Copyright © 2008 Delmar. All rights reserved. Chapter 25 Minority and Ethnic Populations

Copyright © 2008 Delmar. All rights reserved. 2 Healthy People 2010 Health disparities –Difference in health care/status –Elimination of racial and ethnic health disparities one of two overarching goals of Healthy People 2010

Copyright © 2008 Delmar. All rights reserved. 3 Healthy People 2010 Morbidity and mortality trends –Disparate health outcomes associated with: Asthma, mental illness, homicides, STDs

Copyright © 2008 Delmar. All rights reserved. 4 Health Disparities Sources for obtaining data on health disparities among minorities: –State vital statistics records –Hospital discharge data –Health utilization data –National surveys

Copyright © 2008 Delmar. All rights reserved. 5 Health Disparities Office of Minority Health identified the following diseases that contribute to death rates among minorities: –Heart disease, cancer, stroke, diabetes Heart disease –African Americans have a higher rate than other races

Copyright © 2008 Delmar. All rights reserved. 6 Health Disparities Cancer –African Americans have a higher rate than other races Diabetes –Morbidity and mortality rates have increased in all racial and ethnic groups

Copyright © 2008 Delmar. All rights reserved. 7 Health Disparities AIDS –African Americans and Hispanics account for 70 percent of new cases

Copyright © 2008 Delmar. All rights reserved. 8 Health Disparities Perinatal health disparities more prevalent among children born to African American women

Copyright © 2008 Delmar. All rights reserved. 9 Health Disparities Three leading causes of infant mortality: 1.Congenital birth defects 2.Short gestation and low birth weight 3.Sudden infant death syndrome

Copyright © 2008 Delmar. All rights reserved. 10 Health Disparities Causative factors –Social/demographic status –Risky health behaviors –Maternal stress –Depression –Vaginal infections –Late prenatal care

Copyright © 2008 Delmar. All rights reserved. 11 Theoretical Framework Andersen and Davidson’s Conceptual Framework –Population characteristics –Environmental factors –Health behaviors

Copyright © 2008 Delmar. All rights reserved. 12 Theoretical Framework Health outcomes –Health access –Health utilization –Client satisfaction

Copyright © 2008 Delmar. All rights reserved. 13 Factors that Influence Health Outcomes Population characteristics –Predisposing factors Demographic characteristics Social structure characteristics Health beliefs

Copyright © 2008 Delmar. All rights reserved. 14 Factors that Influence Health Outcomes Enabling factors –Personal/family income –Health insurance –Health access –Community health care availability

Copyright © 2008 Delmar. All rights reserved. 15 Factors that Influence Health Outcomes Need factors –Perceived Individuals, group, community perception of health status –Evaluated needs Objective measures of population health status and treatment

Copyright © 2008 Delmar. All rights reserved. 16 Factors that Influence Health Outcomes External environmental factors –Economic climate –Relative wealth –Level of stress –Violence –Prevailing norms

Copyright © 2008 Delmar. All rights reserved. 17 Factors that Influence Health Outcomes Health care system environmental factors –Those that influence access, availability, acceptance of health care service

Copyright © 2008 Delmar. All rights reserved. 18 Factors that Influence Health Outcomes Influences on external and health system environments –Federal, state, and local health policies –Organization of services –Financing

Copyright © 2008 Delmar. All rights reserved. 19 Health Behaviors Personal health practices –Tobacco use Leading cause of preventable death Higher among Native Americans –Substance abuse Binge drinking high among minority males (18-24) Illicit drug use

Copyright © 2008 Delmar. All rights reserved. 20 Health Behaviors Physical activity –African Americans and Hispanics low rates of activity Overweight/obesity –African Americans and Mexican Americans have a higher rate

Copyright © 2008 Delmar. All rights reserved. 21 Health Behaviors Increased risk for: –Heart disease –Hypertension –Diabetes –Certain cancers

Copyright © 2008 Delmar. All rights reserved. 22 Health Behaviors Nutritional habits –Minorities have a higher rate of consuming unhealthy diets –National Five-A-Day for Better Health Program

Copyright © 2008 Delmar. All rights reserved. 23 Health Behaviors Responsible sexual behaviors –Unprotected sex leads to unplanned pregnancies and STDs

