Lorraine Moya Salas, PhD Bianca Altamirano, MSW

 Those challenged by poverty experience the poorest health.  Racial and ethnic minorities experience poorer health relative to national averages from birth to death Higher infant mortality Higher rates of disease and disability Shortened life expectancy

 Health inequalities are a result of both socioeconomic advantage and race/ethnicity independently and in combination.

“One thing of course we must expect to find, and that is a much higher death rate at present among Negroes than among whites. This is one measure of the difference in their social advancement…” ~ W. B. DuBois~

 Health status is a reflection of a myriad of factor including personal choices, historic disadvantage and persistent social inequalities.

 Conditions that foster disparities: “Social determinants of health are life-enhancing resources such as food supply, housing, economic, and social relationships, transportation, education, and health care whose distribution across populations effectively determines length and quality of life.”

 Upstream determinants – change policies and environmental conditions to promote health.  Downstream determinants – interventions

 Behavioral health disorders are comparable across racial and ethnic groups yet ethnic and racial groups are more adversely impacted by their conditions.

 American Indians have a heightened risk for PTSD and alcohol dependence.  Higher rates of schizophrenia in the African American community.  Latino/African American youth have higher rates of PTSD.  Higher rates of psychological symptoms

 Social determinants influence the onset and progression of health and mental health conditions. Environment plays a larger role in the onset of conditions Progression of conditions are impacted more so by access and quality of care.

 Physical health and mental health are interconnected.  Emphasis of interventions may differ but to achieve health – “a state of complete physical, mental, and social well-being and not merely the absence of disease” we must attend to social determinants within and outside health care systems.

 Resilience - successful adaptation despite threatening circumstances, wellness in spite of significant risk.

RISK FACTORSPROTECTIVE FACTORS  Poverty  Community disorganization/violence  Inadequate schools  Trauma - racism  Low birth weight  Genetic vulnerability  Family conflict  Maternal mental disorder  Dysfunctional childrearing environment  Chronic health conditions  Hope/optimism  Social competence  Support family relationships  Parental structure/monitoring  Caring schools  Availability of resources  Social norms  Sense of community  Spirituality/Religion  Bicultural orientation

Direct and Indirect Poor physical health Poor mental health Substance Use

Disease Environmental Conditions Downward Model RacePovertyDepression Stress hormone dynamics (cell survival) Neighborhood Conditions Tumor development

 Underutilization of services Socioeconomics (lack health insurance, geographic factors) Provider bias Communication barriers Lack of diversity among providers Distrust, stigma, alternative health practices

 Comprehensive community interventions  Community Health Workers/Promotoras  Integrated Care/Collaborative Care Models  Culturally tailored evidenced-based interventions

 Effective in changing environmental conditions that are linked to chronic physical and mental health conditions  Limited research on effectiveness of specific community interventions.  Best available evidence

Action Model (Adapted from Healthy People 2020)

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 “Lay members of communities who work either for pay or as volunteers in association with the local health care system in both urban and rural environments and usually share ethnicity, language, socioeconomic status, and life experiences with the community they serve.”

 Improve health care access/utilization, increase health knowledge, and the health status of people of color.  Play a role in changing community conditions.

 “The systematic coordination of physical and behavioral health services” Co-location Coordination Engage consumers in the treatment process Evidence-based guidelines

 Both empirically supported treatments and culturally adapted interventions are effective.  Preference findings, engagement, and retention.  Cultural considerations Historical trauma Acculturation

 Whole-stream interventions  Holistic health  Evidence based practice and culturally adapted/culturally supported interventions