Health Disparities and Determinants of Health

Lecture Objectives At the conclusion of this lesson the learner will: Define health disparities in the United States Identify populations at risk and related health issues Analyze the relationship of the determinants of health to health disparities Discuss nursing efforts to address health disparities

Health Disparities - Definitions “A population is a health disparity population if there is a significant disparity in the overall rate of disease, incidence, prevalence, morbidity, mortality or survival rates of the population as compared to the health status of the general population.” (Minority Health and Health Disparities Research and Education Act, United States Public Law, 2000)

Health Disparities In the United States…. Infant mortality rates for African American women are 12.7% compared to 5.2% for non-Hispanic Whites Vietnamese American women have a higher incidence of cervical cancer than any ethnic group and 5 times that of non-Hispanic Whites Compared to Whites, Hispanics are more than twice as likely to have diabetes. These are examples of health disparities…… CDC, 2013

Health Inequities The avoidable, unfair differences in health status seen within and between populations. CDC 2013

Infant Mortality Rates per 1,000 Live Births by Detailed Race & Hispanic Origin of Mother: U.S., 2005 Source: CDC, NCHS, Health, United States, 2008, Table 18 http://www.cdc.gov/nchs/data/hus/hus08.pdf

Health Care Disparities Health care disparities are racial or ethnic difference in the quality of health care that are not due to access related factors or clinical needs, preferences and appropriateness of intervention

Populations at Risk Minorities Impoverished Women Children Disabled Elderly Veterans Homeless Incarcerated Immigrants Minorities Impoverished

How Do Disparities Occur In Populations? Determinants of Health: Lifestyle and Behaviors Diet, physical activity, substance and tobacco use, sexual behaviors, personal safety Human Biology genetics, age, gender, race, ethnicity Social Conditions Education, economic opportunity, healthcare access, transportation, social institutions, political structure External Environments Water and air contamination, built environments, work environments, hazardous waste, housing quality, residential crowding

Health Disparities Model This health disparities model shows the many layers and factors that impact health outcomes. It is divided into 5 levels each of which can have a negative or positive affect on health. The population is the core of the model and interacts on every level. The population on level one includes the non-modifiable characteristics . Level 2 are those behavioral factors we can control. The next level, social and community networks like the family unit, community organizations, churches, and also social conditions like SES. Level 4 shows the wider influences on health including living and working conditions, food supplies, access to essential goods and services, and the overall economic, cultural and environmental conditions prevalent in society as a whole The Dahlgren-Whitehead model. SOURCE: Dahlgren and Whitehead (1991). Used with permission of the Institute for Futures Studies, Stockholm, Sweden

Efforts to Eliminate Health Disparities Federal Government The National Prevention Strategy Healthy People 2020, 2010, 2000 The Affordable Care Act, 2010 Local Government Montgomery County Health Initiatives Primary Care Coalition Healthcare Initiative Foundation State Government Health Enterprise Zones, 2012 Healthy Teeth, Healthy Kids Oral health Literacy Campaign, Barbershop Men’s Health Outreach Federal Government Healthy People 2020 is the overarching national strategy aimed at improving the nation’s health. Healthy People is in its 4th iteration, the national plan began in 1979 with then surgeon general Julius Richmond’s Healthy People: The Surgeon General report on Health Promotion and Disease Prevention. Healthy people serves as the foundation for the nations 15 health strategy initiatives, one of which is the National Prevention Strategy National Prevention Strategy is a national authorized by the Affordable Care Act and executed by Surgeon General Regina Benjamin. The overall goal of the National Prevention Strategy is to increase the number of Americans who are healthy at every stage of life. The 4 secondary goals are to eliminate health disparities, empower people, provide access through clinical and community preventive services and promote healthy and safe community environments The Affordable Care Act of 2010 is the landmark legislation which would create access to medical services and improves medical coverage for millions of Americans 2. State Government Health Enterprise Zones will be created throughout the state to improve access to care and health outcomes. Grants will be available to Health Departments and Community Organizations to The Healthy Teeth, Healthy Kids Oral Health Literacy Campaign a campaign to raise awareness about the importance of oral health Deamonte Driver was 12 years old when he died from an untreated tooth infection, coverage is also available for children who are eligible for medicaid Barbershop Men’s Health Outreach in collaboration with the University of Maryland School of Medicine is a case finding outreach to identify and screen men for hypertension and diabetes in addition to providing nutritional counseling There are a number of local health initiatives across the states, not only on the county level but also in various cities and towns. The local county government has ethnic health initiatives to address health issues specific to various races and ethnicities. The health initiatives provide special health education and health promotion programs for the populations they serve. The primary care coalition is a network of 11 safety net clinics located in the county, they are all privately run in partnership with the local health department and community organizations. The clinics provide primary care services and partner with local hospitals and providers for diagnostic services and specialty care. The health initiative foundation is a funding resource that grants small and larger awards for the purpose of providing health care services.

What Can Nurses Do? Primary and secondary prevention efforts Policy and Advocacy Research and Data Collection Community Resources Bridge Language Divide What can nurses do to help eliminate health disparities? Work in communities providing education and screening, targeting specific populations, using EBP programming including monitoring and evaluation Become involved with community groups and work with community members teaching them how to advocate for their needs and become politically involved Work with the community health professionals and health departments to conduct research and collect data, providing evidence of the effects of health disparities on populations Partner with community groups, churches, sororities, schools and others to address problems and help to provide needed community services Bridge the language divide by using creative ways to provide language services in the community. These interventions would include both foreign language interpretation and health literacy. Create a database of resources and make available to key community organizations, housing developments, agencies, churches, schools and others to access important services for those who need them

Lecture Summary Health disparities are inequities in health care and health status that affect at risk populations in all major illness and disease categories Those at risk include everybody and especially racial and ethnic minorities and the poor Determinants of health individual and social factors that can have a positive or negative impact on health Determinants which have a negative impact on health contribute to disparities in health Government programs are available but there is so much more to do. It is impossible to decrease health disparities without decreasing the negative impact of the determinants of health Nurses can make a significant difference in the effort to eliminate health disparities!