Copyright © 2008 Delmar. All rights reserved. 24 Health Behaviors Women of color are at a high risk due to risky sexual practices such as: –Prostitution –Not using condoms –History of STDs –Multiple partners –Sex with high risk partners

Copyright © 2008 Delmar. All rights reserved. 25 National Studies and Reports Reports and initiatives that guide nursing interventions –Landmark IOM Report –Black and minority health –Healthy People 2010

Copyright © 2008 Delmar. All rights reserved. 26 National Studies and Reports Creation of the National Center on Minority Health and Health Disparities Confronting Racial and Ethnic Disparities in Health Care

Copyright © 2008 Delmar. All rights reserved. 27 National Centers for Minority Health and DHHS Office of Minority Health provide frameworks for county, state, and national level of health interventions National Studies and Reports

Copyright © 2008 Delmar. All rights reserved. 28 IOM recommendations to reduce racial/ethical disparities general recommendations –Increase awareness of racial/ethical disparities in health care among key stakeholders –Increase health care providers’ awareness of disparities National Studies and Reports

Copyright © 2008 Delmar. All rights reserved. 29 Action Research and Evaluation Participatory Action Research (PAR): –One method public health nurses use to evaluate strategies used to improve health outcomes –Evaluate: Community satisfaction with health services Perceptions of health care excess

Copyright © 2008 Delmar. All rights reserved. 30 Action Research and Evaluation Perceived effectiveness of community agencies to implement coordinated services –Effectiveness of health disparity policies –Changes in health policy –Improvement in health status indicators

Copyright © 2008 Delmar. All rights reserved. 31 Environmental Factors Minorities encounter limited social and environmental resources compared to the larger population

Copyright © 2008 Delmar. All rights reserved. 32 Environmental Factors Public health nurses can collaborate to increase community resources such as: –Jobs –Housing –Child care –Safe environments –Domestic violence shelters –Social services

Copyright © 2008 Delmar. All rights reserved. 33 Improve Health Care Access Minorities often lack access to or delay seeking health care due to being underinsured or uninsured Ways to improve minority health care: –Increase family planning resources –Insurance coverage –Screenings and early detection

Copyright © 2008 Delmar. All rights reserved. 34 Improve Health Care Access Improve mental health care through collaborative partners Promote culturally competent care –Linguistic competence

Copyright © 2008 Delmar. All rights reserved. 35 Improve Health Care Access Promote healthy behaviors –Lifestyle changes –Exercise –Sexual decision-making –Health seeking behaviors

Copyright © 2008 Delmar. All rights reserved. 36 Eliminating Minority Health Disparities Will require public health nurses to take into consideration: –Population characteristics –Environmental factors –Health behaviors in order to develop strategies to make changes

Copyright © 2008 Delmar. All rights reserved. 37 Eliminating Minority Health Disparities Partnerships –Task force/advisory boards –Use of focus groups/community organizations –Planning and implementing health promotion programs –Advocating for environment improvement –Engage in research that will assist the public health nurse in being an advocate for change

Copyright © 2008 Delmar. All rights reserved. 38 Public health nurses engage in prevention strategies at all levels to decrease racial and health care disparities Eliminating Minority Health Disparities

Copyright © 2008 Delmar. All rights reserved. 39 Primary prevention aims to reduce incidence of disease –Nutrition and weight management –Exercise, physical activity, training –Stress management –Smoking cessation Eliminating Minority Health Disparities

Copyright © 2008 Delmar. All rights reserved. 40 Secondary to diagnose early –Provide culturally appropriate care –Provide yearly physicals –Perform screenings –Provide case management –Screen for mental health problems and stressors Eliminating Minority Health Disparities

Copyright © 2008 Delmar. All rights reserved. 41 Refer to mental health services –Collaborate with community groups to market screening programs –Educate minorities on health risks –Advocate for health reimbursements to provide mass screenings Eliminating Minority Health Disparities

Copyright © 2008 Delmar. All rights reserved. 42 Tertiary to prevent further deterioration –Case management –Stress management –Therapeutic communications –Yearly preventive health visits for other health conditions Eliminating Minority Health Disparities