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Eliminating Health Disparities


How typical is this type of condition in this community? ... medications, special instructions, and plans for follow-up care (Crane 1997) ... – PowerPoint PPT presentation

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Title: Eliminating Health Disparities

Eliminating Health Disparities
  • Michael A. Rodriguez, MD, MPH
  • Associate Professor
  • David Geffen School of Medicine at UCLA
  • May 10, 2006

Moving Forward
  • Advancements in biomedical sciences and medical

Public Interest
Public Health
Health Disparities in perspective
  • Identify risk factors
  • Quantify consequences
  • Discover and disseminate solutions

Daily ReportingBasic Questions
  • Who? Name, Age, Ethnicity, Gender
  • What? Type of condition, Outcome
  • When? Date
  • Where? Environment, House, Hospital
  • Why/How? What prompted the Incident

Daily ReportingAdditional Questions
  • Perspective What type of condition is this? How
    typical is this type of condition in this
  • Employment Education Do the people have jobs?
    How much does the individual earn? What level of
  • Environment How much does the environment
    contribute to the condition?
  • Health Costs How much do these preventable ER
    visits and hospitalizations cost?
  • Consequences to Family What happens to the
    families and homes of the individual?
  • Solutions What is being done to address this

  • Background
  • Contributing Factors
  • Efforts to Address

Health Disparities
  • Health disparities are differences in the
  • incidence, prevalence, mortality, and burden of
  • diseases and other adverse health conditions
  • that exist among specific population groups in
  • the United States

Institute of Medicine. Unequal Treatment
Confronting Racial and Ethnic Disparities in
Health Care, 2002
Racial/Ethnic Disparities in Virtually all Health
  • Premature mortality including infant mortality
  • Morbidity
  • Chronic disease (cancer, diabetes)
  • Communicable disease
  • Physiological risk factors
  • Hypertension
  • Obesity/overweight
  • Functional limitations and disability

Leading Health Disparities
  • Cardiovascular Disease
  • Cancer
  • Diabetes
  • Asthma
  • Mental Health

Institute of Medicine. Unequal Treatment
Confronting Racial and Ethnic Disparities in
Health Care, 2002.
  • Type 2 diabetes is more prevalent in Mexican
    Americans (13) than in non-Latino Whites (8)
    (Hertz et al.)
  • Latinos in the US are almost twice as likely to
    die from diabetes as compared to non-Latino
  • (Multicultural Medicine and Health Disparities,

Mental Health
  • Individuals with mental health illness have high
    co-morbidity and mortality rates
  • Over 26 of Latinos in Los Angeles over age 60
    reported major depression or dysphoria
  • (U.S. Department of Health and Human
    Services, 2001)
  • Latinos are less likely than Non Latino Whites to
    seek treatment for mental health.
    (Cooper-Patrick, 1999)

What causes these disparities in health?
Health Disparities
Social Determinants
Access To Care
Quality Of Care
What causes these disparities in health?
  • Social Determinants

Factors leading to disparitiesSocial
  • Low Levels of Education
  • Low Socioeconomic Status
  • Behavior and Environment

Social DeterminantsThe Latino Case Example
  • Education
  • Latino children have highest high school drop out
  • Environment
  • Latino children have greater exposure to
    pollutants, waste sites, pesticides, lead
  • 3 of 5 largest landfills in Latino AA
    communities (Kaiser Network)
  • Employment
  • Latinos are well represented in the workforce,
    but work in low wage and disproportionately
    higher risk jobs.

What causes these disparities in health?
  • Social Determinants
  • Access to Care

Health Insurance
  • Health insurance facilitates entry into the
    health care system
  • The uninsured are more likely to die early have
    poor health status because they are diagnosed at
    later disease states
  • Higher costs, poor outcomes, and greater
    disparities are observed among individuals
    without a usual source of care

Access to Care The Latino Case Example
  • 40 of Latinos under 65 are uninsured
    (National Health Care
    Disparities Report, 2005)
  • Latino children make up 29 of uninsured children
    (Flores et al., 2005)
  • One quarter of the nations uninsured are Latino
    (11 of 44 million Americans) (Goldstein,
  • Reasons include lack of employer-based health
    insurance and low income

What causes these disparities in health?
  • Social Determinants
  • Access to Care
  • Health Care

Racial/Ethnic Disparities inHealth Care
  • Within Medicare
  • Differential utilization based on race for
  • Mammography (Gornick et al.)
  • Amputations (Gornick et al.)
  • Influenza vaccination (Gornick et al.)
  • Lung Cancer Surgery (Bach et al.)
  • Renal Transplantation (Ayanian et al.)
  • Cardiac catheterization angioplasty (Harris et
    al, Ayanian et al.)
  • Coronary artery bypass graft (Peterson et al.)
  • Treatment of chest pain (Johnson et al.)
  • Referral to cardiology specialist care (Schulman
    et al.)
  • Pain management (Todd et al.)

