1. Unnatural Causes: Stating the Problem and Finding Solutions Healthcare Equity : Implications for Recreation Therapist 2011 Mid Eastern Symposium on Therapeutic Recreation Dr. Karen Bibbins Ed.D., CTRS

2. Introductions Why is this topic important/interesting to you?

3. Objectives Increase your awareness of racial and ethnic health disparities and the social determinants of health Identify how achieving equity and addressing healthcare disparities can have implications for quality of care, risk management, accreditation and community benefits Using best practices to address disparities when planning interventions for specific programs in RT

4. Health Care Equity…Is Inequality Making Us Sick Ice Breaker – Perceptions Test Health Equity Quiz

5. Unnatural Causes Groundbreaking 4 hour PBS documentary initially broadcast March 2008 Reframes the national debate over health as a medical detective story solving the mystery of health inequities Deeper exploration into the ways social conditions affect health outcomes

6. Unnatural Causes- In Sickness & in Wealth www.unnaturalcauses.org/video_clips.php Unnatural Causes-Episode 1- U.S. is one of the richest countries in the world, yet we rank 29 th for life expectancy. We spent more than twice what other countries spend per capita on health care. Why aren’t we healthier?

7. Health disparity refers to…  differences in health outcome or status OR  differences in the preventive, diagnostic, and treatment services offered to people with similar health conditions Definitions

8. Healthcare disparity refers to…  differences in the preventive, diagnostic, and treatment services offered to people with similar health conditions

9.  The social, cultural, religious, linguistic and other affiliations often characterized by cultural features such as dress, language, religion, and social organization  A term used to refer to groupings of people according to common origin or background and associated with perceived biological markers Which definition is race and which ethnicity? Definitions race ethnicity

10. Census categories American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Some other race

11. The Story of Race From the AAA Race Project The Story of Race

12. Activity The Perfect Neighborhood www.unnaturalcauses.org/interactivities.php

13. Health Care Equity Health disparities: Examining the numbers

16.  Age-Adjusted Heart Disease Death Rates for Blacks and Whites, 1950-2000  Death Rates per 100,000 Population  100  200  300  400  500  600  700  1950  1960  1970  1980  1990  2000  YEAR  White  Black  David Williams, PhD, MPH, Presentation to HFHS January 30, 2009

17.  Hospital admissions for lower extremity amputations per 1,000 population age 18 and over with diabetes,  by race, 2001-2003 and 2004-2006  Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Discharge Survey and National Health Interview Survey, 2001-2003 and 2004-2006.

18.  Emergency department (ED) visits in which patients left without being seen, by race (left) and payment source (right), 1997-1998, 1999-2000, 2001-2002, 2003-2004, and 2005-2006  Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey, 1997-1998, 1999-2000, 2001-2002, 2003-2004, and 2005-2006.

19. Disparities: A National Problem African Americans are referred less than whites for cardiac catheterization & bypass grafting Latinos & African Americans receive less pain medication than whites for long bone fractures in the Emergency Department & for cancer pain on the floors African Americans with end-stage renal disease are referred less to the transplant list than whites Various healthcare disparities are present as well for certain Asian populations, American Indians and Alaska Natives, Arab Americans, and other communities of color

20. Evidence Institute of Medicine, 2001 Proposed EQUITY as one of 6 aims for improvement

21. Evidence Institute of Medicine, 2003 Reported significant variation in the rates of medical procedures by race, even when insurance status, income, age, and severity of conditions are comparable. This research indicates that U.S. racial and ethnic minorities are less likely to receive even routine medical procedures and experience a lower quality of health services.

22. Evidence Three key themes emerge in the 2008 NHDR:  Racial and ethnic disparities persist in health care quality and access  The magnitude and pattern of disparities are different within subpopulations  Some disparities exist across multiple priority populations

23. Why do disparities in health exist? Social determinants of health  Socioeconomic status  Stress  Environment  Racism Lack of access to care Others

24. Why do disparities in healthcare exist? Health system factors  Complex health system may be poorly adapted to and difficult to navigate for minorities and those with limited English speaking proficiency Care process variables  Issues related to health providers such as stereotyping, impact of race/ethnicity on decision making, and clinical uncertainly due to poor communication Patient level variables  Patient’s mistrust, poor adherence to treatment and delays in seeking care

25. Implications for Recreation Therapist Increase awareness of health care equity Increase awareness of institutional barriers Understand and demonstrate ways to eliminate health care disparities. Focus broadly on how health care disparities affects all Americans Incorporate the role of personal responsibility

26. Best Practices Leisure Ability Model Assessments Interventions

27. Closing & Reflections Video It’s In Every One of Us Does anyone have any closing comments or reflections to share with the group?

28. “ Of all forms of inequality, injustice in healthcare is the most shocking and inhumane. ” - Dr. Martin Luther King, Jr. Closing & Reflections

29. Evaluation and Engagement Please fill out the brief evaluation