Community and Public Health and Racial/Ethnic Minorities Chapter 10 Community and Public Health and Racial/Ethnic Minorities

Chapter Objectives (1 of 2) After studying this chapter, you should be able to: Explain the concept of diversity as it describes the American people. Explain the impact of a more diverse population in the United States as it relates to community and public health efforts. Explain the importance of the 1985 landmark report, The Secretary’s Task Force Report on Black and Minority Health. List the racial and ethnic categories currently used by the U.S. government in statistical activities and program administration reporting.

Chapter Objectives (2 of 2) List some limitations related to collecting racial and ethnic health data. Discuss selected sociodemographic characteristics of minority groups in the United States. List and describe the six priority areas of the Race and Health Initiative. Explain the role socioeconomic status plays in health disparities among racial and ethnic minority groups. Define cultural and linguistic competence and the importance of each related to minority community and public health.

Introduction Strength of America lies in diversity of people Diversity U.S. population Majority – white, non-Hispanic (62.2%) Racial or ethnic minorities (37.8%)

Racial and Ethnic Classifications Classifications used to operationalize race and ethnicity Race – “categorization of parts of a population based on physical appearance due to particular historical social and political forces” Ethnicity – subcultural group within a multicultural society; six main features

Health Data Sources and Their Limitations Challenges to collection of race and ethnicity data Unreliability of self-reported data Classifications are social constructs that change over time and vary across societies and cultures Biased analysis HHS – works to increase reliability of data and amount of data collected

Americans of Hispanic Origin Hispanic origin is an ethnicity, not a race Largest minority group in U.S. People of Mexican origin largest Hispanic group Education Income Health beliefs

African Americans People having origins in any of the black racial groups from Africa 2nd largest minority group in U.S. More than ½ live in southern states Education Income Impact of slavery Health beliefs

Asian Americans Asian Americans – people of Asian descent who trace their roots to more than 20 different Asian countries Native Hawaiian and Other Pacific Islanders (NHOPI) – peoples of Hawaii, Guam, Samoa, or other Pacific Islands and their descendants Immigration Education Income Health beliefs

American Indians and Alaska Natives Original inhabitants of America Many different American Indian tribal groups and Alaskan villages, each with distinct customs, languages, and beliefs Relatively poor health status Indian Health Service

U.S. Gov’t, Native Americans, and Provision of Health Care Many tribes are sovereign nations Tribes transferred land in U.S. to federal government in return for provision of certain services Indian Health Services (IHS) Responsible for federal health services to Native Americans and Alaska Natives Goal to raise health status to highest possible level

Immigrant and Refugee Health Refugees Immigrants Aliens Unauthorized immigrants Can be classified into existing racial/ethnic groups; as a single group, present special concerns

Minority Health and Health Disparities Federal efforts to eliminate health disparities

Race and Health Initiative Goal: eliminate disparities among racial and ethnic minority populations in six areas Infant mortality Cancer screening and management Cardiovascular disease Diabetes HIV/AIDS Adult and child immunization

Infant Mortality Serious disparity in U.S. among racial and ethnic minorities African American infant death rate more than two times that of white Americans Lack of prenatal care Low-birth-weight babies Data from Centers for Disease Control and Prevention, National Center for Health Statistics.Mathews TJ, MacDorman MF. Infant mortality statistics from the 2010 period linked birth/infant death data set. Natl Vital Stat Rep 2013;62(8). http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_08.pdf Infant mortality rates by race and Hispanic origin of mother: 2000, 2005, and 2010.

Cancer Screening and Management Incidence and death rates highest among black Americans for various types of cancer Many disparities attributed to lifestyle factors, late diagnosis, access to health care Less primary and secondary prevention in various minority groups Data from: Howlader, N., A. M. Noone, M. Krapcho, et al. (eds.). SEER Cancer Statistics Review, 1975-2010, based on November 2012 SEER data submission, posted to the SEER web site, 2013. Bethesda, MD. SEER cancer incidence and U.S. death rates, 2010, by cancer site and race.

Cardiovascular Diseases Death rates vary widely among racial and ethnic groups Black Americans have higher rates from CHD and stroke Hypertension prevalence as a risk factor varies according to race/ethnicity Black Americans tend to develop hypertension earlier in life than whites; unknown reason

population, by race and sex, United States, 2014. Diabetes Overall prevalence has risen in U.S. in recent years Prevalence in those 20 and older varies in minority groups Increase in age-adjusted death rates in all racial and ethnic groups Significantly higher in minority groups Data from Centers for Disease Control and Prevention. Age-Specific Rates of Diagnosed Diabetes per 100 Civilian, Non-Institutionalized Population, by Race and Sex, United States, 2014. 01 Dec. 2015 Age-specific rates of diagnosed diabetes per 100 civilian, non-institutionalized population, by race and sex, United States, 2014.

ethnicity: 2008–2012, United States. HIV Infection/AIDS Proportional distribution of AIDS cases has increased in African Americans and Hispanics Attributed to higher prevalence of unsafe or risky health behaviors and lack of access to health care to provide early diagnosis and treatment Centers for Disease Control and Prevention, 2013, April. Rates of diagnosis of HIV infection among adults and adolescents by race/ ethnicity: 2008–2012, United States.

Child and Adult Immunization Rates Older adult immunization rates are substantially lower in minority groups, even though an overall increase has occurred

Social Determinants of Health and Racial and Ethnic Disparities in Health (1 of 2) Many factors contribute to health disparities Strong associations between social determinants of health factors and health outcomes Education, level of income, poverty

Health status by race, ethnicity, and income in 2012. Social Determinants of Health and Racial and Ethnic Disparities in Health (2 of 2) Data from Centers for Disease Control and Prevention. Use of Race and Ethnicity in Public Health Surveillance. Summary of CDC/ASTDR Workshop. Morbidity and Mortality Weekly Report, 1993, 42(RR-10). Data from: National Center for Health Statistics. Health, United States, 2012: With Special Feature on Emergency Care. Hyattsville, MD. 2013. A framework for understanding the relationship between race and health. Health status by race, ethnicity, and income in 2012.

Equity in Minority Health Simple solutions unlikely Solutions to problems for one group may not work for another Solutions must be culturally sensitive Must empower individual and communities Health literacy

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 Culture is vital in how community health professionals deliver services and how community members respond to programs and interventions

Empowering the Self and the Community To enable people to solve their community health problems Three kinds of power associated with empowerment Social – access to “bases;” needed to gain political power Political – power of voice and collective action Psychological – individual sense of potency

Discussion Questions Why have there been so many changes to racial and ethnic classifications in the United States in recent decades? How can community health programs empower minority groups?