Language Barriers
  • Quality of health care requires effective
    communication between patient and physician
  • Communication problems lead to lower patient
    adherence to medications and decreased
    participation in medical decision-making

Language Barriers
  • Spanish speakers are less likely to be discharged
    from the ER with an understanding of their
    medications, special instructions, and plans for
    follow-up care (Crane 1997)
  • Spanish-speaking Latinos are less likely to have
    physician visits, flu shots, or mammograms as
    compared to English-speaking Latinos or
    non-Latino Whites (Fiscella 2002)

Efforts to Address Disparities in Health
Steps Towards Translating HealthDisparities
Research Into Policy
  • Set The Agenda
  • 2) Build The Case
  • 3) Beware of Politics in Science
  • 4) Develop Comprehensive Approaches
  • 5) Recognize that Public Policies Are
    Complementary To Health

Set The Agenda
  • Healthy People 2010- Clinton Administration
  • Goal Eliminate Health Disparities

Set The Agenda
  • Achieving Equity The Healthy People
  • HP 2010 recognizes that communities, states, and
    national organizations will need to take a
    multidisciplinary approach to achieving health
    equity that involves improving health, education,
    housing, labor, justice, transportation,
    agriculture, and the environment.
  • (HP2010 Vol. 1, p. 16)

Build The Case
  • Institute Of Medicine Report (2002)
  • Unequal Treatment Confronting Racial And Ethnic
  • Disparities In Health Care (www.nap.edu)
  • Physicians For Human Rights Report
  • The Right To Equal Treatment
  • Numerous Health Research Policy Publications
  • Health Affairs The Determinants Of Health
  • American Journal Of Public Health, Eliminating
  • Inequalities, October 2003
  • Milbank Quarterly A Journal for Population
    Health And
  • Health Policy, Volume 1, 2004
  • Numerous Books on Health Disparities And Social
  • Health For All Californias Strategic Approach
  • Eliminating Racial And Ethnic Health Disparities

Politics And Science in Federal Reports
  • This first report clearly demonstrates that
  • ethnic and socioeconomic disparities are national
  • problems that affect health care at all points in
  • the process, at all sites of care, and for all
  • medical conditions in fact, disparities in the
  • health care system are pervasive.
  • -National Health Disparities Report, as submitted
    to the
  • Department Of Health And Human Services (DHHS) by
  • Agency for Healthcare Research And Quality
    (AHRQ), July 2003

Politics And Science in Federal Reports
  • This first report finds that, while most
  • Americans receive exceptional quality of
  • health care and have excellent access to
  • needed services, some socioeconomic,
  • racial, and ethnic differences exist.
  • - National Healthcare Disparities Report, as
    released by the DHHS, December 2003

Differences Between the Two Reports
  • Deletes most uses of the word disparity
  • Eliminates the conclusion that healthcare
  • disparities are national problems
  • Removes findings on the social costs of
  • disparities and replaces them with a
  • discussion of success
  • Omits key examples of healthcare disparities

Comprehensive and Integrated Approaches
  • Does health disparities legislation address
  • Social Determinants and Environment?
  • Health Care System?
  • Individual Factor?

A Commitment to Document Disparities
  • Collect and report data on health conditions and
    health care access by ethnicity, SES and primary
  • Include measures of racial and ethnic disparities
    in performance measurements
  • Report racial and ethnic data by use of
    subpopulation groups where possible

Recognition that Health and OtherSocial Policies
are Complementary
  • Invest in young children
  • Provide services and opportunities for the
  • neediest, including health care
  • Strengthen support at the community level
  • Improve the work environment
  • Create a more equal economic environment
  • Assess the effects of economic and social
  • action on health

  • CDC Media Relations-Hispanic Disparities Press
  • http//www.cdc.gov/od/oc/media/presskits/hhd.htm
  • The Office of Minority Health
  • http//www.omhrc.gov/
  • The National Center for Minority Health
  • http//ncmhd.nih.gov/

  • There is a significant body of evidence that has
    identified disparities in health and health care
    for Latinos and other underserved populations.
  • To eliminate disparities, partnerships, research,
    advocacy and more comprehensive policy approaches
    will be required
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