Understanding Social Influences on Healthcare Disparities

1
Understanding Social Influences on Healthcare
Disparities

• Akiko S. Hosler, Ph.D.
• New York State Dept of Health University at
  Albany
• The 19th National Conference on Chronic Disease
  Prevention and Control
• March 2005

2
Why Racial/Ethnic Disparities Exist?

• Because racial/ethnic categories are socially
  constructed to reflect existing socioeconomic
  differences and inequalities
• Race/ethnic categories are dependent on the
  societys collective perception that such
  differences are important
• Race/ethnic categories are not fixed
• Change over time within the same society
• Each society has its own unique way to
  differentiate people based on hereditary
  characteristics

3
Examples of Race/Ethnicity as a Social Construct

• Hispanic category appeared first time in the
  1980 census
• In the 1790 census (the first census), free
  white males free white females other persons
  and slaves were used
• In Great Britain today, Arabs (South) Asians
  and West Indians are distinctive categories
• U.S. categories are not scientific (? genetics)
• Violate the basic principles of taxonomy
• Rely self-reporting

4
But Why Race/Ethnicity Still Important?

• A representation of the structure and dynamics of
  our society
• Functional purposes to advocate needs,
  interests
• Basis of self identity and group identity for
  some individuals
• Governments are responsible for keeping track of
  historic changes of race/ethnic differences (OMB
  standards)

5
Healthcare Disparities - Social Phenomena

• Remind us that health has biomedical causes and
  social causes
• Certain health-related processes and outcomes
  are better understood dealt with on the
  population basis
• Continuing effort to search for social
  variables that make sense
• Beyond race/ethnicity, income education
• Beyond descriptive, cross-sectional analysis

6
New York States Experience

• Russian-speaking immigrants in NYS
• High rates of obesity diabetes, lack of
  knowledge on A1C (language, refugee status,
  economic cultural issues) Ethnicity Disease.
  200414372-377
• Puerto Rican adults with diabetes in NYC
• Adequate healthcare access, but prevention for
  cardiovascular complications inadequate (language
  for older generations, perception for need)
  American Journal of Public Health.
  200494434-437. May/June 2005 issue the Diabetes
  Educator
• Japanese residents in Westchester County
• Low rates of obesity diabetes, adequate
  preventive care, but men are at risk for diabetes
  (high socio-economic status, work-related
  inactivity and stress for men) Am J of Public
  Health. 2003931279-1280