 population
(age-adjusted to the 2000 standard)
Source Differences in the Health Status by
Race/Ethnic Groups. Bureau of Public Health
Statistics, ADHS 2005
26
Rates of HIV/AIDS
Number of reported cases per 100,000
(age-adjusted to the 2000 standard)
Source Differences in the Health Status by
Race/Ethnic Groups. Bureau of Public Health
Statistics, ADHS 2005
27
Rates of Early Syphilis
Number of reported cases per 100,000
(age-adjusted to the 2000 standard)
Source Differences in the Health Status by
Race/Ethnic Groups. Bureau of Public Health
Statistics, ADHS 2005
28
Rates of Gonorrhea
Number of reported cases per 100,000
(age-adjusted to the 2000 standard)
Source Differences in the Health Status by
Race/Ethnic Groups. Bureau of Public Health
Statistics, ADHS 2005
29
Rates of Chlamydia
Number of reported cases per 100,000
(age-adjusted to the 2000 standard)
Source Differences in the Health Status by
Race/Ethnic Groups. Bureau of Public Health
Statistics, ADHS 2005
30
What has to happen

• Systems level changes
• Coordination and leverage of resources and assets
• Enhanced research
• Interdisciplinary approaches to research, program
  implementation and campaigning
• Cultural Competency
• Health Literacy

31
What else has to happen

• Education about health disparities
• Organization of campaign and outreach events
• Share best practices and lessons learned
• Collaborate! Collaborate!! Collaborate!!!

32
Health Equity

• All individuals have the opportunity to achieve
  full potential through healthcare and disease
  prevention
• Fairness in health distribution, information,
  access to care, etc.

Source National Institutes of Health (NIH)
Strategic Plan to Reduce and Ultimately Eliminate
Health Disparities, 2001.
33
Systems of care
34
What YOU can do

• Pay attention to your health
• Get screened
• Seek out!
• Speak out!
• Help out!

35

• Next Faces of Diversity Brown Bag Lunch Series
• Noon to 1 p.m.
• Friday, July 25
• Phoenix City Council Chambers 200 W. Jefferson
  St.
• Join Us!

36
For More Information

• Zipatly Mendoza
• Mendozz_at_azdhs.gov
• Janey Pearl
• Pearlj_at_azdhs.gov
• RJ Shannon
• Shannor_at_azdhs.gov
• Arizona Department of Health Services
• www.azdhs.gov
• Arizona Health Disparities Center
• www.azminorityhealth.gov