© 2010 Jones and Bartlett Publishers, LLC1 Addressing Health Disparities in the 21st Century Chapter 1

© 2010 Jones and Bartlett Publishers, LLC 2 What is your definition of a “health disparities”?

© 2010 Jones and Bartlett Publishers, LLC 3 Addressing Health Disparities in the 21st Century  Overview of Health Disparities : Definition Differences in the quality of healthcare that are not due to access related factor or clinical needs, preferences or appropriateness of intervention.

© 2010 Jones and Bartlett Publishers, LLC 4 Addressing Health Disparities in the 21st Century Definition of Health Disparities  Healthy People 2010 “Unequal burden in disease, morbidity and mortality rates, experienced by ethnic/racial groups as compared to the dominant group”  HRSA : “ Population-specific differences in the presence of disease, health outcome or access to health.  NIH : “Difference in the incidence, prevalence, mortality and burden of disease and other adverse health conditions that exist among specific groups un U.S.”

© 2010 Jones and Bartlett Publishers, LLC 5 Addressing Health Disparities in the 21st Century Education (High School lives longer than a person that has only 9 th grade training) Insurance (most of Hispanics are no insured) Segregation (poor quality, poor preventive medicine, minorities has the worst health care) Life style and Health Behavior (poor habits) Health care provider behavior (physician provide less health care discussion in lower income groups than others, poor understanding of barriers)

© 2010 Jones and Bartlett Publishers, LLC 6 Addressing Health Disparities in the 21st Century  Historical Perspectives for Health Disparities Minority Health  African Americans suffer worse health care and health outcomes than Non-Hispanic Whites. Medical Education  In 1920’s only two medical schools trained black physicians. Poor health outcomes in Black Community. Contemporary disparities  Unequal treatment in health care. Less saving intervention procedures and increase of undesirables procedures ( i.e., amputation) in minorities.

© 2010 Jones and Bartlett Publishers, LLC 7 Addressing Health Disparities in the 21st Century Statistical Overview of Health Disparities. Prenatal care/ infant mortality Low birth Infant mortality NA 7.9% AA 5.7% 7.5% 13.6% Hisp 5.4% 5.6% Asian 3.0% White 2.2% 2.4% 5.7% 2010 People GOAL is to decrease Infant mortality to 4.6%

© 2010 Jones and Bartlett Publishers, LLC 8 Addressing Health Disparities in the 21st Century  Preventive Care  Black and Latino counseling than non-Hispanic White.  Latinos have a risk : Behavior disorders, development disorders, environment hazard, diabetes, asthma, no insurance, poor quality of care, less help by phone, no health care on time, language barriers.  Asthma increase in AA  Adolescents minority unsafe driving, drugs, alcohol, smoking, STDs, depression.  Pregnancy (15-17 yo) Whites11.5/1000  Blacks34.9/1000  Latinos48.9/1000

© 2010 Jones and Bartlett Publishers, LLC 9 Addressing Health Disparities in the 21st Century  Obesity GirlsBoys Adult  AA26.2% 19.4%49.7%  Mexican 19.4%27.3%39.7%  White11.6%12%30.0%  Diabetes in minorities AA and Hispanics  Multiple factors (genetic, prematurity, low birth wt, breast feeding, stress, diet, habits)  Adult Preventive Care  Most of the Hispanics between yo NO preventive care. Low screening test evaluation. NO care older than 12 mo of age : 27% Hispanics, 21% Asian, 18% AA, 14% Non-Hispanic Whites  Elderly Health  End of Life Care

© 2010 Jones and Bartlett Publishers, LLC 10 Addressing Health Disparities in the 21st Century  Progress on Eliminating Disparities HEALTHY PEOPLE 2010 In 2005 midpoint reported significant improvements in health.  Health Workforce Education  Less than 4% of Physicians are Hispanic and 5.3% are AA  5.9% graduate from Medical School are Hispanic

© 2010 Jones and Bartlett Publishers, LLC Why should we eliminate health disparities? 2. What are some potential strategies?

© 2010 Jones and Bartlett Publishers, LLC 12 Addressing Health Disparities in the 21st Century Solutions  Improving clinical care (communities/academic)  Improving health promotions/ prevention  Improving diversity in the health care force  Improve patient/provider communication  Improve workforce cultural competencies  Increase research and policy changes