Healthcare Disparities Module 2018 Kalyan Sreeram

What is HEALTH? Traditional focuses in training physicians include physical and mental well-being. By including social well-being, we could synergistically improve long-term physical and mental well-being for our patients.

Health Equity/Disparities What can influence disparate healthcare delivery? Social: Race/Ethnicity, Gender, Sexual Orientation Economic: Employment Status Cultural: Religion, Literacy/Language Physical: Geography, Disability Intellectual: Cognitive/Sensory Impairment

What determines HEALTH? Biology: Age, Gender, Genes Behaviors: Diet, Exercise, Lifestyle/Daily Habits, Substance Use Service Access: Insurance, Practitioners, Economy Environment: Social Norms, Cleanliness, Education

Upstream/Downstream Determinants Upstream: Acute/Immediate decisions or circumstances leading indirectly to an outcome. “ASSISTS” Downstream: Chronic decisions or circumstances that end up leading more directly to an outcome. “POINTS/GOALS”

HealthCARE Disparities EXAMPLES: Analgesic administration by race/ethnicity Referrals for transplantation

Reasons for Healthcare Disparity

Healthcare Literacy RISK FACTORS for Low Health Literacy? -Limited Education -Older Age -Racial Minority -Low Income -Compromised Physical Status

Whitehall Study of Civil Servants

Excess Mortality in Harlem Study

Unequal Treatment: Confronting Racial/Ethnic Disparities in Healthcare Report done by Institute of Medicine

Challenges in Healthcare by Minority

Challenges in Healthcare by Minority

Poverty vs. Health

Education vs. Health

The Power of Knowledge

How can we bridge the gaps?

PATIENT PROVIDER SYSTEM ACCESS COMMUNITY Assess individual social/cultural patterns at each visit PATIENT Educate yourself with perspectives from colleagues and about what patients want PROVIDER Implement appropriate actions once educated SYSTEM Optimize changes based on effects seen in practice ACCESS Understand what issues people could face before the need to act arises COMMUNITY