UNC 7th Annual Summer Public Health Research Institute on Minority Health

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UNC 7th Annual Summer Public Health Research
Instituteon Minority Health
Current Needs and Current Issues in Minority
Health Research
Chapel Hill, NC June 18, 2001
William D. Hobson, MSDeputy Associate
Administrator,Bureau of Primary Health Care
The People We AreThe People We Serve
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Need for Minority Health Research

• Increasing growth rate of racial/ethnic
  minoritiesin the U.S. population
• Poorer health status of some racial/ethnic
  minority populations
• Increasing percentage of racial/ethnic
  minoritiesof the U.S. population
• Poorer health care outcomes of some racial/ethnic
  minorities
• Some of the factors contributing to the poor
  health statusand poor health care outcomes of
  racial/ethnic minorities are not well understood

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General Indicators of Disparate Health Status

• Higher rates of morbidity and mortality
  forAfrican Americans
• Native Americans and Hispanics have worse health
  outcomes than the total population
• Some Asian/Pacific Islander subgroups havevery
  poor health status outcomes

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Health Disparities
A Key Indicator of the Need for Research in
Minority Health
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HRSA/BPHC Working Definition of a Health
Disparity
A population-specific difference in the presence
of disease, health outcomes, or access to care.
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Bases of Health Disparities

• Differences in Economic Condition
• Differences in Education
• Differences in Other Social Conditions
• Differences in Environment (Work/Neighborhood/Home
  )
• Genetic Differences

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Emerging Research Topics Requiring Further Study

• The Provision of Less Optimal Care
• Racial Ethnic Variations in Response to
  Medical Treatment

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Historic Concept of Race in Health Care Research
Is Based on Several Flawed Genetic Assumptions

• That race is a valid biologic category
• That genes determining race are linked to those
  determining health
• That the health of a population is largely
  determined by the biologic composition of the
  population

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Alternative Multidimensional Concept of Race Is
Based onA Socially Constructed Taxonomy

• That reflects cultural determinants
• That reflects socioeconomic determinants
• That reflects Legal determinants
• That reflects political determinants
• That reflects biologic determinants

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Intermediary Factors ProcessesEffecting Health
of Minorities

• Health Practices
• Psychosocial stresses
• Environmental Stresses
• Psychosocial resources
• Access to medical care

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Assumptions Regarding the Statistical Validity
of Racial/Ethnic Data

• That racial and ethnic categories and group
  designations are both consistently defined and
  consistently ascertained
• That the categories and designations are
  understood by the populations questioned
• That the survey enumeration, participation, and
  response rates are high and similar for all
  populations
• That the responses of persons are consistent in
  different data sources and at different times

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Minority Health Issues
Issues of Access

• Economic
• Geographic
• Cultural
• Linguistic
• Social

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Minority Health Issues (cont.)
Issues of Health status

• Infant mortality
• Low-weight births
• Chronic disease incidence rates
• Communicable disease incidence rates

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Minority Health Issues (cont.)
Issues of Patient Care Quality

• Evidence-based medicine
• Cultural competence
• Awareness of the patients environment (home
  work)
• Disparities in treatment (provision of
  less-optimal care)
• Disparities in patient care outcomes
• Differential response to pharmaceuticals
• Racial and ethnic variations in response to
  treatment
• Improving patient education
• Changing clinician behavior

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Minority Health Issues (cont.)
Issues of Genetics

• Predisposition associated with race/ethnicity
• Protective factors associated with
  race/ethnicity

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Minority Health Issues (cont.)
Issues of Prevention

• Analysis of traditional approaches (What works
  what doesnt?)
• Analysis of current innovations
• Design and testing of new approaches

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Minority Health Issues (cont.)
Issues of Health/Human Services Integration

• Analysis of traditional approaches (What works
  what doesnt?)
• Analysis of current innovations
• Design and testing of new approaches

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Minority Health Issues (cont.)
Issues of Health Care Policy

• Effect of various market pressures on services
  to minorities
• Effects of changes in the health care
  marketplace on minorities
• Benefits shortcomings of health insurance on
  health care access and health status
• Health care financing for the poor and
  underserved
• Safety net providers

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Minority Health Issues (cont.)

• Issues of Cultural Competence
• Assessment of the association between
  culturalcompetence and improvement in health
  outcomes
• Cost benefit analysis of culturally competent
  servicesin ambulatory health care settings
• Evaluation of the effectiveness of cultural
  competence curricula in health professions
  school
• Assessment of community-based education as a tool
  to teach cultural competence
• Does provider-patient racial or ethnic
  concordance improve patient satisfaction?

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Minority Health Research Challenges

• Some members of racial and ethnic minority groups
  shun participation in research studies because of
  historical mistrust due to past experiences with
  racism, bias or exploitation in health care
  delivery and past health research.
• Some racial and ethnic minorities feel that their
  groups have not benefited from their
  participation in past research.
• Differing values and social, cultural, religious
  and spiritual beliefs related to health may
  inhibit certain groups from participating in
  research protocols or studies.

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Minority Health Research Challenges (cont.)

• Members of diverse racial and ethnic groups that
  are fairly new to this country may neither be
  accustomed nor willing to participate in research
  conducted according to traditional U.S.
  methodologies.
• Many faculty within institutions of higher
  education neither use nor teach research
  methodologies that are culturally competent and
  use participatory action.
• Funders of research have been slow to require
  principles of cultural competence, participatory
  action research designs and advocacy-oriented
  approaches in grants and contracts they support.
• There is a need for research to validate the
  efficacy of culturally and linguistically
  competent approaches to health care delivery.

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In summary there is no shortage of need for
minority health research andcertainly no
shortage of research issuesthat are pertinent to
and vital for racial andethnic minority
populations and researchers.
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The People We AreThe People We Serve