Diversity & Aging: Health Disparities by Gender, SES, and Ethnicity May 4, 2010

Overview  Diversity in the aging population  Health disparities: Gender, SES, & Race/Ethnicity  Responding to diversity in the aging population

Figure 1.5 Population trends for minorities Diversity of Older Adults in the U.S.

Diversity of the Aging Population  Gender  Socioeconomic status  Race/ethnicity: Diversity within ethnic groups  Each group has unique demographic structure

Gender Differences in Health  Which sex is healthier, men or women?  The answer is complicated

Gender Differences in Health  Compared to men, women:  Have higher life expectancy & lower death rates  Report poorer health, more disability  Report more mental health problems

Health Disparities  Gender  Socioeconomic status  Race/ethnicity

Health Equity Quiz  How does the U.S. rank in terms of health equity?  What (if anything) surprised you?

Socioeconomic Status & Health  Effects on health related to accumulated advantage or disadvantage over time  Following influence SES:  Occupation  Income  Property  Education

SES & Health  Socioeconomic status does not CAUSE health  SES related to factors that influence health:  Access to & utilization of medical care & insurance  Health behaviors (e.g., smoking, diet)  Stressors & Social support

SES & Health  Poverty associated with the following:  poor nutrition  substandard housing  exposure to pollutants & violent behavior  limited access to health care

SES & Health  Better-educated, wealthier:  Healthier  More preventative health care  Better medical treatment  SES strongest determinant of whether health maintained w/increasing age

Protective Factors  Some w/low SES maintain good health  Protective factors:  Quality of social relationships  Family support, religious involvement, & effective coping skills

Health Disparities  Gender  Socioeconomic status  Race/ethnicity

Race and Ethnicity  SES differences btw racial groups largely responsible for racial disparities in health  BUT, racial health disparities persist even among those who share the same SES  Health disadvantage reflects more than racial disparities in SES

Racial/Ethnic Disparities  Research on African Americans suggests:  Lower life expectancy at all decades of life  More functional impairment from chronic disease  Less access to health care; medical technology

Racial/Ethnic Disparities  Research on Hispanic Americans suggests:  Use less formal services  Barriers (e.g., language barrier, lack of insurance)  Characterized by diversity:  Mexican Americans have health advantage  Puerto Ricans have most jeopardized health  Cubans have least jeopardized health

Racial/Ethnic Disparities  Research on Asian Americans suggests:  Most advantaged ethnic minority group; highest SES of any minority group  Still, diversity between subgroups  Underserved by social service agencies  Expectation for family care

Racial/Ethnic Disparities  Research on Native Americans suggests:  Characterized by diversity  Lower life expectancy & disability (e.g., diabetes)  Informal support; less likely to use formal  Important role of older women

Racial/Ethnic Disparities  Disparities could be related to:  Genetics  Environment/Lifestyle  Access, utilization, & quality of health care  Effects of prejudice or discrimination

Multiple Jeopardy  Patterns of inequality reinforce one another  Multiple jeopardy:  Refers to a person in 2 or more disadvantaged groups  Related to cumulative disadvantage

Responses to Minority Group Aging  Different groups have different health & social service needs  Diversity exists within ethnic groups  May mix traditional medicine with modern treatments

 Disparities in health outcomes btw genders, SES groups, and races/ethnicities  Related to access to resources (e.g., neighborhood) & knowledge (e.g., health behaviors)  Multiple jeopardy: Intersection btw gender, race, & SES  Reducing health disparities has implications for population health Summary